‘Science, Sustainability Are On Top Of Our Mind’: Dr Sanjeev Panchal of AstraZeneca On Improving Supply Chain

AstraZeneca became a household name during the pandemic, delivering the Covishield vaccine to millions in India. Despite their primary focus being oncology, cardiovascular, renal, and rare diseases at the time, the company pivoted to vaccines in collaboration with Oxford University and global partners, driven by its commitment to science and putting patients first.

Sanjeev Panchal, country president and managing director of AstraZeneca in India told The Core that among the foremost learnings from the pandemic were forming partnerships, the importance of early screening and the supply chain.

“The whole supply chain, can we make it more sustainable? Because these things can come in future,” Panchal said.

Beyond its success with the Covid-19 vaccine, AstraZeneca is also making strides in cancer care by integrating medicines with advanced technology. Panchal highlighted the company’s focus on early lung cancer screening and diagnosis.

AstraZeneca's global ambition is to eliminate lung cancer as a cause of death by 2030. To bring this vision to India, the company is leveraging artificial intelligence technology and X-ray imaging.

“In India, we are using technology, which is AI, and we are using x-ray, providing AI, partnering with the AI company and with the government to ensure that we understand early lung cancer and not detect at late stage”

By partnering with AI companies and the government, AstraZeneca aims to enable early detection of lung cancer, shifting focus from late-stage diagnosis to identifying the disease at its earliest stages.

In this week’s The Core Report: Weekend Edition Panchal also spoke about the sustainability of supply chains, why early detection of diseases is important and improving access to medicine.

Here are edited excerpts from the interview:

Many of us are going to doctors, particularly those who are maybe in the northern part of India, including Mumbai, because of some sort of respiratory problem, cough, cold, all of that. I think it is mostly linked to pollution, but there could be other reasons as well. But doctors are therefore aware of this, and they know that people are suffering from this. They prescribe medicines that are fairly consistent in keeping with this time, which is seasonal. But for someone who is heading a pharmaceutical company, I'm assuming your outlook is a little different. You're not looking seasonal, you're looking long-term. As you look at your dashboard, particularly in India right now, what do you see, and what are the kind of issues that you're facing, confronting, and picking up?

I think we are a focus-driven organisation, so we always look for how to deliver life-changing medicine, and bring the science to patient as fast as possible. We’re also driven by values. We're really inspired by values for saying, when we follow science, then we put patient first.

As you rightly said, there are different diseases happening in the country. I was in Delhi and in Bombay, meeting doctors who are treating cancers, who are treating respiratory diseases. But we are very clear that when we are participating in any country, our purpose is clear — how do we reduce the disease burden, and how do we address the unmet needs with the science which we have. I think that has always been our outlook.

When we look back, let's say for this year, we're looking at how much access we have brought to these medicines into our country, and what else we can do in the next year. So, overall, that's what the first thing which we look for.

The second part, in addition to science, I also look for sustainability. How have we done in terms of a sustainable society, both access for our medicine, but at the same time, for the planet. These two things, science and sustainability, are always at the top of our mind. When you look behind and when we even look forward and reducing the burden of disease and addressing the unmet need with the science. That's how we look at it.

I'll come to oncology in a bit. Let's talk about respiratory for a moment. I know that you've also been launching products, including for chronic obstructive pulmonary disease, and that's part of your portfolio, but you launched something recently. What are you seeing there, including in countries like India right now, which calls for, let's say, greater R&D, more products, more response to patient needs?

One, just to give you a big background about our portfolio, our portfolio of AstraZeneca globally, and also in India's focus on oncology, which we'll talk about later. We have biopharmaceuticals. In biopharmaceuticals, we have two-three arms, rather. One is focussing on cardiovascular metabolism. The second is focussing on respiratory disease. The third is focussing on vaccines and immune therapies. Another one is respiratory disease. All five therapeutic areas, broadly into oncology, biopharmaceutical, and rare disease. That's where I've been focussing.

