09 Jan Pharma sector engages with public sector to combat chronic diseases
Kasper Boedker Mejlvang, General Manager, Novo Nordisk, talks about the company’s long fight to supply medical supplies and technologies to all patients in Denmark and the world and its ambitions to actively partner with governments to create stronger and more sustainable healthcare systems.
What is Novo Nordisk’s mission and what new innovations has the company brought to the medical field of chronic diseases?
Novo Nordisk is almost 100 years old and is linked to the discovery of insulin that took place in Canada in 1921. The company was founded in Denmark because two doctors, one of whom had diabetes herself, managed to bring back the patent for insulin to manufacture and commercialize it in Europe. Since the company was established in 1923, we have been one of the leading companies in the fight against diabetes. We have made many different innovations along the way in new types of insulins and GLP-1s that help people control their disease, which is very complex to manage in daily life. In recent years we have also expanded into other molecules and innovations to better control diabetes. The disease is a global pandemic; the number of people with type two diabetes has been increasing globally for years, linked with urbanization and adoption of Western lifestyles. Today there are more than 460 million people living with diabetes, and this number is expected to increase dramatically to more than 700 million by 2045.
We were the first company to find easier ways to inject oneself with insulin by using different types of pens that are much more convenient and reduce the stigma associated with injecting oneself in public spaces. One does not need to use syringes to pull insulin out from vials, instead patients can use ready-made pens with very sophisticated needles that one does not really see or feel. These came out in the mid-1980s. We are currently launching new generations that allow for connectivity to smartphones and registering insulin doses and timing, which can be combined with continuous glucose monitoring devices.
Another recent innovation that surprised the market was our ability to produce GLP-1s as a tablet. GLP-1 along with our other treatments consist of large proteins that historically have only come in liquid form for injections. No other company has been able to put these large molecules into tablets. We launched this innovation last year; we acquired a company that helped us develop the technologies that make this possible. In the first nine months of 2021, the company recorded an increase of 12 percent in net profits. The biggest driver of our recent growth has been this new class of GLP-1 products. These are making a huge difference for people. They have been well received by both specialists and primary care physicians as well as people living with connected conditions.
Is the company looking to differentiate its offerings and field of focus?
There is still a lot to do within the area of diabetes and insulin. We have a lot of innovations coming. For instance, we are looking at once-a-week solutions and glucose sensitive insulins. In addition to the molecules, we are also developing medical devices. The recent launch of our connected pens are a part of our innovation journey. In terms of new diseases, we are moving towards non-alcoholic steatohepatitis, cardiovascular disease and Alzheimer’s disease. All of these diseases have huge unmet medical requirements. Based on our core competence within endocrinology and understanding of the metabolic system, we have high hopes in our ability to address these needs. We also hope to diversify into some rare blood and endocrine diseases that also face significant unmet needs.
Additionally, we are moving into tackling obesity; this is a huge and undermet market. Unfortunately, people living with obesity are stigmatized. Healthcare systems have reduced obesity to a matter of eating less and exercising more; yet this focus has not solved the issue. Today, there are more than 650 million people living with obesity. Novo Nordisk has managed to bring forward some innovations in recent years that can really make a difference in terms of medical treatment options. We hope to be able to be a part of solving the global obesity pandemic and defeat diabetes. The strong progress of our research and development pipeline shows how capable we are in tackling these issues.
What is the company doing to promote preventative measures to decrease the rise of deadly diseases?
We have a large social responsibility strategy that is focused on prevention, innovation and affordable access. Both obesity and diabetes are linked with global urbanization. We are looking for public and private partnerships to improve the healthcare ecosystems in large urban environments around the globe to see what we can do to help make populations healthier. One of our initiatives is called Cities Changing Diabetes and involves a number of large cities around the world, including Houston, Mexico City, Buenos Aires, Madrid, Copenhagen, Belgrade, Istanbul, Beijing, Shanghai, Seoul and Jakarta. We are working with different public and private partners to improve access to healthy food, create infrastructure to reduce physical inactivity and enhance communities and healthcare services. For example, in Houston it is difficult to move anywhere without taking a car. The municipality is looking into improving infrastructure to facilitate walking and biking. Another aspect is the massive social inequality tied to both obesity and diabetes that makes the accessibility of affordable and healthy food options a key priority. Our efforts to tackle obesity is important because the condition of having excess body fat creates physical and mental problems for the individual. This will prevent other diseases like type two diabetes and cardiovascular disease.
