ICON Public Limited Company (ICLR) Earnings Call Transcript & Summary

Hi. Hello, everybody. This is Erin Wright. I cover life sciences tools, diagnostics at Crédit Suisse. And welcome to our 2020 Crédit Suisse Healthcare Conference. It's obviously in a virtual format this year, which is a little bit interesting. But if you would like to ask a question during this fireside chat with ICON, feel free to e-mail me at [email protected]. And hopefully, we'll get your questions answered. And with that, we'll start with our second presentation of the day. It's with the CFO of ICON, Brendan Brennan. We also have the IR -- Head of IR, Jonathan Curtain, on as well. But thank you so much, and welcome, Brendan. And hopefully, we'll have a good discussion here.

I did want to start out a little bit with sort of the most recent trends in the quarter. I think the COVID-related wins is where people kind of want to dig into. You've won over 100 awards year-to-date. You've definitely been winning your fair share of awards on that front, over 20% of the new business award's COVID-related. I guess can you speak to the timing and magnitude of revenue contributions associated with that? And what you've seen to date and what you anticipate in the coming quarters?

Sure. Thanks, Erin. And it's always great to be at the conference, so thanks for inviting us once again. I have to say the weather outside the window here in Dublin is probably not what it would have been in California, but hopefully, next year, we'll be back on track. So just in terms of, obviously, as you say, we've done a good job of proportionately winning COVID work. And it's been in excess of 20% for our business wins for the last couple of quarters. It has been predominantly -- when you look at the split, I think we mentioned that there's been over 100 projects that we've won. And obviously, a lot of that is treatment work and then fewer vaccine studies. However, we have been successful at winning vaccines. So these, of course, as you know -- and are working on one with our largest customer, Pfizer, at the moment, which obviously is moving in the right direction. That work has been -- it's been going now since, certainly, with some of those lead vaccine indicators have been going now since August. So we did see some of that revenue coming through in our Q3, and it's not in a significant way, and we're seeing it much more significantly, obviously, as we come into Q4 now. And certainly, as we go into Q4, we expect to start ramping out our vaccine trials. And that will continue into quarter 1. I suppose the big piece, if you like, differential is the treatment work can often be consulting and laboratory type work on the treatment side of the house. Whereas the vaccines is usually more you're running the large-scale Phase III trials for the vaccine candidate. And you're talking about those very large numbers of patient populations that we've been hearing about in the media between the 44,000 and the 60,000 patient cohorts that you've been talking about. And of course, with that comes at just a very, very significant increase in the amount of pass-through costs that will be recognized through the CROs that are running these trials over the next couple of quarters as well. And I think the one thing people probably need to understand is there's 2 elements to that. In some instances, the CRO will be doing that investigator payment piece and administering that. In some instances, they may not necessarily be doing that. So it may just be their normal direct fee revenue that is going through the books, and so it will be a mix of those 2 pieces. So as we see, as our revenue ramp, a large reason why we increased our guidance obviously, from Q2 into Q3 when we did that, was really to reflect that additional revenue that we've seen from the COVID studies, specific to those COVID studies that we're running, obviously, and the ones that will ramp up in Q4 specifically. But obviously, that is something that will then drip into next year. And one of the reasons that we're a little hesitant about, as we said, we moved guidance for 2021 from January to February, was we feel that we do need to get a bit more of an understanding and a grasp on some of the next tier of vaccine candidates that are coming through in terms of the speed to development and also the relationship with sites and the speed to patient recruitment on those particular trials. And so for the established first tier, we're seeing that, we're -- that's moved to the revenue. Certainly, it's reflected in the revenue uptick in the guidance that we mentioned. And then you'll see, obviously, a continued elevated levels of pass-through costs. Certainly helping the top line, not to the same extent as you would normally expect on the bottom line, obviously, because a lot of that pass-through doesn't have a huge amount of margin. So obviously, that's kind of a bolus to the top line, it will be less of an impact on the bottom line. And most of what we showed in the guidance uptick for Q4 is truly related to the vaccine studies that will be active during Q4.

