Building on this admirable production base, covering most of Egypt’s medical needs at some of the region’s lowest prices, domestic manufacturers are increasingly looking to produce high-tech products in-country and reduce Egypt’s reliance on imports. Next, came a welter of nationwide presidential initiatives aimed at eradicating many of Egypt’s most pressing epidemiological challenges from Hepatitis C to chronic non-transmissible, lifestyle diseases. And then followed a comprehensive structural transformation and resetting of the entire institutional, financing, and regulatory apparatus, pushing the pharmaceutical and medtech providers embedded in Egypt to rethink their approach and attracting new market entrants.

Indeed, it is hard to overstate the boost to investor confidence in Egypt’s life science sector that these collective actions have sparked. “Not all that long ago, this country was mired in geopolitical instability and enduring a painful devaluation of its currency, both of which presented significant challenges for the companies that make up our industry,” recalls Samir Khalil, executive director for PhRMA in the Middle East and Africa. “However, what we have witnessed since has been an admirable turnaround, with double digit sectoral growth, twice the amount of FDI, and a proliferation of new opportunities to do business and introduce innovation,” he observes.

 

The outlook for specialty care is exceptionally promising as nationwide efforts to broaden access to innovative treatments take shape

Hazem Abdel Samie, MSD

 

Recent data from IQVIA certainly suggests enviable growth momentum for Egyptian pharma. The market – estimated to be worth around USD 6.3 billion in 2021 – now ranks second only to Saudi Arabia within the Middle East and Africa (MEA) in terms of value, number one for volume, and is a clear pacesetter, currently registering growth three times faster than the regional average.

Moreover, this performance is seemingly grounded in very solid market fundamentals. “Looking at Egypt today, we find a comparatively robust legal and regulatory framework coupled with a government that is increasingly committed to improving the welfare of a rapidly expanding population that is projected to exceed 160 million by 2050. This translates into a great deal of scope for responding to both current and future unmet needs,” opines Ahmed El-Shazly, general manager at Pfizer.

Meanwhile the managers of pharma multinationals active in Egypt remain acutely aware of the underlying latent potential of a mega market on the cusp of maturity. “At this moment in time, this is a pharma market predominately driven by the private, out of pocket segment and skewed towards primary care products, but the whole equation is about to get flipped,” predicts Hazem Abdel Samie, managing director of Egypt, Libya, Sudan and Yemen at MSD.

“The outlook for specialty care is exceptionally promising as nationwide efforts to broaden access to innovative treatments take shape, and it is beholden upon companies like ours to think ahead and prepare ourselves for the unfolding opportunities,” he believes.

This is to a certain extent already backed up by the stellar business performance of many of the local affiliates. AbbVie is a case in point. “I’m proud to say we’ve been experiencing an accelerated growth trajectory here in Egypt lately. In fact, last year our local operation grew more than 35 percent organically, making the cluster I represent one of the real standout performers for our company globally,” confides Ali Sleiman, general manager for Egypt and the Levant.

 

The Egyptian life science sector is simultaneously exhibiting the characteristics of both developing and developed markets. This means rewards can be steep for early movers

Ahmed Ezz El-Din, Cleopatra Hospitals Group

 

“It’s certainly a fine time to be operating here. We only established a legal entity here as recently as 2014, but what we’ve experienced since has been exponential growth and a 20 percent increase in our headcount,” agrees Hatem Ismail, general manager of Bayer. “Nor do I foresee this to change any time soon given the expansive yet ageing demographic profile and the clear political will to attain heath equity in what is, after all, the Arab world’s most populous nation.”

Such sentiments are also replicated by medtech developers and private healthcare providers. “It’s frankly a fascinating time in this country’s evolution because the Egyptian life science sector is simultaneously exhibiting the characteristics of both developing and developed markets. This means rewards can be steep for early movers,” explains Ahmed Ezz El-Din, CEO of Cleopatra Hospitals Group, the first private hospital to break through into the EGX30, the Egyptian stock exchange’s top thirty stocks.

“Under these types of market conditions – and providing they manage to put an appropriate business model in place – private hospitals and clinics can relatively easily start to tap into double-digital growth both in revenues and profits,” he expects, pointing out that, his own group’s value has “multiplied seven-fold since our 2016 listing.”

