We’re doing more and more work in emerging markets, and when we at HRW are working in any market we put the findings in to the local context; culturally, socially and practically. To help expand our understanding we often consult members of our expert panel to help explore nuances and key considerations. These interviews are often very interesting and very telling, and they help advance our understanding of how to tailor the approach to reflect local nuance but provide comparable findings globally; a process our clients often find valuable to participate in. So we have been doing a few prospecting interviews in some of the markets and therapy areas where we’re doing an increasing amount of work to help share this understanding with our clients in advance – as part of this quest we have been able to secure permission to share some excerpts of a recent interview with a KOL in Saudi Arabia. Our physician: Dr. Nassar, an Egyptian physician working in the Kingdom of Saudi Arabia (KSA) for 10 years- since 2006. Consultant Haematologist, known for his work on Bone Marrow Transplant and Eye manifestations of Graft versus-host-disease. HRW: In what ways do you think physicians in Saudi Arabia are different to Europe and the US? Dr. Nassar: There is less research done here. In particular many hospitals including Ministry of health and private sector hospitals are mainly concerned with providing health care service without the experimental aspect. Another difference is that there is a lot of change and turnover of medical staff. Most senior experts come from elsewhere, stay for a few years in Saudi Arabia then go back to their home countries. This continuous dynamic atmosphere may be beneficial to give some new blood and new ideas but is bad because it makes our teams unstable. HRW: What are some of the key patient types in Saudi Arabia that may be less common elsewhere? Dr. Nassar: We have two main types of patient here in KSA; Saudi patients and Non- Saudi patients. Saudis are insured and covered by governmental hospitals and also often covered by private coverage (if they work in private sector jobs). Saudi patients are often reluctant and not adherent to use medications they are prescribed or following medical advice given as they have the ability and access to different hospitals in private and public sectors; so instead they go visit and consult many physicians and usually switch between different doctors and treatment protocols. Some patients also go abroad for better medical services; they may want to make use of medications still under the process of being approved by Saudi FDA. So, patients go outside to take these treatments or to be enrolled in clinical trials on new treatments. In KSA and other Gulf countries, we also see an increasing population of people under 40 and increased family growth rates. It’s expected that aging populations will increase in the future due to high quality medical services and high affordability of payments for these services. HRW: How are pharmaceutical companies perceived in Saudi Arabia? Dr. Nassar: Pharma companies are perceived in different ways. Some companies– in addition to providing medication- provide also social services and medical services; others don’t do that. One good example is Novartis who provide services for patients and doctors. For patients, they provide free testing for Cytogenetic Response for patients with Acute Myeloid Leukaemia. These tests are very costly and available in public hospitals only. Others provide awareness and free services to patients; follow up with patients via a hotline. Other companies- like Janssen of Velcade- provide physician services; for example, they provide us with a password for free access to international medical journals and up to date published research. At the patient level, pharma companies are branded in patients minds by name. Patients always focus more on the original country of brand not on the company name itself. For example, a patient might ask for the German product versus the Turkish one. HRW: What does the future hold for healthcare in Saudi Arabia? Dr. Nassar: Saudi Arabia is still growing and is an open market with many opportunities. It is considered ‘emerging’ because it is still following and applying results of research work conducted in western countries rather than conducting its own research. According to the kingdom vision released recently by Prince Mohammed Bin Salman- Kingdom Vision 2030- the country is going into more investment in private sector. The role of governmental involvement will decrease gradually, and private sector would be allowed in the near future to increase its role in covering the needs and providing services. The cost of hospitals and revenue from health care services will push to more involvement of private sector and we will see more privatization. Talking about health economics and market size, still 80% of expenditure is covered by public sector (governmental sector) and private sector may be 20- 25%. Private sector needs development to face the needs to cover expatriate medical services (expatriates are 35% or more of the population in KSA) and thus we need more focus on private sector hospitals to be able to fulfil the needs At the moment Saudi is always 1 or 2 years behind the rest of the globe in the new treatments. In KSA, we use the new treatments after around 4 years of its 1st introduction in western countries. Here we require American FDA approval and then Saudi FDA approval and some other routine paperwork in addition to a commercial agent to take on the logistics agreement and make it available in KSA. We need to decrease this period of time to less than 2 years if possible, to be running with global advancements in new treatments in all therapy areas. HRW: If you were going to give advice to a pharmaceutical company launching a new product in Saudi Arabia, what would you tell them are the keys to success? Dr. Nassar: In my opinion, there are 3 things that companies should consider. The first thing is presale services: to establish a database of doctors working in this field and therapy area and to communicate with them with all data available on the new medication and new researches and trials, as because we’re not conducting as many studies here we may not have the latest research. The second thing is after-sale service: to dedicate part of the revenue for patient’s sake and doctor education as well. Offering free tests and lab analysis, SMS and phone hotlines and follow up, direct patient services, health care days. In addition, continual education for doctors is an important offering that helps a product succeed in KSA. The third third point is for pharma companies to consider their local distributor. Avoid using brokers who bring the medication to Saudi Arabia via un-assured ways which lead to low priced medications available via brokers but sure these medications are delivered in low quality control measure like temperature and other issues. So, the company should take care of the whole process and its main components: • Patient: provide the product to them and offer support • Drug: availability, transportation and logistics • Health care providers: research and updates For more information on how we work globally, click here. For more details on the work we’ve done in Saudi Arabia or to request a KOL interview in your therapy area, please get in touch. Apply Now!