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Is the Greek pharmaceuticals and healthcare sector, once a strong bridge between Europe and the East, on the mend after suffering the recent ravages of the global financial crisis and subsequent austerity policies?
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Greece is a country with a glorious history: the cradle of Western civilization and world-renowned for its contributions to art, culture and politics. In modern times, the Greek pharmaceuticals and healthcare sector too once had a global reputation as a bridge between Europe and the East, with positive economic indicators, and a burgeoning domestic market. However, the ravages of the global financial crisis and subsequent austerity policies have made Greece in 2017 a much trickier market to navigate than ever before.
The importance and significance of the Greek pharmaceuticals industry has long been much appreciated by those in the know. Comprising the second largest sector of the entire national economy, and providing some 26,100 jobs directly, and a further 87,000 indirectly, the pharmaceutical industry's "total combined impact on GDP is estimated to stretch to as much as EUR 7.55 (USD 8.06) billion," according to Mihalis Himonas, general manager of the Hellenic Association of Pharmaceutical Companies or SFEE. "We're talking about what is undeniably one of the critical pillars of the country's economic future, especially given the sector's strong competitive activity, as well as its latent potential for soaring growth rates in the years to come."
Alexis Tsipras, prime minister
None of this disguises the fact, however, that the local industry has taken a real hammering in recent times. "It's important to recognize the extent to which the Greek market has been disfigured by the country's financial and banking woes. Prior to the crisis Greek pharma could legitimately claim to be the sixth largest market in Europe, on a par with or even outperforming other, small yet sophisticated, markets such as Belgium, Switzerland and Austria," wistfully reflects Christos Dakas, managing director of Shire Greece and Cyprus. "Even back then, there were some serious question marks about the local market's long-term sustainability especially given the distinct lack of proper spending controls," he admits, "but what we have witnessed subsequent to the imposition of austerity measures has been both dramatic and traumatic: the downsizing of public expenditure on pharmaceuticals from a heady EUR 5.2 (USD 5.55) billion in 2009 to a mere EUR 1.945 (USD 2.08) billion today!"
Andreas Xanthos, minister of health
Indeed, the sheer vigor with which successive Greek governments of all stripes and colors have set about slashing public expenditure on healthcare has been absolutely unprecedented. In the words of incumbent Prime Minister Alexis Tsipras, "the bailout choices and reforms imposed upon Greece by its creditors have been akin to placing a nuclear bomb under the foundations of our national health service." According to the Foundation for Economic and Industrial Research (IOBE)'s latest statistics, public expenditure for healthcare now stands at EUR 8.7 (USD 9.29) billion, representing a 45.7 percent decline since 2009 with private expenditure also enduring a tortuous slide during the same time period. "When Greek hospitals are running out of bandages, the only bit of budget not being attacked by the Troika is military expenditure," laments former Finance Minister Yannis Varoufakis.
Bersimis Sotirios, president, EOPYY
"There have been meticulous efforts on the part of Greece's governing classes to sternly stay within budget as part of the stringent 2014 reforms mandated by the European Union and quite frankly this trend is expected to continue for the foreseeable future," observes Athanasios Athanasiadis, head of the IOBE's Health Economics Observatory. Indeed, barely one year into the implementation of an extensive 3-year restructuring and service optimization plan for Greece's National Organization of Healthcare Services Provision (EOPYY), one of the largest state insurance systems of its kind in Europe, it's president, Bersimis Sotirios, can already claim to have produced "savings of more than 200 million euros with a lot more to follow."
"The total healthcare spend today accounts for 8.2 percent of GDP, which is a testament to the fact that there continues to be sustained investment into the sector, but the total value of the Greek pharmaceutical sales has plummeted to EUR 5.6 (USD 5.98) billion, represented by sales of EUR 4.1 (USD 4.38) billion to pharmacies and retailers and EUR 1.5 (USD 1.6) billion to hospitals from a high of EUR 8.2 (USD 8.75) billion prior to the onset of recession," elaborates Athanasiadis.
Michael Massourakis, chief economist, SEV (Hellenic Federation of Enterprises)
This deterioration in fortunes has been alarming for patients and private industry alike. While Prime Minister Tsipras describes his country's compromised access-to-healthcare situation as "provoking nothing short of a humanitarian crisis," pharmaceutical players, for their part, deplore what they see as the arbitrary nature of the cuts. "The government's commitment to capping the public pharma budget to one percent of GDP is absolutely nonsensical...that particular metric only works when a country's GDP is at its peak and stable, and enjoys the potential for growth, But in the context of Greece where the GDP is continually contracting and has already reduced to 25 percent of its original value, these sorts of criteria lose their relevance and rationale," argues Astellas' managing director, Harry Nardis.
