Myriem Tamimy gives an overview of the ongoing situation for Janssen and pharma multinationals more generally in Morocco, discusses the next steps in the authorities’ pharma strategy and the role that multinationals will have in the process, and highlights the challenges related to managing in a time of COVID-19.
Could you start by introducing the scope and the scale of Janssen’s Morocco and Tunisia affiliate?
The affiliate has been present in Morocco for the last 30 years and has partnered with Maphar, a local manufacturer now part of the Eurapharma Group for the production and distribution side of the business. Our drugs are therefore manufactured under license and represent a volume of about 1,600,000 units.
As the entire group is focusing on innovation, thanks to a strong pipeline and commitment to provide access to innovative medicine to patients, it was decided in 2015 to open an office here in Morocco which would take care of regulatory registration of products and access to innovation, as well as the promotion of our total portfolio. It was a very exciting journey for the teams as it was built from scratch for Regulatory & Medical affairs to support the introduction of our innovative portfolio for instance. Rapidly, Morocco moved to become the hub from where we cover and manage our Tunisian, sub-Saharan and more generally, French speaking African countries.
We believe that our role is to be actors, by engaging, shaping and driving constructive debates with authorities to foster an optimal environment.
How do you convince Morocco’s authorities that they can balance the embracement of the latest therapeutic innovations, as they are still struggling to tackle basic healthcare needs?
It is a long journey. We need to be resilient and never take no for an answer. It is crucial to step by step, overcome the first ‘no’, and move the conversation to a “yes but”. If you start to challenge the framework, to be resilient, authorities start listening. We have for example reached a step in which the ANAM (Agence Nationale de l’Assurance Maladie) was willing to open up to the dialogue with regards to the efforts we have been putting in terms of managed entry agreement. Throughout this journey, I was positively surprised by the capacity of the authorities to listen to us.
It is important to make a demonstration of the benefits that result from these innovations to the authorities. Unlike in other countries, we sometimes miss the data to prove the benefit. But our work does not stop at local authorities. The market in Morocco is hybrid and composed of different segments to address: the private sector, the hospital sector and the public sector. Janssen focuses on bringing breakthrough and lifesaving innovative solutions in areas such as haematology, malignant cancer or prostate cancer where local needs are very important.
This added-value of course comes with a price, which is a challenge from a reimbursement body perspective but also from an out-of-pocket patient perspective. Our work is to really try to focus, channel by channel, to identify barriers and solutions to overcome them.
Do you think Morocco has the framework to allow and collect the necessary data in order to have the readiness to enter in the discussions the industry wants to have?
Everything is possible, and I was actually positively surprised by the reactivity displayed by all actors during the COVID-19 situation. This crisis has strengthened the consideration of digitalization and data management; the insurance industry has been able to digitalize their operations while others are willing to accelerate it.
The authorities definitely have a commitment to enhance their digital capabilities in order to protect the information better but also to enable analysis. This might not happen in 2020, yet a lot of work has been done in the healthcare sector in the last year as it is an important focus. From a data collection perspective, it will probably take another couple of years, but it is on the way. Our overall objective is to accompany authorities in the implementation of health technology assessments and tools. This will not happen overnight, but with time and resilience.
Mental health has become a priority for authorities in Morocco, an area where collaboration with industry is crucial, and Janssen is a good example of a company that has become a true partner to the system. Could you tell us about this collaboration and how it reflects on your approach to the Moroccan market?
Authorities still face the challenge of changing the population’s mindset toward mental health, communicating the consequences and explaining it. It is already a challenge we address with the families of mentally ill patients.
We are pioneering programs for schizophrenia management for example (with a monthly injection rather than daily pills), but also for those suffering from severe depression disorders. We are aware that some changes must occur in the management of mental health in hospitals. Instead of having big national programs, we use a very targeted bottom-up approach by partnering with local public health infrastructures or centres.
In addition, we have partnered with a network, which was developed with Janssen, to support Morocco’s practitioners and professionals working with mental health patients, to strengthen the overall network and build awareness campaigns in order to upgrade the management of mental health in the country. It is happening progressively, with several actors and maybe to be scaled up in the future by partnering with the Ministry of Health.
