"Executing differently takes courage" (2/5) - The Chinese pharma ecosystem : balancing systemic scale and constant reinvention

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I've placed Guillaume Delmotte in the second position of this series on execution because he brings something that the other episodes simply don't have.

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To me,

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it's a systemic reading of execution.

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In China,

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execution isn't an individual decision.

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It's a mode of operation for the state.

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It's very centralized in its objectives and very decentralized in its application.

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And it's permanent in the testing.

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And what this model reveals has something fundamental to it.

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It's that large-scale execution is only possible when partnerships are built for the long term and when we accept to constantly reinvent how we reach the goal.

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So after Vincent,

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who spoke to us about staying the course,

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Guillaume shows us what happens when constant adaptation becomes the course itself.

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So in an uncertain context,

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they might be stronger than us.

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It's a continual reinvention of the solution.

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The solution isn't unique,

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it's multiple and must adapt to the reality of the context.

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Asia is context.

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Context is the most important thing.

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So what they've created is digitized care pathways for all minor pathologies,

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the virtual hospitals that are certified with doctors who are connected.

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So there are players who have virtual hospital licenses,

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in fact,

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where it's as if you were going through a whole hospital,

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a care pathway connected to pharmacies.

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Plus,

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since they have the data,

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they plug in air to go even faster.

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So they have a playground where they play around with a lot of data.

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What is the technological ecosystem?

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of services,

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of companies already integrated into the chain and the flow of patient management.

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Instead of doing a partnership,

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we're trying to create an ecosystem.

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Hello,

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everyone.

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Welcome to this new episode of PharmaMinds.

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Today,

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I'm very happy to be here with Guillaume Delmotte.

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Hello,

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Guillaume.

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Hello.

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Thanks for having me,

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Natalie.

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Guillaume,

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why are you here today?

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Because with a very international background,

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20 years at Ibsen,

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including Europe,

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Russia,

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and China.

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And it's precisely this last stage that interests me most particularly.

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We're going to talk about China today.

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The goal of the conversation is to get a very detailed map of what's happening in China today from someone who's just back,

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who's just unpacked in Paris.

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Exactly.

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And who's going to tell us what he saw?

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I think he's seen a bit of the future of pharma.

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He's seen smart hospitals.

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He's seen how AI can transform a society.

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and also how pharma gets on board when it's in a society that's transforming.

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That's basically what I want to find out.

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Of course,

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around that,

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we're going to have a very interesting leadership journey,

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if that's okay with you.

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That works for me.

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I've only been a witness to what I've seen.

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I don't know everything about China,

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but it's true that there are some quite interesting things for us to adopt or at least rethink probably in our societies and in this pharma world.

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Yeah.

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Yeah.

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We can see that it's an emerging market.

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China is still the second largest pharmaceutical market in the world with its own specificities.

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Over the last 20 years,

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there's been a technological leap,

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an economic leap in this country.

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It's worth taking a look at.

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And then we were talking about Shanghai as the New York of Asia.

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So we said,

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well,

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why not?

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Let's go for it.

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Let's go to China.

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What year is this right before COVID?

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That was November 2020.

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2020,

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yeah.

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The start of COVID.

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So I was appointed in January 2021.

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I've learned to take a step back.

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And actually for China,

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regarding this experience,

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you have to take a step back.

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They're used to navigating.

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There's also Guangxi,

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which is part of their daily work.

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Guangxi is the network.

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So there's the network,

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first,

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second,

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and so on.

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So they navigate the network.

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So the solution sometimes isn't technical.

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Okay.

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It's going to be a bit of relationship building that will definitely help to grease the wheels.

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So it's a continual reinvention of the solution.

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So that means there are many possible solutions.

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Exactly.

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And that are also easily accessible to everyone.

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Exactly.

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And then sometimes they don't imagine they can succeed at things.

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And then if we launch them,

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if we launch into a project that might be totally iconoclastic in a way,

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they'll go for it full tilt without asking questions.

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Yeah,

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there's not too much reluctance.

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Yeah.

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Exactly.

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Even breaking down the barriers they had in their minds.

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Oh,

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yes.

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Because the strength of this vision is that the solution isn't unique,

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it's multiple,

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and must adapt to the reality of the context.

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Right,

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right.

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You see?

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Yeah,

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they're very used to...

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Fluidity.

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Okay,

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yeah,

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reinterpreting the context every time and clearing everything.

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Well,

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clean slate,

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blank page,

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and start over.

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Asia is context.

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Context is the most important thing.

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So they're strong right now then?

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So in an uncertain context,

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they might be stronger than us.

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They're confident.

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But sometimes they can be paralyzed when things get circular as they reinvent a solution.

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Yes,

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they take their time.

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Optimization in progress is sometimes slowed down,

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meaning we start everything from scratch,

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even though...

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Yeah,

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do you maybe have an example that you could possibly give me?

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When you say sometimes something iconoclastic,

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well,

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we can try them on that.

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And then after a moment,

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they finally say,

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OK,

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and they jump.

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Well,

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I've had,

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for example,

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pricing is highly regulated in China with progression factors set by law.

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So a state rule written down.

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And one day,

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sort of jokingly,

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I said to them,

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what if we broke free from that?

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What is it?

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What factors are linked?

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We had one,

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three and six month formulations.

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So to simplify,

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let's say one,

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the three is three times the one.

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And the six isn't three times,

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it's 2.80.

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So it's a rule we have that comes from I don't know where.

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And so we wanted to launch a product in six months.

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We had to negotiate the price in 31 provinces.

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So it's a lot of work.

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And we were moving on to preparing for price access and so on.

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And I told them,

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what if we broke free from this rule?

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What if we invented a new one?

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Based,

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of course,

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on real world evidence data,

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health economics or whatever,

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to demonstrate the value offered over time.

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And so,

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well,

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once they got started,

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well,

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they managed to break that rule.

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Two or three accepted,

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and then through the network,

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they worked on the other networks.

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So it kind of changed the local law a bit then.

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It changed the local law,

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and especially now in tenders,

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it allowed us to strengthen the product value and not get caught up in the price drops of other formulations.

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Yeah,

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yeah.

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Okay,

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so you,

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yeah,

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they invented a kind of new value model,

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a valuation model.

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We cut the link between one,

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three,

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and six.

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Yeah,

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yeah,

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by offering a different value.

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Exactly.

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At least a different interpretation.

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A different story.

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Yeah.

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A way,

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a vision.

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So the official...

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A different perspective.

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Yeah.

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Okay.

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Interpreted the product's value,

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but outside the traditional scope.

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They agreed to look at that.

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Okay.

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And that's a continuous job of,

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well,

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negotiation,

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influence,

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reflection and interaction.

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Always ongoing.

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So that means it's very close.

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Does it mean politicians are very close to,

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well,

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agree to be very close to...

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industry players to have that close contact?

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Or how does it work?

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Well,

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what you have to see is that if I summarize China,

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to simplify it for everyone,

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China is like Europe in a way regarding a product cycle.

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You get a marketing authorization at the European level.

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In China,

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it's the same.

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You'll get a registration,

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so a marketing authorization for the market.

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And then once you've got the marketing authorization at the European level,

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you cascade it to each European country.

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which will have its own pricing rules and reimbursement rules.

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Well,

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it's the same in China.

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The only difference is that the price will be negotiated just once at the central level.

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Okay,

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it's like a European price?

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Exactly.

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We have a European price at the Chinese level.

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But after that,

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everything becomes the country's mechanics of interpretation and execution,

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meaning in each province we have to renegotiate reimbursement.

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a product status relative to the province's health policies.

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Right,

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right.

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Oh,

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yes.

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Okay.

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Getting the product into a tender.

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So on a marketing platform,

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it's like another country you have to plug into to get the trucks in.

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Then you have to get the product into the hospital level.

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Those are listings,

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which doesn't happen every day with,

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I'd say,

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a set number of products that can be present.

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So you have to bring one product in and practically push another one out.

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Really?

281
00:08:17.579 --> 00:08:17.799
Okay.

282
00:08:18.179 --> 00:08:18.519
Exactly.

283
00:08:19.059 --> 00:08:20.220
And so all of that multiplies.

284
00:08:20.580 --> 00:08:21.460
So this whole chain...

285
00:08:21.880 --> 00:08:25.343
means that in every province we had local market access teams,

286
00:08:25.443 --> 00:08:25.984
medical teams,

287
00:08:25.985 --> 00:08:26.364
of course,

288
00:08:26.584 --> 00:08:27.465
and commercial teams.

289
00:08:28.266 --> 00:08:28.826
By commercial,

290
00:08:28.966 --> 00:08:29.987
I mean distributors,

291
00:08:30.127 --> 00:08:31.128
distributor management,

292
00:08:31.388 --> 00:08:32.289
supply logistics,

293
00:08:32.409 --> 00:08:33.670
marketing teams practically,

294
00:08:33.930 --> 00:08:35.051
and of course sales teams.

295
00:08:35.792 --> 00:08:37.994
So we had many companies in each of the,

296
00:08:38.534 --> 00:08:39.815
practically every single province.

297
00:08:40.116 --> 00:08:40.356
Right,

298
00:08:40.616 --> 00:08:40.816
right.

299
00:08:41.196 --> 00:08:42.337
And then a province,

300
00:08:42.638 --> 00:08:44.920
just so people can really grasp what that actually means,

301
00:08:45.360 --> 00:08:47.862
so China is the same size geographically as Europe,

302
00:08:48.002 --> 00:08:49.864
but you have four times as many inhabitants.

303
00:08:51.460 --> 00:08:56.423
Province on average is 40 million inhabitants up to 180 million inhabitants.