In respiratory, what we are trying to ensure we bring innovative medicines. We announced a few launches recently. One was specifically for RSV (respiratory syncytial virus), which is for babies who are preterm, and therefore, their lungs are not well developed, and they can cause infection of respiratory virus. And we have recently announced there is no such treatment for it. This is not a vaccine. This is monoclonal antibodies for the babies who are born who can't say, but we are seeing their lungs are not well developed, and we need to ensure that we bring that science to the small babies who are the future generation for our country. I think that's very advanced science for that generation. On the other side, we recently announced a launch of, soon bringing a launch of a product for COPD, and there we see a huge mortality as a risk, both for smokers as well, and we see a lot of patients getting hospitalised.

We are trying to bring those advanced technology, and we're launching soon. We announced in the stock exchange also that we'll be launching in the month of January. So, we are addressing that part of unmet needs.

You can see two ends, and a preterm babies who can get affected very early, and the patients who are actually getting to hospitalisation because of exacerbation and at a risk of mortality, and bring a high-end science of global to those type of patients. So, that's part of bringing innovation and respiratory. The other thing which you would have seen earlier was that one of our products, we wanted to improve access for our medicines, which are already there in the market.

We had this product, and we partnered with another company to ensure that there we have already shaped the market. We want to further improve the access for our medication. We are partnering with the companies to ensure the reach of that product becomes even better, and we improve the access.

You can keep focussing on science to our specialists. At the same time, we are also improving access for our medications in the respiratory disease, which I'm specifically talking about here.

Right, and I'm going to ask you about the mix between manufacturing, distribution, partnerships, and many multinationals, including yourself. I've sort of adopted a similar strategy there in recent years, even as you simultaneously step up your R&D in India, but I'll come to that in a second. The biggest recall for AstraZeneca, obviously, in the last few years has been Covid, and you did mention monoclonal antibodies. Tell us about what is life after Covid been like?

One of the things is that Covid, we all have been impacted in some form the other, not directly maybe, but overall, we really take pride in the way we brought the Covid medication into, not for medics, but vaccine into the whole world. We are not a vaccine company at that point of time. We are an oncology, CVRM, and rare disease company, but we were inspired by our purpose, putting the patient first, followed science, and do partnerships, and we did with Oxford, and we did across the world with the different countries, manufacturing, work with different partners, of course, with the government organisation to ensure that vaccine reaches across the part of the world.

We're very proud that we delivered 3 billion doses of vaccines across the world, and at the same time, we had some independent data from AIRfinity, which was published in the Imperial College of London Lancet in June, which showed that we actually saved more than 6 million lives between 8 December 2020 to 8 December 2021. So, the idea was that this was not possible until and unless we've collaborated. That clearly showed that if we come together in the place where the health system is tested really hard at that point of time, we really feel proud of what we have done.

At the same time, if you see the partnership, at some places, we directly supply to the government. In India, we're a real example of science and technology transfer, which happened to Serum Institute of India to ensure that we bring these doses not only for India, for our country, but also to low and middle-income countries. And there, you would see that we were very clear that we want to have an equitable access of the vaccine, and we delivered it at no cost.

So, this gives us pride as a company. So, we are doing something for the world at a time where collaboration would have made the biggest difference. We might not be the vaccine company at that point of time, but we still partnered with Oxford to ensure we deliver equitable access of our vaccine at no profit.

And we also ensured we use different models of partnership, and SAE is one of the models which we did for our company.

From what you're saying, I can see that partnership itself is one of the residual, let's say, benefits of the Covid period. The ability to work with companies across the spectrum, research organisations, and so on at a much accelerated level, which I'm sure you otherwise do. What are the other residual benefits of the Covid-19 pandemic, including in innovation and research and development that have stayed on within the company and maybe the industry as well?

Yes. So, two parts. One is what we learned.

We learned that partnership is critical, and how do we extend that partnership into all the things which we are doing, whether we are in oncology. We really believe one of the, and as you're saying that what we also, let me say one more, two, three things here. So, one is that early prevention is very important.