 

Chasing Universal Coverage

“For an endeavour of this magnitude, ultimate success will hinge upon the robustness of the system being implemented and the material ability of that system to sustain itself both operationally and financially. Over the years, we have witnessed many excellent ideas and laudable public health initiatives in other countries that sadly could not be taken to the finish line because they lacked sustainability and ended up simply not being viable,” warns GSK’s general manager Mohamed Eldababy.

“Currently, only 60 percent of people benefit from any kind of health insurance whether through the state or privately. This means that, for the government to make good upon its promise to attain true universality by 2030, some 40 million still need catering for within a decade,” calculates Eldababy. “The big question is whether the country has it within itself to find the infrastructure, capabilities, human capital, and financial firepower to actually handle that?” he wonders.

Mohamed Eldababy

 

For the government to make good upon its promise to attain true universality by 2030, some 40 million still need catering for within a decade

Mohamed Eldababy, GSK

 

Most commentators and industry insiders however confess to being deeply impressed by the profound sense of purpose and preparation that has so far gone into this venture. “There can be no doubt that this is an absolutely monumental undertaking where the government has dared to dream. But it is also the very first time for this country that the industry has been presented with a solid, well thought out and properly costed plan and roadmap for actually getting there so I personally feel very encouraged about what is taking place,” admits MSD’s Hazem Abdel Samie.

“Bringing everyone under the umbrella of universal health insurance which entails rolling out the scheme across 26 governorates and about 70 major cities is certainly no mean feat and will require coordinated and dedicated effort over a sustained period of time, but we are broadly confident that the plan is realistic,” he adds.

So, what exactly does the new insurance scheme look like and precisely how will it be funded? “The new system strives to cover all Egyptians with comprehensive health insurance. It is to be mandatory so there will be no opting out of the scheme and the entire population must be enlisted and covered, as well as pay contributions to receive services,” explains Hossam Sadek, former CEO of the Universal Health Insurance Authority (UHIA), a new body – formed in 2018 – responsible for managing the benefit package and services as well as drugs that will be offered.

“As the payer, the UHIA is responsible for pricing and overseeing the decision-making as to which specific therapies will be reimbursed by the public system. This means interacting closely with drug manufacturers and signing managed entry agreements that ensure positive end-outcomes,” he clarifies.

Khaled Elrefae

 

It is fantastic to see all stakeholders involved in the management of healthcare sitting down together and trying to put a new process and system in place

Khaled Elrefae, Ipsen

 

“We have created a variety of income resources for the system. On one hand, it will receive direct contributions from citizens as a percentage of their income and co-contributions from employers as well. On the other hand, the Ministry of Finance will be acting as a safety net and shouldering the contributions of vulnerable people and the unemployed,” elaborates Sadek.

Additionally, further revenue streams arise from a plethora of new taxes on tobacco products, drivers’ licenses and car sales among others. “The tax on cigarettes will be updated every three years and tied to inflation and the growth of the market so as to help bake in sustainability,” he notes.

Meanwhile the scheme is being implemented gradually on a geographically sequential basis thus enabling the state time to capitalize itself and amass financial reserves that can be reinvested so as to also avail of investment income. Having already successfully launched across the governates of Port Said, Luxor and Ismailia, the attention is now squarely upon extending it to include Aswan, Suez, and South Sinai as well.

And it is not just the inclusivity of the end objective, but of the actual process itself that has galvanised and mobilized many in the industry. “We have been categorical right from the outset that we cannot manage this alone. To make true our commitment to our nation we require everyone to pull together. We depend upon the ideas, innovations, technologies and investment from the private sector, and are counting upon industry to join the fray and become active protagonists in co-authoring Egypt’s new health map,” affirms the freshly appointed minister of health and population, Khaled Abdel Ghaffar.

“It is fantastic to see all stakeholders involved in the management of healthcare sitting down together and trying to put a new process and system in place, thereby creating universal coverage for Egypt’s 100 million-plus population,” applauds Ipsen’s general manager for MEA, Khaled Elrefae. “That is precisely the sort of approach that can tip the scales between success or failure.”