Okay. And so how are you risk-adjusting some of that COVID-related work? And as some of that works through next year, do you expect a lag between that time and when things normalize from an underlying clinical site work if we do normalize into the second half of next year?

Yes. And that's a good question. It's really the way we're looking at things, Erin, is -- our expectation is ex COVID, the patient recruitment and the site kind of scenarios of the speed -- the normal speed to patient recruitment, if you like, probably will be more like H2 2021. And we certainly still are seeing where we know we're significantly improved from where we were in Q2. Obviously, in terms of the site access, it's up to over 60% now in terms of normal site access. That continues but not at the same pace as it was earlier in the year. We were talking about 2% to 4% improvements on a weekly basis earlier in the year. That has moved down to about 1% to 2%. So certainly that the impact will still be there in Q1, Q2. Obviously, I think what we've seen then is the bolus of COVID work has really helped CROs, particularly to come back to normal faster, if you like. And that transition, we do see -- probably be seeing being somewhere between Q2 and Q3 as we move into next year. So we do think it will take at least the first 6 months of next year, certainly through to quarter 1 before non-COVID work is back up to pace to where we would like it to be. And so there is that piece of transition from that high pass-through vaccine type work in the first half to a more normalized cadence with maybe more normal margin profiles as we go into the second half of next year. And I think that's something that's really important to understand. We do see these inflated revenues with these vaccine trials hitting in Q4, Q1, Q2 to a lesser extent, and then more of a normalized pattern to revenue and margin profile as we think and talk about Q3 and Q4 question.

And as you mentioned that, how should we think about the hiring dynamics thereon with some of this COVID work? How is it different? Obviously, you talked about the pass-through component. But if you could speak to kind of what you need to do from a hiring standpoint.

Yes. No, I think it's still going to be a year of very decent growth. We've still seen very, very good levels of underlying RFP flows. Obviously, that's been augmented by the COVID work that's going through at the moment. But we still see probably we're going to be hiring in the region of 5% to 6%, maybe even 7% additional staff as we go through the course of next year. I think our feeling is that we'll try to do that in normal course, try to get those folks in and embedded faster, so probably more in the first half. But we'll certainly be looking at the revenue profile and the flow of revenue as it comes in through the year. And as we always do, this is a balancing exercise in every CRO organization. In the last 9 years that I've been the CFO, it's been something that we constantly focused on every quarter. And getting that balance right, trying not to get too far ahead of the curve, trying not to fall too far behind the curve is the constant work that we do with CROs and trying to obviously get good revenue forecasting to help us to really inform that rate of hiring. But certainly, we're thinking somewhere in that 5% to 7% range.

Yes. Okay. And what are you doing to help mitigate some of the limited access to sites? Obviously, it's more virtual work. How much of that is sticky in terms of like post-COVID world? Do you anticipate more of that virtual type of work? Or does it just revert back to normal?

