Abbvie has taking a leading role in the Egyptian pharmaceutical industry by bringing their new all-oral hepatitis C treatment to Egypt, the country with the highest prevalence of the disease in the world, making the company a major stakeholder in the country’s highest priority healthcare issue.
How would you assess the innovative pharma industry’s current success in influencing government policy regarding reimbursement at a broader level, in the context of a national health insurance scheme?
Encouraging Egypt to work towards a national health insurance system with significant reimbursement for pharmaceutical products is a priority for the pharmaceutical industry. In general, the current trend is still towards low prices, aggressive negotiations, and localization of manufacturing, and the few instances of public spending on innovative products has been limited in scope and volume. That said, we are trying to influence policy to increase patient access to innovative medications generally, both through the PhRMA association in Egypt, organized under the Egyptian Society for Pharmaceutical Research, and through the healthcare group within the American Chamber of Commerce. The multinational pharmaceutical industry wants to support Egypt in its efforts to develop a national health insurance system, to invest more in the country, but at present the pricing structure discourages significant investments in Egypt.
As such, this is the industry’s starting point; to work to update the pricing structure to more sustainable levels, so that we can increase our investment in the country and work as effective partners to the government. The pharmaceutical industry’s role in healthcare should not be limited to just selling a drug, but through comprehensive diagnosis and treatment support, where we contribute to education, awareness, diagnosis, treatment, and support the structures and processes that make it possible.
In this regard, we have seen some positive signals for the first time very recently. A group of multinationals recently had the privilege to meet with the new Minister of Health, His Excellency Ahmed Emad Eldin Rady, and he communicated that the ministry, with the support of the government, is willing to take corrective actions in this regard. This is a significant shift in mentality for the Ministry of Health. Minister Eldin Rady has also committed the ministry to form a task force and committee under Deputy Minister Tarek Salman, to work with the industry on this issue.
Having just launched the first all-oral hepatitis C treatment in the world, how has Abbvie joined the fight against the hepatitis C epidemic in Egypt?
The Egyptian Ministry of Health approved Qurevo, an all-oral treatment for hepatitis C, in record time. Abbvie came to an agreement to provide Qurevo (ombitasvir/paritaprevir/ ritonavir) for use in Egypt’s national hepatitis treatment centers, in recognition of the immense need for hepatitis treatment in Egypt. Egypt has the highest prevalence of the hepatitis C virus (HCV) in the world with more than 14 percent of the adult population carrying the virus, and each year between 150 000 and 180 000 individuals are infected. Since the greatest need for HCV treatment is in Egypt, to serve patients at a global level it was essential that Abbvie bring Qurevo to this country in an accessible way.
Abbvie first joined the battle against HCV two years ago, when we began by aiding physicians in the diagnosis of the disease by providing them with the tools they needed to more easily diagnose patients, for example FibroScan devices so that they could avoid having to perform liver biopsies. We also started an infection control project in collaboration with the Claude Bernard University in Lyon, with the aim of providing an infection control-training course for all Egyptian medical students, such that they must all be certified in infection control before graduation; this program has now been fully implemented in universities across the country.
Given that HCV is an issue that affects nearly every family in Egypt, it is a disease that most of your team must have a personal connection to; how does this affect your team’s motivation?
An Abbvie motto says ‘our heart is always on our work, because our patients are always on our mind.’ For my team, our patients aren’t just on our mind, but in our lives and in our hearts; everyone in this affiliate has friends, relatives, or neighbors who have been touched by HCV, or knew someone that died from it; as such, the fight to prevent and treat HCV is something emotional and personal for all of us. Moreover, Abbvie Egypt is driven by the fact that we are in a position to help Egypt as a country, and thus it is our national duty to do our utmost to combat HCV.
When the decision was made to enter the HCV area in Egypt with Qurevo, it was a revolution for the Abbvie Egypt team and a cause for much celebration. The arrival of such a product is literally a dream come true; many never believed it possible that HCV would ever be cured with just a few pills. This has given our team a chance to do something wonderful for their country, and we are all incredibly proud and honored to be in a position where we are now working to write history in our daily work; one day, our entire team will be able to tell their grandchildren that they were a part of overcoming the HCV epidemic in Egypt.
With Qurevo now on the market, what will be the next steps Egypt needs to take to effectively reduce HCV prevalence?
Reducing HCV prevalence will not be easy, but is certainly possible. The key issue is that up to 180 000 people are newly infected each year, so minimizing the spread of HCV is as important as treating already infected individuals. At present, the majority of these new infections actually occur in hospitals and medical facilities, so to minimize the spread of HCV we must focus on the healthcare sector itself. So the primary area to focus on is awareness amongst healthcare providers, and of course also among the public, so that the significance of this disease, and the importance of being tested, are well understood. Second, we must ensure proper infection control procedures are taught, understood, and followed by healthcare providers. Finally, we must redouble our efforts to diagnose and treat infected individuals, and invest in building up the capabilities to diagnose and treat greater volumes of patients.
Of course, the coordinating entity for all of these activities at the national level is the National Committee for the Control of Viral Hepatitis (NCCVH), and Abbvie works closely with the committee on a variety of issues. Our infection control program for medical students has been very well received, and is ensuring that the new generation of healthcare professionals will be effectively equipped to help stop the spread of HCV.
The long term objective is to reduce HCV prevalence in Egypt to levels similar to those in Europe or the US, that is between two and three percent. To achieve this goal within the next 15 years, between 300 000 and 500 000 patients need to be treated. At present 180 000 patients are being treated by the national program each year, with an additional 30 000 treated by the Health Insurance Organization, and significant investments will be required to build up the infrastructure and capabilities necessary to treat more than 300 000 patients each year.
Is the commitment there to make the necessary investments to accomplish this goal?
Yes. There are significant budgetary and financial limitations to overcome, however all of the stakeholders are committed to doing what is necessary to combat this disease. Abbvie is here with high commitment to cure HCV, and the level of the government’s commitment is very strong, as fighting HCV is the president’s highest healthcare priority; in fact, the president has been involved in several initiatives himself. Significantly reducing HCV prevalence will be very difficult, we must admit that, but it is achievable and the will is there to see it done.
The president has personally approved a second initiative that we are also involved in, which is to reduce the mortality rates of neonates by 50 percent. It too is a very complex project requiring better availability of and access to medications, improved education in neonatology, awareness, and building up capabilities and investing in equipment. Orchestrating such a wide array of changes, commitments, and investment in Egypt would be nearly impossible without the president’s support, but with it significant progress can be made.
Abbvie is in a unique position, having gained significant political support and experience by arranging this market access initiative for Qurevo: how are you leveraging this influence and experience to promote similar access programs for treating other diseases?
In addition to HCV, there are many disease areas that need to be given more focus and a higher priority from all stakeholders, especially the government. For example, autoimmune disease is significantly impacting millions of Egyptian patients in many aspects such as ability to work and quality of life, and will lead to total dysfunction if left untreated. To do so, huge efforts need to be made in all areas: awareness, diagnosis and access to the treatment as early as possible to prevent disease progression and dysfunction. This means educating and engaging all of the relevant decision makers to the greatest extent possible about the disease, about the patient journey, how they suffer, and how much being properly treated can improve their quality of life, which helps to create a patient-centric mindset and engage them emotionally. Hopefully we will be able to get the best treatments reimbursed soon, and we are confident that this is possible because we are seeing signs that we are successfully changing the thinking of the decision makers. This is our goal and our job; to change policies in the country to make the best medications available for all patients regardless of the price.
