Welcome & introduction

Federica Santoro 0:15

Researcher, signal assessor, QPPV. There are so many career options for those interested in pharmacovigilance. But how do you know which one fits you and where to start if you're new to the field? My name is Federica Santoro, and this is Drug Safety Matters, a podcast by Uppsala Monitoring Centre, where we explore current issues in pharmacovigilance and patient safety. Joining me today are two seasoned professionals: Myriam Salem from Health Canada and Francesco Salvo from the University of Bordeaux in France. Myriam works as national supervisor in the clinical trials compliance team, and she also volunteers for the Canadian Medication Appropriateness and Deprescribing Network. Francesco instead is a professor of pharmacology. He heads the regional pharmacovigilance centre in Bordeaux and is also the vice - president of ISoP, the International Society of Pharmacovigilance. For this episode, we spoke about all things career: what types of jobs are out there, how to get your foot in the door, and what skills you need to remain competitive. I hope you enjoy listening.

Federica Santoro 1:36

Welcome to Drug Safety Matters, Myriam and Francesco. I'm delighted you both could make the time to talk to me. And we're calling in from three different countries. Myriam, you're based in Montreal, Canada. How are you today?

Myriam Salem 1:58

I'm great. Thanks, Federica, and thanks for having me on this amazing podcast.

Federica Santoro 2:03

My pleasure. And Francesco, you're joining us from France, from Bordeaux. How are you doing?

Francesco Salvo 2:10

I'm fine. Thank you, Federica, and thank you for the invitation from you and Uppsala Monitoring Centre.

Federica Santoro 2:15

Our great pleasure.

Myriam's career story: Vioxx and patient stories

Federica Santoro 2:17

So let's get started. We have plenty of ground to cover today. But before we dispense any career advice, I'd like to hear your personal stories. So, what attracted you to pharmacovigilance? You know, what is so special about this field of science that made you think back then, yes, this is what I want to do in life? And also, how you broke into the field, how you took those first steps that set you on that career path. Myriam, why don't you start, please?

Myriam Salem 2:48

Yes, of course. I'll start by saying that, to be honest, I had no idea what pharmacovigilance meant. I had never heard about it. But I stumbled upon it. And it was actually in September 2004. I was a biologist at Merck. The company was extremely successful, one of the biggest companies. I was extremely proud to be working there. I was working on the anti-inflammatory drug pathway and we had a blockbuster. If you've ever heard about it, it's Vioxx, and I was working on that pathway – until September 30th, 2004 hit. All of my colleagues and I were invited to a retreat in Mont-Tremblant, which is a little bit close to Montreal. And the head of research at that time gathered us and told us that Merck was voluntarily withdrawing Vioxx from the market. Vioxx was at that point one of the most prescribed medicines worldwide and one of the biggest successes of the company. And I did not know at that time that Vioxx would become one of the case studies I would learn about in pharmacovigilance 10 years after that moment. So it's only in 2014 that I've learned about pharmacovigilance and learned that I actually had fallen into pharmacovigilance without knowing anything about it. So that's how I stumbled on pharmacovigilance. But what made me choose it and what made me go into the field was actually an encounter with a patient. So after my years at Merck as a biologist, I started coordinating clinical research trials. First at a service provider, clinical research organisation, where I was coordinating bioequivalence and phase one studies. But it's while coordinating phase three oncology studies in an academic setting that I met that patient who was extremely grateful for having survived her cancer diagnosis. But at the same time sad because she had developed some adverse drug reactions that would not let her do some small trivial tasks. So she wasn't able to hold a cup, for example, with her hands because of the neuropathy that chemotherapy had generated. And when you think about it, you know, doing the dishes, she was telling me, was something that she could not do at home anymore. And it was something that just started to make me think: we are entering all of these adverse drug reactions in a database, but what happens to these adverse drug reactions? Who takes care of that patient, who tells her what to do with her neuropathy? So that's when I started digging. And I came across a training on pharmacovigilance, and that's the first time I read the word pharmacovigilance. And the more I learned about pharmacovigilance, the more I wanted to research it, the more I wanted to learn about the pioneers in pharmacovigilance. And it just became something that, for me... I realised recently that I've always seen pharmacovigilance as sitting at the intersection of science and social humanities. So I think that's what attracts me to pharmacovigilance. You have both worlds, you're taking care of someone, taking into consideration all of the aspects of that person. And I would like to quote, I guess, two of my favourite people in pharmacovigilance, Dr Ed Napke and more recently, Dr Albert Figueras, who both said it in the same type of way. Dr Ed Napke, who was a pioneer in pharmacovigilance, said that it is the patient we must serve and not the drug product. And Dr Albert Figueras said it most beautifully as well, that real pharmacovigilance is not about medicines, but real pharmacovigilance is about people taking medicines. And I think that pharmacovigilance combines these two worlds that are extremely important to me.

