We Want No Patient Left Behind: Dr Anil Kukreja, Astrazeneca

India's reputation as the ‘pharmacy of the world’ has been damaged by the shortages of Coronavirus vaccines. Nonetheless, vaccination of people in the developing countries chiefly depends on bringing Indian production back on track. Astrazeneca India, established in 1979 and headquartered at Bengaluru, Karnataka, is one such firm working in this direction. AstraZeneca Pharma India is the operating company and covers manufacturing, sales and marketing activities of the company in India. Dr Anil Kukreja, Vice President - Medical Affairs & Regulatory, Astrazeneca, speaks with BW Healthcareworld to elaborate on recent collaborations/partnerships and future plans. Edited excerpts:

How is the company dealing with the pandemic?

The pandemic severely impacted us all. We were not untouched by the impact in any way but are proud today that AstraZeneca was able to contribute to saving millions of lives across the globe owing to the vaccine discovery. Our core value of ‘science-led innovation’ gained relevance in a way never imagined before.

Being a patient-centric organisation, we promptly identified the challenges in patient-healthcare professional (HCP) connect when the lockdown hit us and could swiftly develop tangible solutions. Activation of ‘Virtual Patient Care Management Services’ as part of our ‘Beyond-the-Pill’ solution supported with EMR and Telemedicine Services enabled better connection between them during the period of restricted access to physical clinics. We initiated patient education campaigns via our e-Pharma partners across social media channels.

At the business level, we were thinking ahead of time and laid impetus on new age processes such as omnichannel connect with the healthcare professionals. We further invested in a stronger digital ecosystem that enabled virtual connections between our representatives and HCPs and timely delivery of life-saving drugs at the patient’s doorstep. These processes have emerged as industry benchmarks today.

Even today, we follow a completely hybrid mode of working, engaging and leading the business in this new normal.

Apart from the development of COVID vaccine, the consistent achievements in the pipeline, accelerating performance of our business, the extraordinary commitment of our people and continued supply of our medicines played an important role in fuelling our overarching objective of ‘No patients left behind’.

We are embracing digital ways of working, enabling us to collaborate in new ways, apply best practices and solve business problems in real time.

What are the recent healthcare innovations and research that AstraZeneca is undertaking?

We have a constant focus on scientific innovations in therapy areas we are in, our sustainability initiatives are designed to transform the way healthcare is accessed and delivered.

We are committed to developing new medicines to help more patients and healthcare systems globally with innovative and transformative whole disease solutions. AZD 7442, the only long-acting monoclonal antibody cocktail against COVID-19 received emergency use approval for prevention of COVID-19 in high-risk immunocompromised people in United States recently. This monoclonal antibody cocktail has shown effectiveness in immuno-compromised patients i.e., cancer patients, those with chronic kidney diseases, patients undergoing organ transplantation etc. As we continue to develop more ways to tackle COVID-19, we can foresee a future where LAAB therapies would complement vaccines to protect vulnerable people against the disease and help manage the condition in those infected with the virus.

There is a continued need for new options and better outcomes for patients. In HER2-positive metastatic breast cancer who often experience disease progression after initial treatment with available standards of care, we are coming up with Trastuzumab Deruxdecan (TDxd) which has shown significant improvement in the overall survival rate. We intend to bring another first-in-class biologic product (Tezepelumab) with a unique mechanism of action (TSLP inhibition) that consistently and significantly reduces exacerbations in a broad population of severe asthma patients with no phenotype or biomarker limitations. We are enhancing our understanding of disease biology with the aim of treating, preventing and, in the future, even curing complex diseases.

We are also looking to get approvals for wider use of our current products in Diabetes and Oncology as trials are showing benefits. There is a shift in the usage of leading diabetic and cancer-related drugs for a wider scope and we see huge potential for this segment. Examples of such drugs would be like Dapagliflozin, an oral anti-diabetes drug that has shown benefits in not only preventing heart failure but also in managing chronic kidney disease and is being further evaluated for additional indications like Heart Failure with preserved Ejection fraction (HFpEF) as well as post Myocardial infarction. Osimertinib which is used for prolonging survival in Stage IV NSCLC, has now shown results in improved disease-free survival in patients with early-stage NSCLC (most common form of Lung cancer. Similarly, Olaparib has shown promise for select germline BRCA positive early Breast cancer thus offering hope for treatment with curative intent. Acalabrutinib is our first molecule in the Hematoncology portfolio and is best in class medicine amongst BTK inhibitors in the management of Chronic Lymphocytic Leukemia and also approved for addressing unmet needs of patients with relapsed/refractory mantle cell lymphoma (MCL).

Let us know about your recent collaborations and partnerships with hospitals or healthcare startups for healthcare innovations.

We are pioneering new approaches to engagement in the clinic and beyond to deliver a better patient experience and improved outcomes. We have curated a platform with Business Sweden called ‘The India-Sweden Healthcare Innovation Centre’, which is envisioned to develop an ecosystem of open innovation that start-ups and healthcare delivery stakeholders can use to collaborate and address current and future challenges in the healthcare sector in India. This platform will enable the development and scale up of solutions through frugal innovation for affordable and accessible healthcare in line with the objectives of the Government of India. It is a tripartite collaboration between the Swedish Trade Commissioner’s Office, All India Institute of Medical Sciences, New Delhi and Jodhpur including us as knowledge partners.