304
00:08:56.964 --> 00:08:57.604
So it's a very,

305
00:08:57.704 --> 00:08:58.525
very big country.

306
00:08:58.785 --> 00:09:00.706
And a GDP that can be equivalent to Belgium.

307
00:09:01.707 --> 00:09:04.229
Shanghai has the GDP of Belgium all by itself,

308
00:09:04.269 --> 00:09:06.070
and it's 25 million inhabitants.

309
00:09:06.350 --> 00:09:08.191
So it's about understanding countries,

310
00:09:08.351 --> 00:09:08.511
even,

311
00:09:08.531 --> 00:09:09.032
for example,

312
00:09:09.072 --> 00:09:12.914
sometimes slightly different ways of thinking within the same country.

313
00:09:13.255 --> 00:09:13.495
Right.

314
00:09:14.235 --> 00:09:17.798
So this decentralization of execution means that we adapt the tactics.

315
00:09:18.598 --> 00:09:21.080
There's even a statement by Sun Tzu from The Art of War.

316
00:09:21.260 --> 00:09:23.501
which is geography,

317
00:09:23.541 --> 00:09:24.561
commands the strategy.

318
00:09:26.182 --> 00:09:27.763
So this dimension of context,

319
00:09:27.783 --> 00:09:28.623
of the landscape,

320
00:09:28.983 --> 00:09:33.765
of the forces at play will both guide a tactical strategy to be implemented in the country.

321
00:09:34.025 --> 00:09:34.526
In any case,

322
00:09:34.586 --> 00:09:36.146
they have a local health policy and...

323
00:09:36.847 --> 00:09:39.448
They have local health policies with their own objectives.

324
00:09:40.188 --> 00:09:40.308
Now,

325
00:09:40.348 --> 00:09:43.890
there are regions that are more or less poor compared to the rest of the country.

326
00:09:44.550 --> 00:09:48.271
So it's true that Shanghai is perhaps better off in terms of innovation,

327
00:09:48.331 --> 00:09:49.512
of innovation coverage.

328
00:09:50.492 --> 00:09:54.501
compared to a province that's further west and which might have fewer resources,

329
00:09:54.742 --> 00:09:56.866
which will focus more on cardiac or diabetes,

330
00:09:56.886 --> 00:09:57.488
for example.

331
00:09:58.943 --> 00:10:00.745
You have to fit your product into that logic.

332
00:10:01.085 --> 00:10:01.325
Right.

333
00:10:01.785 --> 00:10:04.568
Because each province basically has its strategic axes,

334
00:10:04.728 --> 00:10:05.889
even for medications,

335
00:10:05.929 --> 00:10:06.429
when they say,

336
00:10:06.489 --> 00:10:07.931
I accept new ones for this,

337
00:10:07.991 --> 00:10:08.651
for example.

338
00:10:09.011 --> 00:10:09.552
And for others,

339
00:10:09.572 --> 00:10:09.712
well,

340
00:10:09.752 --> 00:10:11.353
I have more difficult conditions or...

341
00:10:11.854 --> 00:10:12.635
That's exactly it.

342
00:10:12.895 --> 00:10:13.555
Every province,

343
00:10:13.595 --> 00:10:13.956
exactly,

344
00:10:13.996 --> 00:10:16.238
they have a general health policy that they must apply,

345
00:10:16.239 --> 00:10:16.698
of course.

346
00:10:17.258 --> 00:10:22.763
Then they have the capacity to have flexibility to adapt this general health policy to their local level,

347
00:10:23.083 --> 00:10:24.004
at least provincially.

348
00:10:24.985 --> 00:10:26.526
But they still stay within the framework.

349
00:10:27.027 --> 00:10:27.247
Then.

350
00:10:27.547 --> 00:10:29.949
We get back to classic elements because China,

351
00:10:30.389 --> 00:10:30.830
Poland,

352
00:10:31.190 --> 00:10:31.470
Russia,

353
00:10:31.811 --> 00:10:32.531
all these markets,

354
00:10:32.611 --> 00:10:34.093
all these countries have the same issues.

355
00:10:34.293 --> 00:10:34.593
Actually,

356
00:10:34.673 --> 00:10:35.394
just like France.

357
00:10:35.754 --> 00:10:35.974
Yes,

358
00:10:36.034 --> 00:10:36.194
yes.

359
00:10:36.274 --> 00:10:36.695
Europe too,

360
00:10:36.755 --> 00:10:36.955
right?

361
00:10:37.315 --> 00:10:37.655
Exactly.

362
00:10:38.156 --> 00:10:41.278
We're dealing with an aging population with a huge need for care.

363
00:10:42.439 --> 00:10:44.501
We're more into curative than preventive care.

364
00:10:45.202 --> 00:10:46.543
We have systems that are clogged,

365
00:10:46.623 --> 00:10:46.903
actually,

366
00:10:46.923 --> 00:10:49.265
in the end by the demand.

367
00:10:49.726 --> 00:10:50.927
Everyone is in the same boat.

368
00:10:51.827 --> 00:10:52.268
Exactly.

369
00:10:52.448 --> 00:10:53.228
Products coming in,

370
00:10:54.029 --> 00:10:54.870
which are revolutions,

371
00:10:54.910 --> 00:10:56.051
which have real technicality.

372
00:10:56.515 --> 00:10:59.838
but which states can no longer pay for full price,

373
00:10:59.918 --> 00:11:02.280
at least the price requested.

374
00:11:02.980 --> 00:11:09.826
So it's about finding the balance between how I provide good care in my country at a price that remains affordable.

375
00:11:10.226 --> 00:11:11.848
And they have the same constraint as we have,

376
00:11:11.908 --> 00:11:12.228
actually,

377
00:11:12.388 --> 00:11:12.848
in the end.

378
00:11:13.069 --> 00:11:15.110
And I think it's becoming more and more acute.

379
00:11:16.011 --> 00:11:16.191
Yeah.

380
00:11:16.371 --> 00:11:16.511
And,

381
00:11:16.972 --> 00:11:17.132
well,

382
00:11:17.232 --> 00:11:18.433
could you tell me some ways,

383
00:11:18.733 --> 00:11:19.134
I don't know,

384
00:11:19.294 --> 00:11:23.337
smart ways maybe that they've tried to use to solve it or not?

385
00:11:24.558 --> 00:11:25.098
Lots of things,

386
00:11:25.199 --> 00:11:25.519
actually.

387
00:11:25.763 --> 00:11:27.064
that I was able to experience.

388
00:11:28.164 --> 00:11:30.665
The first thing I'll focus on that is the hospitals,

389
00:11:30.725 --> 00:11:32.086
the smart internet hospitals.

390
00:11:32.606 --> 00:11:34.066
So since they are all hospital,

391
00:11:34.407 --> 00:11:35.347
all hospital-based,

392
00:11:35.527 --> 00:11:36.247
and for a cold,

393
00:11:36.267 --> 00:11:37.248
you go to the hospital.

394
00:11:38.428 --> 00:11:39.729
For unfortunately a cancer,

395
00:11:39.730 --> 00:11:40.709
you go to the hospital.

396
00:11:41.990 --> 00:11:42.630
For diarrhea,

397
00:11:42.710 --> 00:11:43.610
you go to the hospital.

398
00:11:44.031 --> 00:11:45.131
So it clogs up the system.

399
00:11:45.371 --> 00:11:49.353
So what they've created is digitized care pathways for all minor pathologies,

400
00:11:50.953 --> 00:11:54.755
for virtual hospitals that are actually certified with doctors who are connected.

401
00:11:55.531 --> 00:11:58.132
So there are players who have virtual hospital licenses,

402
00:11:58.372 --> 00:11:58.752
in fact,

403
00:11:59.032 --> 00:12:01.533
where it's as if you were going through a whole hospital,

404
00:12:01.553 --> 00:12:03.894
a care pathway connected to pharmacies.

405
00:12:04.754 --> 00:12:10.396
So they are trying to relocate a portion of the patient flow to virtual platforms that can be easily managed.

406
00:12:11.836 --> 00:12:13.937
To the point that when I say virtual hospital,

407
00:12:14.137 --> 00:12:17.558
we can practically have a care pathway and treatment for oncology,

408
00:12:17.698 --> 00:12:17.878
well,

409
00:12:17.898 --> 00:12:19.859
for cancer through the virtual hospital.

410
00:12:20.399 --> 00:12:20.639
Right.

411
00:12:21.055 --> 00:12:21.215
Okay,

412
00:12:21.335 --> 00:12:21.455
yeah,

413
00:12:21.475 --> 00:12:23.016
the idea is that little by little,

414
00:12:23.196 --> 00:12:24.377
even with the progress of a drug,

415
00:12:24.397 --> 00:12:26.058
we shift pathologies to virtual care?

416
00:12:26.638 --> 00:12:27.038
Exactly.

417
00:12:27.399 --> 00:12:29.660
We're just taking our first steps in telemedicine,

418
00:12:29.680 --> 00:12:30.280
for example,

419
00:12:30.500 --> 00:12:31.041
in France.

420
00:12:31.701 --> 00:12:35.103
And that's because they also have a very advanced culture of digitalization,

421
00:12:35.223 --> 00:12:35.463
you know?

422
00:12:35.843 --> 00:12:36.604
I have a phone,

423
00:12:36.684 --> 00:12:38.865
I didn't need a credit card or anything else anymore.

424
00:12:40.866 --> 00:12:41.526
They have WeChat,

425
00:12:41.546 --> 00:12:42.687
which is their local WhatsApp,

426
00:12:43.407 --> 00:12:45.248
but it integrates all the functionalities,

427
00:12:45.408 --> 00:12:48.390
meaning you can pay your electricity bill through WeChat,

428
00:12:48.490 --> 00:12:49.871
you can take out a life insurance.

