AstraZeneca PLC (AZN) Earnings Call Transcript & Summary

Good afternoon. Welcome, and good morning to some of the colleagues and guests online as well. So thank you for being here today. Please allow me to take a moment to introduce myself. My name is Pam Cheng. I head up Global manufacturing, supply chain, IT and sustainability at AstraZeneca. I'm a chemical engineer by training, and I'm absolutely privileged to be working for a company that improve lives of so many around the world and doing so in very responsible ways. So before I start, we're going to talk obviously a lot more about HealthEquity at AstraZeneca today. And after the session, we will post a material we will present on the AstraZeneca Investor Relations website later this afternoon. So let me start. This is our usual forward-looking statement, and I encourage you and ask you to take note, please. I will start with some prepared remarks around sustainability and AstraZeneca. We will recap some of our health equity journey thus far. We will share our expanded health equity strategy. We will also touch on some specific examples of health equity in action. And then finally, we will have ample amount of time for Q&A before we wrap up. All right. So let me start by sharing a bit an overview of AstraZeneca, our ambition and our sustainability strategy before passing on to my colleagues, David Fredrickson and Marc Dunoyer. So earlier this year at our Investor Day, we've shared a new, bold ambition, let me move out of the way. We shared a new bold ambition of launching 20 new medicines and reaching over $80 billion of total revenue by 2030. Now we see a clear pathway to $80 billion of total revenue, because we have a very strong growth portfolio of existing medicines. On top of that, we have a very robust pipeline of new medicines across many therapeutic areas. Now more importantly, we are investing in new categories and new technologies to completely transform treatment and care in many of the disease areas that will fuel growth beyond 2030. Now at AstraZeneca, we really do believe pushing the boundaries of science. Everything we do is grounded in what we believe science can do. If you -- as mentioned, we have a wide, broad portfolio of medicines spanning across many therapeutic areas. And the disease categories we focus on has an enormous burden on human lives, on the economics and the health of our planet. Now if you look at our global footprint, we have a strong global footprint that enables access to patients across 125 countries around the world. All this is underpinned by sustainability. At AstraZeneca, we don't look at sustainability as a special project. We don't look at a sub special initiative, is fundamentally embedded in everything we do from drug discovery to manufacturing to delivery of our medicines to the patients around the world. We are very pleased to be leading in sustainability within the sector and beyond. Our sustainability strategy is a very comprehensive one. Certainly, it includes the fight against the climate crisis, where we are taking actions, bold actions to decarbonize across our value chain as well as taking actions in nature. We also focus significantly around health equity and health system resilience. All this underpinned by the right behaviors and the right culture, doing business in the right way. We are on track to achieve our near- and longer-term objectives and sustainability. And let me show you a bit more. You may have all heard about the Ambition Zero carbon strategy of AstraZeneca. It is, if not the, among the most ambitious sustainability agenda in the sector and beyond. If you move your attention to the left side of the slide here, for Scope 1 and 2 emissions, we have achieved versus baseline of 2015 a 68%, 6-8% reduction of greenhouse gas emissions for Scopes 1 and 2. Our bold target is by 2026, we will reduce our Scopes 1 and 2 absolute terms by 98%. So you can see we've already at the end of 2023 achieved 68% reduction, we will get there by end of 2026. Recently, we've announced something very exciting, which is the completion of a clinical program to convert one of our respiratory medicines Breztri to a next-generation propellant with near 0 global warming potential. That's a crucial milestone to decarbonize our pressurized meter-dose inhaler medicines, PMDIs. Now if I shift your attention to the middle of this slide, this is a really important insight here. We have fundamentally demonstrated that it is possible to decouple our total revenue growth versus Scope 1 and 2 emission reduction. Now you may have -- you may hear from many companies and saying, our business are growing. So therefore, our emissions are growing. But truth of the matter is versus 2015, our revenue has nearly doubled, while we have reduced the absolute terms of Scope 1 and 2 emissions by 68%, fundamentally, decoupling growth and greenhouse gas emissions for Scope 1 and 2. We are also on track to achieve our Scope 3 target in 2030, where we -- our ambition is to have our Scope 3 emissions across our value chain and then achieving net 0 before 2045. Now we also understand that fighting the climate crisis is beyond any one company. And that's why we play a leadership role in mobilizing the health care sector to achieve decarbonization faster. Our CEO, Pascal Soriot, chairs the health system task force of the sustainable market initiative or SMI. And the aim is to work with peer companies within the health care sector to accelerate near 0 health care delivery. Now let me move to health system resilience. We are also very focused on building more sustainable and resilient health care systems across the world. In 2020, AstraZeneca, along with the World Economic Forum and the London School of Economics, we founded -- we cofounded the partnership for health system sustainability and resilience, quite a mouthful. PHSSR, much easier. It is now active in over 30 countries around the world. It's a global platform with the goal of really supporting the health systems around the world to be more sustainable and to really improve population health in the longer term. We focus on a few key things. One is really, how do we advocate the increased investment in health, helping local governments see that an investment in health is a strategic investment, not simply a cost. Secondly, working with local health care systems to really ensure that we have the right resources to focus on early screening, early detection and early treatment. And above and beyond that, working with the local health care system to ensure that there is robust workforce planning such that it is ready for future crisis as we see it. We also are engaged in key, ongoing initiatives like the Lung Ambition Alliance, Act On COPD, Act On CKD, the orphan drug collaboration as well as the SMI, the Sustainable Market Initiative that I have mentioned. Now all of us recognize the impact of climate crisis on our planet and on our health. It is not only just disrupting lives and health systems around the world, but it is also worsening the diseases around us. The global population is aging. The burden of corona diseases is increasing. And what they are doing is pushing health care systems around the world to a break point. Now we -- unfortunately, we also see the impact disproportionately on certain communities and the underserved population. We see that across all the markets we operate from the United States to Europe, Middle East, Africa to China to Japan. So patients demand better access to care. Health care professions want more sustainable solutions and investors look for companies that prioritize health equity. And sustainability on top of the agenda. We fundamentally believe that we cannot continue to run as a business without taking action to ensure health care is more sustainable. So with that, I'm going to pass it over to my colleague, David Fredrickson, right now. Dave, over to you.

