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By 2030, we want to treat one in five cancer patients in India: Lara Bezerra, MD Roche India

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Lara Yumi Tsuji Bezerra, Managing Director, Roche India came to India with close to 24 years of pharma experience, across sales, marketing and general management in Janssen Cillag, Wyeth Biopharma and Bayer. A year into her India stint, she was re designated as the Chief Purpose Officer, as she led a transformation of the company from being a commercial to a value-based organisation. She tells Viveka Roychowdhury how the Company is strategising to go from getting one in 50 cancer patients treated to one in five by 2030

You came to India in October 2017 as the Managing Director of Roche India. Why did you say, on your LinkedIn blog, that your India posting would be your biggest challenge in life, even bigger than your last posting in Venezuela? What made you say that? Do you still think that?

Yes, I did say that and I do think so today as well.

Why? Is India such a tough place?

Not because it’s tough. But we believe it’s urgent to deliver medical solutions right now – even as we develop innovations for the future. We are passionate about transforming patients’ lives in India and what we want to do is give back to the patients. So we have to see that patients have both: access to healthcare and go beyond, to help develop the healthcare ecosystem.

So the challenge is that today we have people who are reimbursed (for health expenses), we have some people who have access to healthcare. But, even if we do everything super well, and our work pays off, there are probably 700 million people who do not have access to healthcare (*1).

India has 1500 oncologists for 1.3 billion people. China with 1.4 billion people has 25,000 oncologists. The US with 330 million people has 11,000 oncologists. Brazil with 220 million people has 2000 oncologists (*2).

So, the challenge here is that, if we need to make a difference in India, and benefit patients, we not only have to work with these problems but also go beyond. So how do we increase the capabilities and capacities of these oncologists? As health is a State subject, how can we help in different States? And this is our strategy. We do not look only where we can sell our drugs. We also look at how can we collaborate with an external stakeholder, develop the ecosystem as well as develop the capabilities of these oncologists. What if we use the primary health centres to diagnose cancer and the secondary health centres to treat cancer? There are so many things that we can do. This is the challenge.

There is a huge opportunity in India because right now, healthcare is the focus of the government and the private sector. The question is, the challenges that we have right now were created by a health system that we had in the past; that will not be the health system of the future.

If we look to work with these challenges, we might solve them but we will not create the health system that is needed for the future. So we acknowledge the challenges that we have now but also look at what the health system would be in the next few years. Because by that time, India will be the third biggest economy in the world. We will be able to allocate resources to healthcare. And, when we are going in this direction, how can we think about building the ecosystem in a way that it is ready when we arrive there? We need to adapt and change to standards of care that are much better than what we have today.

If we go (ahead) thinking about universal healthcare, both public and private sector should work together to develop technology for better healthcare for patients, the best value and outcomes for patients. So that when we arrive there, the technology is almost ready for us, and we need to just adapt it to what we need.

If we think about technology to solve today’s challenges, then we will have to change it fundamentally later on. This is my challenge here.

What is Roche’s strategy for India? Could you give some examples of how Roche’s global tagline, Doing Now, What Patients Need Next plays out in India?

The global purpose of Roche is Doing Now, What Patients Need Next. In 2018, we reflected on how we can translate it into a plan for India. Our Vision 2030 is that we inspire people to transform healthcare in India, and care for every patient’s life through innovative and sustainable solutions. We do that with both, short-term and long-term strategies.

In the short term, we look at how we can help patients benefit from our medicines in existing healthcare ecosystems like ESIC, CGHS, State schemes, etc.

At the same time, we work for the long term with people who would like to help us in improving the healthcare landscape. We strongly believe that we need to increase the capacities of the oncologists to impact more patients at a faster pace.

Our strategy is State-centric, it is a learning-based approach that leverages the States’ diversity, since State governments are primarily responsible for healthcare delivery and systems. Our strategy is structured to respond to State capabilities and needs. Our approach is to broaden and expand access to our innovative therapies, and increase the number of patients’ lives we can touch and positively impact. We have more or less 27 launches in the next few years. So unless the health system is adequate, not all patients would be able to get the benefit.

Our State cluster is based on a ‘Grow, Build and Invest’ model which helps enhance existing levels of healthcare access and supports better penetration for innovative healthcare solutions. The ultimate objective is to help all States evolve, maximising patient outcomes across India.

We have also partnered with other pharma companies to increase patient access to cancer therapy. For example, last February, Roche Pharma India and Cipla entered into an agreement under which Cipla will promote and distribute tocilizumab (Actemra) and Syndyma, the second brand of Roche’s cancer therapy, bevacizumab (Avastin) in India.

Where does India fit into Roche’s global strategy in terms of revenue share?

Roche is going through a transformation globally to focus more on patients and trying to see how can we get our medicines to patients faster.

With one of the strongest pipelines in the industry, we will have 27 launches in the next few years, we are aiming at approx. 13 line extensions and 14 novel molecules in multiple indications addressing the unmet medical needs.