Philippe Lambrinos, managing director of Pierre Fabre is equally forthright. "The budget appears to be arbitrarily determined without taking into consideration the real needs of Greek patients and the fact that it keeps being lowered year per year is wholly out of touch with reality...In every civilized country, the trend has been for healthcare and pharmaceutical expenditure to increase every year as costlier, new generation, sophisticated products enter the market. This regressive trend is thus clearly unsustainable," he declares.
Pascal Apostolides, president of SFEE (Hellenic Association of Pharmaceutical Companies), managing director, AbbVie
Even more concerning to the industry is the elaborate array of mechanisms established to deal with any overspending above and beyond this 'closed' and restricted public pharma budget. "The ceilings put in place are purely and simply insufficient to respond to the burden on tertiary healthcare and the soaring numbers of uninsured people so expenditure frequently spirals out of control with the excess spending covered on one hand, by the patients themselves whose out-of-pocket costs have tripled and, on the other hand, by the industry via rebates and clawbacks to the point where as many as one in four medicines prescribed are now paid for by none other than the pharma producers themselves," explains the SFEE's Mihalis Himonas.
Mihalis Himonas, general manager, SFEE
"In line with the most recently released figures, we now have a curious situation emerging in which the drug makers and developers are effectively being forced to shoulder some EUR 615 (USD 657) million in clawbacks and EUR 318 (USD 340) million in rebates so it's difficult to imagine how they can remain financially stable if this climate endures much longer without at least some firms pulling their products from the market or reigning in their investment," reasons AmCham's executive director, Elias Spirtounias.
Already signs are afoot that these sorts of tendencies are occurring. "Sustainability rates have now dropped to such a low point that it is increasingly difficult to continue investing as much as we would normally like to... To date some 13,000 people have lost their jobs in the local marketplace and this is because the cost of doing business has become unaffordable," reveals Janssen's managing director for Greece and Cyprus, Efthymios Papataxiarchis.
Theodore Tryfon, president of PEF (Pan-Hellenic Union of Pharmaceutical Industries)
While the concepts of the 'clawback' and 'rebate' are increasingly common features among the crisis-hit economies of Southern and Eastern Europe and today represent policies that most industry stakeholders have belatedly resigned themselves to, the way in which these measures are being implemented in Greece has been causing deep concern. "The general sentiment expressed by private industry is that we are not wholly against horizontal measures such as clawbacks and rebates, just so long as they constitute balanced, transparent, residual measures following the implementation of structural reforms aimed at establishing a rationalized healthcare system...Our grave worry in this particular instance is that they are being applied in isolation from the other very necessary steps," explains Anne Nijs, managing director of Roche Hellas.
"By definition, a clawback is a temporary measure put in place when a target is exceeded and there needs to be contributions by the pharmaceutical industry in order to share the burden. Ideally, the state should put targets that are realistic and clawbacks to be paid by the industry should cover a reasonable excess, ranging from two to five percent. Equally the theory underlying the imposition of a rebate mechanism should be about the industry providing discounts commensurate to their volume of sales," reasons Pascal Apostolides, general manager of AbbVie and president of the SFEE, before going on to note that, in the Greek context, both policies are being misapplied. "In the local market, both mechanisms have ended up as a perfect excuse to avoid highly necessary structural reforms," he claims.
Dimitris Anagnostakis, general manager, Boehringer Ingelheim
Furthermore, the blanket way in which the clawback has been enforced appears to disproportionately disadvantage companies serving the hospital sector or providing therapies for rare disease as no distinction is made between different categories of pharmaceuticals. "Under the present legislation, when two innovative products enter the market – say for oncology – and they exceed the budget, the entire industry shoulders the burden of this excess, not just those with oncology products. This broad-brush measure is clearly hurting smaller players like us in plasma who already have low margins in the first place, by virtue of the nature of our product...we are thus appealing for the exclusion of highly-specialized medicine such as plasma products, orphan drugs, HIV and growth hormones from the closed hospital budget because there are no false demands for these medicines given the small patient pool," argues CSL Behring's general manager Marianna Konstantinidi. "Simply not enough is being done to differentiate the characteristics of rare diseases and orphan drugs that merits them with a stronger sense of urgency, as opposed to other 'normal' pharmaceutical products," emphasizes Shire's Christos Dakas. "Given the nature of Shire's business, many of our products for rare diseases are reserved for hospital use only and therefore the limited budget has had an impact on the pathway of treatment for the patients that urgently require these life-altering drugs...it's our strident belief that these products should be granted exemption."
