The ongoing pandemic of coronavirus disease 2019 (COVID-19) was first confirmed to have spread in Italy on January 31, 2020. By the end of February the virus started its exponential growth from the Lombardy region. As of today, we have had 231,139 total cases, 33,072 deaths and 147,101 recovered . Since March 8, the country has been in a total shutdown. Most of the Northern hospitals are still COVID-19 dedicated and close to the breakdown, while southern hospitals are managing the hit. In order to face the COVID-19 emergency, one of the priorities of the National Health System was to reduce the flow of non-COVID-19 patients to hospitals by suspending both chronic and new outpatients’ visits. The healthcare professionals (HCPs) are still working under critical conditions and a death toll that is constantly rising (160 deaths among clinicians) . In this scenario, the access to hospital sites has been restricted only to the personnel.
This experience is the first time in decades that the Italian Health System and its HCPs are facing a national emergency. Numerous management problems are emerging regarding both the COVID-19 patients and those non-infected but in need of hospital care. In this scenario of disruption of the status quo and of increasing pressure, the emotional status of the physician plays an important role. Despite the situation, HCPs are still willing to have contacts with pharma companies, a clear sign that we remain their scientific advisors and they need us at their side in this battle (Figure 1). Understandably, their primary focus is not anymore just on our products but on how our knowledge, skills, and tools can support them in winning this fight.
The aim of this article is to share with you the action plan that the Medical Affairs Team of AstraZeneca (AZ) Italy adopted in order to: 1) respond to the COVID-19 emergency, 2) answer to the new needs of HCPs and 3) keep making the difference (Figure 2). We are going to do this from our point of view as MSLs, because we played a key role in implementing the plan and we witness the incredible impact that those actions had on the key opinion leaders’ (KOLs) work.
Face-to-face interactions between pharma and physicians have essentially ceased overnight during the COVID-19 pandemic, but that does not mean HCPs have stopped looking for new medical information. Veeva Engage™ is an application that allows users to plan and make calls with healthcare professionals through video conferencing and online content sharing, either by smartphones, pc or tablets. This effective tool allowed us to be close to HCPs, not only for sharing the scientific evidence concerning our portfolio, but also to grasp their mood, listen to their individual experiences, and be able to guarantee them a more complete scientific information service. The positive feedback that we received from this experience let us think that, even after the current emergency, remote personal interactions will be the new frontier of our job as MSLs.
In order to be prepared for effective interactions with the clinicians, in-house training and exchange were crucial. The Journal Club about COVID-19 was a useful opportunity to improve medical education, to enable medical team members to keep updated about the current medical literature, and to provide an occasion for social interaction. Throughout the weeks, several hot topics concerning the outbreak were discussed, such as the virus mechanism of action , transmission routes , the mathematics of the outbreak  and the associated clinical complications [6-8]. Both MSLs and medical advisors from different therapeutic areas were involved as speakers. The AZ medical team also attended an international webcast held by several KOLs that shared their clinical experience about the new pandemic. All these interesting opportunities provided us with new skills as advisors, and a solid background for peer to peer interactions with the HCPs.
The wealth of new scientific data has been skyrocketing during the pandemic, and an updated ad hoc Medical Information Repository about COVID-19 has been essential to keep up with the literature in a structured way. The COVID-19 repository was made up of original articles, revision papers, consensus documents, guidelines and protocols. All of the files were stored, updated, and easy to access for the medical team members. Using this system, MSLs are able to constantly answer to the HCPs requests with the latest updated material (Figure 3).
Our activity of monitoring and supporting clinical studies and Externally Sponsored Research (ESR) was deeply affected by the contingent situation. COVID-19 free hospitals were mapped in order to carry on studies according to National Pharma Agency emergency guidelines. The collaboration with the Evidence Team allowed to estimate the delay of each study site and re-adjust the milestones of the ongoing ESR studies, and the continuous communication using ad hoc newsletters, granted the drug delivery. In the case of new studies, MSLs participated in virtual site initiation visits together with the clinical operations function. This participation allowed us, as a study sponsor, to guarantee the process and to the study sites to maintain the enrollment.
Finally, as an MSL team we took part in several training sessions to reinforce our fundamental skills in finance, market access, patient safety and regulatory, and good clinical practice. Although basic skills are important, satellite skills are equally essential. Thinking outside of the box represents life skills, being able to solve problems and overcome challenges that we have not seen before. As an MSL team, we have been involved in several training sessions, from strategic marketing, medical information, real world evidence, big data, biostatistics to innovation. Investing our time in development was the best opportunity to grow from these dramatic circumstances and to enrich our support to our clients (Figure 4).
