With diabetes rates climbing globally, the race is on to come up with medical innovations that can alleviate the condition for hundreds of millions of sufferers — and, ultimately, come up with a cure.
In 2019, the World Health Organization (WHO) reported diabetes was the ninth leading cause of death, with an estimated 1.5 million deaths directly caused by the condition. About 463 million adults were living with diabetes in 2019, with the number predicted to rise to 700 million by 2045, according to the International Diabetes Federation, citing the latest data available.
Among the many side effects of the disease, loss of eyesight is among the cruellest. Almost three percent of cases of blindness globally is caused by diabetes, WHO says.
Yet, if Oculis, a Swiss clinical stage biopharmaceutical company, is successful with its plans for a breakthrough treatment that’s in clinical development, diabetes-induced blindness could be managed for the first time ever using a non-invasive approach, saving patients from the current burden of treatment and improving access to care for millions.
The Lausanne-based company, established in 2017 from a university project started in 2007, has been working on a solution that uses eye drops to treat diabetic eye disease, more specifically diabetic macular edema (DME), avoiding the invasive injections that are currently the main way to administer drugs to the back of the eye, where the retina is located.
Dr. Riad Sherif, the company’s Chief Executive Officer, explains that the notion that there could be an easier, better and comfortable way to treat diabetes-related eye conditions occurred to an Icelandic ophthalmologist, Einar Stefánsson, at the end of 1990s, when he was confronted with the fact that many patients were unwilling to be treated by injection.
“Patients were not coming to their appointments for injections, and others were refusing them outright, so they were not getting treated, which worsened their prognosis,” says Sherif, an Algerian-French citizen who qualified in medicine in Algeria before spending the bulk of his career in various roles at Sanofi and Novartis, respectively the French and Swiss pharmaceutical companies.
The ophthalmologist teamed up with a pharmacist, another Icelander named Thorsteinn Loftsson, and the pair started two decades of academic research into finding a way to deliver drugs into the retina – viewed by many as “mission impossible”. This would be particularly helpful, they felt, in treating DME, a disease relatively common in diabetics and which manifests in the form of damage to small blood vessels in the eye, caused by high blood sugar due to poor glucose control
Oculis is now in clinical trials with a drug that can be applied through eye drops to treat DME. “I believe our unique therapy will be able to treat patients earlier because, in general, patients wait — because they don’t like, unsurprisingly, the idea of a needle in the eye. Yet while they wait, their prognosis worsens,” explains Sherif. “So, with an eye drop, the doctor can use an early intervention to treat the condition immediately at the point of diagnosis.”
A second drug, also in clinical trial, treats so-called “dry eye”, which Sherif says is estimated to afflict up to 500 million people. Dry eye has increased during the COVID-19 pandemic, given the effect on many people’s eyes as a result of increased periods spent in front of computer screens. “We have all been spending time on Zoom and similar tools. The overall continued increase in screen time at all ages is causing strains and other issues for our eyes,” Sherif explains.
Preparing for medical business
Medical training is obviously beneficial for someone leading a healthcare company. But it is relatively unusual to find a chief executive who is medically trained, like Sherif. It is also unusual to find someone who went into the medical field knowing that a future in the business world was their ultimate ambition — and that medical training could prove useful training for leadership roles in business.
“I always wanted to go into business, from the start,” says Sherif. “I grew up in a family where being a doctor was almost a prerequisite: my grandfather was a doctor, so I did medicine too. I learned a lot in medicine, in terms of acting fast to fix the short term while always thinking about the long term as well, managing multidisciplinary teams, and taking decisions without having all the information in case of emergencies. On top of the science, it’s an excellent training.”
“As soon as I finished medical training, I wanted immediately to go into business. I had the conviction that the combination of a science background and a business background would put me in a very strong position in pharmaceuticals,” he explains.
Sherif attended the ESCP Business School, which teaches “responsible leadership” across six campusus in Europe, including Berlin, London and Warsaw, before joining Sanofi as International Brand Manager, Africa and Middle East, based in Paris.
It was at Sanofi, and later at Novartis, which he joined in 2002 as Global Sales Manager Transplant and Immunology, that he started to formulate three elements that define his approach to a business career: to learn, to solve business challenges and to build a business.
“I have to say I was lucky to be in leading companies like Sanofi or Novartis, where I truly was able to proactively manage my career and go where I would learn something valuable, or where there was a business challenge and I could be part of solving it, or where there was something to build. These are perhaps my three drivers,” Sherif says.
The opportunity to build a business came in 2016 when he was working as the President of Europe, Middle East and Africa (EMEA) Region for Alcon, previously a division of Novartis that focused on ophthalmology. Sherif was approached by Novartis to become “entrepreneur-in-residence” at the company’s venture fund, a role that involved evaluating biotech companies that might be of interest to Novartis as an investment opportunity.
This marked a significant departure from leading Alcon EMEA, a business with $3.2 billion in annual revenues and 4,000 employees at the time in Europe. Sherif says he was attracted to the idea of venture capital because of prior experience setting up a company in 2009 called Synergium, now a big player in vaccines in South America.
“I had already tested what running a startup was like. On top of that, I was attracted to, and inspired by, the opportunity to move to the startup world. I had always wanted to move to startups at some point, but I didn’t know how VCs [venture capital firms] operate. It was totally new for me,” says Sherif. “After a few months, I realized that I actually liked the operations side, which I told my boss at the time. He said, ‘Listen, you are an expert in ophthalmology. Find a company you really like, convince us that it is a good investment to make, then we will finance it, and you would become the CEO.’”
Shortly after taking up the new position, Oculis came into view as a possible investment opportunity. Given his time in ophthalmology, Sherif was asked to lead the whole process in relation to a possible investment in Oculis, from due diligence to completion, once the decision had been made to invest. The process went beyond completion, as he was made Chief Executive Officer as part of the venture investment.
Harnessing wisdom from large organizations for new ventures
Not everyone with years of experience in a corporate environment would have adapted so easily. But Sherif believes that his years of working in leadership positions at a large company has helped. “I think what we don’t realize is that we learn a lot in big companies. We are surrounded by experts in various functions. I think I would not have been the person and the CEO I am today at Oculis without these 20 years in big companies,” he says.
“So, my recommendation is that big companies are great for the experience, for the learning you get, but if you want to do things by yourself and to test something and to take some risks, you can do that too.”
Pivoting to a smaller, nimbler organization that’s constantly dependent on external financing has brought other lessons. Sherif believes that leaders intent on running their own business generally need to know a good deal about the sector in which that business is operating, in particular, if keeping investors engaged is a priority — as it is with Oculis.
The company recently secured $57 million in “Series C” financing in an over-subscribed round that was co-led by investors from the US, Europe and China.
“I think not knowing the business is not an option,” Sherif says. “Furthermore, investors aren’t just investing in the product, they are investing in a team (talents) among other things. That’s because investors rightfully believe that if the product does not work initially, a star team will be able to turn it around.”
Running a company like Oculis, which is heavily focused on the development cycles typical of the constant innovation seen in the healthcare sector, has also changed how Sherif sees the role of a leader. At Oculis, he sees his role as “being able to zoom in and zoom out”, balancing day-to-day management with looking ahead to a longer-term vision.
“This is perhaps how it’s different at a big company, where you have big teams that are responsible, so you can step back. Here, you need to be capable of zooming in and out all the time. This is perhaps the characteristic of working in a startup, being able to know the details but also having a ‘helicopter’ view, a long-term view, about what you need to do. So, my role is evolving all the time, and I really love it because of this evolution.”