429
00:12:49.971 --> 00:12:51.112
policy through WeChat.

430
00:12:51.152 --> 00:12:53.594
You can even open or buy a car through WeChat.

431
00:12:54.075 --> 00:12:54.595
So there you go.

432
00:12:54.655 --> 00:12:56.577
All these elements are already gathered in the phone.

433
00:12:56.997 --> 00:12:58.198
So they already have,

434
00:12:58.479 --> 00:12:58.779
I'd say,

435
00:12:58.959 --> 00:13:00.560
a digitalized culture for all of that.

436
00:13:01.641 --> 00:13:02.302
So this hospital,

437
00:13:02.482 --> 00:13:04.744
I've always found virtual hospitals to be fabulous.

438
00:13:05.245 --> 00:13:05.545
Plus,

439
00:13:05.805 --> 00:13:06.686
since they have the data,

440
00:13:06.986 --> 00:13:09.068
they plug in AI to go even faster.

441
00:13:09.508 --> 00:13:11.911
So they have a playground where they play around with a lot of data.

442
00:13:13.212 --> 00:13:15.053
And so I think these are things we need to think about.

443
00:13:15.093 --> 00:13:16.695
That would be interesting to bring back here.

444
00:13:17.579 --> 00:13:20.020
So they're trying to relieve congestion through the hospital.

445
00:13:20.460 --> 00:13:20.800
Of course,

446
00:13:20.880 --> 00:13:21.880
they take our ideas.

447
00:13:22.240 --> 00:13:26.141
They're thinking about the famous patient bundles instead of paying for each procedure,

448
00:13:27.082 --> 00:13:27.302
right?

449
00:13:27.303 --> 00:13:29.622
So from a T2A to a DRG or DIG.

450
00:13:30.463 --> 00:13:31.523
So they take our ideas,

451
00:13:31.563 --> 00:13:34.084
but I still found that they have some good thoughts on the,

452
00:13:34.284 --> 00:13:37.305
at least on the patient flow and how they've also created,

453
00:13:37.525 --> 00:13:38.065
if you will,

454
00:13:38.405 --> 00:13:39.465
what they call home inward.

455
00:13:40.586 --> 00:13:45.147
So you can be hospitalized and taken directly home with a whole set of metrics,

456
00:13:45.167 --> 00:13:45.647
of course.

457
00:13:45.927 --> 00:13:48.889
And people who will visit because there's still physical contact,

458
00:13:49.170 --> 00:13:50.331
it's to increase bed capacity.

459
00:13:50.711 --> 00:13:53.453
Elderly people sometimes stay in hospital beds longer than needed.

460
00:13:53.734 --> 00:13:56.176
But even a prostate cancer treated during the day,

461
00:13:56.556 --> 00:13:56.736
boom,

462
00:13:56.916 --> 00:13:57.817
with complications.

463
00:13:58.157 --> 00:13:58.558
Of course,

464
00:13:58.638 --> 00:13:59.518
for a type of patient,

465
00:13:59.598 --> 00:14:01.220
perhaps with low risk of complications.

466
00:14:01.760 --> 00:14:03.041
So that basically means that,

467
00:14:03.322 --> 00:14:03.462
yeah,

468
00:14:03.562 --> 00:14:04.282
they feel that,

469
00:14:04.382 --> 00:14:04.563
well,

470
00:14:04.703 --> 00:14:05.804
it's actually safe enough.

471
00:14:06.144 --> 00:14:07.365
And that's going to save them a bed,

472
00:14:07.545 --> 00:14:07.725
right,

473
00:14:07.765 --> 00:14:09.607
from someone who needs to be monitored a bit more.

474
00:14:09.707 --> 00:14:09.987
Okay.

475
00:14:12.089 --> 00:14:13.050
And how does all that work?

476
00:14:13.070 --> 00:14:13.310
I mean,

477
00:14:13.390 --> 00:14:14.491
are there services that are...

478
00:14:14.691 --> 00:14:15.071
What is it?

479
00:14:15.171 --> 00:14:15.751
Is it care?

480
00:14:16.091 --> 00:14:17.732
It's almost the equivalent of home care here.

481
00:14:17.733 --> 00:14:18.252
Who does that?

482
00:14:19.012 --> 00:14:20.593
Hospitals are practically businesses.

483
00:14:21.013 --> 00:14:22.273
They work with distributors,

484
00:14:22.333 --> 00:14:23.354
so logisticians,

485
00:14:23.534 --> 00:14:24.714
but very advanced ones.

486
00:14:25.254 --> 00:14:27.755
So these distributors no longer just deliver a product.

487
00:14:28.015 --> 00:14:29.095
They even sell services.

488
00:14:30.196 --> 00:14:32.556
They build services with hospitals or even with us.

489
00:14:33.316 --> 00:14:34.897
So everything is taken care of.

490
00:14:35.957 --> 00:14:41.659
Everything is handled and coordinated in a continuum of actors that will therefore allow the person of course

491
00:14:41.839 --> 00:14:45.221
to arrive in a secure and a safer way as possible in their own home.

492
00:14:45.601 --> 00:14:47.302
And have you participated in things like that?

493
00:14:47.322 --> 00:14:47.582
I mean,

494
00:14:47.602 --> 00:14:48.683
are you integrated into...

495
00:14:49.003 --> 00:14:50.804
We've started working on that particular area.

496
00:14:51.184 --> 00:14:52.025
Solutions like that?

497
00:14:52.225 --> 00:14:52.365
Yeah.

498
00:14:53.426 --> 00:14:54.506
We might come back to it later,

499
00:14:54.546 --> 00:14:55.647
but we wanted to think about it.

500
00:14:56.252 --> 00:14:58.493
We were launching a product for a rare disease,

501
00:14:58.773 --> 00:14:59.173
which means,

502
00:14:59.253 --> 00:14:59.393
well,

503
00:14:59.533 --> 00:15:01.574
we have three issues that are the same everywhere,

504
00:15:01.614 --> 00:15:02.054
which are,

505
00:15:02.354 --> 00:15:03.434
we have to find the patient.

506
00:15:04.414 --> 00:15:06.635
The patient doesn't know there's a delay.

507
00:15:07.195 --> 00:15:08.175
We must educate the doctor.

508
00:15:09.336 --> 00:15:11.056
And you need the right treatment at the right time.

509
00:15:11.636 --> 00:15:12.377
And the last point,

510
00:15:12.557 --> 00:15:13.217
so sometimes,

511
00:15:13.477 --> 00:15:14.657
right treatment at the right time,

512
00:15:14.897 --> 00:15:15.878
it's genetic test,

513
00:15:16.078 --> 00:15:17.018
if needed or whatever.

514
00:15:17.338 --> 00:15:18.578
And in the end,

515
00:15:18.698 --> 00:15:18.918
well,

516
00:15:19.079 --> 00:15:21.599
you have to support the patient if we're dealing with a rare disease.

517
00:15:21.859 --> 00:15:23.000
And so there's a chronicity,

518
00:15:23.080 --> 00:15:23.440
if you will,

519
00:15:23.441 --> 00:15:24.120
in the treatment.

520
00:15:26.216 --> 00:15:26.516
Actually,

521
00:15:26.596 --> 00:15:27.277
what I've noticed,

522
00:15:27.297 --> 00:15:29.419
at least through my various experiences,

523
00:15:29.759 --> 00:15:32.801
is that we reinvent something that already exists every day.

524
00:15:34.303 --> 00:15:34.863
For example,

525
00:15:34.983 --> 00:15:35.784
patient programs,

526
00:15:35.904 --> 00:15:36.665
patient management,

527
00:15:36.785 --> 00:15:39.167
the pharmaceutical industry has jumped into apps.

528
00:15:39.947 --> 00:15:41.228
We've all created our own app,

529
00:15:41.549 --> 00:15:41.869
our app.

530
00:15:42.109 --> 00:15:42.269
Yeah.

531
00:15:42.569 --> 00:15:43.170
Then afterwards,

532
00:15:43.310 --> 00:15:45.852
we had all the trouble in the world getting doctors to adopt it.

533
00:15:47.033 --> 00:15:48.394
And we pushed that for two years.

534
00:15:49.275 --> 00:15:50.095
Then after a while,

535
00:15:50.136 --> 00:15:52.377
the product manager would leave and then nobody cared anymore.

536
00:15:52.598 --> 00:15:53.919
And it would die a natural death.

537
00:15:54.619 --> 00:15:55.560
Nobody was using it.

538
00:15:55.904 --> 00:15:56.224
Come on,

539
00:15:56.284 --> 00:15:58.245
there were 20 doctors who had used it.

540
00:15:59.246 --> 00:16:02.148
So instead of finding redoing something actually with the team,

541
00:16:02.568 --> 00:16:03.408
we thought about it.

542
00:16:03.969 --> 00:16:13.594
What is the technological ecosystem of services of companies already actually integrated into the chain and the flow actually of patient management?

543
00:16:14.375 --> 00:16:15.015
In any case,

544
00:16:15.335 --> 00:16:18.878
the key moments where the patient will have a partner with whom we should work.

545
00:16:19.918 --> 00:16:21.139
And instead of doing a partnership,

546
00:16:21.199 --> 00:16:22.860
we're trying to create an ecosystem.

547
00:16:24.216 --> 00:16:25.557
So I'll take one of the elements.

548
00:16:26.097 --> 00:16:26.817
The distributor,

549
00:16:26.957 --> 00:16:27.117
well,

550
00:16:27.157 --> 00:16:27.637
two elements.

551
00:16:27.638 --> 00:16:33.980
A distributor has already set up its patient management app in diabetes because they understood that and they have their chain pharmacies.

