There is a particular kind of meeting that happens in medical affairs teams around the world, usually about six months before a major launch. Someone pulls up a list of names. The names are impressive. They are professors at prestigious institutions, they publish prolifically, they keynote at international congresses, and they are almost certainly already advising three of your competitors. The room nods. The list gets approved. And quietly, somewhere in the background, the nuance required to actually land this product in the real world gets left on the table.
The global KOL is not the problem. The global KOL is brilliant, credible, and genuinely important. The problem is the assumption that they are sufficient.
The local KOL is often the unsung architect of a successful launch. They may not be headlining EASD or ASH, but they know which treatment pathways are actually followed in their region, which guidelines carry real clinical weight versus which ones gather dust, and crucially, they are the person their peers call when they are uncertain about a new therapy. That informal influence is extraordinarily difficult to quantify and extraordinarily easy to underestimate.
Two Poles, One Spectrum
It helps to stop thinking about local and global KOLs as separate categories and start thinking about them as a spectrum of influence, each operating at different scales and through different mechanisms. A global KOL shapes the scientific narrative. They build the evidence base, define the disease, and frame the unmet need at a level that resonates across borders. A local KOL translates that narrative into clinical reality. They know whether the regional formulary will accommodate a new treatment, whether local prescribing habits lean conservative or progressive, and whether the patients will have access to the treatment.
Neither function is optional. And neither can substitute for the other.
The danger for medical affairs teams is the tendency to hire globally and hope locally. A powerful scientific advisory board full of international luminaries creates the impression of comprehensive KOL engagement. But if those voices are not complemented by clinicians who understand the granular realities of their own markets, the scientific story never fully lands where it needs to.
What Japan Taught the World About Local Influence
When Novo Nordisk launched Liraglutide in Japan in 2010 as the first GLP-1 receptor agonist to receive approval in that market, the scientific case was already well established globally. The global data was compelling. But Japan presented a distinctly local challenge. The country’s prescribing culture, particularly for injectable therapies in diabetes, was shaped by deeply embedded clinical habits, a strong tradition of sulphonylurea use, and a regulatory environment that had required Japan-specific clinical studies to be conducted before approval was granted.
The approved indication itself reflected the local reality: liraglutide in Japan was initially indicated as monotherapy or as an add-on to sulphonylurea, a profile shaped not just by regulation but by how Japanese diabetologists actually managed their patients. Getting physicians to consider a GLP-1 analogue, a new class in that market, required clinical advocates who understood the local treatment paradigm from the inside, not just experts who could articulate the global trial data. The uptake of Liraglutide in Japan was not simply a matter of scientific credibility; it required clinical voices that resonated within the specific context of Japanese diabetes care. The lesson was not unique to that market, but Japan illustrated it with particular clarity: global science needs local translation.
Context Is Everything
The right balance between local and global KOLs is not a fixed ratio. It shifts depending on where a product sits in its lifecycle, how established the therapy area is, and the geographic scope of the strategy.
In early development, global thought leaders often dominate legitimately. They are helping to define the science, design the trials, and build the credibility of the evidence base. Their influence at this stage is primarily scientific and reputational. As a product approaches launch, the centre of gravity should shift. Engagement planning needs to move closer to the markets where prescribing decisions are actually made. And post-launch, local KOLs often become the most strategically valuable voices of all, because they are the ones influencing their colleagues in real time, in the environments where those colleagues actually practice.
Geography adds another layer. In highly centralised healthcare systems, a smaller number of regionally influential experts can shape practice across an entire country. In more fragmented markets, the map of influence is more diffuse, and the importance of identifying genuinely local advocates becomes correspondingly greater. What this means in practice is that the question is never simply “how many global versus how many local?” It is “where does influence actually live in this therapy area, in this geography, at this stage?”
Making the Map Reflect Reality
This is precisely where the design of your KOL mapping matters. A map built primarily on publication metrics and congress speaking history will, by definition, skew towards the global end of the spectrum. It will surface the names everyone already knows. What it will not reliably surface is the regional opinion former who has quietly become the reference point for every prescriber in their network, or the community-based clinician whose practical endorsement carries more weight in their local market than any journal article.
At Scout, we work with medical affairs teams to build KOL maps that are designed around strategic intent rather than default assumptions. That means interrogating what influence actually looks like in a given context, identifying the local advocates who complement and connect with the global voices, and understanding the relationships between them. The goal is not to replace the global tier but to build a map that reflects the full shape of the landscape, from the summit to the field.
The False Economy of Global-Only Thinking
There is a subtle risk in over-investing in global KOL engagement that goes beyond missed local influence. It is the risk of building a scientific narrative that the field finds credible in theory but impractical in reality. The global expert validates the data. The local expert validates the application of that data. If only one of those conversations is happening, something important is always missing.
The most effective medical affairs strategies hold both deliberately, not as a compromise but as a design principle. The balance looks different for every product, every market, and every stage of the journey. That is not a complexity to be resolved. It is the complexity to be navigated with care, curiosity, and a map that is honest about where influence actually lives.
By Simon Rosenberg, Director of Research, Scout
simon.rosenberg@scoutdata.co.uk
