Addressing challenges in cancer care through innovative medicines
With the diverse set of health challenges in Nigeria, especially the burden of non-communicable disease, like cancer, diabetes and heart related diseases on the rise, the need for holistic approach to address the situation remain a concern. The Country Manager, Roche Pharmaceuticals Nigeria, Dr. Oladipupo Hameed, and Head Sub-Saharan Africa Sub-Region, Markus Gemuend, in this interview with ADAKU ONYENUCHEYA highlight the challenges in cancer care and Roche’s effort in addressing the disease through its innovative medicines for treatment as well as partnership with the states and federal government for the implementation of health plans and policies to achieve positive outcome in the healthcare space.
In recent times, more Nigerians are being diagnosed late of different types of cancers with limited chances of survival. There are also the challenges of the cost of treatment and inadequate therapeutic equipment like Linear Accelerator. Why is this and how could these be addressed?
Because of the size of Nigeria’s population, non-communicable diseases will become the major focus in the next 10 to 15 years. The burden of that scope of disease, especially cancer will be prevalent in the country in the next 20 years. They are far more expensive to treat than your regular malaria and infectious diseases because a lot of them are long term.
We see that many people in Nigeria die from these non-communicable diseases, as a result also; the healthcare facilities have not yet been developed to the state where patients can properly get diagnosed or treated for many of those diseases.
Diagnosis today is one of the biggest problems, and that is why a lot of people will go outside the country to get the proper diagnosis, start their treatment, and then come back home to continue the treatment.
Also, diagnosis today has gone beyond looking at the patient, examine and do a few tests and say the patient has malaria or tuberculosis. Diagnosis today is so specific that they are able to tell you if it is a cancer, what type and stage of cancer, the genetic profile of the cancer, such that they can now prescribe the best drug for you to use.Unfortunately, we do not have those facilities here. The capacity and capability for health professionals to do their work and get the result that the patient deserves, is where the problem is.
Also, we have health insurance in Nigeria, but only about five percent of the population is on health insurance. So until we get a larger number of people, like in Kenya, they have about 50 percent of their population, then we will address this issue of cancer completely.
What measures should be taken to solve the issue with cancer treatment and prevention?
There is no other solution in any African country, including Nigeria, than to build a universal health care system that ensures every Nigerian has access to healthcare and there is coverage. For example in Europe and country like the United States, you can then depend on income level and then decide how much you want to pay out of your pocket, so that your premium to pay insurance comes down. You could pay nothing and then your premium is a bit higher or pays something and contributes when your premium is lower. But then it is unlimited payment. For instance, you can pay N20, 000 or N30, 000 a year, depending on what you choose and no matter what illness you have, everything is covered out of that pool, because imagine if 40 to 60 million Nigerians pay a certain amount into such fund, there is a lot of money available.
Secondly, And that is where we come in as Roche for partnership with the federal ministries, states, private and public hospitals, we really work on improving that healthcare system, because our drugs are administered in hospitals, so you need to make sure if you are a patient that when you go to a hospital, from the moment you enter the door with the disease, assuming it is cancer, then you get properly diagnosed and referred to the right treatment and then you can get treated. That is where we really work as Roche on the improvement of the cancer system and facilities including educating doctors, training nurses, first of all looking at proper diagnosis because often times patients are misdiagnosed, they think it is something the doctors are familiar with because they are not familiar with cancer diagnosis because it is new.
What plans does Roche have to address these issues of cancer to ensure the health system is favourable to all citizens?
Our efforts are engaging with private insurance companies to include cancer into their insurance policy, so to cover in those five percent, not just the basic diseases but also cancer. We also work on putting Non Governmental Organisations (NGOs) in place, enabling them the awareness, treatment and engage individuals to also donate money, for those who can’t afford. We can’t expect only the government to take care of this; they have their roles and needs many more stakeholders to come to the plate. In Europe or the US it was not just the government who did it, it was private industry, its just partnerships, through partnerships, solutions are found.