Panagiotis Giannouleas, general manager, Angelini Pharma Hellas
"As far as I personally read the situation, these short term horizontal measures were imposed with immense haste and there was a complete lack of foresight on their implications and likely impact to the industry. In essence, the government agreed a target with the creditors and then opted for the easiest route to fulfilling that target without due consideration of the detrimental knock-on implications for patient outcomes, innovation and long-term prosperity," confides Konstantinidi.
The clamor of voices that share this viewpoint is widespread. "One cannot help thinking that Greece is being led down a false path to recovery... endeavoring to correct the system merely through successive clawbacks, rebates and price reduction tears down the pathway to healthy growth in the long-run. If the administration continues to insist on persevering with this myopic and narrow approach solely focused on cutting prices, then we are soon going to witness new problems coming to the fore," affirms Theodore Liakopoulos, head of Johnson & Johnson Medical and chairman of the medical devices and diagnostics committee within AmCham. "Those in power may have adapted expenditure, but little has been done to actually change the system. Greece today is afflicted with one of the lowest Healthcare Quality to Expenditure ratios in Europe. We are spending less and what we spend, we spend less effectively which effectively means we've focused so much on cost that we have forgotten about quality and outcomes," he stresses.
Harry Nardis, general manager, Astellas
"Perhaps the most disheartening aspect is that many of us are finding it hard to see the light at the end of the tunnel," confesses Marcos Gerassopoulos, country chairman of Sanofi, "What we thought were going to be temporary measures are increasingly taking on an aura of permanence."
In the words of Angelini's general manager, Panagiotis Giannouleas, the entire exercise of "hasty price slashing" is looking increasingly "counterproductive." "The Greek market is experiencing the deployment of horizontal measures on a scale never experienced by any other EU member state and we have now reached a point in which their impact is going to be much lower than the desired results...there are very low expectations to be achieved from this tactic from now on." While he applauds a proposal currently under consideration to reduce the clawback by 30 percent annually for the next three years, he fears that the government's obsession with price will just lead to a ratcheting up of the rebate: the type of "financial sorcery that merely shifts the same financial burden just through a different source."
Thanos Athanasiadis, research associate, Health Economics Observatory, IOBE
A fundamental concern for many innovator drug developers is that the disproportionate emphasis on price slashing will result in a situation where novel, state-of-the-art therapies are no longer entering the market, which would be an especially hard blow given Greece's hitherto decent reputation for market accessibility. "Until now we haven't experienced any obstacles in launching innovative products, but this might soon change because there have been discussions underway about implementing an additional clawback of 25 percent for first-time, innovative medicines being released into the market," observes Stavros Theodorakis, managing director of Chiesi Greece and Cyprus.
Konstantinos Kofinas, managing director Greece and Cyprus, Merck
Already with regards to internal decision-making, some firms are deciding against launching some latest-generation therapies. "We have, for example, a product in our global portfolio called Glybera-widely heralded as one of the first gene therapies ever approved-but it is far too expensive to become a financially viable product in Greece at the moment. Taking into account the size of the market and the effects of the crisis, the average citizen simply cannot afford such high-premium innovations in the current context," admits Theodorakis.
Most innovator firms would like to see a shift away from the price-slashing emphasis of policy-making and a gravitation towards focusing on the value-contribution of each specific product or product category. "We hope that the Ministry of Health will listen to our objections and counter-proposals and will work out a legislative framework which will protect patient access to new therapies by expediting the evaluation of these therapies through Health Technology Assessment (HTA) and that the state will then enter into the most optimum reimbursement schemes based on successful experiences from other EU member states such as managed-entry accords, price/volume agreements or risk sharing," declares AbbVie's Pascal Apostolides.
Anne Nijs, general manager, Roche Hellas
Leveraging HTA, however, raises it own problems when there is no existing national agency in place possessing the capabilities to carry out that function. "Current proposals mandate that products must be available in 14 other countries, seven of which must have a HTA protocol, before they can enter reimbursement on the Greek market, which is tantamount to ensuring an additional delay of at least two years!" exclaims Merck Hellas' general manager, Konstantinos Kofinas. "This procedure, combined with the 25 percent clawback, would represent a considerable motivational deterrent for companies who would otherwise be very inclined to bring their latest innovations to market," confirms Dimitris Anagnostakis, general manager of Boehringer Ingelheim Greece. "When you consider that the life span of your average pharmaceutical product is only around ten years, a delay of as much as four years in total when securing the market access is going to considerably compromise the potential revenues to be made from that product," he adds.
