Change Makers Elcin Barker Ergun of Menarini Group on Driving a New Renaissance in Healthcare

Well, thank you so much. Great to be here. And you know, it's a real pleasure. Here we are in Florence, birthplace of the Renaissance.

Absolutely. I think we're really in an era of incredible change and progress. I think so many things have been there, but now they're all coming together as we are going to precision medicine in a very, very determined way. And also academia and the whole ecosystem, but also both on the diagnostic side and on the therapeutic side. So it's really the Renaissance.

In reality, we have not changed our focus on cardiovascular treatments. If we look at the world and mortality rates, cardiovascular diseases are still the number one leading cause of death. We are the sixth biggest cardiovascular company in the world and we have every drug possible in that area, and we will continue, for the reason that there is still a huge unmet need in that area, and we all have to put a lot of efforts to bring more products and also make sure what we have available is used in the right way in hypertension control and everything.

So I joined Menarini as Group CEO in September 2019. Then our owners always had the vision to enter into oncology. So my coming was very much related to that, and the biggest priority was to accelerate oncology and also turn our company's direction to become more and more an innovative pharma company.

You know, this is an area that I love talking about because it takes me back to that Renaissance question you asked about our industry at the moment. So when you look at all the difficult-to-treat mutations or alterations — if you look at lung, we have immunology, but we now have drugs for ALK, ROS, other things. When you look at AML, today we have three inhibitors, IDH inhibitors. And when you look at breast, now we have a drug in near-SARM mutation, but also in many different areas we have pathways now where we're able to create drugs. So wherever you look, we are in that Renaissance of targeting very difficult-to-treat mutations, and we're truly now going for personalized treatment.

Most of the applications today are ctDNA, but circulating tumor cells, which are rare cells in the blood, can also inform us about the tumors in a complementary way. And that's really exciting, to be able to find these markers in the blood rather than, as you mentioned, a bone marrow biopsy or lots of imaging studies.

I think it's very important because now, for instance, in Europe — Europe is very fragmented, and liquid biopsy or blood-based tests infrastructure is very scattered in Europe. In emerging markets, in China and other places, there's also tremendous work to be done before you bring your therapeutic, in order to help create that testing infrastructure. So I think to really fill this Renaissance of innovation, we need to work with authorities together to accelerate also to the diagnostic side of this equation.

So I'm a computer engineer myself, right? Not a typical background for a CEO of a biopharma company. And so if you ask me, my honest opinion is that we don't have the Renaissance yet on AI translated into innovation. You know, AI has really transformed in many different areas. How it can inform us more on the discovery or research side, where processing data is very important — for us, when you've really cracked a real Renaissance using AI, that is the part that I would have liked to see and I still would like to see us using it there to guide us.

Like in any other area, we are increasingly using them, and that gives a lot of efficiency in those areas. But it's not a breakthrough innovation, it's small. Acceleration of clinical trials, you can also have a lot of AI on forecasting clinical trial efficiency, recruitment — all of those things are guiding us very well. But the breakthrough AI translation in drug discovery and research, in my opinion, is yet to come.

I'm somewhere in between, right? AI will continue, John. It's extremely important, it's fascinating, it's going to be transformational already. But we need to find a way to regulate it. We won't be able to totally regulate it because it's going to go at tremendous speed, but we do have to find a way to protect people's rights.

In things like augmented reality, for instance, right? There's incredible applications there. It suddenly makes you access different locations or allows you to communicate via technology in such a different way that opens up new possibilities for all of us. So one part of AI, the first translation, is about efficiency. The other is the breakthrough in drug development, and that's where diagnostics then comes in.

When I joined the R&D part of our industry, I realized our R&D people, mostly coming from medical, biology, and other related fields, have their own language, right? I know the IT world has its own language. I think it's not easy for these two parts to talk and to understand each other. We have to find ways, more user-friendly, to bring these groups together, possibly to really crack that and unlock those breakthrough innovations.

We're talking about all these fascinating innovations, but at the same time, if you look at where we are and why cardiovascular disease is still the leading cause of death — not only in emerging markets or the developing world but also in the US and Western Europe — and that has to do with the underlying issues. When we look at obesity, today it's a big problem, right? And everywhere it is a real big problem. If we don't also create awareness, education — now new drugs are coming also into those areas — but we need to also create continued education and awareness in underlying things. If you consume too much sugar, it's going to affect your metabolism, but it's also going to make you more prone to cancer.

Because we in the Western world target a drug for a specific thing, we don't always look at it holistically. Now those concepts are coming more and more. The second part of the equation is how do we get access to treatments.

What excites me is to be able to have the resources to unlock innovation, to make a huge impact on patients' lives. But also from a leadership perspective, you can be a role model in these jobs. You want to say to the world, look, if I did it, you can do it, right? Everybody can do it. Because we talk always about the bias, but people like myself also show that there's also not bias — there is a system out there that is also able to bring people like myself to these positions where you can make a tremendous impact and also influence other people.