“The law is already arousing interest from around the world because as soon as you unleash universal healthcare in a country like this, you convert a false big market – where there is massive unmet demand, but faint prospect of responding to it – into a genuine one where opportunity is magnified,” notes Karim Wissa, managing director of the French Chamber of Commerce.

“Especially because this market has been underinvested in for such a long time, we are suddenly seeing the floodgates open with hospitals now willing to invest, insurance players looking to join, and brokers wanting to do business. They understand the potential and actually believe in it,” he insists.

 

Sweeping Structural Transformation

One aspect that really marks out Egypt’s healthcare and life science reforms has been the sheer extent of the structural reorganisation underpinning them. “The application of the universal health insurance system has involved the formation of no less than three new government agencies: namely the inauguration of the UHIA as purchaser, the establishment of the Healthcare Organization (HCO) as provider, and the opening of a General Authority for Healthcare Accreditation and Regulation (GAHAR) dedicated to quality assurance and accreditation,” explains Novartis’ country president Sherif Amin.

“To me this demonstrates that the government has properly thought things through and is completely serious about rationalizing and professionalizing the way our sector functions by separating out the tasks of pooling, purchasing and supervision,” he adds. “The idea of adopting universal health insurance has been on the table for many years, but finally, courtesy of steps like this, it is becoming a hard reality.”

Sherif Amin

 

The government has properly thought things through and is completely serious about rationalizing and professionalizing the way our sector functions by separating out the tasks of pooling, purchasing and supervision

Sherif Amin, Novartis

 

“What we have seen so far is that the authorities have chosen a very scientifically driven process. Their approach has been to distribute responsibilities across different agencies so that, in place of one government entity with overlapping functions dominating everything, we now have a much more transparent separation of duties, missions and specializations,” observes Samy Khalil, country lead at Takeda. “This is most welcome because it provides considerably better clarity for all stakeholders including industry,” he reasons.

“Not only has this setup helped companies understand where to go, but it shows that Egypt is a now a country of institutions with proper processes, regulatory pathways and rules,” extols Karim Wissa of the French Chamber of Commerce. “It indicates just how far Egypt has come and is a fine hallmark of its newfound maturity.”

In a similar vein, a beefed-up and freshly empowered Egyptian Drug Authority began operating as an independent regulatory body in Summer 2020 with the agency now reporting directly to the Prime Minister instead of the Ministry of Health. Not only has this served to consolidate drug registration procedures, but it has resulted in significantly faster registration timeframes for most key therapy areas.

“Clearly a lot of work has gone into ironing out the bottlenecks because what used to take three years has, in certain instances, now been brought down to about six months,” confides Sanofi’s country manager Ahmed Raouf. Little wonder that companies like AstraZeneca have radically upped their launch ambitions. “We’re actually hoping to launch up to 25 new products or indications within the next three-year cycle,” reveals the company’s country president, Hatem Werdany.

Ali Sleiman

 

We are finding the new leadership team within EDA to be forward-thinking, flexible and very open to enacting accelerated pathways for original therapies and cutting-edge innovation

Ali Sleiman, AbbVie

 

AbbVie’s Ali Sleiman very much agrees that there have been palpable changes. “We are finding the new leadership team within EDA to be forward-thinking, flexible and very open to enacting accelerated pathways for original therapies and cutting-edge innovation,” he admits. “There is even a recent study by IQVIA which finds that Egypt has become the fourth fastest market in the Middle East and Africa for registration of products and new product launches.”

Central to this has been the EDA’s adoption of a fast-track regulatory mechanism for new drugs already approved by the FDA in the United States or the EMA across Europe. “It’s a real gamechanger that moves the dial by dovetailing on the decisions of other world-renowned regulatory authorities. Simply by complying with certain requirements, companies now have the choice to follow a path that can help them bring a product to market within 18 to 24 months of your American or European approvals,” recounts Khaled Elrefae.

Meanwhile, international recognition for Egypt’s regulatory process and capabilities has also improved considerably. “The International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use (ICH) recently granted observer status while the World Health Organization (WHO) now categorizes EDA at maturity level three, compared to the FDA at four, both of which speak volumes about how far this country has come and the direction of travel,” points out Sleiman.