You know, you would have seen that the amount of mortality which happened in COVID were the patients who had comorbidities, right? And those of the patients, the science told us that if you have comorbidities, you are probably immunocompromised for that section. And you would know the immunocompromised patients were the ones who were more impacted for Covid.

At the same time, they were healthy people as well. So, what was important was that can we do early screening and understand if patients have, you know, any diseases which they should help become a major centre of that. So, one of the things which we are doing is to focus on early screening and diagnosis in lung cancer, for example.

Our ambition is to eliminate lung cancer as a cause of death, a global ambition in 2030. So, what we are doing, bringing that in India, and we are using technology, which is AI, and we are using x-ray, providing AI, partnering with the AI company and with the government to ensure that we understand early lung cancer and not detect at late stage, can we do it early. So, that is one part of our early doing things.

Early screening is very, very important to making health system resilient. The second piece we realised is that how do we partner with the government. So, when we were doing the policy changes which are happening across, how do we partner?

So, we can't achieve everything alone. So, we are partnering with Kannada government, we are partnering with the Goa government to ensure that we bring those early screening in the public system to reduce the disease burden. So, partnership became a very important part of our collaboration.

And third is, I think the impact on the planet and sustainability was very, very important. So, the climate change which is happening and how AstraZeneca is really taking a lead in terms of becoming carbon neutral and net zero. And you would have heard recently that we announced in India that we are planting 60 million trees to reduce decarbonise.

At the same time, the whole supply chain, can we make it more sustainable? Because these things can come in future. So, what we have done is, one is that we did Covid vaccine.

We have this learning, three learnings which we are applying. And recently, last week, we announced a partnership, India partnership for health system sustainability, resilience and sustainability. So, that is a PHSSR report, which was done in more than 20 countries.

We work with the London School of Economics and the government to bring that report. We just launched on the last week and you would hear more about it to ensure that if we have such future situation, is our system resilient enough and what changes should be made in future. So, we are even more future ready.

A lot of learning for us and we have really implemented these learnings, what we are doing today, but also the reports which we are trying to bring for the future.

That's illustrative. And Covid, of course, was sudden. It came in early 2020, devastated the world and it also started receding in about a year's time. Something like cancer is an ongoing challenge at various levels and you as a company are obviously working on it again at various levels. Tell us about what are the kind of issues or specific cancer conditions that you're working on right now and how promising are some of the medicines that you've launched including right now in recent weeks and what are the kind of cancer conditions again that they are likely to address or cure?

Overall our cancer pipeline is strong. So, we started with lung cancer, especially let's say India, we've launched our first product in lung cancer.

And I talk about how we are expanding our learning and the science of cancer and how we can address the drivers of those diseases, both in terms of understanding the science and how do we address the drivers of the disease. So, one is we are in lung cancer. We recently launched also a new medicine in breast cancer.

We also launched a new indication for GI (gastroinstestinal) cancer and we also have GYN and GU (genitourinary) cancer. So, we're looking at different tumour types. We have something for haematology, a cancer as well, but mostly solid tumours is something which we have these therapy areas.

Now, what is evolving? The science is so fast evolving that within lung cancer, you have different stages. So, you have stage four cancer and stage three cancer.

What we are doing is we are first learning the types of cancer and we are also looking at how do we treat those cancer early. So, on one side, we are trying to detect early. We are treating the late stage cancers, for example, lung cancer and then we have breast cancer in which there's an expression of HER2 and HER2 low, HR positive.

We're learning different mechanism in terms of cancer and to treat that, it's basically precision medicine if you would see that the right drug for right patient at the right time. So, we have antibody drug conjugates is what you would see. We're looking at how do we bring those new modalities and which is actually bringing a revolution of ADCs over chemotherapies there.

Now, we have antibody drug conjugates and then tomorrow we will have mechanism which is cell therapies, a radioconjugate. So, new platforms are also emerging to treat cancer.

And the kinds of cancer you talked about, you talked about gastrointestinal, you talked about lungs. Now, what is the prevalence and you talked about breast. You started with that. What is the prevalence in India between these at least in the way you are responding to them with medicines versus in India as well as versus the rest of the world?

