Sanofi asks ‘What If?’: Why the ‘big questions’ must be asked

At the Royal College of Physicians on Thursday 27th July, Sanofi held an event focused on the state of UK life sciences and what can be done at this critical moment in time. Seeking to bring people together to reflect on the challenges and opportunities that the sector faces, and to foster an open dialogue between policymakers, healthcare professionals, commissioners, and patients, the evening was well-attended, and the perspectives shared enlightening and equally thought-provoking.

Jessamy Baird, managing director of Sanofi UKIE and vice president of the Association of the British Pharmaceutical Industry (APBI), gave the opening remarks, reminding attendees that UK life sciences chase the miracles of science in order to find a way to help and improve the lives of patients – now, she said, it is necessary to work with Government to keep the UK at the forefront of that mission.

Dialogue, partnership, external debate, and poetry

The Sanofi ‘What if?’ initiative seeks to ‘ask the big questions’ about improving human health. It is a campaign run internally to inspire Sanofi’s teams, sparking challenging conversations in dialogue and partnership, so as to create an external debate. And there is no more important a time than now for such a debate in this country, Baird said. Indeed, such discussions are vital for making improvements, and making a difference for people.

It is the real voice of the people, in fact, that Sanofi seeks to bring to the forefront. A company passionate about inclusiveness, diversity, and equity, Baird highlighted how Sanofi has recently been working with patients, carers, and patients’ loved ones to create poetry, in the People’s Poem creative writing programme, closing 18th August. 

The poetry programme has been developed specially to shine a spotlight on important health issues, inviting people to share their lived experience of health through creative writing. Providing a platform for this form of expression permits space for more people to be part of the discussion around the health of the nation and the ‘big questions’ surrounding health. A celebratory event will take place during National Poetry Day on 5th October.

Learning from the pandemic example

Next, Baird welcomed Professor Sir Jonathan Van-Tam, former deputy chief medical officer at the Department of Health and Social Care, to the stage for a ‘fireside chat’ – one of the few people to have worked through two pandemics – and began by asking him what, given his experience during the COVID-19 pandemic, might be brought forwards from the value and partnerships that were shown in that period.

Prof Sir Van-Tam – a specialist in influenza, including its epidemiology, transmission, vaccinology, antiviral drugs, and pandemic preparedness – replied that, due to being a national and international crisis, with a death toll accumulating day by day, people in all parts of the ecosystem went into a different mode of operating. Indeed, the common mission focus was ‘relentless’. 

In response to Baird enquiring whether that same sense of mission could be continued now, he noted that the increasing prevalence of chronic disease and an ageing population were factors that had been “bubbling to the surface pre-pandemic”, but factors that had rightly been silenced during that time. With learnings gleaned about urgency, collaboration, and the benefits of not having rigid boundaries between the state and the private sector, those old agenda items are being picked up again – but new ways of working across the ecosystem must be applied.

“We are capable of learning,” Prof Sir Van-Tam said. But now is a pivotal moment in terms of whether things go back the way they were, or whether those learnings are appropriated.

“When you look at this globally,” Baird replied, “in the UK, everyone was incredibly proud to be part of the UK and deliver science back to the population.” Nonetheless, since then, the pressures around bed capacity and other such examples have been exacerbated: might there be key learnings on how to maintain population health, when compared with other countries?

Unfortunately, Prof Sir Van-Tam thinks the system was run too thin approximately a decade beforehand and has been under enormous pressure for a long period of time. So it is that he believes there is a serious discussion ahead on what type of healthcare system is wanted in the future, and how that can be funded. “Some deep thinking is going to have to be done,” he said.

Prevention of ill health: A psychological contract

As part of the UK Government Vaccine Taskforce, Baird asked whether Prof Sir Van-Tam still felt the same passion for the prevention of ill health that he did during that critical time. Indeed, proud of the work of the Taskforce – work that resulted in delivery of licensed vaccines around the world – he noted how the relentlessness, the complete non-tolerance of ‘business as usual’ or that mindset’s speeds, as well as a complete acceptance of failure, were important in the process. Deeming it the ‘psychological contract’ between the people involved and their work, he admitted he’d never seen anything like it before. And he believes an aspect of that is what is needed now:

“That pace, for the patients who are waiting, must be relentless,” Prof Sir Van-Tam stated. “That is not an argument for spending money on things that are not good value – nobody works in an infinite resource system, there will always be constraints, but that doesn’t mean the psychological contract should be relentless to find medicine for rare diseases and high disease burden.”

