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Overtime pharma industry is realising that duly deserved place of preventive medicines need to be focused on specifically in this disruptive climatic, social, economic and political situation. Recent pandemic accelerated this thought in such a way that it is not only the prevention but also the concomitant use of pharma products along with nutritional products.

The pandemic has proven that Indian healthcare industry is one of the most responsive industries for supplying key medicines across globe; managing workforce safety and preparing vaccines and therapeutics with evolving government restrictions.

With these achievements, industry has started taking stock of what lies ahead. This will likely to bring fundamental disruptions in industry operations. Even the ‘Healthcare Focused Budget’ would like to experience reforms in terms of increased spending on public health, fund allocations for tele-medicine to connect villages for healthcare reach, introduction of Phase II Production Linked Incentive (‘PLI’) Scheme to manufacture APIs and reduce dependency on China for APIs, etc.

It has been very evident that, in future Indian Healthcare industry needs to have a resilient infrastructure as well as supply chain to absorb new shocks. The lessons of 2020 can be building blocks to prepare ourselves and consider new business model.

1. Advantages of Technological Applications:

Industry is expecting to see growing traction of “nichebusters” rather than the old-fashioned blockbuster model. The industry is looking at unmet needs and developing drugs to address that need. This “nichebusters” concept is growing towards development of precision medicines to ensure “the right patient or patient population for targeted therapy with precise molecule”.

Also, pandemic has proven that industry needs to optimize the clinical trial process. Invention of “Fast-track” COVID-19 vaccine has really been a boon to entire human race. Several strategies have been used to optimize clinical trials and reduce the vaccine generation time. This will be taken as a priority in next year for the development of other drugs as well.

Radiomics is the emerging technology which enables drug developers to gain deeper insights from medical images. This will accelerate therapy development and will also help discovery of new biomarkers that will enhance clinical decision-making and treatment.

In terms of supply chain, industry has already started gaining full transparency and visibility across the value chain with the growing adoption of industry 4.0. With this pandemic, industry has started re-evaluating their strategies, risk tolerance, and overall network footprint to address issues in supply chain. This may increase dependency in local supply chain than global one. Also, the increased adoption of digital tools, telehealth, and app-based ecosystems make patient-level data more available and hence, this data should be considered to serve the demand through patient-centric supply chains.

2. Challenges faced by evolved Working patterns:

Post-COVID-19 industry is likely to adopt more efficient ways of working. Out of necessity, organizations have shifted towards lean organisational structure to be more efficient and productive.

The working model will be Hybrid as organisations need manage working in field as well from home as well. Accordingly, systems, processes and norms are need to be consolidate for smooth operations.

Also, in a quick response to the pandemic, industry started looking for effective collaboration for solving business problems and challenges. So, the new term emerged as “cross-functional work culture”. The thought behind this was the cross-functional work strategies will play an essential part in brainstorming, idea generation and presenting innovative business solutions. And this trend will continue to grow next year as well. New capabilities will also be needed in coming years as the workforce shifts from manual skills to more technical skills.

3. Awareness of Patients and thereby Communication:

Digital transformation in the pharmaceutical industry was already there even before COVID-19, but in the pandemic time this shook the Healthcare world to its foundations. And patient communication is no longer an exception!

Digital leaders such as Amazon and Google started seizing opportunities to develop virtual platforms for personalised patient communications.

Healthcare practitioners stared valuing and depending on digital tools as well as tele-medicine. This technology has overcome physical barriers to interaction (especially under COVID-19), broadened the healthcare conversation, facilitated information flow with patients, encouraged treatment adherence and percolated self-management of chronic diseases in patients. One of the best examples of this is AI-driven pathological testing. This emerging technology is assisting to analyse thousands of pathology images of various cancers to provide highly accurate diagnoses and predict the right anti-cancer drug combinations. The other example is Chatbots. This is a virtual health assistant that can fill a multitude of roles from customer service representatives to diagnostic tools and even therapists.

Even, healthcare consumerism has gained the momentum in 2020. The way patients used to receive information is changed now. Now, patients are likely to expect knowing costs of medications, procedures, etc. Patient consumerism has brought transparency via drug discount cards and other online services. Also, telemedicine as well as e-health gadgets experienced a widespread adoption during the pandemic and are likely to be continued in near future.

