19 Sep On the frontlines of the COVID-19 crisis
Steve Cutler, CEO, ICON, describes his company’s efforts to combat the COVID-19 pandemic and how the crisis has pushed new digital technologies forward.
Can you give us an overview of ICON’s operations?
ICON is a contract research organization. We provide services to the pharmaceutical, biotech and public sectors in the development of drugs and devices. We run clinical trials for pharmaceutical and device companies that want to move their products to the market when they do not have the in-house resources and capabilities to do so. We are outsourced on a contract basis and run trials all around the world. With our recent acquisition of PRA Health Sciences, we have grown to 38,000 people in 50 countries around the world. We collect required data and help to submit the data for approval and registration. We allow biotech and pharmaceutical companies to be flexible in terms of their resources.
We were founded 31 years ago in Dublin and were only five people at the start. Since then, we have grown dramatically, moving to the United States in the 1990s and expanding to Europe, Asia, Latin America, Australia and many other countries. It has been a wonderful journey going from a five-person start-up to annual revenues approaching $6 billion and getting close to having $20 billion in market capitalisation. It has been an extraordinary story, and one in which Ireland has played a major role. Most of our senior leadership team are in Dublin, and we have a significant workforce in Ireland — approaching 1,000 people.
What makes Ireland an attractive place to do business?
Ireland punches above its weight in terms of what it does and how it contributes to the world stage. It is a country with a small population of only five million people. However, the country is well situated and sits as a conduit between U.S. operations and Europe. Due to Brexit, Ireland is now the main English-speaking country in Europe and has a particularly significant opportunity to be an intermediary between other parts of the world and the European Union. Our workforce is extremely well educated and innovative. It is a labor force that is very open and willing to travel and engage with other cultures. This unites many characteristics that make the country well suited to perform on the world stage and be a coordinator of business activity across the globe.
How have partnerships with Irish entities supported your company’s growth?
Enterprise Ireland and the Irish government have given us tremendous support. They helped us build capabilities within Ireland and provide new jobs. The tax rate in Ireland is positive for us. Being an Irish-born-and-bred organization has allowed us to redeploy our capital and reinvest in further business developments. The environment in Ireland has been very positive from corporate, communications, cultural and labour availability perspectives.
In terms of universities, we have great partnerships with University College Dublin and Trinity College Dublin as well as others to develop and bring graduates into our business. We collaborate with them on executive training and leadership courses. Our partnerships have ranged across the spectrum with different organizations within the country; they have brought a great deal of value to ICON.
How has the acquisition of PRA Health Sciences strengthened the company?
The acquisition has transformed our business and doubled our size and revenue. ICON had revenues around $3 billion in 2020 and will get close to $6 billion in 2021. We’re looking to continue to develop and grow as an organization. The PRA acquisition has brought us wonderful new technology in decentralized clinical trials and new patient-centric approaches that allow us to speed up the digitization of clinical trials. As a partner to our customers, we need to be involved in ground-breaking innovation; we need to continue to push forward new ideas and solutions. We have been able to create interesting opportunities for customers with the technology that PRA brought to our Accellacare global research network, and our home health networks. The synergies from a revenue and capabilities point of view will allow us to bring forward fully integrated, efficient and compelling solutions for our customers to improve the development of their drugs and devices.
How do you leverage your research and development department to come up with new innovations?
Our research and development are around how we operationalize clinical trials and how we bring new technology, data, analytics and processes together. Ireland is an important part of that. We acquired FireCREST about a decade ago. They are a technology group that supports investigators’ sites around clinical trials. They help provide training and information on protocol. Information surrounding the clinical trial can be obtained from and submitted to the site through a portal or website. This allows us to run clinical trials more effectively. They have been a big part of our continued development and a perfect example of Irish innovation.
How instrumental was ICON at combating the global COVID-19 pandemic?
