A promising drug candidate can clear every scientific hurdle and still fail commercially because the company behind it misjudged which markets would actually pay for it, and in what order. Leen Kawas, a scientist and entrepreneur who serves as chief executive of EIT Pharma, and sits on the board of directors for Inherent Biosciences, has treated international market awareness as a discipline biotech leaders often underweight relative to the scientific work itself.

Why Biotech Cannot Stay Domestically Focused

Drug development is expensive enough that a single national market rarely justifies the investment on its own. Regulatory approval, reimbursement negotiations, and distribution infrastructure all vary by country, which means a company’s commercial strategy has to account for multiple markets from an early stage rather than treating international expansion as a later problem to solve after domestic approval. Kawas has pointed to this as a structural feature of the industry rather than a strategic choice, since the economics of drug development simply do not close within most single national markets alone.

What Market Awareness Actually Requires

International market awareness is not the same as having a list of countries where a drug might eventually launch. It requires understanding how each market’s regulatory pathway, pricing environment, and clinical trial requirements will shape the actual timeline and cost of bringing a treatment to patients there. Leen Kawas’ work through Propel Bio Partners, the venture fund she co-founded and helps manage, involves evaluating exactly this kind of market-specific risk across the portfolio companies the fund supports, since a scientifically strong asset can still represent a poor investment if its path to any given market is longer or costlier than competitors assume.

The Regulatory Variable

Regulatory requirements differ enough between major markets that a trial designed primarily around one country’s standards can create real friction when a company later tries to use that same data elsewhere. Kawas has described the value of designing clinical programs with multiple regulatory audiences in mind from the outset, even when that adds complexity to the trial design, because retrofitting a program for a second market after the fact is considerably more expensive than building in that flexibility early.

Reimbursement as the Hidden Bottleneck

Regulatory approval only solves part of the commercial problem. A drug that clears a regulatory agency but cannot secure favorable reimbursement in a given market may struggle to reach patients there regardless of its clinical merit. Leen Kawas’ experience taking Athira Pharma through late-stage clinical development gave her direct exposure to how differently reimbursement negotiations play out across markets, since the same clinical data can support a strong pricing position in one system and a weak one in another, depending on how that system evaluates value.

Why Timing Across Markets Matters

Sequencing matters as much as market selection. Entering a market too early, before infrastructure or physician familiarity with a treatment category exists, can waste resources that a later, better-prepared entry would use more efficiently. Kawas has argued that international market awareness includes this sequencing judgment, not simply knowing which markets exist but understanding which ones are actually ready for a given therapy at a given moment, a judgment that depends on tracking conditions abroad continuously rather than assessing them once during initial planning.

The Investor’s Version of This Discipline

Through Propel Bio Partners, Leen Kawas applies international market awareness from the investment side rather than the operating side, assessing whether a portfolio company’s international strategy is realistic before committing capital to it. That evaluation often surfaces assumptions that look reasonable on a slide but do not hold up against the actual regulatory and reimbursement timelines involved. Catching that mismatch early, before too much capital is committed to an unrealistic sequence, is part of what she has described as the fund’s actual value beyond the money itself.

Why This Awareness Cannot Be Delegated Entirely

International market strategy is often handled by a dedicated commercial team once a company reaches a certain size, which can create distance between that team’s assumptions and the scientific and financial leadership actually making resourcing decisions. Kawas has resisted fully delegating this awareness, arguing that market judgment needs to inform scientific and financial decisions from the earliest stages rather than being bolted on once a drug is further along. A company that treats international awareness as someone else’s department risks discovering the mismatch between its science and its market only after both have already been built around incompatible assumptions. Further background is available at https://www.leenkawas.com/.