We will continue our efforts to serve more patients in India by foraying into rare diseases as well. A step in this direction was the recent launch of Hemlibra for Haemophilia A patients this year. We will also explore bringing in treatment options for Spinal Muscular atrophy (SMA), Huntington disease, Neuromyelitis Optica (NMO) and neuromyelitis optica spectrum disorders (NMOSD).

With support from both Basel and the regulators here in India, we are bringing all our new innovations to serve the patients.

You will be completing two years in India this October. What has struck you about your stint here, which is different from other countries, which defines the country for you?

The diversity of thought in India is something that defines the country for me. The moment we decentralised the model and put each State in charge to self-organise, we saw great outcomes. Many people used to be only in sales but now they have to develop their own strategies and self-organise.

It took us 3-4 months to self-organise, but the teams were highly motivated and started to make their plans. Their capability and speed amazed us. And this is India, if you trust and believe, and give space to people to show their capabilities, to not be afraid or limited by targets, they just unleash a potential that you could not imagine. Both intellectually and from the heart. The objective becomes to help society and as many patients as possible.

This is something completely unique to India. Different States might have different approaches. But, when there is a common intention to help patients, all of this gets together and something much bigger happens. This is the principle of diversity. If you have a diverse group and you start to have conflict, and as a leader you are not able to get them to work together, then you fail in a big way. But if you can make a diverse group work together, then beautiful things happen. And what is the difference between these two outcomes? The common intention, goal, purpose.

I’ve noticed that whenever we have different ideas, conflicting ideas, when we ask, what can we do for the patients, how can we make this work and then suddenly, everything aligns and we go for it.

Collaboration is something that the Indians believe that they do not have but they do have it. I’ll explain with an anecdote. I remember discussing with a doctor about how we can collaborate with more doctors, in parallel with their work on Ayushman Bharat, the National Health Mission etc. to make it better.

And he said, “You know, Lara, I do not want to disappoint you but here in India, we are not used to collaboration. I’ll tell you why. My neighbour and I were good friends. When we were growing up, he had better grades than me. My mother told me to focus on my studies, forget your friend and you have to be better than him. It was focussing on me getting more than him. This is how we Indians have grown up. To compete rather than collaborate.”

I told him I heard what he was saying. And went on to tell him what we were doing in some States to help patients. If an oncologist can train someone in a primary care centre, and the diagnosis is made there, we can try to have an infusion centre there. We can try to give home care, then we can have much more patients treated. This is what we want to do.

The same doctor got excited and said, “If you can do that here as well, I will bring 20 doctors together and we can sit together and we help out.” That’s when I reminded him that he had said Indians could never collaborate!

So India is a country where everyone will collaborate to help patients. The point is, there is competitiveness, but when it is for a good cause, all Indians will stop everything that they are doing and they collaborate. The collaboration comes with a common purpose. This is what is extraordinary in India.

A lot of pharma companies have been uneasy about patents, the data protection laws and strive to protect information about their products which could be used by generic players. What is Roche’s view on this?

We have to see data in a much bigger perspective. For you to make decisions for the best patient outcomes, general data has to be shared. There has to be the right data sharing policy.

For example, as a patient, I am going to different places, I have different treatments during my lifetime. With my authorisation/consent, I let it be shared at every step. If I go to a doctor when I am 30 years old, and someone asks for my primary and other data, then I can share it with a fingerprint. And the doctor can then make a personalised healthcare plan for me. And if this data can also have information about the health schemes I am eligible for like ESIC or CGHS of Ayushman Bharat, the doctor can also tell me what is the standard of care and funding I can avail of.

So data has to be used and collected in the right way with proper consents but if we are able to share this, then the Government can put in place the right policies and take the right decisions for the different parts of India. Therefore, the purpose of the data has to be very clear. The best patient outcome has to be the purpose of all we do.

Could you tell us something about Roche India’s The Blue Tree programme? How many patients are benefiting from this programme and what is the kind of support offered to cancer patients and their families during the treatment journey, from diagnosis till completion of therapy? How do patients sign up for this programme?

In 2015, in order to tackle the range of barriers to accessing cancer care, Roche India developed “The Blue Tree” programme which is run by a third party. This initiative was tailored to address the multiple hurdles that patients experience during the course of their treatment. Through a single platform, the programme mirrors the patient journey and enables patients to overcome these access hurdles – primarily diagnosis, affordability, and adherence.

It provides multiple services including diagnostic support, guidance on funding, reimbursement, documentation assistance, disease information, medicine support, medicine delivery at home and even home infusions. Today, The Blue Tree has supported more than 4,900 patients, partnered with more than 900 doctors and increased its reach to about 590 treatment centres across India.

The length of treatment and medical eligibility of the patient is decided by the treating physician as per the medical standards in India. Once enrolled, the programme coordinator is in touch with the patient and helps the patient access the various services available through the programme.

References:

*1)https://thediplomat.com/2019/06/indias-ailing-health-sector/ assesses on 14/08/2019
*2) https://ascopubs.org/doi/figure/10.1200/JGO.17.00188

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