When COVID-19 vaccination campaigns have already, there will be an impetus for patient information sharing. The entire campaign needs to manage with systems and get data on how Covid-19 vaccines are distributed, sharing data with pharmacists, doctors as well as state and federal government entities. And, blockchain can be used to be an effective tool in improving the accuracy of medical records and cutting cost.

4. Challenges to Build New Business Model:

Traditional ways of working are quickly getting displaced with new ways. Now companies need to focus on multiple short term goals to achieve a long term vision. Sustainability and stability have become important factors for every organisation to grow post-COVID-19. Organisations need to be strengthened internally with vision and mission and this can be supported with work culture.

And this can be achieved only after leveraging on growth levers, mitigating risks, optimum use of resources and focusing on delivering results. With these four drivers industry can still achieve a strong level of continuity and grow in post-COVID era.

This article has been written by Dr. Smarta- CMD (Interlink) and published by e-version of Business World.

Initially, sustainability was the factor restricted only in the boundaries of organization’s reputation. Company’s vision was much limited while structuring sustainability initiatives in the business. But as we surpassed our old vision of sustainability, we now know that it’s not all about the Reputation but several critical factors like- Business values, growth-oriented functions, chasing opportunities and the list is never ending……

Let us see four barriers resisting expansion and adoption of sustainability in an organization:

1. Scarcity of Key Performance Indicators (KPIs)– Lack of KPIs leading to absence of data regarding measurable key business objectives, ultimately creating hurdles in the path to achieving desired goals.
2. Inadequate system for sustainability initiatives– Less field force accountable for sustainability, poor organizational support to sustainability activities, lack of skills and poor prioritization of sustainability initiatives are some of the factors worsening the condition of business performance.
3. Lack of capital investment– Less or no investment in new and innovative techniques to manage the business operations resist the sustained growth of an organization.
4. Insufficient data and knowledge to execute sustainability initiatives- Availability of required capital to invest in sustainability activities is not going to work with inadequate knowledge regarding sustainability execution.

Looking at these four sustainability barriers, it would not be wrong to say that establishing a strong and systematic unit in an organization which is solely dedicated to the sustainability and scalability initiatives, having all the skills to continue maintain the growth and ultimately increasing the rate of growth would be beneficial to build a superior and persistent business organization for the future.

Pharma-Nutrition as a subject by itself, considering one is not complete without other part in bringing wellness to life. Hence, it is that amazing combination where prevention, cure and wellness of patient are taken care of.

Pharma-Nutrition in New Normal era:

Pharma is transiting from Medicines to Food for Special Dietary Use (FSDU) to Pharma Nutrition as the food has various dimensions and each country has its own food habits. It may a fully nutritionally balanced or there could be a total lack of it.

Nutrients are best available through food and how it is cooked, use of oil, fats and the spices are used. Food occupies a significant role in Health. Health domain in next normal era is likely to witness significant changes across the world.

Beyond that it is a matter of palate and organoleptic senses issue. Few May live life with burgers and aerated drinks, few may have their own ways.

However, obesity in childhood and Diabetes in younger age makes us feel that there is a need of something like Pharma – Nutrition.

 Pharma- Nutrition convergence

Father of medical practise Hippocrates has already said that “Food be thy medicine, Medicine be thy Food and walk a mile….” which is a powerful message on the medical practise all over the world. A step beyond, traditional Indian medicines, provide a three cornerstones formula for fullness of health!

1. Ahar
2. Vihar
3. Aushadhi…..

Essentially Diet, Exercise and Medicines!!

Fig. 1.1: Pharma Nutrition Convergence

To effectively respond to viral infections, pharmaceutical products can repair the inflammatory and degenerative regions that degenerate in the respiratory tract and restore homeostasis of the metabolic processes. Simultaneously, nutrition and micro-nutrients continuously build up immunity of the same patient. Is it not Pharma-Nutrition has symbiotic effect to make patient healthy?

Other way round also, immuno-protection is the corner stone of the medical practise. The preservation of the immune system is the strategic measure of public health in social and clinical management of life-span extension world-wide.

Growth and opportunities for Pharma-Nutrition

A. Technology influence:

On one hand as a result of fermentation technology there are ways of creating plant products and on the other hand scientists are taking help of making the nutrients available in precise quantity as per individual need.

 One is acting at developmental stage and the other one is looking at designed quantity for the patient!