Federica Santoro 7:28

So inspiring. Thank you for sharing all those personal anecdotes. And I bet a lot of our listeners can relate to that passion for patients' well-being.

Francesco's career story: cerivastatin and good mentors

Federica Santoro 7:40

Francesco, how about you? What is your pharmacovigilance career story?

Francesco Salvo 7:45

My story of pharmacovigilance started when I was a student in medicine, and I was a bit lost because medicine is quite wide. Every one of us, when we're in medical school, dream about being a surgeon, for example. And I don't like to be a surgeon because of the long, for example, time in operatory block. So I understand quite quickly that I want to go into some more research or public health field. And pharmacovigilance arrived when, during studying clinics, I started to understand that for every disease there was the last bullet point that said drug-induced disease. For hepatologic disorders, for renal disorders, cardiac disorders, and stuff like this. So I say, okay, quite nice. Why not try to understand better that? And then, as for Myriam, I go through some passionate people that talk about drug safety. At that time, it was Prof Achille Caputi in the University of Messina, and I say, okay, let's see what happens. And I had in my mind, okay, let's go to the summer, and then in September come back eventually to this institute. It was summer 2001, and as for Myriam in 2004, my story was related more to the cerivastatin withdrawal in 15 of August, so in the middle of the summer, a voluntary withdrawal of a drug that caused a sort of communication wave of drug safety. And this convinced me a bit more about doing that. Thereafter, in September, we started to make anamnesis of some patients in paediatrics at that time, and I was capable to make a diagnosis after a lot of therapeutic errors for a child that was exposed during pregnancy of his mother to phenobarbital, so to antiepileptics that are really known to be potentially fetotoxic, but no one understands that. Everyone thinks about alcoholic syndrome. So I say, okay, it's my place, let's go to that, and then I started with a thesis in pharmacovigilance. And then it's like, I break in, really, in the field through a specialisation in medical toxicology, and after specialisation a PhD, coming in Bordeaux, met a lot of people that I love: Prof Bernard Begault, Prof Nicholas Moore, Prof Antoine Pariente, that really helped me also to understand better the French system. And now I have the chance to be the director of one of the most important regional centres in France – and maybe also in Europe – that is Bordeaux, and I'm very proud of that.

Federica Santoro 10:28

Drugs don't often get withdrawn from the market. So I find it really interesting that you both cited one example like that in both your career stories. It's so funny. But thank you so much for sharing all that. And I think it's also really nice that you both highlighted the value of mentors and inspirational leaders in your... in shaping your careers. And who knows, you know, now you might be inspiring through this podcast the next generation of pharmacovigilance professionals, so...

Listener question: regulatory versus academic realities

Federica Santoro 11:00

You work in two different settings, right? A regulatory authority, Myriam, and academia and research, Francesco. So, one of our listeners, Alex, a pharmacy student in the US, asks, how different does pharmacovigilance look depending on where you sit? Are you working on different types of questions or different timelines? Are you facing different pressures? In other words, what does your everyday job look like? Francesco, why don't you start?

Francesco Salvo 11:38

For me, so it's the same field, of course, but we answer two different philosophical, I would say, or basic questions. From academia, I'm interested in understanding or improving safety science. And I think that from a regulatory point of view, you have to answer to the question: is this drug safe now, and need I to do some actions in order to reduce some risk? So, from academic point of view, my work is, I would say, more hypothesis-driven, more innovation-driven. I need to develop methods, I have long timelines, and probably I have just one pressure that is more to publish my findings. From regulatory point of view, it's a bit different. I think that there is, sometimes you have urgency to answer to questions. You speak more about population safety level, you need to have, I would say, a real-time decision, a mandate that is really public and legal, and you work in a more structured process or framework. But Myriam, please complete it.

