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Going global

How can healthcare communications agencies achieve effective clinical positioning across a broad spectrum of markets?

A globe with large business figures standing on various pointsIn the 21st century, our world is connected in a way our ancestors could never have imagined. We buy bananas from Ecuador in our local supermarket, we speak to a call centre in India to find out our local train times and watch disasters in faraway lands unfold in real time on CNN. We get on flights as if they were buses and speak on webcams to people on the other side of the world as if they were sitting in our front room. This new phenomenon of interactivity can be summarised in one word – globalisation.

Globalisation has many different definitions depending on context. If we are to explore globalisation in our world of medical communications, perhaps the most appropriate definition to start with is the one provided by the World Health Organisation: "Globalisation, or the increased interconnectedness and interdependence of people and countries, is generally understood to include two interrelated elements: the opening of borders to increasingly fast flows of goods, services, finance, people and ideas across international borders; and the changes in institutional and policy regimes at the international and national levels that facilitate or promote such flows."

So what does globalisation mean for pharma?
The first stage of globalisation is the opening of new markets, and in today's world these would be the fast-moving markets in the developing world, such as India, China and South Korea. The great economic growth experienced by these emerging markets has also created a much greater demand for healthcare and prescription medications than in the past. Although much of the short-term demand for drugs will be for generic treatments, the sheer size of the populations in these countries makes them potentially enormous markets for the industry, as well as possible future centres of drug development, as their research costs, in increasingly sophisticated laboratories, are a fraction of their developed country counterparts.

If the US and Europe, historically the focus of pharmaceutical business, want to stay competitive in this changing landscape, they will have to find creative and productive ways of interacting with these new players, for example, the recruitment of international sales and marketing forces, and the growth of digital communications. They will also have to develop strategies and programmes that address the unique pricing and regulatory environments of each individual country to ensure maximum uptake of, and accessibility to, their products. With these growing demands on global marketing teams, and the need for an innovative approach to the new world, there will be a demand for global medical communications agencies who can help steer a path through these new and unchartered waters.

The role of global medical communications
In this changing environment, medical communications agencies will need to understand how to help the pharmaceutical industry achieve clinical positioning that is not only credible and well-founded, but impactful and applicable across the full spectrum of global markets. A number of activities fall in the realm of medical communications that can help achieve this aim, which are discussed below in the context of the larger global picture.

Key Opinion Leader (KOL) development:
Historically, building solid relationships with healthcare professionals (HCPs) has been integral to the success of most activities falling in the bracket of medical communications.  However, given the global shift from a 'physician-prescriber' to a 'stakeholder-payer' scenario, it is likely that in the future there will have to be a refinement of the roles of KOLs, with perhaps a change in priority and focus from the KOL to the payer relationship. Although HCP KOLs will always have an essential role to play in driving avocacy and influencing peers, in an increasingly cost-driven environment, relationships with payers could gain equal importance. It could even be argued that payers will become the 'new KOLs.'

As this will need to happen on a global level, a global medical communications agency can really add value and support to their pharmaceutical company clients with centralised, well-structured KOL management programmes that include all professional stakeholders.

Market access:
The shift from the 'physician-prescriber' to 'stakeholder-payer' model discussed above will make the ability to influence payers of paramount importance to pharmaceutical companies. Marketing staff will be actively seeking individuals who are experienced working in this field, to help position their products in markets where there are vast and subtle differences in terms of pricing and reimbursement, payer and physician education, and formulary access. As this is such a fundamental shift, involving a whole new approach where cost is at least as important as clinical benefit, there is a real opportunity here for a global medical communications agency with an understanding of and experience in global market access, to help shape and roll out these new programmes.

Medical education:
Complex targeted therapies need educational support to help all relevant professional stakeholders understand their place in clinical practice, so there will always be a need for high-level scientific communications at international congresses and in peer-reviewed journals. However, to ensure that messages delivered on an international level are successfully cascaded down to the local markets, there will be a growing demand for integrated programmes that provide a consistent thread, while ensuring key messages are appropriate for the markets in which they are delivered.

Examples of such programmes include classic evidence-based educational programmes aimed at clinicians connecting evidence, education and practice change. Programmes that encourage adherence to treatment are also likely to see a growth, in order to optimise both clinical and economic value of therapy. Reflecting these changes, there will be increased emphasis on educational initiatives designed specifically for nurses and pharmacists, based on their growing role in patient management. There is also likely to be an increase in integrated payer programmes to reflect increasing payer power and the need for payer insight and engagement.

However, one of the largest areas of growth we have seen in recent years – and a trend that is likely to continue – is in the area of non-promotional activities, covering disease awareness and unmet medical need, where product mentions are included only as part of an unbiased appraisal of all therapy options. In Europe, a tightening of national and international codes of practice has led to growing emphasis on provision of non-promotional educational programmes, that can form part of a healthcare professional's Continuing Professional Development (CPD). However, years of associating pharmaceutical companies with 'selling' can be difficult to shift, so it will become increasingly important for pharma to demonstrate that their non-promotional activities really are as such, and do not contain an ulterior motive.