Aside from the delays that such a system would trigger, many stakeholders are quick to point out that this kind of referential HTA mechanism can never be properly fit for purpose. "Emulating the outcomes of other European HTAs is problematic because the needs of other European patients are not necessarily reflective of the needs of Greek patients. The model really needs to be adapted for the Greek demographics to be efficient. Attempting to replicate HTA outcomes in the UK, for example, is completely irrelevant because the cost of hospitalization and relevant treatments differ radically...As a collective, we would gladly welcome a local HTA process wherein innovation is evaluated diligently for the value that it offers," advocates Astellas' Harry Nardis.
Amgen, for its part, has also been calling for a localized in-country HTA apparatus capable of ensuring therapeutic protocols that specifically cater to the needs of the local market. "We are a strong proponent of the idea of more localized solutions such as a Greek HTA and having the decision-making power stay within the country," reaffirms the company's general manager Matti Arvela. "As an innovative company with a strong emphasis on biotechnology, we are firm supporters of a system wherein value is acknowledged and differentiated and would very much like to see a holistic and local market specific approach adopted in Greece that sheds light on a product's added-value, impact to patient, and the long-term savings in avoiding hospitalization along with a health economics perspective of its opportunity costs."
Government stakeholders, meanwhile, are eager to stress their desire for collaboration and demonstrate that they have taken these comments on board. "The plan is very much to build our very own HTA system, but this will take time...our ultimate goal is to design a new national policy on pharmaceuticals, a new powerful social contract between the State, society and the pharmaceutical market organizations," divulges Health Minister Andreas Xanthos.
Makis Papataxiarchis, managing director, Janssen
Despite the perceived difficulties of the Greek market, pharma firms have nonetheless continued to exhibit great commitment and staying power. "Regardless of the challenges posed by the financial squeeze, most actors are perceptive of the underlying potential of this important market and acknowledge that there are no shortages of patients with inelastic needs that need responding to," reflects Merck's Konstantinos Kofinas noting that "the big multinationals have not been panicking and resorting to large-scale layoffs or fleeing the market."
Amgen's Matti Arvela, reasons that firms will always be loath to retract products from the market unless they consider it absolutely necessary because "once you've taken a drug out of the market, it typically takes more than double the time of the retraction for products to be reintroduced, and that's not counting the additional complication of needing to re-instill the trust of the consumer."
Theodore Liakopoulos, general manager, Johnson & Johnson Medical Devices
How then are firms going about coping with the intricacies of these abnormal times and uncertain revenues? What are their survival strategies? Many outfits have been responding by hedging their bets and diversifying the sources of their revenue streams. "We mitigate the challenges by having a balanced and diversified portfolio. We do not want to be dependent on just one or two molecules. Moreover, we also try to keep a balance between in-licensed products and our own development. For the latter, we have more control over the costs of the products, whereas for the former, we can access market segments where we do not have capabilities of development and production," discloses Aris Mitsopoulos, vice president of indigenous success story, Rafarm.
Elias Spirtounias, executive director, AMCHAM
One popular strategy is to amass an OTC portfolio that can offer some respite from the onerous taxation on prescription products. "We've actually made it a strategic focus to grow the OTC side of our business from 18 to 30 percent of our total sales...Though the OTC portion in Greece is currently below global standards, the fact that these products are insulated from clawbacks and rebates adds to their value as revenue generators... our own OTC portfolio is now bringing in some EUR 3.5 (USD 3.75) million up from EUR 1.2 (USD 1.28) million five years ago courtesy of our star product Tantum Verde," recounts Angelini's Panagiotis Giannouleas. "I think finding ways to invest in the healthy part of the system is imperative, which in Greece right now translates to the OTC segment...our action plan for mitigating the crisis is to invest in sub-segments in the market lacking price controls and where the supply looks less volatile," concurs Pierre Fabre's Philippe Lambrinos.
Marianna Konstantinidi, general manager Greece & Cyprus, CSL Behring
For others it's as much about re-thinking the business model and conforming to the "new rules of the game."Anfarm's CEO, Eugenia Nicolaou, gives one such example. "We are right now busy calculating down our prices, which stands to the complete contrary of the situation years back when we were not allowed to engage in discounts...Whereas formerly we used to sell directly to hospitals and the prices were fixed and frozen, nowadays we are compelled to compete in small tenders, according to the characteristics of each hospital and region and we're becoming increasingly cognizant of the fact that this kind of competition is fiercely premised on cost," he recounts.
