The Daily News Egypt interviewed Novartis' CPO Head and Country President Basyouni Abouseif and chief scientific officer at the company, Sameh Rakha, to discuss the company's progress in Egypt, and the introduction of breakthrough medications in Egypt. Could you tell us more about Novartis Egypt? Abouseif: Novartis is a company that has been in Egypt since 1962. It was one of the first companies that were initiated in Egypt and we've been more than 50 years serving the pharmaceutical industry in Egypt. Novartis was established as a joint venture company between CIBA, GEIGY, Sandoz and Wander under the name of Swiss Pharma. In 1970, CIBA and GEIGY merged to become CIBA-GEIGY. Finally in 1996, Novartis was created worldwide with the merger of CIBA GEIGY and Sandoz. Novartis is committed to providing solutions that address the evolving needs of patients and societies. The company provides a unique portfolio that meets diverse healthcare requirements. In Egypt, Novartis consists of the divisions of Pharma, Novartis Consumer Health over the Counter (OTC), Sister Companies of Alcon (eye care products) and Sandoz (generics). This is why we have strong presence in Egypt. Novartis Egypt employs over 1,750 associates at the manufacturing site and scientific offices and has more than 50 marketed pharmaceutical brands that cover a wide range of therapeutic areas including oncology, blood diseases, cardiovascular diseases, diabetes, organ transplant, neuroscience, ophthalmology, respiratory diseases, rheumatism and arthritis. Since the company was initiated, we had one clear mission to "Care and Cure". The mission has evolved over years, and our golden theme now is to "ensure providing the right medication to the right patient at the right time". You recently launched a free educational programme for doctors. Could you tell us more about that? Abouseif: Egypt is one of the biggest and leading countries in the region. If we consider calculating the number of Egyptian patients suffering from some chronic diseases, like for example: diabetes, hypertension, or cancer, etc..., the number would exceed 40 million patients. One of the challenges we faced was that Egyptian doctors have a problem in evaluating the medical evidence available, which we call the evidence-based medication. The challenges faced are in how to understand the medical trials studies and how to participate in them. Egypt is a big market. That made us think about how you calculate the number of patients in things such as diabetes, hyper-tension, or someone who need oncology medication. All companies make some sort of medical trial. Novartis had to raise the question about whether or not Egyptian doctors have enough knowledge and [can reach] the high capabilities that would qualify them. That's how we got the idea.
Rakha: The process of assessment or appraisal during clinical researching is one for the healthcare professionals. We found that professionals are hungry to learn. So we thought about creating a series of educational programmes, or sessions, to be provided to doctors referred by the universities and the Ministry of Health. Novartis Egypt has become a member of the International Clinical Research Operation. We are lucky to have the capabilities to do clinical research. We also have plans to expand in the Middle East and we have been recently recognised as the number one partner with the Ministry of Health, in terms of the number of our joint operations and research. We have conducted the first wave of training, and the second and third waves will be before the end of the year. Currently, we are taking steps to seek international accreditation for the programme from international care systems. The programme was kicked off last 13 December as a free educational platform targeting University and MoH physicians with specialties of interest. Inclusion in the program is done through University and MOH's nomination. The programme is run in the form of waves – each two days – covering the areas of: Good Clinical Practice (GCP), medical statistics, medical writing, publication and critical appraisal. How long does a wave of sessions last and how many medical professionals receive the training each wave?
Abouseif: For the coming wave, we'll also take referrals from the universities and from the ministry. As for the number of candidates; in the first waves, we had around 30 doctors. Due to the high demand, we are thinking about expanding it. As for the age groups, during the first session, we had mostly doctors in their mid-thirties and that will also be the case for the second wave.
