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Hyper-collaboration in thehealthcare and life science industry –The new imperative
Dr. Franziska Thomas, Ben van der Schaaf, Dr. Ulrica Sehlstedt, Robert Smolander,
Matilda Berg, Jacqueline Gross

The COVID-19 pandemic demonstrated the ability of thehealthcare and life science industry to respond to unexpected
needs with unprecedented speed. However, independent of
the pandemic, the industry was already facing transformationin light of multiple, highly disruptive innovations not only inthe traditional field of drug modalities, but also in related
fields such as digital, AI, data and medical devices. This new“Future of Health” is driven by a multitude of new players andinnovations with disruptive potential and new ways of thinking
about health, both at a large scale
for population health and at an ultratargeted level through the potentiallycurative treatment of individual
diseases, such as for CAR-T or genetherapies and precision medicine.
The industry’s response to thepandemic and its transformation
towards the Future of Health may
at first seem unconnected, butthey share the same foundation –innovation is no longer driven by one
or two companies, but rather, by a large number of players
in an extended partner ecosystem, requiring collaboration atan unprecedented scale. Driving innovation at speed requires
all players to think and act in large “hyper-collaboration”
networks.

The successful rapid
development androllout of multiple
COVID-19 vaccines
has demonstrated
the potential speedof innovation within
healthcare and life
sciences. Our third article
explains why the same
ecosystem collaboration
approach is underpinningwider changes inhealthcare, transforming
innovation speed as wemove to the Future of
Health.

What does hyper-collaboration mean?
“Hyper-collaboration is based on the fundamental belief that
it is innovation ecosystems, not individual companies, which
will deliver the novel solutions the world is waiting for. Hypercollaboration means seeing ecosystems for what they are: not justcandy stores full of opportunities, but fiercely competitive arenas
in which companies fight for the best partners, technologies,
and networks to create, build and defend added value. It also
implies adopting a mind-set that, until proven otherwise, someone
somewhere has already figured out what works best – and that it
is unlikely that this person works in your company.” [Ecosystem
Innovation, Prism First Semester 2017]

Although hyper-collaboration itself is not new, it is now
becoming central to success in a growing number of sectors.
Companies that fail to change and adapt risk being sidelined
by newer, more agile players. The remarkable success of
small biotech companies in beating established players in therace for a COVID-19 vaccine is just one recent example of thistrend.
In this article we look at how hyper-collaboration is now
becoming a key success factor for the healthcare and life
science industry, and draw some lessons on how to makeit work effectively. These lessons are also relevant for otherhighly complex industries with new and potentially disruptive
players, such as aerospace, transportation and finance.
A fast-evolving landscape creates a need for
hyper-collaboration
Innovation is happening at a faster pace than ever, withdigital and data-driven technologies alongside new moleculartreatments disrupting the healthcare and life sciences industry
and causing new players to emerge.

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This is manifested through:•	A greater ability to combine basic research and large
data approaches to rapidly improve understanding of thehuman body and diseases.
•	
New tools to develop and deliver medications in termsof both biological tools (such as CRISPR gene editing)and hardware such as robotics and 3D printing.
The time from discovery to clinical concepts has therefore
shortened significantly, with a multitude of new concepts
rapidly emerging and moving into usage.
Innovation across the sector is also becoming much more
complex. The industry has moved from being dominated byseemingly simple chemical molecules that could be applied
as tablets or solutions such as aspirin, to the introduction
around 20 years ago of more complex biological compounds
such as recombinant proteins and antibodies (e.g., insulin
or Herceptin). These have been driving much improved
treatments for diseases such as rheumatoid arthritis andcancer, and have been a major growth driver.
Today, the landscape is changing again, with more and more
complex drug modalities, including cell and gene therapies
and mRNA vaccines (as seen in COVID-19 vaccines), now
becoming commercially available.
The hemophilia example below demonstrates both how
innovation has accelerated over the last decade and how
well-established players can rapidly be made irrelevant by
new and innovative approaches that are often driven by newentrant biotech companies. A further insight is that there are a
multitude of radically different new treatment options on thehorizon, with some uncertainty as to which technology will
ultimately win.