How robust is Denmark’s health sciences sector?
It is strong. One reason is that public-private partnerships are popular and successful in Denmark. We have a decent value chain from research at universities to biotech start-ups and big pharma companies. Due to the small size of the country, different stakeholders know each other well. Furthermore, there is a general culture of trust in Denmark that makes it possible to come to agreements faster and maintain strong commitments. Our solid industrial framework plays a vital role in supporting the Danish economy. Although our tax levels on personal income are high, we have an efficient public sector that supports people moving to Denmark with strong infrastructure, healthcare, childcare and other services. This has attracted companies and international investors in the past.
The Danish life science sector has grown tremendously in the past decade. The sector accounts for 22 percent of total exports out of Denmark and is worth $28.8 billion. If we continue to succeed, the sector is expected to bring in more than $57.5 billion in exports by 2030. There are good prospects for the future if we manage to continue improving framework conditions. We look to grow in areas to double or even triple exports by 2030.
How has the COVID-19 pandemic affected Novo Nordisk’s operations?
We have learned several lessons. One positive to come out of this horrible crisis is that it has underlined the importance of private and public partners working closely together. We went into a partnership with the government early to increase testing capacity. Within weeks, we were able to establish testing facilitators to do rapid testing, which made it possible for Denmark to get out of the first lockdown rapidly. The same goes for vaccine companies and their collaboration with healthcare systems to develop, test and produce vaccines at record speeds.
We hope that we can build on these learnings to reduce barriers that may have existed historically, and create better ecosystems to solve health challenges around the world. In the future, global healthcare systems will be under immense pressure from rising chronic diseases. While in the past the main enemy was infectious diseases, people are now living longer. Urban lifestyles will increase chronic diseases dramatically and burden healthcare systems. These issues will not be possible to be solved with the ecosystem we have today unless we find innovative partnerships solutions. More focal points underlined during the pandemic were weaknesses within global supply chains. In some healthcare systems, this has led to a level of protectionism and politicians advocating for nationalization of medical supplies. We need to be able to explain the necessity of having global supply chains in the coming period. We need to have good dialogues on a political level to make sure we have robust supply around the world in the future.
What is the company doing to support sustainability and cut down carbon emissions?
We aspire to become not just the best in the world, but the best in the world in terms of environmental sustainability. We were one of the first companies at the turn of the millennium to start reporting on a triple bottom line, not just on our corporate social responsibility webpages, but in our annual reports, with environmental targets committed externally. We report on targets that we set for ourselves in terms of environment and social responsibility. In the beginning we focused on production. With most of our production in Denmark, we launched several initiatives here. One of our key innovations was a symbiosis created in collaboration with other companies in heavy industry. Waste streams from one company are used as a resource for another company. This is still quite an innovative set up. If you go to industrialized parts of Denmark, you will see pipes connecting different companies that transport energy, steam and water.
Based on various improvement initiatives, we reached our target of having all supplied electricity in Denmark from renewable energy sources in 2010. By 2020, we had an ambition to achieve the same goal for our entire global production, which we achieved. We are setting a 2030 target to expand beyond production to our full value chain, which will be carbon dioxide neutral by 2030, including suppliers and distribution. We also want to find a solution in recycling our materials to become a fully circular company. For example, we recently engaged with A.P. Møller – Mærsk to transport our products with biofuels. We are running a pilot out of Denmark in terms of recycling in which we take back our disposable plastic, glass and metal pens and reuse them instead of burning them or having them end up in a landfill. We produce more than 700 million pens per year that are distributed around the globe. We would really like for those materials to be reused.
How significant is the U.S. market to Novo Nordisk’s international portfolio?