Cheif Scientific officer at Novartis Sameh Rakha (Photo Courtesy of Novartis Egypt) How were Novartis' sales and production rates affected during the country's economic turmoil? Abouseif: Our commitment is mainly a commitment to the patient. Despite the turmoil, it remains better than many other countries. Our commitment since the January uprising was to continue investing in the country and not withdraw our investment. Definitely, the turmoil influenced the overall economy but with the resources that we put into the country, we kept growing. Throughout the past three years, the Egyptian patient and doctor have seen and realised our commitment and, as a result, our growth was around 1.5 times that of the general market growth. If the growth was around 7%, our growth was around 15%. We added resources, investments and each year we add around 100 new employees. What about Novartis' market share? Abouseif: We are the second biggest pharmaceutical company and we are aiming to be the first very soon. Every month we are aiming at our momentum to be number one. What is your profit/market share target for 2014? We are aiming to maintain the same average growth of around 15% – that is 1.5 times the average pharma market growth, thus allowing us to gain more market share. Do you export medicine produced in Egypt? Rakha: Yes, we export our products to Latin America, North Africa, parts of Asia, and Switzerland. Abouseif: Our production site is well calibrated like any other production site. Novartis Egypt production site fulfills the highest Health Safety and Environment (HSE) global standards, so we don't face any issues with the quality. We export to 10 countries including in Europe – around 30% of our production. We are also studying the possibility of exporting to Gulf countries. So you plan on making investments in the country during the coming years? Abouseif: We invest in different ways. Definitely, our commitment for investment is there. We are investing in people and adding labour to the country. We are investing in adding resources to upgrade technical operations. Our future plans, however, will also depend on improvement in current local environmental and industrial challenges. What are the main challenges that the pharmaceuticals industry faces in Egypt? Abouseif: : Due to the existing bureaucracy, that has been imbedded in the country since a very long time ago, the private and the multinational sectors are facing some communication hurdles when dealing with the governmental sector – which has an impact on all types of industries including the pharmaceutical industry. The Ministry of Health is aware of such problems and is currently working diligently on improving them. One of the challenges we face, which impacts our patients, is the speed of bringing new medication into the country. The registration process for a medicine approved by the FDA [Food and Drug Administration] or the European Union and already available in market would require two to three years. A fair-pricing model is also another problem. We have different levels of medicine – innovative and generic. In order to make an innovative medication, it costs some $2bn or $3bn, from the trial of the molecule to bringing it to the country. Rakha: These figures are increasing and if it costs $2bn or $3bn this year, it will be for example $5bn n or $6bnin the future. As you move forward, the cost of production of a new medication increases. Abouseif: Novartis Worldwide spends around 22% of its pharma division total sales on research and development – which amounts to around $9.6bn annually. I need a fair price for us as a company to continue investing in new medication, while also being fair for the patient. We need to work out a new mechanism and model, and the ministry is currently working on a better model. The third issue is related to intellectual property rights. If a company produces a medication, X or Y copies your product. We need to have synchronisation among the government bodies to ensure we are respecting those rules. The fourth issue is counterfeit medication. There are some provinces in the country that are known for producing counterfeit products. Can we discuss the issues with the pricing model a little further? What progress have pharmaceutical companies made in talks with the ministry? Abouseif: Simple – we had two reservations. The first was fundamental, while the second was secondary. The first reservation was the comparison list; when thinking about a product that I will introduce to the Egyptian market, what is the list of pricing references that will be used?. We had a main request to review reference lists and the calculation of the reference list. Egypt used to use the lowest price then deducts an additional 10%. The methodology of calculating the reference list was also in question. The question was – would it be the average or the lowest one? The second reservation was about how frequently we can review the prices. Four years ago, the dollar cost was around EGP 4.5 – now it costs around EGP 7.5. This also has an impact on our cost structure. We need to keep the appetite of the multinational companies to keep investing in the market. I can't invest in the market while I'm losing money, when that balance doesn't exist. These are two critical areas. There are currently communications between international companies and the ministry to address these problems. Rakha: The interactions with most pharmaceutical companies lead to the inability of the companies to price the medicine, or may delay its introduction. This will automatically reflect on the patient. High level communication between the pharma companies and the Ministry of Health is currently in progress and moving positively in the right direction towards reaching the most suitable and balanced solutions to address all the above mentioned issues. Are there any suggestions for the new price comparison list? Abouseif: The calculation model will include five countries with the average of the highest and the lowest price being considered. The pharma companies are currently working with the Ministry of Health under the umbrella of "Pharma Group", where a committee comprised of representatives from the ministry of health and the pharmaceutical companies have been working together. We received a draft as a pharma group and we will collectively respond as companies, then our response will be communicated back to the ministry for further discussions. I hope that prior to the end of the year, after the parliament elections, if we can reach a final agreement this will be a great achievement for the country. We believe that the minister is more open and pragmatic. What will be the average for the price increases? Abouseif: No, this is not a price increase. We are only talking about new molecules here. We didn't decide, nor have we agreed, that old medication will be reviewed. It's not on the table for discussion. Rakha: We are also working on speeding up the registration process, especially when there is a breakthrough medication. The Ministry of Health is showing a very good response. Is there breakthrough medication that can be introduced? Rakha: We'll have to wait till the end of the year to see but there might be an introduction prior to the end of this year. Abouseif: As a multinational company, from four months ago until the end of 2016, we have 16 new medications that will be introduced world-wide.
