Before taking on his new position as VP and general manager of GSK Greece, Antonino Biroccio was already familiar with the Greek affiliate, having spent three years there in previous roles before a five year global stint that took him to Spain and Singapore. Biroccio outlines the company's significant investments in Greece and the importance of the country as a hub for GSK’s clinical trial operations. He also discusses the need to introduce more value-based criteria for drug price negotiations in Greece in order to move away from a unique evaluation focus on price. 

 

What was the value proposition that brought you back to GSK’s Greek affiliate in Summer 2022 for a first country manager role?

As an Italian I am incredibly happy to be back in Greece, a country in which I feel at home, and at GSK, an affiliate in which I worked previously and know the dynamic and talented team well. My background is as a chemist and after obtaining my PhD, I worked in several pharma companies in both scientific and commercial roles.

Greece is a strategic country for GSK and the entire organisation here is dedicated to creating sustainable health conditions via strategic alliances with our partners throughout the healthcare ecosystem. By doing this, we aim to increase the prevention of disease and foster rapid patient access to innovative treatment without restriction.

Thanks to my previous experience at GSK Greece across therapeutic areas I am familiar with the domestic pharmaceutical landscape and recognise that significant progress has been made in my absence. This includes the creation and formation of a health technology assessment (HTA) body, improvements to the reimbursement procedures, and increased incentives for investing in Greece.

Moreover, my global experience has helped engender a clearer and more complete understanding of how resilient health systems should look. For example, there should not only be increased generation and use of real-world data (RWD), but also a ‘digital mindset’ to make well-informed policy decisions, and a capitalisation on the value of prevention via vaccinations; a key learning from the COVID-19 pandemic.

 

GSK has gone through a lot of changes in the past couple of years, with its consumer healthcare arm being spun off, the impact of COVID-19 on revenues in 2021, and a new visual identity to name but three. How have these global trends filtered down to Greece?

Our local strategy is fully aligned with the company’s global mission and vision. GSK has become a global biopharma company with the purpose of uniting science, technology, and talent to get ahead of disease together. We aim to positively impact the health of 2.5 billion people over the next 10 years, meaning one in every three people globally will be positively impacted by a GSK product.

This bold ambition for patients is reflected in our new commitment to growth and step-changing performance. We prioritise research into vaccines and medicine across our core therapeutic areas of infectious diseases, HIV, oncology, and immunology. At the core of this is our R&D focus on the science of the immune system, human genetics, advanced technologies, and our world-leading capabilities in both medicine and vaccine development.

GSK has had a presence in Greece for more than 40 years and today delivers more than 50 innovative medicines for conditions ranging from respiratory diseases like COPD and asthma to HIV, rare diseases, and cancer. We are also a leading company in vaccine development with the broadest vaccine portfolio in the industry and several products on the national immunisation list. Our vaccines cover both children and adults in areas including meningitis, flu, polio, and shingles, and we are now awaiting European Medicines Agency (EMA) approval for our new RSV vaccine, which has outstanding data.

GSK’s investment in Greece over the past five years is significant and entails a wide range of investing initiatives that contribute to the Greek economy and support the priorities of the National Healthcare System in addition to improving patients’ lives and supporting the role of their healthcare professionals. Additionally, Greece is a key hub for our clinical trial operations and real-world evidence (RWE) generation. Greece is the second and third largest patient enroller globally for two of GSK’s clinical trials in lung cancer and multiple myeloma respectively, drawing on the high level of healthcare professionals that exist here.

We will continue utilising our experience, creating synergies with other stakeholders, and showcasing the value and efficiencies of the innovation we are offering to society. Moreover, GSK is actively participating in dialogue with the Greek government around the sustainable restructuring of pharmaceutical policy in Greece as an individual company and as a member of the Hellenic Association of Pharmaceutical Companies (SFEE), our industry association.

While our innovative pipeline, one of the most promising in the industry, is an immense source of pride, we are equally proud of our human resources. The GSK Greece team currently consists of over 150 highly educated and talented people, and in 2022 alone we increased this headcount by 21 percent. We are committed to continuing this increase in 2023 to cover our continuing activities in areas like clinical trials, RWE, and new product launches.

 

How would you assess the level of talent in Greece, and what is GSK able to offer potential recruits?

People can see the opportunities that GSK offers in terms of its product pipeline and business growth. Moreover, we have worked hard to earn GSK Greece recognition as a great place to work, and the senior leadership team has fostered a strong company culture where people are able to grow and thrive in an environment based around diversity and inclusion.

