Hits Like a BRIC - Pharmaceutical Executive

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Hits Like a BRIC
How to make sense of the growing diabetes market in Brazil, Russia, India, and China


Pharmaceutical Executive



Aging Population, Different Diseases
While the patients are there, the issue for pharma companies is that the BRIC diabetes markets are not well formed. In developed countries, there are armamentariums of medical technology, frequently updated clinical guidelines, and innovative therapies that can screen, diagnose, and adequately treat the symptoms and sequelae of diabetes. But in BRIC countries, there is a lack of disease awareness and access to screening. Half of all type 2 diabetes patients in India remain undiagnosed, according to the International Diabetes Federation. Part of the problem is that the majority of patients must visit specialist pathology laboratories to access disease-monitoring tests, and the costs to do that may be prohibitive. What's more, compliance remains a core challenge in the treatment of diabetes, with only 2 percent of patients in India owning a meter for blood glucose self-testing, according to Stefan Björk, Novo Nordisk's senior adviser of corporate stakeholders.

This lack of awareness of innovative therapies and the costs of the therapy, rather than the appropriateness of the therapy, drives prescribing decisions. Therefore, BRIC physicians favor traditional or generic therapies—including insulin injection. Indirectly, this contributes to stigma for diabetes patients, who may wrongly perceive that injectable medicines are addictive. For this reason, and because of needle phobia (which is stronger in the BRIC countries because of inadequate patient education), half of diabetes patients in China visit healthcare professionals for injections.

Given these issues, the challenge of tackling type 2 diabetes in BRIC countries may seem overwhelming. In Brazil, Russia, India, and China, there are more than 5 million healthcare professionals, over 50 official languages, and taken together, hundreds of millions of patients. Pharma firms must also consider logistics, given that selling drugs within these countries means disseminating therapies across 25 percent of the planet's land mass. On top of that, healthcare systems are unwieldy, inconsistent in quality, and underfunded; data from World Bank shows that China and India have less than three physicians per 1,000 people, while Russia's 12.5 health workers per 1,000 are concentrated in a highly inefficient secondary-care system.

The industry has already seen how intellectual-property challenges from generics competitors and governments are serious barriers to business, as are opaque regulatory and formulary practices. The few institutional checks through BRIC countries' procurement and prescribing chains often breed corruption, counterfeiting, and disregard for legal procedures. This means that Western pharmaceutical companies don't operate in a transparent market within BRIC, and, ultimately, patients lose out due to a lack of enforced standards in drug safety, quality, and efficacy. More than half of Russia's total healthcare expenditure, for example, is in informal and out-of-pocket payments, according to the 2006 Global Corruption Report by Transparency International.

What is Pharma's Role?

Despite the big and still-growing problem of diabetes, only five of the top-20 pharma companies have diabetes projects in clinical trials, according to http://ClinicalStudyResults.org/. This may mean that, for Big Pharma, commercial success in treating diabetes is not due to innovative R&D alone, but due to innovative marketing execution.

Indeed, a recent initiative underscores that point. At the 19th World Diabetes Congress in Cape Town, South Africa, Lilly announced that it had underwritten an International Diabetes Federation grant for $10 million to fund translational diabetes research to find cost-effective and sustainable solutions to improve diabetes outcomes in developing nations. This action reflects Lilly's recognition that new medical-intervention practices are needed to manage the treatment of diabetic populations in the developing world.

But given the range of issues that come under the umbrella of marketing—from awareness to pricing to logistics and beyond—pharma companies' success in BRIC countries may depend on how well they can partner. By committing to long-term relationships with local partners and governments, pharmaceutical firms can undertake a range of activities that support sales and marketing efforts, and gain insights from customers and stakeholders by taking a lead in public-health issues.


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