Pam, thank you very, very much, and just take a moment to introduce myself to those of you online or in the room, who I haven't had an opportunity to meet, I'm David Fredrickson. I'm the Executive Vice President of our Global Oncology business. And alongside my colleagues on the executive team who are joining you today have been co-lead on this important work that we're doing within Health Equity. If we can go to the next slide, I think it's really important and Pam has laid out that we really do see an expanded definition of sustainability and the connection of sustainability to be inclusive of climate health system resilience and equity. Now if we look back to our journey to date, our journey to date has been one where certainly Health Equity has been part of the work that we have done, but we're evolving our Health Equity strategy so that it's an integrated part of our core business and goes beyond corporate social responsibility and philanthropic efforts. But I do want to just highlight some of the very successful foundation work through our philanthropic programs that we've got a deep history with. Starting with the Young Health Programme in 2010 and Healthy Heart Africa in 2016 through these programs, we've surpassed our target of reaching 50 million people in these programs 2 years early, and we're on plan to achieve our target of training 170,000 health care workers by 2025. We'll go to the next slide, please. Now beyond our foundation in philanthropy, we've also, over the last several years, been working to expand access through a number of different important strategic adjacencies that relate specifically to our therapeutic areas. In oncology, we are founding members of The Lung Ambition Alliance, which is the aim of which, together with our partners, has been to really focus in on how do we eliminate lung cancer as a cause of death. And again, Pam mentioned this before in a broad sense, but specifically within lung cancer, how can we actually drive early detection, early and precise diagnosis, delivery of innovative medicines and the improvement in the quality of care. In our biopharma business, we're very proud of the role that we played during the COVID-19 pandemic, where we supplied our COVID-19 vaccine at cost, which was estimated to have saved greater than 6.5 million lives in the first year alone of its availability. And in rare diseases through our acquisition of Alexion in 2021, we're now present in over 70 countries with our rare disease treatments, and this is all made possible through the AZ Global footprint. And we'll go to the next slide, please. Now with all of that, as we have embedded the work that we are doing on equity into our therapeutic areas where we must go and where we realize the greatest opportunity to go is in improving outcomes. Going beyond just thinking about our medicines and access to medicines, which is essential and important, but really understanding the entire patient journey and the criticality of closing the care gaps that exist at every step within this patient journey. We've spoken about these steps before, but early detection, meaning that disease is detected and identified early that it's precisely diagnosed. Based on that precise and timely diagnosis that then guideline-concordant care is being delivered and that the patients are able to adhere and stay on therapy as appropriate with the best possible experiences. Each of these different dimensions creates the opportunity for either optimal care or a gap in care. And those gaps in care result in suboptimal outcomes. And when they're optimized, it actually results in the best possible outcomes. Next slide, please. Now really, very importantly, this is where our essential lens of health equity is being built into the way in which we approach this work because we know that there are many determinants of health outcomes that affect each and every part of this process. There are behavioral, social, environmental, genetic factors, all of which can amplify the quality of care or the gaps in care that patients receive globally. And to address these gaps, we're broadening our pillar from access to health care to health equity at AstraZeneca. Next slide, please. So in so doing, we've dedicated a significant amount of time to evaluate all of our existing Health Equity initiatives and also to really look forward to what are the future opportunities that we see on the horizon. We've engaged with stakeholders across the ecosystem to identify areas of unmet need, what are the areas that we have to improve, where are the places that we can lead, how do we maximize our opportunities and now we're actioning these high-impact opportunities by embedding Health Equity across our global organization. And what's really essential is that we're able to do that in a framework that can be readily executed within the markets that we are operating in because ultimately, the delivery of health care happens locally at a postal code level within the markets. Next slide. As we think about that and as we focus in on that, we very much though acknowledge that inequities exist across all markets and across all income segments. So while, of course, health equity is very much an issue upon which we need to be focused when we think about low and middle income countries, even in high-income countries, which I think we're all well familiar with. There are many people who can't get access to health practitioners can't get an early diagnosis, don't receive the right care. And our vision is to remove the barriers to health care and to give everyone the chance to be as healthy as possible and to empower our leaders within individual markets to be able to take initiatives to be able to drive change, and we aim to measure our impact through these initiatives, and we'll be introducing new key performance indicators next year around specific measurement. Now this ambition is fundamental, and it's a fundamental transition that we are going through right now and how we think about and conduct our business and strive to reach more patients. And we will, of course, hold ourselves accountable to the goals that we set. Next slide, please. There are 3 pillars of our health equity efforts, science, delivery and engagement. And what's important is that we're seeking to build equity into the process on the front end. What we've certainly learned in our work on climate and the efforts that we make there, it's that you can't inspect sustainability. And on the back end, you've actually got to infuse it throughout the entire process. When we think about doing that in science, we're focused on increasing the diversity in our discovery, improving diversity of clinical trial participants, which we also will refer to as clinical trial diversity and ensuring post-trial access to our medicines. The delivery component is focused on more equitable screening, detection, diagnosis, which we've already mentioned, while also expanding our programs to ensure affordable access to our medicines. And lastly, engagement. Engagement is about supporting strategic partnerships with key global and local stakeholders, including public, private and academic as well as engaging our employees. There is no question that in order to drive against equity, we have to do this through partnership, very similar to what Pam described as what we know as the blueprint and the recipe for success within the climate initiatives that we've taken. Next slide, please. As we double click here on to science and specifically on discovery diversity, diversity and R&D starts with understanding genetic data genomes, exomes can vary very much based on ethnicity. We want to better characterize and understand what we call OMIC data. So genomic data from a diverse population or diverse populations to allow us to bring the right drugs to the right patients. We've already built a database with 1.4 million exomes and genomes that have been sequenced, and this data comes from our own clinical trials as well as external collaborations that we have across several geographies. In 2017, we launched a company-wide genomics initiative as part of our R&D efforts for the future. And trial participants were given the option to consent for blood drawn to be sequenced and over 280 trials now collect data or have collected data in order to be able to get to these results that we have. And now we have meaningful sample sizes across oncology, biopharma and now with rare disease. As of 2020, 92% of our samples were of European descent, above an average of 95%. We've worked hard over the last 4 years to improve the ratio. And through our efforts in Mexico, South Africa, South Asia, we're now at 66%. So really, really contributing to a much more diverse sample of this discovery data that we have, and we expect to further improve the diversity and remain committed to this very important effort. In terms of future ambitions, last year, we came together with our industry peers alongside with Regeneron, Novo Nordisk and Roche to form that together for change initiative, which is really aimed at driving even further improvements in discovery diversity. NIH data showed that less than 2% of genetic information studied today originates from people with African ancestry. And this initiative seeks to address in equities in STEM careers and research with a two-pronged approach. The first is the Diaspora Human Genomics Institute or the DHGI, which will establish a grant program to support research and capacity in genomics and related fields, at Meharry Medical College and the second, in close collaboration, with the local black community, DHGI will facilitate building the largest African ancestry genomics research database with up to 500,000 volunteer participants. Really, with this diverse data set, also look to leverage AI. AI provides the opportunity to better understand relationship between targets and diseases, allows us to generate hypotheses that lead to new projects that can then enter into the clinic that are appropriately tailored for specific populations, and it enables us to better understand all of the patients that could benefit from different mechanisms of actions that we have within our portfolio. This data is more important than ever for guiding our pipeline decisions, and it really also importantly helps us to understand on-target safety, clinical biomarker, precision medicine strategies, a more diverse OMIC database should help us to gain a better understanding of target disease relationships across different ancestry genetics, identifying gaps and shape our future R&D strategy. Next slide, please. Now as we move from discovery diversity, that then takes us into inclusive research and development. And we know that really core to this is improving our clinical trial diversity, not only to meet the evolving regulatory requirements, which are evolving across the globe with an expectation of increased diversity within many of the health authorities with respect to their own populations being represented. But because we believe that having more diverse clinical trial populations will enable faster recruitment and improve equitable access. And it's these types of win-win situations where it's both good for accelerating the business as well as good for driving equity that we think are exactly the kinds of things that we need to be focused in on. Earlier this year, we published a review of 246 U.S. sites -- excuse me, 246 U.S. studies that we conducted across Phase I to Phase III trials across 57 different indications. And in that publication of the paper, we concluded that the overall representation of racial and ethnic minorities in those studies was fairly balanced with the 2019 consensus data. We also, though, understand that the diversity and understanding of the diversity of our participants against disease state populations allows for more accurate understanding of disparities and gaps. We have an internal bespoke clinical trial diversity dashboard for all of our Phase III studies now that are enrolling in the U.S. and also those that are enrolling in Brazil, which is an incredibly diverse country in terms of allowing for us to be able to enroll into our global understanding and diversity within these studies. And this tool and dashboard allows our clinical teams to monitor on a real-time basis, diversity through age, sex, race and ethnicity of participants being enrolled into that study. And again, it's all at real time. We're increasing, also establishing collaborations to codevelop solutions and contribute to industry best practices. We've worked with a number of external collaborators just this year, partnering with Sex and Gender Minority Alliance, collaborating with national medical fellowship to train new doctors to run clinical trials and AZ-sponsored the Black Health Matters Summit back in August, and we continue to actively work on the work with all of these groups. We're working together with a number of our sites to support their capabilities to recruit diverse populations through both site and patient support, health care practitioner training and community engagements. And all of this is underpinned by a new, written standard on clinical trial diversity, which guides our R&D principles here and ensures that clinical trial populations represent real-world demographics. We'll continue to develop and seek to understand and shape the landscape here. But what I want to really highlight importantly is we've understood our data. We have set forth a goal for improving against the benchmarks that we've got, and we have specific initiatives and