 

Outcome-based Procurement

Another freshly created, but vitally important actor is the United Procurement Agency (UPA) which acts as a strategic health technology management entity aiming to enable efficient allocation of resources by securing the highest quality therapies and medical devices for the best possible price in the public sector without compromising accessibility to innovation.

“Having a national centralised procurement authority enables the nation to audit tail spend, prevent wastefulness, and generate savings that can support financial stability and sustainability of our public health system. It’s ultimately about securing the biggest bang for our buck, while simultaneously ensuring a robust and resilient supply chain capable of withstanding shocks,” explains Major General Bahaa El Din Zeidan, the agency’s chairman.

He is also keen to stress that all decisions are guided by science and pharmaco-economics by harnessing evidence-based technology assessments, value-driven procurement methods and fact-based negotiation in accordance with fair and transparent processes.

Doctor Bahaa El Din Zeidan

 

Having a national centralised procurement authority enables the nation to audit tail spend, prevent wastefulness, and generate savings that can support financial stability and sustainability of our public health system

Bahaa El Din Zeidan, UPA

 

“An automated centralised ordering system allows all public hospitals access to a diversified catalogue of medicines, medical supplies and equipment at controllable costs, and all our evaluations are based on multi-criteria decision analysis (MCDA), depending on weights and points,” emphasises El Din Zeidan.

Naturally, the international pharma community has warmly welcomed this development. “While harmonised purchasing places the State in a stronger negotiating position, that effect is somewhat counterbalanced by an improved procurement and tendering process which is more objective and easier to navigate. This, in turn hands, us much greater visibility for planning,” says Mohamed Ali Abd El-Azim, Cairo site director for primary and small molecules at GSK.

“Our job is to focus on when and what new products or product lines to introduce as well as to add more volume on lines that need it so having the UPA really helps organise the panorama a bit. It gives us a better idea of what is needed, thus helping us prepare well ahead of demand,” he reasons.

 

We are currently living through a golden era of healthcare provision in Egypt with genuine interest from decision makers to improve patients’ lives

Mohamed Swilam, Roche

 

What international pharma especially likes, however, is the prospect of scientifically driven treatment evaluation. “Egypt’s appraisals of new treatments are now increasingly reliant on health technology assessment (HTA) technologies and the benefits that treatments can bring to patients, unlike previously when price was the sole consideration in tenders…We’re actually collaborating closely with the authorities to design and apply these tools which will ensure that the limited resources of the healthcare system are expended in an efficient way, delivering the best possible outcomes for both patients and the healthcare system,” recounts Mohamed Swilam, general manager at the Swiss pharmaceutical heavyweight, Roche.

The ultimate impression is therefore that Egypt has become a market that truly recognizes the value of innovation. “While generics companies might still be the biggest players on the local market, multinational originator drugmakers are the biggest contributor to overall market growth, which is a strong indicator of the country’s real commitment to bringing in novel therapies,” opines Novartis’ Sherif Amin.

“We perceive a real shift in dynamism towards appreciating and understanding the value of innovation,” agrees Swilam. “In my humble opinion, we are currently living through a golden era of healthcare provision in Egypt with genuine interest from decision makers to improve patients’ lives… and the best is yet to come,” he concludes.

 

Ascending the Value Chain

At the very same time as Egypt is opening the door to imported innovation, there are also signs that the country’s homegrown drug developers are becoming gradually more innovative.

EVA Pharma, the largest Egyptian pharma company and the second biggest player in the entire local market, has been making a real effort of late to scale the value chain. “With more than a century of heritage behind us, our roots are very much as a branded generics outfit, but we have been transitioning into innovative products in recent years by establishing an in-house R&D footprint with strong capabilities in fields like proteomics and genomics,” says the company’s CEO Riad Armanious.

They are managing this partly by catalysing local collaborations with external researchers having established a central laboratory featuring a variety of tools that the research community are unlikely to gain access to within the region’s universities.

Riad Armanious

 

Local detection, diagnosis, and discovery are  important weapons in the battle against some of our country’s most pernicious epidemiological challenges such as non-alcoholic fatty liver disease (NASH) and our work on genomic sequencing goes some way to addressing this

Riad Armanious, EVA Pharma

 

Meanwhile EVA Pharma has adopted a strategy of targeting niche areas and gradualist innovation. “It’s important to remember that innovation can take many forms. Incremental improvements to therapies can make a big difference for patients considering that diseases manifest themselves differently in different patient groups and that patient needs differ according to local contexts and geography,” explains Armanious.

