AWARENESS, AWARENESS, AWARENESS
One insidious problem haunting Brazilian healthcare is, perhaps anachronistically, alluded to by Schopenhauer: "Talent hits
a target no one else can hit; Genius hits a target no one else can see." If there's truth to that, the genius will have to
open policymakers' eyes. As Piccolo claims that, even with a disease as well-known in North America as multiple sclerosis,
in Brazil, "awareness is still very poor in general terms. It's still very common for people to confuse multiple sclerosis
with simple sclerosis, which is linked to some kind of dementia for the elderly population." Piccolo points to education,
awareness, access to the right information, and campaigns like his company's own "Viver Bem Faz Bem"—living well makes you
feel well—to reach out to the 30,000 Brazilians with multiple sclerosis, of which only 10,000 are being treated with disease
modifying therapies. "We usually say this number should be doubled, at least. The other 20,000 are simply not being diagnosed,"
Claudio Coracini, general manager, specialty pharma, Shire
Hagop Barsoumian, general manager of Chiesi Brazil, says that although asthma competes for resources that are already allocated
to hypertension and diabetes, only people suffering from hypertension and diabetes already know that they have basic medicines
supplied by the government. "Asthmatics," he says, "do not realize they have access, and it will take some time to make them
aware. Chiesi has the production capacity established, and we think the demand will increase over time. We will be prepared
to supply the government with our drug because it is the basic drug for asthma treatment."
This preparation dates back to 2004, when, Barsoumian says, "the federal government decided to buy a huge amount of sprays,
and, at the time, Chiesi sold 1.6 million units to Brazil—basically sprays for the whole country. That was the time they decided
to update their plans and make investments." However, the situation changed. "After that, the federal government decided to
no longer buy directly, and the rights to purchase went to the cities. The federal government and the states put some money
in, and then the cities were told to play their part. What you have today is underperforming, and the result is that asthma
is still not well-treated in Brazil," says Barsoumian.
In ADHD (attention deficit hyperactivity disorder), the situation is once again repeated. "The treatment rate is very low
in Brazil," says Claudio Coracini, general manager of specialty pharmaceuticals at Shire Latin America. "It's a relatively
new disease, and awareness is low among stakeholders. Therefore it is our role to educate everyone involved around the disorder.
On the other hand, it's important to note that ADHD treatment has been growing at 30% average annually, compared to 12% growth
in the pharmaceutical market overall. This is somewhat due to an increasing trend of parents becoming more comfortable bringing
their children to doctors for ADHD treatment." And though Coracini is still in the early days after 2011's launch of Venvanse,
he believes that, "within five years, we expect Brazil to become the third or fourth market for Shire, and a top 5 ADHD market."
And if anyone could make it happen, it is Coracini, responsible for introducing Cialis in Brazil, which has remained in the
top 3 best-selling drugs, and had far surpassed Pfizer's Viagra long before sildenafil's patent expired in 2010.
ORPHAN DRUGS: PLEASE, SIR, CAN WE HAVE SOME MORE?
Claudio Santos, general manager of HGT (Human Genetic Therapies) and Coracini's counterpart at Shire, has already illustrated
the Dickensian desire for more, having grown from six people at the end of 2007, to nearly 100 at present. But Santos' main
focus is on another orphan-related topic. "For HGT, one very important element is the basic regulatory framework, because
there is none for orphan drugs or rare diseases. Today, the rules are the same for orphan drugs as with blockbuster drugs
targeted to GPs, which means that there is significant investment and development that still needs to be done to improve the
infrastructure and regulatory framework around orphan drugs," Santos says.
Claudio L. Santos, senior regional director, medical affairs, Shire
Although there are some exceptions, notably Gaucher Disease, which is already covered by the official health system, Santos
wants to foster the development of official clinical protocols for diseases like MPS II and Fabry—not only for Shire's therapeutical
alternatives, but for all therapies available for lysosomal storage diseases. "We are working along with Interfarma because
there is not a single focal point in the MoH or ANVISA to discuss orphan drugs," Santos says. "It's hard for us—because it
simply doesn't make sense."
SWING YOUR PARTNER: DOING THE SAMBA SQUARE-DANCE
"Many companies are looking for good partners in Brazil. Why? The big companies are in Brazil. But many middle and small sized companies are looking for a certain kind of partner to enter in Brazil. What kind
of partner? An ethical partner with experience. Then the question inevitably arises: Why not choose a Brazilian company?"
asks Fernando Loaiza Sotomayor of Bagó Brazil.
Mr. Guillaume Drianno, country manager, Servier