Myriam Salem 12:50

Thanks, Francesco. I think that, and this is my personal point of view on this aspect, I think that yes, you're right, regulatory has to abide by, you know, certain regulations, but there is also some type of collaboration, a lot of collaboration with academia, where you also rely on these research that are happening externally to see how you can manage these risks. So, for example, I have worked in the opioid setting because in Canada we were facing a major epidemic of opioids. So a lot of people had, you know, all of these dependence syndromes, and we did collaborate a lot. And I think that you need that type of collaboration across the fields ultimately to ensure the best balance of benefit, harm, uncertainty, and you know, you want the patients, you want the population to be safe. So I think that it's... that collaboration is extremely important.

Federica Santoro 14:05

So you definitely need both types of organisations for pharmacovigilance to thrive as a scientific discipline, and you need many other actors in reality, and we'll cover some of those later.

Listener question: to specialise or not to specialise

Federica Santoro 14:17

But Alex, our listener, had another question. So, do you think as a trainee that you should also experience both environments early in your career? Or is it more practical or advisable to pick one track and go deep and specialise in that, Myriam?

Myriam Salem 14:38

You know, Federica, I love this question, and I'll tell you why. I think that pharmacovigilance, more than any other discipline, needs a variety of people and needs a variety of experiences because it's not a one-size-fits-all science. And I think that if people do specialise in one aspect and decide to dive into it, pharmacovigilance needs these people, needs the people that know exactly how to do signal detection or know exactly how to risk communicate. And I also think that if you want to experience various environments, it will give you also another perspective because pharmacovigilance is not working in silos. And I really like, you know, the fact that pharmacovigilance brings communities together and the fact that you may experience various settings. So I think that there is no real mould on how to, I would say, break into the field, but I think that it's important to have a variety of backgrounds.

The PV career landscape

Federica Santoro 15:51

And that leads nicely into my next question. So, because pharmacovigilance thrives with collaboration and multiple stakeholders coming together, then it's clear that regulators and academia aren't the only places where PV scientists can work. There are many more options out there. Francesco, where can a PV specialist work?

Francesco Salvo 16:16

One of the most important, I would say, elements that we need to take into account every time is that PV, as Myriam said, is an ecosystem. You can do PV with many entry points, with many missions. And of course, each one of us needs to find at one time the best for him or for her. So, for example, I work in academia for research, but I work also in hospital for a sort of clinical pharmacovigilance. So, case review, case analysis, case-by-case assessment, signal detection on index cases. That is really, really the core of the work of pharmacovigilantes in general. We need to have strong cases to have a strong pharmacovigilance system. So, thereafter, these cases could be communicated – it depends on the system, of course, but in a moment arrive to the marketing authorisation holder or industry, if you wish. So, for industry side of pharmacovigilance, you need to be really trained and really capable to comply with the standard operating procedures, so in order to make it completely traceable. You need to have, I would say, in mind that sometimes you need, for example, benefit– risk evaluation at drug level, because a regulatory once in a while will ask you that. And you need to be capable to, I would say, to manage or to account on risk minimisation measures and risk management of the drug. Thereafter, you can have classically, for example, the CRO, so the consulting of pharmacovigilance. So CRO means clinical research organisation that in pharmacovigilance are also PV CRO, in which you do the job for some clients, that could be, for example, industry or even sometimes also regulators. And from the last, I would say, 10 years, there is a lot of need on the tech side, I would say. Before it was just, I would say, basic statistics, descriptive statistics or disproportionality, but with AI, with different models, now we need really to have people that also have a sort of profile that could be attractive also for tech companies. So the tech companies that develop tools that could be useful in pharmacovigilance, but for developing it, they need also pharmacovigilance input. So this is more or less, I think, the most important roles that people from pharmacovigilance can do for this field.

Federica Santoro 19:06

Thank you for that nice overview.

Listener questions: skills for modern pharmacovigilance

Federica Santoro 19:09

And you sort of answered the next question already. Our listener Alex, again, had another question on the skill set that people need to succeed in PV, whether that skill set has changed since you entered the field. And you did mention how statistical and data science skills are definitely more essential now than perhaps when you started, but are there other skills that you find are needed now and weren't perhaps at the beginning of your career?