You recently re-launched one of your latest innovative medicines for breast cancer treatment here in Nigeria, Herceptin SC. What brought about the improvement of the new drug?
Roche stands for innovation, not only do we look for new medicines but also existing medicines, how we can improve the experience for the patient or provide the hospital or the doctor with the right medicines for treatment. You know how burdensome it is to administer intravenous, if takes a long time, it is not nice for the patient. We were looking on how we can improve administering our medicines and develop a subcutaneous technology, not just for Herceptin but also for other products that are available in Nigeria. So that for lymphoma has been turned to a medicine now administered subcutaneously and we will bring that here to Nigeria.
We want to make sure it is an easier administration and for a hospital that is very attractive, the doctor doesn’t have to run around three patients and change Intravenous therapy (IV) and look at whether everything works well. So its five minutes for a patient and a little time to observe and then the doctor can diagnose or treat other patient. It is really an improvement for the healthcare system, not just for the individual patient. And again that is the role the pharma company has, how they can reduce time of treatment and have the same effect so that doctors and hospitals can use the infusion chair for more patients and they have more time to diagnose other patients either it is for cancer or other illnesses. So when we develop medicines and then they get introduced, we look at what is working well and where we can improve. That is why we focus on Herceptin on the subcutaneous, while we look also for new medicines that will even improve the outcome of cancer care.
How would Herceptin SC improve the survival rate of breast cancer and the quality of life of women in Nigeria?
Herceptin IV like we said is not a new drug for the treatment of breast cancer, but Herceptin targets a certain receptor in the female body. That receptor it targets help to shut down a certain activity in it that makes the breast cancer extremely aggressive. Now with Herceptin SC, with the fact that it can treat and target that receptor, it has reduced the risk of death from that type of breast cancer. That is how it helps to reduce and improve survival with breast cancer cases. That is the extra benefit of having the SC formulation, but the value of the IV and SC are basically the same. It does the same thing by lowering the risk of deaths and then the aggressiveness of the breast cancer type in the black population.
In a nutshell, it makes the idea of treatment easier for the patient and more willing. After much experiment carried out, people preferred the subcutaneous formulation, because in five minutes they are done and can go home rather than stay in the hospital for hours.
Although it was a very complicated manufacturing process, and was not easy to produce this formulation that you can administer so fast without any harm to the patient. It took us a while to develop this manufacturing solution and now, not only in Nigeria but it is introduced in all other parts of the world. It is possible because we have the manufacturing capacity established. Ideally you can do the administration of this drug on your own at home, without the nurse or doctor being present
Nigeria has been battling with medical tourism and brain drain, what is wrong and why have we not succeeded in reducing it?
When you compare the Nigerian health system to others from more developed countries, where there is health insurance available for all citizens, both the public and private health insurance, which is made compulsory or at will, just like Switzerland where you can’t live in without having a health insurance, whether you have a job or not, so you pay into a health insurance system and the government or company you work for, depending on the situation, contributes. So with that there is fund, pull of money that is aggregated from everybody so that those unfortunate ones who get sick get access to those funds.
People don’t have health insurance in Nigeria and it is this basic understanding that health is such an important goods that everybody, personally should contribute to as well as the companies you work for or the government, depending… And then that money can pay for particular illnesses that are expensive to treat, like cancer, diabetes, or hypertension and the non-communicable diseases that everybody can get
I have seen statistics between 600 million and 1.2 billion US dollars which is what leaves the country in terms of medical tourism and then you think about it, that if those patients are treated here and pay for the treatment either through own means, NGOs, or in the future, through insurance, then hospitals can become a business and that is what it is in other developed countries, hospitals or treatment centres do the right thing for patients, but they are also businesses, because through more and more patients being treated and paying through the insurance, it becomes a sustainable business model.
