The Czech Republic has a tradition of being a developed country. Its residents deserve to access innovative medicines as quickly as patients in Germany or Austria if they become seriously ill. Mehrdad Doustdar, the new managing director of the Czech branch of MSD (Merck, Sharp & Dohme s.r.o.) as of November 1, who worked in these countries before coming to Prague, is convinced of this. He has roots in Iran, from where his parents emigrated to Europe after the Islamic revolution. He is an Austrian citizen but in management positions he has lived in different countries and travelled the world, absorbed its diversity, and learned the importance of listening to customers and respecting the work of colleagues.
Your work career has been associated with MSD for many years, where you started from the bottom – as a sales representative. You gradually worked your way up to senior positions. What from your experience will you utilize in your work in Prague?
I started working for MSD about 16 years ago, first as a student intern. In all countries, in any position, I enjoyed every second of my work. It was rewarding for me both from a professional point of view and for my personal growth. I am very grateful to MSD for that. There were certain defining moments that shaped me on my managerial journey. Already as an intern, I saw how important the work of each colleague in the company is and how together they contribute to the fulfilment of the higher purpose of the entire company. When I became a sales representative, I realized again how important it is to be in contact with customers – physicians, even outside the building, not just in the office. Then I worked in regional roles for various positions around the world – in the Middle East, Africa, Europe, Russia. I learned how important the diversity of individual countries is. Every market is a little different and it is essential to get to know its different culture. However, the most important thing is to be able to listen. Not only to speak but also to perceive what is happening around you. In managerial positions, whether in Switzerland or Germany, I then realized how extremely important it is to create such an environment for people in the company to give their best.
Why the Czech Republic?
It was my own voluntary and completely deliberate decision. I have not applied for another similar position in another country. I was interested in being right here in the Czech Republic. What I like about your country is the incredible development in the last ten years and after the Velvet Revolution in general. Healthcare and the pharmaceutical industry are at a very good level, although some areas can be improved, and this is a big challenge. For example, healthy life expectancy in the Czech Republic is still below the average of EU countries, roughly two years less for both men and women. I also see in the statistics that every day one woman dies of cancer caused by the HPV virus. Or that around 800 patients with stage four lung cancer die every year without receiving modern treatment in time.
Do you think that innovative medicines reach patients late in the Czech Republic?
The period from the market authorisation of a drug to the moment it physically reaches patients themselves is still too long, on average around 500 days. Although improvements have been made in recent years, there is still room to shorten this time. These are often life-saving drugs. In the countries where I worked, in Germany, Austria or Denmark, patients get their medicines significantly faster. Of course, there are also countries where things are worse, but I would like it to be faster in the Czech Republic. Together with my team, I would like to contribute to this.
It is certainly good that you are trying. However, you worked in economically strong countries. Isn’t it the case that the speed with which innovative drugs come to a given country simply corresponds with their economic possibilities?
You’re right that economic background plays a role but that’s only part of the story. There are also other aspects, such as the setting of pricing and reimbursement processes or a continuous dialogue with key entities of the healthcare system, including payers, within which it is possible to continuously respond, with a certain vision of longer-term development, to changing needs. The possibilities of modern medicine and new therapies bring new issues and challenges related to healthcare set up and securing access of patients to these innovations. I come from Austria, which is very similar to the Czech Republic, in terms of culture, mentality, architecture… And I see that the Czech Republic has the potential to reach the same level, even economically. My father knew Prague and Czechoslovakia because he went there fifty years ago, that is, before the revolution in Iran. From his story, I knew not only that Prague is very beautiful but also that there are many talented people and that you are a very advanced industrial country. Therefore, I believe that there is considerable potential here to further improve the quality and length of life, also thanks to faster access for patients to modern medicines.