Case study – Hemophilia A
The evolution of treatments for hemophilia highlights thepace of change in healthcare. This rare disease leads touncontrolled bleeding due to a lack or reduced levels of
coagulation factor VIII. The first treatments with coagulation
factors purified from blood became available about 50 years
ago, but were mostly used to treat acute bleeding episodes.
Treatment was revolutionized in the early 90s with the
production and preventive use of recombinant coagulation
factors, which allowed patients to live much more normal
lives and survive much longer into adulthood and beyond,although with a heavy treatment burden.
But then very little happened until, in 2014/2015, approval
was given to the first recombinant factors with extended halflives, resulting in less frequent injections and more effective
treatment. However, there was still a significant population ofpatients for whom the treatment became inefficient throughautoimmune reactions. Although this effect can be treated,
it is a significant burden on patients. This effect has now
been solved by Roche’s Hemlibra®, a bispecific antibody thatmimicked the effect of factor VIII and was initially approvedin 2017/2018. This is now quickly surpassing other treatment
options.
However, in parallel with traditional protein and antibody
treatments, alternative treatment options such as siRNAand, most impressively, gene therapies are about to become
available. The first gene therapy for hemophilia is now inregulatory review, with a potential approval this year, andpromises a complete cure for this genetic disease that will – if
successful – make both existing treatments and those thatare still in development obsolete.

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New alliance models in times of hyper-collaboration

2017/20182014/2015
1992
50 years ago

Factor
VIIIa mimetics

First purified
factor VIII

Factors purified
from blood for
acute treatment
Issue: Contamination
through blood
product, e.g.,
Hepatitis C of HIV

Repair the
genetic defect

EHL1
factor VIII

Recombinantfactor VIIIFirst direct
treatment

Submitted

Modified factor
First biotech
product
Produced cleanly
and w/o blood

Enables easierand better
prophylaxis
Issue: Immune
reactionsGene therapy2
Bispecificantibodies

Potentiallycurative

Better prophylaxis
and no immunity
against factor VIII

Issue: No
long-term data
yetIssue: Life-longtreatment

Issue: Short halflife and immune
reactionsFigure 1: Haemophilia treatment developments

The same effect has also been demonstrated in the race
for a COVID-19 vaccine, in which traditional methodologies
competed with novel and largely unproven new approaches
such as vector vaccines and mRNA vaccines. Ultimately,
these were more successful, but it would have been
impossible to predict mRNA’s resounding success even ayear ago. As technological complexity and innovation speed
increase, effective collaboration becomes central to success.

Managing greater complexity in ecosystems
Oncology (the treatment of cancers) is a further exampleof hyper-collaboration and gives us a taste of the future of
medicine in general as we move towards the “Future of
Health”. Although cancer treatments are traditionally basedon a combined approach of surgery and radiotherapy or
chemotherapy, newer treatments also see combinations withmolecular therapies based on the characteristics of individual
tumors. Additionally, in recent years, we have increasinglyseen approaches using the activation of the immune system,
either in immune-oncology drugs or with the use of ultratargeted cell therapies such as CAR-T.
For the future, there is an expectation that treatments could
well entail the use of between five and seven drugs or drug
modalities in combination, which will require a network ofmultiple players and IPs. In addition to these complex drug
combinations, future treatments will require the developmentof the right diagnostics and tools to analyze tumors, as wellas the right support to analyze and curate the data gained
to predict the right treatment for the right patient (precision
medicine). On top of that, we expect that, with constantly
improving treatments, cancer will become a chronic disease
and require treatment of patients in their own homes,
supported by remote monitoring. This is where innovations
such as Alexa and the logistics offered by an Amazon
pharmacy can bring in additional players and innovations.
Again, this is a trend that was also accelerated by the
pandemic, when immune-suppressed cancer patients wererightfully scared of being treated in hospitals with COVID-19
cases.
This results in significant complexity challenges when it
comes to organizing clinical trials, and also raises questions
around the management of IP in order to make collaborations
more attractive for small biotech or medtech players, as wellas large pharma or tech companies.
How hyper-collaboration helped develop the COVID-19
vaccine in record time
As well as picking the right solution from a widening numberof potential treatment options, innovation success now
depends on hyper-collaboration between multiple players andbiotech companies.
The development of COVID-19 vaccines is a best-practice
example of how companies have tapped into new typesof partnerships and technology to successfully bring novel
pharmaceutical products to market in record time. During theHyper-collaboration in the healthcare and life
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first half of 2020, hundreds of promising COVID-19 vaccine
candidates entered preclinical trials. The majority of thesecandidates were co-developed by pharmaceutical companies,
academic research institutes and governmental agencies,
such as AstraZeneca and the University of Oxford, Arcturus
Therapeutics and Duke-NUS Medical School, and Moderna
and the American National Institute of Allergy and Infectious
Diseases (NIAID). Partnering in such constellations secured
joint access to quality research, as well as drug development
capabilities and funding.
Of the four established global vaccine powerhouses (Pfizer,
Merck, GSK and Sanofi), only the first actually delivered
an effective solution – but solely by choosing an unproventechnology (mRNA) in a new partnership with BioNTech. The
other three major vaccine makers stuck with proven methods
involving much longer timelines and failed to get the same
results. Merck abandoned its trials, while GSK and Sanofi
have some promising vaccine candidates, but are well behindthe frontrunners. GSK has belatedly stepped up its efforts
to build out its partnership with CureVac, another company
focused on mRNA technology.
So what did Pfizer do differently to succeed, not only in thevaccine field, but also by becoming a major player in mRNA
technology through its partnership with BioNTech1?
1.	It acted decisively in mobilizing its resources toward
developing an mRNA vaccine. It bet on an unproventechnology and an untested partnership with BioNTech.
The partnership was started on a handshake, and thecontracts followed later – which is highly unusual in drug
development. In contrast, Merck’s CEO declared earlyon that timelines of less than a year were unrealistic,
and it stuck to its existing development methodology.
1. From “How we did it” by Albert Bourla, Harvard Business Review May-June 2021

