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Transforming healthcare through diagnostics

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Throughout its 125-year history, Roche has grown into one of the world’s largest biotech companies, as well as a leading provider of in-vitro diagnostics and a global supplier of transformative innovative solutions across major disease areas. Since the company’s founding, it has been developing innovative solutions for a wide range of chronic and life threatening health conditions that continue to revolutionize healthcare.
As the firm continues its commitment towards developing medicines and diagnostics that improve people’s lives, Capital’s Groum Abate reached out to Dr. Allan Pamba Executive Vice President, Diagnostics Roche Africa for in-depth insights on the pharmaceutical firm’s progress in the continent. Excerpts;

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Capital: What is Roche and how has it worked in Africa?

Dr. Allan Pamba: Roche is one of the top five leading global pharmaceutical companies. At Roche we focus on finding new medicines and diagnostics and then utilize data-based insights to evolve the practice of medicine that help patients live longer and have better lives.
We have been around for 125 years experience and specifically in Africa we’ve been around for over 70 years. We have a presence in Africa in more than 40 countries with actual physical presence in 12 countries. Our greatest contribution to society is long-lasting innovation. By gathering insight from data and developing new medicines and diagnostic tools, we ensure the right treatment reaches the right patient at the right time for the right value. From my end, I work in the diagnostics division.

Capital: Can you tell us about your investment in Africa?

Dr. Allan Pamba: We have offices in 12 countries with our biggest presence at the moment being in Egypt, Morocco and South Africa. In South Africa, we have a scientific center, where we do a lot of training particularly in; laboratory technologies, policy in the area of diagnostics, lab management, and so on. We also have a research facility which is a fairly new huge investment which we made recently. In the facility, we do a lot of gene sequencing work which goes on to support countries beyond Africa. All in all, we are continuing to grow our presence in Africa. And at the moment we have in the diagnostics division a big 10 year ambition for Africa.

Capital: There are new medicines and equipment coming out every day. So how can Africa get access to these new equipment or medicines?

Dr. Allan Pamba: By having a physical presence in the continent we are able to connect with all the right key stakeholders, be it in government or in the private sectors, to make them aware of all the new technologies that are coming out.
So having these stakeholder engagement platforms enables us to share information with ease. Second, with respect to diagnostics in particular having a big ambition in Africa means we are going to have to talk to a lot more partners about their diagnostics backbone in their country and understand their plans. Following that we are best suited to then understand how we can work best together to achieve those plans to strengthen the country’s diagnostics by working with the government.

Capital: Diagnostics needs expensive equipment and most people in Africa can’t afford this. How can you manage to get these things to the poor people in Africa?

Dr. Allan Pamba: Health equity is a huge priority in our agenda since we live in a world that is very unequal. And mostly the middle classes that are a small proportion of people can pay their way through health care. But the majority of people in Africa more than 80% fall below the middle class and so affordability become a challenge. There are two points that I will make to this. Number one is we will be advocates for patients. I believe that we can put more investments in health care; governments can allocate more investments into healthcare so that affordability for the 80% who are not in middle class begins to be addressed. So that is one side of things. So let’s talk about how we invest more in healthcare maybe more towards the Abuja declaration, I.e. 15% of GDP. And then under that how do we put more of the health investments into diagnostics so that there’s a better balance between money going into treating diseases with medicines and money going into being accurate in what we are treating.
At the moment what is happening at the frontline is that many doctors are giving patients what we called shortcut therapy, that is, a patient comes with a fever you treat them for everything, malaria, you treat them for sepsis and meningitis, and as result we waste a lot of treatment resources. If you had a diagnostic that tell you precisely what the patient’s problem is then you could just use one treatment and sort out that problem. So let’s build efficiency into the health system through diagnostics that will result in savings in what we’re spending on medicines.
And then finally as an industry we also have come up with business models that recognize that one size does not fit all. So we must ask ourselves how we price our products correctly within the environment. Where we are present as a business, the US is very different from Ethiopia so we have to recognize that the same patient with cervical cancer in stage one in the US is going through the same thing as a patient with cervical cancer stage one in Addis Ababa; but, how then do we make sure that patients are happy so that where they are does not become a barrier to accessing the innovations. And that is about understanding the context in which we are doing business and tailoring our business to that context, rather than expecting the country to tell itself of our business and we intend to tackle this issue in our 10 year plan.