Also, one thing that we are losing apart from money to medical tourism is that we are encouraging expertise in other countries and not here. The more our people go there, they are used for knowledge, research, and we are building the capability in other countries. Our doctors here are very good, but the more they don’t see these new diseases or new types of diagnosis, we are not helping them to even become experts in doing this and this is also an extremely important part. You find out that our doctors trained oversees are so good that foreign doctors refers people here in Nigeria. We have a situation that our people will go to the US and the doctors they see over there are also Nigerians wonder why they are not in Nigeria, only because there are no facilities here that is why they are not able to stay.
The pharma industry in Nigeria gets less attention and support from the government, how can this be addressed and as well giving them their rightful place?
The government also needs to recognise that pharma companies are partners. Everybody needs to come together into the counter space. Doctors and we work together closely on the field, we know where the problems are. Although, one needs to commend the federal government, they just recently launched the Cancer Control Plan and we were part of that. In doing anything related to the healthcare system, companies and industries need to be brought on board to also give their own knowledge and expertise in that area. I think the federal government and some state government have been doing that quite well in the recent past. Oyo state government, Niger, Taraba state government called us that they have a problem and know we at Roche have the expertise and sort for our support. That is the why government needs to work with industries, it is not all about the thing you want to sell, we have expertise, we are trained and go to conferences, we see the best practices in other countries, and we can give you clear examples of what the government is doing in breast cancer in Ivory Coast and Kenya, which are also African countries. Government needs to see industries as partners and bring them on board to support and guide and also lens their own voice policies and things like this.
Does Roche have any collaboration with the Nigerian Pharma industry to boost productivity and effectiveness?
A lot of partnership brings trust and respect, we and all other partners come together and look for solutions. We are not just a company that sells products, because you can’t be successful in the future with that, it is impossible. Also, Pharma companies have to change their business module and that is what we have done. So we view ourselves as someone that can help to improve the whole healthcare ecosystem and we have medicines and diagnostics to help them achieve that goal.
That is how pharma industries and we at Roche can contribute to making a difference. Because the discussion has to come from the price of medicines, even if the price is zero, if you don’t properly diagnose, the patient doesn’t benefit and that is not sustainable, so the solution is their role in the healthcare system, their capabilities and to find the right commercial and arrangement. That is not the issue, we believe the issue is price, but we will find the commercial solution.
Accessibility and affordability are also challenges hindering quality healthcare service delivery in Nigeria and with the goal of Roche, which is ensuring that every patients gets the right and equal treatment, considering the population of this country, how would you address this in ensuring that the treatment reaches every community?
You can see that already, through our engagement with various hospital where we have what we call center of excellent agreement, we have increased the number of patients that get access to good diagnostics and treatment, but the price is still more reasonable. When you look at Nigeria and other Sub-Saharan African countries, the cost to the patient is often times higher than in Europe and the US, which is absolutely crazy. However, often times it’s not that the price of the drugs coming into the country is higher, no, its actually always lower than in the Europe or US, a lot of them because of the supply chain, logistics, the non-regulated environment often times, in the end the price becomes very high, where there are import duties, mark ups, Foreign Exchange (Forex) supply chain, there are so many challenges, and one of our goals is that when we agree on a price for patients in Nigeria, that should also be the same price charged to the customers, not having all kinds of mark ups in between. This is what we are working on and to truly make it more affordable here as well.
The Nigerian patient deserve the same or better treatment like any patient anywhere in the world, we shouldn’t take that for granted. That is something core to our belief at Roche, that whatever is used to give a better life and outcome to anybody anywhere in the world, should be available here. Our doctors know what to do; the drugs should be there as well as the support system. The drugs can not be used just by anybody, it has to go along with the right medication, the right specialist, the right environment so that you have the right output, which is what is seen everywhere else. That is the way we are working, we are building the ecosystem and support system with whatever partner we can get to ensure that the patient at the end of the day gets the best drugs and the best outcomes.
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