MSD GCC’s Ashraf Mallak looks back on a “transformational” two years since his last PharmaBoardroom interview back in 2021, with the set up of a new regional office, a raft of new launches and expanded indications, and the landmark inclusion of its HPV vaccine on various national immunization programs. Mallak also weighs in on the importance of driving cancer care, awareness, and prevention; how his organisation is adapting to and supporting ongoing healthcare reforms in the GCC; and the direction in which he sees the region’s healthcare ecosystem evolving.
The entire healthcare ecosystem in the GCC is maturing across regulation, private health insurance, vaccinations, and local data generation.
What have been the main developments for MSD in the GCC region over the last two years?
The last two years have been transformational for MSD in the GCC. Following the spin-off of the company’s women’s health business, we have opened a new regional office and have focused on getting the affiliate up and running. To this end, we have brought a significant number of innovative new medicines to the GCC, as well as expanded the indications for our existing therapies, including our cancer immunotherapy. This therapy now has more than 20 indications approved across the region, one of the highest numbers worldwide.
Other significant milestones include introducing our gender-neutral Human Papillomavirus (HPV) vaccination in national immunization programs in different countries in the GCC in partnership with local health authorities. HPV vaccines have historically only been targeted at women, but the science now indicates that they should also be given to men, meaning that efforts were deployed to shift mindsets and gain approvals. MSD also poured efforts into raising public awareness of the HPV vaccine via social media and other channels.
If we look at our performance in the GCC, the investments that we have made in bringing new innovations to the market have had a good impact on our growth trajectory. New indications for our cancer medicines, getting our HPV vaccine on countries’ national immunization programs, and good uptake for our pneumococcal vaccine have all contributed to our mission to save and improve lives.
Finally, our tireless work has been recognized by external stakeholders, with MSD GCC being recognised as ‘Cancer Awareness Partner of the Year’ in December 2022 by the Emirates Oncology Society and is certified as a ‘Great Place to Work’ in both the UAE and Saudi Arabia – a testament to our outstanding workplace culture and our commitment to diversity, equity and inclusion.
As a representative of one of the world’s leading oncology companies, how would you characterize MSD’s role in driving cancer care, awareness, and prevention forward in the region?
MSD is in the unique and privileged position of manufacturing leading medications to treat cancer and leading vaccines for cancer prevention. This comes with a responsibility to act as a partner to the overall ecosystem and find solutions for both the prevention and treatment of cancer. We work to help ensure that GCC countries such as the UAE and Saudi Arabia are among the first in the world to approve new indications, which comes with a lot of work in terms of file preparation but is paying off for patients.
MSD has also partnered with various patient organizations to amplify the voices of cancer patients, as well as drive prevention and awareness of the importance of early detection.
In my opinion, we are only scratching the surface of public awareness around cancer and need to develop more ‘out of the box’ solutions to reach more people. MSD recently partnered with a popular food delivery company who, using their digital platform, were able to deliver brochures to population groups within the segment for potential cancer cases.
Finally, increased patient access through our indication approvals also comes with the responsibility of supporting the low-income population. Hence our dedication to launch a Patient Support Program (PSP) in the UAE. We launched the AWN program in 2021 with the aim of providing access to cancer medications to those who most need them but who otherwise would not have access.
Is the regulatory framework in this part of the world sufficiently developed to appraise the value of combined therapies?
Our immunotherapy is the basis for new combination cancer treatments, but not only for MSD. Other companies are therefore keen to partner with us to create these combinations, especially given the increasing number of indications that our immunotherapy now has. In the near future, we are working on the launch of two new cancer medications which work in combination with our immunotherapy. Regulatory approval of these combination therapies is underway, and we will continue to expand the opportunities for combined treatments moving forward.
What is your take on the pricing negotiation process in the GCC? How is MSD collecting data to ensure it has all the necessary tools at its disposal for positive discussions?
The new wave of specialised precision medicines like gene therapies targets a limited patient population and comes at a high price. These therapies are potentially game-changing, but their absorption into the healthcare system will require governments to adjust their budgets accordingly and prioritise.
This trend is driving a revolution of pricing systems across the GCC and is leading to wider adoption of health technology assessment (HTA) practices, especially in the UAE and Saudi Arabia. When it comes to HTA, the name of the game is local data generation, which helps establish a treatment’s relevance for people in that country. MSD has established the collection of this data as a core effort as it has become a key tool in our pricing negotiations, helping more clearly determine how a therapy brings value. Value-based pricing – another crucial trend – will depend on this local data. I also want to emphasize our strict compliance with data protection laws in the GCC region, ensuring the privacy and security of patient and healthcare data
However, there is no need to reinvent the wheel and we should learn from Europe, where HTA is well-established. In Germany, for example, companies begin collecting data two years ahead of registration in preparation for future value-based pricing negotiations. In the GCC, we currently do not begin until post-registration, but I foresee a more proactive approach in the future.
