Amine Sekhri, country manager for Roche Algeria discusses the potential for personalized precision medicine in Algeria and Roche’s important position within the Algerian market
Could you please start by introducing yourself to our readers?
This is actually my first role as a country manager. I am a physician, started my career working in clinical research before joining the pharmaceutical industry. I have been with Roche for many years, working in different positions in other countries, before taking my role in Algeria in 2015. I feel immensely privileged to have returned to my country after several years away, considering the country’s vast potential and the multitude of opportunities to really make a difference here, for the wellbeing of patients as well as for the industry.
Tell us a bit about the scope of local portfolio. Which therapeutic areas are driving the revenues? And in which segments do you identify an evolution in demand?
Most of our demand in Algeria is driven by oncology, both as a consequence of the Algerian government’s substantial efforts and investments in this area, but also in line with the specificity of the Roche pipeline and our longstanding prowess and reputation in cancer treatments. Recently we have been seeking to diversify our reach, while also maintaining our leadership in Oncology. Leveraging our experience in R&D in chronic diseases, we are doing a lot more around the CNS therapeutic area by bringing in new therapeutic options for conditions such as multiple sclerosis.
We are also moving a step further in approaching new innovations in oncology. The main breakthrough is, of course, in immunotherapy, but there are also parallel innovations underway in integrating personalised healthcare and molecular biology to treat cancer. This is specific to Roche, who have been pioneering this branch of medicine for many years. Our ambition in Algeria is, as always, bringing in these exciting new innovations as speedily as possible.
Roche has been at the forefront of pioneering personalised precision medicine. The big question is how prepared is Algeria to embrace this approach?
I think we have made great progress over the past decade. When the first generation of targeted therapies and personalised medicines were launched in Europe, no one would have believed that it would work and that drugs such as Herceptin® which requires a specific diagnostic test would now be provided to every breast cancer patient in Algeria. Over this time, Roche has liaised closely with the key stakeholders and worked with them on behalf of patients. It is a result of all this, and work by the whole medical community, that the importance of personalised healthcare and targeted therapy has been brought to light.
Since then, science has moved to another level, driven by a better understanding of genomics, molecular biology, and data analytics. We believe that Algeria has the potential to embrace these new technologies considering the healthcare system, the local epidemiology and medical needs expressed by patients and healthcare professionals. It is a matter of time. To achieve this as soon as possible, a joint collaboration on education and infrastructure will be a major lever.
The challenge must be that, as a company, Roche possesses a lot of new exciting therapeutic solutions, but as a prerequisite a certain amount of base infrastructure needs to be put in place for them to work. How do you overcome this?
Personalised medicine relies on big data and its collection and processing. This is indeed a requirement in order to implement these sorts of cutting-edge solutions. When discussing access to healthcare, the focus seems to be on the drug only. For us, access to healthcare should include the whole patient journey from day one when symptoms appear up to treatment follow up. We must ensure that at the end the patient is benefitting and receiving the best treatment. This is the vision that underpins our ongoing collaboration with the Ministry of Health and explains why we entered into a partnership 2 years ago to be an active contributor in the implementation of the National Cancer Plan. We must share our expertise and provide our support as a healthcare partner. We also learn from them about the issues they are facing and willing to solve them together for patients. We are assisting by putting in place some of this missing infrastructure. For example, we supported the Ministry of Health in developing the national cancer registry and are playing an active role in developing accreditation of the cancer research centres through PACT program.
Could you tell us about some of those projects?
We are proud of the establishment of the national cancer registry. It is key because it helps define, assess, and evaluate the data about cancer in Algeria. Without this we couldn’t have a plan for addressing cancer. This was a simple step and the Minister of health was very keen to work with us. It was very quickly executed, and some very basic implementations had a high impact. In 2017, the data were presented at the international congress for cancer registries. It was impressive as few knew about the tremendous work the Algerian National Cancer Registry team were doing.
We are simultaneously engaged in a whole array of other initiative. We are one of the first companies to invest in clinical trials in Algeria and have 4 projects waiting for approval. This is because we genuinely believe in the potential in Algeria, both in healthcare and in making Algeria part of the international research network.
In 2014, one of the main projects was the idea of the so-called “Mammobile,” or mobile breast cancer screening units. Is that a project still operating?
Yes, and we are particularly delighted of this because it advances the diagnostic aspect of a patient journey. Every year thousands of patients across the country are screened through this initiative. However, to diagnose properly, we must begin by raising awareness. Roche and patient organisations have been harnessing TV advertising to raise awareness on breast cancer. We follow the principle that the earlier the diagnosis, the better the chances of survival. It is very important for patients to understand its benefit and it is why we collaborate with the health authorities and patient organisations to increase such awareness. This year the screening program is planned to go nationwide and is now endorsed by the Ministry of Health. This will further increase its impact.
