Our goal is to have HPV vaccination as part of State mission: MSD India MD

In a Q&A, Rehan A Khan talks about his firm's strong focus on R&D and its commitment to making drugs affordable

MSD India has signed several agreements around molnupiravir during the pandemic, and says that going forward, its focus for the Indian market would be vaccines and oncology. In an interview with Sohini Das, Rehan A Khan, Managing Director, MSD India Region speaks about how the firm expects HPV vaccination to become a part of the national immunisation mission. Edited excerpts:

How has business fared during the past two years of the pandemic?  

The year 2021 was a defining one in India's healthcare landscape. As one of the five fastest growing MNCs in India, we had successfully announced non-exclusive voluntary licensing agreements for the drug molnupiravir (an investigational oral antiviral medicine that significantly reduces the risk of hospitalisation or death) with eight Indian generic manufacturers and witnessed successful HPV vaccine launch as well. We licensed molnupiravir to 4-5 other companies through the medicine patent pool as well.

We also successfully launched our more advanced Gardasil-9 (nanovalent) HPV vaccine, giving broad coverage against the virus. This is coming on the heels of 2021, where we witnessed significant growth in business and delivered our best performance in the past five years.

As you are aware, cervical cancer is the second-most common type of cancer in Indian women, and HPV (human papillomavirus) is its most common cause. It’s disheartening that every eight minutes, a woman dies in India of cervical cancer. However, the disease is treatable and preventable with timely diagnosis, treatment and vaccination.

As for our cancer care management eco-system, we are exploring partnerships with various state governments to enhance the clinical capabilities of our doctors, and are working with them to standardise treatment protocol in cancer care.

We are focused on increasing affordability and accessibility of our oncology products and having various initiatives such as patient support programmes.

'MSD for Mothers' is another initiative through which we work with governments, non-profit organisations, experts, advocates, innovators to help end preventable maternal mortality in India. In partnership with NGO Manyata, we have helped train 9,000 healthcare and facility staff, and aided 350,000 safer deliveries at an investment of $215,000.

What is MSD India's share in global production?

Our company is committed to Aatmanirbhar and Make in India, the best example of this being that we are one of the few global pharma companies that make in India, for India and the rest of the world. Eighty per cent of our total volume is produced in India, which is the largest API sourcing hub for MSD globally.

What will the key areas of focus for the India market be?

We've been using leading-edge science to save human lives for more than 130 years through the development of important medicines and vaccines. Our goal is to bring our best-in-class products from our global portfolio to address the un-met medical needs in the country--whether it is through our vaccines portfolio, which aims to help save lives across all stages, or extending and improving the life of cancer patients through our treatments.

We are a country with massive inequities in the disease areas, with a lot of opportunity for MSD to serve. Our government has increased spending in healthcare, with plans to go up to 5 per cent of GDP by 2025. This will bring huge potential to serve better to each patient and serve a greater number of patients.

Our recent investment in India’s leading impact driven VC fund, HealthQuad, will contribute to a robust and sustainable healthcare ecosystem through innovative solutions in financial inclusion, patient engagement and supply chain, in India and across the world.

Will vaccines and oncology continue to be a key focus area for MSD in India? Any other therapy area that you want to focus on?

In oncology, we will expand patient access by getting more approvals for more indications. In vaccines, our focus will be HPV and pneumococcal portfolio, both of which are under penetrated. We would work on driving vaccine awareness and uptake.

Vaccines and oncology will continue to be a priority.

What has the uptake for HPV vaccine in India been? Any conversations with the Indian Government to make HPV part of the immunization programme?            

There has been double-digit growth and our focus continues to be on HPV and pneumococcal vaccines.

The central government is also considering adoption of HPV in the national immunisation programme (NIP). As I mentioned earlier, building partnerships to improve access to healthcare is something we consider to be our strength, so our work on that front is ongoing. To that end, we continue to have talks with state governments on comprehensive cancer care management through prevention, where one of our goals is to have HPV become a part of state immunisation programmes.

What are the new indications that DCGI has granted for your cancer therapy Keytruda?

The DCGI approval for Keytruda has come across new indications--lung, bladder, head and neck--which we secured in September 2021.

Beyond the approval from the Indian regulator, Keytruda is also being evaluated in more than a thousand clinical trials in multiple cancer types against the current established therapies. Regulatory agencies across the world have granted approval to Keytruda in more than 30 indications. So, we hope to have a lot more great news coming up on that front.

How will Keytruda be priced in the India market?

In India, there is differential pricing for the drug, which is an outcome of multiple factors involving research and development, and clinical trials. Apart from this, we are evaluating multiple-access initiatives so that we can make our drug available to the thousands of patients in our country.

What is your market share in oncology?

Keytruda became the No. 1 brand in oncology in 2021.

Keytruda has obtained health insurance benefits in markets like Korea. Will treatment with Keytruda be covered by insurance in India as well?

The health Insurance sector in India is still in the nascent stage. Yes, some of the markets you mention have achieved remarkable penetration rates, but India has witnessed the world’s largest healthcare initiative under Ayushman Bharat. We have initiated discussions with various stakeholders including the insurance industry about the same and hope these discussions will be fruitful. This treatment is covered under health insurance in India.

Tell us about your research centre and how much business it is likely to yield.

The additional capital investment of $16 million in our Pune centre is evidence of our commitment to India to enhance the innovation ecosystem. The Human Health division has had an established presence in India for over a decade, with 65 per cent of our forecasting organisation based in Pune.

The vision for our data and analytics capabilities is to improve business and patient outcomes around the world through analytics and technology. Similar to MSD’s US hub, our team in Pune will focus their efforts on answering some of the most important business questions--whether it is applying advanced analytics to inform strategy decisions or delivering insights in less time at high quality.

Apart from pricing regulations, what are the other challenges in the Indian market and how is MSD India meeting them?

Our efforts will be to continue focusing on production and manufacturing in India, which constitutes 85 per cent of our global output. Our efforts in the years to come will be dedicated towards R&D. These investments have been made possible by a pricing model that rewards risk-taking and innovation.

Continuous efforts in research and development are key to our industry. We have a long track record of making our medicines and vaccines accessible and affordable globally, and are firmly committed to doing the same. We work together with the governments of various countries to establish and implement strategies that ensure affordability and availability for our drugs and therapies in the longer term.