“Local detection, diagnosis, and discovery are also important weapons in the battle against some of our country’s most pernicious epidemiological challenges such as non-alcoholic fatty liver disease (NASH) and our work on genomic sequencing goes some way to addressing this,” he continues. “Non-cellular mRNA could also be an interesting technology for a player like us, as it does not necessarily need huge economies of scale to develop,” he suggests.

Another standout local icon currently in the process of diversifying its capabilities is the Egyptian International Pharmaceutical Industries Company (EIPICO), which will soon enjoy the distinction of becoming the first company within the MENA region able to develop biological products starting from the cell line all the way through upstream, downstream, formulation and packing to final dosage form.

EIPICO 3, as the new plant is called, will manufacture seven biological products, four monoclonal antibodies (MABs) and three biopharmaceutical proteins with an investment cost estimated at EGP 2 billion,” confirms Ahmed Kelani, the company’s chairman and managing director.

“We already started constructing the factory, previously we have finished the technology transfer, activating an agreement with Pharmadule, which specializes in the design & construction of modular pharmaceutical manufacturing facilities. 14 products have already been registered and production is expected to start at the end of 2023,” he details.

 

Rigorous IP protection is a prerequisite to a thriving innovation society and an absolute imperative for a knowledge-based, technology-intensive industry like pharma

Mohamed Nasser, Amgen

 

An additional significant recent investment aimed at pushing Egypt up the value chain was the April 2021 inauguration of Gypto Pharma. Billed as the largest ‘pharma city’ in MEA, Gypto Pharma Chairman Amr Mamdouh explains that “Egypt’s medicine city is set to play a key role in transforming Egypt to a regional hub for medical production and exports.”

The project’s first stage involves a non-sterile 33,000 m2 site containing 10 production lines for liquid, semi-solid, and solid dosage forms and another sterile production area containing five production lines with advanced technology in partnership with international collaborators. Its second stage contains a 60,000 m2 site dedicated to the production of antibiotics, hormones, and oncology drugs. Overall, Gypto Pharma has ambitious plans to launch 160 production lines with an annual capacity of 150 million packages.

If Egypt’s policymakers genuinely aspire to see large-scale technology transfer occurring, however, they will likely first have to stiffen the frameworks around intellectual property protection. “Rigorous IP protection is a prerequisite to a thriving innovation society and an absolute imperative for a knowledge-based, technology-intensive industry like pharma,” warns Amgen’s MEA lead, Mohamed Nasser.

“The enforcement of IP law is something that we must always be on top of. As a member of the board of trustees of the Egyptian Pharmaceutical Industry Association, it remains one of the main points of concern and a key area for further discussion,” relates Ali Sleiman.

 

Clinical Trials Shortfall

Of course, to really nourish in-country innovation Egypt becoming more competitive as a clinical trials destination could have a huge impact. “Historically, we Egyptians have maybe not always understood the importance of embedding clinical research locally and the role that trials play in spurring on innovation, but we are finally seeing a shift in attitudes, not least among our political leaders who acknowledge the nexus between scientific research, innovation and elevated levels of public health,” reflects Riad Armanious.

“At present, there are around 15,200 clinical trials conducted in Africa, of which perhaps 7,900 are based out of Egypt. With a bit more structure though, there would be the possibility to do many more, especially in therapeutic areas such as oncology,” thinks Amgen’s Mohamed Nasser.

Amel El Beshlawy

 

We possess the region’s largest population, and play host to numerous eminent professors able to contribute to global research projects

Amel El Beshlawy, Paediatric Hospital of Cairo

 

“Egypt has been approved for inclusion in clinical trials for three of Amgen’s global pipeline products, which we are of course immensely proud of, but we would ideally like to see more Egyptian centres and hospitals being certified for inclusion in future clinical trials so as to give companies like ours greater options and possibilities,” agrees the company’s general manager Egypt, Levant and Iran, Ahmed Kishta.

