The head of Management Center for the North West Africa of a large multinational speaks out about the defining characteristics of the Algerian pharmaceutical market and discusses the importance of training local medical practitioners in clinical research techniques and methodologies.
Now, you are the Head of the Management Center for North West Africa and also the GM for Morocco, could you start telling us about the geographical strategy Roche has and also what is the rational behind this configuration?
We are organized in several regions: Latam Region, European Region, Asia – Pac and also the EMA region (Eastern Europe, Middle East and Africa); within Africa we have sub-regions that have certain number of countries under its supervision. In my case, it is the French speaking Africa, also including Libya. In this area, it is Algeria, which constitutes 50% of the sales of the region (Morocco, Tunisia, Libya, Algeria) and also within my management center we also have West Africa that includes Cote d’Ivoire, Cameroon, Senegal, Mauritania and others. Under this context, Algeria, with its level of sales, is the biggest country of the region. This division is to simplify the organization of countries that have certain affinity, common language and background. Another sub-region is South Africa and they are grouped with the English speaking countries. We also have 2 regions that are grouped in Dubai with Egypt, Qatar, Saudi Arabia, Jordan, Lebanon and the others. Another region are the Central-Eastern Asian countries and finally we have stand alone regions like Turkey or Russia because these countries are huge in terms of volume and size so they are not grouped with another region.
To continue with the regional coverage, how would you define Roche’s North Africa strategy and what relevance does this region represent in Roche’s approach to emerging markets?
Within Roche, we are very much specialized within hospital very high-tech products; having said this, our key markets in a global scale are Japan, USA and Europe. I have to say that, unfortunately, oncology is now becoming a disease not only for developed countries like Europe or the US, but also in Latin America and Africa. Here, we are transitioning from having infectious diseases to the oncology area. Therefore, Roche has made one of its goals to increase its presence in Northwest Africa. The key under this context is to increase access; the problem that we are facing in emerging markets and especially in Northwest Africa is access. We have high technology products that come with a high price tag, but they also come with a high value for patients. One of the main initiatives that we have within Roche is to improve access in a sustainable way. For example, some people may say that it is easy to improve access by giving the medicines for free, but that system will not be sustainable throughout the years. Additionally, you need the drugs but you also need the infrastructure. Under this context, our goal is really to have a sustainable access and we can only achieve this with cooperation from the governments.
In the case of Algeria, I have to say, that the country is in the privileged position of being a relatively wealthy country, it has resources like oil and gas so they are able to buy the type of products that we have. Nevertheless, access is still an issue in Algeria as it is in any other country. I think that every country has an access issue but just in different levels. For us now, one of the key issues that we are tackling with in NW Africa but also in the MEA region is how to have a sustainable access. I underline the sustainable access because only access can be misunderstood by giving a solution of just lowering the prices, but at the end, this will not be sustainable. Also it is necessary to have everyone involved, government, population and infrastructure in order to be able to offer this improved healthcare.
Algeria has a very particular healthcare system, since it is fully reimbursed by the government or the minister of health. How different is Algeria within the region? How is Roche adapting to the Algerian configuration?
I think that the Algerian population is privileged because the have a remarkable healthcare system; they do not have to pay for any medication, they have hospitals and pharmacies. I have to admit that other countries in the region do not have the same luxury; the situation is very different in these other countries where, for example, 50% of the population do not have access to any type of insurance. Having said that, there are also other things that need to be improved. It is necessary to expand the infrastructure; each time the population is in need of more healthcare and, despite the government efforts, there is still the need for improvement not only in infrastructure but also in professional training. We need doctors and nurses to manage the hospitals, in every level, from the student to the professional level. There is the need to train the people also abroad, to get experience to be able to implement it here in the country.
Roche has a strategy and approach that are custom according to every country. Even if they are neighboring countries, each of them has its particularities to be treated individually and Roche makes that distinction.
Talking about achievements, could you tell us about the milestones of Roche here in the Algerian market and the full scope of the therapeutic areas in which Roche is involved?
Roche has recently had a change of management here in Algeria and in the region; clearly my goal for my region is to become the most respected healthcare partner. Our goal is to really work together with the government, Ministry of Health, PCH (here in Algeria), the medical community, in order to really have a win-win situation. We want to grow as an enterprise but we also want to help and make sure that our partners see this also as a way of balancing to help them with their growth. I have to admit that we are not there yet; we have to change and improve some aspects. We have learned from our activity here in Algeria and now we want to improve. Roche is committed especially in the area of Oncology, Hepatitis (C and B) and Rheumatoid Arthritis. These are the 3 biggest areas that we are developing; all these require hospital products that require attention.
Additionally, one of our aims is to be working together with different players here to make sure that we are able to provide the population with different healthcare access. Let’s take as an example the mammobile, we want to make sure that we are able to allow women to identify breast cancer as early as possible breast.
Before going into that topic, we know that your products are mostly hospital oriented; can you tell us about the interaction with an institution as the PCH? How would you describe it?