552
00:16:34.900 --> 00:16:36.021
If they improve compliance,

553
00:16:36.081 --> 00:16:36.241
well,

554
00:16:36.501 --> 00:16:37.781
they have more stable revenues.

555
00:16:38.722 --> 00:16:39.762
Instead of taking the pill,

556
00:16:39.962 --> 00:16:42.383
I'd say six months out of the year or seven,

557
00:16:42.463 --> 00:16:43.084
eight months gain.

558
00:16:44.104 --> 00:16:45.305
So they had set up this project.

559
00:16:45.665 --> 00:16:46.645
So we proposed to them,

560
00:16:46.685 --> 00:16:46.845
well,

561
00:16:46.865 --> 00:16:47.966
we're going to do the same thing,

562
00:16:48.306 --> 00:16:52.527
but for this rare disease to support patients so they come back for their injection.

563
00:16:53.368 --> 00:16:53.488
So.

564
00:16:54.152 --> 00:16:55.353
It's with nurses calling.

565
00:16:55.533 --> 00:16:56.834
It's with support programs,

566
00:16:56.994 --> 00:16:57.354
actually,

567
00:16:57.695 --> 00:16:57.875
on,

568
00:16:58.295 --> 00:16:58.415
well,

569
00:16:58.455 --> 00:16:58.935
reflection,

570
00:16:59.276 --> 00:16:59.656
stress,

571
00:16:59.876 --> 00:17:00.457
psychology.

572
00:17:01.257 --> 00:17:02.878
So they had already put everything in place.

573
00:17:02.958 --> 00:17:04.619
So instead of reinventing the other thing.

574
00:17:04.760 --> 00:17:06.100
There's the distribution circuit,

575
00:17:06.161 --> 00:17:06.381
right?

576
00:17:07.001 --> 00:17:09.563
Plus they have the strength of having the distribution circuit,

577
00:17:09.564 --> 00:17:10.243
the pharmacists,

578
00:17:10.263 --> 00:17:10.824
the nurses.

579
00:17:11.504 --> 00:17:12.405
So instead of using,

580
00:17:12.685 --> 00:17:13.586
reinventing something,

581
00:17:13.806 --> 00:17:16.808
let's use the strengths of each and everyone because we're all going to benefit.

582
00:17:16.988 --> 00:17:17.188
Okay.

583
00:17:18.009 --> 00:17:19.530
And so that's the more conventional part.

584
00:17:19.850 --> 00:17:21.091
So we teamed up with them.

585
00:17:21.191 --> 00:17:22.252
We reworked the program.

586
00:17:23.948 --> 00:17:25.209
The more discovery part,

587
00:17:25.229 --> 00:17:26.010
we thought actually,

588
00:17:26.390 --> 00:17:29.413
this pathology is the sum of a certain number of symptoms.

589
00:17:30.494 --> 00:17:34.137
And it can also be the sum of a certain number of medications that you take.

590
00:17:34.697 --> 00:17:36.219
It's 10 years of therapeutic delay.

591
00:17:36.359 --> 00:17:36.479
Yeah.

592
00:17:36.719 --> 00:17:37.540
So before we find it.

593
00:17:38.341 --> 00:17:43.525
And so we asked them and we're working with them with a deep mining learning machine in all their pharmacies.

594
00:17:44.026 --> 00:17:47.308
Meaning that actually we're starting to work to screen a whole set of,

595
00:17:49.410 --> 00:17:49.550
well,

596
00:17:49.590 --> 00:17:51.172
not clients coming to the pharmacy.

597
00:17:51.712 --> 00:17:52.752
And we're trying to understand,

598
00:17:52.792 --> 00:17:58.134
could we bring together a list of medications taken over time to try to detect,

599
00:17:58.354 --> 00:17:58.514
well,

600
00:17:58.574 --> 00:18:00.534
patients who aren't yet aware that they're sick?

601
00:18:02.055 --> 00:18:03.415
That's actually the power of data,

602
00:18:03.615 --> 00:18:04.055
if you will,

603
00:18:04.295 --> 00:18:06.136
but working within an ecosystem of players.

604
00:18:06.576 --> 00:18:06.776
Yes,

605
00:18:06.816 --> 00:18:07.957
we can activate right away.

606
00:18:08.317 --> 00:18:08.477
Yes,

607
00:18:08.537 --> 00:18:08.957
exactly.

608
00:18:09.337 --> 00:18:09.817
And legally,

609
00:18:09.897 --> 00:18:10.857
is everything possible,

610
00:18:10.937 --> 00:18:11.377
feasible?

611
00:18:12.518 --> 00:18:12.698
Well,

612
00:18:12.858 --> 00:18:13.498
legally speaking,

613
00:18:13.658 --> 00:18:14.478
everything is possible,

614
00:18:14.598 --> 00:18:15.078
provided that,

615
00:18:15.079 --> 00:18:15.459
of course,

616
00:18:15.699 --> 00:18:17.119
all the necessary conditions are met.

617
00:18:17.359 --> 00:18:17.539
Well,

618
00:18:18.019 --> 00:18:20.160
there are all the data privacy regulations in China too,

619
00:18:20.240 --> 00:18:20.440
right?

620
00:18:20.680 --> 00:18:22.482
And those are definitely important to keep in mind.

621
00:18:23.102 --> 00:18:27.546
But actually access is in many cases somewhat simplified compared to some other places.

622
00:18:27.686 --> 00:18:27.986
Let's say,

623
00:18:28.006 --> 00:18:28.547
for example,

624
00:18:28.867 --> 00:18:31.769
there are generally more opportunities to access a wider range of data.

625
00:18:32.030 --> 00:18:32.990
So our players.

626
00:18:33.371 --> 00:18:33.631
For you,

627
00:18:33.651 --> 00:18:34.151
for example.

628
00:18:35.132 --> 00:18:36.173
Not necessarily for us.

629
00:18:36.513 --> 00:18:37.114
For everyone.

630
00:18:37.354 --> 00:18:39.656
But for institutional players or very Chinese players.

631
00:18:39.776 --> 00:18:40.116
I see.

632
00:18:40.357 --> 00:18:43.239
They have convenient access to data that is made much easier.

633
00:18:43.559 --> 00:18:43.880
I see.

634
00:18:44.120 --> 00:18:45.441
And that's where I come back to the point.

635
00:18:45.481 --> 00:18:46.722
Let's not reinvent something,

636
00:18:46.802 --> 00:18:47.062
you know.

637
00:18:47.723 --> 00:18:47.943
Yes,

638
00:18:48.203 --> 00:18:48.423
yes.

639
00:18:48.503 --> 00:18:48.624
No,

640
00:18:48.764 --> 00:18:48.924
but.

641
00:18:49.924 --> 00:18:52.285
But then it works because there are precisely these,

642
00:18:52.765 --> 00:18:52.965
well,

643
00:18:53.045 --> 00:18:55.346
what you call distributors who do this,

644
00:18:55.366 --> 00:19:00.087
who already have an established bridge between the pharmacy,

645
00:19:00.287 --> 00:19:01.907
the patient and almost the hospital.

646
00:19:03.308 --> 00:19:03.628
Yes.

647
00:19:04.088 --> 00:19:05.268
So it's more like something.

648
00:19:05.288 --> 00:19:07.489
But I've met players who have virtuous hospitals,

649
00:19:08.109 --> 00:19:08.269
sorry,

650
00:19:08.349 --> 00:19:09.049
virtual ones.

651
00:19:09.389 --> 00:19:09.509
Yeah.

652
00:19:11.170 --> 00:19:11.290
Well,

653
00:19:11.370 --> 00:19:18.332
all they're thinking today is how through AI they actually guide the diagnosis to have a more productive doctor time in the sense that they can see more people.

654
00:19:18.592 --> 00:19:18.712
Yeah.

655
00:19:19.068 --> 00:19:21.430
since it will still allow for treating people quickly.

656
00:19:22.131 --> 00:19:22.952
Support services,

657
00:19:22.972 --> 00:19:24.994
so all of them are really thinking about,

658
00:19:25.214 --> 00:19:25.554
I'd say,

659
00:19:25.874 --> 00:19:27.095
moving forward in the service,

660
00:19:27.176 --> 00:19:28.717
and therefore in the capture,

661
00:19:28.737 --> 00:19:29.137
if you will,

662
00:19:29.838 --> 00:19:30.439
of the patient.

663
00:19:31.740 --> 00:19:33.802
This is actually a vision for 2030,

664
00:19:34.422 --> 00:19:37.425
how we manage to provide better care for an aging population,

665
00:19:37.885 --> 00:19:39.527
because that represents 25%

666
00:19:39.887 --> 00:19:40.848
of their population,

667
00:19:41.268 --> 00:19:41.909
and above all,

668
00:19:42.189 --> 00:19:45.052
to catch up with health care and health standards worldwide.

669
00:19:45.844 --> 00:19:46.085
Today,

670
00:19:46.245 --> 00:19:49.772
one third of the molecules developed for the next 10 years come from China.

671
00:19:50.212 --> 00:19:50.713
10 years ago,

672
00:19:50.974 --> 00:19:51.715
it was 3%.

673
00:19:52.196 --> 00:19:52.717
So there you go.

674
00:19:52.918 --> 00:19:53.559
They've tripled,

675
00:19:53.859 --> 00:19:54.461
quintupled,

676
00:19:54.781 --> 00:19:55.603
multiplied by 10.

677
00:19:55.963 --> 00:19:56.845
It's how we restart,

678
00:19:56.965 --> 00:19:57.847
how we reinitiate,

679
00:19:57.887 --> 00:19:58.208
actually.

680
00:19:58.893 --> 00:20:00.154
So we're in this race then?