collaborations that we're engaging in, in order to be able to achieve those. Next slide, please. Now as I turn to delivery, I've already spoken about efforts that we've had underway on health awareness and education, and it's the second pillar of our strategy that will also continue to stay committed to in our philanthropic efforts, Young health, the impact there continues to grow. YHP combines community programs, research advocacy, particularly in vulnerable and under-resourced communities. And it's through 50 nonprofit organizations, including UNICEF, that we're able to address primary risk factors for noncommunicable diseases such as tobacco use, harmful use of alcohol, physical inactivity, unhealthy diets and exposure to air pollution. And this all allows us to also really hone in and focus on prevention and early intervention. And YHP aims to reduce the burden on health care systems, promote equitable health outcomes for all individuals and improve system resilience. And this program is not static. Our educational content aligns with our climate resilience, equity focus and our impact continues to grow. There's over 40 active countries, more than 15 million young people that we've directly researched and over 800,000 people that we've trained. Next slide, please. Now in addition to this, I mentioned Healthy Heart Africa, again, with aim to reduce the burden of cardiovascular disease in Africa by improving access to prevention and screening services. It's been active for 10 years and has continued to expand. It's now in 9 countries across sub-Saharan Africa. At the end of August of this year, we've conducted over 61 million blood pressure screenings. We've identified over 10 million people with elevated blood pressure, and we've recently broadened our focus to include chronic kidney disease, recognizing really the interconnected nature of these health issues which is not just true within Africa, it's actually true for all of the people who we are focused on with CKD and also with cardiovascular opportunities. We also have done work on Cancer Care Africa, just simply to mention specifically across Morocco, Algeria, Egypt and Kenya. We're working together at transforming cancer care by collaborating with local governments, NGOs, health care providers on a more sustainable cancer ecosystem, and we can share more about that in our coming meetings with you. Now next slide, please. Now I addressed and spoke about closing care gaps earlier, which remains a very important key factor in improving equitable outcomes which I talked about before. But if we go to the next slide, I think that it's important now to dive into some specific examples to really bring this to life across our therapeutic areas. And as I mentioned before, this is not something that is simply a challenge, which it is in low and middle-income countries. We see stark disparities and access to trials, guideline-based care and our medicines across all countries, Brazil to Japan, Kenya to the U.S. Now people at the highest risk of disease are not being screened across the globe. And there's lack of access to timely and high-quality precision diagnostics and treatment, and that's true even in a high income country like the U.S. 82% of people who are high risk for lung cancer in the U.S. are not screened. Therefore, we are detecting lung cancer late. When we detect it late, outcomes are poor, as low as 5-year overall survival rates when detected late that are below 15% and as high as 80% when we're able to catch it early. In China, it takes on average 4.5 years for patients to receive a definitive diagnosis for their rare diseases. In Spain, fewer than 3% of diabetic patients with CKD are actually taking an SGLT2 inhibitor. In Brazil, 40% plus cancer patients have to travel over 100 kilometers for their treatment. Each of these helps us to understand the very local country-specific challenges that are being faced and that are causing disparities in care and care gaps and a deeper understanding of these determinants of health allow us to be able to target communities and work together locally to be able to focus on those who are at greatest risk with tailored interventions. So what will work in New York to get patients screened on therapy is not what's going to necessarily work in Louisiana, much less what will work in Sao Paulo, what works in rural China may not be what works in rural France or Vietnam, and we need to have a program and we're working on programs and efforts that allow us to be able to tailor appropriately, but under a global ambition. Next slide, please. Certainly, affordability and access, which has always been something that has been important to the work that we do continues to be important. I want to share that we're guided by 4 principles when it comes to our sustainable affordability. First, we absolutely are focused in on the sustainability of both the health care system and our research-led business model. Secondly, and critically important, we understand that in order to be able to focus appropriately on this, that we must ensure that the value is considered and that the value for our medicines has to reflect the clinical value of our medicines to patients and the broader impact on society and the health care system. I think it's really important to note that in all of our research and development efforts, we focus in on medicines that we think are really having an opportunity to be best in their class or create new classes to advance and become standards of care. By focusing in on that high-impact science and high-impact medicines that then allows us to be able to have conversations about the value of our medicines in the right way. The third component is access through collaboration with payers and providers on solutions to enable sustainable access. And lastly, of course, affordability and understanding that we must have variability and flexible approaches to how we think about pricing and also affordability programs based on the ability to pay. Now even within all of this, I think that it's worth noting and while it's not on this slide, there are a number of very important tools, and I think these tools will be an important part of how we think about our performance indicators that we'll lay out in 2025 that are really alternative access mechanisms that already exist today for how we're able to provide access to our medicines in ways that are innovative and solutions-oriented. We have patient assistance programs that are tailored across the board, early access programs, compassionate use and charitable programs and clinical trials. So there's a number of different ways that we're able to actually ensure that our medicines are able to get to patients both through our commercial efforts but also through these other alternative mechanisms. Now the next slide, if we can turn to it focuses on a broad case study of examples of the solutions that we've implemented. And I think what's important about this particular slide is that you can see that affordability and accessibility varies really significantly across markets, and it depends on a number of factors. Price is just one. So as you take a look at this, you can see that we have to obviously work across multiple dimensions from optimizing coverage at a national level for markets with developed access and established reimbursement down to case by case focusing on infrastructure and policy in markets where there's much more limited access and a lack of reimbursement. We complement this work with our affordability solutions and with accessibility solutions, whether that's infrastructure, or patient and HCP education, appropriate engagement on diagnostic tools, access to medicines, support for adherence programs. All of these are things that we bring together as part of our approach for a tailored comprehensive way that we manage access to our medicines. Now the third pillar of our strategy is capabilities and engagement, if we go to the next slide, and we're focused in on this across our stakeholders. So I've talked a lot about the work that we do to partner with external collaborators. We've also convened our own health equity board, which met together for the first time last month. We're really delighted to have a number of leading experts from physicians to directors of policies, member of nonprofit organizations, all of whom are advising on local health equity strategies in specific markets, and we're really getting an opportunity to learn from all of them, and we appreciate that. In terms of culture and employee engagement, our employees are incredibly energized by the work that we're doing within all of our sustainability pillars but are very, very energized by the work that we're doing within health equity specifically, and we're engaging our employees to really build a culture where health equity strategies are integrated into the business and become part of the work that we do every single day. Next slide, please. So now Marc and I are going to go into some specific examples that will help to bring how we're bringing equity in action even further into life at AstraZeneca. And if we go to the next slide, I want to focus this one on lung health. Now our commitment to lung health spans oncology and biopharma. And I think this is really important. There's a very clear opportunity for us to link together efforts in lung cancer, COPD and in asthma and really to have opportunities to be able to talk about how can we have the highest impact engagements and interventions locally in order to be able to make improvements across all of these. That also allows for a much more cost-effective ways of approaching this within markets and many, many more patients to be able to be reached. And it shows a unique opportunity to be able to build bridges across our therapeutic areas. All of these diseases have high unmet needs, and we have a deep pipeline and ambitions to change outcomes for patients across each of them. Lung health is also impacted by worsening climate. I do think that this really brings together the convergence of the 3 pillars of our sustainability effort, 25% of lung cancer diagnosis is associated with air pollution and around 75% of emissions from COPD is associated with hospital care. Next slide, please. So as we think about also the social and wider determinants of health, including those environmental factors that I just mentioned, we know that lung health is absolutely affected by determinants of health because genes, daily behaviors, where you live, the environment, income, education level, they all influence lung disease development and risk factors such as smoking, air pollution, occupational risk, low socioeconomic status are also shared across asthma, COPD and lung cancer. So what we also know is that these same factors can also lead to barriers in patients having the access to optimal care like detection, like screening, like diagnosis ability. And so at the heart of our work is that we want to improve lung health outcomes to drive a better understanding and work with partners to address these in common risk factors and in common barriers. Next slide, please. So to put this into practice, first and foremost, as I talked about the efforts in clinical trial diversity, we're building data analytics capabilities to set our baseline. Based on understanding that data, and understanding the determinants of lung health and the burden of lung disease and the burden of that lung disease at a postal code level, we then have the ability to start to work on how do we address closing care gaps in these particular segments and working together within the community in order to be able to do that. And one of the first places that we're starting on is how can we bring what is today limited access in a lot of these communities to our clinical trials. Next slide, please. We're also driving early detection of disease through lung screening programs. And in the interest of time, I'll move relatively quickly through these. But one of the things that's very, very important that we're doing and the work that we've got here is making sure that we've got partnerships on lung health screening with AI partners to be able to take a look at x-rays and scans and be able to apply those retrospectively on existing images. This is a really good approach in low and middle-income countries where there may be actually quite a lot of scans that are available but not the ability or the workforce to be able to go through those. We're on track to screen 5 million patients through these methodologies by 2025. We're proud of the work that we have been contributing to and being a catalyst on the U.K. lung screening effort, which is based on really accelerating low-dose CT scanning. We ran the initial awareness campaign, supported evidence generation and economic modeling for funding support. And we're really pleased to see that this program is running and having a profound impact with thousands of patients, or I should say, people now having been identified as lung cancer patients and being able to do that with over 3/4 of them being diagnosed at an early stage, and that's something that's absolutely critical. So last, I would just say that there's an opportunity, as I mentioned, to really make sure that diagnostic capabilities are being joined together across these lung diseases, and I look forward to sharing more about that. But right now, let me pass it over to Marc who's going to walk through the work that we're doing in heart failure, amyloidosis -- amyloidosis, excuse me, and rare diseases. So Marc, over to you.