It's a great question. And I think it's -- there's 2 elements to that conversation. The first is the concept of the remote visit, if you like, or doing your clinical trial remotely. And then the second is the virtual trial. And obviously, just for the sake of all of the folks who are listening in, the remote piece is when the CRA doesn't physically go to the site. But the patient, of course, they'll go to the site and has the interaction with the doctor. And the clinical monitoring is the remote element of the trial. The virtual trial is where the patient stays at home and does their interaction with the doctor over an iPad or a Zoom call. And then also, in some instances, the monitoring can happen remotely as well. And you're really working with probably more like super sites from a doctor interaction perspective. So 1 doctor could be covering a lot more patients in the trial process. So the build and the structure of the virtual trial versus the remote trial are very different. Remote trials, I think, was always something that was there. And it was always something that was there in a proportion of the existing normal trials. So people would have said -- more from a risk basis in the past, they would have said, "Hang on, this is a new site. We want to spend more clinical monitoring on that site. So proportionately, more of our site visits are going to be there. However, this site over here, it's an experienced site, an experienced investigator. Probably we can do a more light touch, remote-type monitoring there. So maybe it's more calls interaction, reviewing the data remotely." And that's the way we look at it. So people would have really looked at it from that perspective in the past. Obviously, then what we saw during the height of the pandemic was everything flipped, 60% remote. So all of the visits that we were doing on our clinical research trials were effectively remote or 60% of them were remote. And what we've seen, obviously, is that come back now post the worst peaks of the cycle of the pandemic, and we're probably now in a situation where 30% or 40% of the work we're doing is remote on those trials. I think as we -- the real fundamental shift before and after will be 5% to 10% as a proportionality of risk management, where it was in the past. I think 30% to 40% is probably the way to think about it as we go forward as a proportion of those normal trials. And I think that's -- it's good from a cost-based perspective. It's good from a structural cost perspective for the customer. And it also is something that is very doable. I think one of the important things in terms of differentiating maybe between CROs, some folks have asked me today and previously about remote monitoring is, is there any differentiation, i.e., are there any particular software systems that allow you to be a better remote monitor than others. And I have to say one of the things that I think is really hugely impactful here is our site network that we have on ICON. I think one of the facts that we have are our own embedded staff at the site, working with the site allows us to have a better communication feedback out of that site. And I think it's the relationship with the site around remote for more monitoring that will be as important as we go forward. So I definitely think 30% to 40% of all trials possibly as we go forward will be remote. Virtual trials are an entirely different thing. All you're starting to see in the industry is a lot of interest around virtual trials, you're seeing tens of trials in that sphere where the trial is fully virtual. Of course, we have the Symphony offering now where we can do true virtual trials where the patients don't leave their own homes. We can have our nurse monitors go to the homes and actually work with patients to ensure that they're getting the drug, that the temperatures control and that all of the pieces you'd expect from clinical monitoring perspective or a clinical oversight perspective are done, and that the patient is able to use the technology. And all of those pieces to be actually able to have the investigator visit remotely. So that's an exciting new area where there's a lot of interest, but a relatively small overall part of the industry as this point.

In terms of the remote monitoring and remote work, is that -- you mentioned the cost being obviously better from your perspective. So does that -- is that going to be meaningful from a margin perspective longer term for your business? Or are there offsets?

Yes. I think there is -- I mean obviously, there is an element of you don't have the same -- and I think really using the advantage is as much for us, but it as for our customers, so you don't have the same pass-through cost, the travel to site, the accommodation costs for the CRA, which are normal pass-through cost that we would pass back through to our sponsors. And obviously, proportionately, they're significantly lower. But there's also -- I think there is -- we have to balance those 2 things. Maybe just make this one point is that, again, in talking to CEOs and biotechs and large pharma companies, they don't want to lose the connection with the site. So they don't want to move entirely away from the idea of having physical site visits and the importance of the relationship with the doctor. So they don't want to completely move away from that. So even they are saying, well, we lost -- like the cost dynamics of having a proportion of our trial remote, they don't want to go too far remote. So I think one piece on the -- one of the things that makes me think 30% to 40% is probably around the right proportion is -- has been that feedback from those CEOs about that type of relationship. From a margin perspective, from an ICON perspective, I think we're moving in this direction. It's a subtle change in margin at this stage. I don't see it being a significant uptick to our gross margin. Certainly, it does reduce the total dollars that are spent on the trial. And of course, as you guys know, we often pass those savings back to our customers. So it is -- while it is as good as, if not a little better than what we've seen in the past, it's probably not going to move the overall margin profile of the company significantly. And what we want to see, obviously, is a reduced cost for our customer per trial. And while that might reduce the overall dollars that go through and the direct fee elements that we don't pass through should be a greater proportion of that, plus, we want to see more volume of work, obviously, moving through and maintaining margin is still very much how we focused on margin profile there.

And can you give us an update on your response from a cost mitigation standpoint? What has been temporary versus structural in terms of the cost savings associated with all the, I guess, volatility that you've seen?

