“Medical Affairs has a Central Role to Play in Building Trust Between Doctors and Healthcare Stakeholders and the Pharmaceutical Industry”

Cesar Sanz Rodriguez, Associate Vice President, Medical Affairs Lead Mid-Europe (MER), Eastern Europe, Middle East & Africa (EEMEA) Regions, MSD

Interviewed by James Coker  |  @EMJJamesCoker

Cesar Sanz Rodriguez is Associate Vice President, Medical Affairs Lead Mid-Europe (MER), Eastern Europe, Middle East & Africa (EEMEA) Regions, MSD. He spoke to us about his progression into medical affairs from a clinical background, the changing role of medical affairs in the pharma industry, and the exciting advances currently taking place in cancer treatment.

Q: What were the main reasons you decided to join the pharma industry following your earlier career practicing onco-haematology?

A: During my training as a specialist in onco-haematology, I trained at the Hospital Universitario de la Princesa in Madrid, which had one of the largest stem cell transplant units in Spain at the time and was very geared towards scientific progress. That nurtured my interest around drug development and made me believe that, as a physician, I could take my ability to help patients to a different level by becoming actively involved in clinical research.

Coming from a very strong academic background, I was unsure what it would be like to conduct clinical research in a for-profit environment. I therefore decided to enrol in a management degree to better understand how pharmaceutical companies operate. From there, I joined MSD, taking a combined role in medical affairs and clinical research. I think of my career in industry as fulfilling and aligned to what I have always felt is my personal mission and vision as a physician.

Q: To what extent has the world of medical affairs evolved during your career working in industry?

A: Very significantly. Over the last 20 years, and particularly in the last decade, pharmaceutical companies have been confronting new challenges, which have led to a re-thinking of the skills they require. Today, there are limitations on interactions between physicians and industry. Yet, in recent years, we have seen how companies increasingly need to understand the science around their products and its impact on clinical practice; they must master the methodologies used in health economics and outcomes research (HEOR)-based market access processes and adapt to the rapid digitalisation of healthcare.

In this context, medical affairs aims to enable scientific exchange by meeting the clinical needs of healthcare professionals and patients and helping compound development, scientific communications, and improved patient care through all the insights gathered.

Q: In what ways do medical affairs strategies and operations employed by MSD in the MER & EEMEA regions differ to other regions of the world?

A: The MER & EEMEA regions at MSD include all the mid and small-size European countries, Russia, the Middle East, and all of Africa. Countries may be classified into 3 basic groups:

1) High-income Western European countries with well-developed healthcare systems providing universal coverage. The main challenge around policy and market access is connected to the funding of a sustainable healthcare system. From a scientific standpoint, these countries make significant investments in R&D and have strong research infrastructures.

2) Countries with GDPs lower than the EU average but experiencing high levels of growth. Healthcare spend is below the EU average, meaning there are higher mortality rates and a clear gender gap compared with Western European countries. These countries are striving for improved health status, which drives important discussions around health system reforms. Access to innovation is often challenging due to affordability issues.

3) Countries with low income and/or less stable environments. These countries often have no universal healthcare systems and spending on health is very low, leading to major healthcare inequalities and lower life expectancy. Health ministries often lack long-term agendas and there are challenges around affordability and sustainability.

As you can imagine, there is no ‘one size fits all’ approach. Our ultimate goal is to advance patient care by facilitating access to innovation and its translation into real clinical practice.

Q: As someone with expertise in onco-haematology, could you tell us what excites you most about the future treatments in this field?

A: I believe we are living through a revolution in cancer care. The arrival of immuno-oncology therapeutics will likely represent a change in the paradigm of cancer treatment. As a haematologist, this is very interesting to watch. However, it remains challenging to manage severe immune complications, such as graft-versus-host disease. Other approaches to immunotherapy have, to date, provided limited clinical benefit.

The advent of cancer-targeting immunotherapies has opened a new horizon in therapy. MSD is making significant scientific and clinical contributions to this field and we have been excited to observe the results of many clinical trials across multiple tumour types. Obviously, there is plenty for the medical community to still understand around how these and other checkpoint inhibitors work, which patients may benefit most, as well as how they will be used in combination with other anti-cancer agents. Nevertheless, current evidence indicates that cancer-targeting immunotherapies are here to revolutionise cancer treatment.

Q: What are the biggest challenges in medical affairs in the pharma industry in your view?

A: Firstly, medical affairs will be key in enabling pharmaceutical companies to explain what new treatments mean to the patients, in terms of clinical effectiveness, adherence, and quality of life, and also beyond the patient, exploring what pharmaceutical innovations mean to physicians and healthcare systems. The medical affairs organisations that can effectively communicate medical and scientific data, while providing real-world context for such data, will truly provide value to the clinical and scientific community.

Medical affairs should also play a critical role in identifying and collecting clinical insights that facilitate corporate strategies. Some of those insights will come from data generation and others will come from scientific exchange activities and analytics applied to medical and product information requests.

Finally, I believe medical affairs has a central role to play in building trust with healthcare stakeholders. Medical Science Liaisons and medical advisors must be well informed, ask the right questions, listen to the answers, and contribute insights. Medical affairs organisations need to contribute unbiased, peer-to-peer scientific exchange.

Q: Finally, who or what inside or outside the industry inspires you and helps you shape your ability to bring innovative, lifechanging solutions to patients?

A: My daily inspiration comes from the idea that medical affairs can make meaningful contributions to improving public healthcare by putting patients first. Innovative and lifechanging solutions come from understanding the disease, what different treatment options can offer, the gaps around optimisation of patient care in a given healthcare system, what challenges patients face in being compliant with their medicine, and how healthcare professionals make treatment decisions. Medical affairs is naturally positioned to help in that process.

Keeping the patient at the centre is vital. Many years ago, when I was interviewing for a position at MSD, I was inspired by a quote I read while sitting in a waiting room. The quote, from 1950, was extracted from a talk by George W. Merck, President and Chairman of the company at the time. He said: “We try to remember that medicine is for the patient. We try never to forget that medicine is for the people. It is not for the profits. The profits follow, and if we have remembered that, they have never failed to appear. The better we have remembered it, the larger they have been.” I found this quote very inspiring and it helped me reconcile my personal mission. Almost 20 years later, I still see this quote as very relevant.