681
00:20:00.955 --> 00:20:01.095
Well,

682
00:20:01.135 --> 00:20:01.535
exactly,

683
00:20:01.595 --> 00:20:04.258
that we give birth to a new biotechnology ecosystem.

684
00:20:04.918 --> 00:20:07.700
And I think that's key for us for the medicine of tomorrow.

685
00:20:08.081 --> 00:20:09.422
So that means these are plans that,

686
00:20:09.522 --> 00:20:10.102
for example,

687
00:20:10.122 --> 00:20:11.924
you were talking about even the virtual hospital,

688
00:20:11.964 --> 00:20:13.725
these are things that were started how long ago,

689
00:20:13.865 --> 00:20:14.506
20 years?

690
00:20:15.287 --> 00:20:16.007
About 10 years ago.

691
00:20:16.348 --> 00:20:16.808
10 years?

692
00:20:17.388 --> 00:20:17.929
It's moving very,

693
00:20:17.969 --> 00:20:18.469
very fast.

694
00:20:18.689 --> 00:20:19.390
So in 10 years,

695
00:20:19.410 --> 00:20:23.634
they managed to have an impact from a strategy at a nationwide scale?

696
00:20:24.354 --> 00:20:27.697
Because there's always this capacity for local execution.

697
00:20:27.877 --> 00:20:28.877
interpreted locally.

698
00:20:29.978 --> 00:20:30.818
So for example,

699
00:20:31.938 --> 00:20:32.098
well,

700
00:20:32.218 --> 00:20:32.638
Shanghai,

701
00:20:32.838 --> 00:20:33.819
and there they've created,

702
00:20:33.979 --> 00:20:34.239
I think,

703
00:20:34.339 --> 00:20:35.119
X square meters,

704
00:20:35.259 --> 00:20:35.399
well,

705
00:20:35.439 --> 00:20:38.880
square meters or hectares of research and development laboratories,

706
00:20:39.060 --> 00:20:39.380
turnkey.

707
00:20:39.980 --> 00:20:42.561
So you as an industrial player can come and say,

708
00:20:42.701 --> 00:20:42.941
well,

709
00:20:43.121 --> 00:20:43.621
I'm interested.

710
00:20:43.661 --> 00:20:43.802
Well,

711
00:20:43.902 --> 00:20:44.802
I'll take the premises.

712
00:20:44.822 --> 00:20:46.242
Of course you pay rent or whatever.

713
00:20:46.882 --> 00:20:50.964
And so they are there to attract as much foreign investment or local investment as possible.

714
00:20:51.164 --> 00:20:51.744
What does that mean?

715
00:20:51.764 --> 00:20:53.424
Do they also do things to work together?

716
00:20:53.584 --> 00:20:53.824
I mean,

717
00:20:53.944 --> 00:20:54.565
is it half?

718
00:20:54.825 --> 00:20:55.085
I mean,

719
00:20:55.105 --> 00:20:55.785
they mix the...

720
00:20:57.021 --> 00:20:58.441
They want to mix public and private.

721
00:20:58.521 --> 00:20:58.741
Yes,

722
00:20:58.922 --> 00:20:59.122
yes,

723
00:20:59.382 --> 00:20:59.762
absolutely.

724
00:20:59.822 --> 00:21:00.802
It's all public-private.

725
00:21:02.603 --> 00:21:04.543
It's the public sector that actually built this

726
00:21:05.003 --> 00:21:06.204
R&D platform area.

727
00:21:06.504 --> 00:21:06.724
Okay,

728
00:21:06.804 --> 00:21:07.064
sure.

729
00:21:07.644 --> 00:21:10.805
And then they bring in the industrial players who are interested in working there.

730
00:21:12.525 --> 00:21:14.306
And so before it was only foreigners.

731
00:21:14.426 --> 00:21:14.886
Now 50%

732
00:21:15.346 --> 00:21:17.247
are Chinese players who could have,

733
00:21:17.367 --> 00:21:17.647
I think,

734
00:21:17.648 --> 00:21:20.127
the weight of a Pfizer of tomorrow very clearly.

735
00:21:21.288 --> 00:21:21.888
What does that do?

736
00:21:22.268 --> 00:21:23.848
What does it change that it's like that?

737
00:21:23.948 --> 00:21:25.709
Is it the proximity between all the players?

738
00:21:25.829 --> 00:21:26.249
What is it?

739
00:21:27.441 --> 00:21:28.081
Or is it lines?

740
00:21:28.082 --> 00:21:28.281
I mean,

741
00:21:28.301 --> 00:21:28.822
being followed,

742
00:21:28.862 --> 00:21:30.162
having a strategic line,

743
00:21:30.222 --> 00:21:30.542
having...

744
00:21:32.043 --> 00:21:32.203
Well,

745
00:21:32.343 --> 00:21:32.903
let's say that,

746
00:21:33.124 --> 00:21:33.304
well,

747
00:21:33.544 --> 00:21:33.964
initially,

748
00:21:34.024 --> 00:21:34.204
well,

749
00:21:34.664 --> 00:21:36.085
it's just managing an ecosystem.

750
00:21:36.285 --> 00:21:39.146
So the ecosystem needs to be well balanced and in any case,

751
00:21:39.186 --> 00:21:40.407
well structured and balanced.

752
00:21:40.927 --> 00:21:42.808
So they do everything they can to attract,

753
00:21:42.968 --> 00:21:43.328
I'd say,

754
00:21:43.508 --> 00:21:45.849
players who would be interested into an ecosystem.

755
00:21:46.529 --> 00:21:47.090
And besides,

756
00:21:47.110 --> 00:21:47.590
we see it.

757
00:21:47.670 --> 00:21:50.871
AstraZeneca today has reinvested heavily in R&D in China.

758
00:21:51.111 --> 00:21:53.913
We can clearly see that today innovation is happening,

759
00:21:53.973 --> 00:21:54.773
particularly here.

760
00:21:56.081 --> 00:21:59.142
Their development time is reduced because they use all the new,

761
00:21:59.483 --> 00:21:59.663
well,

762
00:21:59.803 --> 00:22:01.563
digital technologies with everything,

763
00:22:01.743 --> 00:22:02.824
like deep learning machines,

764
00:22:02.904 --> 00:22:04.325
and they are continuously learning.

765
00:22:04.665 --> 00:22:06.045
We have players like Tiger Med,

766
00:22:06.105 --> 00:22:07.526
so a clinical development,

767
00:22:07.586 --> 00:22:07.746
well,

768
00:22:07.766 --> 00:22:08.426
a CRO.

769
00:22:08.967 --> 00:22:09.427
There's XC,

770
00:22:09.707 --> 00:22:11.308
they do hard clinical trials there,

771
00:22:11.388 --> 00:22:13.709
so with classic arms.

772
00:22:14.449 --> 00:22:15.349
But alongside that,

773
00:22:15.429 --> 00:22:18.531
they continuously plug in a whole set of machines to be able to learn.

774
00:22:19.811 --> 00:22:23.533
And they compare clinical trial results with what was done.

775
00:22:23.833 --> 00:22:24.333
digitally,

776
00:22:24.493 --> 00:22:25.794
so artificial intelligence,

777
00:22:25.994 --> 00:22:27.234
and what was done in real life.

778
00:22:28.574 --> 00:22:29.215
And so that way,

779
00:22:29.295 --> 00:22:31.255
they do a lot of discovery and especially,

780
00:22:31.415 --> 00:22:31.555
well,

781
00:22:31.615 --> 00:22:32.295
pre-phase two,

782
00:22:32.375 --> 00:22:32.856
phase one,

783
00:22:32.857 --> 00:22:34.136
to see if it's going to work or not.

784
00:22:34.396 --> 00:22:35.396
So the decision time,

785
00:22:35.676 --> 00:22:39.417
they accelerate the decision and especially their orientation in the decision.

786
00:22:40.018 --> 00:22:40.378
And for me,

787
00:22:40.518 --> 00:22:42.538
there was a player there who was one of the most,

788
00:22:43.239 --> 00:22:43.439
well,

789
00:22:43.499 --> 00:22:50.141
who is still one of the biggest biotechnology players who overnight changed their entire strategy and totally refocused on vaccine technology.

790
00:22:51.081 --> 00:22:51.501
Before,

791
00:22:51.913 --> 00:22:52.773
He was in oncology.

792
00:22:53.513 --> 00:22:54.634
He was in neuroscience.

793
00:22:55.634 --> 00:22:56.954
Stopped everything to refocus.

794
00:22:57.115 --> 00:22:59.495
So I think most likely on mRNA technology.

795
00:23:01.336 --> 00:23:02.396
But because actually it was,

796
00:23:02.876 --> 00:23:03.016
well,

797
00:23:03.056 --> 00:23:05.437
basically the small candidates they had,

798
00:23:05.537 --> 00:23:07.918
they brought them faster to the crash test and to say...

799
00:23:08.078 --> 00:23:08.798
I don't know why,

800
00:23:08.898 --> 00:23:09.798
but in any case,

801
00:23:09.898 --> 00:23:11.179
a speed of decision-making,

802
00:23:11.279 --> 00:23:12.519
an ecosystem in place,

803
00:23:13.299 --> 00:23:13.439
well,

804
00:23:13.440 --> 00:23:13.819
of course,

805
00:23:13.859 --> 00:23:14.540
attractiveness,

806
00:23:14.700 --> 00:23:14.820
well,

807
00:23:14.821 --> 00:23:16.760
a tax system that can be attractive.

808
00:23:17.480 --> 00:23:19.181
And each province has a GDP goal.

809
00:23:19.541 --> 00:23:20.582
So value generation,

810
00:23:20.682 --> 00:23:22.903
so ultimately a bit of competition between them.

