Ramez Mohsen, managing director at Janssen for Egypt, Jordan, Libya & Sudan, highlights how the company is driving real access to treatments in Egypt through collaboration with various stakeholders. He also assesses Egypt’s attractiveness for clinical trials and the initial results of the government’s prioritization of healthcare.
You were appointed managing director of Janssen’s North African region in January 2018. Could you give an overview of the region you are heading?
The region comprises Egypt, Sudan, Libya and Jordan as well as Ethiopia and the countries at the Horn of Africa. As it is a very challenging environment due to volatile political, socio-economic circumstances in each country, my priorities are all related to facilitating access to our innovative products. Egypt in particular, is a quite significant healthcare market in the region, due to its dense population and because it also supplies other countries like the Gulf states with healthcare professionals. Janssen has been in Egypt for 45 years. We see it as a flagship country in the Middle East and we began by bringing our primary care portfolio to the country. In the last ten years, our focus has changed towards specialized pharmaceutical products. We also have local manufacturing operations in the country through an external producer, Minapharm.
Globally, Janssen’s portfolio spans CNS, infectious diseases, metabolic and cardiovascular diseases as well as oncology. How is this reflected at the local level?
Speaking of Egypt, our portfolio is fully available, with a focus on oncology, immunology and other specialized areas. The recent introduction of a bridged regulatory process has helped us give patients better access to our products, due to a faster registration process. The challenge now is to transform regulatory approval into actual access to the treatments for the patients.
What do you identify as promising growth drivers moving forward?
While we see better awareness of healthcare in Egypt generally, specialized therapeutic areas like oncology, immunology and psychiatry are becoming increasingly important, which is partly caused by increased life expectancy. This is putting more pressure on patients and families as well as on budgets. Higher awareness of healthcare also means that patients are getting more demanding, as they inform themselves on digital platforms. Diseases like IBD, Crohn’s disease and pulmonary hypertension, which have been deprioritized in the past, are now becoming more significant for the payer and as a consequence, healthcare professionals are becoming more specialized and informed.
What is the impact of the Actelion acquisition, which introduces an entirely new portfolio for treating hypertension into the mix?
The acquisition of Actelion is enabling us to provide treatments to previous underserved areas in Egypt such as pulmonary hypertension. We have been able to register Actelion’s products in the country, including the two flagship products Opsumit and Uptravi, using the new bridged regulatory process, which has recently been offered by the Ministry of Health. We enhanced the footprint of Actelion products in the region and add to what Actelion has already achieved in countries like Egypt. It has been a challenge nevertheless, as most of the products have not yet been registered and are focused only on a few accounts.
What steps is Janssen taking in Egypt to ensure patient-centricity?
We are working on different angles to ensure patient centricity in the country. As Egypt does not have a very structured continuous medical education process, physicians essentially have to educate themselves after graduating. As the science is moving rapidly, Janssen Egypt is focusing on ongoing medical education, by bringing innovative new ideas to the physicians and meeting their needs by also using digital channels. We are using apps and webcasts as well as AI to reach professionals, which are spread out all over the country, including in remote areas.
The second topic we are working on is access, as it is a shame to have innovative products while patients cannot receive the treatments because of lack of funding. Hence, we have established an access team, which is finding innovative access models to reach the patients. Patients in Egypt are quite diverse, as the funding for treatments comes from either out-of-pocket, the employer or through public or private insurance. The diversity of payers requires us to be well adapted to the different scenarios to bring solutions that suit all budgets. Hence, we work with NGOs to create funds, so patients can continue treatment and we link up with patient associations, so they can advocate for treatments that might otherwise be deprioritized. Janssen wants to do a complete job, launching innovative products in the Egyptian market and also making them accessible to patients in the best way possible.
The third angle is establishing partnerships with regulatory authorities and government bodies on a large scale to educate the community and bring value to the end-user. Janssen is investing in Egypt, through local production and educating decision makers, with the ultimate goal of getting patients the treatments they deserve.
The fourth focus we have is educating the patients and giving information through digital channels, interacting with patient societies and having online platforms. Janssen is organizing disease awareness campaigns with its partners, one of them being on depression, as psychiatric diseases are stigmatized and deprioritized but demand attention, as they are a real issue in Egypt.