Thank you, Dave, and hello, everybody. So what I'm going to do today is to walk you through from a symptom to a disease and then to different etiologies and biology. So I will start with one very common symptoms, breathlessness. And this represents about 4% to 5% of the GP visits or the emergency visits. So a relatively common symptom -- beyond this symptom, you can go down to the disease. And if you look at cardiac heart failure, congestive heart failure, this represents about 64 million patients around the world, so less than 1% of population. But what is important to remember that the cost of monitoring, the intensity of monitoring, the frequency of hospitalization makes heart failure, a very expensive disorder to treat in the community. And then if you go slightly more right, you have 2 metrics that we have indicated. The first one is 38%, 38% of patients with heart failure are diagnosed in an acute setting. And the other side of the coin is to look at the 46%. In fact, among the 38 patients, nearly half of them had been presenting symptoms during routine visits -- routine medical interventions. So the commonality of these 2 numbers is basically the delayed diagnosis, which obviously bring the patient to a later stage of the disease and to a poorer outcome. If I can get to the next slide. So the initiative that we are taking our harnessing the technology, and in particular, the artificial intelligence that helps detect a certain disease or accelerate the detection. And I would speak in particular about the second initiative that we have seen in Scotland, where the rapidity at which artificial intelligence can help physicians detect has been accelerating the frequency and therefore reducing the waiting time from 12 months to 6 weeks in Scotland, which we know is region of the world where cardiovascular disease are quite prevalent. The other program that we have just go through the use of artificial intelligence through the detection of heart failure outside of the hospital by looking at echocardiography but also looking at specific biomarkers such as NT-proBNP. So this is what we do. And then the other side of it, on the right of the slide is, we are trying to develop innovative ways to reach out to patients who traditionally do not like to consult medical doctors. And we have this example on the very famous football club in the U.K. where we have been able to reach out to these football fans and detecting a greater number of patients deserving medical treatment. Can I get to the next slide. So now I'm going to talk from cardiac failure or congestive heart failure, I want to talk about amyloidosis. And it's important to understand that amyloidosis is not -- is a hereditary disease or well hereditary disease many years ago. And now we have realized that similar forms of amyloidosis in a wild-type population is much more prevalent and in fact, is hiding behind what we thought was heart failure. Today, in the heart failure population, there is probably 40% of patients who, in fact, are suffering from amyloidosis. And on the left, if you look at it, our effort is to try and work on the patient journey. And then trying to have the physicians detecting or being suspicious about the possibility of the diagnosis of amyloidosis. The diagnosis of amyloidosis is usually conducted in reference centers. It is quite an intense type of diagnosis. But the key is for the gatekeepers to suspect the possibility of amyloidosis and, therefore, refer the patient to the reference center. And then the one of the 2 that is frequently used is echocardiography and this has been progressing. However, this is still a very manual examination, and what we are now doing is to try and use AI in different ways to simplify or to help and guide the suspicion, the detection of the amyloidosis. And this is done through different ways, but more often than not, this is a decentralized -- these are decentralized software and systems and the system, the software provides flags to the person conducting the echocardiography. And this is making great progress. The devices, the medical devices have received breakthrough designation in the United States by the FDA and these products are going to be -- the software are going to be available very soon for medical practitioners. If I can get to the next slide. So I was telling you that amyloidosis was hiding before behind heart failure. We are working on 2 types of amyloidosis. Amyloidosis is clearly a priority for AstraZeneca for the cardiovascular, renal, metabolism division as well as for rare disease. We look at the 2 largest type transthyretin amyloidosis and light chain amyloidosis. If we look at the first one on the left, transthyretin amyloidosis, one approach that we have is with eplontersen. It's a silencer that blocks the synthesis of the transthyretin at the level of the liver. But we also have another approach, which is a depleter, which Alexion is developing, which is cleaning or depleting the misfolded fibrils of amyloid. The same approach is taken on a different disease also in the amyloidosis sector, which is the light chain amyloidosis with a product called enclamlimab, where we're also cleaning the fibrils, which are, in fact, coming from the abnormal plasma cells. Today, there is a treatment in light chain amyloidosis in first line, but there's nothing beyond first line, and therefore, a depleter could have great utilization. So we have the similarity of approach between transthyretin and light chain for the depleter approach. And then we have this oligonucleotide approach for the reduction of the production of the misfolded protein in cardiac myopathy. I go now to the next slide and more precisely on the rare disease. I mean, when we talk about -- can I get the next slide? Yes. So can we -- I don't think there is any other sector where the inequity is more visible or tangible. Being born with a rare disease is inherently inequitable. Collectively, all the rare disease represent about 10% of population. So it's a very large number collectively. Obviously, each of them is usually very rare. There are now about 10,000 known rare disease, identified rare disease. A few years ago, there were 7,000 that have been identified, but science continues to distinguish among those rare conditions. But 90% of them do not have an approved treatment. The diagnosis of this takes people for several years until they understand or they know of their diagnosis. 80% is from a genetic origin. And then we have recently conducted a survey of all European countries. We had done a survey, a similar survey in the United States 2 or 3 years ago. We wanted to see whether this was reproduced in Europe, and we have demonstrated that the cost of treatment, the burden of illness for a rare disease patient and the carers is about 6 to 10x higher than the cost of illness for the general population. So it's an enormous cost to the patient and its environment. If I get to the next slide. So Dave was mentioning the various -- the multiple inequities. You can have inequities obviously, across countries. This is obvious. We also have inequities within the countries, and this is what Dave referred to as the inequities at the postal code. But we also have inequities across conditions. There are some disease that are more researched than others or there are more innovative drugs being produced. So what we need to do is among this -- all these inequities, we try to envisage solution to reduce or close gap. And maybe with the advent of genomic medicine, I think what is very important is to understand the importance of the very long and complex diagnosis journey. Even if we diagnose too late for a patient, then we may have lost the window of opportunity for an efficacious treatment to be given. So this is why we are focusing on 2 avenues, newborn screening, which is the next slide. Newborn screening is a public program that's been conducted very successfully around the world. There are about 80 countries that are using newborn screening. However, the population that is actually screened is about 40 million, out of a population of a cohort of 140 million, so about 30%. So it's very widely used. But in fact, the population that is covered is only 40%. The number of disease or conditions that are actually screened is still very, very small. In the United States, which is the most advanced testing territory, you have only 32. In U.K., 9 disease are regularly tested; and in France, 5. I want to mention also that a country like Taiwan, for instance, is well placed as they test about 20 specific conditions. So what we are trying to do is to expand the possibility of newborn screening and also to harness the new technology, the genome sequencing to accelerate and be more precise for this testing. So can I get to the next slide? I think it talks -- Alexion has been working with the Ready Children Institute in California since 2018. In 2022, we co-founded a consortium where we want to amplify the utilization of the genome sequencing to all newborns in the world. In the first instance, we have developed this testing for all patients in America who are spending some time in the neonatal ICUs. And we have now demonstrated that by doing this genome sequencing in this population in the ICU, this is an efficient. It is a cost which is under the cost that was prevalent before. So there are solutions that can be modern using the right technology for this very specific population. What we are now trying to do is to see whether we can expand this not to the kids spending time in the ICU, but to the kid to every newborn around the world. So we are expanding the number of conditions we are testing, and we're also collaborating with many other countries outside of the United States. With this, I will hand back the mic to Pam, who is going to walk us to the end.