After all, Egypt is already naturally blessed with many of the underlying qualities needed to become a preferred destination of choice. “Firstly, we possess the region’s largest population, and play host to numerous eminent professors able to contribute to global research projects. We can now also lay claim to a robust regulatory framework for research, with clear legal guidelines, ethical committees, and insurance for those patients participating in trials. And, while our approval timeframes could certainly be improved upon, we do offer a highly affordable location with a large patient pool of willing participants,” details Amel El Beshlawy, professor of paediatric haematology at the Paediatric Hospital of Cairo.

The bottleneck appears to be more at the administrative level with a fresh tranche of legislations governing clinical trials having been passed back in 2020 but still yet to properly enter into force. “Our assessment is that existing governmental structures are fit for purpose and that there is no need for a new clinical trial-specific body of the sort you find in some markets nowadays, but the legislation really does need to be activated without any further delay,” insists Nasser.

“You see, Egypt finds itself today pretty much in a similar position to where Eastern European countries were back in the late-90s and early 2000s, when several countries were able to successfully establish themselves as clinical trial hubs with excellent transformational consequences. The lesson is that taking that step directly contributed to big improvements in the standard of hospitals, their revenue, as well as the knowledge and experience of physicians. In short, it acted as a catapult to in-country scientific progress and maturity,” he argues.

Others believe it to be just a matter of time before Egypt begins to fulfil its potential as a regional focal point for medical science research. “Big pharma tends to err on the side of caution and tread well-trodden paths when dealing with emerging markets. You generally look for an established track record, because you don’t want to risk running into too many surprises by being the first mover. It’s really a matter of waiting for the tipping point. Once a few centres commence phase two or phase three trials in Egypt, then you can expect more will swiftly follow,” predicts GSK’s Mohamed Eldababy.

 

Manufacturing Strength

Where Egypt is undeniably strong is as a production platform. The country stands proud as the largest manufacturer of pharmaceuticals in whole of MENA, producing 93 percent of its pharmaceutical needs locally by volume, and 85 percent in value, according to the General Division of Drug Traders at the Federation of Egyptian Chambers of Commerce (FEDCOC). And with a robust track record of drug fabrication stretching back to the 1930s, there is a great deal of cumulative expertise and infrastructure.

“The gap between volume and value is largely accounted for by high-tech products – oncology and immunology therapies, vaccines, anaesthetics, and so on – that are produced overseas. Interestingly, many companies that own plants in Egypt are now looking to diversify into more sophisticated forms of manufacturing which would be very welcome for the national trade balance,” remarks Gamal El-Leithy.

According to his calculations, there are currently around 170 factories operating across the country with a further 40 under construction. “Many of the existing factories are undergoing upgrades and expansion, with additional production lines for new pharmaceutical forms being incorporated,” he confirms.

 

Many companies that own plants in Egypt are now looking to diversify into more sophisticated forms of manufacturing which would be very welcome for the national trade balance

Gamal El Leithy, Federation of Egyptian Industries

 

In addition to the sterling progress displayed by the likes of locals such as EVA Pharma and EIPICO, Big Pharma has also been amassing sizeable in-country production footprints. Almost 80 percent of Sanofi’s pharmaceutical products volume for the local market is produced locally, while GSK maintains a 48,000 square metre Cairo facility and another site in Giza enjoying a combined headcount of 700 employees and annual volume output of around 180 million packs. Novartis’ site, for its part, manufactures 57 different SKUs spanning oncology, innovative medicines and generics and employs more than 350 people in fabrication roles.

“We have invested over USD 40 million in our manufacturing site over the past few years and are now producing oncology and haematology products for the first time in-country. This was encouraged by the government, but it also made a great deal of sense for Novartis as well,” says Sherif Amin.

This is because, like many of its peers, Novartis considers Egypt well placed to act as a regional manufacturing hub and export platform, with the company sending around 21 million units a year of Egyptian-manufactured product to other African markets – Nigeria, Cameroon, Ghana and Tunisia among others.

“To our mind, Egypt represents one of only a handful of countries in Africa that could credibly act as a hub for the continent and gateway into a market worth USD 30 billion,” explains Amgen’s Mohamed Nasser.

