The first death unequivocally caused by COVID was reported to the world on January 11th 2020 – that’s just 303 days ago (even if it feels like a lifetime away). And yet, with interim data announced today showing a vaccine candidate from Pfizer and BioNTech to have at least 90% efficacy, it seems certain a vaccine to protect against a virus that was unknown to science a year ago will be approved in the US and Europe, before the end of 2020. Indeed, China has already licensed a vaccine, albeit without the data that would typically be required to support such an approval.
The global scientific community and pharmaceutical industry is delivering technically challenging innovation at a pace that arguably has never been witnessed before. Which begs the question, why?
At a simplistic level, the answer is obvious: need. We are responding to a pandemic that, at a minimum, is a continuing threat to our normal way of life, and for far too many people a serious threat to their health.
But that cannot be the whole answer. After all, the threat posed by cancer, heart disease, stroke, diabetes and Alzheimer’s, if less immediate is no less severe. Indeed, by most measures the morbidity and mortality burden from many of these diseases are greater than the threat posed by SARS-Cov2. And in response we have a succession of “moonshots” and similar grand plans to beat cancer, and immeasurably more resources poured into research and development across these disease areas over the last decade than has been directed thus far at COVID. And despite that, progress, while real in some limited areas, has been modest.
The real engine beyind light-speed progress towards a COBID vaccine has been strategic focus. Large organisations, from Governments to global pharmaceutical companies, have made delivery of a safe, effective COVID vaccine not just a priority but, for this year at least, THE priority. That’s very different from reeling off a list of “priority areas” as large as cancer, diabetes and Alzheimer’s – that is scarcely any more focused than setting out to be “healthy”.
The power of strategic focus is often overlooked, in part because there rarely is one thing in front of us that matters more than everything else. But we under-estimate the impact on delivering ANY of our objectives if we have too many of them competing for attention. We easily recognise that individuals have only limited bandwidth (because we feel that ourselves), but we readily forget that the same is true for even the largest organisations.
The hidden penalty of diluted priorities is the scourge of productivity in the 21st Century. As more and more objectives are added to a complex task, worthy though they are, they exponential increase the challenge for delivery. As society asks not only for drugs that work, but are safe, affordable, generated sustainably, by a diverse workforce and so on, the barriers to success grow exponentially. Worse still, the extra costs from meeting all these objectives simultaneously are largely hidden, subsumed in the general productivity decline in pharmaceutical R&D.
Transparently, the larger the organisation the greater the risk of diluted priorities. Multiple, unrelated projects vie not only for resources but for headspace too. Even large companies, with tens of thousands of staff still typically retain key decision-making within a small handful of leaders, who, like everyone else, can only think about a certain number of things in a day.
The problem with multiple objectives doesn’t stop with dilution and bandwidth, however. Even worse is the problem of misalignment, when actions to pursue one objective hamper or even set back efforts towards another objective. Ultimately, the incentive driving a pharmaceutical company, like every other for-profit organisation, is the profit motive. Different objectives align with this central motivation to varying degrees and over varying timescales (cutting R&D costs increases profit now; developing better drugs increases profit later; improving sustainability might decrease profits overall and so forth). And the larger the organisation the greater the maelstrom that’s created by these competing priorities.
And through all that noise, the strategic imperative to find a COVID vaccine cut like a knife.
Suddenly with all other objectives subjugated, we have seen the speed of progress, efficiency and effectiveness that stands out like a beacon compared to “business as usual”. For sure, co-operation and co-ordination between organisations (whether between companies or with Governments) has made a contribution too. But the only thing that uniquely sets apart the COVID situation from other “grand projects” is the singularity of focus.
There are useful lessons to be learned from all this. Firstly, it’s a problem that grows exponentially with size. Small companies, such as the asset-centric biotech companies DrugBaron usually works with, rarely have such problems. If you only have one objective, you can benefit from the supercharge of focused strategy the whole time. Indeed the Medicxi asset-centric model was explicitly designed to remove unhelpful strategic misalignment that arises when company managers see raising more funds or securing survival as the central focus, rather than testing the hypothesis that a particular drug candidate has a future…
An ever-larger fraction of real innovation comes from these small, highly-focused operations (not least, the foundational technology behind the Pfizer vaccine, invented by the German start-up BioNTech). This is no coincidence – as the COVID experience illustrates, small size and unwavering focus can generate speed, efficiency and output that dwarfs the ostensibly greater capabilities of industrial behemoths who are befuddled by trying to achieve everything rather than something.
Large companies for their part can recognise the cost that muddled priorities imposes. Internal structures that encapsulate teams with a single priority, and isolate them from the need to juggle a dozen balls, pay unexpectedly large dividends. Simplifying their mission, and refusing to admit distracting demands will, over time, pay off handsomely in terms of objectives delivered and value created.
Even Governments can learn that they have only so many arrows in their quiver. Doing one thing at once has surprisingly large benefits over trying to push forward on twenty different fronts simultaneously. It may be difficult to prioritise between, say, fighting climate change and childhood poverty – but taking the easy way out and claiming you are doing both, which is very much the 21st Century malaise, comes at a high price… it is very likely that you will achieve neither. Paradoxically, it is easy when outside factors, such as a pandemic or even a war, impose strategic focus on us – it is a considerably greater challenge when we need to make those decisions ourselves, creating if need be false priorities to ensure that we at least achieve something. But the exhilarating speed with which a safe, effective COVID vaccine is being delivered should teach us a lesson: strategic focus is a hidden superpower available to each and every one of us.
This piece was based on a panel discussion with Sir Mene Pangelos and Nooman Haque, chaired by Mike Rea, on Pharmaceutical Innovation at the CNS Summit, November 1st 2020
RxCelerate Ltd is an outsourced drug development platform based near Cambridge, UK. We specialize in delivering an entire road map of drug development services from discovery and medicinal chemistry through to formal preclinical development and clinical up to Phase IIa. In the last five years, we have witnessed dramatic changes in the drug development …