In Europe, more non-promotional activities are now being included in the strategic communications mix, and are being built into tactical plans; budgets for promotional and non-promotional activities are being separated and, in some cases, there has been a restructuring so that non-promotional and promotional activities are handled by completely different teams. For example, promotional projects remain with the marketing group, and medical departments are given responsibility for non-promotional work.

This response is still evolving in Europe, and is likely to be influenced by additional changes in the US, where there has been an even stricter tightening of regulations. In the US there is now a complete split between promotional and non-promotional (CME) education, with agencies no longer being able to work on both. In fact, such is the continuous need to prove that pharma-sponsored CME activity is transparently non-promotional, there is a growing number of cases in the US where pharmaceutical companies marketing competing products have partnered together on CME programmes, for the greater good of clinical practice, despite their rival interests.

This increase in educational programmes is also likely to lead to a corresponding increased use of e-learning. Although there has always been widespread agreement that CPD/CME is a valuable ethical commitment, it can be hard for healthcare professionals to set aside time for study, particularly if it involves attendance at a meeting. E-learning allows the healthcare professional to manage his/her time more effectively and is a natural progression from the way today's undergraduates are taught. To reflect this growing trend, the European Accreditation Council for Continuing Medical Education (EACCME) is already developing a position on e-medicine, including e-learning, and it is likely that the organisation will provide pan-European accreditation of both meetings and materials in the near future, in line with the situation in the US.

Patient communications:
In Europe, there is currently a lack of harmony in the area of health and medicines information directed at patients, with differing national approaches, and unequal access of patients to such information, not to mention legal uncertainty for manufacturers. To help bring Europe in line, a proposal was submitted to the EU Parliament in December 2008 on the provision of information to patients about medicinal products. They are in still in consultation, but the outcome is eagerly awaited, as the end result will hopefully improve the access of all EU citizens and patients to high-quality information on health and prescription medicines.

Meanwhile, the US is renowned for its relaxed approach to advertising of prescription-only medicines directly to the consumer. However, over time, this situation is likely to change; it is expected that there will be a tightening of the reins, so that direct-to-consumer marketing programmes in the future will focus on informing patients about the availability of treatments in general – instead of a specific brand name. This will be a fundamental shift from the way that the US currently markets to patients, and presents a real opportunity for global medical education agencies, with longstanding experience of patient communications, to step in and help them make this transition.

How to ensure your global programme meets local needs
The cascade process:

Developing a global medical communications programme is about developing internationally pliable tools that bring together locally-driven acumen within consistent, measurable frameworks. Rather than paying for the origination of an activity in each and every market, return on investment and consistent delivery of key messages are maximised by developing one central programme, with sufficient flexibility to meet the needs of local markets.

There are a number of challenges to take into consideration when planning such an activity. The first step is to acknowledge that it is impossible to create activities that will work in every EU member state. The real skill lies in identifying points of commonality and dissimilarity, then providing initiatives and materials that are tiered accordingly so that the lowest common denominator will be satisfied. A targeted cascade of activities should be developed with intelligence, knowledge and sensitivity depending on local needs, enabling the smaller markets to participate, while embracing the needs of the more commercially powerful regions. It is impossible to do this cost-effectively without a wealth of local expertise to address issues such as language and cultural differences, medical practice variations across regions and between countries, resource management across virtual teams, proof of value and ROI and territoriality. Global medical communications agencies need local insights into each of the markets in question to deliver successfully effective global medical communication programmes.

What does a truly global medical communications agency need?
A truly global medical communications agency needs an understanding of all elements of the marketing mix so that synergies can be maximised across brand communications, medical communications, public relations and e-marketing. It needs to have a global, physical presence in all the key markets, so that local expertise can be harnessed, to ensure the successful roll-out of the central programme. Agencies that can navigate the demands of working in joint ventures and across divisions within one company, as well as those who have the ability to work with people from different countries and cultures (which requires experience with different languages, regulatory environments and attitudes about life and work) will also separate themselves from their competitors. And finally, given the increasing importance of market access and digital education, agencies that can also offer expertise in these areas will be one step ahead.

Whether the delivery path is a banana plantation in Ecuador, whose produce eventually arrives in a small supermarket in Croydon, or a new diabetes drug developed in Japan, intended for used in patients around the world, globalisation is now an irrevocable part of our daily life. Companies that do not adjust their strategies and activities accordingly, will find it increasingly difficult to adapt and compete in this changing landscape. This is where global medical communications agencies, with their expertise and experience in developing creative and productive ways of reaching out to key stakeholders can become true strategic partners. If they are doing their job properly, they will be making the life of a global marketing manager an easier one: on hand to provide all the necessary advice and tools, so that, together, they can ensure that consistent messages are being delivered to the right people at the right time. And ultimately, improving patient care – around the world.

The Authors
Julia Holt is client services director at ApotheCom
Sandy Royden is CEO of Huntsworth Health Europe and can be contacted at

To comment on this article, email

1st March 2010


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