Axios International's 25th Anniversary

Axios International completes 25 years of operation in 2022. What has been the key inspiration / vision that has helped the company grow?

The building of Axios International1 is very strongly connected with my experience of working with WHO, as part of the UNAIDS Drug Access Initiative. As a part of this initiative, I was in-charge of negotiating with pharmaceutical companies to launch one of the first antiretroviral (ARV) access programs in some of the emerging economies of the world which helped address the rising incidence of AIDS. Once these programs were successful, I realised that access would not be limited to just HIV treatment but in fact, should be used to address several unmet needs of people across different diseases. And with that vision, we founded Axios International in 1997. And ever since, our vision has remained the same – to enhance healthcare access for people across the world.

How has Axios International impacted the lives of patients over the last 25 years? What has been the company's global and, more specifically, Asian footprint till now?

At a global level, Axios International has reached more than 9 million patients over 100 countries in the last 25 years.

In the early days, we were only focused on supporting poor patients with access to healthcare, but we gradually realised that there is a large segment of middle-class people who are neither rich enough to buy medication nor poor enough to get donation. Over the years, we've tried to address the needs of this segment through innovative tools and personalised cost sharing programs. We strongly believe that simple price reduction or rebates are not the route to build healthcare access, and companies need to consider the entire treatment cycle, and constantly follow up with patients to ensure that they stay on treatment and benefit from optimum health outcomes.

1 https://axiosint.com/

In Asia, ageing populations and high healthcare needs demand that healthcare stakeholders work with each other so that their combined strengths can effectively address the diverse needs of people. Axios has always believed in multi-sectoral collaborations, and we look forward to working with Asian governments and other stakeholders to support people in JOSEPH SABA

CEO, Axios International

the most effective manner possible. In fact, in Malaysia, we've a partnership with the National Cancer Society2 to ensure that cancer patients are comprehensively cared for , covering all aspects of treatment right from understanding of the disease, to access to healthcare and finally, to adherence for long term benefits. Apart from oncology, we also run a range of patient support programs in Asia that cover multiple therapeutic areas, including immunology, haematology, psychiatry, pulmonology and gastroenterology.

How do you define healthcare access and adherence and how do you ensure that your patient support programs can help achieve both?

Going back to my initial working days when I was a part of the UNAIDS program, I had a strong realisation that treatment plans only work if they are followed through by patients completely and are not left mid-way. This is the only way to maximise patient’s medical benefits. And so, this has been our guiding principle while working at Axios International throughout. We've always ensured that our patient support programs carried a critical component of patient follow-up. This component ensures that Axios is engaged with patients even after they leave the physical settings of a hospital or clinic

2 https://cancer.org.my/ leading to long durations of treatment cycles and hence, optimum health outcomes. In fact, some of our past studies have demonstrated that patients who are part of the Axios' programs have much longer treatment durations than even patients who are completely reimbursed, highlighting that a proper follow up with patients after they leave the hospital is key to delivering quality treatment.

What has also assisted treatment adherence is the development of scientific tools like Patient Needs Assessment Test (PNAT)3 by our team at Axios International. PNAT is an insightful tool that understands why certain patients drop out of treatment cycles, the various reasons beyond price affordability that can play an important role in impacting patient will to stay on treatment. This tool has further expanded the scope of our programs, ensuring that adherence is strongly ingrained in all our access solutions.

How big is the Axios family currently, and how do you ensure that all of them have a strong commitment towards building healthcare access?

Our Axios family has grown substantially over the years, and we have a strong team of over 200 employees today. We’ve our international offices located in Africa, Asia, Middle East, and Europe that work with healthcare stakeholders across the globe to ensure that we can support populations in most of the developing countries and emerging economies of the world.

While our teams have different areas of expertise but the one thing, they've in common is the commitment to empower people with healthcare access. We ensure that when we seek staff, we look out for this commitment in particular and as we work together, we further instil the spirit of this purpose through internal engagement. Patient-centricity

3 https://axiosint.com/adherence or providing highest quality service to our patients has always been the motto at Axios International; our employees understand and practice it sincerely and all our patient support programs are designed accordingly.