It is, he said, too early to see fully whether pandemic learnings have yet been taken forwards, but the collaborative conversations are critical and from an early stage. “It will mean,” he said, “that companies can manage their programmes through phases 1, 2, and 3, and governments and public health agencies and regulatory bodies can have a chance to think about what they want much earlier and say so earlier.”

A whole ecosystem, but a lingering fatigue

Baird asked whether operations across the ‘whole ecosystem’, the joining up of ‘academia and the life sciences sector’, and the global impact of that way of functioning could be captured again. While Prof Sir Van-Tam believes that the regulatory system must remain independent, in terms of how the NHS delivered, mobilising the healthcare system, almost all of it, in the recovery – it was, he said, evidence of “what can happen when there is a concerted attempt to mobilise in this country”. However, he warned that pre-pandemic norms of operation mustn’t be reverted to. 

Nevertheless, Baird said, there has been a slide in the number of trials in the UK, and patient recruitment issues and pressures on the NHS have limited the ability of the UK to remain a global leader in the space.

“Everyone’s tired,” Prof Sir Van-Tam replied. “The public, the healthcare system, the leaders are tired.” And so, he believes ‘inspirational leaders’ need to be found to help move conversations and get the country’s ‘mojo’ back. What’s clear, he concluded, is that the “NHS has got to change in some way; it can’t do what it has always done.” In short, what’s needed is radical thinking.

Chasing the miracles of science – A collaborative effort

To follow was a panel discussion – ‘What If We Came Together to Chase the Miracles of Science?’ – focused on leveraging the strengths and value of the UK life sciences sector. Moderated by award-winning TV and Radio presenter, Juliette Foster, it brought together Prof Sir Van-Tam and Baird, as well as: Sarah Woolnough, CEO of Asthma & Lung UK; Baroness Nicola Blackwood, Chair of Genomics England; and Paul Blakeley, Life Sciences Policy Lead at the Tony Blair Institute for Global Change. 

Opening the discussion with mention of the 75th anniversary of the NHS this year, the ongoing and critical efforts to solve the Alzheimer’s disease issue, and recent advances in medical technologies permitting the unlocking of new routes for gene therapies in rare diseases – Foster rightly called it a “complex and exciting journey, and rewarding”. 

The UK is extremely well positioned to “ride the wave of success,” she noted. Nonetheless, there has been a decline in R&D, in clinical trials, in pharmaceutical manufacturing, even, and recently published Life Sciences competitiveness indicators showed a fall in 2021/2022 of 47% in a single year. “High-quality, blue-sky thinking is required,” Foster continued, and explained that that was why the panellists had been selected. 

Balancing positivity with realism, and education

Beginning discussions with a poll to the audience on whether the public sees the value of the Life Sciences, 42% were optimistic, but a considerable percentage less so. Woolnough at first challenges the results, having spent the majority of her career in medical research charities and spent time talking to patients accessing research. Foster countered that that was a specific base, but Woolnough replied the people have to be taken ‘on a journey’.

“We have a pretty unique research charity sector, funding huge amounts of research in the country, good by international standards,” she said. “So, there is a cohort that sees the hope for the future.” 

Prof Sir Van-Tam disagreed: “We’re having this conversation in the adult’s space – let’s take it back in the child’s space,” he said. In short, what is needed is the education of the next generation to become deeply engaged in what it is the industry can do in the future. In Foster’s terms, “catch them young.”

With Blakeley in accord, Baroness Blackwood noted the ‘extraordinary participant group’ that Genomics England has, with a 94% consent rate for participation in research – the rate of commitment, she explained, is much higher if someone is personally affected, that is normal human behaviour. To this point, Baird added the very high consent numbers for research during the COVID-19 pandemic.

Whether the public values the life sciences sector aside, Baird mentioned that, in working with patient organisations, what also became clear was the impact of geographies on preventable diseases, notably the “difference between boroughs in London”, and the need for diversity in and access to clinical trials. In Foster’s words, “The connection between health, economics, and lifespan.”

Blakeley mentioned Measles as an example: “People, when it matters, they understand the benefit.”  

Picking the low-hanging fruit first for progress

A second poll asked whether, when health systems, government, and industry engage in partnerships, they drive improvements in the life sciences: with a circa 12% definite response and roughly 78% somewhat, Foster moved on to seeking the opinions of the panel on what opportunities to broaden existing alliances exist when it comes to enabling patients and other stakeholders to navigate the healthcare landscape.

