In Egypt’s diverse marketplace, Novo Nordisk is bringing care to patients across the country with a range of products ranging from affordable established insulin to their most recent generation of innovative products. At the same time, they are investing in localizing production of insulin in Egypt and encouraging best practices in diabetes care through the establishment of 26 Diabetes Centers of Excellence across the country.
How would you assess the current level of diabetes awareness in Egypt?
Overall, awareness regarding diabetes in Egypt is low but it is getting better. The challenge in Egypt is that public discussion of healthcare is dominated by communicable diseases, mainly hepatitis C and thus the attention the government and media are able to dedicate to non-communicable diseases like hypertension, diabetes, and other non-communicable diseases is limited. Of course, hepatitis C is a major healthcare issue for the country, and one that negatively impacts the productivity of our people and ultimately the economy, yet the same can be said about diabetes. In fact, at present the number of deaths caused by diabetes and related complications is higher than the number of deaths related to hepatitis. Communicable and non-communicable diseases should be treated as equally important, with investments made according to their relative severity, but at present this is not the case. However, we have recently observed a shift towards a more proactive stance towards diabetes, and we are glad that Novo Nordisk has been able to take a leadership position amongst companies providing education and awareness related to diabetes at all levels.
Does currently available data provide a clear picture of the severity and cost of diabetes in Egypt?
There is a lot of room for improvement, not just for diabetes but also for other diseases. Healthcare budgets are not driven by health economic data, or by clear planning based on the severity of different health issues like diabetes; instead, the government is operating in ‘firefighting’ mode, and is only able to allocate additional funding to prevent emergencies. If you have good data that provides a clear picture of the issue and includes not just the direct cost but also the indirect cause of the disease and related treatments, it would certainly foster more effective planning and efficient investment opportunities. As of yet, I have not seen a well-founded study with a reasonably sized patient population that gives a clear and accurate assessment of the cost of diabetes in Egypt, including the cost of treating complications. Developing an accurate estimate of the cost of this healthcare issue to the country is very important and we hope that we will be able to work with government entities, including the Ministry of Health, to conduct economic studies on good health in the future.
It is very important that such initiatives and spending on diabetes prevention and treatment are seen as an investment and not a cost. If patients with diabetes go untreated, they can develop complications including heart failure and strokes, and the cost of treating these complications can be more than tenfold than that of treating diabetes itself, not even counting the difference in quality of life. However, this mentality has not yet been strongly established amongst the Egyptian people and government.
Given this status quo, what is your perspective regarding the discussions that have re-emerged surrounding the universal healthcare coverage?
The best-case scenario for Egypt, for any country, is to introduce universal healthcare coverage. This discussion began 12 years ago in Egypt, and since then it has centered on our ability to implement such a system. With recent examples of other countries introducing universal healthcare coverage, for example Indonesia, it has become increasingly clear that it is feasible for Egypt to do the same. Due to the current fragmentation of the Egyptian healthcare system, organizing effective reforms will be challenging to say the least, as will re-organizing existing funding structures into a sustainable system. However, this is a challenge that Egypt can certainly overcome with sufficient dedication.
The implementation of an effective and sustainable universal healthcare system would drive an economic boom in the healthcare industry and support Egypt’s overall economic development. Currently, we only spend USD 35 per capita on healthcare, which is alarmingly low. This is a third of what countries with similar economic conditions to Egypt such as Lebanon or Iraq are spending. There is a great opportunity from both a financial and humanistic point of view as access to medication is poor in Egypt and universal healthcare coverage would benefit everyone in the country, but those with the least income will benefit the most. Furthermore, increased investment in healthcare would create jobs and help increase economic productivity, ultimately driving economic growth.
What have been the different aspects of Novo Nordisk’s leadership in ‘changing diabetes’ in Egypt?
