Merck Morocco's Ahmad ALMWAKEH feels that the winds of change are blowing in the right direction across Moroccan healthcare, with a well-defined national strategy in place to expand coverage to more of the population than ever before. Merck is well-placed to support this transition as the market leader in therapeutic areas including oncology and neurology, and ALMWAKEH outlines his optimism about updates to the regulatory and reimbursement process to ensure that patients in Morocco can access cutting-edge medical innovation as it comes online.
Could you start by introducing yourself and your 17-year career journey?
I am proud to say that I started at the first level in the industry as a medical representative, holding various roles in marketing, digital, market access, and business unit manager before finally assuming my current leadership position as a general manager for Morocco. Living in different countries and societies has enriched my personality and experience while working on various products, and this has ensured that I fully understand the principles of the work.
Having developed your career in a massive market like Saudi Arabia, what challenges have you faced in applying these experiences in Morocco’s different cultural, regulatory, and financial context?
Moving to Morocco came with many challenges beyond being a different post with different responsibilities. However, the opportunity to take on greater responsibility in Morocco was a key attractor.
In addition to taking on a new position, moving to Morocco entailed shifting from an Anglophone country to a Francophone one. Additionally, the Moroccan healthcare system is entirely different from its Saudi equivalent. While these factors presented challenges, I have relished the opportunity to work through them, which has burnished my expertise and justified my decision to take a risk and move abroad.
Initially, I focused on drawing from my experience and the various roles I had previously held. However, I have since developed the skill of picking and choosing only specific experiences to replicate, instead adapting to the local reality and learning what does and does not work in a very different context.
There are special characteristics of the pharma market in Morocco, starting from the contribution of the private sector versus the public sector (almost 80 percent to 20 percent). The health expenditure per capita in Morocco is expected to increase in the future. And the out-of-pocket expenditure (around 50 percent), and we expect this percentage will decrease with the expansion of health coverage in Morocco.
Understanding Morocco’s macro and microeconomics, culture, and regulations has been challenging but worthwhile. I have been enjoying life out of my comfort zone, and the first year and a half has felt like three or four years because of the number of new experiences and events I was exposed to!
What have been some of the key learnings and observations you have made in Morocco that have impacted the direction of Merck’s affiliate?
One of the things I find interesting in Morocco is people’s norms; Moroccans are kind, accessible, and diplomatic.
Secondly, the life and work pace is faster than in the Gulf states. But in Morocco, there is a greater chance for work/life balance, and the life rhythm is calmer than in GCC countries. However, I expect that will change in the future due to the increased competition in the Moroccan market.
Thirdly, the pharma market in Morocco is highly fragmented. In Morocco, there are few clusters; our clients are individual wholesalers and pharmacies. Even the tender business is not unified till now like in other countries. From a business perspective, the fragmented market requires us to negotiate individually with each of them.
Lastly, the high percentage of private healthcare market versus public healthcare market and high rate of out of pocket in Morocco versus other countries.
How would you characterize Merck’s operational footprint, business model, and focus in Morocco today?
Merck is a vibrant science and technology company, and healthcare is part of its operations; scientific exploration and responsible entrepreneurship are key to technological advances that benefit us all. This is how Merck has thrived since 1668 over more than 350 years.
We have a superb and broad global portfolio well represented in Morocco. The company has a strong footprint in cardiovascular, diabetes, and hypothyroidism markets and provides the A-to-Z fertility portfolio to help families with children. In multiple sclerosis, we have two successful medications, and in oncology, we have one of the major products on the Moroccan market for metastatic colorectal cancer.
We are a market leader in Morocco in our therapeutic areas, including oncology and neurology. In diabetes and hypertension, our products are either first or second in terms of units or number of treated patients, and we are the primary provider in the thyroid market. Our portfolio helps patients in many aspects, from chronic to specialty diseases.
Our upcoming pipeline for different therapeutic areas is solid and responsive to real medical needs, including products for growth hormones and other oncology products. We are also planning on launching new dosage forms of our existing portfolio in Morocco to serve patients and medical needs in a better way.
How you are preparing for upcoming launches in Morocco and what does the regulatory framework look like in terms of market access to innovation?
First, In Morocco, the process is well-defined from a regulatory perspective. I hope to see the registration process faster in the future to increase accessibility to innovation.
The challenge is not only registration but also the reimbursement of products. The process has been prolonged for the past two years due to the transformation in the healthcare system and the expansion of new health coverage, and this transition period made it difficult for pharmaceutical companies to gain access to the market and delay the delivery of innovations in the market to answer existing medical needs. However, I believe this is a transition period, and I am now optimistic that we will have improvement in the future.
Second, access to innovative medicines is related to purchasing power, health expenditure per capita, and out-of-pocket health expenditure. Creating new treatments to answer medical needs is expensive, and the ROI should be clear for investment. However, the health economic models can help show these medicines’ impact on the overall long-term health of a patient, the ROI of health expenditure from governments, and the economy.
