The Singapore Association of Pharmaceutical Industries' (SAPI) recently appointed president, Ti Hwei How highlights several unique attributes that distinguish Singapore’s renowned healthcare system from others around the world, while delineating three potential avenues for expanding patient access to innovative medicines.

To begin, Ti Hwei, how would you characterize the specificities of the country’s healthcare system?

Singapore has one of the most efficient healthcare systems in the world. In addition, we have one of the highest life expectancies in the world, currently sitting at 82 years. We spend 5.1% of our GDP on health care, while the OECD countries spend an average of 9.3%. Nonetheless, we have a number of emerging challenges, one of them being our aging population together with its associated healthcare needs. Secondly, we are the nation with the second highest occurrence of diabetes in the industrialized world, just after the US. About half a million Singaporeans in 2014 suffer from diabetes, and we expect this number to go up to a million by 2050. We are also seeing a rise in the occurrence of cancer.

Can you depict the key role that SAPI is currently serving within Singapore’s healthcare ecosystem, while also describing some of the priorities that have been keeping you busy since recently assuming the position of president?

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SAPI is commemorating its 50th anniversary this year. Our vision since the beginning has been to make innovative medicines accessible to patients in Singapore. During these 50 years, Singapore has made substantial progress and our healthcare system has also improved tremendously. But we continue to strive for better outcomes, particularly when it comes to creating faster and more widespread access to innovative medicines to meet existing and emerging unmet medical needs.

We see three opportunities in this regard; the first being the regulatory review approach. We have built a strong collaborative relationship with the Health Sciences Authority (HSA). Thanks to this collaboration, the process of approvals have become more efficient. To further accelerate access, Singapore needs to put in place a policy that prioritizes the approval of new innovative medicines, similar to the approach for generics from India through the Comprehensive Economic Cooperation Agreement (CECA).

The second component is for medicines to reach the public sector faster after regulatory approval. Upon regulatory approval, medicines are immediately available to the private sector. Meanwhile, the process to reach the public sector, which serves 80% hospital care patients, is unclear and lengthy. Without a doubt, this procedure can become more transparent and efficient.

The third area is on government funding for innovative medicines. Singapore has various funding mechanisms to support patients’ healthcare costs. However, the process to include medicines under these mechanisms is also unclear. We aspire to be part of the process and work with the government so that support for patient access can be more efficient.

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What are some recent changes currently impacting the sector?

Recent changes in Singapore are very encouraging and positive. We have a healthcare system is that rather unique; our system is a combination of public and private funding. The population gets a basic insurance supported by the government called Medishield, and they have the option to enhance it with the private sector insurance if they desire. Last November, the government added some changes to Medishield, increasing the benefits and calling it Medishield Life. This new and improved insurance enables the population better access to medical care.

One of the most pervasive topics confronting regulators worldwide is adequately understanding and assessing the fair price of innovation. From your perspective, how have Singaporean authorities performed in this regard?

The Singapore government believes in creating competition to drive access to medicine. Companies price innovative medicines taking into consideration the benefits that they bring to the patients. Following this, and due to Singapore’s unique healthcare system, pricing is open to market forces.

Overall, our healthcare providers welcome and celebrate innovation. The Ministry of Health has a Healthcare 2020 masterplan to better meet the needs of Singaporeans, while the Ministry of Trade and Industry continues to strive towards making Singapore a biomedical hub.

To reach these goals, the government has focused on two key areas. The first is increasing manufacturing output. Singapore is doing quite well in this area, with six out of ten of the top selling drugs being produced here. The second is investing in R&D. Our government plans to invest SGD 19 billion in R&D over the next five years with SGD 4 billion being directed to biomedical research. Our country has been increasing focus and resources in these areas, which is reflected in the amount of pharmaceuticals manufacturing and clinical trials taking place in Singapore. Furthermore, the biopharmaceutical industry employs over 25,000 people in Singapore. Similarly, SAPI is committed to bringing innovation to the country because it is a win-win situation for everyone.

Our healthcare providers welcome and celebrate innovation

Having been previously exposed to neighboring market dynamics, how would you benchmark Singapore’s healthcare system alongside other countries’ in the region?

As I mentioned before, Singapore’s healthcare system is quite unique in the funding model. In other countries, healthcare reimbursement tends to be either completely private or public. Another major difference is infrastructure; Singapore is known for our developed and reliable infrastructure. However, Singapore still faces the challenges of its aging population with its associated healthcare needs. Furthermore, some people still head directly to hospitals for their consultations instead of primary care institutions, while many people are still being cared for in the hospitals for their chronic conditions. This may potentially create crowded hospitals and compromise on the quality of care. The government is trying to change this by encouraging the population to go to primary care institutions first, and use hospitals mainly for specialty care and emergencies.

What do you consider the main factors attracting pharmaceutical companies to come to Singapore?

Singapore has a very stable sociopolitical situation and strong Intellectual Property Laws in place. From a manufacturing point of view, it also has an incredible infrastructure. This gives confidence to the industry that we not only can we maintain sustainable operations, but also keep up our pace of growth. From an R&D point of view, we have many highly trained scientists and clinicians that work with pharmaceutical companies to keep pushing the boundaries of science. This open mindset is attracting some companies to even conduct their first-in-human clinical trials here. Our human capital and infrastructure are the main assets companies consider when they think of Singapore.

And as one of the associations representing multinational interests, SAPI aspires to establish and maintain cooperative relationships with relevant agencies to sustain Singapore’s appeal. Our goal is to extend this private/public sector partnership and ultimately expand access to innovative medicines for patients, while eliciting even greater collaborative opportunities among industry participants.

Our goal is to extend this private/public sector partnership and ultimately expand access to innovative medicines for patients

Shining a more personal spotlight on yourself, what motivating factors encouraged you to take on this extra role presiding over a trade association in addition to managing AstraZeneca’s country operations?

Personally, I am very happy to see the positive impact that the industry is having in society not only in Singapore, but also around the world. We are pushing the boundaries of science to bring innovative and better medicines to the population. Of course we face challenges, but when we overcome them, we make a huge difference in people’s lives. Singapore is the example of how efficiency can be improved when the government and the industry work together collaboratively. I believe that this partnership can be further fostered, to enhance greater results. Yes, SAPI is made up of companies in competition with each other, but we have learnt how partnerships and collaborations can create better outcomes for everyone.

If you had to give us three major goals that you want to achieve during your tenure, what would they be?

Firstly, SAPI is devoted to making innovative medicines accessible to patients in Singapore. This goal is aligned with the commitment of the healthcare system to give better patient care and with the goal of the government to make Singapore a biomedical hub.

Furthermore, I would like to keep expanding the partnerships that the industry has built with the government. Through working together, we will better understand the problems we face and will solve them prudently.

Lastly, while Singapore has a strong intellectual property framework, there is an opportunity to align our patent term extension policies with other developed countries, taking into account the lengthy drug development and regulatory approval processes. This will further enhance Singapore’s position as a center of innovation.