811
00:23:23.883 --> 00:23:26.764
So competition ultimately means conditions,

812
00:23:27.845 --> 00:23:29.125
a more favorable playing field,

813
00:23:29.165 --> 00:23:30.446
especially if you want to invest.

814
00:23:31.386 --> 00:23:33.007
So they compete a bit,

815
00:23:33.227 --> 00:23:33.627
I'd say,

816
00:23:34.087 --> 00:23:35.788
to try to build their center of excellence,

817
00:23:35.828 --> 00:23:37.509
their center of innovation.

818
00:23:38.049 --> 00:23:40.810
The big issue with this country is that there's a reservoir.

819
00:23:40.951 --> 00:23:41.091
Well,

820
00:23:41.131 --> 00:23:41.751
not an issue.

821
00:23:41.971 --> 00:23:43.151
For us as industrialists,

822
00:23:43.191 --> 00:23:44.432
it's that there's a reservoir,

823
00:23:44.572 --> 00:23:46.433
a market potential that is immense.

824
00:23:47.653 --> 00:23:52.455
That is to say that today it's the second largest pharmaceutical market in the world.

825
00:23:53.376 --> 00:23:54.556
If I just take innovation,

826
00:23:54.816 --> 00:23:55.416
it's the third.

827
00:23:56.637 --> 00:23:58.758
It will soon reach a certain number of billions,

828
00:23:58.818 --> 00:23:59.378
50 billion,

829
00:23:59.478 --> 00:23:59.798
I think,

830
00:23:59.818 --> 00:24:00.979
by 2028 dollars.

831
00:24:01.839 --> 00:24:03.780
But that means that with those 50 billion,

832
00:24:03.820 --> 00:24:06.121
it only represents 10 to 15 percent of the U.S.

833
00:24:06.181 --> 00:24:06.521
market.

834
00:24:07.942 --> 00:24:10.983
And those 50 billion only treat a tiny part of the population.

835
00:24:12.004 --> 00:24:12.184
Yeah.

836
00:24:12.384 --> 00:24:12.784
So actually,

837
00:24:12.824 --> 00:24:14.945
I would say it's El Dorado or a mirage.

838
00:24:15.709 --> 00:24:17.470
Because there's an enormous value potential,

839
00:24:17.490 --> 00:24:18.370
a volume potential,

840
00:24:18.430 --> 00:24:18.890
of course,

841
00:24:18.950 --> 00:24:19.471
gigantic.

842
00:24:19.751 --> 00:24:21.752
But how to capture that value and that volume?

843
00:24:22.232 --> 00:24:22.492
Very,

844
00:24:22.672 --> 00:24:23.692
very difficult.

845
00:24:24.113 --> 00:24:27.334
So then the first thing I was talking about is market access.

846
00:24:28.234 --> 00:24:29.295
First step is,

847
00:24:29.415 --> 00:24:31.856
but what we call the landing for the patient,

848
00:24:31.916 --> 00:24:33.297
let's say the landing for the patient,

849
00:24:33.397 --> 00:24:34.557
extremely complicated,

850
00:24:35.358 --> 00:24:37.218
which requires a lot of commercial intensity,

851
00:24:37.478 --> 00:24:38.319
capital intensity,

852
00:24:38.379 --> 00:24:41.880
because you have to be everywhere to be able to permeate,

853
00:24:41.900 --> 00:24:42.321
if you will,

854
00:24:42.341 --> 00:24:43.261
the Chinese fabric.

855
00:24:43.613 --> 00:24:46.176
There are more than 15,000 to 20,000 hospitals.

856
00:24:47.198 --> 00:24:49.541
Just the first 300 represent 25%

857
00:24:49.601 --> 00:24:50.142
of the market,

858
00:24:50.182 --> 00:24:51.003
but we're all on them.

859
00:24:51.403 --> 00:24:52.445
So it's a bloody war.

860
00:24:53.606 --> 00:24:55.488
If we're in the blue ocean strategy concept,

861
00:24:55.529 --> 00:24:56.350
we're in a red ocean.

862
00:24:56.910 --> 00:24:58.773
So you have to go and permeate even lower.

863
00:24:59.198 --> 00:25:01.199
You have to fight continuously to keep the product.

864
00:25:01.439 --> 00:25:03.840
So already getting the product there is complicated.

865
00:25:05.541 --> 00:25:06.221
Price pressure.

866
00:25:07.581 --> 00:25:08.622
When I say price pressure,

867
00:25:08.642 --> 00:25:11.123
it means that if you want to enter the reimbursement system,

868
00:25:11.263 --> 00:25:11.783
you have to,

869
00:25:12.583 --> 00:25:13.304
because they are,

870
00:25:13.944 --> 00:25:17.545
I'd say they're motivated by the percentage drop more than the value that drops.

871
00:25:18.286 --> 00:25:19.166
So you have to give a 50%,

872
00:25:19.306 --> 00:25:20.126
60%

873
00:25:20.166 --> 00:25:20.627
price drop.

874
00:25:21.487 --> 00:25:23.668
But then they set up volume-based procurement,

875
00:25:24.388 --> 00:25:25.769
either national or provincial,

876
00:25:25.949 --> 00:25:27.609
where we're at average drops of 60%

877
00:25:27.689 --> 00:25:28.410
to 80%

878
00:25:28.411 --> 00:25:28.930
of the price.

879
00:25:30.354 --> 00:25:30.554
Ah,

880
00:25:30.694 --> 00:25:36.017
because then the Chinese themselves have local production capacities that allow them to have perhaps more attractive prices.

881
00:25:36.678 --> 00:25:39.299
So already there's also the pay for innovations,

882
00:25:40.020 --> 00:25:40.760
which is compressed.

883
00:25:41.941 --> 00:25:44.302
So that's a real issue then to capture this value.

884
00:25:45.423 --> 00:25:49.445
And then the last one is that the market remains very much at the consumer's discretion,

885
00:25:49.545 --> 00:25:49.886
I'd say.

886
00:25:50.866 --> 00:25:51.407
Because 50%

887
00:25:51.707 --> 00:25:53.148
of the market in value is,

888
00:25:53.708 --> 00:25:55.089
it comes out of the patient's pocket.

889
00:25:55.869 --> 00:25:56.189
Always.

890
00:25:56.550 --> 00:25:56.870
Always.

891
00:25:57.906 --> 00:25:58.026
So,

892
00:25:58.306 --> 00:25:58.426
well,

893
00:25:58.486 --> 00:26:03.188
now we're talking about a macroeconomic crisis and people making treatment choices that can slow down,

894
00:26:03.308 --> 00:26:03.548
you know,

895
00:26:03.628 --> 00:26:04.028
growth.

896
00:26:04.408 --> 00:26:04.808
But still,

897
00:26:04.888 --> 00:26:06.949
we're seeing growth of 15 to 20%.

898
00:26:07.009 --> 00:26:07.209
Yeah.

899
00:26:07.489 --> 00:26:08.209
That's still pretty good.

900
00:26:08.529 --> 00:26:10.490
But so these three limiting factors,

901
00:26:10.530 --> 00:26:10.870
I think,

902
00:26:12.010 --> 00:26:13.651
lead us to ask if it's a mirage,

903
00:26:13.851 --> 00:26:15.311
can we really capture that value?

904
00:26:15.431 --> 00:26:16.752
Many companies had strategies,

905
00:26:16.772 --> 00:26:17.272
for example,

906
00:26:17.312 --> 00:26:19.012
of sacrificing price to get volume.

907
00:26:20.333 --> 00:26:20.493
Well,

908
00:26:20.573 --> 00:26:21.013
afterwards,

909
00:26:21.053 --> 00:26:23.334
you have to go and capture that volume and it's not that simple,

910
00:26:23.354 --> 00:26:23.614
you know?

911
00:26:23.994 --> 00:26:24.234
Yeah,

912
00:26:24.254 --> 00:26:24.374
yeah.

913
00:26:25.310 --> 00:26:25.430
Yeah,

914
00:26:25.510 --> 00:26:28.152
you're describing the life of someone who goes there and wants to do it.

915
00:26:29.332 --> 00:26:30.273
And I'd like to get the,

916
00:26:30.533 --> 00:26:30.773
you know,

917
00:26:30.774 --> 00:26:32.074
the lesson from what,

918
00:26:32.114 --> 00:26:32.394
you know,

919
00:26:32.574 --> 00:26:32.854
is it,

920
00:26:33.074 --> 00:26:33.335
is it,

921
00:26:33.375 --> 00:26:33.515
well,

922
00:26:33.575 --> 00:26:34.655
how do we actually value it?

923
00:26:35.016 --> 00:26:35.576
How in Europe,

924
00:26:35.656 --> 00:26:35.896
you know,

925
00:26:35.956 --> 00:26:36.977
what lesson can you take?

926
00:26:37.017 --> 00:26:37.797
Because actually what,

927
00:26:38.277 --> 00:26:38.398
well,

928
00:26:38.418 --> 00:26:39.898
what's happening is that there are already

929
00:26:40.579 --> 00:26:43.560
Chinese products arriving in Europe that as a result smash,

930
00:26:43.921 --> 00:26:44.101
well,

931
00:26:44.241 --> 00:26:45.602
slash prices when they arrive.

932
00:26:45.942 --> 00:26:46.382
We have the,

933
00:26:46.542 --> 00:26:46.782
you know,

934
00:26:46.822 --> 00:26:48.103
the US questioning things.

935
00:26:48.323 --> 00:26:48.823
There's always,

936
00:26:49.284 --> 00:26:49.404
well,

937
00:26:49.464 --> 00:26:50.665
innovation always has a cost.

938
00:26:51.645 --> 00:26:51.905
What is,

939
00:26:52.506 --> 00:26:53.006
they don't say.

