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Theodora Savlovschi-Wicks: Hi, Anna. It is a pleasure having you as a guest on The Human Protocol podcast. Thank you so much for agreeing to join us as a guest. Obviously, we've been in touch for a number of years and I'd love for our listeners hear a little bit about your story and what brought you here. So, first things first, can you please introduce yourself to our listeners?
Anna Titkova: Thank you. ⁓ Hello, Theodora. Thank you very much for your invitation. It's a great pleasure for me to share my story and to share my expertise and my life with your audience and with you. My name is Anna Titkova. I am a country head of Pratia Ukraine and International Operations Director of Pratia. This is the international site network. We operate in eight European countries and the United States of America from the previous year. We've got the network of clinical research sites, our own or affiliated based ones where we perform clinical researches. In Ukraine, I built this business in 2020 and we've got our personal clinical research site. It was the first clinical research unit in the country that dedicated exactly for clinical researches and the range of affiliated sites in Ukraine.
Theodora Savlovschi-Wicks: Thank you so much. obviously you found it, perhaps, yeah, Ukraine in March 2020, pretty much when the world started going a little bit mad and you've opened that first clinical research site in the country. What was it that made you decided, you know, to build something at that particular moment? And what did you believe that others perhaps didn't? Or what did you think was the solution that others didn't see?
Anna Titkova: Yeah, it was March 2020. I felt like the world was holding its breath. ⁓ still remember the 20th of March, the official announcement of the COVID pandemic, isolation, stop of the movements of the people. And a week after, on the 27th of March, I registered two companies on the territory of Ukraine. ⁓ for many people, it was a time to pause. ⁓ for me, it felt like a moment I ignore. ⁓ I thinking, if not now then when. And Ukraine was usually considered as a good country for clinical researches. We had this quite potential in clinical studies ⁓ I felt a kind of responsibility to act on it. ⁓ you know, I am a doctor and I've been in clinical research for many years before 2020, a part of clinical research team. And for me, this was my personal decision, something personal at that time. I believed in overall. In our doctors who were the same as I am, about patients, about teams, more than I believed in the fear of uncertainty, ⁓ then others saw risk, I saw that possibility. And that I believed more than anything was that waiting for the right time is not just another way for standing still. ⁓ And that was exactly the time when we should do something. And actually did. So during the two years from 2020 to 2022, I arranged a clinical research site. As I said before, it was dedicated purely for clinical researchers. I built the network of eight affiliated clinical research sites. And we have started some COVID studies that was the peak at that period of time. We were the world's best recruiter. in hospitalization COVID study. We randomized 500 patients in vaccination study on one site only in COVID vaccination study. So actually that decision that was done in March 2020, it was right one and one of the best one in my life.
Theodora Savlovschi-Wicks: Wow, I can't even imagine what that was like to build it. When you look back at how things were, how you were before February 2022 and where you are now and who you are now, what is the most honest thing you can say about what has changed?
Anna Titkova: So, when I first began, I believed that success was the right path. Controlling my hands, in every step, I thought if I worked harder, pushed faster, I could bend the world into my will and could reach whatever I want to come to this my final destination. But life has its own plans on you, and perhaps the most honest answer is that I lost a certain kind of innocence. As before February 2022, believe that that was enough planning, yeah, that was discipline. This is how actually I did before receiving ⁓ some my scientific degrees, ⁓ coming this scientific path medicine to become a doctor, ⁓ cardiologist after general ⁓ medicine certification. that belief survive a war. ⁓ And what replaced was something probably more stronger. ⁓ I've become more direct, more decisive, but also aware of how fragile everything is around us. And I feel things more deeply now, such things as responsibility, accountability, fear even, some kind of gratitude even to the situation that we've got around us. And perhaps I stopped chasing every door, each door that opened simply because it was here. I built now bridges that matter. So I would like to find people with whom I can build something meaningful with whom I can have this communication, collaboration, as life really taught me that you never arrive to your destination, you just keep evolving.