2.	Pfizer recognized that the global need and urgency
changed the environment, with risk and short-term
return becoming less important. It went all-in for
the “moon-shot” challenge of a six-month vaccine
development timeline, “doing the right thing” while
also playing the new circumstances well and taking fulladvantage of regulatory flexibility.
3.	It leveraged the partnership with BioNTech optimally,
which is clearly the other big winner in this story.
Well before the final terms of the partnershipwere hammered out, investments were made andconfidential information shared because of mutual trustfrom working together previously.

The importance of ecosystems
However, Pfizer’s success was not due to a single partnership– there was a whole ecosystem behind it. This included theChinese researchers who shared the genetic sequences of
the COVID-19 virus (which made the fast development of all
vaccines possible), the designers of the boxes that allowed
vaccines to be shipped and stored at ultra-cold temperatures,and the developers of the liquid nanoparticle vesicles, which
deliver the mRNA to the cells in the body.

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New alliance models in terms of hypercollaboration
Vaccine developers

Contracted manufacturers

Figure 2: COVID-19 vaccine-manufacturing partnerships

Most importantly, as vaccine candidates moved frompreclinical into clinical trials, their developers began toestablish additional partnerships with vaccine manufacturers
to secure large-scale production capabilities. Given the hugedemand, this required partnerships with up to 20 different
contract manufacturers for each vaccine, which broughtsignificant challenges around complexity and scale.
The hyper-collaboration extended beyond traditional contract
manufacturers, as their capacity remains insufficient. This has
given rise to a new type of innovative partnership, in whichpharmaceutical companies offer their spare capacity to theirown competitors. For example, Sanofi conducts fill-and-finish
activities for BioNTech, while Novartis, which no longer has a
vaccine business, produces vaccines for Pfizer-BioNTech
and CureVac.

Of course, Pfizer was not the only winner in the vaccine race,and others also achieved great success due to collaboration:•	Moderna accelerated its strategy by 3–4 years andwas close on the heels of Pfizer with a highly effective
vaccine. It saw its share price increase sevenfold.
•	
AstraZeneca was not an established name in vaccines
before the pandemic, but it (rather than UK rival GSK)
moved fast and quickly established a collaboration with
the University of Oxford, and delivered an effective
vaccine within the year.
Lessons on managing extended networks effectively
Although alliances are not new to the healthcare and life
science industry, their current scale and complexity are, andthis will only grow over time. Instead of traditional bilateral
networks, partnerships and alliances will often require
involvement of multiple players, including biotech, pharma,
medical device and health tech companies, as well as
academia, payers/providers and even regulators. This makes
it critical to be able to successfully manage not only one or
two collaborations, but a network of hyper-collaborations. The
same is also true for other highly regulated industries, such as
telecommunications and utilities.
Hyper-collaboration brings multiple benefits, including sharedrisk, reduced cost, greater utilization of unused IP, better
access to funding and talent networks, more innovation
capacity, and improved transparency and trust with patients.
However, there are also challenges, including alignment ofgoals, objectives and incentives; tracking progress acrossmultiple partners; managing IP; standardizing processes
around data collection, annotation and sharing; and logistics.
Like any stress test, the pandemic has shone a spotlight on
how well – and how badly – businesses are set up to respondto disruption. Executives should be wary of writing off thepandemic experience as a “one-off”, and instead make themost of it to bring about essential and valuable change.