The COVID-19 pandemic threatened our working habits with unique challenges, while also offering peculiar opportunities to work in new and effective ways. Taken together, all the initiatives adopted by the Medical Affairs Team of AstraZeneca Italy have been essential in order to: 1) guarantee quality interactions with our clinicians, 2) consolidate our partnership throughout the development of new competences, 3) give the answers our partners were expecting from us, and 4) keep the projects moving in the best way possible.
 https://portale.fnomceo.it (FNOMCEO, National Federation of Orders of Doctors and Dentist)
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Maria Constanza Oliveros Celis is a medical affairs leader. She is passionate about science and patient care. She has an entrepreneurial spirit and a strong knowledge of oncology and hematology. For more than a year, she served as Vice President Medical Affairs Italy. Leading different therapeutic areas with a special focus on bringing digital technology and innovation into the medical department. Her focus is to have an enterprise approach avoiding silos functions and therapeutic areas. Maria leverages people development and brings together past experiences to a new team. She earned her MD degree in 2000 and specialized in Clinical Nutrition both in Venezuela and Italy. Her PhD in medical biochemistry was earned from the Università degli studi di Bari.
Maria Carmela Filomena is the Medical Science Liaison for the North-West Region of Italy at AstraZeneca Lab. She holds a PhD in Experimental Pathology and Neuropathology from University of Milan and a Master in Pharmaceutical Management from Alma Laboris Business School. After spending many years in preclinical research focused on the skeletal and cardiac muscle pathophysiology, she began her career at AstraZeneca as a MSL in the cardiovascular, renal and metabolic therapeutic areas. She became a crucial point of contact with external KOLs in the identification of medical unmet needs and non-promotional dissemination of best standards of care. Her passion is her work dedicated to delivering optimal treatments to patients. Resilience and serendipity are the key elements of a satisfying private and professional life in Maria’s opinion.
Marco Gorini is the Head of Innovation & Medical Excellence for Astrazeneca Italy. He is responsible for defining and implementing medical innovation strategies and patient centric solutions. He aligns strategies, metrics, and building capabilities for medical teams while also deploying regional initiatives. After spending nearly a decade working in commercial roles in previous companies, he began his medical career as a MSL and a Clinical Science Liaison Manager with several teams. He loves to inspire each member of the team with the same vision and ambition to play to win.
Andrea Iurlaro is the Medical Science Liaison for Southern Italy (Puglia, Campania and Molise regions) at AstraZeneca Lab Italy. He received a Ph.D in Biology and Biotechnology from the University of Salento and he has a solid scientific background. As a MSL, Andrea worked with the most influential KOLs in cardiovascular, renal and metabolic therapeutic areas. He is constantly trying to link his passion for following science with the goal of improving the lives of chronic disease patients. Pragmatic and passionate, he is always seeking new scientific evidence to share with both his colleagues and stakeholders.
Jacopo Marangon is the Medical Science Liaison for the Lombardy region at AstraZeneca Lab Italy. He has a Ph.D in Biophysics from the University Nova of Lisbon and a well-rounded scientific background with several years of academic experience. As a MSL, Jacopo worked in cardiovascular, renal and metabolic therapeutic areas building a strong scientific partnership with the primary KOLs of the region. While at AstraZeneca, he has been involved in several milestone projects about medical education, customer relationship management, and digital innovation. He strongly believes that passion, curiosity and optimism are the key ingredients to personal and professional fulfilment.
Antonio Rossello is the Medical Science Liaison for the Sicily – Calabria – Basilicata regions at AstraZeneca Lab Italy. He has a Pharmacy degree from the University of Catania. He has a solid commercial background from previous work experiences as well as AstraZeneca. His love for science and data dissemination led him to his actual role within the cardiovascular, renal and metabolic therapeutic areas. Antonio is committed to building a strong scientific partnership with the KOLs of his regions. He is actively involved in several projects involving medical education and scientific dissemination. He combines experience with curiosity to explore new ways to grasp the appropriate solutions to achieve ambitious goals.
Laura Zappavigna is the Medical Science Liaison for the center Italy at AstraZeneca Lab Italy. She holds a M.Sc degree in Biology from the University of Rome “La Sapienza” and a master in clinical studies. Before joining AstraZeneca, she had extensive experience at the department of Interventional Cardiology at the San Camillo Hospital in Rome, providing her with a deep understanding of both patient and physician needs. With her experience in clinical studies and her passion for cardiology, she brings great enthusiasm and positivity to the job’s daily challenges.