For tuberculosis, we used a very different approach. It is a public health concern with increased emergence of multi-resisting cases and difficulty with treatment availability. In order to provide support to the government, we offered drugs and partnered with the Ministry of Health to sign a memorandum of understanding. We have enhanced online platform of education for practitioners specialized in tuberculosis, to ensure the standards of care are similar everywhere.
There is an open dialogue and it is an ongoing dialogue; listening to KOLs and scientists to find the best approach possible is a part of the government’s strategy.
Whether it is on therapeutic areas or channels, Janssen is using a “micro-approach” to tackle issues. How does it impact the work of your team?
It is a very relevant point, but this approach relates to the organization of the market. In Morocco, the market is highly fragmented and there cannot be a stand-alone approach, which is very different from what happens in Tunisia or Algeria for example.
First, this approach is possible thanks to a highly engaged and highly performing team, which can be a hard equation to handle! The common root is the access to innovation. In the case of Morocco, we look at it by segment – through the public sector, private sector and hospital sector – while adding the complexity of patient flow. Our objective is to always twist our perspective in order to understand the unmet needs and identify the gaps. This is true for all the therapeutic areas. Once we have done this, we align our strategy to unmet needs per therapeutic areas.
A bigger scale project is through our contribution to the LEMM (Les Entreprises du Médicament au Maroc) to enhance the focus of biomedical research in Morocco. Morocco has so far been able to develop a strong industrial and manufacturing footprint with the help and support of multinationals, and we would like to find a framework to replicate this success in the field of biomedical research.
It is time for the country to upgrade and to create a new type of jobs in the clinical research area, which is aligned to the Ministry of Industry’s expansion plan. It would be an added source of employment and a new source of added value for the country, which would ultimately benefit patients by easing access to innovation. The Intellectual Property status is in a good frame in Morocco, but it would need to go even further and be even stronger in order for multinationals to bring, protect, and provide access to innovation.
We dedicate a lot of our time to challenge the current regulatory network and shape one that would allow for this. In order to be operational, we must be creative and think on the challenges that we can turn into opportunities.
Over the years, you have been a witness and actor of the pharmaceutical industry. What do you believe have been and will be the main changes occurring in the next years?
The current situation is a turnaround for Morocco. It has always been a great ecosystem and now needs to define its place for the years to come. There is ongoing public debates on which model to embrace. Should we be more protectionist? Or on the contrary more open to innovation? I believe this debate will continue for at least another couple of years.
I believe there are a lot of lessons to learn from observing other countries that are facing similar situations, with non-communicable diseases and similar patterns of epidemiology. Romania is an example of what could be done. They have adopted a model which enacts the fact that they have limited resources, but where there is a deal that once drugs have been approved and tested in bigger markets, then they should be accessible to patients. I think that this could be sustainable and applicable in Morocco.
Overall, there are still a lot of question marks. I don’t believe Morocco will go towards a more protectionist path as a strategy. This is not aligned with the King’s vision of openness shown over the years, and with the multitude of trade agreements we have signed. Morocco acts as a role model for sub-Saharan Africa.
From a multinational perspective, Morocco is able to provide a guarantee thanks to its stability in terms of economic and political situation. In the next years, I believe Morocco will be a great surprise but for the moment, it is still about driving the debate, shaping the environment and being resilient. It is important that we all remember that our constitution states that Moroccan citizens should have access to fair and equal healthcare.
Speaking about the COVID-19, how have you embraced the challenge and what have been the most challenging aspects thus far?
As a Moroccan national, I can say I am proud to see how a crisis such as COVID-19 is being dealt with by the authorities. Solutions have been raised and found, communication has been clear, and this period of time allows us to focus on the next priorities for the country.
We will grow out of it, as human beings of course, but also from an organizational perspective. The mindset is changing every single day. As a multinational company, we have been looking at our digitalization strategy for quite some time now and the ways to communicate with healthcare professionals; it has accelerated because of the situation.
In weeks to come, the focus will be on COVID-19’s management toward patients in severe immune stage of the disease, thus it is necessary to provide an answer to our professional partners. Through this journey, I am interested to discover what the situation will be and what will be the retention from it. There is a great potential to leverage on the local, regional and international scale for network connection through digitalization and enhanced knowledge sharing. We are actively engaging our teams to find solutions that will be sustainable for the future while challenging ourselves to be more flexible.
