New rules for the In-Vitro Diagnostic Industry with Maurizio Suppo

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I know that on the title the focus should be on the In-Vitro Diagnostic situation but I promise that you will not regret this episode if you are on the pure Medical Device industry.

Maurizio Suppo, from QARAD (Guess about the acronym? Maurizio will reveal it at the end) is really a great guest and I really enjoyed to discuss with him about the situation regarding the IVD industry but also a lot of other topics related to Medical Device in general.

Here is a highlight of the topics we will discuss:

The urgency for the In-Vitro Diagnostic Industry to wake up and start engaging with the new IVDR
The risk if some manufacturers are out of business
Notified Body Situation for the In-Vitro Diagnostic Regulation (IVDR)
The proposals that could be made to the European Commission in case some manufacturers are late
The talk that Maurizio will do at the TOPRA Symposium 2019

I know a lot of people are asking me if this is possible for the European Commission that they extend the due date. Maurizio provided his answer and I would agree that this is a great solution.

Who is Maurizio Suppo?

Maurizio Suppo obtained his Ph.D. in Molecular Biology from the University of Turin. He held executive positions at several world-renowned IVD companies and was the Director of the European Diagnostic Manufacturers Association (EDMA). Maurizio joined Qarad in 2012 and became co-owner in 2016.

Podcast Transcript

Welcome to the Medical Device Made Easy podcast. Here is Monir El Azzouzi from easymedicaldevice.com. And today we will talk again or once more, one more time about IVD, so, in-vitro diagnostic manufacturers. This is a topic that is less discussed currently because we are really focused on the MDR. But I wanted to find some that can help us to understand the situation for IVD manufacturers currently. And for that I have with me Maurizio Suppo from QARAD who will be our guest today, and he will really guide us through the situation for IVD manufacturers and will help us also to know what they should do already now to be in a good shape for the future. So, Maurizio, welcome to the Medical Device Made Easy podcast.
Thank you, Monir. I hope I will be able to give some useful information for the audience.

Introduction of Maurizio Suppo

Yeah, I’m sure you will be doing that. So just for the beginning, Maurizio, can you just introduce yourself for the audience?
Yes, Italian. I work in the IVD industry for more than 33 years always in the quality regulatory environment. So that gave me a good chance to follow up from a situation that in the beginning, Europe was fragmented. There were countries without regulation for IVDs, countries with some regulations only for certain selected types of IVDs and countries with more general, you know, I remember France, Germany, then later on Spain, regulations. And then I lived through the, writing and the implementation of the IVD directive. Okay, that’s more than 20 years ago, of course. And now there is the second big step forward of the European Union in terms of legislation with the IVD regulation.