Theodora Savlovschi-Wicks: Wow, there's so many powerful lessons in what you have said there. I guess a lot of us, especially in the Eastern side of the world, right? We were taught to believe that hard work and very good work ethic and determination and ambition helps you be where you are. But as you said, sometimes life has other plans and it is quite difficult to navigate the unknown. What would you say during those first days of the war, the first days of the invasion, what would you say those meant your team, for your patients, the trials that you were running, how did that feel like?
Anna Titkova: You know, these first days are difficult to put into words, into exact words. And there was a shock, of course, for everyone outside of Ukraine and much more for people staying in the country. But quickly it turned a kind of focused urgency. So people were just calling, ⁓ doesn't matter, someone whom you know, of course, relatives, friends. So just with the
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question, where are you? ⁓ How are Are you alive? So what we can do? How we can ⁓ help each other with some information that is coming which you can get from someone like an advice like their path, what they are doing, how they are managing their life during these first days after the invasion. Of course, if we are speaking about clinical trials, everything was stopped. I believe you heard about this and each sponsor, each client, they immediately stopped operation on the territory of Ukraine. So they stopped ongoing clinical studies, they stopped shipments, they stopped any kind of collaboration, let's call it in such a way, with Ukraine during the first days, weeks of the war. For our patients, of course, it was terrifying. Many of them were already vulnerable because suddenly the system they depended on felt like they might collapse. And for the team, of course, it was also impossible to balance. how to balance the fear of their lives, the lives of their family, and at same time they need to show up for others. And of course I remember that moment that we discussed it. Of course some of the people, they leave the country, they leave the city. Some of them this decision that they need to ⁓ where are now because that's the best place where they can feel the safety. Let's call it here safety in that ⁓ definition and they have the work, have families, have parents, they have friends here and this was their decision to stay in the country. But of course, we do not know what was the best answer for everyone. Everyone made it according to the situation where he or she was at that period of time. But yet continuing even in the small ways, gave people a sense of structure, the sense of purpose when everything else felt like it was falling apart. That was maybe one of the main things that we were working on at the beginning. were paying salaries for three months, the first three months during the war period. So to help our employees to maintain their life during that period of time, to find out where they can stay and what they can do.
Theodora Savlovschi-Wicks: Okay, I guess, you know, in some of your previous conversations, you've described clinical trials as really the care ⁓ many of your patients who don't necessarily have access to alternative ⁓ What you say that means on the ground, you know, for a patient who's losing access basically to the care?
Anna Titkova: Yeah, we were trying to find this patient first of all. how it was going on during the first probably few months it was stopped everything in Ukraine. So it was silence any movements at all. Then after the two three months we started to receive some notifications from sponsors from CROs that they allowed us to continue the follow-up visits. So any new recruitments but at least to follow up with the patients. So and we were working with our patients we're trying to find out where they are. who are still in the country, in the city or in the region, Kharkiv region for example, the majority of my sites, they were in Kharkiv as well. And some of the people, they took this medication, they go to the patient homes and it was also stressful because you were knowing this route of your, for example, study coordinator or a nurse to the patient home and when you're receiving some of this phone notification about new bombard
Theodora Savlovschi-Wicks: Yeah.
Anna Titkova: in some way or shellings and you understand that you're person somewhere in this region in this area so all of this it was too much emotional but overall what kept people there was not obligation it was conviction and the team in Kharkiv knew exactly what it means to stay. These were not abstract decisions. They were made day by day, sometimes hour by hour, what to do, how to proceed. And yeah, it's a good example of this dedication probably about what we're speaking about, this humanity, about patient-centricity at the end. So how people understood their purpose and that becomes personal.
Theodora Savlovschi-Wicks: Mm. Wow, so the site in Kharkiv continued operating through active bombardment purely through conviction, right, and through the dedication of everybody working on the site and working with patients. That is absolutely astonishing. You've spoken obviously a lot about the need for sponsors and CROs to hear that Ukraine shouldn't be written off as a location for clinical research. Obviously it's still an area of conflict in that regard and we all know that activity in Ukraine has slowed down tremendously. ⁓ What you want the CROs and the sponsors to understand that they currently do not when it comes to Ukraine specifically?
Anna Titkova: Yeah, I started this my loud speaking about Ukraine probably four years ago. For me, it was like an internal duty just to remind about ourselves, about our industry, about our patients, about our medical professionals. And I want them to see beyond the headlines, to understand the human reality behind the situation. Ukraine is not just a place of risk. It's a place of commitment, resilience, the place of capabilities.