That apart, we bring patient-centric initiatives from time to time. We recently launched an initiative called 'Project Chariot' to help diagnose and treat patients with Chronic Lymphocytic Leukemia (CLL) in India. We have done this in collaboration with the Rajiv Gandhi Cancer Institute and we have rolled out this programme across North India and Delhi NCR region. Through this initiative, we are aiming to help identify and support the CLL reference laboratories (CRLs) in strategic locations across India and connect peripheral hospitals with their closest CRL and expand the test access to CLL patients across the country.

We have also joined hands with a health-tech startup, Tricog, to roll out another programme called ‘Project HeartBeat’ this year, for early and accurate diagnosis of patients with heart attacks. This project addresses the unmet need for early diagnosis and intervention for patients with suspected heart attack by enabling cloud-based artificial intelligence (AI) supported interpretation of electrocardiograms (ECGs), routing patients to the nearest labs or centres, thereby ensuring accurate diagnosis and timely treatment and ultimately improving patient outcomes.

We continuously explore partnerships with public health institutions such as the hospitals run by Employee State Insurance Corporations & Central Government Health Scheme (CGHS) to co-develop innovative solutions such as 'metabolic management centres', 'asthma exacerbation clinics' and 'skill enhancement curriculums' for doctors and paramedics for improving patient outcomes.

Can you share the details of your global innovation hubs? Also, how are you supporting the healthcare startups in India through your partnership with AIIMS and Business Sweden?

A.Catalyst Network is an interconnected and dynamic global network of more than 20 AstraZeneca global health innovation hubs bringing together digital, R&D and commercial resources to reimagine how we can improve patient outcomes. It encourages connected decision making, collaboration, knowledge sharing, research and development, commercialisation and fostering of innovative technologies.

Through our A.Catalyst Network, we are co-creating challenge-based solutions with and for patients and working with partners to establish integrated and strong health systems that benefit the whole patient experience – from prevention and awareness, diagnosis and treatment, to post-treatment and wellness.

The network embodies our commitment to Growth Through Innovation as ‘a catalyst’ to develop new solutions for patients. It aims to address healthcare challenges, increase access to healthcare and scale and showcase patient‑enabled innovation through partnerships within the health ecosystem.

Developed in 2019 in partnership with the National Association of Software and Services Companies (NASSCOM) and then expanded to include AIIMS Delhi and AIIMS Jodhpur, leading public hospitals, the India Health Innovation Hub was launched to focus on the development and integration of advanced technologies into existing infrastructure. The year 2019 also marked the inauguration of the India-Sweden Healthcare Innovation Centre, developed and supported by AstraZeneca as a knowledge partner in association with AIIMS Delhi, AIIMS Jodhpur and Business Sweden. This is where industry, academia, companies, countries, government and society work together to nurture breakthrough innovation.

This centre provides and facilitates opportunities for start-ups to collaborate and help solve some of the problems in the healthcare delivery landscape of India. As the knowledge partner, we are collaborating and researching with various startups across models to find solutions to current challenges in the healthcare system and the changing public healthcare scenario. Some applications include AI-based technology for predictive health risk imaging and deep learning AI to segregate vitals data. With the groundbreaking work by these startups supported by us, we are fostering a homegrown innovation ecosystem through partnerships across the globe, thus helping in the transfer of knowledge as well as capabilities to bring solutions with wider impact.

Our India Hub focuses on utilising digital technologies, such as Artificial Intelligence (AI) and the Internet of Things IoT and gearing them towards alleviating the healthcare burden in India, where 43 per cent of the overall mortality rate is attributed to Non-Communicable Diseases (NCDs). Our vision for our Health Innovation Hubs is to create and strengthen partnerships across emerging biomedical clusters – to accelerate innovation, increase healthcare access and improve outcomes for society.

What are the research available with the company about the new Omicron variant?

AstraZeneca has developed, in close collaboration with Oxford University, a vaccine platform that enables us to respond quickly to new variants that may emerge.

AstraZeneca’s AZD 7442 a long-acting antibody combination for the prevention of COVID-19, retained neutralising activity against the Omicron SARS-CoV-2 variant (B.1.1.529), according to new preclinical data. The study was performed independently by investigators at the US Food and Drug Administration (FDA), Center for Biologics Evaluation and Research. AZD 7442 is intended to help protect the most vulnerable populations, such as the immunocompromised, who may not mount a sufficient immune response to COVID-19 vaccination. Protecting the immunocompromised from getting COVID-19 could help prevent viral evolution that is an important factor in the emergence of variants.

Another latest independent University of Oxford study supports the use of Vaxzevria as a third dose booster against Omicron.

We are also collecting real-world evidence evaluating the effectiveness against the Omicron variant with academic groups in the southern African region.

Are there any talks with the Indian govt about kids' vaccination?

As a marketing authorisation holder, this question could be best responded by the Serum Institute of India.

Recently 'Subject Expert Committee' rejected SII's application for Covishield booster dose. What's your take on this and what according to you is the future of booster dose in India?

In India, AstraZeneca is not the marketing authorisation holder for the COVID-19 vaccine, Covishield. As such, the marketing and distribution of the vaccine is led by the Serum Institute of India. To the best of our understanding, the Indian Government has approved additional precaution doses of homologous vaccine for frontline healthcare workers as well as for the elderly with co-morbidities.