David Slade, the head of leading TGA-licensed compounder Slade Health, spoke with BioPharmaDispatch after the company recently announced its expansion to New Zealand.
Slade Pharmacy was established by Mr Slade's father in 1965 with a community pharmacy in the Melbourne suburb of Mount Waverley. The company's TGA licensed pharmacy compounding facility is located in the same suburb.
"My father also had a pharmacy in North Richmond. I would spend a lot of time there doing deliveries and serving customers. I guess the family business was part of my DNA growing up and I took an interest in pharmacy."
Mr Slade studied pharmacy and commerce, during which he worked in the family business that by then had expanded into hospitals. "We began to service the Epworth Hospital in 1981 and we are still located there today."
"Hospital pharmacy is something that has always fulfilled my professional interest. It is far more complicated in terms of service delivery where we are dealing directly with what are very sick patients. In 2003, we took an interest in building our own sterile compounding suite, which at the time was located at Epworth. It is actually still located there. As we grew, we opened our TGA licensed facility in 2012, which was a huge step for us, and that is where Slade Health began."
Mr Slade said the company's licensed compounding operation is now spread across three sites in Australia with a fourth to be constructed in New Zealand to enable its recently announced expansion to that country.
"We are forecast to make over one million infusions this year," he said. "International expansion has always been a personal and professional objective. The opportunity in New Zealand came about as a result of a tender. It certainly has been a challenge because the pandemic happened at the time the tender was submitted. So, all our discussions and negotiations have been through Zoom.
"International expansion certainly is a challenge and one about which we are really, really excited. The opportunity to provide chemotherapy services to around 40 per cent of New Zealand's cancer patients. We plan to bring our know-how to New Zealand and create and build a world-class facility that will be able to compound not just the products today, but products into the future and deal with clinical trials."
He said, "The past 12 to 18 months have certainly been challenging. We have gone from bushfires to floods and the pandemic. When the pandemic first hit, I do not believe I have seen anything like it in terms of the impact on the supply chain. It has really highlighted the need for Australia to have a strong local manufacturing presence whether that be for medicines, gloves, masks, face shields and syringes.
"We need to make sure our supply chains are robust and I think they largely are. We did not miss a shipment through the last 18 months, despite all the issues we had to contend with. The strain is there but our ability to manage those events that are out of our control is also there."
Mr Slade said his company noticed a reduction in the number of patient admissions in the early period of the pandemic.
"Once the country was through that first round, other than Victoria, things picked up again."
He said the treatment technologies have changed dramatically in terms of complexity since the company started its chemotherapy compounding service.
"The treatment technologies have changed massively since we started and they will continue to change. We are now dealing with both chemical molecules and biologicals, which are even conjugated and mixed together. The complexity of handling those molecules has also changed. The standards around mixing have changed. Then equally just storing and transporting them. These molecules are very complex and any temperature excursions outside a defined range can lead to them being inactivated.
"Importantly, all these changes mean improved outcomes for patients because the disease for which they are being treated is being better managed.
"The standards we operate to in Australia are perhaps the highest in the world and that has ensured the products we are compounding are delivered safely, handled appropriately and patients are getting access to the best quality treatments. The last thing we would want to see is compounded facilities set up that do not operate to a standard and ultimately that would be essentially a negative outcome for the patients in whom these treatments are being infused."
On emerging technologies and the need to adjust, he said, "We look to the future to see what is coming down the pipeline. It is not just biologicals that are coming through. We know that there are mRNA technologies, vaccine, gene and cell technologies, really, really complex molecules that are going to transform how treatment is delivered."
He continued, "There will certainly be new technologies that we will have to get our head around in terms of how we procure, store, compound and deliver these products. We will see very targeted therapies that are tailored to individuals and very personalised. It will become perhaps even more bespoke so we will continue to need to have systems in place that allow us to compound these molecules and deliver them in a timely way."
Mr Slade said he expects the recently announced chemotherapy review to look to the future and consider how best to deliver these new technologies to patients.
"Part of that will be the increasing administration of chemotherapy in a patient's home or closer to where they live.
"Another consideration should be reducing the complexity with respect to the paper-based requirements associated with ordering chemotherapy. Moving to electronic systems, ensuring aligned regulations across the states and territories while not requiring additional paper-based administrative processes would make a huge difference. The pandemic has seen changes in attitudes to the adoption of electronic systems and that has been one positive.
"I am very positive the review will have a forward-looking approach. I think all stakeholders understand the importance of delivering safe, timely, affordable treatments to patients wherever they might live. I think it is only fair and appropriate that the government review current arrangements because so much has changed since the last review in 2013. They have allocated a significant amount of time to work through how the system is working and what needs to happen in order for it to be improved.
"Quite frankly, I think the system is very, very good. If there are improvements to be made, then happy to talk about those with all stakeholders and make sure patients get the best treatments. I think ultimately that is what everyone is focused on and I really genuinely believe that.
"Certainly, for our part of the supply chain, the medicines and treatments that we are talking about are very complex, both from the perspective of prescribing, right to the patient receiving an infusion. It is a complex supply chain. To the extent there are differences of opinion, I think at the end of the day for patients receiving treatment for cancer, I think that drive to get the best outcome for patients really does filter through all stakeholders. Even if there are differences in opinion or differences in how the system should be set up and designed, I think that overriding drive to look after the patients will see the industry get to the right outcome with respect to any government policy or how the system needs to be set up for the future."