Yes, sure. I think a lot of it has been -- we've seen a lot of a run-through of our organization over the last 6 months. And some of the cost savings we took at the time were always going to be short term. There were certain reductions to salaries, which we now have and we'll be reimbursing to our employees over the course of the year. So over the course of year, there is no saving, if you like, from a cost perspective in the organization. It was more really rather a timing difference on when the costs hit. Other elements, I think we will be looking longer and harder around the need to travel as much as we would have done in the past. The structural element of our office infrastructure, as we are all sitting here in our home offices. I don't think any corporate -- C-suite officer would tell you that offices are a thing of the past. I don't believe that's something that's going to be the case as much as some people maybe want to think that. But I think people are certainly, at the C-suite level, are going to want people back in the office physically, it's important culturally. It's important from a training perspective. It's important from developing new staff members. So I do think that's going to still be a way of looking at things. But I do think the concept of satellite offices or smaller offices, maybe something that's -- maybe something that's come to an end. The center-of-excellence office, I like the concept of, maybe 1 office per country. You're associated with that office. Maybe it's only a matter you go in for a week or 2 a year, where you need to do training. But I think that there's an element and augmentation of the ability to do work from home will be important as well as you do that. But I think structurally, that's something that we're thinking about further developing. And it's not there yet. We obviously still have the same market infrastructure we always had. But I think it's something we want to think a lot more about, a lot harder about. And something that, as I said, that center-of-excellence concept is something we want to take. I spend a lot of time over the last couple of weeks, Lord knows, talking to our own budgeting process for 2021. And that's certainly something that I want to see developed as we go through that period.

Okay. Great. And I don't think you are -- really anyone in the industry has really noted any meaningful cancellations associated with COVID or disruption of that nature. But when we think about a portion of your trials are therapeutic related, once we do see a vaccine come out, do you think there will be a reprioritization of innovation across the space, maybe you would see some cancellations? Or any sort of response like that in a post vaccine world?

I think you'll probably see reprioritization. I don't know if that necessarily means -- leads to cancellations. I think you'll probably see it's just a natural tapering down of business wins that are COVID specific and then kind of a resurgence of the non-COVID work as we did at the beginning of the crisis. Let's be honest, when we saw, people look at kind of our own profile of the business, tapering down the stuff that they thought wasn't going to be as impactful. And then obviously, significantly upticking their COVID expenditures in their organizations. So I think you'll see that probably that inverse graph go the opposite direction as we go into 2021. I think that will be something that will help offset any risk to COVID cancellations as we go through the course of the year. That said, I think anybody who's out of Phase III -- and I think I made this point. Anybody who's out of Phase III trial is not about to cancel their Phase III trial. I think if they've gotten that far, they're going to be committing to that. And the Lord knows, we will definitely need more than 1 COVID vaccine. Obviously, we saw the good news from Pfizer this morning. But we certainly will need other vaccines out there, and that will be something I think that will certainly take -- still be very, very prevalent in Q1, Q2 as we go through next year. And after that, yes, I think you're tapering down in business awards. Will we see the same strength when we saw 20% plus in the couple of quarters we've had? Will we see that same strength as we go into Q4 or in Q1? Possibly not, maybe it tapers out a bit even from this point. But I don't think cancellations probably, it's more of a tapering off of additional business units.

Okay. All right. And then have you seen any sort of cash collection issues, dynamics from a working capital accounts perspective? Are you seeing longer payment times from customers, shorter payment times, anything that from investigators that you're -- worth noting?

Nothing that, I suppose, speaks specifically to 2021 or COVID or the biotech funding or the market in general. I think we've seen -- it's been a -- I think earlier in the year, we were being quite conservative with our cash. And obviously, as you would expect, during Q2, it was a very, very strange time. But while we haven't seen any significant bad debts, we haven't seen any real bad debts at all to be absolutely honest. The industry remains extraordinarily well funded. And obviously, that's still playing through into business wins, but it's still playing through into cash collections. And if anything, 2021 will be -- or sorry, 2020 will be a better year from a cash generation perspective from an ICON perspective, Erin. So it's been very beneficial from that perspective. So I think other than the normal trends, if you like, where you do see the larger pharmas looking for longer commercial days credit, and that has been a continuing trend in the industry over some years now really, that hasn't gone away. But no, in terms of the collectability of those debts, once the invoices are raised, we haven't seen any issue with that at all.

