Jeff Dufour, country manager Switzerland and BU lead Internal Medicine at Pfizer, discusses his first impressions of the country, his priorities for greater dialogue with Swiss healthcare insurers, and Switzerland’s potential as a ‘test market’ for the company.
Can you give our international readers an outline of your background and why taking the role of Switzerland country manager last July was the right move for you at that point in time?
I started in the industry 23 years ago in sales at Glaxo [now GSK – Ed.], where I worked my way up from a sales rep into marketing before eventually – after seven years – moving to Pfizer Canada in 2002. My goal was always to work in marketing – especially in the US – which for me is the major league of marketing. It was amazing to work in New York.
However, it was always clear to me that to take things to the next level I needed to become a country manager. Last year, I started thinking about the types of country in which I might potentially want to work. Asia was a possibility, as was Latin America and my homeland of Canada; but my real goal was to move to Europe. I wanted to experience a more traditional European market. Switzerland became available and it seemed a great fit for me and an exciting opportunity.
What were your first impressions of Switzerland as a country?
It is a country that punches well above its weight class and has a level of sophistication that is genuinely surprising for a nation of only eight million people. Almost everything about Switzerland is incredibly advanced and the country is at the cutting-edge in a number of different aspects. The train system is impressive in how on-time it is and how it can go anywhere in Switzerland; some of the climbs that the trains here make are remarkable.
The country really is extremely efficient and well-run. Even when you go to the stadthaus (town hall) to deal with the government, it is impressive how smoothly and efficiently everything works; especially coming from New York where dealing with government agencies is not easy.
What about your initial thoughts on Switzerland’s healthcare system?
The Swiss healthcare system is particularly interesting from an American perspective because if you take the logical conclusion of President Obama’s healthcare reforms in the US; it’s Switzerland. There would have been 365 healthcare insurers rather than 65 insurers but, basically, all citizens would need to get insurance. For those who could not afford insurance, the government would step in to make sure they got it. I did not realize that there was a place in the world that fitted this model. When you look at that level of sophistication, it shows that the dream of Obamacare can work.
The quality of care here is superb. Patients interact with practitioners, they do not stand in long lines, the equipment is new, and the doctors are well trained. The most jarring aspect, however, is the lack of sophistication around electronic medical records (EMRs) and electronic health records (EHRs). Universal medical records are still a few years away. This is where it is clear that Switzerland’s Federalist system of 26 cantons really do drive the country; it will take time and some effort for the cantons to agree on standards. Switzerland is therefore a country that in many ways is very sophisticated and cutting edge; but can a little slow to adapt initially. It will be interesting to see how healthcare reforms in Switzerland play out as to a certain extent, the cantons will need to agree on them.
What have been your key priorities during your first six months as country manager?
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Pfizer feels that the Swiss affiliate has a lot of potential. We do very well here but there are definitely areas in which we can improve. One such area is clinical trials and bringing more clinical trials to Switzerland. We do a lot of clinical trials in oncology but there is probably room for us to do more in paediatrics and rare diseases for example. Switzerland is an ideal place to do clinical trials for any of the more sophisticated therapeutic areas because the levels of being able to find patients and treat them effectively is very high here.
The next area of focus is how we can accelerate access to medicines. Swissmedic is right at the cutting edge. However, the fact that it takes 539 days for regular approval means that Switzerland takes longer to approve medicines than its peers. If something is granted fast-track, however, it is as fast as anywhere that does fast-track. Adaptive licensing [the progressive or staggered approval of a medicine based on a prospectively-planned process, enabling a medicine to be authorised for use in a restricted patient population, following which the authorisation may be extended to a broader patient population – Ed.] is something that is very important moving forward and, to date, we have not seen enough to know what that is eventually going to look like in Switzerland. Certainly, in areas like oncology, rare diseases, and even for some of the autoimmune conditions, adaptive licensing is going to be critical for Swissmedic to maintain or even advance its global premier positioning along with the world’s most important regulators: FDA (US), EMA (Europe), PMDA (Japan), Health Canada and TGA (Australia).
Reimbursement is quick through the Federal Office of Public Health (FOPH) [BAG in German – Ed.] but could be quicker. I would also like to see us build a different relationship with healthcare insurers. Right now, speaking only for Pfizer Switzerland, we do not have any real relationship with the health insurers or the FOPH and there is an opportunity to look at things differently.
The sales and marketing currently in place in the Swiss market is very effective but still fairly traditional. Therefore, there is an opportunity there to get ourselves ready for 2020 and beyond. If we do not change, it will become stale. Swiss privacy laws mean that people are wary of giving up their data to ‘Big Brother’, but we can certainly do more in terms of digitalization. Because of the privacy laws, it may not be possible to use Big Data, but we certainly could be using the data we have more effectively.
