Addressing Challenges: Perspectives from Innovate Health Forum 2024

In the dynamic realm of healthcare innovation, the Innovate Health Forum 2024 recently hosted a thought-provoking panel titled “Challenges in Pharma Production and Distribution” Here, industry leaders shared profound insights into the evolving landscape of Romanian healthcare. The discussion delved into how continuous innovation and investment are crucial for improving access to new treatments and elevating care standards, underscoring the vital role of healthcare in enhancing community and national well-being.

Roxana Botea, Country Director at Johnson & Johnson Romania opens the discussion with a focus on innovation in healthcare, highlighting the importance of continued investment to improve access to new treatments and care standards.

“We’re discussing innovation across many fields, in all areas, but where is innovation more critical than where it can save lives or improve the quality and longevity of life? If we talk about challenges, it’s clear, as my panel colleagues also mentioned, that in Romania, we still do not allocate the necessary budgets to have the same access to medicines as other European countries. We know we face a budget deficit that impacts health and will continue to do so, but we believe that health is practically an investment in the well-being of individuals, communities, and the entire nation.

Coming from Johnson & Johnson, where we innovate in very important therapeutic areas where we need to find solutions for conditions like cancer, hematologic, immunologic, and neurological disorders, we see how crucial it is to continue investing together with all partners in the health sector so that Romanian patients can have access to treatments and care at European standards. In 2023, we managed to introduce new compensated treatments for Romanian patients, and we are pleased to see the results of our efforts through gaining access to these treatments. We are preparing to launch four new products in 2025, and our team is very focused on bringing innovation to the healthcare field as soon as possible.

In addition, our investment in healthcare does not stop at developing and marketing treatments for severe conditions, but we also invest in initiatives aimed at educating future health specialists. I am very proud to mention here the scholarship with the University of Medicine and Pharmacy in Bucharest. At the same time, we have corporate responsibility projects like Women in STEM, now in its sixth year. We are involved in STEM fields and various projects investing in the well-being of the community where we live and operate, such as a recent reforestation action near Bucharest and various campaigns to raise awareness about the necessity of blood tests, for example. We naturally talk about prevention, which we discussed earlier, and early diagnosis, as well as other awareness campaigns like “What’s the deal with the prostate?” a campaign trying to remind men in Romania to go to the doctor to check how they are because we believe the sooner, the better, and an investment in our health is an investment for many more years of healthy living.”

Continuing the conversation, Livia Stan, Policy & Market Access Director at MSD Romania transitions smoothly to discuss specific issues in oncology, emphasizing the dire need for enhanced cancer awareness and screening, especially among women.

“If we talk about oncology, it’s evident that there aren’t as many campaigns, and I think it’s excellent that there are specifically to show the importance of going for check-ups.

We need to be aware because there are over 100,000 oncological cases each year in Romania. Each of us has a family member or a friend who is affected by cancer. This means a quarter of a million people are affected because we are either relatives or somehow involved in the journey of oncology patients. We try to help and support them, which means that every year the Romanian state loses a lot of money because these patients are out of the social and economic system, and their relatives accompany them through hospitals and struggle to help them. At one point, it was calculated that among these, 45,000 are women every year. Since you asked about our chances and how we can better understand this disease, it is indeed harder for women because the main cancers are those related to the breast and cervix. It is difficult in certain social environments for them to admit they need help to go to the doctor, and they also lack the financial support to afford quality treatment.

Unfortunately, access to treatment needs to be as quick as possible, but in Romania, this does not happen because we still have delays in the early detection of cancer types. For women, very few have access to a breast mammography compared to other European countries, where about 75% of women admit they have never had the chance to undergo such a check compared to 11%, which is the European average. It’s an incredible figure. Regarding the Pap smear test, which can identify lesions and prevent cervical cancer, in Romania, still 45% of women have never undergone such screening, while the European average is around 10-11%. The fact that we don’t have enough health education in Romania raises the question of who is to blame. We return to the old dispute that we must have health education in sexual education, and whether there are sufficient material resources to reach these women with information, screening, treatment, and psychological support to help them ultimately in this disease.

Unfortunately, Romania holds the top positions in Europe in the number of detected cancers and in mortality caused by them. Consistent with what I was saying, if they haven’t already left the country to work and receive treatment in other countries, they die in Romania. The Romanian economy is affected, and then we cannot cope, there are many sick leaves, not enough money is collected for the National Health Insurance Fund.”

Building on the challenges highlighted by Stan, Mihai Fugarevici, Country Manager at STADA Romania elaborates on the pharmaceutical industry’s role within the healthcare system and its current struggles due to financial constraints.

“I see the Romanian healthcare system built on three pillars: one obviously is the medical staff, including doctors, nurses, pharmacists, etc. The second pillar is represented by the administrative structure, and we discussed earlier about more or less efficient hospitals, and so on. The third pillar, which I see as equally important and about which we talk the least these days, is the medication itself—the pharmaceutical industry. Ultimately, when a doctor faces a patient, he goes through a diagnostic area, investigates the case in a hospital unit, and then it leads to treatment, which at that point involves the pharmaceutical industry. If you ask me, the pharmaceutical industry is a strategic pillar of the healthcare industry, and we need to keep that in mind. Unfortunately, if we take a closer look at the healthcare system, we will find that the largest part of this system’s expenditure is the administrative part and salaries, not entering into salaries because that’s a very sensitive area, and we understand why it’s sensitive. And of course, there are challenges that both I and my colleagues face when we talk about employees, the administrative part which consumes a lot from the health budget, and unfortunately, there remains a very tiny slice for the medication budget, which in itself represents treating patients.