Great. Thank you, Marc, and thank you, Dave. So I'm going to wrap this up with what we've started with. So we've got a clear strategy to launch 20 new medicines between now and 2030 and reached $80 billion of total revenue by 2030 as well as achieving mid-30s percentage of core operating margin by 2026. We firmly believe sustainability, including health equity, has to be at the core of what we do. So we will work very hard to drive health equity, as you heard from Dave and Mark, at the same time, delivering shareholder value. So with that, we're going to move to Q&A. So alongside myself, Dave and Marc, we also have our colleague, Stefan and Elena here today. Stefan is the Vice President of Policy, Patients Advocacy and Health Equity. We've got Elena, who heads up -- who is the VP of Global Market Access and Pricing for Biopharma. So if I can ask that we keep today's questions, Q&As to focus on sustainability and health equity topics, if you may, given the time.

[Operator Instructions] so I get to play the moderator.

It's Ben Yeoh at RBC Global Asset Management. A few questions, if I may. I was wondering on the overall strategy, how it supports your ambition. Obviously, there's a social license to operate underlying. But I was wondering whether you feel that sustainability and health equity is giving you a competitive edge anywhere else, maybe in talent and recruitment or policymakers or the like. Secondly, on the health equity piece, particularly, I'm interested in some of the developed markets like the U.S. Obviously, access to health care and poverty is an issue. There are other lens, gender lens, race lens and stuff. And again, do you think this is helping in terms of commercial ambition? Or is it just a sort of social license to operate? And similarly, on the clinical trials piece, obviously, this can help for better patient population and clinical data and the like. And apart from just meeting regulatory kind of standards, again, is it helping commercialization or strategy piece? And then the last one on the net zero. You mentioned decoupling, particularly between growth and things in Scope 1 and Scope 2, and that's quite impressive considering quite a lot of other industries are not being able to achieve that. I wonder if, is there anything in specific detail, which is making your plans and execution unique on this? And do you feel that this is something the industry can do? Or is this just something which is kind of special to how Astra is looking at this?