Is there an issue with data collection in the UAE due to the fact that expats tend to stay in the country for such a short time?
We see this changing in the GCC, which is investing more into securing long-term stay for its expatriates and their families, in large part thanks to new regulations such as the ten-year Golden Residency Visa in the UAE- and there are other examples from Saudi Arabia and Qatar which also encourage the growth of public and private partnerships.
This will bring greater uptake of healthcare and insurance in the GCC.
Globally, MSD is a major clinical trials sponsor, but is the GCC ready to take on a greater share of worldwide clinical research?
There are a number of different reasons why MSD did not have a clinical footprint in the GCC in previous years. Some of the external reasons include the need for a large population and a large number of patients to conduct trials but also for an established research infrastructure.
However, things are changing and last year we signed an agreement with the Department of Health of Abu Dhabi (DoH) to start exploring observational research in the UAE. We invited our Global Clinical Research Team for a visit to Abu Dhabi to assess preparedness for clinical trials which showed great promise due to a number of factors: the diversity of the UAE population, the high calibre of the healthcare infrastructure and institutions, the talent and competence of researchers with vast international experience as well as the regulatory environment of the UAE.
Another notable factor is our close collaboration with the government which is working hard to remove any barriers to ensure that clinical research is facilitated in the country. In summary, we are hopeful that this will mark the start of the expansion of MSD’s research footprint in the GCC.
MSD has the biggest portfolio of vaccines in the industry as well as the most-used vaccine in the world. What impact is this portfolio having in the GCC and how developed are countries’ immunisation regimes?
There are three important areas to consider. The first is that paediatric vaccines, such as the ones provided by MSD in measles, mumps and rubella (MMR), will always be part of the national immunisation programs. MSD was the first company to develop those vaccines for children and as a part of its commitment to support patients, we will always continue to provide countries with those vaccines
The second is that the HPV vaccine is especially important as one of the only vaccines for the prevention of cancer, one of the biggest issues in global health that draws the greatest amount of investment. Governments have realized that it is better to invest in the prevention than the treatment of cancer and MSD is currently undertaking research with its partners to explore and assess messenger RNA (mRNA) technology to develop preventive vaccines for melanoma, among other cancers.
The third is that you should improve what you have. Paediatric vaccines have remained largely the same for a long time and are working well, but we are also introducing new jabs, such as for our new pneumococcal conjugate vaccine that provides broad coverage against 15 serotypes of Streptococcus pneumoniae that has a high burden by causing Pneumococcal diseases in both paediatric & adult populations in our region and worldwide.
How straightforward is it for a company like MSD to have an impact on population health and vaccination regimes in the UAE?
Driving public awareness of vaccines and treatments will continue to be a priority for MSD. After COVID-19, there was clearly a greater acceptance of the concept of vaccines among both the general public and authorities. The governments of the GCC are now in the driving seat and have embraced the importance of collaboration with manufacturers, healthcare professionals and payers to build a strong foundation to be able to deliver quality care to patients in our region.
The approval of a gender-neutral HPV vaccine, for example, tells us that we have the right environment for that. There is still, however, work to be done in terms of building up public awareness and acceptance.
With the introduction of mandatory health insurance in the UAE, your client may no longer be the government, but multiple private consumers. How will this impact MSD?
There is both a public payer (the government) and multiple private payers (insurance companies) in the UAE today, both of which have different dynamics. The public side, for example, has been very proactive in terms of vaccination uptake, while there remains work to be done on the private side with the insurance companies.
The private insurance market in the GCC is expanding rapidly in terms of the population served, numbers of hospitals and pharmacies, and treatment options, which is good news, but we need to ensure that vaccinations are included in their policies. MSD is engaged in trying to find solutions via partnership with insurers in this regard, and there are several options on the table. Today, operating models are continuously assessed by private insurance companies in the GCC, in order to accommodate new solutions for the growing private market.
How do you see the GCC healthcare ecosystem evolving in the coming years?
The entire healthcare ecosystem in the GCC is maturing across regulation, private health insurance, vaccinations, and local data generation. This is being driven by policies that increasingly incentivise healthcare companies to invest here, especially in Saudi Arabia and the UAE.
Do you have a final message on behalf of MSD?
This is the message closest to my heart: MSD is unique in terms of offering both innovative medicines and vaccines to tackle some of the world’s major health issues including cancer. This is a clear demonstration of our mission to improve lives and I believe we have the right capabilities and competencies here to drive positive changes throughout the healthcare ecosystem.
Additionally, we will continue to aspire to be both the partner and employer of choice in the GCC, building up our diverse and inclusive culture even further to attract and retain the best people.