You have become the head of Novo Nordisk’s operations in Romania in March 2008. Can you first give our readers an idea on how the market environment was at that time?
With regards to the national program for diabetes, 2007 was a year of big changes. Most importantly, drug medicines for diabetes were moved from hospital to retail pharmacies. As a result, there were no more long queues at the hospitals and the medication came much closer to the patients; a number of requests were sent to the retail pharmacies in order to ensure compliance with cold chain requirements, which complied immediately. This step towards decentralization went hand in hand with a rational open minded prescribing process. Within the new set-up, the fit therapeutic solution becomes the first line decision, rather than basing themselves upon what is available in the hospital pharmacy. This was a very significant and good move from the Ministry of Health, which has significant improved the quality of treatment in the country.
Of course, this decision did not solve all the issues. Diabetes medicines remain a milestone for the small cities and Romanian countryside’s, where clinics and specialists are insignificant developed within the continuous increasing of pathology, GPs are still playing a minor role through medical letters of recommendation. Therefore, the treatment of diabetics in Romania is driven by diabetologists, almost 100% located in the big cities with a majority ratio positions in the university centers.
A positive healthcare system characteristic in Romania is the fact that diabetes medication together with the specific medical devices as: glucometers, self-monitoring tests, are 100 % reimbursed for people with diabetes in Romania. Even this way, there are still a lot of residual patients untreated or with inappropriate treatments grids.
A possible discrimination between the rural and urban patients could appear. It is thus harder to guarantee treatment in rural areas?
This is indeed a system issue. Rural residents are forced to go to the nearest cities of considerable size, in order to obtain their necessary treatment. Changing the diabetes way in Romania is our gold goal; everywhere Novo Nordisk is present in the world, we are having important contribution in bringing a normal life for our patients.
Free medication means a lot of expenditure for the government. Can you tell us more about this burden?
The government has to follow the increasing pathology trend by managing the budget issues together with the installed procedures. It is a difficult task needed high competences and responsibility toward patients. Naturally, there has been an increased spending for diabetes. But rather than comparing with the lower expenditure rates of 2007, we should instead focus on the real needs of the patients. Honestly speaking, we are currently far away to cover these needs.
First of all, we are not at all sure of the number of patients with diabetes in Romania. For about 4 years, the official number of 600 000 has not been changed. In reality however, the percentage of incidence about 8% of the total population brings in our attention a real figure of 1.6 million of diabetes sufferers, in different stages of the disease. There people are clearly not diagnosed and therefore untreated.
What improvements can be made here?
The current bottleneck is the low number of physicians that are treating diabetes. All in all, Romanian diabetes patients are being treated by 450 specialists; that means a significant number of patients per specialist which is difficult to manage nowadays and statistically, impossible to control in the future. For the last 2 or 3 years, we have however seen the authorities making efforts in increasing the number of specialists.
It is in our interest and in our way of thinking to give a hand to creating more specialists in the country. Novo Nordisk therefore has a long term program that should be executed together with the authorities, and exists of study grants for people that want to include diabetes as a second specialty. This is one of our key areas of development.
This year, on July 1st 2011, Novo Nordisk and the Romanian authorities have together launched the National Registry for Diabetes Patients. Created and developed at Novo Nordisk, this multitasking program was given to the authorities as a donation. This Diabetes Registry will represent the most important tool in managing the diabete disease in Romania by giving a clear perspective on the number of diabetes patients in Romania, what stages of disease they are in and how they are being treated..
Just now, when we are speaking, the Government is started already the program implementation across the country.
The Diabetes Registry will finally allow the authorities to look at the real needs of the Romanian diabetes patients, to measure progress and set priorities for national diabetes action plans.
In your view, where do you still see room for improvement regarding such cooperation?
We should continue this partnership at the level of the industry, while the authorities are the ones that are setting the healthcare priorities. Companies can additionally come with expertise and tools that may be of synergy with the efforts from the government. What I expect from the government is long term programs with guaranteed continuity, regardless of which team is in charge at a policy level. I strongly believe that the government officials at the Ministry of Health should be fighting more for the budget. In the past few years, I have not at all seen an increased interest for healthcare from their behalf. Healthcare is a low priority and a poor sector in terms of budgeting. But just like I fight within my company for what I want to achieve, I expect the same from them. At the end of the day, health is a priority with a big social impact. Without sufficient funding, the Romanian healthcare sector will stay behind compared to other countries in Europe and beyond.
When we take it back to an industry-level, Novo Nordisk is of course not alone in the market. Nevertheless, the company holds the majority of the market, like in many other countries. What were the main success factors to get to that leading position in the Romanian context?
