GSK’s Witty does some tough talk on India M&A

My colleague Vikas Dandekar, Pharmasianews bureau chief in India, recently tweeted the following comments from GSK CEO Andrew Witty (at an investor call). 

“I’m not paying 37 times earnings for an Indian company, I am just not.”

“We are going to walk away from opportunities that go out of our price range, and where we don’t think we can drive value….”

“We’re not going to get drawn into the bidding frenzies.”

Witty can perhaps afford to be a bit choosy given the position of GSK’s Indian subsidiary. For years, Glaxo was number one in terms of market share in the country and only fell lower when in the wake of its integration with SmithKline Beecham in the early 2000s it consciously decided to chase profitability over market share and pedalled down on certain price-controlled products.  Even now it continues to be in the top five (number four) by market share. Last fiscal GSK Pharma’s net sales grew 12 per cent.  It has also demonstrated an ability to think out of the box – being one of the few Big Pharma subsidiaries that did India-specific product-licensing deals with the likes of Eisai, Organon and Astellas to bolster its offerings in the country. Also,  there have been no major mega-deals (after the merger with SmithKline Beecham) to rock the boat.  In terms of volumes, GSK India is already a significant contributor to the GSK stable.

Against this backdrop, Witty’s stance might be easier to comprehend.

India to screen 7 crore for diabetes and hypertension

The Public Information Bureau recently issued a release recording Cabinet approval for a national programme to prevent and control cancer, diabetes, cardiovascular risk, and stroke.  “The programme will be implemented in 20,000 Sub-Centres and 700 Community Health Centres (CHCs) in 100 Districts across 15 States/Union Territories by promoting healthy lifestyle through massive health education and mass media efforts at country level, opportunistic screening of persons above the age of 30 years, establishment of Non Communicable Disease (NCD) clinics at community healthcare and district level, development of trained manpower and strengthening of tertiary level health facilities.”

“It is expected to screen over seven crore adult population (30 years & above) for diabetes and hypertension, early diagnosis of NCDs and treatment at early stages. To fill the gap in the health delivery system, about 32,000 health personnel would be trained at various levels to provide opportunistic and targeted screening, diagnosis and management of NCDs,” it says.

Well, sounds good. Though Vikas Dandekar of pharmasia news (whose tweet sent me to this release) thinks it may lack commitment. I for one, am surprised we even got this far. I recall the first time I wrote about India’s dual burden of communicable or infectious and non-communicable diseases with my colleague Jeetha D’Silva at The Economic Times was in the year 2002 using WHO data.

I got an extract of that article from the Internet and here’s what we said : “The chickens are coming home to roost. The first-ever global analysis of disease burden due to cardiovascular risks, conducted by the World Health Organisation (WHO), shows the burden is getting heavy in the developing world.The WHO says that while tobacco, blood pressure and cholesterol have been leading risks in the developed world, they now feature prominently in middle income countries and are beginning to show up in poorer developing countries as well. The analysis is part of the World Health Report which is to be released at the end of this month. The thrust of the analysis is that cardiovascular disease is no longer a “western” problem.”

That WHO report was probably not the the first warning either.

Of course, am happy that government is beginning to addresss the problem in what appears to be a cohesive, structured manner.  It isn’t too late – provided we don’t take the next ten years to begin implementing the programme.

India’s looming healthcare tab from lifestyle diseases

A survey by drug maker sanofi-aventis on diabetes and hypertension prevalance in outpatient settings in ten different states in India revealed some preliminary results based on findings from two states – Delhi and Maharashtra.

The study “highlights a high percentage of diabetes and hypertension patients who are suffering from associated co-morbidities such as kidney disease, dyslipidemia (uncontrolled cholesterol level), and also shows that there are a significant number of cases where patients are suffering from one or both the conditions, in spite of no family history or genetic predisposition towards either disease,” says a sanofi statement. ” The results also alarmingly show that almost a quarter of the hypertensives were still undiagnosed and unaware that they were living with a serious medical condition.”

I have no doubt in my mind that the findings from other states will not deviate hugely from the trend. This begs two questions : won’t this level of disease weigh down India’s ability to emerge rapidly as a ‘super power’ (which many of our key opinion leaders in politics, media, business and social life assume is a matter of course). And two, shouldn’t the country start addressing ways to curb the huge healthcare tab of treating all these sick Indians? We need a massive programme that combines prevention, early diagnosis and intervention and is executed with missionary zeal. Such a programme could potentially also dovetail into how best to use Indian systems of medicine to treat diseases that Indians seem to be more prone to than many other nationalities, for instance.

In the meantime, see findings below :

Parameters Maharashtra  New Delhi region
Prevalence of diabetes 40% 33%
Prevalence of hypertension 56% 48%
Prevalence of both diabetes and hypertension 29% 21%
Unaware they had diabetes 5% 3%
Diabetics with no family history 41% 32%
Patients with uncontrolled diabetes 73% 62%
Diabetics with kidney complications 31% 27%
Unaware they had hypertension 26% 24%
Hypertensives with no family history 46% 42%
Patients with uncontrolled hypertension 79% 77%
Hypertensives with kidney complications 32% 23%

Pfizer’s Nigerian nightmare. Or is it the other way around?

Children who participated in an allegedly botched Pfizer drug trial in Nigeria in 1996 may still have their day in an American court. The US Supreme Court has refused to block a suit brought against Pfizer by their families. The plaintiffs contend that Pfizer tested its experimental antibiotic Trovan during a meningitis epidemic in Nigeria without following due process of written informed consent. Nor did it warn the families of the drug’s side-effects or inform them that an approved drug was being distributed free by an aid organisation nearby. It also allegedly administered a low dose of a control (approved) antibiotic to make Trovan seem more efficacious.  Some children in the trial died while others suffered lasting damage. See here for details.

Pfizer – which has denied all wrongdoing – had insisted that the lawsuits should be filed in Nigeria not the US but the plaintiffs allege that Nigeria’s “corrupt” courts will not deliver justice. Pfizer has already paid the Nigerian government $75mn to settle claims.

This is a case that India should follow closely to its logical conclusion. To know why, look no further than Bhopal to see how good the country is at protecting its people. Now put that together with the pace of drug trials in the country and the absence of adequate oversight.