Hatem Werdany

 

It certainly makes a lot of sense to complete as much of your production for Africa as you can here in Egypt, because the manufacturing and workforce costs are much lower than in Europe thereby generating significant savings and the regulatory framework for exporting is also especially friendly

Hatem Werdany, AstraZeneca

 

“It certainly makes a lot of sense to complete as much of your production for Africa as you can here in Egypt, because the manufacturing and workforce costs are much lower than in Europe thereby generating significant savings and the regulatory framework for exporting is also especially friendly,” points out AstraZeneca’s country president, Hatem Werdany.

“As with any other product traded in Egypt, you obviously need to get the requisite licenses and paperwork done in order to secure the approval for export, but overall, the EDA goes out of its way to make the process very easy. If your product is not traded on the Egyptian market, you deal directly with an external agency and you get privileges as a local manufacturer to export without complications,” attests GSK’s Mohamed Ali Abd El-Azim. “What’s more. The fact that Egypt has signed many trade agreements with its neighbours across the Gulf, Morocco, Algeria and throughout the continent also counts as a decisive plus factor.”

 

Healthcare Infrastructure: Levelling Up

Concurrently to the roll out of Universal Health Insurance, the Ministry of Health, courtesy of a series of high-profile presidential decrees, has introduced a plethora of initiatives to screen and treat patients in the short-term. “In total there are more than 20 presidential initiatives in play focused upon solving the big issues in health, welfare and education under the umbrella of the so-called ‘Decent Life’ program, and these have been enjoying a lot of success in providing speedy respite to those with unmet needs,” notes Sanofi’s Ahmed Raouf.

Here the ‘100 Million Seha’ program stands out as a unique and unprecedented campaign, which has received deserved domestic and global accolades. It successfully tested more than 30 million Egyptians for Hepatitis C with the goal of eradicating the disease in the country when the country had previously been afflicted by has one of the world’s highest rates of Hepatitis C infections.

 

The establishment of GAHAR is a gamechanger. Now all public medical facilities and medical professionals are being forced to demonstrate compliance with quality standards and most private chain hospitals are considering accreditation too

Loay Badr, BD

 

“Egypt actually became the first country to go from approximately 12 million Hep-C patients to zero and this progress has been acknowledged by many healthcare organisations, profiling our country very much as a trendsetter and paragon in the matter,” enthuses Novartis’ Sherif Amin.

Another very highly impactful initiative has been for women’s health with the aim of counteracting the scourge of breast cancer. “More than 15 million women have been screened in a record time and those that have been detected received the best available diagnosis and treatment options available at the global level. I am proud as an Egyptian and immensely pleased that Roche Egypt was able to be such a key protagonist in contributing to this unequivocal success story,” relates Mohamed Swilam.

“It’s encouraging to see how engaged and active the government has been towards alleviating the nation’s most prolific public health challenges and, as a company, we are now on the lookout for other therapeutic areas to cooperate on such as supporting the authorities in the management of difficult-to-treat diseases like multiple sclerosis, haemophilia, and haematological diseases,” he suggests.

Meanwhile the government has been intent upon levelling up the nationwide quality of healthcare infrastructure by establishing a dedicated agency to accredit and enforce standards across care facilities. “The establishment of the General Authority for Healthcare Accreditation and Regulation (GAHAR) is a gamechanger. Now all public medical facilities and medical professionals are being forced to demonstrate compliance with quality standards and most private chain hospitals are considering accreditation too,” observes Loay Badr, country manager for Egypt and regional leader for the Levant and North Africa at BD Group.

“Our mission is to set the standards for all healthcare facilities in the country. These standards must be accredited internationally by the International Society for Quality in Health Care (ISQUA),” clarifies Ashraf Ismail, chairman of GAHAR.

“At the end of the day, our country has been bequeathed an eclectic mix of healthcare infrastructure, with certain hospitals dating back hundreds of years and others that are very modern. Because these facilities were built at different times, there is a startling lack of consistency across the system; some are well designed, equipped, and staffed, while others are barely fit for purpose because of the old infrastructure. This is what we seek to rectify by enforcing a national code according to which all healthcare facilities must meet to be built or licensed,” he elaborates. Having identified the inconsistencies, his agency is certainly wasting no time in taking steps to ameliorate the situation. During the past three years alone, GAHAR has already registered and accredited more than 195 facilities.