It is different in the sense that you are bound to just one client; the company can get an order than can be very large or you can also loose the tender. Under that context, it can have its risks. Here, as I stated before, we want to become the most respected partner with PCH. We have to improve our operations with the experience that we have now and really become this partner. We will perform in a way that will show our commitment to this partner that we are talking about and avoid faults in the future.
You were mentioning before about the very interesting initiative of the “mammobile” and being breast cancer the one of the leading causes of death here in Algeria with approximately 10,000 new cases every year; what role do you see Roche playing in the education and prevention of the Algerian population in regard to cancer and breast cancer?
As a pharmaceutical company we cannot interact directly with the patients, but we help patient associations, government initiatives or initiatives that are lead by physicians, in order to improve early detection. The earlier, for example, breast cancer is detected, the easier it is to save the patient. We work very close with patients associations, Minister of Health or individual doctors who have initiatives to increase the visibility and awareness of the diseases. For example, in Algiers it is quite easy for a woman to go to a doctor’s appointment and do a mammography, for example; but in areas that are far away from here like the south of the country, it is much difficult to have access to diagnostics. That is why this initiative that we co-sponsor was basically having a bus that was driving into the communes and villages that were far away, in order to allow the women to have the mammography there and get their results on the spot.
Under this same context, being Algeria a Muslim country it is, therefore very interesting to see how a company is approaching a woman centric disease. Can you share with us the difference in approach that you can see when reaching out and communicating with Algerian women and women in other countries? How is the initiative being received?
It is key to take religious and cultural differences into account if you want to have a successful campaign. Here, it is key to work ethically and also with government authorities in order to make sure that what Roche does is also in line with the plans of the government. Finally, if we help to identify a disease, we also have to be sure that later on these patients will be treated. It is not possible to diagnose a patient with a disease but then telling them that they cannot be treated; that is even worst. For this reason, it is important to work closely with patient associations, the Minister of Health and the doctors to really make sure that whatever we do is sustainable. The strategy is to work together with the relevant stakeholders and not to do it on our own, because working alone will lead to failure and give the idea that we are doing it under our own interests; therefore it is very important to have a very broad-base approach that will also fit other aspects such as culture and religion.
Actually you touched on something that is somehow complicated to talk about as a pharmaceutical company, you have medicines and we also talked about the fact that it is important for the patients besides having the diagnosis to actually go and get treatment; therefore there is also a question regarding the interaction when it comes to educate the doctors to make sure they get the right knowledge and information avoiding conflicts of interest with the pharmaceutical companies. How do you manage this kind of challenge?
One of our missions is continuous medical education, we are very much engaged in our focus areas: oncology, hepatitis and rheumatoid arthritis. We have different approaches, for example the traditional one that is taking a group of physicians to key congresses such as ASCO – key oncology congress in the US, ESMO – key oncology congress in Europe – and so on, this is a key way to educate physicians and there they can learn about all products existing in the market. We also have symposiums or stand-alone conferences where we talk about our products; we have speakers coming from France, for example, and they come here to discuss new studies and results of the different sectors that we are in. Additionally, we also give support with grants for events that physicians organize here in Algeria. During these congress or symposiums they will speak about our products but also about other products.
When you were mentioning besides oncology, Roche also has a focus in hepatitis C and also rheumatoid arthritis, how is Roche approaching these particular diseases and tackling them? How competitive is Roche in those areas?
Right now, we have competition in all areas; from our point of view, our objective is that our sales representatives (product specialist) have the know-how of the product and of the disease so they can help the doctor to really make their own choices. We believe that our products are superior to other products and we have data and studies to show it; that is the way we address and try to convince doctors. We are very scientifically driven and we have studies to show to the doctors about our products.
Surely, competition is intense. For example, in hepatitis C there are other products that are competing for patients and there is also us that are trying to show the doctors why it is better to treat with our products; products that we believe have a better safety profile, better efficacy and therefore is better for the Algerian patient. Certainly, at the end, it is the choice of the doctor. We inform and give the key messages of our products and then it is the doctor that, depending on the patient, has to choice the best product for each case.
Now, looking at a bigger picture, Algeria is quite a “virgin area” in growing rapidly and yet there is plenty still to be done for the pharmaceutical industry; the country is growing double digit every year, therefore, attracting more and more international pharmaceutical companies and of course also competitiveness/competitors. Here most of our interviewees mentioned that there were looking into areas such as oncology or hepatic areas, just to mentioned a few. How are you prepared in the face of this rising competition? How can Roche sustain its position?
We are, not only here in Algeria but in the global scope, very much focus in innovation, really bringing products with a high degree of scientific and medical innovation, in this areas that I mentioned before. This is the biggest value that we have; we truly believe in innovation, especially in our focal areas.
