Brand Vista worked closely with AstraZeneca to position and develop the strategy for new drug, Zavicefta (previously known as CAZ-AVI), an antibiotic specifically developed to treat patients who develop severe, highly resistant infections in hospital. The drug was launched in the US in 2015 by AstraZeneca’s North American partners Allergan, under their brand name Avycaz. And, as part of the AZ divestment of the small molecule antibiotics portfolio, is expected to see first global launches by Pfizer in 2017.
We talk to Simon Smyth (SS), Global Analytics, Forecasting & Insights Director within AstraZeneca’s Antibiotics Business Unit, and Simon Hagger (SH), Senior Global Marketing Director and commercial lead for Zavicefta to find out why robust insight is critical to a successful launch…
Q. What were your roles in the development and strategy of Zavicefta?
SS: As the business insight director my principal role is to deliver the insights that help define the market, inform the unmet need, understand physician behaviour, assess demand and build the product forecast. My remit also included supporting the business development activity, which is an important part of the valuation of any asset.
And over the last three years I have worked with the business development team to support discussions with potential buyers - ultimately, Pfizer was the right fit.
SH: As the global commercial lead, I was the co-chair of the global product team. I had to ensure that the decisions we made around our development programme received an appropriate commercial voice at the right time.
In terms of the strategy, Simon and I worked closely together. We built on insight work and conducted advisory boards and other stakeholder interactions to create a strategy and build a plan for Zavicefta that would optimise resources and deliver sustainable and credible growth for the brand over time.
Q. How important is the gathering of accurate and detailed insight in the successful launch of a new drug?
SS: Absolutely critical. It shapes and drives everything from the pre-clinical stage through to launch.
Insight work shapes the product profiles in response to the wants and demands of the physicians and helps us to understand where the gaps are and how effectively our product fills that gap. Fundamentally, it underpins the product valuation - and therefore ROI - on the project by providing the insights that support the assumptions of the forecast model. It is these valuations which help support the investment decisions the company makes.
SH: Intelligent insight is the backbone to every successful brand launch. It’s the ability to get under the skin of a customer to find those deep, penetrating truths, and to be able to interpret and assimilate those truths - that is what makes the greatest difference.
A great agency will be able to quickly move that customer from a conscious to a more subconscious state, get under their skin and go beyond what they’re preprogrammed to tell us. We rely so heavily on the person leading the insight work to really understand our space, know where we are trying to reach, and navigate their way through to those penetrating truths.
Q. What are the common challenges for pharmaceutical companies when it comes to gathering (and applying) such insight?
SS: Insight work must be of the highest quality and as robust as possible. We need experienced and reliable agencies that we trust to go out into the field and deliver against that brief. It is about distilling the ‘so-what’ from what can be mountains of research - that’s where the value lies. Having an agency that can confidently work independently is also very important.
SH: There are multiple challenges involved…
Firstly, we need to be crystal clear in stating our goals when briefing the agency. Experience tells me that the extra time invested in the project and agency brief pays big dividends downstream.
The second challenge is finding an agency that possesses that rare mix of being able to understand your space in sufficient depth, while possessing an armamentarium of insight techniques.
The third challenge lies in reconnecting with the agency after the research to debrief and assimilate the findings in search of those proverbial penetrating truths. One of the most rewarding things about working with Brand Vista is that they come into a debrief meeting with everything very well lined up and they have already started to put that jigsaw puzzle together.
Q. Pharmaceuticals is a complex area. How did you work with Brand Vista to ensure that they had the necessary understanding to partner with you on the project?
SS: I had a strong referral from a longtime colleague of mine, and she shared past projects and helped me to understand what Brand Vista are like to work with. We gave them the materials, the market opportunity map and brand information and let them get on with it. We were thoroughly impressed with how quickly they got up to speed.
SH: Our relationship was built on trust. To be successful, agencies like Brand Vista need to feel part of the core team, not external vendors.
It meant we had to trust them with conversations and access to materials, and give them the support that they would receive if they were employees of AstraZeneca. We had to let them immerse themselves in our space.
Brand Vista also played their part by filling their teams with quality, seasoned pharmaceutical executives. That instils confidence; it is about being partners.
Q. In the case of Zavicefta and working with Brand Vista, what was different - and better - in the approach to gathering actionable insight?
SS: Brand Vista were able to quickly understand the therapy area and distil key insights and issues from really in-depth research. They also had clarity of thought in both workshops and deliverables, and were exceptionally proactive, as well as being able to work independently. And they were fun to work with!
SH: Brand Vista know the space, they know the insight and they fill us with confidence. They devoted the same amount of time and energy as we did in making sure the brief was clear and well thought out, and proposed various approaches (building on previous experiences with us) in terms of techniques that ensured we could deliver against our research goals.
We frequently interacted during the insight projects, often live during the research itself, challenging our interpretations of the feedback and making tweaks to the interviews. I remember some difficult conversations on more than one occasion as the Brand Vista team challenged our thinking. But we listened, because we trusted them, and often shifted course as a result of their interjections.
Finally, they came back with a polished and insightful client presentation and report where, together, we uncovered many of those actionable insights.