Francesco Salvo 19:42

Yes, you cited, of course, the growing importance of data science and statistics. I would say also literacy in automation stuff. To be a nice pharmacovigilant today, you need to be capable to understand and work with the new tools that are arriving, I would say, day by day, in order to be more accountable, more coherent, and eventually can be more prepared, I would say, for a huge arrival of cases. Of course, the core competencies will be ever there, and the growing competencies need to be managed with the core ones. We need to understand pharmacology, we need to know medicine and clinics, we need to know the clinical reasoning, we need to know how to code. And I would say, also, we need to know how to communicate, and we need to know better and better how to communicate because there is a sort of, also, pressure on that, and there is also, it is mandatory in some sense, for agencies in particular, to communicate about risk. And I think that for the last, I would say, skills, you need also to have soft skills. One of the most important, as Myriam said before, is collaboration. You need to be open. We cannot have pharmacovigilance only by medical doctors, only by pharmacists, only by data scientists. We need to work together in order to maintain a diversity of our job and having also different approaches that thereafter could really raise and evaluate a signal in a very deep manner. Critical thinking, of course – you need to be capable to challenge, and you need to be capable to be challenged on what you think concerning a signal. And of course, at the end, everything could be resumed in an ethical judgment. So when we do pharmacovigilance, we need to be, I would say, every time on the side of patients in some sense. So, maintain an ethical posture when we have to manage with the drug safety.

Federica Santoro 22:02

Right. So we cannot have a discussion about careers without mentioning AI, artificial intelligence, I'm afraid. Of course, it's on everyone's minds, but we also got a question on this from one of our listeners, Mohammed in Yemen. He's a pharmacist and a researcher in healthcare management. And he asks, as AI becomes increasingly integrated into PV, which competencies should early - career professionals prioritise to remain valuable over the next decade? Million dollar question, Francesco, and that's for you again.

Francesco Salvo 22:43

I love to think about a sort of comparison between pharmacovigilantes that know how to use artificial intelligence and pharmacovigilantes that don't know it. And I think that it's not a matter of being replaced by the AI, but it's a matter to continue to work in PV. And I think that people that know how to manage AI will replace people that don't know it. Human judgment will remain – in health, in pharmacovigilance – will remain central. AI could augment, could improve, and could facilitate the work of a pharmacovigilant. So we can imagine AI as a tool in order to be more focused on really high-level value tasks. Moving more in detail, I think that we need to be, and I cited also before, to have a literacy on what artificial intelligence is. So we need to understand, for example, the outputs, the biases, the limitations of that. Of course, there is an enormous, I would say, field concerning data governance, quality, traceability, reproducibility, development of tools, testing of the tools. And in that sense, of course, we need to be engaged on that, and we need to test, we need to be capable to critically appraise what artificial intelligence provides to us. And understand that there is not one AI, there are multiple AI that can help us in different tasks. So we need to be there, to be engaged, in order to train models, in order to fine-tune models, in order to, I would say, help artificial intelligence tools to be more and more specialised and do a part of the job that needs to be contextualised and needs to be, of course, in particular in high-risk situations, take into account the human. So having the human - in -the -loop priority when we speak about artificial intelligence.

Federica Santoro 24:57

We have a two-part episode on AI in pharmacovigilance in the podcast archive as well, where we touched on the career aspect too, and what pharmacovigilance professionals need to understand about AI to remain relevant on the job market. So people can listen to that if they're interested in this particular aspect. But thanks for sharing all your advice. And now, I'll give the word to Myriam, who's been silent for too long.

Training versus experience

Federica Santoro 25:27

Myriam, let's discuss the training versus experience conundrum. You know, when you get into a new career path, whatever it may be, people always ask, well, but do I need to train? As in, do I need to get more education and learn about this particular topic more? Or can I compensate with hands-on experience? And what's your advice? If you're entering pharmacovigilance from a different discipline, perhaps, what's the best way to find a job? Training or experience?

Myriam Salem 26:08

I think that one doesn't exclude the other, in my opinion. I think that if you have the opportunity to have hands-on experience, take it. But then at the same time, if it doesn't happen as quickly as you would like, I would also say, look for trainings. And there are a lot of available trainings. Some of them are even free if you want to, you know, continue on learning, some of them are more structured. I think the value of training wherever you are in your career is extremely important to be able to have that solid knowledge, to be able to debate about the safety of a medication and to be able to stand by your point when you're confronted to a decision related to either signal detection or any other type of decision you need to take in the field. I think that anything you learn in the field, either through hands-on experience or through training, is valuable and will give you greater perspectives and expand your horizons. So I would say, continue learning, stay curious. The field is evolving, as we've heard Francesco mention it, and look for a workshop, look for conferences or a symposium, and UMC has lots of tools also available for everyone. I think that staying curious is important.

