Kadri Maegi-Lehtsi, general manager of Roche Pharmaceuticals Estonia, discusses the company’s established footprint in the Estonian market and their mission
to give back to the Estonian society not only by providing innovative and highly needed medicines, but also through awareness and lifestyle campaigns.
In Estonia, Roche focuses on marketing and sales for oncology, virology, inflammation, central nervous system and metabolic disorder. How do you manage to have a leading position in the market despite tough competition?
Our established footprint in the Estonian pharmaceutical market is primarily due to two factors: our products and our people. In fact, the majority of Roche’s employees come from the healthcare sphere, mostly doctors and pharmacists. While none of us are executing our profession, we truly regard it as our core mission. We love our job and we do it not only for Estonian patients but also for ourselves, in the event of any of our close relatives falling ill. As the leader in the pharmaceutical landscape, we are actively shaping the environment through our membership and participation in the Association of the Pharmaceutical Manufacturers of Estonia (APME).
The main reason why we are taking actions to be a key player in the pharma market here in Estonia is the delay with which patients receive innovative medicines, compared to other similar sized countries like Slovenia, Slovakia or the Czech Republic. Our market access procedures are naturally part of the cause to the delay. Just like anywhere in Europe, the population is aging which, in turn, means more healthcare support and more medicines are needed. On the one hand, life expectancy is growing, yet there is an increasing need of more resources for healthcare. Overall, Estonian healthcare accounts for only 6 percent of the GDP, which is fairly small if you compare it with Slovenia which spends close 10 percent of the GDP in healthcare. Some countries value healthcare more than others.
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Our health minister announced that he will increase the healthcare budget, but this measure carries with it several also obligations, such as HCV and HIV drugs reimbursement, emergency aid financing etc, which were separated from general healthcare budget. As a country, I believe Estonia really needs to work towards valuing certain aspects of healthcare, one of these being the lives of elderly people. I personally see the future of health being more personalized. If we manage to get more information from the genomes and not only from the oncology field, we would be able to tailor medical solutions to patients needs even more.
Speaking of oncology, a segment in which Roche is a leader, Estonia has seen a steep decline in mortality from cardiovascular diseases in both men and women since 2000, but hardly any change in cancer mortality over the same period. How do you explain this?
I believe that, even in Estonia, there are some selected cancer types – such as breast and prostate cancer – that have led to many local success stories. It goes without saying that one way to fight against cancer is first and foremost prevention, then early detection, multi-disciplinary treatment and last but not least palliative treatment. Each of these four fundamental pillars has to be covered in order to attain results in the foreseeable future. Where we, as Roche, are the undisputed leaders in the country is in partnering with societies. For instance, we have been partnering with the cancer society for more than 10 years during which we understood that there will never be a time when cancer totally disappears, and this is why we are active in early detention and prevention – it is a form of social responsibility for us.
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As an international company established here in Estonia, we feel we have a mission to give back to the Estonian society not only by providing innovative and highly needed medicines, but also with awareness and lifestyle campaigns – which we carry out with the support of the cancer society. Every biologics in our portfolio, such as Herceptin® or Avastin®, are available in Estonia – where we find an issue is with those therapeutic areas involving only a small amount of patients. However, products like Kadcyla® for the treatment of HER2-positive metastatic breast cancer patients was approved and registered in the United States and the European Union in 2013, but Estonian patients only got access to it five years later (this year).
What can the government do to reduce the gaps in access to medicines between Estonian and the wider European patients?
Whenever we have discussions with the government, I must say that everyone is willing to cooperate and come up with solutions. However, if the resources are limited, regulators must make tough and complicated decisions. On a positive note, since 2014 there is the possibility to make separate agreements, just like Italy with their medicines agency AIFA, which consists different managed entry agreements to provide access to medicine.
As an OECD country, we are not the poorest country in the world and this is why we should be proud of it. Estonia has had economic successes and in that sense, we should have fair prices. Roche is not a non-profit organization and to this purpose we need to have a financial return in our investments in research and development and take risks for future R&D as well.
As a pharma association, we have done a great job in the country because as I am sure you are aware we regrouped innovative and generic companies under one organization and I believe it is the right thing to do because if innovation is not here during the patent time, then there is limited way for generics for biosimilars to enter to the market. When we go to the health insurance fund and the Ministry, we represent all the pharmaceutical companies having as one goal, that of treating patients. We have a very fruitful cooperation, although we sometimes have different targets.
You have been operating in the country for more than twelve years. We feel that Estonia is a country that has a great potential but has particularly suffered from lack of PR. Based on your experience, in which areas do you believe that Estonia can stand out in the region?
Off the top of my head, I think Estonia is rightly known for e-health, genomics and the potential of coming up with solutions in the field of personalized medicines. I do not think that there are many governments in the EU and in the rest of the world whose governments have an established government strategy for personalized healthcare. We have our governmentally-funded genome bank that already has 50 000 genome profiles which will be added by 100 000 shortly. This will provide potential for the research, not only for Estonia but also for other countries and the global companies operating in these countries. In my vision, Estonia could be an excellent platform to test personalized solutions. We have a legacy of Skype and TransferWise, why can we not be a pilot country for personalized healthcare?
