When Global Strategy Loses Local Momentum

Why the best global healthcare programs are built for adoption, not just approval 

Why do so many global healthcare programs look strong at headquarters then lose momentum the moment they reach local markets? I’ve been wrestling with that question, and refining my answer, since taking my first international secondment assignment in London 15 years ago.

Since then, I’ve led an agency team in the UK, opened an office in Singapore and built long-term partnerships across Asia Pacific, Latin America, Europe and Africa. Across very different markets and models, one lesson has remained constant: global scale does not guarantee local adoption.

Every company has different needs, structures, and ways of working. Not every agency partner or model is equally equipped to operate globally. But beneath those differences are three uncomfortable truths that repeatedly determine whether a global program travels or stalls:

1. Local insight is not a localization step – Healthcare delivery differs drastically across regions, countries and even localities. Strong global programs are not crafted exclusively in the Northeast pharma corridor or California’s biotech hubs and then localized at the end. They begin with disciplined curiosity about culture, treatment pathways, access requirements and patient experiences. That is how global teams develop plans grounded in local realities, and how affiliate partners recognize their own markets in the strategy from the start.
2. Alignment is the work, not the pre-work – Most companies default to either top-down or bottom-up global planning. Both models fail when they operate in only one direction: one group of stakeholders, either global teams or affiliates, is left with a plan that does not reflect its needs. The strongest programs replace the false choice between global control and local autonomy with a bi-directional process built on alignment from the start. In some of the most successful programs I’ve worked on, internal adoption required as much agency time and energy as the external activity itself.
3. Reach is not the same as relevance – The healthcare agency landscape is full of “dots on a map.” But an office does not automatically create healthcare expertise, and global reach does not automatically produce connected thinking. Holding companies often build through acquisition across sectors. Independent agencies may avoid expansion because many local offices become loss leaders that strain the core business. Pharma and biotech leaders therefore need to define the capability they are actually buying. Is geographic presence enough, regardless of healthcare depth? Does success depend on local insight and execution? Will affiliates continue using their own in-market agencies, or does the organization need one connected partner that can align activity and share learning across markets? The right model is not the one with the most dots. It is the one designed around how the organization needs to work.

Earlier this year, a top 10 pharma company approached us after trying nearly every version of global planning: top down, bottom up, regional and local. They wanted to know how they could think about global differently. Our answer was not another off-the-shelf model. There is no single global operating system that works for every organization. The real strategic advantage comes from being willing to test different models, learn where friction appears, and design an approach around the organization’s actual decision-making, capabilities, and culture.

For those leading global work from the client side: where does momentum most often break down? Between global and regional teams, between regional and local teams, or between strategy and execution? And what have you seen genuinely improve adoption across markets?

Next week in Chicago, we’ll put these tensions at the center of our panel, Borders, Budgets and Buy-ins. Leaders across pharma procurement, communications and advocacy will examine what it takes to move from a globally approved idea to a locally adopted program, and where even well-funded strategies lose momentum. GHMC agency partners from around the world will also join us, giving attendees the opportunity to exchange perspectives with local healthcare experts from the world’s largest network of independent healthcare agencies.

If you’ll be in Chicago on October 14 and want to join a candid conversation about what makes global programs work in local markets, register today. Space is limited.