Vikrant Shrotiya outlines how Novo Nordisk's phenomenal recent global performance in obesity and diabetes has played out in India and the relevance of India to the global group. He also examines some of the key affordability and access challenges in the Indian market and how the company is engaging in collaborative solutions to tackle them. Finally, Shrotiya foregrounds the vital importance of a comprehensive approach to chronic diseases in making a meaningful impact to patients.


Can you briefly introduce yourself and elaborate on the mandate you received upon joining Novo Nordisk in India three years ago?

I joined Novo Nordisk India just before the onset of COVID, transitioning from Saudi Arabia. The key mandate was to accelerate our growth and solidify our presence in India. The focus was not only on expanding our footprint but also on introducing innovative solutions early on. Additionally, the responsibility extended to strengthening our engagement in clinical trials within the Indian landscape. Despite the challenging circumstances, our aim was to propel Novo Nordisk’s growth in the region to new heights, building upon the successful foundation laid in the previous four years.


Considering you left India 15 years ago and had a successful career in the GCC region, what prompted your return? Could you elaborate on the rewarding aspects you find in working in India, given the evolving landscape and infrastructure changes?

India, to me, has always been an intriguing puzzle, and if you can decipher it, it becomes a goldmine of opportunities. The satisfaction lies in meeting the substantial need for our products across the country, positively impacting countless lives. Moreover, India undergoes significant transformations every year. Infrastructure developments, like the new Bangalore airport, are just one example. Over the past five years, the number of doctors has surged by 60 percent, expanding access points. The changing landscape includes the proliferation of digital distribution channels, pharmacies, and healthcare facilities in every corner of the country. The government’s increasing participation in healthcare, aiming to surpass two percent of GDP, further emphasizes the opportunities. Initiatives like Ayushman Bharat, a vast healthcare program, are benefitting thousands. Despite the challenges, the evolving nature of India makes it an immensely satisfying and rewarding environment.


In the dynamic pharmaceutical landscape, marked by a robust sense of confidence, how do you perceive this optimism influencing the industry?

The pharmaceutical industry, both domestic and multinational, shares a positive outlook, anticipating substantial growth in the market, possibly reaching over USD 100 billion by 2030-2035. Government initiatives such as the PLA scheme for active ingredients, including APIs, and the focus on clinical innovation are seen as catalysts for accelerating production and fostering a thriving healthcare ecosystem. The goal is not necessarily to compete with other nations but rather to enhance healthcare accessibility within the country. Personally, I believe in setting internal benchmarks, aiming to exceed our impact on patients from the previous year and contributing collectively to advancing healthcare in India.


Reflecting on Novo Nordisk’s journey, especially in the context of its historical focus on diabetes care and the recent foray into areas like obesity and other rare chronic diseases, what key learnings have emerged? Are there specific strategies or shifts in the business model that you believe should be carried forward?

Since the discovery of insulin in 1923. Novo Nordisk has centred its efforts on revolutionizing diabetes care. Over time, the company expanded into addressing haemophilia and rare diseases. The recent strategic move into combating obesity acknowledges the substantial prevalence of this condition, especially in India. However, Novo Nordisk is now broadening its scope to encompass a spectrum of chronic diseases, including cardiovascular issues, and Alzheimer’s among others. The focus has shifted from merely “changing diabetes” to a more comprehensive goal of “changing chronic diseases.” Novo Nordisk enters specific therapeutic areas where it believes its innovation can make a meaningful impact, emphasizing a commitment to addressing unmet needs rather than pursuing opportunities for the sake of expansion. This targeted approach ensures a dedicated focus on areas where the company’s expertise can truly make a difference.


Could you provide an overview of Novo Nordisk’s operations in India, encompassing aspects such as manufacturing, clinical trials, and the broader affiliate functions?

Novo Nordisk’s presence in India is comprehensive, spanning quality, regulatory, clinical trials, and commercial functions. The company has had a manufacturing collaboration with Torrent for over 30 years. Notably, Novo Nordisk has played a pivotal role in providing access to innovative products, such as purified insulin and analogs, addressing critical needs for millions of patients in India. In the domain of clinical trials, the company actively engages in major trials with over 250 centres and a dedicated team, emphasizing in-house expertise rather than relying on CROs.

One distinctive achievement is the establishment of global shared services in India, a pioneer in this space. Nearly 7-8 percent of Novo Nordisk’s global workforce, totalling around 3,500 people, operates from India. This initiative, initiated 15 years ago, includes functions like medical writing, regulatory, finance, business accounting, business analytics, and clinical trials, all centred in Bangalore. Novo Nordisk’s commitment to shared services has not only enhanced operational efficiency but has also contributed significantly to employment, with Bangalore alone employing 30,000 individuals in the pharmaceutical sector. This multifaceted approach has laid a robust foundation, showcasing Novo Nordisk’s sustained commitment and potential for future growth in India.


Could you shed light on the epidemiological challenges posed by diabetes in India?

Over the last two decades, diabetes prevalence in India has witnessed a steady increase, attributed to genetic factors, environmental influences, and the interplay of epigenetics. This diabetes “tsunami” is characterized by an alarming rise in early-onset cases, with individuals being affected at younger ages. The demographic challenges in India amplify the complexities, particularly in rural areas where awareness, detection, and treatment accessibility pose significant hurdles. While urban centres benefit from better healthcare infrastructure, the majority of the Indian population resides in rural areas, making widespread awareness and detection paramount.

