Novo Nordisk Singapore's Praful Chakkarwar explains how he leverages his experience in a range of geographies in his current role, how COVID-19 has helped facilitate the affiliate's digital transformation, the burden of diabetes and obesity in Singapore, and his experience in bringing innovative new treatments in these fields onto the Singaporean market.
Could you begin by introducing yourself and your journey with Novo Nordisk across India, Switzerland, Dubai, Turkey, Malaysia, and now Singapore?
I trained in India as a medical doctor before joining Novo Nordisk as a medical advisor back in 2006. I had not heard of the company prior to joining but I was very familiar with their products. Coming from a family of medical professionals – there are over 30 doctors in my family – I always knew I wanted to do something different, so the move to pharma was quite natural. It has allowed me to maintain a strong connection to healthcare while also getting to be part of a business.
Additionally, joining an organization with a long-term purpose like Novo Nordisk was especially appealing. The company has 100 years of history in insulin innovation that really make a difference to patients’ lives. Moreover, Novo Nordisk has a strong focus on people development and offers rich career opportunities; something I personally have benefited from.
After India I moved to Switzerland, also in medical affairs, where I helped run a study – at that time the world’s largest – on insulin usage which covered everywhere from Latin America to Australia, barring the US and Europe, meaning that I spent almost 200 days a year on the road.
Next, I moved to Dubai, working primarily in medical affairs and clinical research for the Middle East, Africa and India. Being able to start programs that meet the educational needs of healthcare professionals in the African continent was quite a rewarding experience.
My next stop was Turkey, where I headed the clinical, medical, regulatory, and quality functions for the Turkish affiliate. That was a completely different experience again, as English is not particularly prevalent in Turkey, neither internally nor externally. However, this was another incredibly rewarding experience and Istanbul still stands out as probably the best place I have ever lived, with amazing people, a great social life, a rich culture, and excellent food.
Having been in Turkey for almost three years, I was then given the opportunity to move to Malaysia as part of Novo Nordisk’s regional setup there, at that point covering Southeast Asia and Australia, where I also worked in clinical, medical, regulatory, and quality functions.
After this globe-trotting experience, you took on your first country manager role in Singapore in January 2020. How has your first year on the job been amid a global pandemic and what have been the main challenges?
I would characterize 2020 as ‘completely unexpected’. I arrived in Singapore on January 21st 2020, shortly before DORSCON orange level was announced due to COVID-19. Basically, I had about eight days to meet the various stakeholders and customers in person!
The biggest challenge at that point was getting to know the different stakeholders, especially given our long-held belief that face-to-face meetings have the best impact. To a large extent, the last few months have refuted this assumption, with growing acceptance of virtual platforms from all parties. Going forward, there will still be a significant place for face-to-face interactions, but digital communication has made probably a decade’s worth of progress in less than a year and will have continued influence on how we operate in our day-to-day business.
To what extent has the COVID-19 pandemic pushed a somewhat reluctant pharma industry to embrace these digital communication tools and what do you think the long-term impact will be?
We all work for patients, but those are not the people with whom we, as a pharma company, interact directly. We interact through healthcare professionals. The way health services are rendered to patients is evolving well, but patient-doctor interactions and relationships still tend to be quite traditional.
The last year changed this paradigm dramatically, pushing healthcare professionals to adapt to virtual platforms and increased digitalization to better communicate with other stakeholders, get more information, and participate in conferences and educational discussions.
Pharma has always been willing to go for greater digitalization, but there needs to be infrastructure in place to complement this willingness. Many people have evolved their own infrastructure at a personal level, becoming more digitally-savvy, and institutions have embraced more digital approaches. During the first months of the crisis, telecom companies were extremely busy putting up receivers and ensuring that the infrastructure for remote working and communication was in place; this infrastructure has helped improve overall acceptance of digital tools and aided pharma’s digital push.
This has been highly beneficial for Novo Nordisk, we in Singapore had a limited digital presence pre-pandemic. In a three-month period, we were able to transform and go fully virtual in all our interactions.