It is during the knowledge dispersal stage where cross-disciplinary excerpts carry out joint research in time. Like economy is going towards “Shared Economy”, research is also moving towards “Shared Knowledge” and insights to shorten time and makes a meaningful contribution which in turn leads to technology concurrence.

B. Human microbiome:

Pharma – Nutrition concept should aim at searching its soul in human microbiome.  More insights from human microbiomes would generate more solutions for human beings.

Fig. 1.2: Growth and opportunities for Pharma-Nutrition

C. Pharma-Nutrition ingredients:

 The fullness of health approach should be derived from the strengths of both disciplines. Strengths of pharmaceuticals industry for its R&D capabilities, defining quality, safety and efficacy as well as standards of each molecule or evidence-based nature of discerning product can be combined with nutraceutical strengths of nutrition, clinical nutrition, biochemistry, bioavailability, bio markers, to ensure wholesome heath progress. Several bioactive compounds including fibre, secondary plant molecules, friendly bacteria, essential fatty acids, probiotics and probiotics can be manufactured with promising value proposition.

Moreover, many pharma molecules are extracted from natural plants or by technology which humans can use as medicines or as nutrients. Vitamins, minerals, curative and prophylactic solutions have been derived from many such combinations.

Nutraceutical molecules like Lutein, Lycopene, Zeaxanthin, Spirulina and others have in-built properties to prevent and also cure few medical conditions.

Optimal health and elimination of chronic disease can be accomplished by this combination.

D. Combating malnutrition:

It is perceived that a number of modern diseases are linked to poor diets and the concept of “malnutrition”, even in those who are getting sufficient quantity of calories and lacking proper balance of several food ingredients such as amino acids, peptides, minerals, etc. Furthermore, there is budding evidence to indicate that definite nutritional balance through supplement can preserve patient health beyond widely used medicinal treatments.

Emerging issues

The new ‘Pharma-Nutrition’ has to face five major challenges:

1. Education to healthcare providers
2. Difficulty in patenting the products
3. OTC prone nature of Nutraceutical products
4. Prescription limitation of dieticians and nutritionists
5. Belief system of HCPCs

Pharmaceutical companies will learn to collaborate for benefits of patient’s health. Nutrition companies need to improve their research and development to enhance their scientific capabilities as well as building key relationship with drug companies and practitioners.

New landscape

Pharma-Nutrition may not be a concept in practise as it is observed that majority of specialities have the tendency to provide nutrition benefits to patient at a particular function where they feel it’s better to provide some sort of strength to the patient.

Modern medicines usually focus on single target condition and provide entire relief or cure, irrespective of its effects on other organs. On the contrary, the multi-target medicines (Pharma-Nutrition) may be used in synchronised way to provide maximum benefit to patient.

References:

1. G. Folkerts, Pharma-Nutrition-An Overview_Springer_ www.springer.com_Accessed on 5.11.2020
2. Tamar C. Weenen, Bahar Ramezanpour, and Eric Claassen_ Food-Pharma Convergence in Medical Nutrition-best of Both worlds_PLoS One_journals.plos.org_Accessed on 5.11.2020
3. Niki A Georgiou, Johan Grssen, Renger F Witkamp_ Pharma-Nutrition interface: the gap is narrowing_PubMed.gov_pubmed.ncib.nlm.nih.gov_Accessed on 5.11.2020

Corona virus disaster has turned out to be an eye-opening situation because of which many powerful nations have suffered and are still suffering. Number of small and big businesses are facing adverse impacts and Pharma industry is not an exception. China is the source of 40% of the global APIs & dominating 68.3% of chemical API market worldwide. In 2018, APIs exported from China accounted for 81% ($30 billion over $37 billion) of total value of exported Chinese pharmaceutical products. Indian pharmaceutical industry despite being a global market leader at generic drug formulations, largely depends on imported APIs from China. APIs which are used to manufacture at least 12 essential drugs such as paracetamol, ranitidine, ciprofloxacin, metformin, acetylsalicylic acid, ofloxacin, metronidazole, ampicillin, amoxicillin, ascorbic acid and some fermentation-based intermediates for which India solely depends on china.