Okay. And then just going back to sort of the underlying growth trends. You mentioned high single-digit RFP growth, I think, in the most recent quarter. How much of that was COVID related? I just want to break out, is that underlying RFP flow?

Yes. No, I think it actually does come quite close on the underlying RFP flow as very, very solid. So it was more like high single digits underlying RFP flow and probably was over the top of those numbers when you add back in the COVID numbers. So it was still a very, very solid environment from both a COVID and a non-COVID RFP flow perspective.

Okay. Okay, great. And then one of the differentiators, I think, for ICON is kind of the site network strategy. You've done several deals, whether it be Symphony, PMG, MeDiNova, like, what -- can you give us an update on the strategy on that front? How that's playing into your long-term vision here? Do you anticipate to do -- doing more deals in that segment? I'm curious how that's progressing.

No, it's been -- it's going really, really well. And I think our -- happenstance, I suppose, but our timing has been pretty, pretty good as we could come into this COVID crisis. The patient recruitment of these types of vaccine trials works extraordinarily well through those types of site networks, we can get patients in fast through those networks, and we can get them in faster versus nonconnected networks, if you like. So it has been really, really strong and really good. They performed extraordinarily well in North America, particularly this year, where most of the COVID work is being done. And we're very proud of them and their part that they've played in the development of vaccines to date. So it has been a great, great time for us to be really betting in that infrastructure across the organization and a huge success for the company. So no, we're super keen on continuing that developing that relationship and expanding those relationships into other sites where we could take over the clinical research work. Obviously, we did that with the DuPage network of Chicago. And that continues, and it is working well. So we're seeing a lot, a lot of positive traction there, a lot of really strong interest, particularly around the vaccines work. As I said, it's been a huge positive bolus of work that's come through from that perspective. And also, of course, then we -- with Symphony, and we talk about virtual trials thereon. Symphony has been hugely in demand in terms of that ability to have the nurse and visit the patient in the home and really continue that trial perspective when you do have other infrastructural problems that are happening in terms of the health infrastructure. So that has been an area that's been of huge, huge interest, and we want to see grow very significantly over the next couple of years as we do want to continue with the overall Accellacare model which we've rebranded our PMG and MeDiNova networks to now is our global Accellacare offering. And really continue that good work that we've seen. Predominantly, as I said, obviously, they've been in for a couple of years now, but certainly very, very strong solid growth in '20, and we'd like to see that to continue into '21. So I'm very, very happy, I suppose, is the short answer. And we had those -- are doing -- and we do feel as much as anything at the moment, that they represent a differentiator for ICON.

What sort of long-term -- if you can break it out as such, like, long-term growth rate across that segment of the business, do you anticipate over the longer term, excluding obviously some of the COVID bolus?

I'd like to see them still striking in the -- I think, overall, as a long-term organization, if we kind of go back from this year, we always want it to be in the high single digits. I'd certainly like to see those guys in the low to mid-double digits as -- growth over the next -- the medium term, if you like, the next 3 to 5 years. That's certainly, I think, an ambition that we would have in the organization to see them outpace the growth of the core organization. And I think it's certainly -- something that they certainly have sprung into that in '20, and they can have the potential to keep going with that in '21.

Okay. And you most recently did the Oncacare, the minority investment, I think it was 49%. Do you anticipate acquiring the rest of that? How does that also play into the site network strategy?