What is Novo Nordisk Singapore today and what is the importance of the country to the company?
Novo Nordisk’s Singapore country office was established in 1998, over 22 years ago, and Singapore has always been highly relevant for us in the region. Singapore is a healthcare hub where many patients from neighbouring countries come to get treatment due to their high level of trust in the healthcare system in Singapore.
Singapore also plays an important role for Novo Nordisk from research and development perspective. There are long term research projects that are run together with esteemed institutes in Singapore. Novo Nordisk recently started research project with GIS & NUS to study Non-Alcoholic Fatty Liver Disease in Asian population.
In Singapore, we have a product portfolio with a primary focus on diabetes, a presence in growth disorders and haemophilia, and – for the last two years – obesity. We also have some products which offer support in hormone replacement therapy.
The Singaporean HSA is often held up as a regional gold standard regulator, but what has your experience of bringing innovative products to market been?
The Singaporean authorities are very well connected internationally and work collaboratively with authorities in other countries. However, for Novo Nordisk, our experience in bringing innovation to market in Singapore thus far has been a mixed bag. The HSA has a lot on their plate, with many different companies attempting to bring their products to this visible and important market. They have a very stringent and structured process – as do all major regulators – which works like clockwork but does take significant time.
The HSA also has certain expedited pathways which allow companies to bring their innovative portfolios to the market more quickly, which has been beneficial for Novo Nordisk. However, these pathways are not necessarily available for every product, so negotiations around the value of the product need to take place, which also take time before the products are taken up for evaluation.
I am broadly optimistic because the HSA’s intentions to accelerate the speed at which innovation can be brought into the country are very visible. This attitude also extends to biosimilars, which stand as an alternative to established products and improve access to treatment.
Additionally, in 2015 Singapore introduced a health technology assessment (HTA) body, the Agency for Care Effectiveness (ACE), which evaluates the broader access needs and potential of certain medications. ACE evaluates drugs and then makes recommendations to the government on whether these products should go on the reimbursement list. This year ACE has opened up to proactive submissions from the pharma industry – only in oncology thus far – but this is a positive step in bringing innovation to patients.
It is also important that the innovations are accessible not only in private sector but also reaches patients in public sector sooner than later. Singapore’s public healthcare system is quite robust and serves more than 85 percent of chronic disease patients and ACE has been playing an important role in helping bring new treatments to public sector patients. Thus allowing discussions to take place soon after the medications become available in Singapore and finding ways to make these medications accessible in the public sector should be the area of focus for both industry and ACE.
How would you characterize the burden of diabetes and obesity in Singapore and the approach of the Singaporean healthcare system and physicians to these illnesses?
The healthcare burden of chronic diseases is significant in Singapore. Indeed, in 2016 the Singapore government launched a ‘War on Diabetes’, knowing that the overall burden on the healthcare system would be enormous in the coming years. Chronic diseases have many related complications, so the aim of organisations like the Health Promotion Board (HPB) is now prevention, with increased focus on better control and the promotion of healthier lifestyles.
8.6 percent of the Singaporean adult population is suffering with diabetes today, with 8.7 percent living with obesity; the prevalence is almost the same.
1.7 million people in Singapore are at risk of developing obesity related complications in the coming years. The challenge is raising awareness of this threat; HPB is driving many initiatives but there needs to be more public-private partnerships not only focused on prevention but also taking care of those suffering with obesity. Novo Nordisk is the market leader for obesity in Singapore today, and we are working closely with professional bodies such as Singapore Association for the Study of Obesity (SASO) to reach this large at-risk population. In 2020 our work with SASO included supporting their efforts in providing guidance for people living with obesity on how to deal with the threat of COVID-19. We are also working with SASO to create large scale public awareness for people in Singapore, providing support to SASO’s efforts in creating certified education programs on obesity for health care professionals.
For those people suffering with obesity today there is limited information on where to go and seek professional help.