The wise steps taken by Indian government for pharma during this crisis are one of the most important growth propelling factors. The government has now come up with two schemes for pharma; one is the PLI scheme which gives some financial incentives based on sales made by selected manufacturers for 41 products which covers around 53 APIs and the incentive ranges from 5-20% based on the incremental scales. That is going to help companies in terms of bridging the gap between the Chinese prices and India price to some extent. The second scheme which the government has come up with is the bulk drug park and this scheme is primarily to provide easy access to world class common infrastructure which will be located in these parks where companies can come, set up and make use of the common infrastructure. And this is again for a period of five years. As we need to build our strength, the government has come up with these schemes which should help in compensating price gap between China and India to some extent.

India is both competitor and customer of the Chinese API industry:
We are currently the largest producers of generic medicines with a share of 20% of total global production, catering to over 60% of world’s demand. Third-largest medicine market in the Asia Pacific region with Well-established, strong local manufacturing capabilities, with an international export profile are the factors which are really highlighting our identity as ‘Pharmacy of the world’. India is by far the world’s champion of drug master files (DMFs). Drug master files (DMFs) are voluntary submissions to the import country authority, and contain confidential information about human drug products. APIs belongs to the Type II of DMFs, which is concerned with drug substance, material used in their preparation, or drug product. While China holds 12% of DMFs from the U.S., India holds almost half of them. Being the largest holder of DMSs gives India the edge to export higher-value APIs, enlarging the industry’s attractiveness. Indians generally speak better English than Chinese, which facilitates pharmaceutical trade with developed countries. Access to low cost vaccines, affordable generics & HIV treatment from India are some of the greatest success stories in Indian pharmaceutical industry. It is now widely accepted that without the likes of Sun Pharmaceutical, Ranbaxy, Dr Reddy’s Laboratories, Cipla and dozens of smaller Indian companies, many African countries would not have been able to cope with the public health challenges they face. No wonder India is called the “pharmacy to the world”.

Specialty areas to concentrate in future:
HPAPIs:
Nowadays, there is an area of interest in API domain called as HPAPI- High-potency active pharmaceutical ingredient, gaining its identity in Pharmaceutical market worldwide. They are APIs that require special handling due to toxicity and used in extremely small doses in finished drugs. Traditional examples of HPAPIs are cytotoxic compounds and sex hormones such as estrogen. Deeper analysis says that, the generic side of the industry will drive meaningful growth in the HPAPI market. Generics is one of the strongest domains in Indian pharma sector. Having said that, there exist bundles of opportunities in HPAPI sector for India. As per the latest report published by Research Dive, the global HPAPI market is estimated to generate 42,491.7 million and rise at a CAGR of 10.5% during the forecast period from 2020 to 2027. Oncology-focused medicines are one of the leading molecules creating maximum growth due to innovative pipeline candidates and upcoming generic entries. The Asia Pacific region is estimated to witness the fastest growth.
We are now emerging as a 2nd highest supplier base for generics with HPAPIs. Main API producers are headquartered in 24 different countries/territories, though most are based in either India or mainland China. New product introductions are a core growth driver for the generic API industry, and many of the upcoming opportunities are oncology-focused, high-potency compounds. Accordingly, many manufacturers across many territories have been making investments in HPAPI capabilities. Thus, companies should anticipate similarly high levels of competition as product markets develop. Looking at our nation who is blessed with ancient history of medicines and generic portfolio, profitable growth is anticipated in this area in near future. Rather than representing a well-differentiated, more insulated market segment, trends in HPAPIs are still aligned closely with the underlying dynamics of the pharmaceutical industry. Investments in this part should be viewed as essential steps to keep pace with the market.

API & data security:
Now looking into API security, the potential for insider theft exists at every level of the pharmaceutical production and distribution chain. Individuals employed at production sites, distribution centres, and pharmacies are all potential insiders. The API is stored in a secured vault until it is ready for use. It is then moved to the production area, where it is combined with inactive ingredients to make the final dosage form like pills. The pills are then packaged and sent out to distributors, leaving the control of the original facility that made them. In this whole process, there are chances that a small quantity of APIs can be lifted unofficially. Manufacturers can’t afford to overlook such malpractices as most of the APIs are highly expensive. Fortunately, at the pharmaceutical distribution sites, most employees are professionally licensed pharmacists and pharmacy technicians, bound by the ethical standards and keenly aware that a breach would result in the loss of their licenses. Quality assurance (QA) plays a central role in pharmaceutical production, and it is used as an element of theft prevention as well. At production sites, manufactured pills are pulled at random for QA checks. While these checks are primarily intended to ensure accurate formulation, they also provide a check against the diversion of API that would lead to detectable changes in pill formulation.