Capital: There is this concept about personalized treatment in the west, when do you believe Africa will reach this stage?

Dr. Allan Pamba: Technology is increasingly moving towards personalized treatment. And this is leveraging the power of new diagnostics tools that are predictive of what will work for which patients. So for example, there are different kinds of breast cancer that will respond to one of the medications say Herceptin while others may not. And we can test you genetically to be able to see if you have the markers for which this medicine will respond to. What it means therefore is that when you are diagnosed with breast cancer we know which medicine you respond to. This is important because it means the money you spend on that medicine delivers more value. You don’t get patients with breast cancer all put on Herceptin since only a small proportion of the lot respond while the others don’t respond. So this in nutshell is personalized medicine.
I do not see any reason why over time we should not be able to bring this into Africa. It’s down to the three key areas that we talked about earlier, that is, one government’s need to increase it’s spend on the health budgets or the allocation of GDP that goes into health. Number two, we need to increase efficiencies in the health system and avoid waste, sometimes with diagnostics that sharpen the diagnosis so you’re not wasting your treatments. And then number three, as an industry, we need to change our business models so that we put the business model in the context of the economy where we’re doing the business and not apply the one size fits all method which is very inapplicable.

Capital: What’s your stance on generic medicines?

Dr. Allan Pamba: Generic medicines are a mixed bag, they’re very good generic medicines and not so good generic medicines and there in between. This is the experience that I’ve had just as a patient or as a doctor in Africa. Now the challenge is always around patient safety. So it starts with that. Regulators in the countries like the Ethiopian FDA for example need to be very stringent on selecting generic medicines that actually do what they promised that they will do in terms of quality, service, quality control, and so on. This is purely on a patient safety basis. A lot of multinational pharmaceutical companies talk about this because when you register a medicine in a country as the originator you’re the one who invented the medicine. You’re the only one who can register it in the country. So we would register a medicine college excellent in Ethiopia because we invented it. Then an Indian producer will make a generic version of it. We call it ‘Y’ because we have registered it in Ethiopia and we will then sell both x and y. It’s already registered. You don’t need to register again.
Now, if anything goes wrong with the patient ultimately there’s a question mark around x, yet the original product against X and Y are not exactly identical. So there’s a patient safety here that can actually jeopardize or there’s even patients getting product X that has all the data because there’s a signal or a problem that has been seen with another product that looks like it, but it’s not it. So the main thing around genetics is quality control. The best thing about genetics is they help to lower prices, because India, China, other countries can sometimes produces these medicines at a lower cost of lab.

Capital: Regarding HIV, you’ve said that it is no longer a new generation problem, what do you essentially mean by that?

Dr. Allan Pamba: I can say that confidently because over the last 20 years the Global Fund for malaria, TB, and HIV has raised so much money to tackle those three diseases. And a lot of investments have been put in place across Africa both for diagnosis and treatment of HIV AIDS. And the result of that has been a decline in the number of new cases or new infections of HIV/AIDS because number one, more people know their status. And I generally believe that when people know they’re infected, they’re less likely to transmit it. What driving the transmission before was a lot of people who didn’t know they have it so they have multiple sexual partners and transmit it? So testing is more available now and people get to know their status.
Number two is that treatments are available since there’s a lot treatments and viral load testing because those two go together. There are people who have HIV who even if they were to have multiple partners would not transmit it because they’re always virally suppressed. There walking around with zero virus level in their system because they’re getting a viral test which shows that they’re getting treatment so the virus is suppressed. And they’re getting a viral load test twice a year, sometimes three times a year which shows that the treatment is working and the viral load is low, low, low. These two are the reason why HIV/AIDS and look at that sentence, you can have treatment for your entire life and you can get checked for your viral treatment for your entire life. Now what that means is we don’t see clinical AIDS which we used to see before when there were no treatment patients in three, four, sometimes longer 5 or 10 years where we would often advance to clinical AIDS. We don’t see that. So the generation that is coming up now, the teenagers, that are growing up now wonder why we worry about HIV/AIDS. For them it’s just like a flu, it’s like diabetes, except the inconvenience of taking a pill a day, because now we’re down to a pill a day, soon we’re going to be a pill a week.
And I’m told that we’re developing an injection that you get once every three to six months, so the whole space is changing a lot. We’re also seeing a lot of research on a vaccine for HIV AIDS. And again it’s just a matter of time before a vaccine will be found. But in between now and then, we do have to address the issue of teenagers growing up now who never saw AIDS and the risk perception of it is not there.