Tell us about some of the key initiatives undertaken by Axios International that have helped the company improve patient experience while setting new benchmarks in the industry?

We’re proud that Axios International has always evolved over the years to build tools and systems that serve patients in the most effective manner, immaterial of where they are.

Our fundamental achievement is in the design and development of our patient support programs that are based on scientific analysis and are personalized for optimum outcomes. Unlike many players in the healthcare access space who seek to support patients through subsidies and short-term incentives, our programs take a comprehensive view of treatment plans and offer access solutions with the help of scientific and insightful tools like Patient Financial Eligibility Tool (PFET) and PNAT.

PFET is a unique confidential assessment tool that helps determine the true financial capability of patients by considering three key parameters – income, assets and standard of living. PFET ensures that we can offer treatments to a large community of patients who are neither rich enough to buy medication nor poor enough to receive donations. Based on this tool, we design our cost sharing programs where patients pay only a part of the treatment cost, and the rest is funded by other healthcare stakeholders in the ecosystem.

PNAT, on the other hand ensures that patients stay on treatment for longer durations, increasing their overall probability of improvement and full recovery. PNAT aims to understand the unique requirements of each patient across 5 key dimensions - social and economic,

therapy related, patient related, healthcare team and system, and condition related aspects. It is used to understand and address the many barriers, patients and their families encounter daily as they strive to maintain optimal health. Our other big initiative that has helped patients tremendously, especially during the ongoing pandemic, has been the offering of our digital healthcare solutions, Axios+4. We are in the digital age and we need to leverage this technology to better serve our patients. These tools have further helped us engage with patients after they leave the physical settings of a hospital and have allowed us to communicate and follow-up with them through their treatment cycle. It is after all, the follow-up with the patient which is of tremendous importance and plays a big role in them sticking to their overall treatment plan.

COVID-19 has exposed several inefficiencies within the healthcare sector in Southeast Asia and beyond. How did Axios respond to the pandemic and how did you ensure that your patients were looked after throughout?

In the middle of 2016, when we were working on our access and adherence solutions, we realised that a gap existed once patients left the physical settings of a hospital. Since patients were not in touch with healthcare providers anymore, there was no certainty that they would follow their treatment schedules as planned which could lead to suboptimal health outcomes. And that is when, we started working on our digital healthcare solutions to ensure that the engagement between Axios International and patients is continuous and unhampered.

As a result, when the COVID-19 pandemic struck the world, I'm proud to share that our patient support programs remained untouched, we looked after our patients just the way we were caring

4 https://axiosint.com/digitalsolutions for them before, and there was no negative impact on their treatments. With the help of our digital solutions, our program managers ensured that we constantly communicated with our patients, that they received their treatments and there were regular follow-ups. In fact, COVID-19 illustrated the need to be in touch with patients in the space outside hospital settings and throughout their treatment journey, something that we at Axios International were anyhow doing through our programs.

What is the future of healthcare access in Asia and what role do you see Axios International playing in it?

Healthcare access will be strongly linked to reaching patients outside the hospital space going forward, and digtialisation will play a big role in achieving it. Also, access will not just be about making medication available, but it will focus on patients receiving their full course of treatment for optimum health benefits.

The healthcare sector will also need to prepare itself holistically to ensure that whenever next public health emergency strikes, we have all the resources to tackle it efficiently. We should be able to reach out to our most vulnerable patients and look after them in the most comprehensive manner.

The future of healthcare will also be about personalisation. We will see lots of personalised medicines being produced which will have to be matched with personalised treatment plans and follow ups.

Multi-sectoral collaboration is another area which will be important in the future of healthcare. No single stakeholder has the wherewithal to serve large communities of patients, partnerships between public and private sectors will gain more importance leading to the development of synergistic models which will strengthen healthcare access.