Listener question: certifications in Canada and Europe

Federica Santoro 27:40

What about specific requirements in certain regions? Souad, a clinical trial associate, actually based in Canada, too, asked if there's a specific certification required in the regions you're based in.

Myriam Salem 27:59

So I know that, for example, in general, in Canada, to break into the field, having training would help, but is not necessarily required. That's what I would answer Souad. You know, having a training certainly helps understand the various roles and helps break the silos, but you... at the minimum, you need a scientific training. I've seen colleagues with a Bachelor's degree in various topics. So I'm trained as a biochemist and then a pharmacologist, so it doesn't necessarily have to be healthcare professional to break into the field, but it certainly helps if you... if you have an additional training because it helps you understand the terms, it helps you understand the language. So when you are interviewing for these positions, you know what they're talking about and you know what you're looking for.

Federica Santoro 28:59

Francesco, do you have anything to add? Myriam told us about what the requirements are in Canada. What about France or perhaps Europe?

Francesco Salvo 29:11

So, thank you for that. I think that Europe is more or less the same pharmacovigilance system. We have the European Medicines Agency, we are under the same, I would say, rules. I think that the most important part is not to be just focused on the regulatory side. We need, of course, to comply with regulation, but we need to have also some trainings that give to us the soft skills that we speak before, but also, for example, the concept of public health impact of what could be an adverse drug reaction. So try to have and to find trainings that help you to be, I would say, on the cross line of different specialities, for example, pharmacovigilance and pharmacoepidemiology, drug safety in preclinical setting, in clinical setting and in real world. So try to have, I would say, at level of Master's area one, something that could be wide, that could help you to understand the clinical pharmacology and general aspects of drug safety, then come back in a specialisation in which you can have both regulatory aspects and public health aspects, and then go deep and step by step find your path.

Federica Santoro 30:31

And ultimately follow your interests, right? As we've said, there's potentially so many ways to develop and so many skills to pursue that it's also important to remember, follow your heart.

Networking as an expat

Federica Santoro 30:44

Now, it strikes me that all three of us are expats. We weren't born in the countries where we work, so let's touch on that a little bit. Relocating to another country for work is usually very exciting, but it also poses challenges if we're honest. So, Myriam, what advice would you offer to those who are not only looking for a job in pharmacovigilance, but perhaps they're doing that away from home. And so they're navigating an unfamiliar job market.

Myriam Salem 31:19

That's an important question, Federica. What I would say is, try to build connections, participate in conferences. You know, some may be free, some may have special rates if you are still a student. Create networks and reach out to mentors. It could be either at universities, it could be through LinkedIn sometimes, you know, you can reach out to people. And most of the time, universities have lunch - and -learn sessions. Most of the time you can drop in to these sessions. Sometimes you do also have these sessions in hospitals that are affiliated or linked to universities. And I feel that this is a very important place to start with, to start to understand, you know, the variety of what is expected, but what are the fields that people are working on, and to hone in on what would be interesting to you and what would be passionate to you as well. So, I would say, don't be afraid to reach out to mentors, to leaders in the field. What I found is that most people are extremely happy to help, and most people are very genuinely open to give advice. So that would be my own advice.

Federica Santoro 32:39

I can relate, and that certainly did wonders for me. Networking both in person and online on LinkedIn, that certainly helped me, as an Italian, navigate the Swedish job market. Francesco, would you... is there something you'd like to add?

Francesco Salvo 32:55

Yes, and I of course agree with what Myriam said, and it's... I think that you have to think of what you want to do and then find the occasion to do it. Just to say about mentoring and about congresses and about conferences that there are a lot. You need to choose the best one for you. Probably more on the, I would say, industrial side, you can have, for example, some DIA events or World Drug Safety Congress. From more academic side or public side, you can have the ISoP conferences. And for example, for ISoP, we are also building and trying to build a mentoring programme for students to be, I would say, connected with people that already have networks. So sharing networks is also something that, I would say, scientific societies need to do more because pharmacovigilance, even if international, is very small. So relationships matter, and as seniors, we need to do more to attract younger people and give them opportunities to work on that.

