Cipolletta Innocenzo, Carlo Rosa - Appunti per la ripartenza

Thank you for the invitation. So, I think it's worth putting ourselves back in context for a moment, because it's not the context of today but the context of two months ago — actually, I'd say more, four months ago. We're talking about February. I distinctly remember one day: we have a company in China where we employ about 150 people. In Italy, people were talking about what was happening in China, but we felt very distant, protected by what we considered an astronomical distance. But one day, during our weekly video conferences, I saw our managers in China, instead of participating in the meeting all together in the conference room, were in their offices, only three of them — out of 150, there were only three in the company — each in their own office wearing a mask. At that point I asked what was happening. We are in Shanghai, so we are far from Wuhan, and there I understood that in reality that pandemic, that virus, would not stop. It was impossible for it to stop because there were still millions of people traveling from China back to Europe. At that exact moment, we decided to stop everything. We said: all the research projects — and we have 15 on new products — stop everything and put 150 people, who are less concentrated between California, where we have a large research center, and Italy, to work on what needs to be done for COVID-19, because it's likely that the virus will arrive in Europe soon. From that moment, within six weeks, we developed essentially two products: we developed a product commonly called the swab test, but which is actually a very complicated product based on molecular amplification technologies that can identify a thousand copies of the virus if present in the swab sample taken from the patient. This cost us sweat and hard work, of course. Then we developed a serological test. This work, done by a group of American and Italian researchers working in our R&D, was then supported by testing centers in Italy and the United States — in Italy, the Spallanzani, San Matteo in Pavia, Niguarda, several centers where we tested the product before putting it on the market. To give you an idea of the effort: we normally take 18 months to develop a product. This time we did it in eight weeks. In eight weeks, we developed two products, put them on the European market, and also obtained approval in the United States within 72 hours. Not only that, but BARDA, a US federal agency that identifies companies that can help the country in critical moments, partially funded these efforts and helped us get approval. So I must say that at this moment America has been very close to DiaSorin. DiaSorin is a global company: 40% of our revenue comes from the United States, 40% of our employees are in the United States. So the reflection is this: we reacted very well, we developed products that are now in use. Think that every month about 6 million people around the world are tested with DiaSorin products — a small part in Italy, and then all the other countries that are obviously critically under great pressure from their healthcare systems due to this epidemic. So, to summarize what you asked, Professor, we put what we had into it, we gave up developing other products to very quickly give hospitals around the world diagnostic tools that would allow them to identify infected patients and thus begin that segregation that saved us all, and the treatment of patients in intensive care or not, which was largely successful. And then, clearly, as we have seen, the mortality rate of this epidemic has been high, but thanks to segregation and patient identification, we have, in my opinion, avoided many more deaths than there might have been.

Well, let me line up a few answers. I think the lockdown was the only true way out of this situation, or to prevent the contagion from spreading. I won't say things that are already well known to everyone. The problem is that mortality was very high when the saturation of hospital capacity to receive patients was reached. The lockdown in all countries served to flatten this famous curve because when patients — unfortunately what happened — exceeded hospital capacity, problems started and mortality increased. So I continue to say the lockdown was fundamental, especially in a time when there are no specific drugs and no vaccine. A vaccine obviously wouldn't have done anything for treatment. So I think the real challenge is to try to convince people — who are fed up, including myself — of working from Monday to Friday and then spending Saturday and Sunday on my balcony. Yet we all did it. Today, when I go out and hear people's comments and especially hear virologists who can't find a common line, I remain very perplexed because, in my opinion, no one knows where the virus is, whether it has gone away — it hasn't gone away. You see that there are already talks about outbreaks in countries like the United States, which were more lax with lockdowns, especially in some states. So from my point of view, while not being a virologist, I would say we need to be very careful. But I would invite everyone to reflect on one thing: we were relatively fortunate — if one can speak of fortune — because this virus arrived in Italy at the end of the so-called flu season, no? It arrived in Italy at a time when the year was particularly mild from a climate point of view. So we are approaching October, facing a flu season where the symptoms of this influenza — a respiratory illness — are symptoms that can easily be confused with those of COVID-19. The real problem is that for that season the system must be ready in terms of diagnostic capacity for differential diagnosis, to immediately separate patients suffering from a common cold or flu from patients who have COVID-19, because we saw the most dramatic problem is when patients who are unfortunately infected with the virus enter hospital facilities and from there the contagion begins, which is difficult to control. So, in my opinion, the challenge for my industry right now is to be able, by the flu season, to provide tools — more swabs, diagnostic instruments — that allow immediate localization and differentiation of patients with cold symptoms from patients with confusing symptoms linked to COVID-19, to separate them and ensure we avoid contagion. That is DiaSorin's challenge and that of all other diagnostic companies at this moment. Regarding the vaccine, I am not an expert, but we have chatted in recent weeks with companies currently involved in vaccine generation. I believe we will face this year and part of next year without a vaccine. So, as I said before, we must prepare for a situation where the possible outbreak of new clusters — which I think is inevitable — is immediately managed and contained, so that we can proceed to a normal life while avoiding lockdowns that, as we have seen, risk suffocating the country economically.