Q. Were there any particular insights which proved to be game changers, or which surprised you in any way?
SH: One of the most telling insights that we uncovered lay in the mindset between the Intensive Care Unit (ICU) specialist and the Infectious Disease (ID) specialist.
The ICU Specialist showed us clearly that they needed another weapon in the fight against resistant bacteria in their hospital setting. While the ID Specialist also had the survival and recovery of the patient as their goal, as custodians of antibiotic policy, they were also about giving the right dose to the right patient at the right time to ensure maximum longevity of the antibiotic for the future.
We uncovered this tactical vs. strategic mindset in successive pieces of work, and it was reflected in our final positioning statement. Ultimately it led us to develop selling and educational materials that would cater for these two distinct audiences.
Q. What are the challenges of launching this particular drug, and how did Brand Vista’s insights enable you to address these challenges?
SS: One that stands out is the ‘Zavicefta’ moments project. Physicians manage patients based on lots of different risk factors, and we really wanted to get a better grip on this and properly understand those precise CAZ-AVI moments, where various risk factors came together in a patient to point to CAZ-AVI as the go-to option.
Risk factors are an important approach because we don’t have a diagnostic test - physicians don’t know what the bug is until days later, and that is part of the problem. Brand Vista came up with a great methodology with which to go out into the field and understand this, and it worked very well. We identified three key buckets of factors that physicians use to assess patients: severity, probability and fragility.
A lot of this work has fed into the creative process. As physicians themselves are likely to be unsure of precise CAZ-AVI moments, we can use this research and analysis to influence the sales and marketing messages and materials to make sure they understand the most appropriate patients to be given CAZ-AVI.
Brand Vista were absolutely fantastic throughout the creative testing, helping us to understand what messages really resonated with physicians and why.
Q. You talk about the creative testing. What creative approach did you ultimately take and why?
SH: We wanted to push the envelope and get out of the traditional pharmaceutical industry approach by moving away from the standard patient images. We wanted the key messages from our early insight work to ring loud and clear in our creative execution.
But the testing of creative concepts certainly met some resistance.
None of our creative work included pictures of patients, so it was very against the grain of the industry nowadays. Some of the focus groups asked us ‘what about the patient?’, but how much of this drug really is about the patient? The decision is being made by the physician to save that patient’s life, so a lot of our imagery reflected the analogies clinicians had used about fights, battles and wars against resistance.
We really stepped out of the box, but we achieved our aim by listening to customers and refining the creative to the point where it was still edgy but it resonated with different customers, whether ID or ICU.
SS: Brand Vista gave us huge confidence internally that the image we ultimately went with was right. The way that Brand Vista conducted that creative research, did all the testing, and presented the insights made it clear that this was an unequivocal winner.
Q. How was the insight applied to help shape and inform the market strategy for the drug?
SH: Through our insight journey with Brand Vista, we came across some experts who argued that the pharmaceutical industry itself holds some responsibility for the resistance problem that we now face, by making antibiotics widely available and financially accessible. Well maybe, maybe not!
But what it did tell us was that the medical community was willing to embrace price points that would cause them to at least think twice and reserve CAZ-AVI for only those patients at greatest risk. We were prepared to go in there with a different mindset in terms of the way we managed the pricing phase of the research plan.
Q. How did the identification of risk factors - rather than having a ‘target patient’ - provide a stronger platform and focus, and is this a standard approach?
SH: It is unusual to plan to launch a product without clearly defined patient profiles. I’m sure that will evolve into more discrete patient pictures later but, at launch, the important goal is to work with our customers to identify risk factors and the combinations that could become a CAZ-AVI moment.
The commercial implication of this approach, of course, is that you need very well trained and informed sales teams in place. Without the traditional clearly defined patient to target a clinician with, the conversation requires an approach at a much higher level.
Q. How important was the fresh pair of eyes and logical approach that Brand Vista brought, and how did this benefit the resulting approach to communication of the product?
SS: I like the fact that Brand Vista aren’t an agency that deals exclusively with healthcare, particularly when it comes to creative and marketing. I like the difference that brings to their view. We can get siloed in our thinking and all start coming from the same angle; Brand Vista weren’t afraid to challenge us…
SH: ...One example of this is the big investment decision we made to go back to a second round of creative testing. Brand Vista said we had a couple of ‘good’ concepts, but that they could be ‘great’ concepts. They advised us to go back and refine them to find out how to take them to that next level, and that was kind of unprecedented with an agency.
It was a decision that involved time and dollars but it resulted in something that was more differentiated, and which clearly articulated that unmet need, giving it clear ownership in the space.
Q. Zavicefta has now been acquired by Pfizer. What role did the insight and rigour applied to the strategy play in attracting them?
SS: Pfizer wouldn’t have seen any of the Brand Vista work when they were determining whether they wanted to do the deal. However, a lot of our insight work underpins the brand strategy and the assumptions that drive our forecasts.
SH: We have now gone through the handover process with Pfizer and shared a lot of those insights, as well as the materials we developed as a result of applying those insights. And they have definitely been impressed with what they have seen so far.