Many of our interviewees have highlighted the risk-averseness of Swiss culture. Will this change in approach to stakeholder relationships therefore even be possible?
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The Swiss are not risk-averse but very deliberate about change. Having said that, I do not see why we cannot try to create a case for faster change. There are areas of mutual overlap to start having a conversation to create change. Also, new GMs such as myself always have the opportunity to start new relationships. I have worked in Canada – a country with a very centralized healthcare system – as well as in the US with its very decentralized system, so I have an open point of view on how we could approach things.
Pamela Alexa, your predecessor, explained how Pfizer was beginning to treat Switzerland as a ‘test market’, what is your view on this?
There is no reason that we should not be a country where medicines are filed right after the FDA. It is a chance for us to establish a footprint in Europe and an opportunity that we are going to be putting a lot of energy behind. Expanding our clinical footprint here will also be helpful as it will put Switzerland at the top of the mind of headquarters in New York. It will also help Swissmedic, who will have had more exposure to the product as they will have had to approve clinical trials. There are therefore a lot of benefits to expanding that clinical footprint and finding ways to get filed early. That is why adaptive licensing is important. The EMA has put forward its pathway for adaptive licensing and Switzerland is going to lag behind unless it can get that done as there are some very interesting oncology therapies for rare cancers coming that will probably go the way of adaptive licensing rather than fast track.
Given that the Swiss reimbursement system is more like that of the US than other European countries, we may be in a place to look at new models for areas such as gene therapy. Products can be brought to market in a much more controlled fashion with the same challenges as the US in that patients can change their health insurer every year. That creates a real challenge for looking at guaranteed outcomes in gene therapy and other similar areas. A payment model spread over two to four years is unlikely to look like our current model where the authorities give the full value at the point of intervention. I think that sitting down with the insurers and trying to find a way to connect with them will be important because the payment models of the past cannot be the payment models of the future. The lifetime value of treating these patients with new technologies like gene therapy are going to bring incredible value, outcomes and cost-savings to the system.
How would you say that Pfizer has performed globally in 2017?
The innovative side of the business performed very well in 2017. Albert Bourla, group president of Pfizer Innovative Health (PIH), has been a great leader and the innovative health business, after some tough years without any significant launches has really had a renaissance and been able to launch several fantastic therapies over the last couple of years, especially in oncology. Ibrance® has been a phenomenal success for Pfizer Switzerland and globally. The innovations are arriving; we can do new things that we could not do for patients that were not possible before. Therefore, these are more promising times for patients with cancer and auto-immune diseases. The pipeline is pretty exciting for Pfizer.
The established health business will continue to do well but it is a tougher model and more competitive but we have new growth opportunities with our Biosimilars portfolio.
What are your expectations for 2018 here in Switzerland?
We have gotten ourselves into a much better place in the NOAC market. The competition has been more dominant here than any other market, but we are up to that challenge and we believe that we can start to have an impact there. We think that Eliquis® is the better choice for many patients.
The oncology business will continue to be a strong growth driver for the next couple of years; Ibrance® will continue to be a very important brand – it has more than doubled the size of our oncology franchise this year alone – and we have many launches to come. We just had Bavencio® approved, our first immuno-oncology product produced with Merck.
The other area where we are expecting growth is Inflammation and Immunology (I&I), Xeljanz® continues to be a strong growth driver for Pfizer Switzerland and we will have a new cream product coming out in 2018 for atopic dermatitis. It has been a long-neglected condition so there is a lot of potential there. Nobody is dying from this condition but it causes a lot of sleepless nights and suffering for patients and parents.
Another question is how do we do a better job with our customers? We need to be more impactful and evolve our model of how we connect with newer digital channels.
We hear a lot about ‘patient-centricity’ these days. What does it mean to you and to Pfizer?
We need to have earlier clinical experience for patients with unmet needs, our products need to be approved more quickly, they should be reimbursed faster, and get to the patient quicker. I am not a big believer in ‘beyond-the-pill’, I am much more focused on getting the treatment to the patient as quickly as possible. At Pfizer we talk about putting patients first; I think that is a better way to go.
When we return to Switzerland in five or six years, what do you want to have achieved?
I hope that we can establish ourselves as the pilot launch country in Europe for Pfizer. I would like to see us have a fundamentally different relationship with the insurance providers and the FOPH. I don’t know exactly what it will look like but it has to be a more common interest relationship than what we currently have. It would be great to see Swissmedic further differentiate itself as a premier regulator in the world and for Pfizer Switzerland to be considered one of the best affiliates and a great place to work, a top affiliate for talent and the best environment for pharma because of the great relationships we have with stakeholders.