940
00:26:53.378 --> 00:26:53.518
Hey,

941
00:26:53.578 --> 00:26:55.079
let's link concrete innovation.

942
00:26:55.780 --> 00:26:56.120
Aren't there,

943
00:26:56.180 --> 00:26:56.600
I don't know,

944
00:26:56.700 --> 00:26:58.942
more grounded things to link innovation and cost?

945
00:26:59.482 --> 00:27:00.383
So for us,

946
00:27:00.443 --> 00:27:02.624
do you mean in terms of what should we do about it?

947
00:27:02.765 --> 00:27:03.425
Or is it more,

948
00:27:03.585 --> 00:27:04.586
what can we learn from it?

949
00:27:05.166 --> 00:27:05.306
Yeah,

950
00:27:06.147 --> 00:27:06.267
well,

951
00:27:06.647 --> 00:27:07.248
it comes down to,

952
00:27:07.288 --> 00:27:08.809
is it viable and what can we take?

953
00:27:09.389 --> 00:27:10.270
What's the trend that's,

954
00:27:10.830 --> 00:27:13.072
since we actually have three models that are completely different,

955
00:27:13.152 --> 00:27:14.092
but none of them work.

956
00:27:15.493 --> 00:27:15.633
Well,

957
00:27:15.673 --> 00:27:17.955
none except for one that rewards innovation,

958
00:27:18.015 --> 00:27:18.856
but isn't viable.

959
00:27:19.796 --> 00:27:19.916
Ah,

960
00:27:19.996 --> 00:27:21.417
you have to find the right balance.

961
00:27:21.578 --> 00:27:21.958
For sure.

962
00:27:22.934 --> 00:27:25.075
I'm gently leading you towards the vision of pharma,

963
00:27:25.215 --> 00:27:26.496
but it's true that it's a matter of,

964
00:27:26.936 --> 00:27:28.417
it's about pricing or models,

965
00:27:28.457 --> 00:27:28.938
quite simply.

966
00:27:31.039 --> 00:27:31.159
So

967
00:27:31.539 --> 00:27:33.920
I think that in a rather iconoclastic way,

968
00:27:34.020 --> 00:27:35.201
the whole pricing discussion,

969
00:27:35.982 --> 00:27:37.543
at least regardless of the country,

970
00:27:37.803 --> 00:27:39.123
leads to the same conclusion.

971
00:27:40.524 --> 00:27:42.766
It's how much they can pay for a certain number of people.

972
00:27:42.767 --> 00:27:43.946
Yeah.

973
00:27:44.406 --> 00:27:45.247
So all the data,

974
00:27:45.667 --> 00:27:46.728
I'd say health economics,

975
00:27:47.228 --> 00:27:48.749
the value generated over time,

976
00:27:48.849 --> 00:27:50.330
I think in the end we just arrive at...

977
00:27:50.450 --> 00:27:50.630
well,

978
00:27:50.670 --> 00:27:52.371
it'll cost me 100 for 100 people,

979
00:27:52.391 --> 00:27:53.451
so that's 1,000,

980
00:27:53.471 --> 00:27:54.411
so on and so forth.

981
00:27:54.751 --> 00:27:54.871
So

982
00:27:55.511 --> 00:27:58.872
I think it's still complicated to find the right balance among these three visions,

983
00:27:59.893 --> 00:28:01.333
which is I pay for innovation,

984
00:28:01.413 --> 00:28:03.093
but people can't afford the treatment,

985
00:28:03.273 --> 00:28:04.094
or vice versa.

986
00:28:04.334 --> 00:28:04.594
Well,

987
00:28:04.734 --> 00:28:05.954
I don't pay for innovation,

988
00:28:05.994 --> 00:28:07.475
but I can't continue to develop.

989
00:28:08.015 --> 00:28:09.295
We need to find cooperation,

990
00:28:09.355 --> 00:28:10.015
collaboration.

991
00:28:11.736 --> 00:28:14.737
China has an execution firepower that's quite impressive,

992
00:28:14.897 --> 00:28:15.637
and it's worth it.

993
00:28:15.657 --> 00:28:19.998
I think it's a good move to do combined research with them because they can quickly test.

994
00:28:20.158 --> 00:28:24.222
a product's value or the potential power of the molecule.

995
00:28:25.123 --> 00:28:26.464
And they have the infrastructure,

996
00:28:26.544 --> 00:28:28.105
which has still greatly improved.

997
00:28:29.226 --> 00:28:30.487
It's not yet totally ideal,

998
00:28:30.708 --> 00:28:32.950
but it's still extremely significantly improved,

999
00:28:32.990 --> 00:28:33.871
all the technologies.

1000
00:28:34.551 --> 00:28:36.173
So I think we can already learn,

1001
00:28:36.393 --> 00:28:36.513
well,

1002
00:28:36.514 --> 00:28:41.558
we can learn and reflect on how we use new technologies and how we reapply them in our European environment.

1003
00:28:42.839 --> 00:28:46.162
But that would mean it's a regulatory reflection within a legislative framework.

1004
00:28:47.658 --> 00:28:50.380
and even see tax incentives to be able to bring back,

1005
00:28:50.400 --> 00:28:50.900
if you will,

1006
00:28:51.040 --> 00:28:51.901
a creative energy.

1007
00:28:52.981 --> 00:28:53.902
I'd say that's mostly it.

1008
00:28:54.122 --> 00:28:54.582
With China,

1009
00:28:55.123 --> 00:28:55.803
in execution,

1010
00:28:55.923 --> 00:28:56.844
especially in detection,

1011
00:28:57.524 --> 00:28:58.465
then patient testing,

1012
00:28:58.745 --> 00:28:59.245
phase two,

1013
00:28:59.565 --> 00:29:00.126
phase three,

1014
00:29:00.406 --> 00:29:00.546
well,

1015
00:29:00.586 --> 00:29:01.006
phase one,

1016
00:29:01.046 --> 00:29:01.506
phase two,

1017
00:29:01.907 --> 00:29:03.387
can really be a partner we should work with.

1018
00:29:03.788 --> 00:29:05.709
I'd say we should do what China did to us,

1019
00:29:05.849 --> 00:29:06.209
in a way,

1020
00:29:06.429 --> 00:29:07.010
at the beginning.

1021
00:29:07.870 --> 00:29:09.331
When we wanted to invest in China,

1022
00:29:09.351 --> 00:29:10.612
we had to bring our technology.

1023
00:29:10.812 --> 00:29:10.952
Well,

1024
00:29:10.992 --> 00:29:13.233
let's bring in the Chinese with their thoughts,

1025
00:29:13.273 --> 00:29:14.074
their proposals.

1026
00:29:14.858 --> 00:29:17.701
And let's also start duplicating what they're putting in place.

1027
00:29:19.602 --> 00:29:22.065
Then when it comes to the discussion of price specifically.

1028
00:29:22.385 --> 00:29:22.925
Or value.

1029
00:29:23.206 --> 00:29:24.927
Or when it comes to the value of innovation.

1030
00:29:25.087 --> 00:29:25.468
Honestly,

1031
00:29:25.728 --> 00:29:29.211
I think that's probably the thorniest and most challenging question there is to answer.

1032
00:29:30.192 --> 00:29:31.253
Would you like to share a bit,

1033
00:29:31.453 --> 00:29:32.114
maybe a vision,

1034
00:29:32.254 --> 00:29:33.155
a vision for pharma?

1035
00:29:33.375 --> 00:29:35.437
Because everything you're telling me is fascinating.

1036
00:29:36.098 --> 00:29:40.061
I think we've only covered a tiny part of everything you have to tell us,

1037
00:29:40.101 --> 00:29:40.702
but I've already.

1038
00:29:41.062 --> 00:29:41.222
Yeah,

1039
00:29:41.262 --> 00:29:43.285
I've already understood a lot about the mindset,

1040
00:29:43.305 --> 00:29:44.046
the organization,

1041
00:29:44.066 --> 00:29:44.446
as you say,

1042
00:29:44.447 --> 00:29:45.067
the vitality.

1043
00:29:45.347 --> 00:29:46.749
And in terms of vision,

1044
00:29:46.809 --> 00:29:49.052
how if we if we take a more global look at pharma,

1045
00:29:49.232 --> 00:29:49.492
maybe,

1046
00:29:50.093 --> 00:29:50.453
I don't know,

1047
00:29:50.473 --> 00:29:51.054
you choose.

1048
00:29:52.572 --> 00:29:52.772
Yes,

1049
00:29:52.792 --> 00:29:53.333
so global,

1050
00:29:53.553 --> 00:29:53.833
local.

1051
00:29:54.053 --> 00:29:54.433
European,

1052
00:29:54.473 --> 00:29:54.593
yeah.

1053
00:29:54.974 --> 00:29:55.274
I'd say,

1054
00:29:55.354 --> 00:29:55.474
well,

1055
00:29:55.514 --> 00:29:56.715
my vision of things anyway,

1056
00:29:56.935 --> 00:29:59.497
after 20 years of looking and seeing things here and there.

1057
00:29:59.837 --> 00:29:59.997
Yeah,

1058
00:30:00.137 --> 00:30:00.357
sure.

1059
00:30:00.718 --> 00:30:01.758
Before getting into my vision,

1060
00:30:01.858 --> 00:30:06.441
I'd say what's very interesting is that every time I went into a country or discovered a country,

1061
00:30:06.501 --> 00:30:07.642
whether it was the Czech Republic,

1062
00:30:07.722 --> 00:30:08.483
Sweden or whatever,

1063
00:30:09.003 --> 00:30:10.984
every time I'd face local teams who'd tell me,

1064
00:30:11.465 --> 00:30:11.725
yes,

1065
00:30:11.825 --> 00:30:12.205
but you know,

1066
00:30:12.665 --> 00:30:13.326
in my country,

1067
00:30:13.626 --> 00:30:14.507
it's completely different.