It’s a matter of public record that we helped Pfizer run their large-scale coronavirus vaccine trial that was first to market in just 250 days from start to the emergency use authorisation and thus helping get people vaccinated very early on. We were proud to be a big part of that. We had around 1,000 people working on the big phase-three trial in North America, South America and Europe. We organized the sites and made sure we followed the nearly 50,000 patients in the trial, collecting and reporting the data and working with our colleagues at Pfizer to get the vaccine initially registered on an emergency-use basis and later a fully approved basis. Other trials around pediatric populations and pregnant women are ongoing. Our involvement is a source of pride for ICON and Ireland.
The pandemic helped us think differently in how we do trials. Offsite monitoring and management of trials and other digital techniques and technologies have taken a quantum leap forward. If there is a silver lining coming out of the pandemic, it is that we now recognize our ability to move ourselves forward at a dramatic pace. We must take these important positives out of what has been a very challenging global tragedy.
What benefits have come from recent investments in vaccines and the biopharma industry?
The pandemic has precipitated many major changes, particularly in our industry. Everyone knows what a clinical trial is now and the contribution the biopharma industry has made in bringing the COVID-19 vaccines to the market. Some of the new technology that has come out of these vaccines, such as messenger ribonucleic acid (RNA), applies not just to the COVID-19 vaccines, but to the flu, zoster, respiratory syncytial virus and oncology. The potential that messenger RNA technology has to treat a whole different group of diseases is extraordinary. We want to be a key part of helping our customers realize the potential of such scientific advances for the benefit of society.
How have new digital technologies helped ICON push efficiencies in its clinical trials and internal operations?
New technologies are being applied on many fronts. Machine learning and artificial intelligence are being used in more routine tasks to file documents and process case reports. Robotics and machine learning offers us an opportunity to move the more routine tasks away from our associates and have them use their brains and skills in a way that engages them and allows them to feel more fulfilled.
Additionally, we can use technology to improve the way we collect data in clinical trials in a much more effective way. Wearable technologies allow us to manage and monitor heart rate, blood oxygen levels, blood sugar and pulse rates, for example. We have a group called Symphony Data through which we can collect data from pharmacies, mainly in the US. We receive data from several hundred million patients that allows us to see — on a de-identified basis — the diagnoses, the drugs they are being treated with and the consequences of treatment decisions. Our ability to map and monitor that data allows us to be much more effective in how we run trials and actions and conclusions we take from the collected data. There are a variety of ways in which emerging technologies are aiding us to be more efficient as we head into the future.
How important is sustainability to ICON and other Irish companies?
ICON and the government of Ireland take the impact of climate change on our environment and minimizing our carbon footprint extremely seriously. We are looking at how to travel less and have fewer requirements to be on aeroplanes. For example, we normally ship out sample tubes from our central laboratory that provides testing on blood samples from patients in trials. In the past we have let the sites order as many as they would like, which has led to a significant amount of wastage. We have changed the way we do this and predict how many tubes they need based on the number of patients they are likely to recruit. Consequently, tubes are not thrown into the trash and wasted if patients do not get recruited. Even in these little ways, we are always trying to find out how we can do thing be better.
On the more social side, we have ongoing initiatives in terms of diversity and inclusion. We feel strongly about being a more and more diverse organization. A significant majority of our company are females, and we encourage women to come forward and be well represented at senior management levels. We also want to make sure racial and physical disability diversity are important components of our efforts. Diversity brings significant strengths and advantages to organizations; diversity of opinion and approaches allow us to get to the best solutions.
How significant is the relationship between the U.S. and Ireland?
The relationship between Ireland and the United States is incredibly important and rooted in significant emigration over the last couple hundred years; there is a large Irish diaspora based in the United States. The Irish heritage in politicians and in all levels of society in the United States is palpable. Those links provide an opportunity for Ireland to be its own entity in terms of a partner in trade and foreign policy. Ireland is a highly effective collaborator, and its people are open and transparent. American business appreciates working with countries and people who are straightforward and have a can-do attitude. Enterprise Ireland and several other groups have facilitated our deep relationship, which is appreciated on both sides. The US is also incredibly important for ICON. It is our largest country in terms of number of employees and many of our customers are headquartered there. We also recruit a lot of US patients into our global trials.
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