New Rules for In-Vitro Diagnostic

So it’s good then you have kind of all the history that happened for this kind of regulation, which will be great, and I think it will be great then for the audience to really learn about that and understand it. So, just for starting, so maybe we can still continue with the history for IVD (In-Vitro Diagnostic) and IVDR (In-Vitro Diagnostic Regulation). So, what is exactly the kind of changes that were happening there? What is the starting point now and what is our current situation regarding the products that will be now considered within IVDR?
Well, essentially the biggest innovation is that the European authorities have really decided to close the gap that we have in Europe versus the major legislations. And, of course, everybody has in mind FDA right. Because the situation was really, the delta was too significant. Think about high sophisticated products, which are in an area that is particularly sensitive to people, which are the tumor markers, in the United States’ FDA. Not only there, also in other legislations, they are quite highly regulated, all the cancer markers. And in Europe, they were under the directed framework. They were self-certified.
[Monir and Maurizio] Okay.
Companion diagnostics, the same. In Europe, self-certified IVDs and in the other legislations, very highly regulated. So the European authority really decided to close the gap by shifting the European legislative framework in a direction that is much closer to FDA in terms of complexity, okay, and I would say even cost, but not really exactly duplicating the modalities for the registration. So Europe, in that, retains its own unique approach. But overall, I have to tell that clearly the cost of compliance is going up. Okay, the cost of compliance for IVD companies, it’s clearly now being driven up, and that, Monir, as we were discussing before, it’s likely to have an impact on how the shape of the IVD market will look tomorrow. That brings me to highlight the major difference between the regulation and the directive is this revolution in the way that the products are classified. At most importantly is the revolution, the complete flip around of the ratio of products subject to the notified body control and the products that were self-certified.
Yeah, I can remember that. Yeah, before, so the classification was not really the same as for medical devices, and, as you mentioned, they closed the gap maybe with the FDA, but I think they also closed the gap between the medical device products and the IVD product because in terms of classification, the way you are considering them, we see similarities also now on the chapter, MDR and IVDR.
Totally correct. Totally correct. And the point, the point is that we have under the IVD directive, we had basically only 15% of IVDs under the scope of notified bodies, okay. And, you know, these are all the products that were in Annex II of the IVD directive, blood typing, hepatitis, toxoplasmosis, et cetera. And 85% were in the self-certification regime, and these are not my data. These are data from the European Trade Association, MedTech Europe, of course. And now these percentages completely flip. With some people, they are even saying that maybe only 10%, not 15%, of IVDs will be left in the self-certification regime. So you name a reagent, just name it, and every likely it will fall under the, the control of notified body. And that, let me add, it’s complete mind paradigm shift for many IVD manufacturers, which let’s face it, until now, they have happily lived in what I call the blue ocean of self-certification with no clue at all of what does it mean to work with a notified body.
Yeah, they never had any audit. They never had any unannounced audit, surprised audit, or any nonconforming managed .
Not only, not only that, which is an extremely valuable point, but they never had their technical documentation reviewed and challenged by an outside organization.
So it will be really a challenge also for them. I mean, a challenge for notified bodies, because there will be really a big need now of notified bodies for this area but also a chance for all the manufacturers where they can be surprised where before they were able to sell the product without any issue, and now they will be challenged by a notified body saying that maybe their product is not correct or not compliant. So it can, what happens,
And that, Monir, brings us to the other salient and significant point of the regulation, is the concern that industry has on the notified bodies. Because, okay, it’s clear, the European regulators sent a strong signal saying we want basically all of the IVD market under the control of notified body with very few exceptions, which are the products that remain in class A. And then it’s understandable, but on the other side, we are concerned, when I’m saying we is consultants, of course, industry, of the fact that the notified bodies, the European authorities, they have raised the bar so high for notified bodies in terms of competence, in terms of independence, needles to mention the joint assessment audits that notified bodies are subject. Also medical device notified bodies. Which are much tougher, okay, than the one, the processes in the past because, Monir, you know that in the past, notified bodies were nominated and monitored only by the authorities, the health authorities of the country that they belong, okay.
Yep.
And now with these joint assessment committees. So, the bar has been raised so high, and this has intimidated many notified bodies from applying to become a notified body for the Rs, for the regulations. So we have seen a significant reduction in notified bodies for medical device regulation that have applied, okay. Now we are at number four, nominated.
Yeah.