Myriam Salem 34:00

It's so funny, Francesco, because this is exactly what I was thinking. You know, everyone is connected in the PV community. I've never seen a scientific discipline that connects people that way. So I think that it's... what you said, you know, just once you reach out to some of the people, you'll eventually see that everyone will become a familiar face.

Listener question: building international collaborations

Federica Santoro 34:22

And if we keep on the networking and the collaboration topic, our listener Mohammed has a related query. He focuses on low- and middle-income countries, and he asks, for professionals working in countries where PV systems are still developing, what advice would you give to help them contribute to the global PV community and build those meaningful international collaborations?

Myriam Salem 34:53

I think that I'm going to touch upon some of the aspects that we discussed and that Francesco mentioned. You know, there are some societies that you can join, like the International Society of Pharmacovigilance. You can also volunteer. I know that there are some networks from colleagues that are on the African soil, for example, who are creating their own communities of practice. And I think that if you can reach out to these people, there are lots of amazing initiatives that already have built some type of international collaboration. But there's also something else that I found interesting. You know, I'm an avid reader of Uppsala Reports, and if you take a look back at the Reports that were written even, you know, a few decades ago, there's lots of information there on countries that have now amazing pharmacovigilance systems that went through what Mohammed is discussing and that have great insights or tips on how they did it. So I think there's a lot of great examples that can be used to build upon your own pharmacovigilance system and network.

Federica Santoro 36:13

Thank you. And I'm glad you cited Uppsala Reports because this year marks its 30th anniversary, believe it or not. So we'll link to that in the show notes as well, but I can definitely recommend it to our listeners. If you'd like to know more about the pharmacovigilance field and its thriving community, subscribe to the magazine.

Listener question: rewriting your path

Federica Santoro 36:35

We'll end with a very thought-provoking question from our listener Alex, who says: if you were starting your career today, knowing what you know now, would you take the same path or do something differently? Francesco, I'll let you start.

Francesco Salvo 36:55

Very, very tough question. I think that in every career you have times in which you want to change, in which you are struggling with six - month contracts... You have in every path some difficulties. But at the end, of course... Now there is a sort of selection bias that I arrived to be professor, so of course I will do the same path because I feel that what we are doing is important from a public health point of view. I met and I do a lot of very interesting stuff, discussions. There is an intellectual diversity in this field that is really exciting. And I think, from more or less 10 years now, there is a new, I would say, envy to do different stuff, it's an evolving field. The impact of artificial intelligence and large language models in pharmacovigilance is really, really starting, so it's very, very exciting. Stay curious, adaptable, and pharmacovigilance will love to have you in.

Federica Santoro 38:05

Thank you. How about you, Myriam? Anything you would do differently if you could rewind?

Myriam Salem 38:12

I would not necessarily do anything differently. I really love how I fell into pharmacovigilance. I really love that pathway and the way that it helped me understand, you know, the drug development process from A to Z. And although I went back to the beginning, to the clinical trials world, safety and pharmacovigilance, I see it starts also there. So it's not only in the post-marketing setting, but very early on in the drug development process. And knowing what I know now, I wish there was more training while I was in the scientific field and I would have known that pharmacovigilance existed at the very start. So at the end of the day, you can take several different paths, but in every path, you will see that pharmacovigilance was there all along.

Federica Santoro 39:15

I wish everyone listening good luck in their job hunting and thanks again to you both.

Myriam Salem 39:23

Thank you.

Francesco Salvo 39:24

Thank you so much.

Closing, resources & credits

Federica Santoro 39:33

If you, too, would like to tell us your career story or offer career advice, send us a voicemail via the top link in the show notes. It's simple and we'd love to hear from you. In the show notes, you'll also find some helpful resources on pharmacovigilance careers. And if you enjoy the podcast, do subscribe in your favourite player. We'll be back soon with another episode, but until then, you can get more pharmacovigilance stories on our news site, Uppsala Reports. If you want to learn more about Uppsala Monitoring Centre and how we promote safer use of medicines and vaccines globally, visit our website or follow us on social media. For Drug Safety Matters, I'm Federica Santoro. Thanks to our listeners Alex, Bsma, Mohammed and Souad for submitting questions, and thank you for tuning in. Till next time.