Even the way firms are tracking and engaging with their customers is being reconsidered under the new strictures. "Companies are turning to us for reliable go-to-market strategies that can withstand the uncertainty of the business climate. Within this context, they are, in particular, seeking out sales force optimization methodologies and multi-channel avenues," perceives Nikolaos Kostaras, general manager of QuintilesIMS.
One sub-sector where Greece remains highly resilient is the arena of in-country drug fabrication. 55 percent of the drugs in Greece are imported, whereas the rest are manufactured locally. Of that remaining proportion some 16 percent tend to be local (largely generic) brands while the remaining 29 percent represent contact manufacturing assignments for multinationals. "Many indigenous pharma firms possess strong manufacturing capabilities, with 27 plants currently under Greek ownership. Capitalizing on this strength, many multinational companies elect to partner with local Greek companies for their manufacturing needs, not only for the domestic market, but for exporting internationally," explains the SFEE's Mihalis Himonas.
Marcos Gerassolpoulos, managing director, Sanofi
"Drug manufacturing enjoys the distinction of being one of very few parts of the national economy still attaining significant growth with Greek outfits exporting on a regular basis to 141 different countries," analyzes the IOBE's Athanasios Athanasiadis. "This is down to the fact the Greek brand is trusted, not only in terms of meeting quality standards, but also in creating innovations that are pragmatic and customer-centric. For example, much of the ingenuity boasted by manufacturers here is in making products more user-friendly and effective, as opposed to the chemical-level innovation boasted by other research hubs in Europe," he elaborates.
Of the few multinationals with their own in-country manufacturing footprint, one company stands high above the others in its level of commitment, namely Boehringer Ingelheim. "For our production portfolio, more than 20 products are produced in Greece ranging from products for diabetes to antihypertensive and anti-inflammatory medicines. 70 percent of production is dedicated for exports, whereas the remainder is geared for the local market. Furthermore, plans are underway to expand our facility and site through an investment of EUR 40 (USD 42.7) million, mostly driven by our high-performance diabetes therapies," recounts general manager, Dimitris Anagnostakis.
Nikos Kostaras, general manager Greece, Quintiles IMS
When pressed on why his company has selected Greece above others as the optimum destination to make such investments he cites the Greek pharmaceutical landscape as "being laden with talent and promoting an impressive culture of dedicated physicians and scientists." "As a European market, the standards that we hold are on a par with some of the most advanced scientific environments in Europe so it makes sense to be utilizing this potential," he opines.
Michalis Massourakis, chief economist of the Federation of Greek Industries (SEV) concedes that "Greece's technically gifted, smartly educated labor force, sound infrastructure and a well forged reputation for quality" all win the country plaudits, but stresses that there is "no room for complacency when having to face down competition from cheap-labor neighbors such as Bulgaria and Romania." His opinion is that more could and should be done to safeguard one of Greece's "golden industries". In particular, he singles out how "high energy costs make it difficult for manufacturers to operate to optimum performance."
John Bouros, CEO Alvion Pharmaceuticals
Perhaps what differentiates many Greek manufacturing firms most from their counterparts in neighboring European member states, is their particular flair for extroversion and looking beyond national borders. Vassilios Katsos, president and CEO of one of Greece's most iconic and recognizable drug developers, Pharmathen, explains how his firm's staunchly outward-looking orientation has enabled it to develop to the point where it now proudly accounts for almost one percent of Greece's entire export and boasts sales of over EUR 200 (USD 213.5) million. "Understanding the distinction between merely conducting exports and being an outward-looking company has been a fundamental driver of our success," he discloses. "In the latter instance, this characteristic becomes embedded in the organization's DNA, which influences investment activities and overall corporate mentality," he avows. In this way, Pharmathen has deftly managed to blend "the culture of leadership and strong vision that is emblematic of a family business, whilst incorporating mechanisms for efficiency and expansion that is characteristic of the high-performance global business world," he concludes.