Theodora Savlovschi-Wicks: ⁓ Mm.
Anna Titkova: And what people may not fully understand is how much effort it takes to continue under these conditions and how much that effort reflects the dedication of the team here. And when you choose to work with Ukraine, you're not just accessing the market. You're partnering with people who have proven under the hardest circumstances they will not give up easily. And we see the new clinical trials that are coming to Ukraine. Of course, it's not like it was before. So before the war we've got 600 plus active clinical trials, 200-300 new clinical trials were ⁓ each year. ⁓ course now we've got like 70-80 new ⁓ trials coming to Ukraine, but they are coming. And this is such a hope, this is such a part of the new life for people, the belief in the future for everyone, for patients, for our doctors as well. And that was my to say about this, that ⁓ as a nation, we deserve to be ⁓
the map ⁓ of the world map. ⁓ We the people deserve to be inside the community, inside the clinical research community for our doctors, for our ⁓ medical who could still understand that they are the same doctor, the same PI, as someone from the United States, from Poland, from For patients, they still have this access to medication, especially now, ⁓ when got this limitation, especially during the first years of work, was such a limitation of the number of ⁓ medications that available on the market due to the shipment ⁓ delays, issues, cancellations of the... Even to the chemist, just the person can go and buy this.
Theodora Savlovschi-Wicks: you
Anna Titkova: It was not possible even to buy if you have money. we have this, of course, financial issues of all of the people inside the country. You can imagine how difficult it is to maintain their well-being there. So limited by this possibility. They're limited ⁓ financially. limited physically to get proper treatment, proper examination even. And clinical trial them, it's the ⁓ option how they ⁓ come and get success to treatment, to there. ⁓ And is also a sense sometimes that decisions are made far away from the reality on the ground. And I would want more listen, more trust, and willingness to engage with complexity rather than stepping away from it. It's doable. We confirm this. With the new clinical studies coming, we confirm that we can do clinical research in the same with the same quality as it was before and is going on in other countries. ⁓ even I've got this example of one of my studies that were conducted previous year ⁓ in We've got such a good feedback from our patients who are sending messages for our doctor regarding the better quality of life that they started to understand. what does it mean to have a normal, finally, the normal quality of life? And you know, if previously we were struggling with everywhere, yeah, to find these patients, to find the proper patients, to convince them to participate in clinical trials, now we haven't got such a problem. We just need trials and our patients, are waiting for them.
Theodora Savlovschi-Wicks: So Ukraine is still very much there, is still very much ready to conduct clinical trials. Don't shy away from it is the main message, right? What would you say the international clinical research community do well throughout this period of active conflict? And where do you think it perhaps could have done better when it comes to Ukraine specifically?
Anna Titkova: Yeah. Yeah. story was a good example of how industry can react, how we can collaborate and how we can hear each other and hear our needs. ⁓ And were moments of real kindness, messages, this flexibility. People were trying to help however they could. ⁓ There these donations, humanitarian shipments to ⁓ When we speaking about clinical research during these first ⁓ weeks, it such
Theodora Savlovschi-Wicks: Yeah.
