A discussion with Prof. Klaus Dugi, EVP and Chief Medical Officer at Ferring Pharmaceuticals

No, thanks. It's a pleasure to be here and thanks for the opportunity to speak to the audience. Yes, so as I said, I'm the Chief Medical Officer for Ferring in Switzerland at headquarters. The role of Chief Medical Officer is a little differently defined at our company. I'm responsible for Global Medical Affairs, Drug Safety, Quality Assurance. We also have a Chief Patient Officer that reports to me, along with Health Economics and Outcomes Research, and something we call the Global Innovation Lab, which focuses on digital health and new approaches. I joined Ferring two and a half years ago. For close to 15 years before that, I spent with another privately owned pharma company in Germany. Most of my time there was in Research and Development, developing new medicines in various therapeutic areas. I also spent two years as the General Manager in the UK and Ireland to see the commercial side of pharmaceuticals. Before joining pharma, I spent six years at Heidelberg University Hospital. I'm a physician by training, and in Heidelberg I received my training in internal medicine and endocrinology. Before that, I spent four years doing basic research at the National Institutes of Health in Bethesda, in the US. So that puts me in a nutshell.

Yes, thank you. Obviously this is an unprecedented situation. WHO now 10 or 14 days ago declared this a global pandemic. A traumatic circumstance, but there were always scenarios of a pandemic happening. We're now in the midst of one, and we see what kind of consequences that has. It's obviously a very volatile situation; it changes to a great degree from day to day. But in these days, it's also important for management to stay calm, to be there for employees, for our customers or patients. As you said, I have the privilege of chairing our coronavirus task force. What we tried to do there is to stay ahead of the curve, to try to perceive what could happen next and react to that. To give you a few examples: When it was clear that there were hot spots in the world like northern Italy, when there was a higher incidence of cases, we asked all employees coming back from these places to stay home for two weeks. We later had two employees who turned out to be COVID-19 positive, but because they had quarantined at home, they never saw other colleagues and could not infect them. Another thing is that our IT department said, 'Well, you know, we may have to go at some point to a work-from-home policy. Let's prepare for that. Let's increase the bandwidth, order additional laptops, find additional tools so that we can connect virtually.' And we also sent an email to all employees: 'Please take a computer home every day, your charging cable, your headset, because you may have to work from home at some point.' So when we did that, I think we were quite well prepared, and it worked quite well. So yes, there were hiccups at the time, but overall the work-from-home policy works quite well. Lastly, six days after we implemented the work-from-home policy, we had a couple of colleagues here at headquarters who tested positive, but because they had stayed home the last six days, there was no risk of them infecting other Ferring colleagues. So is everything we're doing perfect? Of course not. It's also an unprecedented situation; we have to learn from that. But by working cross-functionally in the task force with our HR colleagues, legal, manufacturing and product supply, commercial operations, our Health and Safety Group, etc., we try to take the right decisions in a timely fashion, meeting daily. So far, under the circumstances, I think it's going really well. And the last thing I would say is the importance of communication. In real estate they say it's about location, location, location. I think in a crisis it's about communication, communication, communication. So we send a weekly email to all employees to update them, to provide resources that we have made available on our intranet pages. We've done a few videos to all employees. Last Thursday we had a town hall with the executive committee where we gave a presentation and then 40 minutes for questions and answers. We're inviting people to have virtual coffees, etc. So communication and cross-functional collaboration are key to getting through this crisis. And I'm sure it's the same in all other places as well.

Yes, so that's an excellent question. When this situation emerged, we said we really have two top priorities: one is the safety and well-being of our employees, and the other is to continue to supply our patients with our medicines. Our mission is to help people live better lives. If they don't have access to our medicines anymore, that would be really bad. Put yourself in the shoes of a patient with pancreatic cancer who has been told by the physician that there is this drug that may give them a longer life, that is well-tolerated, and they go to the pharmacy and find it's currently not available. Or a young woman with inflammatory bowel disease who has come to trust and rely on her medication, and she is told the drug is no longer available. So that is the key business priority: to be able to keep manufacturing and supplying our products. That's why someone from manufacturing and product supply is a member of our daily task force, and we are doing everything to protect our colleagues working in manufacturing so they can continue to come to work. Part of the reason we went to work-from-home policy for office colleagues was to separate them from manufacturing colleagues to make sure there could not be any cross-infection. We changed the workplace, separated workstations, and put plexiglass barriers instead. So for colleagues who go to work in manufacturing, the infection risk is minimized. We had to be creative with transportation because many flights are not operating. It's also nice to see how we can work together with other pharma companies because we are all in the same boat. We chartered planes together with other pharma companies to transport ingredients or products from country to country. So far, I'm happy to report that all of our manufacturing sites are operating, maybe at a slightly reduced rate, but at the moment we are still able to manufacture and supply our medicines and bring them to patients. But it is a volatile situation; we have to stay on top of everything, observe the situation day to day, and be agile to make quick decisions in the interest of our employees, our company, and most importantly, our patients.