Addressing these challenges presents both obstacles and opportunities. Increasing awareness about diabetes, fostering early detection, and promoting optimal outcomes require collaborative efforts from government bodies, healthcare professionals, and communities. However, the issue extends beyond medical considerations and encompasses socio-economic factors. Affordability remains a critical challenge, with a stark contrast between those who can afford comprehensive treatment and those who struggle to access quality healthcare.

Encouragingly, some state governments have taken steps to assist citizens in procuring essential medications, reflecting a positive shift in addressing affordability concerns. Novo Nordisk, as an organization, is actively involved in supporting diabetes patients, with initiatives spanning more than a decade and encompassing 5,000 individuals. Furthermore, the company collaborates with Centres of Excellence across India, such as the Karnataka Institute of Endocrinology and Research, to provide sustainable models for diabetes management. Despite the existing challenges, these initiatives and collaborations aim to contribute to transforming the diabetes landscape in India, promoting awareness, accessibility, and optimal healthcare outcomes.


In the context of India’s evolving healthcare landscape and the rising prevalence of diabetes, how does Novo Nordisk navigate the challenge of affordability, especially with its focus on delivering highly innovative solutions?

Navigating the challenge of affordability in a country like India, where healthcare priorities are shifting from infectious to chronic diseases, requires a collaborative approach. Novo Nordisk actively engages with government initiatives, such as CDIC (Changing Diabetes in Children) and collaborations with Centres of Excellence. The company acknowledges the government’s evolving focus on addressing non-communicable diseases (NCDs) and actively participates in programs aimed at improving access to medications.

Affordability is a critical factor in treatment decisions, especially when 95 percent of healthcare expenses are out of pocket for patients. Novo Nordisk recognizes the need for uniformity in treatment pathways but acknowledges the decentralized nature of India’s healthcare system. Despite national guidelines, treatment decisions often rest with individual doctors, influencing the trajectory of patient care.

The challenge extends beyond treatment pathways to insulin utilization. Only a fraction of the diabetic population in India is currently taking insulin, highlighting the need for early insulinization. The absence of a centralized access system places treatment decisions in the hands of individual clinicians, contributing to delays in insulin initiation.

Addressing awareness and adherence challenges is integral to improving diabetes management in India. Novo Nordisk collaborates with the medical community to promote understanding of the disease’s seriousness, encouraging timely and appropriate treatment. Additionally, initiatives like CDIC play a crucial role in diabetes education, fostering awareness and adherence to recommended treatment paths.


Considering the social and political landscape in India, how is obesity viewed, and how has Novo Nordisk approached the introduction of its obesity medication in the market?

Obesity in India is transitioning to a condition associated with prosperity, particularly in urban and literate populations. However, there is a need to shift the narrative from viewing obesity as a mere cosmetic issue to recognizing it as a complex disorder with far-reaching health implications. Novo Nordisk advocates for medicalizing obesity, emphasizing its role as an epicenter for various diseases, including hypertension, diabetes, infertility, and cardiovascular diseases.

The prevailing notion in India often attributes obesity solely to calorie imbalance and individual responsibility. Novo Nordisk aims to alter this perception by highlighting the complexity of obesity, advocating for its recognition as a disorder that requires comprehensive medical attention. The company emphasizes that obesity is not just a personal responsibility but a condition demanding a multifaceted approach to effective management.


Amid Novo Nordisk’s global success, could you provide insights into the company’s performance in India?

Novo Nordisk has experienced robust growth in India, reflecting its global success. The recent launch of oral semaglutide in the country has been particularly noteworthy, achieving strong uptake and contributing to a significant double-digit growth rate. The performance highlights the successful introduction of innovative pharmaceutical solutions tailored to the Indian market’s needs, marking a positive trend for Novo Nordisk’s presence in India.


In a non-reimbursement market like India, where only 5 to 7 percent of the population receives reimbursement for medications, how has Novo Nordisk managed to achieve successful product launches, especially for oral semaglutide in the context of diabetes and obesity?

Navigating a non-reimbursement market in India, where a significant majority pays out of pocket for medications, demands a strategic approach. Novo Nordisk has successfully launched products, including oral semaglutide, employing several key strategies.

Firstly, conducting clinical trials in India has been pivotal. This approach not only provides doctors with hands-on experience during the research phase but also strengthens their conviction and faith in the product. The first-hand knowledge gained through clinical trials contributes to a deeper understanding and trust in the efficacy of the medication.

Secondly, Novo Nordisk focuses on pre-launch engagement, emphasizing scientific communication, innovation, and the value of control. By involving healthcare professionals in discussions about the science behind the product, its innovative aspects, and the clinical benefits, the company establishes a strong foundation for adoption. This collaborative approach ensures that healthcare professionals become advocates for the medication.

The introduction of oral semaglutide, which transforms an injectable molecule into a tablet, is particularly significant. The shift from injection to tablet addresses the common fear associated with injections and accelerates the adoption and diffusion of the therapy. This transformative aspect has proven to be a game-changer in facilitating the acceptance of the medication among both healthcare providers and patients.

While the absence of widespread reimbursement remains a challenge, Novo Nordisk’s commitment to scientific engagement, clinical evidence, and innovative solutions has played a crucial role in achieving successful product launches in the Indian market.


Looking ahead, what are the strategic priorities and expectations for Novo Nordisk in India in the next 2-3 years?

The foremost strategic priorities for Novo Nordisk in India revolve around delivering the best to the country. This entails a strong focus on bringing innovation to India, further enhancing clinical trial participation, and ensuring broader access to innovative products. The aim is to not only introduce cutting-edge solutions but also strengthen their adoption, conduct more robust clinical trials, and facilitate widespread access to these innovations. The dual commitment to both social and commercial fulfilment underscores the company’s dedication to making a meaningful impact on healthcare in India.