But you remember the story. You know, from 80 to 58 when this joint assessment audits came into place, and now from 58, I don’t know how many notified body have applied for the medical device regulation, probably 20, you know. It’s very secret. The European Commission doesn’t disclose data. But if we look at specifically at IVDs, you know, seven or eight have applied. And now we discovered that some have dropped out from the race. We all know about LRQA. We all know about UL. You understand. So, NSF was also a notified body that applied, particularly with the mission of being the partner for the IVD industry. And then it was forced to pull out of the race.
Yeah, so, as you mentioned, there is a big need of notified bodies. We have four notified bodies for MDR as of today. So, BSI UK, TUV SUD, Dekra, and recently yesterday, IMQ, at the day we record. But I checked again the list and the NANDO database, and zero are still for IVDR.
Which is understandable because the commission clearly wants to progress what is more urgent now. The most urgency is on medical devices because their deadline, their date of application, the end of the transition period is like 10 months away.
[Monir] Yeah, true.
But for IVDs, so it’s understandable that IVDs will come later. But what is more concerning is that with a third, you know, if we are lucky, we may have seven, maybe even, say, eight. You know, some people, they say six. It is roughly a third of the notified bodies for IVDs that we have today under the directive with a workload that has been estimated, again, not by myself, but by MedTech Europe, to be at least eight times as much as they have today.
Eight times for manufacturers or for the notified bodies?
No, for the notified body.
Okay, so they take eight time more resources–
With 1/3 of the notified bodies.
Okay.
So you do the math, and what is the result? The result is potentially long, long waiting lists. You know, these massive, massive amount of workload that will hit the notified bodies very hard when the time will come. And this is another excellent point that we, Monir, we already discussed before when were prepping this cast. Is that one thing is are the official deadlines that you see in the regulations, okay, everybody knows that it’s May 27, 2022, okay, for IVDs. But in reality, the real deadline that IVD manufacturers will be confronted is the date that the notified body will give them for submission. Because the notified body, if we look what is happening already today for the medical device colleagues, the notified bodies, they are saying, hey, if you want me to approve your medical device by the May 27, 2020, you know, next year deadline, you have to submit the documentation, the whole set of technical documentation to me by October this year. You know, we are almost in September, okay. September is few days ahead of us, and medical device companies may face an October deadline, which is like a month away for the submission of that. This is shocking, okay. These deadlines, these soft notified-body imposed deadlines, are the harsh reality with which industry will have to confront.
Yeah because I think everybody now is thinking May 2020, but at the end, it’s really not the right date. And I can also understand notified bodies, that they need some time also to review all the documents and then to be giving the approval. But yeah, it’s really, I mean, it’s a lot of time that is provided for them with less time for manufacturers to be ready also for the notified, for the medical device regulation. I think it will be the same that will happen for the IVDR. So we consider May 2022, but it will maybe October 2021 that everybody should–
Exactly, exactly.
Okay, so I see also as we discussed about MedTech Europe, I see how they were already alerting about all those kind of issues. And we start also to see a lot of countries like USA or Australia that starts also to provide some warning to the European Commission. What can they do? I mean, what is the consequence of that? Because everybody now is saying maybe we can extend the due date, et cetera, so what’s your idea on that?
But first of all, you’re totally right in the concern that it’s on the industry side. Everybody knows that MedTech Europe, Serge Bernasconi wrote a letter to the European Commission saying, hey, you know, this is, we have a certain sense of urgency, and the time is running out. What are the mechanisms that you are putting in place, you, the commission? And the European Commission replied very formally saying, yeah, for the moment, everything is fine. We are running along the, it’s normal cruising. But people are concerned. So what will happen? Nobody has the crystal ball, okay. I am kind of skeptical when I’m hearing people saying, yeah, you know, at the last minute, the European Commission will just push further back in the future the deadlines, which is, in other words, they will extend the transition period. I don’t think it will happen because it will imply an official modification of the regulation, okay, which is something that I don’t think the European Commission will consider. What more realistically, but this is purely my position, will happen, it is something like it happened already with the MDSAP. Our people that are on the line may understand, they know that MDSAP is the Medical Device Single Audit Program. And the Canadian authorities, they were crystal clear, you know, January 1st, 2019 is the deadline you need to be certified by MDSAP if you want to continue to sell in Canada. So what happened, so we are talking about facts, Monir, it is not speculation, okay. As you and I know, these are facts. What happened is that the Canadian authorities, they realized that there was also in this case for MDSAP certification, there was a