Well, I think as a lot of people who work with site strategies will know a lot of what you'll see in those kind of sites can often be the more ambulatory-type patients. So folks are coming in. It could be a pain-related CNS study, it could be a vaccine study, obviously, as we're seeing hugely at the moment. So often, those sites are less around specialities and more around general practice. What the whole point of the Oncacare sites are -- is to really establish site networks with particular oncology sites, and to really try to embed that model of the remote clinical research at those sites. And you're not looking at the probably the premium sites in that regard. You're looking at the kind of the secondary tier of oncology sites, which are often the sites that actually recruit more patients because there are such demand that the more high-profile sites and so much competition that you actually see more productivity often in second-tier sites. And so that's what that investment is about. It's actually the gentleman, who was the leader and entrepreneur who developed the MeDiNova organization, who will be leading that, so he has a lot of experience and time in developing relationships with doctors and is now obviously moving into those oncology sites. And it's going to be global in nature. I think there is the potential in the future that we could effectively acquire the remainder of that, but that will very much depend on the performance of this asset over time. And we're obviously super excited about it, and obviously, a very large minority interest there. But it certainly is something we're working with in partnership with those folks and certainly are very keen to have it really help us as a way of getting oncology patients into our sites.

And did you break out the contributions for that business?

No. No, it's a private organization. So what you will see, I suppose, there will be a separate line over time on the P&L that will show out the share of the return on that investment. Yes, that will be...

Okay. Great. And then so given your balance sheet positioning here, kind of what are you thinking from an M&A perspective? How does the pipeline look? What areas are a focus for you, whether it be on the site network front or Asia, Central Lab, other areas that you're interested in?

Yes. We want to continue on it, Erin. We've, obviously, as I said, had a very good year from cash generation perspective. We want to really get those dollars to work from an M&A perspective now at the back end of the year. The M&A opportunities went pretty quiet halfway through the year, to be honest. There wasn't a lot of traction there from really March to September. I think we've seen it, obviously, pick up in the last couple of months, and you've seen some announcements in the space, obviously, in the last couple of months. And certainly, we are very active in a number of M&A opportunities. And while we're getting a little close to the wire in terms of end of this year to get something across the line, we're very hopeful that at the very least, we'll see something in the early 2021 in terms of M&A and really starting to use those dollars that we've been generating to help build out the infrastructure. I think the areas you spoke of are still key spots. Certainly love to do more lab work. We're certainly seeing speciality testing being a very hot area, and that's an area we'll continue to look at. The geographical spread is something we'll continuously look at in terms of the Asia piece specifically. And as I've always said, the CNS is an area where we'd love to continue to acquire, and rare disease and often disease products is also an area where from a therapeutic mix perspective are certainly areas where we would look to augment through M&A as well.

Okay. And I think you've always leveraged more the partnership strategy when it comes to leveraging data assets. Is that still the mentality at ICON?

Yes, very much so. I mean we see ourselves as experts in delivering the benefit of analysis on data and not being data aggregators in ourselves. I think other people have better access to data, have better kind of control around the data. And being certainly a step away, can breathe up a little bit more in terms of the blinding of the information that comes across those. So that we can ensure that when we are getting data, what we are exporting is the consolidation of that data from various sources. But then obviously, the analytics around how we use that data to drive really feasibility and how that moves the organization forward in terms of pace to patient recruitment. Our OneSearch tool that we've been working with in that space has really come on in really extraordinary start over the last number of years. The speed and the quality of the data is always something that we've said was absolutely permanent. So we really try to look for partners where the data is fresh, where they are constantly working on the data flows to ensure the freshness of that. And as we said, where we really do feel that EMRs and EHRs are, when properly maintained and kept up safe, are definitely the best source of data to be doing your analysis whether be it real-world evidence or be it feasibility analysis. So yes, I think that plan and that consistency of approach is working well for us. We feel that we are expert at now plugging different data sources together, consolidating and analyzing that. That's where we feel our expertise is, and that's where we feel that the OneSearch tool really can differentiate in terms of patient identification. As we've always said, that's the metadata element of patient recruitment. That's the top-down where you get those large sets of patient data. We take it from numerous sources, we analyze that. We get that -- a heat map of where the patients are. And of course, we're using the electronic bio records of our partner sites in terms of our own site networks there as well, bleeding that in. And of course, it's the ability and connection to the site and to the doctor that's so paramountly important to actually make that turn all of that data analysis into patients actually attending a site and attending a clinical trial. And still, we feel -- that's why it's so important to have both parts of the story. You need the data, you need the analytics, you need the analysis engines, but you also need the connectivity to the sites to be able to get the patients, identify the patients and get them on to the trial.

