42-43 - Diversity through development

Within the pharma industry, more companies are focusing on how they can increase diversity not only within their company, but also throughout the product development life cycle and in engagements with external stakeholders.

This change is needed. In the clinical trial space alone, marginalised groups are repeatedly under-represented in clinical trials, despite often being impacted to a greater extent by the effects of a condition.

This problem isn’t abstract – it has real, and human, consequences. In 2019, the FDA halted the roll out of an HIV drug because not enough cis-gender women were involved in the clinical trial. As a result, women who are living with HIV missed out on what could’ve been an essential treatment. Simply put, patients are incredibly diverse, and pharma industry activities don’t yet mirror that diversity. But the foundations of change are beginning to emerge.

In line with the rapid advancements made in digital transformation at every level of an organisation, the capacity for technology to enable a more representative future has skyrocketed. From increasing diversity and inclusion among key opinion leaders (KOLs), to reducing barriers to engagement in clinical trials, technology holds the key to progress.

From advisory boards to KOLs, decisions made within pharma organisations have wide-ranging ripple effects. Trial structure, evaluation and engagement methods are often already pre-determined by advisory groups before patients are even involved.

Expert advisory groups can spark rich discussion, highlight key insights about the trial and improve the process for everyone involved. But in-person meetings don’t uniformly facilitate this type of result, because there can be limitations on who is included due to time, budget and geographic location. It’s often easier to risk including fewer viewpoints – and as a result, trial design, execution and decision-making can be less successful.

With a hybrid virtual engagement strategy, pharma companies can switch the conversation from how many people they’re able to invite to how many people they want to invite. Free from logistical constraints, teams are free to expand into newly gathered insights that may have been missed before. They’re able to include participants who were previously impacted by geography, time and other commitments.

Not only can a more holistic hybrid virtual engagement strategy introduce new participants into key discussions, but this approach can also ensure that experts who tend to be more reticent in a group setting still have their insights heard. Through asynchronous participation in meetings, those personalities who tend to dominate conversation still have their say, but not at the expense of anyone else.

Each input can be considered in its own time, with equal opportunity for involvement from all participants. This democratisation of discussion can elevate voices that may have previously been overlooked, talked over or not considered properly. In particular, patients with privacy concerns, less experienced junior HCPs, and groups that historically experience bias can fully contribute and add much-needed perspective and nuance to any conversation.

According to the European Medicines Agency, as trials have become more complex, the cost of bringing a drug to market doubled in the period from 2010 to 2018. A large factor driving the increased complexity is lower patient recruitment and retention rates. Any unexpected developments in the trial process, including patients dropping out halfway through and needing to be replaced, can be costly.

But this cost isn’t just felt in the bottom lines of a trial sponsor, but also in the impact on patients. One of the largest factors determining enrolment and retention in a trial is a participant’s socio-economic status. For patients that can’t take repeated time off work, or for whom transit is a challenge due to health status, location or cost, the basic requirements of trial participation may be a deal-breaker.

By lowering barriers to engagement, technology can make trial participation more accessible. The need for meetings that are fixed in a certain location or time can be avoided with asynchronous remote trial participation, meaning participants will be able to engage in the trial on their own time schedule, often from the comfort of their own home.

Amongst other concerns from the sponsor, the financial impact on a patient can be overlooked in the trial process, but through virtual engagement tools, patients with less money and time are able to engage on their terms.

Often, global collaboration is restricted for participants who may not be comfortable speaking in a second language, or for groups comprising speakers of many different languages. In face-to-face settings, fine details, specialised vocabulary and the need for interpreters can leave key opinion leaders frustrated, dissatisfied and less likely to engage in the process. As a result, opportunities for collaboration aren’t fully realised to the extent they could be.

At a trial level, both cultural and language barriers can dissuade people from enrolling and fully participating in trial-related activities. Information may feel inaccessible, cultural sensitivities may not be communicated fully, and the patient’s sense of belonging in the trial can be minimised as a result.

Through in-built translation tools on platforms like Within3, cross-language communication can be made seamless, open, and most importantly accessible for those who don’t share the same first language.

Once again, this can empower trial patients to participate on their terms. The ability to participate in a native language can be both liberating for the patient and valuable for the trial in gaining a complete consultation.

It’s important to understand not only the potential capabilities of technology to improve diversity in the life sciences space, but the work it is already doing. Recently, our client success organisation worked with a client to design a women’s health patient advisory to gather patient perspectives on attitudes, beliefs and behaviours surrounding menopause.

With a personal topic that could be impacted by different cultural norms, virtual engagement had a key role to play. Through a double-blind trial using pseudonyms and removing personal identifiers, the team were able to identify opportunities to gather patient information in a controlled, comfortable setting. Participants that may have been put off by face-to-face interaction when discussing a personal topic were empowered to participate on their terms.

As a result, the trial team gained a candid data set that was able to overcome cultural and societal taboos.

There are many ways to view the work of pharmaceutical organisations through a diversity and inclusion lens, from diversity of thought among KOLs to empowering patients to participate in trials on their terms. And while there’s no one-size-fits-all approach to building diversity into all levels of a company, technology has a vital role to play in democratising the debate and lowering barriers to KOL and patient engagement for the industry. When applied correctly, it can have transformative effects for those the pharmaceutical industry seeks to help.

More on diversity and inclusion in pharma and healthcare coming up in the September issue of PharmaTimes.