Look, this is an important question, a dilemma. First, I think the ethical problem is a real one: the availability for everyone of a healthcare system that is accessible. Having lived in the United States for almost eight years, I experienced firsthand the profound inequality of the American system on one hand, and the excellence of the American system on the other — because it's created by insurance, but it's undeniable that there are world-class centers of excellence in the US in terms of cutting-edge technology availability, clinical trials, and so on. So, to be clear, I am a very strong supporter of a public healthcare system because I think it is a characteristic of mature democracies. In this, I think America lags behind from a certain point of view. However, I am also a manager, a person responsible for a company, and it's very interesting — this question — because, to my great surprise, about six months ago in the United States, I participated in a dinner discussion in New York with important figures from some American universities, academics. They argued, very interestingly, that the real way would be to nationalize biomedical research. They said that the NIH and other US government agencies distribute billions of dollars, partly to industry, so on some topics considered a common heritage, this research should be done and production implemented at a public level. This surprised me to hear it said in the United States, because America is the land of liberalism par excellence. But on the other hand, it doesn't surprise me because, as you know, the American academy often expresses representatives who, as often happens with educated Anglo-Saxons, are actually deep democrats, almost socialists. So I believe we should find a solution that guarantees free access to certain basic drugs and technologies. This obviously happens within public healthcare systems; one cannot debate the value or price of cost. This is certainly true in underdeveloped countries where the costs of these technologies are not sustainable. But on the other hand, I put on the hat of the CEO, the entrepreneur, who takes risks and bears enormous costs — enormous costs of clinical research, because the costs are partly the research itself, but the validations, the trials required by regulatory authorities today are frightening. Moreover, the fragmentation of these regulatory authorities means that to sell in Europe you do a trial, then repeat it in America, then in China, then in Japan — truly endless. So, on one hand, I am an entrepreneur who takes entrepreneurial risk, puts significant resources into innovation. Often this innovation may not lead to a product because they are research bets — some you win, many you lose. So I must have a return on the capital invested in this risk. Therefore, I think we need a solution that on one hand continues to allow companies to be deeply stimulated in innovation — there's no denying it, what stimulates companies is competition, ultimately profit, and I am deeply convinced of that. On the other hand, I believe that for some developing economies, access to these technologies should be allowed at controlled prices proportional to the purchasing power of those countries. This already partly happens, but unfortunately it has also happened that countries like India have decided on some drugs considered life-saving to completely circumvent patent protections and synthesize their own drugs, disregarding all the effort a company may have put into developing that product. So, in summary, I remain a convinced supporter that competition, companies, and the aspiration to generate profit are a great engine that drives people and companies to do research, take risks, and bring innovative products to market. So the thesis expressed by those American academics does not convince me. On the other hand, I think that in some geographies, these technologies should be offered at different prices, although I realize that often the problem is not just giving a pacemaker at a lower cost, but you need to put it in a hospital that doesn't exist. So developing countries must make an effort to create infrastructure and hospitals so that companies can introduce these technologies.

Professor, I would have a much more local idea or ambition, and let me explain what I'm referring to. There was a very interesting article just today in the Corriere della Sera about this. I think this pandemic, the behaviors of some governments — which may be explainable but must be accepted — have shown everyone that we need to work as a team. When the pandemic broke out, we discovered the selfishness of states. The Americans came out with the concept of 'America First,' which is not new as you know, but they applied it very well to what they considered strategic leverage. We all witnessed blatant cases of American companies either not producing certain things or not exporting. At the beginning of the pandemic, there was controversy about some German behaviors. So we discovered that in times of difficulty, each state, fortunately, follows its own interest — this is inevitable. So I think Europe must wake up. On one hand, there are 330 million Americans with purchasing power and technology of a certain type; on the other, there are 1.3 billion Chinese who also have increasing purchasing power, finance, and research. It is unthinkable that Italy with 60 million, France with 60 million, or even Germany fight alone. So I think the real reflection after what has happened is that we must significantly accelerate the decision to create an agency at the European level, equivalent to BARDA in the United States — an agency that is well-funded, identifies European champions (national champions no longer exist, but European champions) in the technological supply chain that must be controlled at the European level to be able to counter and compete with these giants that will come again, though not at this level. If we look at the last twenty years, we have already brushed against this three times. So it will happen again; we must not be caught unprepared. But it's not Italy's problem to be caught unprepared; it's Europe that can no longer be caught unprepared. So this is an extraordinary opportunity, given that we are talking about a lot of money on the table, to dedicate a part of this money to a series of European-level programs that leave Europe in five or ten years technologically strong and independent, able alone — all together — to manage the next pandemic. This, from my point of view, is an extraordinary opportunity. I hope this suggestion can be accepted. On the other hand, Europe is now preparing the Recovery Fund plan, which should also strengthen the resilience systems of different countries. There is certainly an operation to be done at the European level.