And yeah, you know, reproductive medicine and maternal health is our key therapeutic area. That's the area where we want to be the leading company, the most trusted company in this area. So this is especially close to our heart in these difficult times. I'm also here to say that this part of our business is currently most affected because due to the statements from ASRM and ESHRE advising fertility patients to not become pregnant at this time, that's obviously also an important business risk for us. However, this is a sensitive topic, and it can't be up to Ferring to provide guidance to patients or reproductive endocrinologists, etc. But what we can do is to support the dialogue. We can have a dialogue with patients, obviously not talking about our products but about the situation in general. We have connections to various patient advocacy groups; we are in constant dialogue, and we have a team working hard discussing with the reproductive endocrinologists that we have worked with for many years, sometimes decades, to hear their opinions. And we also see that some feel that the positions from ASRM and ESHRE might be too far-reaching. There is also some pushback from some clinicians saying, 'We are well aware of the infection risk; we can take the necessary precautions, and we ought to be cognizant of the fact that treatments cannot stop altogether.' Put ourselves in the shoes of a woman who wants to have fertility preservation because she may have to undergo chemotherapy for cancer; she cannot wait six months. So these are important considerations. I think Ferring can only be a broker at this point to have the dialogue between patients, physicians, societies, and as you said, also with regulators and healthcare systems. An important topic is that due to the guidelines, we also need to decide what we know at this point about vertical transmission, pregnancy outcomes, etc. It is an emerging situation. The initial publication from China suggested there was no vertical transmission. Then I think there were a couple of cases that suggested maybe this is possible. There are questions; it's certainly not determined at the moment. And we haven't to date, luckily, seen any difficult outcomes with infants that may have been infected with the coronavirus. So there is a clear need to generate more data, and that's something that Ferring can contribute to by maybe supporting studies and registries to give us more information. At the moment, I think the general opinion from most physicians and societies is that pregnant women should not worry too much; there is little evidence that there is harm to the babies. But it is an important area that we need to follow the science on, and Ferring is committed to helping generate data that hopefully will put women, couples, physicians, and others at more ease, which will gradually allow starting pregnancies in this time of the coronavirus. But it's important to follow the science.

Yeah, so I think that's the question that we all ask ourselves. Obviously it's very difficult to say; none of us has a crystal ball. But as you say, both privately and professionally, that's what we talk about: what could be the long-term implications? I think that depends on how this crisis will evolve, how many lives will be lost, the impact of the loss of human life — which is the number one priority — but also what's going to be the depth and length of the economic recession, and the time needed for recovery. Because we will have an impact on society. A few thoughts come to mind: After this crisis is over — and we will get through it, there's no doubt about that, it's just a question of when — then in some countries there may be more push for local production, which has implications for globalization. We saw all the benefits of globalization, but maybe there are also things that we take a step back and reconsider. I think people see now that the world can also work to a certain degree with less business travel. Maybe there will be more remote working or working from home in the future. There will be discussion on what's the right level of investment into healthcare and science, especially in those countries where not everybody has access to healthcare. What does it mean to them in such a crisis? And will there be any consequences going forward? So even though we all already see the consequences of the change in our lives, we are still relatively early in this pandemic, and I would say it's quite difficult to say at this point what the long-term implications are. As I said in the beginning, critically for us as a business, we try to stay on top of things, observe what the trends are, what is changing, and also maybe see some opportunities to come out of this as a better company, more customer-centric etc. So there are always opportunities in the future. At the moment, we have to deal with this health crisis and also with the economic implications.