Capital: Non-communicable diseases are increasing in Africa. How are you preventing the same by diagnostics?

Dr. Allan Pamba: This is an area where my personal view is that Africa is not ready. Africa is not ready because you and I every day we hear about relatives with cancer that are diagnosed by the eyes. Already the breast lump is so big you don’t need the diagnostic tools to tell it’s on higher stages. This is similar to prostate cancer.
We hear about people suffering from heart attacks, and we hear about people suffering from strokes. These are things I never heard about when I was a young child. And suddenly even as a doctor trainee we used to flip through those pages in medical books, and then say you’ll never see this.
The three infectious diseases we’ve dealt with over the years, malaria, TB and HIV have had vertical programmes to which patients gain stable treatment for a long term. But if you have diabetes, if you have a risk for cancer, there are no systems today in place that are similar to what we see with HIV that will help you prevent from getting to that late stage. And what we are doing is saying can we build our business in Africa in a way that addresses this challenge, this gap diagnostically both in the private market and in the public market so that we don’t just think about the middle class. We should also think of how we can partner with governments to find solutions as we did with HIV/AIDS in our gap problem to find solutions that help people in mass.
We have identified three disease areas where we want to build diagnostic capacity in Africa. In infectious diseases, we are already succeeding with HIV, and we want to expand because the same machines today we’re doing 60% of all viral load testing in Africa. We’re doing it by having placed this equipment in hospitals across public hospitals in Africa. And we place them through our programme that we call the Global Access programme but it’s a partnership that has PEPFAR, USAID, Global Fund, with all of them contributing funds. They pay us, the governments in Africa order the machines, the machines are then put in there. And they pay us and we then send reagents for tests around HIV patients who come and get tested. We want to expand the testing panel from HIV to hepatitis, HPV which causes cervical cancer and tuberculosis. It is the same machine and no new machine is needed you just increase the testing panel and we think we can succeed because the machines are there. So it’s just a matter of expanding the tentacles.
So infectious diseases, in the area of HIV, hepatitis, HPV and tuberculosis, then cancer, are the new area we are looking into.
Moreover, Roche historically has been very strong with cancer medicines like Herceptin for breast cancer, for example, and others as well.
We have what it takes to improve cancer diagnosis in Africa and our focus is on cervical cancer because we can diagnose HPV very early and it can predict a woman’s risk of developing cervical cancer. But with the same platform using for HIV we can also tell you if a woman comes to you also test for HPV and actually her risk factor for cervical cancer in 3 or 4 or 5 or 6 or 7 and 8 years what she needs to be checked again and so on.
So cancer is there and we are also looking at how we can stretch the capacity of the few pathologists that we have in the continent. At the moment, we have one pathologist for 1 million people. One pathologist for 1 million people cannot look at all the pathology slides coming out of hospitals. How can we leverage technology so that we know where the pathologists are, we connect them to different hospitals. And even when you’re in rural Ethiopia we can get a biopsy of that growth that you have either in your breast or somewhere, prepare the stain, take a photo, put it on the internet and they will read it and in two days you have your results. The more we do those digital connections the earlier we’ll diagnose cancers, the more cancers will prevent. So in the current cancer space, we’re looking at that.
And then the third space is cardiovascular heart disease. We have technologies that can be leveraged to detect blood biomarkers of the heart disease early when it’s still possible to have more affordable interventions. Again, we want to see a scale up of this in the continent. So that within the government health delivery system, we can do all these things I’m saying.

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