Finally, more relevant data will be needed to inform decision-making - data from access programs will provide breakthrough insights on the disease evolution, treatment, patients’ perceptions, outcomes and cost. Healthcare actors and professionals will need to explore approaches to capture accessrelated real-world insights (RWI) to better understand the impact of access interventions so that more efficient ones can be designed in the future.

I believe that Axios International will continue to play a dynamic role in the future of healthcare access. Equipped with our comprehensive patient support programs, strong adherence initiatives, digital healthcare solutions, our inclination for partnerships in global/ regional healthcare ecosystem and our investments in capturing RWI, we will always ensure that we serve our patients in the best possible manner. Going forward, we intend to widen our reach across Asia by expanding our patient assistance programs and by covering new chronic diseases to serve a wider spectrum of patients. Building sustainable healthcare access is our vision for Asia, and we will keep working towards it.

AUTHOR BIO

Joseph Saba is Co-Founder and Chief Executive Officer of Axios International, a global healthcare access company with approximately 25 years of specialised experience developing practical and sustainable solutions to patient access challenges in emerging markets. Under his leadership, the company has launched a number of successful drug access programs and developed innovative access strategies and new models for healthcare systems strengthening.

Erbe Academy in Singapore

Learn, Experience, Share

Education is one of the core pillars of the Erbe Group vision. The Erbe Academy program is one of the company's success stories. It provides a network for doctors, nurses and the company's global sales team to gain new knowledge and experience and share it with peers. In addition, the Erbe Academy qualifies employees to act as reliable partners for healthcare professionals and institutions worldwide. Erbe does not merely want to offer products, but also holistic solutions for their customers. Now they are taking the next step and starting to enhance the success story of the Erbe Academy.

As a family-owned and operated business, Erbe develops, manufactures and markets surgical systems for professional use in various medical disciplines all over the world. Erbe technology leads the market in many countries and is therefore an inherent part of the working processes in the OR. The portfolio comprises devices and instruments for electrosurgery, thermofusion, plasma surgery, cryosurgery and hydro surgery. By combining these technologies, innovative applications become possible, particularly in General Surgery, Gastroenterology, Gynaecology, Pulmonology and Urology. Erbe employs more than 1300 people worldwide, over 650 of them in Germany. Approx. 170 employees work in research and development. The intensive collaboration with renowned users from medical schools and hospitals is the key to success with which Erbe successfully furthers developments in medicine.

Christian O. Erbe has been running it in fifth generation since 1996. Following Reiner Thede's retirement, Christian O. Erbe restructures the management board in 2020 with Dr. Helmut Scherer, Daniel Zimmermann, Prof. Markus Enderle and Marcus Felstead.

This new management structure strengthens the future viability of the company, enabling it to achieve the goals of the Group's strategy for sustained profitable growth. To continue this positive development, the Management is focusing on internationalization, digitization, and environmental sustainability and promoting a culture of responsibility in all departments and Areas.

Erbe is opening up new markets and thus expanding its competitive position to be able to offer superior customer benefits as a solution provider, both medically and economically.

Erbe Singapore

Erbe Singapore was founded in 2013 with Fritz Maier as its appointed Managing Director. Erbe Singapore’s core activities are sales, marketing and education and technical services for our products in our region. Our region spans Australia, New Zealand, South East Asia, South Asia, and Korea including the Pacific Islands. In the recent years, Erbe Singapore has taken on global roles in the field of clinical studies, marketing communication and digital solutions.

Fritz Maier spoke to Asian Hospital and Healthcare Management Magazine, about their recent venture: The Erbe Academy in Singapore

Why is education so important for Erbe Singapore?