First of all, Italy in general is known as a manufacturing hub in the pharma industry. But oncology is a very competitive area. So going into this area, we want to put Italy absolutely in that center of innovation, because in Italy there are extremely good scientists. So far we created a portfolio in the last three years of three transformational drugs, and all of them two in the hematology area, all first-in-class. So this is a very exciting journey for us, and also growing our US organization.

You know, the next threat could be from the AMR, antimicrobial resistance area, John. This is a very neglected area. There is some now awareness on the whole topic, and we are one of the few companies who actually have a portfolio, and some of these drugs are life-saving. But we don't yet have an ecosystem that is appropriately recognizing the importance of antimicrobial resistance. Every year over one million people die from antimicrobial resistance. But it's not just about bringing new drugs to this area — it's also about what can we do in terms of access to these drugs.

It's a very big topic about women in leadership now. Let's start with the not so bright side of it. Menarini is a top 50 global pharma company, and we have, along with me, only three other women who are CEOs of other top 50 global pharma companies. This is a very small number. I think at the board level there has been progress, but at the CEO level we have not seen that progress. So, you know, I think partly that is to do with the education systems in different countries, right, where women may not feel well empowered. Or I don't know — when I studied computer engineering back years ago, it was a 50-50 class.

It was time. So actually in high school I graduated from biology, so I was always fascinated. But it took me a while to really find my passion and to move into the pharmaceutical sector. Now, originally I worked for big technology US companies, actually. So originally I'm from Istanbul, but most people, actually most women, study engineering. So in computer engineering it was half even in the 80s. And also some others — chemical engineering, industrial — are majority, actually. So therefore I think that gives you a very good base where you don't feel different from the start. You feel like, okay, well, it just doesn't matter. I think this is a very important start. When I joined some companies later on in the UK, for instance, there weren't women engineers. You see that, I think, starts all the way from the beginning.

I did my profession as a software engineer, and then to the UK with a top US company. And then I transitioned into the CFO role first, so I went through finance, and then I moved into general management and regional management, and leading the pharma P&L. So but there I did a very important turn, and I believe those are things maybe where people, men and women, but maybe more women, don't take risks. When you have a large P&L in a big European company, you know, four billion, five billion, it's a big power job, right? And you don't necessarily want to go to a smaller job. But our industry, in a very healthy way in my opinion, became more innovation-driven. I believe today, to be a successful pharma CEO, you need to know in a way the machine end-to-end. You need to know how you get to that innovation from a functional perspective. The engineering gave me a very good analytical background, and I put a very sound finance on top of it. But then commercial is essential, in my opinion, as well to run a pharma company. I think it's critical. But then for our industry, R&D is extremely critical. But in terms of also geographies, I think it's increasingly important if you're a global CEO to have a cultural curiosity and to be able to understand what motivates and engages each culture.

It is different, John, in the sense that the US is a fast-paced culture. It's a culture that is very focused, very result-oriented. The 'what' is very important in the US. In Europe, the 'how' comes into picture. So when you look at Northern Europe and Southern Europe, the management styles, the leadership styles are different. Northern Europe — Nordic countries, Netherlands, Germany — these are more consensus cultures. You have to come around the table regardless of your hierarchy to really discuss matters and to get into an informed decision with participation of different people. In Southern Europe, there's hierarchy, but relationships are important. You first have to create the relationships, create trust, and then based on that you can really work the other things. The 'what' and 'how' — I think that's fundamental today in global leadership. And I don't think it's about being a woman or man, but I think it's about truly having that appetite to learn, an appetite to really have a very strong vision, and the ability to bring people towards that vision, to really do both in terms of delivering, of course, the financial goals that are very important, but creating a purpose — particularly for us, very important — in order to really create a patient-centric company that is able to bring these transformational treatments to patients.

I think that's a great question. And there is where, like Medscape and other CME providers, come into the picture. I think you guys are doing also a phenomenal job as part of this ecosystem to help us. You know, we give grants, and through that there is independent education, obviously. Within our framework, we also have other chances and opportunities to educate physicians. I think, you know, a conference like ASCO, for instance, has got so many different ways — because it's not only the conference itself but what you do around that conference. Best of ASCO, best of, you know, all of these things in other areas — it goes into different parts of the US, it goes to different parts of the world. So I think our work is incredibly well-organized from the way we are working in that ecosystem to really educate through physicians and other collaborators.

Well, this is a very regulated industry. So within that framework and through the patient advocacy organizations, whenever we have them as our counterpart, we do our best. And there are areas, I think, that can improve in different parts of the world. But overall, I think it is a well-organized industry and an ecosystem to really fulfill what we're doing.

I'm passionate about science and innovation. I'm somebody more excited about what is possible, what is breakthrough, what can we do differently with all these resources that we have, where that can change a course of a treatment or something very important and impactful for the world. So those are the kind of things. I'm an Aquarius myself, so you know, we are really those people who want to be at the lead of the next very important thing. So I love what I'm doing. It gives me every opportunity. I consider myself very lucky and humbled to really be able to bring all these therapies. Possibly it would be that I would still want to do other breakthrough areas like AI and whatever to come as next.

Thank you so much, John. Thanks for having me.