Well, from this point of view, I am a great nationalist, in the sense that I have been fortunate enough to see research groups at work in America that work for us, research groups in Italy, Germany, and England because we have several development centers. And I must say that our Italian young people perform very, very well. I must also say that unfortunately in Italy, industries that do research in Italy — sorry — commercialize, they make Italy a market, but those who produce and do research are few realities. So you understand that when DiaSorin looks for an engineer — we hire about 30-40 a year in Italy — we choose the cream. So if we look for an engineer, I set very high standards because we look for a graduation grade of 110, we look for a certain type of experience. For every position I advertise, even with very selective criteria, I get ten candidates. So it's obvious that if you look at the engineers, chemists, and biologists at DiaSorin, you find extraordinary people. Let me tell you an interesting anecdote. Three years ago, we bought a company in California that specializes in molecular diagnostic technologies — the same technologies that allowed us to do the molecular swab test. The head of this business unit, which has about 300 people and about a hundred million euros in revenue, is an American. I also left him a research group near Milan, saying, 'You decide what to do. Do you want to merge everyone in California?' He said, 'Give me a couple of months.' After a couple of months, he said, 'I need to talk to you.' I thought things were going badly. But to my great surprise, he said, 'I saw these guys — biologists, chemists, some engineers. I have worked for 30 years in the largest American medical companies, and it's true that I chose to come work with you on purpose, and I had an incredible pedigree. I have to tell you, in 30 years of career, I have never seen such people.' This made me extremely proud, but it also makes me understand that I am probably seeing the top 0.5% of the country in terms of people. But this shows that we have universities of great quality, polytechnics that are well-known internationally. There are fantastic centers of excellence in Italy, but as you know, the problem is the average, not the excellence. So I am a great supporter of the fact that, speaking of investments in the future with this windfall that could come to us in the coming years thanks to Europe, if we don't spend a significant part of that windfall to rethink structures and invest in new generations — education — we will do the last and definitive disservice to these generations. Because I am deeply convinced that the only thing we can truly do to allow these young people to overcome the trap of inequality is to educate them, give them the opportunity to increase their purchasing power. How do you increase purchasing power? Certainly by playing football well, but for the remaining 99.999 thousand who are not Ronaldo, by studying, going to the polytechnic, going to a good university, getting a degree, and thus earning purchasing power. So education, all the way.

Look, let me tell you an experience that DiaSorin had. One of the things I enjoy most, my president knows. It all started three years ago. I have two children, and my wife is an immunologist, and I am a chemist. As often happens when you are in love with science, our two children study economics and architecture. So, the spontaneous question at 10 p.m. in the kitchen is: why did it happen? How is it possible? The answer was: how is life science taught? It's taught by getting your hands dirty. It's impossible to fall in love with life science — which I and my wife work in — without seeing a cell. If you read about it in a book, or if you see how it works, you immediately realize it's an extraordinary story. Even this virus, SARS-CoV-2, is a extraordinary life form, with incredible mechanisms, seen purely from a biological point of view. So, after that kitchen meeting, DiaSorin launched a competition called 'Made for Science' — crazy for science. Every year we run a public competition for 1,500 Italian scientific high schools. We give them topics: for example, this year, unfortunately, we had to postpone the final, which normally takes place in June. This year's topic was health and life science. These high schools put together programs and projects they want to realize in their schools. Finally, we select eight high schools from all over Italy that come to Turin for a kind of final with a jury of truly Italian personalities who gladly participate. There is a contest, and two winners receive 70,000 euros for first place and 50,000 euros for second each year to realize this experiment in their school laboratories, allowing them to get their hands dirty. I have always asked myself: why can I only reward two? I can't replace the state; there are 1,500 scientific high schools in Italy. But what would it mean for the state to do it for all 1,500? To equip scientific high schools with laboratories where, over three years, students can experiment and fall in love with science. With a budget of perhaps a hundred million euros — which is nothing in the state budget — you could do it. So this, in my opinion, is the invitation: to the private sector — there are many companies doing wonderful things with schools — but in the coming years, if we don't seize the opportunity to invest in schools, starting from high schools and technical schools, we had an incredible tradition of technical schools that produced industrial experts who built our companies, but today they have been completely abandoned. So we must reinvest a few billions of what arrives to do those things. Because, I repeat, by doing so we do two things: we make the country modern and enrich it with thousands of young people, and we leave them the task of coming up with ideas. But at least we give them the necessary culture to be able to generate them. If one doesn't study, they can't have the ideas that transform a garage into a small company, or a small company into a larger one.

Thank you, Professor.