Our main goals are to contribute to the Greek economy, support the priorities of the national healthcare system and healthcare professionals, as well as to improve patients’ lives. GSK Greece and its team can play an important role in all these goals, drawing from our global knowledge and experience base to provide innovative, value-based, and patient-centred solutions.

 

What do you see as the main milestones that Greece should look to hit as it progresses towards a more resilient and sustainable health system?

We need to recognise what Greece has already achieved, including the creation of an HTA body, improvements to the reimbursement procedures, and increased investment incentives. Moving forward, we feel that including more value-based criteria in the negotiation process is crucial; there needs to be a move away from the unique evaluation focus on price. SFEE data for 2022 shows that discounts reached up to 70 percent in some cases either through automatic mandatory returns or directly through the contracts signed by the negotiation committee. This level of discount cannot be supported by the industry and can jeopardise the flow of innovative medicines and vaccines into the country, creating a barrier to patient access.

How pharmaceuticals and vaccines are being priced in Greece is not a challenge because Greek law mandates that the country must have the average of the two lowest prices in the Eurozone. However, available resources could be allocated more effectively to support the introduction of innovative medicines and vaccines to the market.

There needs to be a clear strategy in place. By 2025 over 50 percent of the European population will be above 50, creating an urgent need for a more robust and sustainable healthcare framework that allows patient access to innovation in a timely manner. One example of this is vaccines. COVID showed the key role of prevention in fighting disease, but Greece – like many other countries – devotes only a small portion of its healthcare budget to immunisation. Given that the global pharma industry is close to developing 100 vaccines focused on adults, a better framework with more adequate funding for vaccines is clearly needed. Greece should follow fellow Southern European countries like Spain and Portugal, which have increased funding for immunisation in recent years.

Clarifying the roles and accountabilities of the different actors and bodies involved in the decision making and payment process for vaccines, as well as their interconnection and cooperation, will also be important.

 

Given that the Greek healthcare budget has not significantly increased for years, do you see there being scope to reorganise and reprioritise just based on existing funding levels?

Naturally, the level of funding for innovative products needs to increase. Innovation is currently being penalised in terms of funding but, having seen the Minister of Health’s latest comments at a SFEE event, I think that there is a willingness to increase the budget.

I also feel that innovation needs to have a separate well-funded budget to allow speedier access to innovative products for the right patient. At the same time, we also need to review how we introduce a new product on the value-based criteria.

A sole focus on price will lead, in the end, to more and more discounts, which companies cannot afford. Additionally, while Greece is an important and strategic market for GSK the reality is that we are a global pharma company and there are many other countries that are quickly accelerating the protection of their citizens. For this reason, we need to compete in a clever way, knowing that resources are less, and position our resources properly by having the right criteria in place. Greek prices are already one of the lowest in Europe, so there is little wiggle room.

 

The move to value-based negotiations has largely progressed in countries with the ability to generate a lot of data to prove safety and efficacy over the years. Is Greece (and GSK) in a position to be able to do that?

Absolutely, and GSK has put RWE at the centre of its strategy in Greece. A significant portion of our investment in Greece goes towards RWE work. We believe that RWE can help policymakers make better decisions and currently have six RWE studies underway with the aim of proving the sustainable added value of our innovative medicines for Greek patients.

GSK Greece also invests heavily in pharmacoeconomic evidence generation, which helps substantiate the value of our innovative products from a patient, payer, and societal perspective. We will keep working on, and investing in, value-based criteria that can help payers to take the right decision for the right product to reach the right patient in a timely matter.

 

How optimistic are you about Greece’s direction of travel and its ability to continue to build on the progress already made in the coming years?

I am an optimistic person and remain optimistic that Greece is transitioning towards a more sustainable, resilient, and inclusive healthcare environment. The significant funding injection that the EU Recovery & Resilience Facility (RRF) represents will go some way to supporting this. The pandemic brought about long-overdue reforms in the pharma sector and became an accelerator for change, while also showing the benefits of using the RWD, having a digital mindset, and the value of vaccination and prevention. These learnings should be embraced, which will further incentivise companies to invest in health in Greece.

The COVID-19 vaccination experience was one of the most cost-effective public health interventions in the world and underlined the immediate need for a sustainable funding channel across European member countries for accommodating the introduction of new vaccines in a timely manner.

Finally, we would like to see a reshaping of the clawback mechanism and more funding for pharma expenditure. This would help create the right data to drive better value-based decision-making, creating more efficiency, and ultimately improving patient outcomes.