Clinical Insights: Market Growth Projected In China and South Africa

By Ed Miseta, Chief Editor, Clinical Leader

Zaher El-Assi is always looking for new opportunities. The president of Merge Healthcare’s eClinical division, which produces cloud-based software for the clinical trial industry, spends much of his time travelling around the globe to locate growth markets for clinical research. He recently had the opportunity to witness the growth potential in two countries: China and South Africa. In this first of a two-part interview with El-Assi, he discusses these overseas markets and the potential they hold for companies conducting clinical trials.  

Ed Miseta: You have been doing some global travel to find new markets for clinical trials. Are there any areas where you see growth potential going forward?

Zaher El-Assi: I recently travelled to South Africa to explore new territories for us. In terms of clinical trials, it is a really unique market. It has an interesting patient population with a diverse DNA pool. The country also has specific diseases and social challenges, including TB and HIV. I believe there is a good opportunity there for companies working on those disease groups. For an emerging market, I believe there is good potential there for trials and for product development teams. That is something you do not see in a lot of new markets. With over 500 sites, that also makes it one of the top 20 clinical trial sites globally.

Miseta: Did you come away with any concerns about the market?

El-Assi: Yes and no. South Africa is not a country that is a leader in technology adoption, but at the same time I felt one of the best opportunities there is how desperate the people are for technology. They want it. They need it. But in many cases it simply remains unaffordable. We were also told by clinical staff that no one had really gone there before or tried to work with them. I visited several sites that were using the most inexpensive EDC (electronic data capture) system they could find, because it was all they could afford. They have just not received the support of the industry in any way, shape, or form.

I attended a conference there called SACRA (the South African Clinical Research Association).  They have done an unbelievable job of getting virtually every single CRO there to be a member, as well as the sites, regulatory bodies, and non-profits. This was a regional meeting held in Johannesburg, so they had a couple hundred people in attendance. I believe they had another 60 at the meeting in Cape Town.   

Right now they are where we [in America] were 20 years ago. They are that far back. But at the same time their mindset is that they have to start doing what others are not, so they might be able to someday do what others can’t. They will simply not accept the fact that they are a developing country or that it is ok for them to fall behind the efforts in other countries.

Miseta: Who were the attendees at these events?

El-Assi: There were a lot of CROs but also pharma people. I believe every major pharma company was in attendance, mainly managers and monitors. Something I learned was that Sanofi has a fairly large presence in South Africa. On the CRO-side I saw representatives of Quintiles, PPD, and several other relevant players. Many local players, as well. 

Miseta: Are there any interesting opportunities you became aware of?

El-Assi: Yes. This is a very appealing market with many unique opportunities. For example, we learned about a potential public health initiative to screen 25 million people for TB. When you start to do the math on that, it could represent a huge opportunity from a data management perspective. There’s going to be a significant need for technology to manage the images, data, and reporting for those 25 million tests. I think there is a good potential for us to get involved there and grow along with them.

Miseta: Any other areas you’re looking into?

El-Assi: Israel is an area worth exploring. We are also looking into China, which I think will be a very attractive market for us. It continues to grow very rapidly for us with a suite of smaller CROs. We are also actively working with Quintiles [Kun Tuo] in China. Every interaction we have had there has been extremely positive. There are plenty of clinical trial opportunities. There is a lower cost to perform trials and a large patient population. That makes it a great place to do studies, and it is probably the fastest-growing clinical trial market globally. A year ago they may have been 23rd in the number of sites, and in one year they made their way up to 12th place. They have created thousands of new sites in just 12 months. That kind of growth is insane.

Miseta: Are there challenges you will face there?

El-Assi: There are. One of the challenges for us is that we are competing against local providers. Some of them are not credible and do not have quality systems that have been validated. Many of the local companies don’t even trust them, but they can’t ignore them because of the price point. If we had to compete only on price I would not go there at all. But we do have the quality card that we can play that helps us to compete. Working with Quintiles and every major pharma company also helps us to build our credibility there. Regardless of how we compete, it’s an area where we have to play because I see China as the largest international opportunity for us in the next 12 to 36 months.

In part 2 of this interview, El-Assi discusses mobile technologies, the promise they hold for trials, and where they stand today.