For example, the GI cancer is quite high overall in Asia if you look at the gastrointestinal cancer. Gastrointestinal cancer can have the liver cancer, the bilary tract cancer. It's a different form of cancers than GI.

The prevalence is very high in Asia and also high in India. Lung cancer, again, high in India. You will see lung cancer both for smokers and even we are seeing in non-smokers. Breast cancer is high. So, you will have some cancers are high in prevalence and some cancers that are high in mortality. So, the prevalence and being the population which is huge in India as you could see, we want to ensure that we are addressing those unmet need by bringing those both early screening at one stage and at the same time can we bring those innovative medicine faster for our country.

I think that's what we are trying to do and therefore you would see the launch we are doing in cancer is much more faster versus previous years.

Right and you talked about lung cancer amongst non-smokers. Is that a new trend and what in your understanding is causing it?

It's both. The science is evolving. We are seeing in smokers and non-smokers as well and as the science is evolving. What we understand is that we would need to address both. It can't be only one. So, that's the evolving science as we go ahead but cancer is at the end of the day.

The cancers for example COPD is very smoking which you're talking respiratory and this thing that smoking can all only impact lung and we can also see is it in men and women. So, we are understanding a science better, the modalities better but at the end of the day, you are addressing the disease causing that and addressing the different types.

Let me flip the question around. So, from your portfolio of drugs, what's the biggest selling cancer drug?

I won't say exactly that but for us

In percentage or proportion.

Yeah, I think the lung cancer drug is the biggest as of now selling which has been there in the market for more than 70 years and I won't take the brand name but you can see the report but so lung cancer drug is the biggest drug which is selling for us and it has been in the market for six to seven years and some for a breast cancer drug is like at the one year to be into the market.

So, you're saying your top cancer drugs are lung and breast in that order?

Yes, so lung and even lung you have. So, for example another drug which we have can also be used for GI and also for lung. So, now same drug and also have more indication but put together a portfolio of lung is the biggest portfolio.

And the overall AstraZeneca India portfolio, what would be your top three drugs?

Our top three drug will be the lung drug which is for example Tegviso which is already in the stock exchange available. Tegviso would be the flagship product for us which is helping to meet unmet need in the cancer and then we also have a drug in biopharmaceutical which is a heart attack medication for us. That's number two for us overall in the biopharmaceutical space and then we have other cancer drugs which are coming up especially breast cancer and GI cancer.

You talked about early screening in a couple of contexts and including in the context of what we've taken away from Covid. Tell us about early screening in cancer. How does that work and how could that work?

Early screening, the basic premise is that if we can detect cancer early there are higher chances of both survival and if it is very early there are chances of cure. But the challenge today is that it's more than 70 percent of the patients, at least let's take lung cancer example, are being detected at stage four which is too late and the survival rates reduces, the mortality chance reduces. And across the world what we are trying to do is can we do a stage shift in terms of how do we detect cancer.

If we can do stage shift of three to four to three three to two to one and even detect much much earlier for example in India the amount of x-rays which are done both for a regular checkup and even for employment you know a person would go for x-rays. What we are trying to do is that in work in private setting but mostly also in the partnership with the government where you have a health system much more established we are saying that all the x-rays for example if they can be screened by AI technology which we are partnering with Cura AI to see if we can find detect nodules in that x-ray and if it detect nodules we can then go for low dose CT scan and find out if this patient could be or a person not still a patient could be at a risk of cancer. Which means we are not detecting probably at stage four we are probably detecting at very early. That's what we are trying to drive.

We used to say we have been half a million scans already in India and we have detected 1857 nodules up till now. So that's been the progress which we have made over an year, past year.

And that's interesting so you're saying you're essentially scanning x-rays which were not taken with the objective of detecting cancer. They were taken for something else.

Yes, they're taking for something else and they will look at 29 modalities in that x-ray and if they find nodules because AI technology is very powerful right. Sometimes you might not see very specifically for that person but AI can see and say okay if this is this would be probably cancer then we can go to the next step and take the next step forward. So this is very very helpful both for and we are not doing this in India also we are doing in other parts of the country and this is very helpful to drive our early screening and diagnosis.