Okay. Great. And then switching to the Central Lab business. I think I asked in the most recent quarter kind of how that business was trending, like is that improving at all from our last conversation? And then do you think that having that Central Lab business has helped you win COVID-related work?

It certainly hasn't hurt. We have seen -- they've moved up well during the course of the year. Obviously, they were very impacted by site closures in Q2. They're now back to very, very positive territory. And as we go into Q4, I think they are probably even going to be -- their year-over-year performance will be up substantially, so certainly in the high single digits. So very, very good performance from them as we go into Q4. So very happy with the performance. I think they have been additive in terms of their ability to effectively have us as another part of the dial. I think one of the things that you really benefit from a broad spectrum of service is that when you are dealing with the mid-tier or the biotech type partners that you do represent the full suite of offerings that you can do all of the pieces. And I think from a lab perspective, that's definitely a very, very keen attraction for people who are thinking about all my data is in one place, whether it be lab data, be it a clinical monitoring data. So I think it gives that sense of comfort to people that there's a consistency of management of information, but also that there is an overarching executive management relationship around all the different service lines that I'm working with. And so I have that feeling of connection into that organization because not only are they doing the monitoring, they're doing the data management, they're doing the lab work, doing all the different pieces. So I think that's definitely of significant benefit on those types of relationships. And I think we've definitely seen that playing through both our strategic relationships, but also on those smaller and biotech-type relationships.

Okay. And strategic alliances, you kind of mentioned it, but is this significant portion kind of your business at about -- do you anticipate these strategic partnerships being more involved going forward or less? And do you anticipate ICON focusing more on biotech going forward versus large pharma? How the priorities changed? And maybe they've changed in the COVID environment. But how do you anticipate that playing out over the next 3 to 5 years?

No, I think the big strategic relationships will always be important, Erin. If you look at the concentration in our industry and certainly, in the ICON company profile, the concentration has always been pretty significant. Big customers are always going to be a very large part of what we do, and I think that will be unchanged as we go forward. And I'm very proud of those relationships we have as well. When we think of relationships like the ICON-Pfizer relationship, it's been a relationship that we're extraordinarily proud of and has been going for an awfully long time and has no sign of evading anytime soon. So I think that will be just a part of the overall structure of the pieces. That said, proportionately, even though biotech isn't still the same proportion, the proportion of growth, obviously, is much stronger there. So business wins, the profile of business wins are now startingly catching up on where we were with large strategic-type relationships. And that's just the volume of stuff that's going through the pipeline is very, very significant. So I think it will probably be more of a balanced approach to the forward -- in the future. I don't know if we're going to get to 50% mid or small or mid, 50% large. I think that's probably still a ways off for ICON, certainly. But I think that's certainly how we're trending towards over what time period, I suppose will be the question that we'll probably do more head-scratching on, Erin.

Okay. Okay. That makes sense. And just on that Pfizer relationship, you've recently kind of renewed that relationship. Were there any sort of big changes from a financial implication standpoint there? And do you anticipate any contract renewals or changes in 2021?

Nothing significant that is occurring to me in 2021 outside of Pfizer, obviously. Just trying to think through large relationships, if there's anything looming and I don't believe there are. There are some tweaking on some MSA terms, certainly, but there's obviously a normal cadence, but I don't think that's actually very, very significant there. In terms of Pfizer, I suppose the one piece of additional work that we've put on was we're also now under the lab-preferred provider relationship as well. So that's been good to see, and it's helping our overall growth in our Central Labs. So that's been positive. But the nature of the relationship, as I said, is very strong. And the proportionality, as we've seen, probably won't be decreasing in terms of their concentration this year as our largest customer. There's no indication that, that'll significantly decrease next year, either. So it's going to still be a very significant relationship as we go forward. And as I said, with the only major addition to call out probably is the lab piece.

Okay. All right. Well, thank you so much for the time today. I appreciate it. And I hope everyone has a great day. Thanks.

Thank you very much, Erin. Really appreciate it. Thank you.

Yes. Thanks.