Great. Thank you. I counted 4 sub-questions. That's okay. I'm just trying to keep track. So I'm going to attempt to answer your first part and the last bit. And then I'm going to ask, perhaps, Stefan and Dave and Marc to address the question #2 as well as the trial diversity question number three. So let me -- so it's a great question, Ben. Thank you so much for that. I have to say, sustainability strategy, inclusive of health system resilience as well as health equity is one of the best sort of employee engagement tools. When we speak of sustainability, when we speak of health equity and health system resilience, we speak to every one of the 90,000-plus employees within the company. I've been the Chief Sustainability Officer since January of last year. And I have to say, if there's one common language within AstraZeneca, apart from patients, it's about being sustainable in what we do. Now in terms of sort of your last bit of questions around how are we achieving that decoupling of total revenue growth and greenhouse gas emission. I think if I keep my answers concise, it's about translating strategy to actions. So you hear a lot of companies talking about their ambitions around greenhouse gas emissions and sustainability and so on and so forth. Truth to the matter is, I think 99.9% of it is in what you do with it. Are you translating into practical actions to decarbonize across your value chain? So on Scope 1 and 2, very simply put, so I have global manufacturing. We have 28 manufacturing sites around the world, multiple R&D centers around the world. We've got an ambitious target of saying by the end of 2026, we will reduce our Scopes 1 and 2, which is within the walls of our operations, we will reduce those greenhouse gas emissions by 98%. And we're doing that by a different few things, going with renewable energy. So how do we stay away from fossil natural gas to renewable energy like solar power, wind power, for example, in Sweden, we are completely sort of using renewable energy for our R&D and manufacturing facilities using wind power and solar power, for example. We are going with biomethane in the United States and in the U.K. Now doing that cost us a little bit of more money upfront, but we believe longer term, it's the right business to do. It's the right thing to do, and it's good for business. And last bit, if I may, and then I turn it over to Dave and Marc and then Stefan here, the integrated sustainability strategy, including health equity and health system resilience, these topics are definitely helping us opening doors to conversations with local policymakers, with our stakeholders to really have those constructive and meaningful conversations around driving health care to be more sustainable as well as better access for patient care. So we see that across the world. So maybe, Dave, should I hand it over to you first?

Sure. Thanks, Pam. Much appreciated. And Ben, I appreciate the question. To be really explicit and clear, I absolutely believe, and you called out the U.S., but I think if we -- you also said more broadly in the developed markets, I absolutely believe that our health equity work is a driver of our commercial ambitions. I believe that the whole effort that we are putting into this is to certainly maintain the excellent and important philanthropic efforts that we've had, but how do we look at this as something that if embedded into our business allows us to get our medicine to more patients, allows us to improve outcomes for those patients. And certainly, we think that we create shareholder value in doing that. To be really specific around that, at the first level, clinical trial diversity is important in order to be able to get the approval of our medicines across many different markets. The FDA in the U.S. has made it clear that clinical trial diversity is something that they're going to be measuring and that they're holding companies accountable for. Today, it shows up as post-marketing commitments in a lot of our studies, but we anticipate that more and more, it's going to be an expectation in terms of just on the front end to be able to get to approval. So that's one, just license to operate element, but that we think is important. Secondly, we see so many important gaps as it relates to precision and timely diagnosis and the decentralization of diagnostic approaches to be able to deliver our precision medicines. I'm really proud of the work that we've done in oncology, really also dating back to Arista and the EGFR days, but almost all of our medicines in oncology that we launch come with a companion diagnostic. The ability to be able to then drive the medicines to the patients who can benefit from that is reliant on us being able to have timely and accurate diagnosis of patients happening across the globe and specifically in developed markets to be able to ensure that we can identify patients who benefit from our medicines. And the last thing that I would say on this is, and Pam alludes to this, but is -- by having this as part of our agenda, it allows us to play a role as convener with groups that can continue to ensure that our therapeutic areas remain national policy priority areas. We're able to bring people together who are unified around the interest of eliminating cancer as a cause of death or addressing rare disease and doing that with an equity lens. That is an agenda item around which many stakeholders are interested, trying to ask them to be a part of helping us to drive share on our medicines is a much less compelling agenda topic. And so I think that it really affords us the opportunity to align our agenda with stakeholder agendas that allows us to be able to have, I think, much more productive conversations on key policy elements that are beneficial to cancer, COPD, rare disease patients and that also are beneficial to helping ensure our medicines can get to those patients.

Thank you, Dave. And let's finish up with the clinical diversity question.

Yes, sure. Dave already touched a bit on this. But clearly, again, our health equity strategy has been designed to create social value, to create shareholder value and then to also engage our employees. And on trial diversity, what we see when we speak about COPD and lung cancer, it is in areas in Canada like Ontario, it is the 2 bottom deciles from a socioeconomic perspective where over 50% of the burden of disease is. So knowing that not every ZIP code and not every area in a country has equal number of people at risk of disease is critically important for us to focus our efforts but then also the efforts that our stakeholders bring to the table to improve case finding and to bring health care to some of these populations that have been under engaged historically. And so that will help with trial enrollment and then trial diversity as also very important scientific benefits for us to better understand the safety and obviously, the clinical profile of our medicines, we need to have that diversity in the population that is included in the trials. So there are important benefits to that. I just wanted to further expand a bit on resiliency of health systems and health equity and why this is so important because you also know that health systems, they are really struggling with the uptake of technology. It's usually not the absence of technology. It's the lack of uptake. And so from a resilience perspective and long-term sustainability, it is important that we keep patients out of the hospital. And our pipeline, the products that we have, they help avoid COPD exacerbations or as Dave mentioned, if you are able to screen and early detect lung cancer at early stages, it avoids a lot of intensive care later on and improves outcomes. So it does align with social goals, with helping the health system become less reliant on hospital-based care. And of course, then it adds shareholder value to us because our assets are oriented towards those goals as well.

Yes. Thank you, Stefan.

Justin Smith from Bernstein. A quick one might be simplistic. Diversity of clinical trials, cost of trials, statistical power, more and more subgroups. Just how do we balance all of that here with this messaging?

Stefan, you want to?

Yes, there is a cost of -- of course. But as I said, the benefit, we believe, outweighs the cost, but also we have to be selective. We can't do everything. And I think that is a critical aspect of our health equity work. We have to focus in the things that you mentioned in the geographical areas. And we also got a question online about the KPIs that we mentioned, we will disclose next year. We will be selective on those KPIs. You will see the focus also from a geographic perspective. And as we define underserved groups within countries like China or the U.S., we are going to be very focused. But that focus should help us have an impact and a cost-effective impact. So yes, there are increased costs to these things. underserved people are more costly to reach. That's why focus is necessary. But we've demonstrated through Healthy Heart Africa that Dave mentioned, we have pivoted to diagnose chronic kidney disease, not just elevated blood pressure. That comes with a cost as well. So we had to be more selective in the patients and that increased segmentation has been an important part of that. But then also finding new technological ways, more efficiency in testing technology and then ultimately partnering as well in terms of funding. So we are now working more closely with governments also to provide funding for these initiatives. And that is the last point I want to make that we don't have to fund everything. These are partnership-based approaches where we're trying to align our goals with the goals of governments and of other stakeholders and that we all put our resources together with that geographic and therapy area focus to make a difference that is cost effective for us all.

So Stefan, if I can add, and then maybe, Dave, you want to weigh in. I think clinical trial diversity goes beyond just the regulation that regulations we have to meet or cost considerations that we definitely have to think about, but it's really also about the science. It's about having the right population representing what we are intending to achieve with the medicines that we are developing, right? So I think it's really that science piece that brings together in terms of what is our right profile of the population we need to drive. So Dave, would you like to weigh in on this a little bit?

