REFORMING PUBLIC HEALTH: LESSONS FROM INDIA PHARMA INC

The pharma industry, one of the key stakeholders of public health, have a huge responsibility to ‘do good’ and ‘be part of the solution’

Improving public health is a development priority for India, but while the country has made some noteworthy advances in this sphere, mammoth challenges remain to be conquered. And, it is growingly evident that only a strong and sustainable partnership across the entire health value chain can be the solution to tackle them.

Therefore, as India’s focus on health intensifies and the government drafts ambitious plans to make its population healthy, we would also have to take the pharma sector’s perspective to ensure access and quality in public health. Hence, one of the major discussions at the 4 th edition of Healthcare Sabha – The National Thought Leadership Forum on Public Health was on ‘The Path Ahead in Public Health – A Pharma Perspective’.

dsc_6804An eminent panel comprising Viveka Roychowdhury, Editor, Express Healthcare and Express Pharma (Moderator); N Rajaram, MD, Sanofi India; Umang Vohra, MD and Global CEO, Cipla; Anuja Kadian, Head, Government Affairs, AstraZeneca Pharma India; AG Prasad, VP – Cluster Head, Sales & Marketing, Glenmark Pharmaceuticals, came together to highlight several pertinent factors such as access to medicines, drug pricing, patents and intellectual property, government policies and means to achieve UHC. Roychowdhury steered the discussion through the companies’ latest initiatives on increasing access, affordability and quality of medicines, healthcare in India; the panelists’ views on Ayushman Bharat and measures to make it successful, and the role of the pharma sector in Ayushman Bharat and other government initiatives. Let’s examine a few of the most important insights shared by them and how can they be applied effectively to transform our public health system for the better.

Strategic investments are key to improve public health – N Rajaram

Rajaram was a very strong advocate for investments which would make medicines affordable without compromising on quality, for instance manufacturing technology. He informed that as a company which has been manufacturing in India over several years, Sanofi has invested over ₹ 5000 crores in upgrading their existing facilities or acquiring new ones. Hence, falsifying the general belief that MNCs only manufacture expensive medicines, 25 per cent of Sanofi’s portfolio today is priced between ₹ 1 to ₹ 5. Thus, a therapy or five-year treatment for a patient can be between ₹ 5 to ₹ 25. However to do that, he stressed on the need to build expertise for developing products at an affordable price without compromising on the quality. And, this can only be done with a capacity for large scale manufacturing.

He also laid emphasis on investments in innovating as well. He explained that it is important to develop solutions and encourage incremental innovations which would bring value to the Indian market. He cited the example of disposable insulin pens which is used all over the world. However, they are priced at `2000 and above and moreover it generates a lot of plastic. Therefore for India, Sanofi developed reusable pens which are priced at 1/10 th of disposable ones. This instance is an example of how incremental innovation and out-of-the box thinking is crucial to serve the health needs of the Indian population. However, it also highlights the importance of investing in innovation and human resources to train them to think differently.

India’s public healthcare can take a leaf out of these measures and ramp up investment in research and infrastructure creation to strengthen its current capacities and build more capabilities.

We have to aim for Universal Care Coverage – Umang Vohra

Vohra underlined the role of pharma companies in enabling access to medicines and informed that Cipla has always endeavoured and stood for access. He accentuated that enabling access to quality medicines in India was the vision of its Founder KA Hamied and till today, Cipla continues to be driven by this vision. However, he also stressed that now it looks at access differently and believes it to be more than just that affordability. He states that access is more about creating an ecosystem which enables and empowers the citizens to avail good quality healthcare conveniently and affordably.

He advocates that the policymakers and public health sector too should realise this and work towards for a more comprehensive strategy towards expanding healthcare access. Putting it in the context of Ayushman Bharat, Vohra lauded it as a very bold and worthy initiative but he also opined that this should only be a step towards achieving Universal Care Coverage and not just Universal Health Coverage.

Outlining some measures which could help in achieving this larger and more effective outcome, he said that Cipla, in its bid to expand access and its generics business, has ventured into most of the tier II-III areas of India and has realised that the community health centres (CHCs) and primary health centres (PHCs) in these areas could be mobilised in a better manner to enable and expand the reach of quality medicines and healthcare to these regions.

He spoke on how right diagnosis and training is essential to make ambitious endeavours such as Ayushman Bharat successful. Vohra also emphasised on the inclusion of diagnostics in the whole scheme, thus making it more than just about medicines and hospitalisation. He advocated looking beyond just costs and making Ayushman Bharat more outcomes-driven to make it effective and successful.The public health sector should heed this timely and pertinent insight to create a 360 o approach towards serving the needs of its citizens.

Government schemes should be formed in concurrence with all stakeholders – AG Prasad

AG Prasad spoke at length about the importance of assuring quality of medicines to build a sustainable and effective public health system. He informed that Glenmark looks at quality at different levels and includes patient safety, environment safety and pharmacovigilance and is not only concerned about the potency of product. He informed that the company also ensures that its raw materials are sourced only from high quality manufacturers. Mirroring this practice, our public health system too needs to assure quality at each level to fortify it and strengthen it from within.