Way forward in API Manufacturing:
While surfing through one of the Analysis created by PwC, some of the recommendations grabbed my attension. They might not be easy to demonstrate immediately at this point but also are not unrealistic while planning for future strategies.
Some long term recommendations were:
1.Develop large clusters and provide plug-and-play infrastructural support in dedicated zones for manufacturing APIs-
• Construct 2–3 large-sized dedicated zones and lease them to private players for operating manufacturing plants.
• Set up common utilities such as solvent recovery and distillation plants, power and steam units, effluent treatment plants, common logistics centres, regulatory infrastructure and warehousing to make smaller units economically viable in these zones.
• The following support can be looked at to encourage investments in mega parks: – stamp duty waiver – 50% subsidy on water and electricity for 5 years – SGST reimbursement – 75% for 5 years – 50% subsidy on expenses incurred for quality certification/patent registration – waiver on development charges, which are currently at 9% of property cost.
• Evaluate strategic locations for these mega parks, e.g. union territories, where the centre can play a larger role in controlling costs such as like cost of land and utilities.

In the slightly longer term, the government may look at the Chinese model and work on developing clusters for API and also can fuel our HPAPI manufacturing powers. API security and surveillance technologies at industry level is also one of the major factors which has to be taken care of. An emergency is inevitable and it always affects in a very unpleasant manner if we are not fully prepared to deal with it. Self-reliance is must and we have to get habituated to it. India for India and India for global is the strategy that we need to follow. Afterall we have to give justice to ‘Make in India’.

Pharma mergers and acquisitions: – An initiative towards new business opportunities

The Biopharmaceutical industry is probably one of the most active sectors for mergers and acquisitions. These industries do greater number of deals and transactions than any other sector. Both merger and Acquisition are an essential component of the pharmaceutical business model and are crucial for achieving growth and competitive advantage.

How M&A is benefiting the pharmaceutical industry

The single most essential driver for changes in the Pharmaceutical industry is the ever-increasing cost of drug development, which can be controlled with the help of M&A to a greater extent. Most companies can no longer afford to carry out R&D and require high financing or Acquisition for late-stage trials to find innovative compounds and need the capability to navigate complicated regulatory pathways, which are only possible by big pharmaceutical industries. Hence, big pharmaceutical companies who want to enter a new industry or expand their business towards innovation merge with other companies or acquire smaller, creative companies by funding them or buying that company’s stakes. This is how merger and Acquisition can benefit both the big and small pharmaceutical industry.

Case Study: –

The biggest M&A (mergers and acquisitions) of 2020 are as follows: –

AstraZeneca & Alexion: –

By far, one of the biggest pharma deals of the year 2020 was between AstraZeneca and Alexion, where AstraZeneca offered a deal worth $39 billion to Alexion. Alexion has predominantly featured among the top list of biopharma takeover prospects in the last few years. With the purchase, AstraZeneca will strengthen its immunology franchise with a blockbuster of $4 billion, plus a pipeline of 11 drugs for autoimmune and rare diseases. The boards of directors of both industries have unanimously sanctioned the acquisitions. With both the sectors’ shareholders’ consent, the purchase is poised to close in Q3 2021. Upon completion, Alexion shareholders will also get a 15% stake of AstraZeneca.

Way Forward with Mergers and Acquisitions in the fiscal year 2021:

Mergers and Acquisitions, an aspect of the business world that has been rapidly growing in recent years, are poised to bloom in the year 2021 and beyond as it is one of the easy ways for pharma companies to gain horizontal or vertical integration in an industry without having to break into a new part of it from scratch. Due to the pandemic, as the market was at a complete standstill in deal activity, smaller innovative pharmaceutical companies are looking for funds and, bigger pharmaceutical industries are looking for innovations, which means that there is even more significant potential for more M&A deals to take place in the coming years as pharma businesses are recovering and are determining the best and easy way to navigate and grow the market.

REFERENCES: –

• https://www.mckinsey.com/business-functions/strategy-and-corporate-finance/our-insights/whats-behind-the-pharmaceutical-sectors-m-and-a-push
• https://www.astrazeneca.com/media-centre/press-releases/2020/astrazeneca-to-acquire-alexion.html