Globally, it has been difficult to move the conversation around obesity from the aesthetic to the clinical setting and underline the personal and societal implications of this illness. What communication challenges have you faced on this topic in Singapore?
Many people understand today that obesity has a certain health risk, but awareness does need to increase. Around one third of the population suffering with obesity do understand that it has a long-term impact on their health, but the vast majority remain unaware. Additionally, many feel that managing their obesity is their own responsibility, even though it goes far beyond just diet and exercise and should be treated as any other medical condition with help from health care professionals.
The understanding that obesity is a long-term chronic health condition that has been recognized as a disease by various organizations around the globe is not yet there, meaning that patients often do not seek professional help. Additionally, when they do want to seek this help, it can be challenging to know where go.
1.7 million people in Singapore is no small number and everybody should be aware of this condition and its risks; therefore, Novo Nordisk is directing its efforts towards creating more awareness of obesity and its long-term effects, its causes, and the need for professional assistance. And at the same time we are supporting the efforts of various public health institutes and professional bodies that are creating platforms and opportunities for healthcare professionals to sharpen their skills on obesity management.
Are Novo Nordisk’s obesity products available within the public system in Singapore?
Some public sector institutes in Singapore already have obesity management centres, showing that local healthcare stakeholders realize the burden of the disease. There is a need to create even more such centres. Currently these centres are available mainly at tertiary care facilities. However, as large group of population needs help today, the public sector should develop skills and infrastructure to manage obesity in primary care setups.
Obesity management needs a multidisciplinary approach. In the private sector there are limited options where multi-speciality teams are working together. Platforms that create a network of different specialist who may not be physically co-located but work together and provide comprehensive care to patients will be the future of obesity care in the private sector.
Novo Nordisk has quite a long history in digital tools for therapeutics that go beyond the medicine itself. How well introduced and integrated are these kinds of solutions in Singapore?
Currently, we do not have Novo Nordisk’s connected pens available in Singapore, but we will be working towards bringing these innovations, that improve patient care, in near future. However, the digital tools that we are currently focusing on in Singapore are the ones that help patients to improve the overall outcome of their treatment. This includes things like patient support programs and digital solutions which help with adherence and assisting patients as a partner throughout their entire treatment journey.
After such a crazy first year on the job, what have been your proudest achievements and what are your hopes for 2021 and beyond?
My proudest achievement is that my whole team is healthy. We have always been cognizant of how things need to be carried out during this pandemic and the whole team has responded excellently to the change in terms of how we provide our services to the customer and how we reach out to them through virtual platforms.
I am also proud of a launch that we managed to do during the COVID period for one of our new products here . The fact that, despite the challenging situation, we did not delay in introducing a new treatment option for patients makes me very proud.
Moving forward, a key area is making sure that innovation comes to Singapore faster. We are working on reducing the timelines between the first global launch of a product and that product becoming available in Singapore, ensuring that our latest innovations can reach Singaporean patients as soon as possible.
Our other priority area is ensuring that the majority of the population that needs these treatments can benefit from them. With so many people suffering from obesity and diabetes in Singapore, but limited number of people have access to latest innovations today, access needs to increase exponentially to really make a difference to patients’ lives and drive the change. This change is not going to happen with a ten or 20 percent increase in our reach, but will via a ‘moonshot’ increase in ten or 20 times compared to today’s reach.
We are working closely with different partners, knowing fully well that such an ambitious target cannot be achieved alone. Novo Nordisk is looking to bring in new innovations, identify and work with different partners, and then drive the change in these chronic conditions in Singapore.
On a more personal level, what keeps you motivated on a daily basis?
My family is in Malaysia and I have not been able to see them for over six months, but every day the excitement and energy that my team shows motivates me greatly. They really want to make a difference and ensure that patients here can access innovative medications.
Outside of our team, associations like SASO are full of energetic and intelligent people with similar goals in terms of driving change. It is another source of great motivation to know that we are not alone in this fight against chronic diseases.