I think that for Algeria in order to really become competitive on a global scale, it is really necessary to open the country. For example, the visa requirements or working permits to come to Algeria are quite stringent and complicated; this makes it difficult to get foreign speakers to come, international professionals to come, Roche executives to come and, in general, to attack talent from outside of Algeria. It is an issue that does not help Algeria in developing its markets and its capacities. Probably this is similar to other markets as well, not only the pharmaceutical one but also high-tech market, for example. I think that we have talent here in Algeria, but we also need to make sure that we are able to attract talent from other countries. If Algeria really wants to become a hub for biotech or for pharma, it will also need to have trained people from abroad. That does not mean that there is not trained people here in Algeria, but it is also very necessary to have expertise from other countries. For example, if there is the need to build a production facility here in the country and there we have to process working permits that take months to be processed, it really hinders the development here in Algeria. Therefore, it is important to open up the country to foreign qualifies persons from other countries that can contribute to the development of Algeria.
Another important point is also the structure of shareholders of new companies. Right now, it has to be 70% in hands of Algerian shareholders and only -30% in hands of foreign shareholders of an affiliate; this also creates issues. At the end, multinational companies want to have the final saying in their companies. So there is the need to change this structure in order to make it easier for foreigners to invest, if not it will be difficult and not appealing for foreign investment.
Another of Roche’s focal points in Algeria has been the training of medical practitioners in clinical research techniques and methodologies in partnership with the universities of Oran, Alger, Constantine and Annaba. Can you elaborate on these initiatives? What efforts are made to train the human capital and ensure quality?
This is a very important point to highlight. We want to work more and more with countries like Algeria in order to perform clinical research. These researches are potential win-win situations both for Algeria and also for Roche. We are interested in developing new medicines and Algeria has patients that can be treated with new innovative drugs and it also has an interest in being part of this clinical development. We are, as a company, trying to educate hospitals and physicians in ways of conducting serious clinical trial; I am talking about phase II, phase III and trials that will be used in the future to register drugs in the US with the FDA, in Europe, in Japan and here in Algeria too. These are very stringed trials with strict requirements; therefore it is necessary to have dedicated staff, physicians and adequate equipment for testing and monitoring. It is a big effort that, together with the Minister of Health and the hospitals, if it is achieved it will bring the whole healthcare to a different level. Roche is engaged to bring this clinical development into Algeria. This development is still small here but we already have several trials that are running. We had a trial with perjeta, that is one of our innovative drugs, and Algeria was one of our higher recruiters. This was great for Roche Algeria but also for the country because this shows that Algeria can be a top recruiter. Every country is competing and would like to have these trials; the trial done shows that Algeria is also under the capacity to compete with any other country under this matter. And, of course, this contributes to the development of the country bringing high-qualified people, technology and new jobs.
Emerging markets in general, and of course Algeria is not an exception, do not want companies to come in their country and only sell their products, but want to be part of the great innovation umbrella. People understand that Algeria might not be the destination when it comes to first class research. How can Algeria and the North Africa region participate in the research on a global scene? How can it be integrated in regional initiatives when it comes to R&D or clinical research?
One of the key steps is to open up the country in order to bring talent. In our case, we have not had any manufacturing capabilities here but we are now thinking about it. It is also important to be careful specially if talking about biotech manufacturing because this area is very sensitive. For example, in our case, we have only 4 sites globally that are able to develop this type of technology. This is the extreme of innovation, but there are, of course, intermediate processes that can be done here. Another step that can be taken besides opening up the country is also the commitment of the government to pay for innovation. This is an important commitment that the government has to make realizing that if they really want to turn the country into a biotech hub or a pharma hub they will have to pay for it. If they only focus on generics, it is going to be difficult to become a leader of innovation.
Roche has been an active participant and forefront player in the Vision 2020, what can Roche bring to these initiatives? What can be accomplished?
As stated before, we want to become the most respected partner and we are certainly very happy to work with the government in order to discuss the sustainable access topic. The aspect of the drugs involving composition and development for better and, naturally more expensive, drugs; for this reason we are very aware of the issues that this might entails and we are very much willing to talk about viable solutions. We would also like to discuss other topics with the government such as clinical operations, how can we help with our know-how? We are one of the world-class conductors of clinical trials so how can we help to have a high performance clinical operation in hospitals? How can we work on access and infrastructure? We have to make sure to work together with hospitals and also pharmacies; we have products that need a cold chain, for example, so we have to make sure that these conditions are being fulfilled for the benefit of all the patients. Another subject is the stock management, for example monthly orders will help the hospitals to deal with the problem of expiring products, it is better to have short terms of stock management in order to improve accuracy. We want to address all of these topics and work together with the government in order to make sure that patients are receiving the best possible healthcare.
What are your thoughts on the future of Roche in Algeria?
Roche is really committed to become the most respected partner and sustainable access is at the core of our guidelines in the emerging markets. We realize that the emerging markets are the future; in some years, these are the markets that are going to have significant growth in the healthcare system. We think that one of the key issues that we will face as a pharmaceutical company is having the right talent, the right professionals, doctors, product managers, etc. in order to sustainably grow. We need to nurture our talent in order to get people from other markets coming to these emerging markets to implement initiatives and new strategies address according to the specificity of each market and culture. We have taken emerging markets as one of our key developing areas, now we need to develop our people in order to take the right decisions today and tomorrow to be able to grant access to all the patients in Algeria.