So I think, again, an excellent question. My team approached me early on, a few weeks ago, and said, 'Isn't this a great time to provide training to our customers, to the healthcare physicians that we work with?' Because at least in some areas — and Reproductive Medicine is one of them — it's a time when not so many clinical activities are happening, at least to a certain degree. And wouldn't that be a perfect time to focus on training, education, scientific dialogue, to discuss related publications, to discuss maybe future trials, and also training. We did a survey a couple of years ago with a lot of reproductive endocrinologists in several countries, and it was clear that there were areas where the physicians themselves said, 'This may be an area where I could get up to speed, where I could learn more about the latest science and learn from best practice sharing.' So again, it's an opportunity for us to support others in seeing the latest scientific evidence, guidelines, and training. So I think it's an excellent question, and it's something that we are trying to stay on top of at Ferring.

Yeah, well, we see dramatic impact on that. Based on the ASRM and ESHRE guidelines that you mentioned, basically all of our ongoing clinical trials that are still recruiting patients we had to put on hold. Also in other therapeutic areas, we see impacts: patients cannot go to their trial visits because the investigator site is closed or because they cannot travel, etc. It was good to see some guidance from the FDA and the European Medicines Agency on some flexibility on how to deal with that going forward, because there will be a lot of protocol violations as a result. Again, it will be a dialogue between regulators, investigators, and companies on how we can rectify the data and maintain the scientific integrity of the trials, which is obviously important. We also have an obligation to patients who provide informed consent to participate in a trial to make these trials meaningful and learn something for science and therapy going forward. Again, this could lead to more flexibility for pragmatic trials, where patients may be recruited into trials from home and not have to go to the investigator site, or at least we reduce the visit schedule, etc., more digital approaches. So I think clinical trials will also be an area where we have to step back and maybe learn something. There may be more flexibility or more opportunity than we thought. But at the moment, it is a difficult time for clinical trials, especially in reproductive medicine. But as you said, once we get through this, we have to consider that change can be good, and there may be opportunities here as well.

Yes, that's an excellent question. We have more than 2,000 customer-facing employees at Ferring, and pretty much every one of them at the moment is sitting at home because of travel restrictions and restrictions to see customers. So they are using digital tools, remote connections, emails, phone calls, WebEx with their customers. Of course, it's important to follow local compliance rules; we cannot just send an email or call a customer or provide a WebEx without doing it in line with local healthcare compliance rules. But again, this may be an opportunity to see that we don't necessarily have to travel to an investigator and sit for an hour in the waiting room for a two- or three-minute interaction. Maybe there are other ways that our customers, the physicians, actually benefit more from. There will always be a place for human contact — some customers I've been interacting with for many years, and that's perfectly fine. Others may say, 'I only have time after I'm done with my clinic to see someone, and I'm happy to do this via FaceTime or Skype or other meeting tools.' Others would say, 'I'm fine with just searching the internet or having information sent to me if I request it.' So again, I think Ferring, like many other companies, was already on a journey toward a more digital approach to become more customer-centric. And this coronavirus situation maybe amplifies and accelerates some of these changes, so that may actually be a good thing. So I think we may be able to better serve our customers through more flexibility with digital tools going forward. But there will be some who will always want and benefit from personal contact. So I think there will be a mix of approaches, and we need to find out from our physicians, nurses, and other healthcare professionals what their preferred mode of interaction and communication is, and what's the best way for them to learn. So I think, yes, in times of crisis it's important to learn, to improve how we do things, to find opportunities to do things better in the future, to better serve our customers, healthcare professionals, and most importantly, our patients.

Yes. I think we will, as I said, continue to work together. We will find ways of learning from this, what we can do better in the future. I think we are on this journey together to help people realize their dreams of building a family. That will not go away. There may be even now, as we see the downsides of social distancing, there may be more need for families, for connection, for building relationships. So we will get through this together if we keep each other informed, work together, try to find opportunities. These designs, as I said, will help us maybe to come back to fertility treatments sooner than we think at the moment. It's important to design for that. So yes, let's focus on the opportunities, on collaboration, communication, and design. That is the opportunity. Thank you very much.

Thank you. Same for me to everybody out there. Stay safe, stay healthy, and thanks to you for this wonderful opportunity to address the audience. Very much appreciated. Thank you.