Elif Aral, country manager of Pfizer Turkey, stresses that Turkey will continue to be perceived as essential and important, where healthcare is a top priority with its young but aging population. In addition, as the newly appointed Chairman of the Board of Directors of the Association of Research-Based Pharmaceutical Companies (AiFD), she highlights how the association aims to work hand in hand with the new government to entrench Turkey’s position as a globally competitive market and ecosystem for the pharmaceutical industry.

As you have been recently appointed Chairman of the AiFD, what are your priorities?

Prior to the recent elections, the next steps for the future four years of the healthcare sector have been established through the design of the 11th Development Plan (2018-2022), and our priority is to ensure our participation and commitment to this plan is upheld. The government has recently undergone structural changes, including the positions of those responsible for the pharmaceutical sector; however, the strategic visions remain the same.

The healthcare industry vision for Turkey is to achieve competitiveness at global value chain. Association’s long-term strategy is aligned with this vision so we work to contribute to this continued transformation by means of R&D, manufacturing and exports

Could you explain to our international readers what the current problems that pharmaceutical companies are experiencing in the country are?
The main problems at the focus of many innovative companies’ agendas are the pricing pressure and forced localization policy.
With regards to pricing, the current legislation clearly states that the method of fixed exchange rate’s adjustments are to be conducted by TITCK’s price commission, and the required adjustments were carried out in 2016 and 2017. However, in 2018, as a consequence of some economic and fiscal concerns, the exchange rate adjustment that should have been around 23 percent was capped at 15 percent with the introduction of a temporary provision to the related Degree. Today, the gap between TITCK’s fixed EUR/TYR exchange rate and the ‘real’ market exchange rate has reached 50 percent.

With regards to the forced localization push initiated in 2016, the government focused on local manufacturing of genericized products by limiting market penetration of imported products. However instead of forced localization policies, strategies and actions to enhance R&D and therefore global competitiveness would strengthen Turkey’s overall investment ecosystem.

Following the recent elections, do you see structural changes being implemented on the healthcare side, especially with regards to financing?
Looking ahead, we do not expect any major changes to the financing of the healthcare system to be introduced in the coming weeks or months, after its successful implementation through the Health Transformation Program (2003-2013). Nevertheless, it makes no doubt that in the next ten years, the whole value chain of the sector needs to adapt to the global market and its influencing trends. The main topics for change will include a greater emphasis on bolstering the effectiveness of the entire system, bridging the gap between the past focus on increasing the number of services available and the population coverage, which has now reached over 98 percent, and the necessity for a better quality of the services.

Turkey is now focusing on its demographic shift; still young but aging population and next phase of healthcare reforms, targeting advanced healthcare needs. It will be interesting to see the improvements on healthcare outcomes and their effects on disease management due to the implementation of several health programs (screening, healthy living, smoking cessation, vaccination etc.) by Ministry of Health which aim to reduce the prevalence of chronic diseases in the long term. Having said that, due to the prospective demographic shift, pressure on the health expenditure is expected to increase. Therefore, starting today, measures and needs to support healthy aging should be taken into consideration by the government.
As an innovative company, Pfizer plays a major role in aiding the development of this focus on the quality of aging, and we are always partnering with key stakeholders to implement initiatives such as awareness campaigns, screenings, and early diagnosis activities. We are also active in training, partnering with both the government and the physician associations because we see this as a crucial role to play in the healthcare industry.

Could you give us an overview of the scope of the operations of Pfizer in Turkey and document the company’s commitment to the country?
Our business opportunities span from our pipeline, and with almost 15 products preparing to launch in the next five years, the innovation we will continue to bring to the patient will increase, especially in oncology and rare diseases. Moreover, we also have been developing biosimilars and we have products in the pipeline for the next five years that we aim to register in the country.
To meet the medical need of the patients, we continue to research, discover and develop medicines & vaccines. In Turkey, we work hard to make our products to be accessible for the patients.
Overall, the commitment of Pfizer to Turkey is already remarkable: 75 percent of our products consumed in the country are already locally manufactured, while Pfizer’s flagship vaccine Prevnar 13® has been manufactured in Turkey with formulation, filling and packaging phases since 2012. We also stand as one of the largest investors in clinical trials in the country. The Turkish affiliate employs around 1000 people and is one of the global headquarters’ essential and important countries in the European region coming in at around seventh place in the continent.