Our global diabetes market share is around 30 percent. The U.S. market has been our most important market for many years, as it is for many pharmaceutical companies. Almost half of our business lies in the U.S., and we have a very strong position in the market. It has decreased a bit in size relative to other international markets over the past years based on our growth in the rest of the world. After some years of decline, we are now back to growth within the U.S. It will continue to be a big and strategic market for us in the future.
There are specific challenges that exist in the U.S. healthcare system. Social inequality is high and particularly high when it comes to access to healthcare. We have tried to address this issue through many programs set up to bring affordable care to the more than 500,000 Americans with less means. We have reduced insulin prices for many consecutive years. We want to be a sustainable business that helps the government address the challenges they face. We want to be an active partner with public authorities to find sustainable solutions for the U.S. healthcare model and secure access to proper healthcare for all. The system is currently still broken. For example, the cost of insulin is still too high for those who are not covered by insurance, despite having decreased our net prices through large rebates over the years. We want to be an active partner to aid in this reform.
Traditionally, Novo Nordisk was a very Danish-centric organization that relied extensively on internal innovation. As we have grown into an international company that is among the top pharma companies in the world, we have increasingly focused on sourcing innovation externally. We have built strong communities in collaboration with universities in Europe, Asia and the U.S. We recently expanded in the U.S. in the Seattle and San Francisco areas. We have increased the number of external partnerships in licensing agreements and acquisitions in recent years. We will continue this trend moving forward.
Given that in two years Novo Nordisk will celebrate its 100th anniversary, what main objectives have you set for the company?
Our anniversary is a key milestone. It is not a given that any company exists for this long or that a company will remain relevant to society in the future. We have been successful, and we are using this milestone to discuss what it will take for us to be successful in the coming 100 years. We will remain an innovation-based company. We believe that being able to innovate new treatments through research and development will be the key to our success. In recent years we have lifted the bar on innovation to be relevant for decades to come. It is also clear that technological advancements will change the value chain in the future provision of healthcare solutions. This will have large implications on our commercial model, such as how we go to the market with our innovations and with whom. Digital health will play an increasingly important role. We intend to have more partnerships to create the best solutions for healthcare providers and people living with chronic diseases. Additionally, if pharma is to be relevant in another 100 years from now, we need to change the role we play in society to become a more active partner in healthcare systems and invest in health effectively to solve chronic diseases. We need to move beyond selling products in isolation based on key efficacy features and negotiating prices per pack. We need to take responsibility for the outcomes of treating people to the benefit of patients and healthcare budgets. For example, in Denmark the cost of diabetes on the economy is around $4.98 billion per year according to some analyses. The majority of the cost is related to late complications when people are not succeeding in getting diseases under control and end up being hospitalized. We still see far too much amputation, blindness, kidney failure, cardiovascular disease and early death from diabetes—even in a country like Denmark with a strong healthcare system. In addition to these diseases negatively impacting a patient’s quality of life, many patients also leave the job market; there is a loss of productivity.
How can the company and society partner to combat challenges presented by chronic diseases?
If we engage in different types of collaborations to prevent these issues in a more effective way and identify people and treat them more intensively so that diseases are under control, this cost of $4.98 billion would surely decrease, even if we intensify treatment. We would like to embark on these types of agreements and actively aid healthcare systems so that the load is reduced on both the economy and individuals. We are setting some ambitions in Denmark to lead the way because we have a life science industry and culture that facilitates partnership. Even if we have a healthy healthcare system, only 40 percent of people living with diabetes are in adequate control of their disease. We have all the tools to make the number higher than 80 percent, and we aim reach this goal by 2025.
Patients should be able to live as healthy lives as the rest of the population and stay on the job market. This can be done by improving the healthcare system and incentivizing outcomes by creating the best standards of care in primary and secondary care. This can be done through medical education and the newest and most innovative treatments. Chronic disease will be a key challenge to healthcare systems in the future. In Denmark we have a progressive life science industry that has the potential to partner with society to solve challenges in a way that can bring down the burden of chronic disease. We want this type of partnership to succeed and become a model that will inspire other countries struggling with the same challenges.