Khaled Atef Elmounayri, country manager of AstraZeneca Egypt, reveals how AstraZeneca has remained the fastest-growing multinational pharmaceutical company for five years straight in Egypt, despite facing economic difficulties and pricing pressures. He also highlights the need for better education of physicians to improve oncology treatments and destigmatize cancer in the country.
The potential of the market is enormous, due to the constant population growth and the high prevalence of certain diseases in the cardiovascular, respiratory and oncology treatment areas
Can you highlight to our international readership how AstraZeneca’s has been performing since the last time we have met you in 2015?
We have been performing exceptionally well in the last three years, despite the economic challenges, which have existed in Egypt. The country remains AstraZeneca’s fastest-growing emerging market and between 2017 and 2018 we grew by 41 percent. This means we are the fastest growing multinational pharmaceutical company in Egypt currently and have been in this position for the last five years. Our goal of being amongst the Top Five MNCs in our field has been reached and AstraZeneca is currently ranked as the twelfth biggest company in the pharmaceutical field overall, with a turnover of nearly EGP 2bn (USD 120mn).
With the annual results for 2018 been published last month, we have seen AZ returning to growth globally, mainly due to the strong performance in emerging markets. How important is the Egyptian affiliate to AZ’s global operations?
Having the largest population in the Arab World at 100 million naturally makes Egypt a country of high importance for AstraZeneca’s regional and global operations. The potential of the market is enormous, due to the constant population growth and the high prevalence of certain diseases in the cardiovascular, respiratory and oncology treatment areas. With the government shifting its focus on treating non-communicable diseases better, we want to be a strong partner for patients in the country, helping to improve health and lives through our innovative portfolio. We have seen the local pharmaceuticals market growing by double-digits in the last three years and it will continue to be the fastest growing market in the region for the foreseeable future. Hence, it has great importance for AstraZeneca to have a strong footprint in the market and be a true partner of patients and the government.
Given the pricing pressures we have seen in the last three years, how do you ensure your commitment to Egyptian patients by avoiding drug shortages, while also keeping up with the growth targets set by the headquarters?
It was certainly not an easy period due to the devaluation of the Egyptian Pound in 2016 and the, for international standards, relatively low drug prices. As the patient always comes first for AstraZeneca, reducing our output or pulling out of the market was never an option. We continued to supply our products through local production and imports, despite the economic volatility. At the same time, the pharmaceutical market was still growing fast, so AstraZeneca understood that we need to invest and grow as well, to come out of the crisis stronger. With the support and trust of our headquarters, we remained committed to Egypt and recent numbers show that we have taken the right decision.
What do you identify as the main growth drivers for the coming years?
Due to the high prevalence of hypertension and ischemic heart diseases, we have a strong focus on treating cardiovascular diseases in Egypt. Moreover, oncology has become more important recently and we are planning to launch four products in this treatment area in the next few years, including Lynparza and Imfinzi. Market access has become a lot easier recently in Egypt and we can see a clear will by the authorities to facilitate the registration access. It took us only around six months to register our latest products, which puts Egypt in the same league as the United Arab Emirates in terms of registration time. This comparison would have been unthinkable back in 2016.
There is a negative stigma on cancer among Egyptian society, as almost half of the patients do not wish to know they have cancer because they see it as untreatable. What needs to be done to change this misconception?
The main reason for cancer being stigmatized is the high death rate in Egypt, which is caused by the late detection of the diseases, in a stage where successful treatment is very improbable. While raising better awareness of cancer amongst patients is one aspect, the most important change needs to happen in educating physicians. This needs to take place multi-disciplinary, as general practitioners should refer patients to oncologists or radiologists earlier if there are cancer symptoms. AstraZeneca is holding educational events in hospitals, showing physicians from different disciplines how cancer can be detected and then also be treated earlier. Early detection is the basis of a successful treatment, so we can remove the stigma of cancer step-by-step, as patients will see that there are many ways in how this disease can be treated.
We have seen the generic penetration rising in Egypt, giving that the government is interested in cost-containment. With AstraZeneca being one of the world’s leading innovators, what challenges or opportunities do you see for AZ in this environment?
There is no doubt that the government is interested in cost savings and hence generics companies are on the rise in the country. We are seeing new players launching new products and gaining market share very quickly, so it is essential for AstraZeneca to have a position as a science leader. We need to reach out to patients, physicians and pharmacies to promote our brand and keep our positioning and market share. Egyptians trust MNC brands, as they see them as highly effective and of high-quality. Hence, we are raising awareness amongst patients for our products and explain the benefit of our products to doctors and pharmacists. As Egypt is a market with a high level of out-of-pocket spending, there is strong competition between generics and innovative companies.
Can you highlight some of AZ’s CSR activities in Egypt?
AstraZeneca supports the Egyptian healthcare community through continuous medical education programs in cooperation with international centres of excellence and reputable regional and Egyptian medical societies in the fields of respiratory, cardiovascular-metabolic and oncology. We are committed to being a partner of choice for the various stakeholders in the Egyptian healthcare community, so we have established partnerships with the Ministry of Health, National Health Insurance and leading scientific societies. As an example, we are collaborating with the Egyptian Hypertension Society in establishing specialized Hypertension Clinics in public and university hospitals, aiming at reaching a broader patient segment and enhancing the disease awareness of patients.
The government has outlined its plan of completely transforming the Egyptian healthcare system. What would you highlight as the most interesting developments and initiatives launched as a result of the government’s focus on healthcare?
Universal Health Insurance is certainly one of the biggest projects of the government, as it will allow affordable access to healthcare to Egyptian patients when implemented. It is a giant project and will require solutions for funding first, so we will not see the full reform being implemented before 2030. However, the government has also rolled out many national campaigns such as 100 Million Seha and the private sector in Egypt and the industry is supporting these initiatives significantly. AstraZeneca is providing 100.000 doses of hypertension treatments to the Ministry of Health in order to fight cardiovascular diseases in the county. We have also put in place patient support and affordability programs in the diabetes and oncology treatment sector, aiming at increasing patients’ access to innovative medicines, decreasing patients’ burden and improving compliance to medicines.
What is your vision for AstraZeneca Egypt five years from now?
Since Pascal Soriot has taken over the global CEO position, AstraZeneca has really embraced the ethos of the patient coming first. Hence, helping and serving patients is our main priority and we are ready to walk the talk in Egypt. Our goal for 2024 is to serve 2 Million patients more than we are currently and with this approach we are sure that we will be able to grow into a stronger partner of Egyptian society. Our goal is to be the Top Four multinational pharmaceutical company in Egypt in five years.