Furthermore, the talent in the country is important for Pfizer’s mission: the affiliate was established in 1957, and since then, Pfizer Turkey has been taking the steps in investing into its talent by developing the environment, which supports and encourages learning through innovative thinking while rotating among different roles. This initiative has exposed them to different experiences within the organization, not only developing themselves but the company also, creating important assets for Pfizer at a global level. There is a lot of freedom for employees to experience different markets also, working from the US and Latin America to Europe and other emerging markets.

When discussing biosimilars, what is the maturity of the regulatory framework in Turkey?
Parallel to its vision of becoming a globally competitive market, Turkish government has deployed all relevant market policies up until now, therefore, biosimilars cannot be launched into the market without the adequate medical data, a standard practice in many mature markets.

As Pfizer, our biosimilars portfolio is highly aligned with the demands of the country’s market regulations and international standards.

Focusing now on yourself, as one of the most influential business leaders in the country, what does innovation mean for you at Pfizer?
Our aim is to find solutions to the diseases that all of us, the whole society encounter. Therefore, innovation starts with patient unmet needs, continues with R&D at laboratories and clinics and then ensure patient access to medicine.

There are more than 700 drug R & D projects in the world, but only 12 percent can turn out to be a treatment; at every step of this journey there is a risk of failure that needs to be overcome. In Pfizer, more than 80 R & D projects are ongoing, and we are now working on future technologies such as personalized drugs, biologics and gene therapy. It is not difficult to foresee that these technologies will be in the center of future healthcare systems.

Looking at the value chain and its different aspects, starting with R&D, innovation is critical, and we continuously look to see how we can adhere to changing healthcare environment. Moreover, we look at innovative ways to adapt to digital and alternative models to bring more with regards to our manufacturing and operating methods. Therefore, we are a prime example of resilience through our constant search in this aspect.

What are the key skills that you have developed over the past years as the head of the Turkish affiliate?
I started my career at Pfizer 23 years ago. I participated rotational programs and experienced different positions in various therapeutic areas from sales and marketing to government affairs. I learned throughout my career that keeping the needs of patients at the forefront of your mind and being able to understand different perspectives is the key to success. Moreover, working in different regions has differentiated my career aspects, through my responsibility for Central Asia and Caucasus Region, which allowed me to associate with different people and become more understanding of their opinions.

From my time as the head of the Turkish affiliate, I have broadened my understanding of the matrix organization that Pfizer has evolved into. This position has exposed me to the company at a personal level, opening the door to getting to know the people I work with in more depth, not to mention getting to know different companies and leadership teams through heading the AiFD, where these networks continue to develop my career.

You have been head of the Turkish affiliate for over four years. Continuing on, how do you want Pfizer to be recognized in the country?
I aspire to have the affiliate recognized for its successful partnerships and the depth of our portfolio, through our interactions with all the key stakeholders from government, associations and the physicians, all striving for the best outcome for the patient.

What would be your final message to our international readers?
Today, Turkey needs to develop and utilize its potential through the pharmaceutical value chain to be competitive at global level. This can be achieved by establishing a legal infrastructure at international standards which ensures predictability and is applicable for future healthcare technologies. In the same way for R & D, integration of our country with global research networks must be ensured. It is important to develop strong infrastructure for clinical trials as it is in developed countries. This issue should be prioritized for patients’ access to innovative treatments and also development of pharmaceutical research in our country.

The 11th Development Plan of Turkey and the preparations in the sector that is set to follow show how the government and the industry are both aligned for the future. As an international company, we want to see Turkey as a global player and the government has shown this aspiration as well. Now it is time to take the necessary steps to develop the healthcare ecosystem to attract investment into the country.

We have the opportunity of advancing the healthcare ecosystem over the next five years, hand in hand with the new government, to become a global player in the pharmaceutical and healthcare sector – but concrete actions are critical to show this evidence to the rest of the world.