Somehow this industry needs to learn to survive with the remaining funds because, unfortunately, the first two budget elements are very fixed, and the salary part is not only fixed but increasing. The challenge of the industry at this moment, and unfortunately, there are only two solutions I see here, one with these eyes in the budget, and we control how much of this budget goes towards the administrative and salary area so that we also leave the actual treatment of patients. We try to optimize expenses; a budget which anyway is below, let’s say no matter how much you optimize it, it’s never going to be enough, and there will always be problems. I think my colleagues have touched quite well on the budget allocation area, and it’s clear that Romania needs to move much closer to the European average of 9% GDP allocation towards health. But we must also look at the optimization area because, unfortunately, optimism is weighted from the perspective of budgetary increase towards health, especially under current economic conditions. Therefore, the medication of patients needs to be looked at quite carefully, and I say this because I am certainly a fan of innovative medication; the company I represent also has a portfolio of innovative drugs and a portfolio of generic drugs. We understand both sides of the barricade at the same time.”

Liviu Ungureanu, Managing Director of PlantExtrakt shifts focus towards the dietary supplements and parapharmaceutical sectors, stressing the importance of communication and practical solutions in health promotion.

“We were talking about innovation and the challenges that exist in the market. From my point of view, a significant challenge is communication and the focus on solutions. I see it, I’m a more practical guy, the most common word is ‘must’—it sounds good, ‘we must do this,’ but it doesn’t give you any responsibility. And there are three words that are harder to say: ‘I love you,’ ‘thank you,’ and ‘I’m sorry,’ you can rarely say these. So, we should be doing certain things. It sounds very interesting, but how do we do it? And this is again very important. We were talking about communication in the area where our company operates, we also have products from classical medicine, so to speak, because we are the only producer of homeopathic products in Romania. But our core business is indeed on the side of supplements, and maybe we don’t have as many interactions with hospitals, but we do with pharmacies and health food stores. When I talk about communication, first and foremost, we should see the system in Romania, whether we Romanians want this or not because we are talking about the Health System, which is part of an entire system.

We were talking about innovation, and in the discussion with innovation, our concern as a manufacturer has always been to come to market with products that we say promote clean health produced from organic plants without other ingredients that could affect other organs, no offense but there are drugs that treat something but can affect something else, in our case it’s not necessarily a problem, it’s very hard, it’s not simple because you have to go towards the needs of the person, but on the other hand, as my other speakers said, you have to look a little on this production side and what you can do. So, what is what encompasses intelligence, labor work, laboratory work, cannot be cheap, it’s impossible, it cannot be, and then to say one of our concerns which I could say is also a challenge because it’s a theme of the interview, is how we manage to make these innovative products but also at a fair price for the person who purchases, and I think that’s a challenge in the industry because at least in recent years, the cost of raw materials, labor, not to mention taxes, and so on, yes, businesses are done with money, but not necessarily in our company’s DNA is only this financial part, but we are very much applications towards consumers, towards patients.”

Shifting the focus to the governmental perspective, Michel Eschenbrenner, General Manager at Servier Romania, who joined the conference online, offers insights into how strategic long-term planning and increased investment in health can catalyze substantial economic benefits.

“For Romania to reach its economic potential, the health of the population must be treated as a national strategic resource – better health results in stronger and sustained economic growth. Innovation in medicine, the current rapid progress observed in the development of innovative, life-saving medicines, plays a crucial role, increasing quality of life and productivity, reducing the burden on caregivers and the healthcare system. Recent statistical data shows that more than 30% of advanced countries’ economic growth over the past century has been attributed to improved population health.

It is estimated that between 2020 and 2040, improvements in health indicators can add about $12 trillion to global GDP (an increase of 8%). In Romania, improving population health could add $26 billion. USD in the economy by 2040, an additional 9% to GDP, which means an acceleration of GDP growth by 0.4% higher each year. Adequate financing in healthcare is an investment in the health and future of society, with a return of $2 to $4 earned for every dollar invested in health. Reaching a budget allocation of 9% from the GDP for healthcare would bring us closer to the European standards and it is essential to cover the real needs of the patients and of the healthcare system.

Looking at the gap we have in healthcare indicators compared to the European average, we must say that there is a critical need to reverse quite fast these indicators. Romanians’ mortality is extremely high from causes that could be treated or avoided. Both the mortality rates from treatable and avoidable causes are well above EU averages. A Romanian who has reached 65 years old, either male or female, has only 4 years of healthy life left, twice less than the European average. On average, a citizen of the European Union enjoys 64 years of healthy life if he is a woman and 63 years if he is a man. However, if from Romania, a woman will be only 58 years old, and a man 57 years old. Romanians’ life expectancy is the third lowest in the EU: 75.3 years, compared to 80.7 years, the European average. Cardiovascular disease accounts for the most deaths from the non-transmissible diseases, with 17.9 million people annually, followed by cancers (9.3 million), chronic respiratory diseases (4.1 million) and diabetes (2.0 million, including deaths from kidney disease caused by diabetes). Over 24,000 Romanians die annually from diabetes-related causes, a number similar to the population of Sighisoara. Reducing deaths from preventable and treatable diseases is paramount for achieving a higher life expectancy, closer to the European average and steps to be done are in the fields of education, prevention, timely access to innovative treatment, for diseases with major impact. Early detection, screening, treatment from the early stages, and palliative care are key components of the response to bring back years for the suffering patients and advances in the legislation as the National Cancer Plan and the law for Early diagnostic and prevention for Diabetes are great initiatives – we hope to see their norms of implementation and the proper financing for these very soon.”