Maciej Trybulec MD, PhD President of the Board, General Manager, Sanofi Pasteur, Poland
Budget limitations in the Polish vaccine field are a handicap to improving patients’ lives as Sanofi Pasteur General Manager comments: “the National Health Fund’s budget for reimbursement is around EUR 2,7 billion (USD 3.7 billion), but the total budget for full vaccination is around EUR 25 million (USD 34 million).” He adds: “We have one of the lowest vaccination rates in Europe.”
Vaccines belong to Sanofi’s “growth platforms”, and although we are a small business in terms of revenues, we play a very important role in the pharmaceutical industry and for patients’ lives.
We want to be important partner in healthcare services providing modern vaccination to Polish patients and building partnership relations with Polish health authorities. Sanofi Pasteur in Poland is gradually strengthening its position on the vaccine market maintaining leadership in flu and travelers vaccines segment. We have also many interesting vaccines coming from our pipeline. For instance, we are very active on dengue fever, still a worldwide burden. One of the vaccines to treat this disease is in its in final stages and should be available in two years’ time. We also have combo vaccines, which integrate five or six different components and represent today the most advanced and complex vaccines available in the market. Recently Hexacima – a vaccine against six different infectious diseases has been introduced to Polish patients. At Sanofi we believe that there is a constant development and search for new revolutionizing vaccines.
What are the greatest challenges of the vaccine industry in Poland today? How have you been adjusting to the new legislative framework?
The Reimbursement Act has not affected our business, or maybe to a very little extent. The majority of the vaccine market is private, close to 70 percent. The rest is financed by the Ministry of Health’s budget. This budget today is covering the most relevant primary care areas, or so called National Immunization Programs. To put the vaccine budget into perspective, the National Health Fund’s budget for reimbursement is around EUR 2,7 billion, but the total budget for full vaccination is around EUR 25 million. Clearly, this budget is highly insufficient for the modern needs of our Polish society. The fact that combo vaccines are not under public use puts Poland behind countries like Czech Republic, Slovakia and even Ukraine.
Another threat for proper prophylaxis in Poland is increasing noise generated by anty-vaccines movements. In majority of cases arguments brought by them are not based on scientific and medical background. As a consequence numbers of parents who do not want to vaccinate their kids at all are increasing. This is causing a real headache for medical staff and healthcare authorities, because it may lead to the outbreak of dangerous diseases such a measles or pertussis.
Given this situation, what has been Sanofi Pasteur’s performance over the last two years?
Our revenues have been stable over the last five years, with eleven percent growth in 2012 and similar level in 2013. If we compare to the rest of vaccines players, this performance is relatively good. Today, the business goes as follows: the ones who strive in the market are the ones who manage to bring products.
How is Sanofi planning to bring new products and what do you have in your pipeline for this year?
In our pipeline for 2014, we are bringing primary vaccinations for pediatric care. Generally we also have five-component vaccine (Pentaxim) and we are in the launching phase of six-component vaccine Hexacima. A very important product for us is Vaxigrip for the Prophylaxis of flu. This is a growing segment, with a significant perspective due to very low influenza coverage rate in Poland (presently below 4%). We have hopes for the future. We also provide wide range of vaccines dedicated to travelers going to exotic countries.
Fortunately in the biggest cities in Poland we have local Influenza programs. The city offers to seniors aged 65 and above free vaccination. We are also participating in tenders. The issue however is that when you have a free of charge vaccination, not many candidates wish to be vaccinated. Healthcare authorities must therefore educate patients about the dangers of flu and urge people to get vaccinated, especially the most fragile ones (young and elderly ones). Last year, 123 people died from the flu in Poland and several thousand went to receive hospital treatment. Research has been done showing that yearly, total costs related to the flu (indirect costs) amount to PLN 700 million (USD 230 million) in low season and PLN 4 billion (USD 1.3 billion) in high season; this is why education needs to be enforced.
How can Sanofi participate in this education platform?
We are trying to play a role in education. Prophylaxis on flu in Poland requires significant improvement. We have one of the lowest vaccination rates in Europe. This is why we very welcome the initiative of key opinion leaders, doctors, authorities to create so called Influenza Working Group. This interdisciplinary forum has a mission to educate patients, healthcare workers, employers, authorities about risks and costs related to lack of protection against flu. Sanofi Pasteur together with other vaccines producers is taking important part in this activity. This process takes time but it was worth to invest it with the clear benefits to patients, employers to reduce sick-leaves in their company and the whole Polish economy.
How does Sanofi Pasteur demonstrate the value of vaccines to the government and others?
Direct discussions with the health authorities are not simple, even though we consider our relationship to be improving. We are on our side proving that our products bring added value to patients; using pharmaco-economics is a great tool for that matter. Although they understand the value of our products, budget limitations put our efforts in vain as they say they cannot exceed their yearly budget growth above 3.75 percent. The implementation of new products would require doubling or even tripling the new budget which presently is very small; this is the reality.
We are a responsible partner, for all stakeholders, one that cares about patients and wants to see health conditions improve in Poland.
Access to modern vaccines for newborns is not the same as in other western countries, as the vaccines are not on the Polish reimbursement list. What is to be done to resolve this situation?
There are solutions to this situation. In fact, there is potential green light for submitting dossiers for new products to be included in the reimbursement list. To be treated as pharma products, the application has to through AOTM (Health Technology Assessment Agency), which is in charge of defining whether the product gets reimbursed or not. Most applications so far have been rejected, but some were positively assessed. There is a chance that the NFZ (National Health Fund) will include some vaccines into the reimbursement list, with reimbursement in the range of 50, 70 or 100 percent.
The Polish society is very patient and tolerant with regards to out of pocket payments. In Czech Republic they would never accept such copayment or full payment scheme.
What do you see as the greatest challenges for the vaccine industry in Poland and in general in the near future?
One of the important challenges for the vaccine world is to understand the absolute importance of Prophylaxis and public financing authorities should realize this. They need to understand that by expanding their budget in this area and accepting more modern vaccines to the public audience, in the long term they will save money and improve the country’s healthcare system. An American research study was conducted showing that one dollar invested in Prophylaxis is saving four to 10 dollars in treatment; this is why actions need to be taken. Finally, we should provide Polish kids and patients with modern therapies, which are available everywhere across Europe.
In Poland we have managed to eradicate Polio, from the whole world vaccines eliminated vey deadly disease which was smallpox, but there are still many battles to be fought.
Where do you see Sanofi Pasteur Poland developing in the next five years?
We hold great expectations for Hexa/Penta (pediatric vaccines) and flu vaccines. Sanofi Pasteur’s flu vaccines as of 2017 will increase to four strains and this means more efficient vaccines and more lives saved.
One more area which we are developing is the traveler’s vaccines business. At the moment we are the only ones really investing in this segment and we feel this is something to pursue as travelers going to exotic countries need to be preventive.
Sanofi Pasteur is present in Poland for many years and is constantly strengthening its position. This would not be possible without full engagement and professionalism of our team working in Warsaw office as well as in the field. I am proud of the fact that I have the pleasure and honor to lead my Sanofi Pasteur team in Poland.
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