Anna Titkova: uncertainty and stress for everyone, but we understood that we need
to help our patients and especially for oncological patients. And I usually made this example of my patient from Ukraine, a young girl with oncology, Lymphoma ⁓ And was for her the only one way how she was maintaining her well-life being, being in one specific clinical trial. And when shipments ⁓ were stopped, was informed that there is any other option available in Ukraine for her because she cannot continue her participation in clinical trial anymore. This would be the last chemotherapy injection and that's all. And we were working so closely with our colleagues in Poland. It was a very strong and good communication between the regulatory authorities, people from both of the countries. were this association, GCP association in Poland, close connection with sites. And we did such a huge work with quick guidelines, with quick notifications, some instructions, how it's possible to be done, we were successfully transferring our patients to Poland. It was 14 in Pratia sites, but there were more patients transferring to other sites in ⁓ and neighboring ⁓ as well. ⁓ that how united we can be if it ⁓ goes to our patients to the main actual thing of our work in the clinical research and that was amazing. Of course we've got some not so happy end stories. Some of the patients we were not able to be aligned and to be quick in these narrow windows between the research. Some of the patients being on the stress, you can imagine, moving to another country, their parameters were not so nice when they came to the site and sponsored a few to continue this patient's participation in the study. But overall, we showed that we can be united. We can work like one big mechanism in helping our patients. And that's actually the work, the sense of our work in clinical research. But there were also moments that felt isolating. And decisions to pause or withdraw were sometimes made very quickly. And from our perspective, it felt like the full picture wasn't always considered. It's understandable. People were reacting on uncertainty. People were reacting on unpredictable situations that were not counted in any business plans, I don't know, risk management plans in any of the company. But when you're on the ground, those decisions have very real consequences for patients and teams. And that's what we saw and many people they lost this possibility to continue their participation in clinical research and to continue the treatment and proper treatment and examination with their chronic diseases especially. And I think the lesson is that this report is not just about intention, it's about staying engaged even when the situation becomes uncomfortable or complicated. And I think the industry, our industry is still learning how to balance. these two.
Theodora Savlovschi-Wicks: It is obviously quite something quite difficult to balance but obviously what I'm what I'm getting from it and the message of hope is when humanity comes together great things can can be achieved together. You obviously now you lead you lead operations across seven countries I think. What was navigating what what obviously you've navigated really extreme circumstances what what has that taught you about leadership that you think you wouldn't have learned? Any other way.
Anna Titkova: Yeah, did this situation that happened in my life. So I ⁓ this experience now for this four years to looking on the operations from the global perspective, from the centralization of the processes, not only like single person ⁓ staying the country, but like the person who can oversee the in the multinational environment with people with different mentality, with different mindset, people who are coming to our network different level of maturity, with different backgrounds, and ⁓ of them they should be engaged one vision, under one mission. And it has taught me that leadership is less ⁓ about but more about clarity. ⁓ And don't need perfect answers. They need this honesty, direction, and trust toward what you're saying and what you're doing. ⁓ I learned that in this importance of decentralization. And decentralization, I mean empowering local teams to make decisions quickly because actually they understand their realities better than anyone else. This is what I knew from being only a part of the companies, one country. And actually these are the best people who can advise, who can make the decision. They just need this clarity from you and understanding the direction where they need to go. And they will make the best decisions whatever is possible to do. And it reinforces that empathy is not optional and you cannot lead effectively if you are not ⁓ truly to what your people are going through. So you need to understand their ⁓ issues, challenges. You need to try to find out the way how to combine the needs the company, especially the bigger company is, the more difficult is ⁓ to align with everyone, to take into consideration everyone needs difficulties and challenges, but that's the way how the best work can done.
Theodora Savlovschi-Wicks: Absolutely, empathy is a key part of it. as you say, empowering the local teams to make decisions quickly is quite essential. Obviously, we all speak about clinical research with the patient at the heart of it all. And the whole reason we're all in this ecosystem is supporting the patient throughout the difficult journeys. When you're managing blackouts, active bombarding, cold chain failures, staff who may be sitting in shelters they respond. ⁓ How do you hold on to your purpose? How do you carry on? How do you keep the hope?
Anna Titkova: In those moments the purpose is not something you have to remind yourself of. It's something you feel very strongly, just like the part of your daily work. You're waking up with this feeling, with this purpose and you go to bed with the same feeling inside you. And when everything becomes very difficult, the question becomes very simple. Who needs you right now? So you just need to understand
where you can implement this your abilities, ⁓ capabilities, possibilities to whom it's more exactly today to get it from you. ⁓ And ⁓ no theoretical in our case. It's about real patients who are relying on you. It's about real like clinical research staff, your medical professionals ⁓ that ⁓ can, that need adapt these processes very quickly. Sometimes ⁓ 180 degrees or even 360 maybe coming back to the same point but only ⁓ some of the ⁓ ⁓ and activities during that period of time. ⁓ we think about our patients who haven't got any other option. As I said you previously, they really required the from us ⁓ more than before. And that makes work feel very real, ⁓ very immediate. It also brings a sense of dignity to what we do, because even in this chaos we are trying to preserve something stable and something meaningful.
