As the Executive Director of the American-Hellenic Chamber, Elias Spirtounias, is a believer in solutions. He speaks about ensuring the resiliency of the bi-lateral American and Greek relationship throughout transformative times, focusing on garnering investments for the sector, as well as creating spaces for collaboration amongst all relevant parties to reconcile differences and move towards solutions.
We live in a transformative period today – both with the American socio-political landscape and the instability of Greek politics and economics. What are some of the services that the American-Hellenic Chamber of Commerce provides in order to ensure a consistent bi-lateral relationship between the two economies?
The American Hellenic Chamber of Commerce boast a strong presence in the country for around 85 years and it stands today as one of the most dynamic Chambers in the country. A significant majority of the American companies operating in Greece are members of the Chamber, as well as Greek and companies from other countries that have operations in or export to the United States. Apart from direct activities in the US, other companies also work with us primarily because of our stance and reputation here, as evidenced by our strong network of collaborators.
The work of the Chamber is predominantly done through the Committees, which represent a multitude of different sectors. They are comprised of experts in each respective sector and their main responsibility is to draft recommendations, discuss pertinent issues, organize relevant events, as well come up with recommendations that we provide to governments and other influential parties. Our aim is not only to grow our presence, but to advocate strongly in behalf of our members.
Under the circumstances of the crisis, the Chamber has remained resilient and has been vocal in expressing the needs of our Members. We also collaborate with the US Embassy, with whom we have an excellent relationship with, in order to work together to continually improve the relationship between these two countries. At the same time, we urge our member companies to increase their presence or sell their products in the United States because it is a very open market.
Having spearheaded the Chamber for eight years, beginning with the onset of the crisis, what has been your leadership approach throughout this period?
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Despite the tone of austerity brought on by the financial crisis, we managed to keep our presence and keep most of our members throughout. Because of this, we are in a position today to be able to exercise our dynamism in a very effective way. We have kept a very good relationship with every political party and have members of the Cabinet present at every event. In most of our events, we also ensure to invite stakeholders from various sectors related to Health. Besides the conferences, we occasionally organize meetings with policy makers, regulatory bodies and other organizations in order for our member companies to have the chance to meet with them and exchange views though an open discussion.
Of course things are difficult in Greece. Some of our recommendations are well received, some others not – nonetheless, our fight continues. At the crux of the mission of the Chambers is to advocate for its members regardless of the economic conditions and the state of business affairs.
In the macroeconomic sense, what do you believe are the factors that make Greece an attractive investment destination, especially in regards to the healthcare sector?
Investments for clinical trials should be at the epicenter of the discussion, especially with the pharmaceutical industry and how it can garner further developments within the sector. However, according to the current landscape, expenditure cannot exceed 1.945 billion EUR, but 615 million EUR was shouldered by the private sector through clawbacks and 318 million EUR through rebates, therefore almost another one billion EUR of expenditure is accounted for by the pharmaceutical companies. While pharmaceutical companies are fulfilling their social obligation in a time of economic crisis, it is difficult to remain financially sustainable in this manner and things need to change.
Clinical trials are one of the most attractive solutions in this sector. Looking at Belgium as an example of a country with a similar population and market size, it generates over two billion EUR in revenues for clinical trials. In contrast, Greece currently generates 80 million EUR, which is a stark difference. Even Cyprus generates over 85 million EUR in this, area. It is imperative that we begin collaborations and partners to foster this sector, especially with the local industry, which has deep qualifications and expertise in this context. The clinical trials market is a very promising area for investment.
In the broader sense, other aspects such as energy and tourism also present attractive prospects for investment. For the latter, there exists an intersectionality with healthcare given that medical tourism is an area that is also showing potential. There is a growing amount of conferences about this topic that communicate the extent of the capabilities that are available in this sector.
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Given the challenges of clawbacks and rebates, what type of support do you offer your members in regards with this issue?