Another positive by-product of the new approach is that private providers can be contracted to provide public services and compete with the public sector for better service providing they secure accreditation from GAHAR. “Participating in the new system will be key to private providers because the entire population will be covered in ten years,” predicts Ismail.

“Right now, the price point of universal coverage is not what we generally charge compared to the normal insurance model, but we believe it will be very well compensated by volume. Although the cost of providing care in those areas will be lower than the cost of providing care in greater Cairo, the economies of scale will create a win-win solution for patients, hospitals, and the payer,” reasons Neeraj Mishra, CEO of the private hospital group Alameda Healthcare.

 

Too many people think that in Egypt, high levels of care are not provided, which is simply not true, so we need to bust this myth and improve our reputation

Nerraj Mishra, Alameda Healthcare

 

“We are ultimately anticipating a tiered model with a base price that increases with the level of care provided and such a scenario should motivate all providers to really invest into modern healthcare by injecting an element of competition into the mix,” he predicts. “Each person will gain the right to a minimum insurance from the state, then they can add their private insurance in case they want a further level of extraordinary care.”

The expectation is also very much that, one day, Egypt should be able to position itself as a magnet for pan-African health tourism. GAHAR has even partnered with Temos – the most prestigious global organisation in medical tourism accreditation – on mutual recognition of accreditation.

“Too many people think that in Egypt, high levels of care are not provided, which is simply not true, so we need to bust this myth and improve our reputation,” thinks Mishra.

“Egypt has phenomenal medical science and the level of complex work which happens here isn’t the same across the whole Middle East. Doctors here practice at impressive volumes for instance, within Alameda, we treat one million people every year in our hospitals,” he points out.

“Currently, African medical tourists are flying over Egypt to go to countries like Jordan, India, and the Philippines. While these are all good countries with compelling offers, there is nothing that our country couldn’t match so it is about time we seized this opportunity because it could be a great source of income,” agrees Ahmed Ezz El-Din of Cleopatra Hospitals Group.

However, he warns that successful medical tourism cannot be attained and delivered by a single group of hospitals, one pharmaceutical company, or one association. “It would need full-blown support from everybody in the government, as well as airports, airlines, and hotels, and would ideally involve the creation of a multi-stakeholder authority specifically to manage medical tourism,” he suggests.

“Egypt certainly has it within itself to create something unique not only in in terms of medical tourism, but to become a hub and deploy our resources so that African patients can get the treatments they need without leaving the continent…Together, Egypt can become its own health ecosystem covering pharmaceuticals to devices to caregivers if we mobilize all stakeholders,” argues Mishra.

 

Onwards and Upwards

So, what is the international healthcare and life sciences community to make of contemporary Egypt? Clearly that this is a market where the tectonic plates are undergoing realignment, and where vast unmet need and political resolve are combining to produce unparalleled opportunities.

“Egypt is part of a region where challenges undeniably exist. There are good reasons why it took us at Ipsen almost a year to complete the due diligence in identifying the most appropriate in-country distribution partner. But these are broader concerns not specific to the Egyptian context. The country itself is open to business and manifests great prospects,” asserts Khaled Elrefae.

“Historically Big Pharma has planted deep roots in Egypt and been here for a very long time – especially the French multinationals – but midcaps and SMEs have been much more wary and hesitant. I sense even that, though, might be beginning to change,” reflects Karim Wissa of the French Chamber.

“For sure it’s a place where it takes slightly longer to do business, where you risk encountering bureaucratic torpor and a bloated, sometimes inefficient, administration, but that doesn’t mean it’s not ultimately worth it…You gain a lot of white hair, but you make a lot of money in the process. The rewards are great for those who dare,” he adds.

“Anyone contemplating market entry must understand that partnerships and innovative access models are fundamental to making a success of it here,” counsels Novartis’ Sherif Amin.

“This is a country that is eager to partner with the private sector and to build things together. There are always robust discussions to be had around pricing, volumes, and coverage, but overall, this government has shown its hand and is demonstrating serious commitment to healthcare transformation,” he concludes.