bottleneck. So many companies have applied. They may even have received the audit but not the certification itself purely due to workload from these, of course, they are not called notified bodies. In the field of MDSAP, they are called auditing organizations. And so the Canadian authorities, they basically said okay, if you can show with documents that you have applied, maybe you even had the audit, and you are just waiting for the certificate to be issued, it’s okay. You are okay, don’t worry. Later on, they even went further. They said, okay, if you have applied, and you have not received the audit yet, okay, it is not your fault. We understand that the auditing organization are very busy. And there was a third step, which is really demonstrated how flexible the Canadian authority were. They said, okay, if you have already the CAMDCAS, which was the former Canadian regulatory regime certification, it is still okay, but provided that you will apply, and you will get the MDSAP certification. Okay, so these are facts. So what I think may happen is something similar. So, the European authorities may say, okay, listen, if you can show that you have contracted, not contacted unofficially because everybody can unofficially get in touch, but contracted the notified body, and you have made the application, raised your hand and said, we are ready. We have all the technical documentation, and our quality management system is okay. And the notified body had no time to come due to workload, I think that it’s very likely that the European authorities will say, you know what, your current CE mark, because, of course, they are directive-related CE mark, it’s okay. And it grants you continued access to the European market until the notified body will come.
No, it’s clear, and I think the European Commission should try to find those kind, I mean, to maybe disclose or mention about those kind of scenarios because it’s really important for manufacturers to be ready and not give up also. What I’m afraid of also is that some, that we have notified bodies that are giving up and maybe now we’ll have some small manufacturers that will also give up because they say it’s too much. There is too much thing, and we don’t want to invest money, where at the end, we know that we will not make it, et cetera, et cetera because of the deadline, so–
And that, sorry, to interject, Monir, but that is one of the concerns. I think, again, it’s me speaking, my opinion, but I think that these European regulation will change the shape of the European market, particularly, particularly for IVDs. The impact on IVD manufacturers will be much greater than medical devices because as you mentioned before, medical device manufacturers already were used to work with notified body. It’s not that they are totally facing a different environment. That will happen for IVD manufacturers. And that from what I’m seeing, honestly, our consulting company is very specialized in IVDs. We basically work with 70% of the top IVD players. So what I see for the moment, in a bullet statement, is that the big players, you bet, they are on it. They are already working since months, if not a year. And they are preparing very well. The small manufacturers, even some of the medium ones, they still have their head buried in the sand. And when they will wake up, for many of them, it will be dramatically too late.
Yeah, and as you mentioned, there is, I think, a lot of diversity in terms of products. And there is some product that exists maybe only with some small manufacturers and not with big ones. So, losing them, we can maybe lose a big part of the products that people are using and–
[Maurizio] Exactly.
This is maybe risk for patients at the end. Also risk to have no competition so that only big medical device can dominate the market.
Yeah, let me reframe that a little bit. I don’t think really risk for patient. The risk for patient doesn’t come from the fact that certain companies, small companies, won’t be able to offer their products, okay. I think that the risk for patients may come if the European Commission will not put in place these plan B mechanism, okay, that we were discussing before. If they will only apply a very, very strict mentality saying, hey, if you don’t have your MDR, Medical Device Regulation Certificate, you will not be able to place product on the market. If they take such a strict and rigid attitude, and they will take it by telling the notified body to take such attitude, really, there is the risk that certain medical devices, first, of course, because the deadline is coming earlier, and later on certain IVDs will not be available to patients anymore. And that would be bad, and it is so bad that that’s why I’m absolutely convinced, Monir, that the European Commission won’t let this happen.
And I’m sure also, and I hope they are listening to this podcast and that they really get some advices or get some suggestions so that they can .
What will happen on the IVD is a more subtle thing. Is that, indeed, the laboratories, if I would be a laboratory director, today, I have a very wide portfolio. And don’t get me wrong, they are good products, even the ones that are offered by small companies. Not necessarily they are bad quality. So for a laboratory director, you have very wide offer. And everybody knows as the fundamental rule of the market is that more, the more diversified the offer is, the more prices can be contained. If we will drive towards a future situation where small companies may not afford the cost of compliance, okay, what we were saying before, and slowly and gradually, the European IVD market will concentrate in the hands of the big players, which will have less competition and more capability to drive the market in the direction that they want.