Generally, we see a big opportunity for public private partnerships in Egypt as we have collaborated closely with the Ministry of Health and the National Health Insurance on various occasions. A trend we see is that many pharmaceutical companies are still working in silos and I think it is time for the industry to concentrate its efforts by forming solid, sustainable partnerships to ensure the best outcomes for patients.
There is a negative stigma about cancer among the 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?
Egypt is a third-world country without the most luxurious healthcare infrastructure, but we need to do more to change this stigma. Education and awareness amongst the public and also amongst healthcare professionals is needed and we have seen recent efforts by NGOs and the government to improve in this field. People are now more familiar with diseases than a few years ago, so progress has been made. Screening programs are also important, as many types of cancer can be treated better when they have been diagnosed at an early stage. The government has taken the lead with the Hepatitis C screening campaign and Janssen is also active in the field of prostatic cancer, organizing awareness campaigns with universities, spreading the message that cancer is treatable thanks to scientific progress. We also campaign for patients being referred to specialists earlier to ensure the best medical treatment, not only in oncology, but also for pulmonary hypertensions as well as depression. We have seen the fruits of our work now the number of patients being treated has increased and patients are more compliant with their medication.
The government has outlined its plan of completely transforming the Egyptian healthcare ecosystem. What would you highlight as the most interesting developments and initiatives launched as a result of the government’s focus on healthcare?
There are a few very important indices that show that we can be optimistic for the future. The first one is the general prioritization of healthcare by the government from a theoretical perspective but also in terms of budget. This makes it extremely interesting for companies working in the healthcare field to invest and grow in Egypt. The second point is that the government is seeing healthcare no longer as a liability but as an investment, which is crucial for the industry as we no longer have the image of a cost bearer, but as a partner both for treatment and prevention. The third indicator is the introduction of a consolidated Universal Health Insurance focusing on quality, coverage and the participation of the society. We see momentum, investments and actions and the President and the Ministry of Health are following up on the campaigns, such as the 100 Million Seha campaign. The whole executive body is behind this reform program and we have seen a new openness to innovation.
Two areas for improvement are still the introduction of a predictable and transparent pricing mechanism for pharmaceutical products and intellectual property (IP) protection. Innovation has to be rewarded as there is no sustainability for unrewarded innovation. Egypt needs to enforce the laws that already exist; we do not need new laws, just stricter implementation. It is our responsibility to educate stakeholders of the value which IP protection can bring to the country. We want to put intellectual property on the agenda board of the government through communication and education and also show data on how IP protection brings benefits for the patients.
Janssen is one of the leading MNCs conducting clinical trials in Egypt. With the new law on clinical trials currently being discussed in parliament, how do you see the landscape changing in the next few years?
We really welcome the fact that the government is pushing this law and the fact that President El-Sisi has given the law back to parliament shows that he is well aware of the shortcomings the law has in its current form. Janssen is extremely interested in bringing clinical trials to Egypt, as we have already been collaborating with the Ministry of Health for early access programs. Egypt has great potential as a clinical trials destination due to its large population and the prevalence of certain diseases, which do not exist in other countries. Education is still needed however, as there is a stigma among Egyptian patients that participating in a clinical trial is akin to being used as a guinea pig, which is not true as we are not experimenting on patients and the process is well regulated. Clinical trials are a bridge to innovation and I am positive that Egypt will take the right steps to attract more of them.
Where would you like to see Janssen Egypt in five years?
The sole goal for Janssen Egypt is for innovation to be in the hands of patients and we see that the future holds a lot of opportunities, with more appreciation for innovative products. Janssen has been a partner to all stakeholders for a long time and is continuously re-evaluating its position and the market, asking healthcare professionals for feedback. We are also extremely proud of our community services, as we have supported the SOS children campaign supporting girls’ education.
Overall, I am very optimistic about Janssen’s future as we have been one of the fastest growing pharma companies in Egypt and brought innovative products to the patients. In five years, I would like to see Janssen treating patients better and bringing new innovative solutions in the digital area to the country. I also want Janssen to have more of a footprint in the community, being closer to the patients, while also bringing valuable solutions to society. We want to be recognized as a society-friendly company, partnering across the healthcare spectrum.