We work with employees and distribution partners in the region to ensure that our customers receive the right products at the right time and know exactly how to use them. It is therefore important that they are consistently educated on the latest developments of our product portfolio. Our products are safety-related and, if wrongly used, can cause harm to the user and/ or the patient. Therefore, proper education is of utmost importance to us, and a mandatory requirement from the regulators. Furthermore, our products are an integral part during the education of the next generation of Surgeons and Gastroenterologists. We partner up with societies to train basic techniques and new and advanced procedures that incorporate the use of our products.

Tell us more about the Erbe Academy in Singapore. What’s that and how did you establish it?

At the Erbe Academy, we offer many courses and trainings. We share our experience and our know-how and train the participants in using our technologies. We do this for our own employees in sales, technical service and marketing. And we do this for external parties like doctors, nurse technicians, and many more medical disciplines. In the meantime, more than 40,000 persons have taken part in our trainings! At our headquarters in Tübingen, we have a physical academy, worldwide we have been training people “on the road”. Erbe Academy in Singapore will be the first academy abroad. It is based in the German Centre in Singapore and it a makes use of a facility called the Life Science Incubator (LSI) which is a hands-on lab with a simulated operating theatre where people can experience our devices first hand. We can use the meeting and conference facilities for small and large groups. Our office is located there as well.

Which target groups/medical professionals do you address with your academy?

While we certainly address our own employees as well as our distribution partners with typical 1-week seminars, we are planning a large portfolio of customized trainings for nurses as well as doctors in different specialties and fields of expertise. We want our customers to be comfortable and at ease once we install our products, therefore we created this virtual training ground where they can familiarize themselves with our products before they use them in their hospitals.

Do the trainings take place at your premises, on-site at the hospital or digitally via Zoom?

During the pandemic, it got increasingly difficult for us to visit the hospitals themselves, hence we decided to create this space so that our customers can come and visit us with any group size that is allowed. At the same time, our space also has hybrid connectivity, which allows our customers to be trained remotely, not only because of Covid-19 but also the sheer size of APAC that we cover. If a doctor from French Polynesia or Tahiti would like to join us for a training, it would take him or her several days to reach Singapore, imagine that! Therefore, it is more convenient for them to join our trainings digitally.

What is the initial feedback?

During the first Academy training, we conducted the first 5-day International Surgery and Resection seminar. We had 9 participants from four countries and they all enjoyed not only the location of the training but also the training content and the concept of theory and hands-on which gives them excellent theoretical as well as experiential learning experience.

What is the content of the training? What are the objectives of the training?

The content of the training can be a large range but will always include the actual use of our devices and instruments. It could be more focused on how to set them up and how to operate them correctly. Or it could be a training of a specific procedure for example endoscopic submucosal dissection (ESD) which is the resection of early cancer in the gastrointestinal tract. This procedure can be conveniently trained on ex-vivo models and requires repetitive hand skill training that doctors can ideally perform in our new premises.

Training Programs at the Erbe Academy in Singapore – training our employees, distribution partners and healthcare professionals

In a typical seminar for our employees and or distribution partners …we conduct both lectures and hands on sessions that educate them on the different topics/ disciplines, technologies and clinical applications. We mainly conduct two 5-day seminars, 1) Surgery and Resection Seminar and 2) Flexible Endoscopy Seminar. The Surgery and Resection Seminar focuses on General Surgery, Gynaecology, Urology and Hepatology in correlation with both open surgery and laparoscopy. During this seminar, we also focus on imaging technologies, that is used during laparoscopy. The Flexible Endoscopy Seminar focuses on Gastroenterology and Pulmonology. These trainings help our employees and distribution partners to better understand our products and technologies.

The trainings for healthcare professionals will be kicked off with customized trainings for Gastroenterology and Interventional Pulmonology as well as a course covering Basics of Electrosurgery & Safety in the OR. Before developing trainings for other specialties such as General Surgery, Urology, thyroid surgery, liver surgery, breast surgery (which could incorporate the use of ICG fluorescence imaging). These trainings will be targeted at surgeons, endoscopists, nurses and biomedical engineers.