What can QARAD do for you?

No, I completely agree with you. On that case, so what QARAD, so, what your consulting company can do? As you’ve said, you are really specialized in IVD (In-Vitro Diagnostic), so what are you doing actually for your customers?
Yeah, and again, with some exceptions, we are helping the big players to put in place their regulatory strategy for compliance, helping them to be very, very proactive to work with their potential notified bodies. Because, you understand, it’s an act of faith, right? You are working with your current notified body in the hope that it will become a notified body also for the regulation, okay. But I have to say that the big names, you know, maybe there will be some surprises, but most of the big names, I’m sure that they will become. But again, the big names, they stay on the fingers of two hands, even some less fingers, right? So, yes, the strategy of, first of all, identifying the products that are worth IVDR-izing. Okay, if you allow me to invent this new word.
That’s good one.
IVDR-ization, it is something that maybe not all products are worth having because you imagine there are products in the industry that are kind of at the end of their natural life cycle. They are, you know, old, The shape, the state of the art, okay, it’s moving a target, you know. Gradually, the state of the art is changing. Imagine the state of the art of a car. You are young, but you know, I’m almost 60. When I was driving age, the state of the art of cars were definitely different than what is today, right? So there is a natural obsolescence. So, the first step really is deciding what are the products that are worth moving on. And the second step clearly is mapping the intended purpose. Because you cannot, Monir, you cannot, and I’m sure you can do the parallelism for medical devices. You cannot make a serious gap analysis on the data you have or you don’t have unless you have very clearly mapped what is this product for, okay, because the intended purpose lists all the applications that the products has, and you need to have data for every single one of these applications. So let me make a very simple example. So if you say that a hormone, you have a test for a hormone, endocrinology, there are some hormones that also have a cancer marker application in certain situations, of course. And this is backed by literature, by scientific literature. If you make that statement, first of all, it will flip your product up in classification because a endocrinology test, pure and simple, falls in class B while a cancer marker falls in class C, right. But not only that. If you make the claim as a cancer marker, you should have data showing that your test, not somebody else tests, your tests can work in such application. So just to answer to your question what are we doing, we are helping them to prepare their documents. We offer the writing of scientific validity reports, which is a fundamental element of clinical evidence. And mostly what we are doing in these moments is we do IVDR readiness assessments. We review the technical documentation that they compile and they send us, and this is something that can be done in remote. Or my specialty is, I do on-site assessments of the regulatory readiness of the quality management system. Because you know, Monir, that the regulation, also the regulation for medical devices stands on two legs. One is the quality management system. You need to have a lot of processes that are required by the regulation, vigilance the periodic reports, et cetera, et cetera, post-market surveillance, post-market performance followup, which for IVDs, it is what post-clinical followup is for medical device. So, we do gap assessments on the quality systems and on the technical documentation.

TOPRA Symposium 2019

So yeah, I think it’s a complete offer, I think, for companies. And I saw also that you are on the agenda for TOPRA Symposium in Dublin October 1st on this year? So, what will be your talk there?
Yeah, I’m a regular contributor at TOPRA. I was also there last year in the symposium in Sweden. My topic this year in Dublin, other than drinking a good Guinness, it will be to talk about the, the clinical evidence implications, which are fairly considerable for the IVD industry, from an industry point of view. And the fact that I’m talking from an industry point of view is because I work with, as I told you, so many top players that I really see their approach, most of all their doubts in terms of clinical evidence. So that will be a very specialized talk on what is the currently industry, is the approach towards clinical evidence.
So we will see each other then then because I will be also at the TOPRA event. I will be covering the event, trying to see a lot of speakers also and do some small interviews with them, so yeah. And if you want then to meet here with me or also with Maurizio, then just contact us, and we’ll be there on October 1st and 2nd in Dublin for the TOPRA Symposium.
If you offer a good Guinness, I’ll be there.

How to follow-up with Maurizio?

No problem. Let’s do that. Maurizio, for the audience, so where can they follow up with you? So do you have a specific website or?
Yeah, yeah, yeah. It’s clear we have the QARAD. If you are not sure how to spell QARAD, it’s very simple because let me explain the acronym. It’s so simple. It’s Quality Assurance Regulatory Affairs Diagnostics.
[Monir] Okay.
QARAD. You know, you go to qarad.com, and you have all the information that you. And by the way, subscribe to the newsletter because the newsletter, of course, it is extremely laser-focused on IVD matters. But at least, you know, with a few days of delay from the official documents, you have them.
No problem, I will put that, everything on, I will put everything on the show notes or the links. I will put all your details also that people can contact you, and if they have more questions, they can call, go directly to you.
Yeah, thanks a lot, Monir, and let me add congratulations for this initiative, contacting many subject matter experts. And I think it’s a great way to defuse the knowledge about these regulations, and this is very needed particularly now.
Thank you, Maurizio, thank you very much. Really appreciated it. Okay, have a good day.
Bye-bye, bye.