Yes. I think that to Justin's question, and it's a good one, perhaps the element that I'd add is that the reason that we're working on this and the way that we are is that we cannot have clinical trial diversity be an excuse or a reason for trial costs to get exorbitant or trial quality to not be good in the same way that with sustainability, and I think Pam speaks very eloquently about this, we can't have our climate objectives result and costs get exorbitant or the quality be compromised in any way. So that's why partnering at a local level and finding the sites that are willing to side-by-side with us get into the communities, going to sites where there is a diverse population, going and partnering with multiple stakeholders who have vested interest maybe in Brazil is a great example for being able to create the infrastructure that's necessary in order to be able to achieve these joint objectives. And I do think that's part of the reason that it makes this a bit more of a complicated effort to kind of put a single KPI around or a single objective that we've got because it is so multi-stakeholder in nature. But just to be really, really clear, the goal here is to recognize that, yes, of course, we need to be recognizing that clinical trial diversity brings with it investment and at the same time that we need to be ensuring that those efforts are allowing us to activate sites faster, enroll more patients and to be able to counterbalance some of that with the other virtues that come from having more sites, more patients, more diversity being able to participate in our studies.

Jo Walton at UBS. I've got 2 questions, please. The first is on pricing. So because of your wish to have to take into account affordability, does this mean that you have a wider range of prices perhaps than some other of your peers between, let's say, the U.S. and I don't know, Vietnam or somewhere like that, just in terms of that broader reach? And does that give you some risk potentially for when it comes to international reference pricing? And I ask about this because I'm old enough to remember when you didn't have Crestor in Germany for a number of years because you couldn't get a price in Germany. So German patients didn't get it, but that was because you didn't want to risk the price elsewhere. So it's just a little bit about how you balance that equity and not risking things if we get most favored nation status back again from the U.S., that could be a problem for a company such as yourself more than someone who hasn't been as good. My second question is on diagnosis. So I'll go to Marc on this, I think. He talked eloquently about being able to identify amyloidosis through looking at some scans. So let's assume he can do that in the U.S. How does he take that to Europe and other markets? Because if it's done with a company in the U.S. that's had a great idea and done some AI, that company may not be in business in Europe or elsewhere. Is it worth getting involved in that more aggressively yourselves so that you can take some of this good idea and help it be moved around markets?

Two great questions. Thank you. So maybe we go to Elena on the pricing and then Marc.

Yes. Thank you for your question. It's a very, very expert question, I would say. Maybe the first part was about the range of prices, right? So I'm not going to comment on other companies, but we definitely do have a range. We do a lot of analysis, as you might expect, when we do launches to think about the best way to launch a product so that we can reach the most patients and the most markets faster. But with the principles that Dave described before applied, right, which is sustainability value, access and flexibility. And so we take all of that into account. And remember that when we say sustainability, it means we try to establish prices and access that are sustainable for health systems for patients and for our business, right? So that -- it's a significant consideration. Broadly speaking, also, there is a general acceptance of the fact that certain nations with lower G&I should have lower prices. So it's a practice that is quite common across the world and across companies, but we do take consideration and we try to make sure that we have explanations for why there are certain differences. The other part is that not all prices are published. So we try to make sure that whenever we have particular agreements, we protect the business and we mitigate the risk. So that's the first part of your question.

Thank you. Marc?

Yes. So Jo, thank you for the question. The reference I made to the amyloidosis is for a system that's going to combine basically echocardiogram images, which are going to be processed by artificial intelligence and obviously, a combination with some lab data. But this system will be available in a very cheap manner to every hospital around the world. They will be able to access it through the cloud and everything. So it is to be a decentralized software that any clinic or health care system can tap into. But this is not the diagnosis of amyloidosis. This is more what I call the suspicion. This is going to flag to the hospital that this patient should undergo a diagnosis for amyloidosis, which is a little bit more specialized and labor-intensive. So I want to distinguish the diagnosis from the sort of creating the early suspicion that this patient may be suffering from amyloidosis. But this first part, the early suspicion will be decentralized and will be available in a very short term to all clinic and hospital around the world.

Peter Welford at Merrill -- sorry, at Jefferies. Sorry, I've just flying to an old friend, at Jefferies. I wish I was at Merrill, unfortunately, Merrill disappeared a long time ago. Sorry, just an interesting question for you, focusing on PMDIs, if I can do, please. So I guess the question here is, firstly, is there any plans at all to take PMDIs with the new -- with the next-generation propellant into the U.S. because I think you filed in other countries but not yet the U.S. And I guess, how important or not is it in the U.S. market? And then related to that in Europe, do you envisage at all that when on approval, is it then going to be a sort of country-by-country process sort of regulatory driven almost to switch this? Or is this going to be discretionary patient doctor led? Or I guess, trying to understand the drivers beyond obviously, the obvious sustainability one to do this. And I guess related to that then, when this happens, I mean, we haven't seen the data, out of interest, is there any difference from a patient perspective using the next generation, I can't pronounce it, but HF, whatever the thing it is. And then just another one, which is then though, is Breztri, which you talked about, I'm guessing that's a very small proportion currently of your emissions related to PMDIs given it's still in the very early launch stages, particularly in ex U.S. markets. So what proportion, I guess, is Breztri of your PMDI emissions? And is this, therefore, then essentially and ultimately forcing a switch to a branded medicine from some of your older brands because presumably some of the older brands, you're not going to develop or do the trials for a next-generation propellant?

Thank you. Very comprehensive next-generation propellant questions. Luckily, I have global manufacturing and development, so I can answer them. So let me see where we start. So let me answer the question around the efficacy and safety first, the question around whether or not there's a difference to patients comparing the next-generation propellant. For those of you who are not familiar with PMDI, pressure metered-dose inhalers, there's a propellant in the PMDI that supports getting the medicines to the patient's lungs, right? Now as you all know, propellants are known to have global warming potential, and it's harmful for the environment. So we started the journey, actually, 5 or 6 years ago and saying, we need to really be on that journey proactively to switch to a near-zero global warming potential propellant. The one challenge at the time was a GMP grade near zero global propellant didn't exist. So we took it upon ourselves to work with a company called Honeywell to develop the GMP grade of this next-generation propellant. And we've just recently completed our clinical program where we were able to demonstrate with great data that the efficacy and safety of the next-generation propellant. We will start the switch with Breztri, as you mentioned, we will be ready to file and launch hopefully do our first launch in U.K. and Europe next year in 2025. United States is on our road map to switch as well. Ultimately, we will be switching the global market to the next-generation propellant by 2030, not just for Breztri, but across all of our PMDI portfolio. I think that just answered your question.

It's Matteo Paso from UBS Asset Management. So I have a question on the broader equity and access strategy. So how is it declined to specific products? I mean, do you have a specific access strategy for each product? Or do you take the equity strategy and you apply it to single products? Like let's say, for example, Tagrisso. Would you have a specific access strategy for Tagrisso? Or would you say that Tagrisso fits into the overall strategy?