What is Algeria’s current potential for clinical trials and where has Roche as a company been investing in clinical trials?
We take great pride in the fact that Algeria participated successfully in our global trial “PERUSE”, for Perjeta®, which is a therapy for treatment of HER2-positive breast cancer. We also have “MABRELLA” which is a trial, in Non-Hodgkin Lymphoma with a daughter protocol specifically designed for the Maghreb region, where Algeria is the leading country. This trial was presented in San Francisco to the American Hematology Congress in December 2017.
Besides that, we are investing in bringing research and ensuring that Algeria is connected and actively participating in Roche programs. At the same time, we are aware that the infrastructure needs development to extend its capacity and enabling centres to reach the highest level of international standards for conducting clinical research.
Considering the potential of Algeria, we believe that it may become an attractive location for clinical trials, like other markets such as Turkey and Brazil.
One of the exciting pieces of news that has come out recently has been the commitment of Roche to establish a manufacturing footprint in Algeria. Can you update us on what the plan is for that?
As per our joint commitment with health authorities to improve access, we have the firm intention to implement a localisation project for biologics within Algeria. The ongoing discussions seek to determine the optimal way to achieve this. The project is underway and we will make an official announcement in due course.
What are the sorts of considerations that must be factored in to determine how best to localise production?
There are a lot of parameters to consider in a project like this. We must consider the complexity of biologics, that requires sophisticated technologies and “know how”. We also need to find an appropriate partner and source the right human capital. The difficulties are not simply about building the manufacturing side, it is more about human resources and managing and maintaining the quality standards.
Tell us about the ease of market access. You recently launched Perjeta®, and also Kadcyla® How easy is it to bring products to market in Algeria?
Considering new opportunities for patient though launch of new therapeutics in the market, I must admit that it is not always straightforward. Over the last few years we have experienced some delays in obtaining marketing authorisations for new innovations.
As information on new innovations is more readily available to the public, particularly when the medical need is very high. Any patient would hardly understand that the drug may only be marketed in 3-4 years, especially when it is already available cross the border. Our role as an industry is to collaborate and ensure that we deliver our commitment to patients to access to these therapies as soon as possible. This is one of our biggest challenges.
Consequently, we are working with the health authorities to enhance accessibility. We are sensitive to the financial constraints that the government is operating under; however, we do not believe that delaying authorisations is the best solution to these issues. That is why we are aiming to collaborate more closely with all stakeholders to identify more creative and effective strategies to improve Access.
The lion’s share of your activity in Algeria is with the hospital sector and obviously there isn’t the liquidity or financing that there would have been previously because of the depreciating oil price. How do you practically surmount this obstacle?
There are many potential access solutions such as pay-per-performance or risk sharing that could alleviate some of these pressures and eke more value out of the financial resources being deployed. However, most of these solutions presuppose a functioning HTA mechanism, data collection and IT infrastructure so as to be able to track and measure performance. We all know that slashing prices is not the best way to achieve effective public health provision, but the authorities will say they have no readymade alternative to turn to. We have to convince them otherwise and actively support them in maturing their fledgling HTA apparatus. The onus and responsibility is on companies like Roche to lend our expertise to achieve these goals. As one of the pioneers of biotechnology and precision medicine we have a lead role to play and are intent on assuming this responsibility in Algeria.
How disruptive were import restrictions? You had this sudden restriction last year, so for a business like yours?
Thanks to the hospital market, being managed by PCH with oncology as top government priority, we have not experienced a major tension last year. Considering the spending is ring-fenced, health authorities are doing their very utmost to ensure that drugs for treating cancer are available and we must recognize their efforts.
Moving forward, what are your main priorities for the next 4 to 5 years?
Our core priority is to continue leading the way in oncology and addressing one of Algeria’s most onerous disease burdens. We possess one of the richest pipelines in the industry and will do our best to make that available to Algerian citizens. We will simultaneously continue to pursue our strategy of diversification, moving to other therapeutic areas where the unmet medical need is still high. There is also the opportunity to advance personalised healthcare through Foundation Medicine by mixing science with data. This is the sort of game-changer that may enable Algeria to leapfrog forward and accelerate its development path.
Meanwhile, we will continue to invest in R&D, partnering externally and want to embed ourselves more deeply within the local industry. We are highly ambitious and optimistic on this front.