Another point highlighted is that while the government develops public health schemes it should be done with inputs from all stakeholders. He said that often good schemes do not take off and perform as expected due to lack of adequate stakeholder participation. For instance, Jan Aushadhi is a very good initiative taken by the Government of India but the project has not taken up the way it is expected to, primarily, because it has failed to attract reputed pharma companies.

Prasad also pointed out that often lack of clarity and tediousness in government procedures like tendering and procurement dissuade big companies from participating in these schemes. At the same time, he also lauded AMRIT stores, run through HLL which is very successful. He cited it as an example of good partnership between private and public institutions, wherein AMRIT stores source branded products from reputed companies with 30-40 per cent discount and offers 20-30 per cent discount to customers. CGHS and many other government sector institutions also prefer procurement through Amrit stores of HLL.

He advised applying these learnings while implementing Ayushman Bharat, an insurance and assurance scheme, as its success is dependant on the quality of execution. As public private partnerships (PPP) would be crucial to success for Ayushman Bharat and all other large scale public health schemes, the government should take the views of all stakeholders involved to create a win-win situation for all.

Digital technology can make public health schemes effective – Anuja Kadian

As a representative of AstraZeneca she spoke on the Anglo-Swedish company’s 40 years of presence in India and its focus areas. She informed that sustainability is inherent for their global strategy and access to healthcare is key to their sustainability strategy. Their major endeavours include measures for disease prevention, capacity building and access to medicines.

She also spoke on how spreading healthcare awareness is paramount. She stressed on the importance of not only looking at curing diseases but also encouraging healthy living and elaborated on strategies such as CSR funds effectively to expand
access to medicines and healthcare. Throwing more light on AstraZeneca’s efforts in this direction, she spoke on their young health programme which focusses on spreading awareness. She revealed that till date they have reached 2.5 lakh adolescents directly and intend to set up several centres of excellence to spread access. They also promote healthy living as part of their access programmes.

But, the most important takeaway from her was how the use of digital technologies can help reform and improve public health. She spoke on how it is gradually being implemented in the pharma sector to come up with products and processes which are more efficient and efficacious and recommended using these technologies on a large scale to make public health schemes like Ayushman Bharat more successful.

She opined that robust monitoring systems, gap analysis, creating data sets etc are essential to make an ambitious public health plans successful, including Ayushman Bharat. Through effective use and application of digital technologies and ICT technologies, it is possible to gather valuable data sets which would enable us to gather empirical evidences about the public health priorities for the country as well as important clusters of population that need to be served. This, in turn, would help develop targeted interventions and schemes which would get the desired outcomes.

Role of the regulator

Thus, each one of the panelists reiterated and underlined the endeavours of their organisation in creation of value to improve patients’ well-being, and contribute significantly to the quality and protection of life. At the same time, their insights also carried a lot of learnings to improve public health. They also explained that the access puzzle can be resolved only through a mix of measures which would be dependent on medical expertise and good governance as well as efficient healthcare and supply systems.

Dr S Eswara Reddy

Dr S Eswara Reddy

And, the role of the regulator in ensuring all these and helping the pharma industry live up to its potential in an ethical manner is paramount. Hence, Healthcare Sabha had also invited the Eswara Reddy, DCG(I) to present his vision and objective for the pharma industry and augment its role in ensuring an effective public health system.He informed that as the DCG(I), one of his major objectives is to build trust and confidence in the public mind about the quality of medicines that are manufactured, distributed, sold and exported from India.

The second objective is to work towards building a positive image of the Indian drug regulator in the public mind. He also spoke about the measures introduced to ensure quality of the products and to make drug regulators accessible. He further stated that they  have a public relations office where manufacturers, start-ups and innovators can visit or call to clarify doubts, get information and resolve their problems. Measures are also being into place to assure quality, fight counterfeits and make our systems more transparent.

He said, “We are going to make a very comfortable environment for the innovators and manufacturers to carry out their business in India. We are taking several measures to improve ease of doing business in India, be it clinical research or manufacturing in India. We are also open for any national and international audits to ensure that we are fully compliant with the Drug & Cosmetics Act. ”

Going forward

In the past 60 years, innovation and technology have driven huge improvements in global health. However, be it for research and training personnel or reevaluating our health policies and effective reallocation of resources at national and local levels, multi-stakeholder approaches will be pivotal to build an effective public health system which can serve our present and future needs.

And, the pharma industry, generally acknowledged to be one of the most powerful economic sectors across the globe, is also one of the key stakeholders of public health with a very significant role to play alongside governments, international organisations, (NGOs) and others. So, the companies themselves also have a huge responsibility to ‘do good’ and ‘be part of the solution.’ This would mean putting systems in place to enable compliance to national laws, protecting the environment, monitor performance, encourage transparent communication and enhance accountability.