That's a great question. Thank you. I'm going to start and then pass it over to Stefan. So if you look at our health equity strategy, certainly start at the global level at the enterprise level. What it really more meaningful is when you get down to the by country, by market level and then to your point, translating it to by product. So one of the things that we already are working on across the over 120 markets that we work with is really to translate our health equity objectives into the market level. And some of them, quite honestly, it's already being practiced, right? And then ultimately translating to specific products where applicable. So Stefan?

Perhaps the way that I would try to answer this is the access strategy focuses on or starts with the asset, with the brand and health equity starts with the people. And the 2 are coming together. That is what we're trying to do in the strategy to really make sure that health equity is embedded. It's part of our DNA, as I think Dave spoke to that and Marc. But practically, this means that we ask ourselves the question of the determinants. What are the driving factors behind having COPD or lung cancer or other diseases, where are these people and understanding why there are care gaps for these people because it's the characteristic of the person that will determine if you have access to screening or early detection, if you get guideline concordant therapy or not. And that is where we're bringing the 2 insights on how do we kind of maximize the access to our product from a brand perspective and then that we sensitize ourselves more to the needs of the underserved people. And so the 2 is what we're combining together. And I'm sure some of our peers are online as well. So I don't want to go too much into this, but living health equity for us means understanding the people that we're serving really at the local level and not just thinking through the lens of our assets that we have. I don't know if Dave or Marc or Elena want to comment.

Dave?

Thanks. Maybe just Matteo, to pick up on your specific question on Tagrisso. And to be really clear, and Stefan made this point, our access strategies are absolutely product tailored. And so we've got a set of tools that are at our disposal. We've got, as Pam quite rightly points out, an umbrella set of ambitions that we've got. But in terms of how we leverage those tools, it really does vary. So to bring this a bit more to life, I mean, when we take a look at this, the kinds of things that we look at for a specific medicine and even on a specific trial would say, well, what value are we bringing clinically with this particular trial that we're looking at? How does that compare when you think about the value to the comparator or to alternatives? Then within specific markets, we need to understand much, much more around, okay, what is going to be required in order to be able to achieve our objectives of driving to all eligible patients really being able to be treated with these medicines. So with Tagrisso specifically, we have a lot of work that we put into lung cancer detection and EGFR screening and excuse me, EGFR diagnosis, and we had a lot of T790M work that we were appropriately engaging in across different parts of the globe. So it is very much tailored. It depends a lot on the clinical trial results. It depends a lot on the therapeutic alternatives, and it depends on the prevalence of the disease within a particular market. The efforts that we make in one parts of the globe on EGFR will look different where it's more prevalent than in those where it's lesser prevalent.

Great. Thank you, Dave. Thank you, Stefan. So why don't we do this? Let's move online. I see questions coming in. Let's skip a couple of questions in. And if we have time, we'll come back to the room. Yes. There's a question from Priya from OrbitMed. Would you agree that social aspects of health equity is more pressing than environmental aspects? How do you measure currently the impact from your health equity initiatives beyond the number of people reached? So I'm going to give a go in the first part of the question, and then I invite my colleagues to jump in on the second part of the question. So I would say we don't have to go very far to see and feel the impact of climate crisis on our planet, on our health, in the societies we live in. So it's very -- it will be very difficult for me to say it is not a priority. You've also heard about the gaps in health equity and health system resilience from Marc and Dave. It's also very difficult to say those are not important, and they don't need to be addressed. For me, it's like to say which one of your children you like the most. So I think it is a case of and not an or. We really need to make sure we drive our sustainability agenda, inclusive of the fight against the climate crisis as well as addressing health equity and health care system resilience. And I think we have -- as a private sector, as a private company in the life science sector, I think we have an innate obligation to do our part in the decarbonization because we see the connection between climate crisis and health, right? So we are in the business of making people healthy. And if our planet is not healthy and it's making people sick, it's a bit of a moot point. So I think here, we really need to focus on the end, climate crisis, how do we make sure that agenda continue to be front and center for our company and not only for our company but take a leadership role in mobilizing our peers and the rest of the sectors to join in as well. And then also the importance of health equity as we talk about today, how do we make a true difference there as well. So in terms of the measuring the impact of health equity beyond the number of people reached, maybe if I can -- on that note, because we have a similar question from Jamie from Investec. How will the KPIs in health care equity that you intend to publish next year impact remuneration? So I think we can answer the 2 sort of subquestions together. So maybe, Stefan, can I go to you and then invite Marc and Dave to come in?

Sure. And I think it's a great question, Priya. Thank you so much for that online question, Jimmy. So I think, Mark, you can best speak to that this is not a numbers game. Health Equity truly is not only about the big numbers. And Marc has alluded to that, and I hand over briefly. But for us, the qualitative aspects are really important as well. Again, if you think about Healthy Heart Africa, the longevity of this program is also important. It's not just to how many more countries can we expand and do more blood pressure testing. As I said, we're doing more expensive tests to early detect chronic kidney disease. And as part of the longevity aspect of this program, partnerships are crucial. So we are trying to enhance our partnerships. We spoke about shared funding that more organizations have skin in the game. So those are really important aspects because we design programs to -- yes, to be sustainable also from a commercial perspective for us. The other aspect is engagement. Pam mentioned this already, and we've seen tremendous engagement from our internal employees. But when I do interviews with people that would like to join my team, the policy advocacy and Health Equity team, those are the first questions that we get about our sustainability strategy. And I think this is something that is truly important to the younger and older generations alike. And it is usually the first and oftentimes also the last question that we get in interviews. So I think it is a truly important topic and engagement is also a critical goal of our health equity strategy. So Marc, can I hand over to you also for some of the rare disease elements.

Yes. Thank you. So I think the sort of the number of people reached with our indications or assets makes a lot of sense where it starts becoming a bit nonsensical is when you have to aggregate it at the company level with one KPI. Then you're obviously adding indications such as ultra-orphan indication with a few thousand patients globally to -- if you talk about vaccine, you talk to billion of those provided. So obviously, it's the aggregation itself, that doesn't make sense. So I think what we are trying to find is what proportion of the global population are we serving, are we providing rather than how many patients do you serve? Because obviously, you would be adding indication and products assets from very small population to very large population.

Dave, anything to add?

I think the only piece back to the KPI question and the work that we do there, we haven't introduced a target because we haven't set them all internally yet. There aren't industry standards. I mean there are some in certain areas, but I don't really think there are that are is comprehensive. And so within that, and I think Marc reflects it really well, we want to ensure that we've got metrics in place that reflect the work that we're doing and reflect the work that is important for also advancing our business. And so we need to also make sure as we set that, that we're finding ways to reliably measure that and to be able to do that at scale. And so those are some of the critical elements that need to be in place for us to be able to set KPIs that we'd be able to share with the external world and ones that indeed we'd be able to use to attach to remuneration.

Excellent. Thank you. So I'm kindly reminded by my colleagues that it is time, and I'm an engineer, so we will finish on time. So thank you very much for your engagement and joining us today on this important topic. And huge thanks to my colleagues, both here in person and online and joining me to host this session. It is Friday. Many of us had a long week. So please do stay with us for a bit of afternoon tea and a bit of a mix of mingling. Thank you. Thank you very much.