We have been a very stable company that has consistently created value for the Romanian patients. Novo Nordisk in Romania is present within a wide and innovative portfolio, offering to the patients the best and modern treatment existed. Compared to the rest of Europe, the same high quality products (insulin, devices, etc.) have been made available to the Romanian patients. Devices such as NovoPen 4 have also been brought to Romania, and have been made available free of charge in an agreement with the government. We create value for diabetes patients through education programs and Changing Diabetes campaign.
Another leadership initiative is to create higher degrees of awareness for diabetes disease among the General Practitioners (GPs), which are currently seeing diabetic patients much more often than a diabetologist; they could have a tremendous contribution in disease identification and patient orientation toward diabetologist.
At Novo Nordisk, nothing is more important to us than helping to improve the lives of people living with diabetes. Our job is to inspire hope and deliver real solutions that fit the way people want to live.
You clearly work hard on creating more awareness among doctors, but can you also increase the awareness of the patients, with initiatives such as World Diabetes Day?
As a leader in diabetes care, Novo Nordisk sees this as part of the company’s responsibility and a goal that cannot be achieved through science alone because Novo Nordisk is dedicated to changing diabetes – how it is treated, how it is viewed around the world, and how the future of this disease plays out.
Under Changing Diabetes umbrella we engage in such activities, even though they are rather considered as corporate social responsibility campaigns. Initiatives include examples such as the Changing Diabetes Bus in 2009, World Diabetes Day, and so on. The earlier diabetes can be treated, the bigger the influence we can have on the evolution of the disease, as well as the eating habits, the lifestyle, etc. of the patient.
Which also benefits the budget as there are fewer complications…?
This is very true. Diabetes patients that are being treated can go to work, pay taxes, and so on. They are no longer considered as people with a disability. Poorly controlled patients with diabetes end up with complications, and inevitably become a consumer of additional health services such as surgeries etc. The better we treat diabetes, the lesser this overall burden for society will be.
Novo Nordisk is of course also more than diabetes alone, with an additional portfolio in hemophilia for example. How significant is this part of your portfolio in Romania, and how do you see this growing?
About 20% of our business is in hemophilia in Romania today. With our product Novo 7 in particular, we try to create and reshape the environment to grant access to children with hemophilia. This initiative is still a small rare disease program, and so far only focuses on bleedings and emergency situations. There is no regular or home treatment. We therefore try to use our expertise in diabetes to show how a well treated child will not bleed, lose mobility or suffer pain.
When I first entered Novo Nordisk, I was very impressed to hear that the patients are only boys between the ages 3 to 14. Sometimes we have tried to raise awareness through the World Hemophilia Day, but a lot of work remains to be done here. In Romania, the national program for hemophilia should be sized up and better oriented towards the patient base.
Is Novo Nordisk also a leader in this area?
There are roughly 2,000 patients with hemophilia in this market, of which Novo Nordisk covers 1,200. In a next project, we now also try to create a National Registry for Hemophilia Patients.
More on personal note, how would you characterize your personal management style to be able to combine your targets, keep staff satisfied, improve diabetes awareness, etc.?
I have an open management style. Within the management team, we take decisions together. What really characterizes our organization is the open circulation of information. Our people should know what the impact of our actions is, what our plans are, where the difficulties lie. I pursue full transparency in our operations in that sense. All people should know about diabetes, regardless of their specialty. We therefore train our people to be involved.
The Novo Nordisk culture is also very patient-centric. As a former medical doctor, my heart is still medical. I therefore regularly ask myself the question how the patients perceive our company. We do many surveys, and really try to understand what goes on in the minds of the patients.
Going forward, what remain your main priorities and how do you see Novo Nordisk evolving in Romania?
Novo Nordisk will continue to be a leader. We want to convince everyone that good treatment with modern insulin is the best treatment for diabetes patients. We now focus on modern insulin, because this gives the maximum flexibility and comfort to our patient base. This is the future. Nevertheless, Novo Nordisk Romania has the full range of products and services, which enables the doctors to choose whatever insulin is more appropriate for the patient.
There is also the product Victoza® (liraglutide) that has not yet seen its breakthrough in Romania, even though it has been a great success in the rest of Europe. The weak part here are the authorities, as the reimbursement access of new INNs has not been possible since 2008. On the one hand, we understand the fear from the authorities for new molecules due to the price pressure, but on the other hand, Romanian patients should also have the same access to treatment as other patients in Europe. Otherwise the patients in Romania become too isolated compared to their regional counterparts.
Do you have a final message for our readers?
I think that diabetes should be high on the agenda of the authorities, and should be considered as a national priority.
Novo Nordisk is leading the fight against diabetes. Defeating diabetes is our passion and our business. Facing this growing epidemic together, we know we can reach our goal to change diabetes, and even defeat it, in our lifetime.