We believe it is our core duty to speak on these topics and be an advocate for their interests. We do this through conferences, meetings and liaising with various governments. As this situation has been around for quite a long time, our main goal is to find other mechanisms in which problems could be tackled through more sustainable measures.
One key issue today is the low penetration of innovative treatments into the market. Exacerbating the stern regulatory environment is the plan of imposing an additional 25 percent rebate that further hinders innovative medicine to come into the market. Taking into account all the other burdens that mentioned above it is very clear that this additional cost cannot be handled and accepted by the companies. Additional to the cost is the fact that the price of the medicines in Greece can affect other countries’ pricing, and vice versa. If the price is drastically lowered here because of these mandatory discounts, that might affect the prices in other European countries as well. All these reasons plus the lack of a normalized framework of regular payments are reasons why companies are very reluctant in accepting these very stringent measures, apart from the core truth that innovative medicines are absolutely essential for patients’ treatments.
Each year, our Pharmaceutical and Medical Devices Committee presents recommendations through collaborations with associations such as SFEE and PEF. We bring forth the issues to the government and express our ideas in an honest and open way because we are all cognizant to the budgetary concerns that are plaguing the system.
Why do you believe the pharmaceutical companies remained so resilient throughout such severe economic conditions?
The pharma industry has remained resilient and strong in the country because health is paramount. The industry is one of the strongest in Greece not only in the recent years. Multinational companies – especially American companies – invested a lot in Greece and helped in stimulating the economy through providing employment and creating jobs. At the same time, they are also allowing for a transfer of technology to the local industry. Their commitment to the market enabled them to withstand these harsh economic conditions.
Nonetheless, it is undeniable that many, if not all, companies were hurt or impacted by the crisis. However, the fact that multinational companies are able to garner support from their respective headquarters is a luxury that many local companies could not avail. In a large extent, there is a good collaboration between local Greek companies and multinational companies, thus creating a symbiotic relationship wherein both can benefit. Many of them have an exclusive agreement with each other, so they are able manufacture medicines here to export through partnership agreements here.
The State needs to realize that this collaboration could be enhanced through taking some necessary measures and implementing a framework that can sustain growth in the long-run. Many organizations and institutes have produced studies showing that this can be done, so it is more of a matter of political will, overcoming long-standing perceptions, as well as existing special interests in order to formulate a sustainable framework for both the pharmaceutical and medical devices sectors.
Patient associations also need to have a stronger involvement in these discussions. Recently, it was brought to our attention that these associations feel hindered in having their interests heard. These associations should have one of the strongest voices in these discussions because they advocate for the group of people who truly suffers from these measures. As a Chamber, we have taken several initiatives in order to bring several parties together and aim for finding solutions.
What do you believe is the ideal model for collaboration in this landscape and what role would the Chamber play in this context?
As a Chamber, our primary duty is to advocate for the interests of our member companies. We aim to provide suggestions and solutions to pertinent problems that affect the business affairs of our members. Of course, we are conscientious that we need to take into consideration the interests of all the parties involved and try to find a middle ground. We encourage our members to develop a strong rapport with the government and regulators in order to bridge key differences that exists. At the end, we need to have a common language, especially in situations of crisis.
We are a proponent of the implementation of localized solutions such as having a Greek HTA system for the pharmaceutical industry and DRG pricing systems for the medical devices milieu. Therapeutic protocols are more efficient when they specifically cater to the needs of the local market. In order to reconcile the contrasting interests of different parties, we suggest an independent committee that can oversee the gaps in the regulatory affairs. Moreover, the methodologies for hospital tenders also have further room for improvement.
There are issues, but as a Chamber, we believe in solutions. Solutions exists – but only people want to see them and discuss them. We aim to represent the companies in the best way possible, as well as build alliances that are mutually beneficial. It is also important for us to build a rapport with several associations because the power of many outweighs the power of one. Ultimately, we ensure that we are doing our best each day to progress towards a sustainable future.