In Morocco, many universities launched programs to support the market with health economic evaluation and health technology assessment expertise. And this reflects the future positive trend about this topic.
We have been missing, until now, the regulatory and legal framework to adapt to the market access agreement and the country. This includes financial institutions that can be intermediaries between the pharma companies, payers, and the state. This would help the implementation of many market access agreements for innovations and improve answering medical needs concerning the challenges of financing healthcare.
What is your take on the direction the Moroccan healthcare sector is heading to?
I am very optimistic. Several actions are underway to improve equitable access to healthcare for Moroccans.
One of the objectives in Morocco is to start creating a regulatory framework. This needs reform, financing, flow of patients, and many other things. The different ministries are working together to reach this goal. Moreover, there is expertise in the regulatory field here in Morocco, with many individuals studying in France, Europe, the United States, and Canada.
The Minister of Health has clearly defined his objectives in expanding healthcare coverage, renovating the healthcare system, and localizing medical and pharmaceutical supplies in Morocco. Also, we need to develop the healthcare infrastructure (clinics and hospitals in the private and public sectors) to provide and serve the expanding population.
The expansion of the healthcare and pharma market will happen in the medium and long term rather than immediate or short-term. So, I recommend that any company considering the healthcare market in Morocco should not focus on the struggles that we are having now but on their strategic planning for the upcoming five.
What are some of the governmental stakeholders’ expectations for the industry, and how are you collaborating with them?
The first aspect to consider is answering medical needs in Morocco and helping secure national medicinal security through continuous supply. And we are doing this through the alignment with MOH and our local partners.
The second point is that the government wants to localize production, foreign direct investment, and technology transfer. And this point is crucial in the calculations of ROI. The quantifications of need locally in Morocco currently and in the long term besides possibilities that Morocco can play a role as a hub to Africa.
What do you think should be done to encourage greater investment from the pharmaceutical industry into Moroccan manufacturing?
Government regulation should be made simpler, electronic, and faster. Also, there should be support with investment in infrastructure, among other things, for facilities, so companies would be more encouraged to invest here and open manufacturing plants.
The expected role of Morocco is to be the gateway to Africa. Considering Morocco’s political and economic stability can leverage this point—however, the challenge of the number of different regulations and existing current barriers. However, creating an African Medicines Agency can be beneficial if we wait.
Also, better local pricing of medication combined with fair market access agreements in Morocco can encourage international pharmaceutical companies to invest in local manufacturing.
You mentioned before that Morocco was the gateway to West Africa. How would you define the importance of the footprint of Morocco in the regional context?
First, many countries in West Africa are Francophone countries. Also, Morocco’s political and economic stability has enriched the relationships with these countries, and there is a lot of historical bonding between Morocco and these countries. This is reflected in political and economic collaborations with plenty of potential for further advancement. Morocco has a position of power among the North African and African countries and is a hub for the region, and I am very optimistic about its prospects.
Can you give any insights into the significance of Merck’s footprint, operations, and the economic impact it has in the region?
We are part of the North Africa cluster along with Tunisia and Algeria, with whom we share some benefits regarding shared manufacturing. We share similar regulations, so most of the specs of medication in Tunisia, Algeria, and Morocco are very similar.
Our performance in Morocco is very honourable. We are not authorized to share our figures for the current year; however, we can confirm that we are in a good dynamic, where the Moroccan team delivers on its promises in almost all the therapeutic areas in which it operates.
Our portfolio includes exclusively prescription drugs, from advanced therapies to treat cancer, multiple sclerosis, infertility, and certain metabolic and cardiovascular diseases. At Merck, we are here for people at every step, helping to create, improve and prolong life. We deliver personalized treatments for serious diseases and enable people to achieve their dream of becoming parents.
Given Merck’s innovative DNA, what image are you trying to create for the company in Morocco?
We have three pillars that are the essence of our business: we must be beneficial for our patients, beneficial to the country we are working in, and valuable for Merck. Without these pillars, the work will not succeed. Merck is full of heritage, passion, and innovation, and it is dynamic. We are always doing something new. One of the aspects that I like about Merck is that it is okay to try and fail here. We try until we succeed and always aim to be innovative, creative, and curious. Merck is a dynamic, diverse, and inclusive company.
In our daily work, we want to present Merck’s values, like raising the bar, being obsessed with customers and patients, being curious, challenging the norms, and challenging ideas positively.
You took this new role a year and a half ago, which also meant you joined a completely new team and culture. How has this experience has affected your approach to team and talent development?
Interaction with a new culture and different business environments sharpened my skills. Even though I am armed with experience, I learned to evaluate carefully before implementing previous ideas and expertise in my work and with my team.
Active listening, removing barriers in front of ideas, and continuously giving and receiving feedback are critical success factors for our daily work.