Baird asserted that it needs to stop feeling like a ‘them and us’ scenario, less of a ‘piece and piece’, but more in the round, so that patients receive the medicines, the vaccines. On this point, Prof Sir Van-Tam stated that a series of conversations are needed with the population on what it wants from the NHS now and in the future, and to bring those needs in alignment with the challenges, with Government, with life sciences, and to “only expect the low-hanging fruits at first to come forwards.”

Foster then moved the focus to innovation: so much innovation is taking place in life sciences, but how can patient ‘demand signalling’ signpost what they need to see from that innovation, she asked. In response, Woolnough urged, “talk to them, and talk to them early”, while Blakeley added that “partnerships work where everyone is pointing in the same direction.”

Baroness Blackwood brought up the very real need to “get products to patients”, on which point Prof Sir Van-Tam expanded: “Innovation is really important – the emerging data around mRNA vax and abilities with cancer will be groundbreaking.” Baird added that what is needed is a “medicines equity discussion with NHS England, looking at pathways of care, identifying people at risk.”

Woolnough agreed, noting that a story she hears ‘time and again’ is that a patient can’t get access to their GP, that the system is “gummed up at every point in the pathway.” Blakeley stated that the ‘flat out’ nature of working during the pandemic wasn’t possible, that it would lead to burnout. As the Lord James O’Shaughnessy independent review had put forth, what needs to be created is an environment in which “people can do what they need to do in the system.”

Data, regulation, and consistency

At this stage, Foster invited audience questions, the first of which asked what the priorities of the life sciences ecosystem should be. Baird posited longer-term prevention, and not always short-term capacity restraints, asking whether the UK was really capitalising on the data available. Blakeley replied with regulatory issues, and Baroness Blackwood said pace, that NHS and Government decision-making were both painfully slow and that this impacts competitiveness.

The panel made it clear that the healthcare system requires increased capacity and the workforce to enable that. AI for the reduction of burden in various approaches from research onwards is one method. But funding, of course, is a critical aspect: “Levelling up encapsulates it,” Foster said. 

In summary, Baird stated that NICE was set up for consistency and adoption of value in the UK. It’s not so much about the disease entry system, but about not using what is already available across the board. Woolnough agreed that patients want and need the treatment that are right for them, but that oftentimes the postcode lottery comes into play. Patients, she said, need to be empowered to seek out resources available.

Baroness Blackwood concluded that innovation in clinical trials and research needs to consider affordability: the cost going in must be reduced, she said. Meanwhile, Blakeley would like to see the patient and the clinician voice brought into decision-making processes, to which point Prof Sir Van-Tam added that a national conversation with the population about what is wanted in the future, and the realistic economics of that, is the next step.

Final comments

Speaking with Jessamy Baird at the close of the evening, pharmaphorum asked Sanofi UKIE’s MD to comment on the discussions and generally on the state of UK life sciences at this juncture – and why the Sanofi ‘What If?’ report is so important right now.

“By challenging and asking questions, you get people to be creative, have ideas,” Baird said. “The UK's in a very critical time point. It's declining in terms of its life sciences superpower status […] I think in this post-pandemic environment it’s a really good time to have those debates internally and externally across different groups, and create that sense of partnership. We can do more together than we can singly.”

On the Lord O’Shaughnessy independent review, Baird said: “[I]t's quite clear some things we can achieve in the short term and some things are going to take longer. There is not an easy fix for some of the issues. Lack of diagnostic capacity, lack of doctors and nurses who have capacity, lack of comparative treatments that you use in other countries within the trials - there are a lot of complex issues; the slowness of the approvals, the slowness to set up sites. What they are doing is now working on those.”

And to summarise, that keyword – ‘health’ – still rang out clearly as being the essential nub of what matters at the end of the day, that access to medicines in the UK is imperative for patients to attain that, and policy to permit such adoption of those therapies.

“Everyone knows healthcare is associated with a productive, healthy population, and medicine's a part of that,” Baird said. “The UK uses substantially, and spends substantially less, on medicines than other similar countries.”

“I suppose there is a debate to be had about if you adopt […] cost-effective medicines of value better, would you actually derive health gain for your whole population by doing that? That doesn't necessarily have to be the new and shiny ones, but essentially all NICE-approved medicines, if you reach the adoption that they expected, you would get significant health gain for the population,” she concluded.