1068
00:30:15.667 --> 00:30:16.468
It's not different.

1069
00:30:16.844 --> 00:30:17.444
I'd say 50%

1070
00:30:17.885 --> 00:30:19.665
is the same in a way in the mechanism,

1071
00:30:19.745 --> 00:30:20.686
the business model,

1072
00:30:20.726 --> 00:30:22.547
in the state and institutional issues.

1073
00:30:23.127 --> 00:30:23.447
Of course,

1074
00:30:23.547 --> 00:30:23.807
50%

1075
00:30:24.427 --> 00:30:25.328
is specificity.

1076
00:30:26.108 --> 00:30:26.268
Well,

1077
00:30:26.528 --> 00:30:27.669
one is all hospital-based.

1078
00:30:27.929 --> 00:30:30.390
One only does tenders in Denmark and France.

1079
00:30:30.910 --> 00:30:32.291
So there are specificities,

1080
00:30:32.391 --> 00:30:34.172
but there are still a lot of commonalities,

1081
00:30:34.312 --> 00:30:35.072
things in common.

1082
00:30:35.793 --> 00:30:36.313
And contexts,

1083
00:30:36.353 --> 00:30:36.473
too,

1084
00:30:36.493 --> 00:30:37.513
that are somewhat similar.

1085
00:30:37.794 --> 00:30:38.254
Exactly,

1086
00:30:38.334 --> 00:30:39.894
and similar contexts at different times,

1087
00:30:39.914 --> 00:30:40.895
perhaps in that context,

1088
00:30:40.975 --> 00:30:43.116
relative to the country's progress on its realities.

1089
00:30:43.976 --> 00:30:46.397
What I find is we have a pharmaceutical purpose.

1090
00:30:46.477 --> 00:30:47.397
We have an ambition.

1091
00:30:47.517 --> 00:30:50.738
We have a vision as a pharmaceutical industry to provide care,

1092
00:30:50.978 --> 00:30:51.518
good care,

1093
00:30:51.598 --> 00:30:53.419
to save people in some way or another.

1094
00:30:53.739 --> 00:30:54.419
And even for us,

1095
00:30:54.439 --> 00:30:55.339
we talk about patients,

1096
00:30:55.399 --> 00:30:55.959
but in the end,

1097
00:30:55.960 --> 00:30:57.080
it can be our families.

1098
00:30:57.360 --> 00:30:58.760
That's why everyone feels concerned.

1099
00:30:59.220 --> 00:30:59.720
Exactly.

1100
00:31:00.100 --> 00:31:03.601
And I'd find that if our large groups could re-embody a dimension,

1101
00:31:03.661 --> 00:31:05.282
not of financialized success,

1102
00:31:05.362 --> 00:31:07.842
but a dimension more of the care provided,

1103
00:31:08.102 --> 00:31:10.183
the well-being in the care provided,

1104
00:31:10.543 --> 00:31:11.583
with a political vision,

1105
00:31:11.884 --> 00:31:12.124
you know,

1106
00:31:12.164 --> 00:31:13.544
to relaunch innovation.

1107
00:31:13.824 --> 00:31:16.086
relaunch a biotechnological ecosystem.

1108
00:31:16.586 --> 00:31:17.667
To be part of a society,

1109
00:31:17.767 --> 00:31:18.028
you know.

1110
00:31:18.208 --> 00:31:19.889
I think it's a real turn we must take,

1111
00:31:19.949 --> 00:31:21.551
but that requires taking courage,

1112
00:31:21.591 --> 00:31:21.931
I think,

1113
00:31:21.971 --> 00:31:22.451
to speak,

1114
00:31:22.591 --> 00:31:22.992
to say,

1115
00:31:23.152 --> 00:31:23.973
to re-educate.

1116
00:31:24.213 --> 00:31:26.174
We have a big issue finally of putting back.

1117
00:31:26.495 --> 00:31:26.655
Yeah,

1118
00:31:26.935 --> 00:31:27.375
yeah.

1119
00:31:27.376 --> 00:31:28.356
The narrative of science,

1120
00:31:28.357 --> 00:31:28.596
you know.

1121
00:31:29.037 --> 00:31:29.417
Exactly,

1122
00:31:29.457 --> 00:31:30.378
in tomorrow's world.

1123
00:31:30.698 --> 00:31:36.203
I think we need to rediscover how we can perhaps create a service package around the product,

1124
00:31:36.303 --> 00:31:37.344
around patient support,

1125
00:31:37.444 --> 00:31:39.085
in order to transform our business model.

1126
00:31:39.706 --> 00:31:42.288
And maybe we've started to feel our way through that.

1127
00:31:42.548 --> 00:31:44.949
So we'd move from a sale to advice,

1128
00:31:45.009 --> 00:31:49.431
but that requires a lot of societal transformation and interaction with institutions too,

1129
00:31:49.491 --> 00:31:50.471
because you need data.

1130
00:31:51.492 --> 00:31:53.573
And I think there's a real revolution to be had there.

1131
00:31:53.893 --> 00:31:55.334
It's about transforming the partnership.

1132
00:31:55.474 --> 00:31:55.934
Partnership,

1133
00:31:56.094 --> 00:31:57.434
we're in a win-win situation.

1134
00:31:57.995 --> 00:32:02.277
I think we need to create ecosystems where everyone gains one and a half times what they expected.

1135
00:32:03.117 --> 00:32:05.318
These are major projects that don't happen on their own.

1136
00:32:05.518 --> 00:32:06.578
Someone's going to have to lead them.

1137
00:32:07.199 --> 00:32:08.019
We'll have to try them,

1138
00:32:08.059 --> 00:32:09.880
but it's like blue ocean strategies.

1139
00:32:10.260 --> 00:32:10.920
From time to time,

1140
00:32:10.921 --> 00:32:13.081
you just have to add two things together to make a new one.

1141
00:32:13.561 --> 00:32:14.162
Thank you very much,

1142
00:32:14.242 --> 00:32:14.582
Guillaume,

1143
00:32:14.642 --> 00:32:15.782
for those final words.

1144
00:32:16.643 --> 00:32:19.204
To say we've been on a great journey through innovation,

1145
00:32:19.304 --> 00:32:21.645
business models and innovation across geographies.

1146
00:32:22.045 --> 00:32:23.345
To finally tell ourselves that,

1147
00:32:24.346 --> 00:32:24.466
no,

1148
00:32:24.526 --> 00:32:25.506
we're not all that different.

1149
00:32:26.327 --> 00:32:26.727
Exactly.

1150
00:32:26.947 --> 00:32:28.287
I think we have the same goal.

1151
00:32:29.468 --> 00:32:31.949
If our listeners want to ask you questions or contact you,

1152
00:32:32.169 --> 00:32:33.349
where would you like to direct them?

1153
00:32:34.730 --> 00:32:34.870
Well,

1154
00:32:34.970 --> 00:32:35.690
through my LinkedIn.

1155
00:32:35.930 --> 00:32:36.551
On your LinkedIn.

1156
00:32:36.731 --> 00:32:37.071
There you go.

1157
00:32:37.711 --> 00:32:38.251
That's perfect.

1158
00:32:38.732 --> 00:32:39.532
And thank you very much.

1159
00:32:39.940 --> 00:32:40.460
See you soon.

1160
00:32:40.601 --> 00:32:41.221
Thank you very much.

1161
00:32:41.341 --> 00:32:42.622
The lesson of this episode,

1162
00:32:42.662 --> 00:32:43.523
if there is one,

1163
00:32:43.603 --> 00:32:45.784
is that execution is not a straight line.

1164
00:32:47.285 --> 00:32:48.866
It's an ecosystem of actors,

1165
00:32:48.986 --> 00:32:49.647
provinces,

1166
00:32:49.827 --> 00:32:50.447
partners,

1167
00:32:50.687 --> 00:32:51.068
whatever,

1168
00:32:51.228 --> 00:32:51.828
solutions,

1169
00:32:51.868 --> 00:32:52.208
whatever,

1170
00:32:52.389 --> 00:32:54.270
that we reinvent as we go along.

1171
00:32:55.471 --> 00:33:02.475
And what allows us to hold on in such a complex environment is the clarity of the final objective and not the rigidity of the path.

1172
00:33:02.856 --> 00:33:05.457
I have the feeling that it's something we often tend to forget.

1173
00:33:06.678 --> 00:33:07.599
In the next episode,

1174
00:33:07.639 --> 00:33:09.000
we're changing gears once again.

1175
00:33:09.372 --> 00:33:10.853
We're no longer talking about systems,

1176
00:33:10.914 --> 00:33:12.095
we're talking about the field,

1177
00:33:12.335 --> 00:33:13.436
unstable markets,

1178
00:33:13.736 --> 00:33:14.977
teams under pressure.

1179
00:33:16.259 --> 00:33:18.300
And a simple principle is that ultimately,

1180
00:33:18.441 --> 00:33:19.702
when everything is moving,

1181
00:33:19.782 --> 00:33:21.784
the only mistake is not to move forward.

1182
00:33:22.324 --> 00:33:23.625
We'll be with Mark Gailardou,

1183
00:33:23.826 --> 00:33:27.009
who talks to us about this from the EMEA zone,

1184
00:33:27.189 --> 00:33:27.889
Eastern Europe,

1185
00:33:28.070 --> 00:33:28.930
Middle East Africa,

1186
00:33:29.151 --> 00:33:29.831
at MSD,

1187
00:33:30.172 --> 00:33:32.874
where he was the head at the time this episode was broadcast.