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Alliance management is different from project management,
requiring a strong focus on governance, communication,
culture, problem solving, and conflict resolution. All types ofpartnerships and collaboration need a well-designed steeringcommittee that oversees the research plans, governs thecollaboration and ensures compliance. This is a key successfactor to prevent and solve problems early on to build therelationships, agree on and manage intellectual property,
and set the overall objectives of the collaboration. As thepartnerships, alliances and networks grow in complexity,
the role of the steering committee will become increasingly
important for success, as it sets the foundation forcollaboration on all levels.
We can draw some lessons from those companies inhealthcare and life sciences that have been successful inpursuing hyper-collaboration:•	
Alliance purpose, strategy and vision – What to lookfor in an alliance		Alliances are collective efforts to achieve a common
goal, with each party contributing certain capabilities/
innovations/technologies. Accordingly, it is imperative
to clearly define the purpose, strategy, and vision of analliance and the key elements needed to achieve thegoal. When building or entering an alliance, each player
needs to understand its role and position, as well as
the role of the other parties involved and what eachshould contribute in terms of human resources, cash,
knowledge, IP, and equipment.
•	Adequate alliance management
With a multitude of different players involved, it will becomplex to align the overall objective and make sure
all players work towards the same goal. Problems that
occur need to be quickly and efficiently resolved, and
it is essential to ensure compliance from each party
involved. The alliance management and governancestructure need to be clearly defined and agreed at
operational, tactical and strategic levels. Sufficient
resources with the right capabilities need to be allocatedto manage the partnership. Specific areas of focus

should include information and data management,
IP management, commercialization of outputs, andoperational models.
•	
Fair risk and benefit allocation – A new
business model?
All parties involved need to be adequately incentivized
to contribute. With collaboration partnerships
becoming more diverse, greater attention needs tobe paid to relevant risk/benefit-sharing models. Witha large amount of IP and innovation involved, this will
require new and innovative business models to sharedevelopment, launch and production risks, while alsooffering fair compensation models outside traditional IP
and patent approaches.
• Cultural change – From competition to collaboration
		Collaborating in alliances requires a different mindset and culture. To make network- and alliance-based
collaboration models work, companies need toadopt an open mind-set to share knowledge, dataand information, while at the same time protecting
key assets. Assess whether your corporate culture
encourages enough entrepreneurial risk-taking, and if
not, how it can be changed.
• Assess and improve your agility		Companies should learn from their pandemic experience
to understand their current level of agility and what canbe done to improve it, as well as assess organizational
set-up and culture from an “ambidextrous” perspective– can scale/productivity capabilities and speed/creativity
capabilities be delivered in a balanced way?

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Although none of these factors alone may seem completely
novel, the need to be proficient in all of them has now
become central to companies that want to remain relevant
leaders in their fields. Healthcare demonstrates this – in the
recent pandemic we have seen examples of big players being
sidelined by small biotech companies or competitors thatwere able to build meaningful alliances, such as Pfizer andAstraZeneca. In the future corporate success will dependon having the capability to build, maintain and drive complex
networks of alliances and collaborations that are attractive toall players – will you be able to shape the future, or will you berelegated to the margins?

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Dr. Franziska Thomas
is the Head of Healthcare and Life Sciences for Arthur D. Little
Central Europe.
Ben van der Schaaf
is a Partner at Arthur D. Little’s New York office and a memberof the Healthcare and Life Sciences Practice.
Dr. Ulrica Sehlstedt
is a Managing Partner at Arthur D. Little’s Stockholm officeand Global Leader for the Healthcare and Life Sciences Practice.
Robert Smolander
is a Manager at Arthur D. Little’s Gothenburg office and amember of the Healthcare and Life Sciences Practice.
Matilda Bergis a Consultant at Arthur D. Little’s Gothenburg office and amember of the Healthcare and Life Sciences Practice.
Jacqueline Grossis a Consultant at Arthur D. Little’s Frankfurt office and a memberof the Healthcare and Life Sciences Practice.