Stavros Theodorakis, president & managing director, Chiesi Hellas
Nor is it just those possessing hard manufacturing assets who have managed to leverage this timeless tradition of Greek extroversion. Olympias have achieved success by being "one of the first to look at international markets for exports and expand our operations" in the logistics field, according to GM John Kandvlis while PharOS started out in the early 2000s primarily as a pharma consultancy offering product development assistance and regulatory guidance to local producers who had well established themselves in the generics segment, but lacked the expertise to spread their wings and take their brands abroad. "Then in 2005, we resolved to set about conducting our own product development instead of just fulfilling those services for others so set about re-wiring our business model into what it is today: a privately owned generics company marketing value added pharmaceuticals with a global portfolio of over 50 products and a record of having successfully secured over 5,000 market authorizations worldwide," narrates managing partner, Stella Koukaki.
Eugenia Nicolaou, CEO, Anfarm
"Rather than possessing our own fabrication facilities, PharOS struck upon a winning business model by which we partner with entities that own the hard assets, but lack the expertise and know-how to secure the marketing authorizations for their products. We can leverage the inherent flexibility that derives from not having our own in-house production sites, to select the optimum country and manufacturing partner for the particular task at hand and this affords us a certain degree of competitive advantage," she points out.
With such a strong track record in synthetic drug manufacturing, one might be forgiven for assuming that generics hold a dominant position within the local market. However, this is far from the case according to Janssen's Efthymios Papataxiarchis who draws attention to the "sheer perversity of a situation in which the country afflicted with the most serious economic crisis within Europe, at the same time registers some of the highest prices of generics and an abnormally lowest penetration rate of only 22 percent volume."
Stefanos Agiopoulos, country marketing and sales manager, DHL Greece
What this low starting base means, however, is that the government's target penetration rate of 60 percent would almost certainly generate a sizeable impact all round if attained. "A higher penetration of generic products would translate into substantial savings for the healthcare system and, moreover, in an economy with about 25 percent unemployment, having a greater generic presence also means an increase in local production, as the vast majority players in the generic sector are indigenous Greek companies," muses Theodore Tryfon, president of the Panhellenic Union of the Pharmaceutical Industry (PEF). "As a fast-acting remedy to the national health system's financial unsustainability increasing the uptake of affordable but quality generics is exactly what the doctor orders," he jokes.
Vassilios Katsos, CEO, Pharmathen
Many of the local players are certainly placing their faith in that eventuality. "We are currently living through a transformative time in the pharma sector and I am confident that generic medicine will be one of the key players to drive the change," predicts Anfarm's Eugenia Nicolaou. One such player that is betting big on the forthcoming "normalization" of Greece's generics market is a start-up called Alvion, which shrewdly aspires to harness the current distressed market conditions, to propel itself along the path of becoming a Greek multinational.
Stella Koukaki, managing partner; Panagiotis Panagopoulos, managing partner research and development; Theodore Panagopoulos, partner, PharOs Ltd
"Right now, we are witnessing a fundamentally new way of thinking beginning to emerge locally with regards to the role of generics in the market and this will necessitate a radical rethinking of existing business models....The local industry is compelled to evolve rapidly and rethink its standard operating processes to bring itself more into line with the norms of Northern Europe and this, in turn, presents unparalleled opportunities for forward-thinking and proactive entities like us...There can be no other pathway. Alvion is all about grabbing this opportunity by the horns and being a first mover in adapting to the newly reconfigured landscape," bullishly proclaims the company's CEO, John Bouros.
John Kandvlis, general manager, Olympias Logistics, Greece
As the Greek economy lurches down the long road to redemption, many onlookers are left contemplating when the country's once glorious pharma and life sciences industries will be able to shine once again. On the ground, the mood tends to be broadly optimistic. Angelini's Panagiotis Giannouleas identifies some green shoots of recovery in incremental reforms such as the adoption of "one of the most sophisticated electronic prescription systems around." Meanwhile Alvion's John Bouros rightly notes that, not only is "a sense of change finally in the air," but that Greece still "possesses intact many highly sought after attributes ranging from a wealth of technically skilled scientists to quality medical infrastructure, a manufacturing track record and an internationalist spirit uncommon for the region."
Manufacturing facility, courtesy of Rafarm
But against these positive assertions a counter-narrative lingers poignantly articulated by Boeringer Ingelheim's Dimitris Anagnostakis who frets that, "As we become increasingly cognizant of the length of time of this crisis without encountering any kind of signs of a definitive end in sight, fears will accumulate that this crisis may no longer represent just a phase, but rather the new status quo of the Greek economy." In the concluding words of ZeinCRO president, Konstantinos Karakostas: "It is a profound pity to witness a country with such obvious relative advantages not yet being able to fulfil its true potential... The brute fact is that we possess all those right ingredients, but are still missing the glue, as in a proper holistic action-plan, to blend those elements together."