We plan to have these didactic sessions on a weekday afternoon, combined with lectures, cases discussions and practical session into a 2-4hrs package. Now, let’s have a look at how such a customized gastroenterology and pulmonology training is conducted.

Gastroenterology:

The session starts off with lectures on the fundamentals of electrosurgery (power, modes, effects), before focusing on how electrosurgery can be utilized in gastroenterology applications. (including the introduction of some of our proprietary waveforms such as endoCUT, preciseSECT and softCOAG). The next focus will be on the basics and application of Argon Plasma Coagulation (for angioectasias, radiation proctitis, post polypectomy/EMR margin ablation, etc). Participants will then be given the opportunity to discuss challenging cases and share experiences and solutions. The session will conclude with a practical session in the Erbe Academy – LSI Lab, where participants will be able to apply what they have learned on porcine explants with the endoscope together with Erbe technology.

Interventional Pulmonology:

With a similar training style, IP sessions start off with lectures, explaining ‘Fire & Ice’; electrosurgery, plasma surgery & cryosurgery. Before focusing on the various applicative regions of the lung; central airway obstruction, peripheral pulmonary lesions, interstitial lung disease, lymph nodes and nodule biopsies. After case

I was impressed with the focus on technology and clinical outcomes. I was fascinated by the dedication and passion displayed by the trainers and their profound ability to explain complex theories in a simpler manner.

JAMIE GRIMSHAW

Managing Director Erbe UK

discussions and sharing, participants will experience Erbe technology on porcine explants through a bronchoscope.

The Covid-19 pandemic has taught us the benefits of remote streaming and virtual capabilities. Such trainings could tap on the global reach of experts and connect them to our session. These experts could facilitate the session with live/recorded lectures, demonstrations, surgeries.

How big is your training team, who are the trainers?

The training team currently consists of 8 people and we have started with the first resource here in APAC and we will add more with the course of the growth of the Academy. We have full support from our headquarters in Tübingen, Germany. The trainers from the training team came down to Singapore and it was a great pleasure to collaborate closely with our training team. Our clinical and hands-on trainings are developed and conducted in tandem with the Clinical Application Team, a global team of specialists who spends their time with physicians, figuring out their needs and the appropriate way to teach in simulated environments.

What do the participants particularly appreciate?

The participants enjoyed the hands-on sessions during the training. This allowed them to understand the technologies much better in terms of application to real-life settings. The technicalities behind electrosurgery helped our participants understand our products better. Getting hands-on on the actual devices and performing minimally invasive surgery techniques on ex-vivo models is always exciting and allows even non-physicians to get a glimpse of how difficult it is for example to hold a flexible endoscope.

What are the challenges of training the next generation?

For our next generation, which is used to access their gadgets at any point of time, training has to follow new learning elements. We have particularly singled out 6 elements which are: • Brief and Beautiful – mirroring what they see on their mobile devices • Agile and Accessible – short intervals of digital bursts – just like TikTok • Instant and Intelligent – quick videos and how to articles • Collaborative and Communal – Creating digital communities • Relevant and Relatable – solving real problems that the learner has • Blend and Bind – merging the real world with digital

With these challenging requirements- fulfilling the needs of our employees and customers within a blended hybrid world of learning and having to stimulate the next generation - the Erbe Singapore team is looking forward to fulfilling programs of education in our new space. The Erbe Academy in Singapore – the future is ours.

Fritz Maier is the Managing Director of Erbe Singapore Pte Ltd, a wholly-owned subsidiary of Erbe Elektromedizin GmbH Germany. The electrical engineering graduate joined a French automotive company in Paris from 2000-2004 upon completing his MSc (EE) in Germany. After obtaining experience in the automotive industry, the German native joined Venture Corp, a Singapore-based OEM/ODMmanufacturer, and started their European marketing and design office in Frankfurt, Germany. Despite his busy schedule travelling and managing the two subsidiaries, Mr. Maier completed a Global Executive MBA from INSEAD Business School in 2016