Novo Nordisk has lead the way in raising diabetes awareness as well as treating and preventing diabetes in Egypt through a variety of initiatives over recent years, for example by hosting the World Diabetes Day run this year. We have 27 Novo Care Centers around the country, the first of which was established in 2006, providing tens of thousands of free NovoPens to patients each year and carrying out diabetes awareness and prevention initiatives. We also signed a memorandum of understanding with the government last year to establish 26 state-of-the art Diabetes Centers of Excellence across the country, one in each of the 26 Governorates of Egypt, where Novo Nordisk is refurbishing and equipping clinics in major hospitals and educating physicians and nurses to provide the best possible diabetes care. The first of these Centers of Excellence was opened in May 2015 and functions as a ‘one-stop-shop’ for treatment of diabetes and related complications.
Furthermore, we have supplied the government with a fully automated patient management system and have established a central server for our 26 Centers of Excellence. These two systems are continuously synchronized in order for the government to have access to current and good quality data about the numbers of people diagnosed with type one and type two diabetes and the severity of complications caused by this condition.
Novo Nordisk recently signed a deal with EgyVac to produce insulin in Egypt; how significant is this for Novo Nordisk, as well as for Egypt?
Novo Nordisk is proud to have been one of the leading suppliers of insulin to Egypt for more than 80 years. The brand equity we have built in Egypt is amazing and many patients have very high levels of trust for our products, largely because they have used them for such a long time. Furthermore, Egypt is a huge market but we face significant challenges in terms of pricing and affordability. While we have traditionally imported medications from Copenhagen and France, we have decided that it is time that we strengthen our presence in Egypt given the demand for diabetes care in the country.
This is why we have decided to establish a local manufacturing presence, which will require a significant technology transfer. As the market leader in diabetes care overall and specifically for insulin production, Novo Nordisk operates with the most sophisticated technology used for insulin production. We selected EgyVac, one of the companies under the umbrella of state Holding Company for Biological Products and Vaccines, as our partner as they have more than ten years of insulin production experience already, which means that we have a solid platform that we can build upon. Once completed, this facility will be the most recent and most advanced site for insulin production in Egypt in terms of technology, and capable of producing over ten million insulin vials per year.
Will localizing these operations change Novo Nordisk Egypt’s role within the region in the next few years, potentially supplying other markets?
Absolutely, especially considering the COMESA agreement, which allows us to freely trade with 19 other member states in Africa. It is an opportunity that has not yet been utilized by the pharmaceutical industry in Egypt to a significant extent, but we are very interested in exploring this further when the time comes; the process of developing insulin production locally will take a significant amount of time.
From a commercial point of view, what’s the distribution of Novo Nordisk’s portfolio in Egypt? How much of a demand is there for your most innovative products?
There is a good market for innovation and price premium products in this country. With a population of 90 million people, roughly 0.5 percent of the population has an income over EGP 40 000 per month (USD 5000). With a diverse population and thus, a range of income levels there is space in the market for new innovative products at higher price points, as well as more accessible established products. That said, the market for innovative products and thus overall patient outcomes, would be much better if good reimbursement structures were put in place.
Looking forward, what product launches and initiatives do you expect to drive Novo Nordisk’s growth in Egypt?
We will be bringing our entire global portfolio to the market. Our recent launch of Victoza was very successful; many patients are already benefiting from it and the response from patients and physicians alike has been very positive. It has been a high impact product in all markets and Egypt is no different despite the cost barrier. Looking ahead, we will be launching at least two new products each year for the next few years, which is very exciting and has lead us to significantly increase the size of our organization from 78 to 180 employees over the last 18 months in preparation for the increased activities.
What is your vision for Novo Nordisk Egypt five years from now, in 2020?
I would like to see Novo Nordisk become more active in adding value to society and helping people to understand what diabetes is, how to treat it and more importantly, how to prevent it. Increasingly we are able to bring innovative treatments to help people effectively control their diabetes, preventing complications in doing so. I would like to see us much more active in terms of corporate social responsibility, both within diabetes and beyond. While we already carry out many such initiatives, we can definitely do more. Most of all, I would like to see us as recognized as an active partner of the government and institutions in terms of advising and providing free consultation regarding public health policy and how the Egyptian healthcare system can be improved. We play a key role in this fight against diabetes; it is truly Novo Nordisk’s passion and purpose and we will continue to play a leading role in bringing the best possible diabetes care to patients here in Egypt for many years to come!