Right and you said you're working with cure.ai in India?

Yes, yes, yes.

Okay.

So cure.ai AstraZeneca, so we do more awareness. Cure.ai will establish the mechanism and so we have in Goa and in Karnataka all the public hospitals will have that mechanism to detect you know the lung modalities that is AI.

Right, okay. So let me come back to the manufacturing process overall and how you're laid out in India today. So you've been increasing your presence on the R&D front and including in global IT but reducing in manufacturing. Now it's a trend I know several other multinationals are following. Tell us about what is driving it in your case.

As I said, one thing is absolutely clear that we want to bring, our aspiration is to pioneer in science. How do we bring pioneering science in India as fast as possible? Actually we are saying we want to lead in specialist disease area as an specialist disease area because science is so strong and so compelling that we want to bring this faster but also to specialists and transform patient outcome.

In India we have been for 45 years. This year we are celebrating 45 years as a company which is a great recognition that we have been strengthening our footprint. So from starting a factory in 1979 to up till what year.

In over the 45 years we have listed two entities now. One is a listed entity which I head and then you have another entity which is the Pharma India Limited and that has already been 10 years. So in listed entity we have manufacturing, we have a commercial team for example and also for SMM which is doing local clinical trials in India for understanding unmet need of our country.

The other side is GBS which is R&D and not the labs but from the back end side we are doing IEP services. We are also now just from an IEP services we have actually increased our presence to India and also for the globe. So this is what we are doing.

So overall we are strengthening our presence in India and of course we have done a strategic review globally for our factory and we believe that this we will continue to strengthen in these spaces innovative medicine faster and focus on building the innovation and technology hub as in India and use local digital and talent for four countries. So we have four thousand plus people overall in the country.

I can see that shift and so you've said that when you downscale Bengaluru and you said that you would be importing directly because that's faster. Tell us about the manufacturing process. Is this a sort of global shift that's happening as well or is it more to do with countries like India where clearly you're creating more R&D assets versus manufacturing assets.

I think it's more about the strategic review and then we have strategic sites for manufacturing across the world so and you know it's more of a special product which we are bringing into the country but I would still again say that India is an important part and the unwavering support the global is giving and I would say in three parts. One is and I'm very clear about three parts which we will be supporting and strengthening our footprint so one is bringing innovative medicine faster and our pipeline is like you know almost 20 assets globally coming by 2030. 20 new assets so we have a huge you know responsibility to bring that into India.

The second part is the IT component innovation and technology component which we are bringing into and you would see the invested 30 million dollars which is 250 crores and adding 1300 more people there and a third part is sustainability. So if you see our investment into the planting the trees in India. India was selected as one of the country amongst the five continents and five in across the world and we are planting 60 million trees in our 27 hectares of land helping 20,000 plus farmers to ensure that we are focussing on the planet.

So overall our narrative about people society and planet and strengthening footprint in India at an overall scheme from global is very very strong in that sense.

You mentioned earlier about improving access to medicine and that being one trust area for you here and therefore the partnerships which again is something that I've seen with other companies as well. Tell us about how that is working out. I mean why does a country like India need so many partnerships and what is unique in a way if there is about India that it you know the entire sort of distribution part has to be structured or marketing part as well has to be structured a little differently from elsewhere.

Yes overall see for let me give you example both are multinational specifically for India for AstraZenenca and India our pipeline is very strong and pipeline is not only for many very specific. So we have oncology pipeline which is strong, we have biopharmaceutical pipeline which is strong and we have rare disease pipeline which is strong. So for each of these level you would see a partnership is important.

Why because for example early screening because we want to reduce the disease burden and help patient get you know detected early you partner with the government or local partners like AI for example to ensure we do early screening. On rare disease for example we work with an ORDI you know which is the rare disease and we have we have patient advocacy then we have to work with the government that more disease are listed into the national policy on rare disease. So that's a different level of partnership.