Theodora Savlovschi-Wicks: Wow, okay. There will be people listening to this who never had to question whether the building they're working in is safe and who can't possibly comprehend what you and your staff and your patients have gone through. What would you like them to take from your story, if anything?
Anna Titkova: I would want them to value the sense of safety. It's more precious than it might seem. value the peace, to value the opportunities which you ⁓ have and you have ⁓ and fulfill ⁓ the common safe place where you are. ⁓ we're speaking about clinical research industry, remember that ⁓ every data set, every protocol, every ⁓ ID numbering our eCRF. There are real people, our patients, research teams who are making this and actually everyone who works in this industry to maintain these operations, to make them ⁓ fulfilled to make them real. ⁓ And I to say some words about adaptability because sometimes ⁓ we're ⁓ too focused on this and this is a new type of strength for me. So you have to wait for extreme circumstances to practice this
Theodora Savlovschi-Wicks: you
Anna Titkova: flexibility, collaboration, empathy even. Those things should be part of the work already. And you know, in 2024, ⁓ filmmaker, Mstyslav he was receiving Oscar for the documentary 20 Days in Mariupol and started speech with the words, ⁓ I wish had never made this film. ⁓ And I each Ukrainian would say the same, we wish we had never told this story. ⁓ But if story does anything, I hope it makes people. both and think about what truly matters in the work we do daily.
Theodora Savlovschi-Wicks: Wow. Okay. So what is next for you and for Pratia Ukraine?
Anna Titkova: The next chapter, the future, it's not something I think about in terms of ambition, honestly, saying alone. It's something I feel in terms of continuity, responsibility, care. You know, there is still a part of me that still measures time before and after. So when I think about the future, it's not just about growth, expansion, it's about rebuilding a sense of normality that was so abruptly taken away from us. It's about creating something unstable in a place where stability has not been guaranteed anymore. And for Pratia Ukraine, I believe that the next chapter means continuing to open doors to our patients who not have any other chance here and other options ⁓ their life for now. ⁓ means proving again and again that even in the most difficult circumstances, ⁓ and care, can exist. But more than that, it means taking care of people who made this possible. Our teams, who stayed, who who carried when it would have been easier to stop, honestly saying, just to stop and to agree with this reality that we've got. ⁓ And a outcome, ⁓ it's very definition, I believe now, for everyone, not only for me. ⁓ It's not numbers, expansion, KPIs that we've got in the big companies especially, or recognition. ⁓ It should much more I believe. It's knowing that people who stood through this period can finally exhale. To see a teamwork without a background, sense of fear and the patient who can walk in simply to your side because they choose it, not because this was the only one available option for this person. And on a personal level for me, a good outcome would be able to look back at this time one day and to feel that despite everything, we protected something important, that we didn't let circumstances define the limits of what we can actually do, because we kept going, not perfectly, with mistakes, with fear, but with some bigger purpose.
Theodora Savlovschi-Wicks: Wow, I think I'm taking so many incredible lessons of empathy, of determination, of dignity, of hope, of humanity from everything shared with us, Anna. And I'm very grateful for you coming on to speak about what is obviously quite a difficult subject at times. ⁓ And I really, truly appreciate your time. ⁓ Where ⁓ our see you, hear you next? ⁓
Anna Titkova: Surely, I believe that we can speak about this, about our clinical research industry, because honestly, we need to bring these examples to the audience. We need to show that despite all of the challenges, despite all of this craziness and chaos around us in the world, it doesn't mean that we couldn't continue our work, that we couldn't follow this our main principle of humanity in clinical research, because we are doing actually the great work and our people, they need it, they are waiting for it. And we must do this. We haven't got any other choices.
Theodora Savlovschi-Wicks: There's no other choice but to continue. Thank you. Thank you so much, Anna. I think both myself and our listeners will have quite a lot to think of after this conversation. I really appreciate your time. Thank you so much.
Anna Titkova: Thank you very much. Thank you once again for your invitation. I hope that we will have more time to speak with you, to discuss different topics and to continue what we're doing together.
Theodora Savlovschi-Wicks: Absolutely, thank you.