Thomas Rask Nielsen is the General Manager for the Near East Rising Markets Region for Nova Nordisk. In a recent interview with BR Research, Nielsen stressed the need to raise awareness in Pakistan regarding diabetes, also called "the silent killer".
He said that if steps are not taken to raise awareness regarding the disease and helping people adopt healthier lifestyles, Pakistan may have as many as 30 million diabetes patients within the next few years. The following interview is based on selected excerpts from that interaction.
BR Research: Briefly tell us about the evolution of Nova Nordisk from its early days to date.
Thomas Rask Nielsen: Nova Nordisk was the world's first healthcare company to produce insulin. Although there are many different treatments for diabetes, insulin is the foundation of tackling it and eventually all patients of diabetes require it. The reason for diabetes is that the body does not produce enough insulin by itself in patients. After decades of research and product development, today we are able to provide patients with insulin that is, in many way, smarter than the insulin that the body produces.
Over the decades, this Company has emerged as the world leader in diabetes care and also expanded into other healthcare segments. Nova Nordisk products are sold in over 180 countries, while we have affiliates in about 80 countries. The Company employs more than 35,000 people and last year it generated business worth about $15 billion.
Our mission is to provide patients with a better life. So we are looking into constantly improving on ways to prevent, treat and cure diabetes. Our scientists are working on products that can help tackle diabetes with a permanent cure. Our ambition is to ultimately come up with such cures that eventually we will no longer be needed to treat this disease and Nova Nordisk can then diversify into other segments of healthcare. "Changing diabetes" is our mission and patients are at the centre of our strategy.
All companies are measured in terms of their revenues, margins and profits. But we believe that if we focus on patients and on helping to improve their lives, the Company's financial position will be well off as a consequence.
We are also the world leaders in providing solutions for children who have deficiency of the human growth hormone.
BRR: How many people in the world today are affected by diabetes and how may it spread in the future?
TRN: Today, there are about 350 million people living with diabetes in the world. That number is expected to mushroom to 500 million in the next 20 years. The disease may bring disastrous consequences for many countries around the world, as it is sure to take a toll on the productivity of their populations. As the leaders in diabetes care, we can see that just treating the disease is not going to be enough to prevent the threats emanating from the rising incidence of this disease.
People need to be more aware about the causes of diabetes. They need to be informed about lifestyle changes that can help prevent the onset of diabetes. For this reason, Nova Nordisk is also on the forefront of raising awareness about diabetes.
BRR: What are the major factors that lead to the development of this disease?
TRN: There are two kinds of diabetes: type 1 and type 2. Type 1 diabetes has been found to be affecting about one-tenth of the total number of diabetes patients. We do not yet know what causes this disease but we believe that it is genetic. Type 1 diabetes requires immediate care as these patients' bodies have stopped producing insulin naturally.
About 90 percent of the patients of this affliction suffer from Type 2 diabetes. Again, the causes of the disease are not completely clear however, obesity is among the leading causes. Many people today are eating more and exercising less than their body needs. To break it down for the readers; when you eat, your body has energy which is used by different parts of the body. However when your body does not produce the right amount of insulin, the body remains unable to use the sugar that is in the blood.
So you can see that it is very important to raise awareness among people regarding the important of eating right and following healthy habits such as getting regular exercise. Prevention is a major tool in the fight against diabetes.
BRR: Where are the Company's production facilities and research centers situated?
TRN: The main production facility where we make all the raw materials for our medicines is in Denmark. Then we have filling facilities in the United States of America, Brazil, France, and China and soon we will have one in Russia. The technology required is quite complex, so by keeping production of raw materials in one place, we are able to enjoy economies of scale which in turn helps to keep the cost of the medication lower for patients.
For these reasons, it is not feasible for Nova Nordisk to set up manufacturing facilities all over the world. However, we invest in other countries in the form of awareness campaigns and other drives to help inform people about the ways in which they can prevent the disease, or as in the case of patients, how they can learn to live with it.
We also have research facilities in Denmark, China and US. These facilities are continuously working on new products and there are some in the pipeline even as we speak. Although the Company is working on products for other diseases and disorders such as hemophilia; we expect diabetes care and treatment to remain the main focus of our Company for many years to come.
BRR: How much of a problem is the disease in Pakistan and what plans does Nova Nordisk have for the country?
TRN: Nova Nordisk is the world leader in diabetes care, so we want to establish ourselves as the market leader in Pakistan as well. Three years ago we brought in a new general manager in the country and since then he has rejuvenated the team here. In 2011, we introduced a new product offering here which is the pen that can be used in place of the syringe and vial. Then last year, we have doubled the size of our team here, so now we are well poised to gain that leadership role in the country.
The potential for growth in this country is huge. According to official statistics, there are seven million diabetes patients in the country. Medical practitioners in Pakistan have informed us that about 400,000 of these patients regularly receive insulin, while the others do not. Another major challenge is that many people do not know that they have diabetes, so the actual number of people in this country who are suffering from the disease without even knowing about it or receiving any treatment, could be much higher than seven million.
Independent research studies conducted in some parts of this country have shown that the number of people with the affliction was about twice the official estimate. Then there are those people who have pre-diabetes. These patients will almost certainly develop the disease later on, if they do not implement changes in their diet and lifestyle. When you take all these factors into consideration, Pakistan may be looking at as many as 30 million diabetes patients within a few years. That would have very adverse effects on this country's population and their productivity and livelihoods.
Nova Nordisk has launched an awareness drive last year with the help of doctors and other medical practitioners in Pakistan. Under that programme we trained 40 healthcare professionals who were attached to some of the busiest clinics of the country. Diabetes patients have many questions and require a lot of explanations so it is often hard for doctors to take the time to respond to all these queries since doctors in Pakistan have to see many patients. So the trained professionals help split that load and provide more time and attention to diabetes patients.
We want people to get tested, and also to treat the disease in a manageable way if they are found to have it. There is a tendency among some people to panic or to ignore the disease, but we want them to know that they can learn to live with the disease. Above all we need to raise awareness to fight the silent killer.
BRR: What sort of a response is needed from the Government of Pakistan in raising awareness about diabetes and also in helping patients gain access to treatment?
TRN: Typically seeking approvals for selling new medicines in any market is a time consuming and complex procedure. Sometimes this process can take up to 2-3 years. However, the development of the Drug Regulatory Authority (DRA) is a positive step and we are hopeful that this will lead to expeditious approvals for pharmaceutical companies.
The Government can also play a very important role in creating more awareness of the disease and also subsidising medication for those patients who may be faced with financial constraints. The magnitude of the problem is quite high as many millions of citizens are affected. For that reason, it is important that there should be clear and comprehensive Government policy on tackling diabetes.