When you're talking about biopharmaceuticals so for example are one of our drugs which have been into the market we believe that we want to increase the reach of that product and while you focus on bringing innovative medicine into the country as one part you also need to ensure how to be access of those medication. So it's two things which we are doing at the same time. So while we are really focussing on innovative medicine we need clinical trials for that, we need regulatory submission for it right, we need shape the market, shape the science and we are extremely focused on bringing that back.

At the same time we also want to ensure the drugs which can now go to a higher reach we partner with Indian companies for example we have done with in other case which is helping us to reach a more number of number of patients. So we are doing this in parallel focussing innovative medicine but wherever we believe we want to improve reach we do that. We are doing early screening partnership you know with let's say academia with public-private partnership let's put together PPP which we are doing.

At the same time we are also doing to ensure that we bring more disease into the listing for realist. That's how been our approach innovative medicine and improve access of our medication.

Right and as you look ahead are there any marquee projects that you are working on or tracking more closely in India in in the next let's say six months to a year that you can talk about?

Yes so one is I would say the early screening part will be very big for us. The other part is that where we are seeing a higher disease burden for example of course in lung cancer for that matter but also a rare disease is something which we are working we are bringing where disease maybe we have just launched one medication we also have a pipeline for it. Rare disease is something which we need to work very hard so there are 7000 rare disease and we don't have we don't have you know a treatment for all.

So that's something which we want to work on. The other part which I spoke about was the PHSSR which is about you know partnership or health system sustainability and resilience which we are working on. So these are focused outside of bringing innovative medicines.

On one side the team works on bringing innovative medicine at the same time we are working on how do we partner to ensure that we can improve access of early screening or access to disease listing into the national policy so that more patients can get a benefit out of it. So these are projects which we are broadly working on apart from bringing innovative that takes a lot of time to bring innovative medicine and the whole cross-functional team you know works together there.

Right and we're running out of time so me ask you one or two quick questions. You touched upon AI in a few places and of course the work that you're doing with cure.ai and that's interesting. So are there any other problems that you're trying to solve using AI or this kind of AI which is you talked about scanning x-rays but is there anything else on the horizon there?

So AI for sure is the future and both we want to ensure that AI is part of our sustainability strategy but also as the way we do the business both responsibly AI is very very important. So I think as a part of our strategy data digital AI is important. So you would see a big component of that in our GCC which is global business services.

That's where is a huge investment but globally we have AB Nova in 2023. We launched AB Nova which is the health technology that accelerating the science innovation. We're also doing the UNIFI which is a clinical trial platform to world the 70% of our data it allows 70% of our data to collect it at home versus people going to the trial site.

So we are using that technology both in India. So India, Bengaluru and Chennai are now centres for the group. The amount of technology investment which we are doing and globally we are looking at different ways of doing better clinical trials and also how do we improve the health outcomes predicting success early with the clinical trials.

So clinical trial is one, technology is one, innovation is one which we are trying to do and Kira gave an example how do we do early screening and diagnosis.

Sanjeev, it's been a pleasure speaking to you but let me not go away without one last question. How does a CEO of a pharma company stay healthy?

I have always made a point that I walk every day 10,000 steps at least. Whatever time I need to ensure that the walking is very important, prioritisation is very important. So health should be prioritised.

I really believe that healthy eating is not always easy to do that because you travel a lot but walking and healthy eating and prioritising health is very important. I really believe in that personally and also ensure that every of our employees and our families who are working for them together ensure that we remain healthy. For me walking is every day 10,000 steps is a minimum standard to ensure that I remain healthy, have good sleep, you know spend fine time to sleep well which is very very important because that regenerates you a lot and prioritise the whole day to ensure that you are focussing on work, family and also health together.

That's how has been my personal opinion and that's how I take care of myself so that we can contribute. The healthier we are, the better we can do for the patients, for the company and for our country. So health becomes a minimum standard to deliver overall for what we want to do for the country and the company and their employees.

Sanjeev, that's a wonderful note to end on. Thank you so much for joining me.

Thank you. Thank you. Thank you very much.