Despite these nice words, I have to say that we are in a certain crisis. The Czech Republic is even being spoken of as the sick man of Europe, due to the state of its economy. The Czech healthcare itself is also in crisis, physicians are rebelling and demanding better salaries. Priorities, rational spending of public money, including those directed to innovative medicines and new medical procedures, will therefore be discussed again. How could MSD engage in these discussions and contribute to solving such a complex situation?
There are no easy solutions in healthcare. The key is a holistic view, a clear vision or strategy of how healthcare should be organized and financed, with clearly defined management and responsibility of individual actors. We see that most of the world’s healthcare systems face similar challenges related to demographic development, technological progress, new treatment options and securing better access of patients while maintaining their financial sustainability. Each country has to find its own answer to these questions. A significant amount of funds have been invested in the Czech healthcare system over the past few years, which is a good thing. On the other hand, I don’t think it would fundamentally help with the solution of the systemic problems you encounter.
And the industry can also somehow help with the search for a solution, or your company?
We, as the pharmaceutical industry, feel a lot of pressure on the prices and reimbursements of drugs entering the system. Each new drug undergoes a demanding pharmaco-economic evaluation, we negotiate with payers about the terms of reimbursement and availability of drugs to as many patients as possible. However, we do not see a similar discussion about the purpose and effectiveness of other segments of healthcare. In my opinion, this should change. We are trying to draw attention to this. It is necessary to look for savings within the system, to make it more efficient, significantly speed up digitization, focus on defining patient journeys through the system, managing chronic diseases and, above all, on prevention.
When I looked at the data about the Czech Republic, I found out that only about four percent of the total healthcare costs go to prevention. At the same time, most diseases can be prevented, that’s basics. Improving treatment alone has only a minor share in the overall improvement of the population’s health status. Therefore, if we do not also actively focus on disease prevention, healthcare will not be sustainable in the long term. Prevention programmes are more cost-effective than treatment and have economic benefits, a healthy economy is created by healthy people, not sick people. We also want to constantly emphasize this. We deal with vaccines ourselves and know that vaccination is one of the essential pillars of prevention. Of course, we are not alone in this. The Ministry of Health, payers and other stakeholders also play their role. We want to talk to them about it.
For such a holistic approach, one needs to have evidence and data. MSD is one of the progressive pharmaceutical companies as regards their clinical trials and work with data. How can it help the Czech Republic in this area?
Yes, you are absolutely right. The future of our health, better healthcare, higher quality of life, innovative medicines, new technologies, all depend on collecting and working with data. This is absolutely key for MSD. We collect and use data not only in the development of drugs, clinical trials or in the education of patients involved, but also in the manufacturing process or management of our supply chain. Advanced technologies are increasingly penetrating the pharmaceutical industry, with the potential to streamline processes, accelerate innovation, find suitable patients and improve their outcomes, and reduce costs.
In 2014, we opened and since then have been operating one of our three big global technology hubs in Prague (the other two are in the US and Singapore), where everything I listed is being worked on. We have approximately 1600 employees in the Czech Republic, most of them work in this hub in the building across the street. We can offer experience with the use of artificial intelligence, virtual reality, with processing data from real clinical practice, with real-time decision-making based on current data. Data is absolutely essential to the conduct of our clinical trials. We invest about $14 billion a year in research and development. There are around forty trials running in the Czech Republic alone. We get data about diseases, we find out how to fight them, how to treat them. And not only us, but also the physicians involved in these trials. Thanks to all this, we are helping to improve and accelerate the availability of treatment for patients here as well, all at our expense.
You mentioned vaccination. This is often accompanied by doubts, conspiracy theories, etc., not only in the Czech Republic, but also abroad. How do you personally perceive the importance of vaccination and how can your company contribute to greater promotion of vaccination?
Vaccines against a number of diseases are a key part of our portfolio. I have already talked about the role of vaccination in prevention. And you are right, it is sad how in many countries different doubters appear, while vaccination is of absolutely fundamental importance for humanity. It is necessary to keep explaining it patiently, demonstrating it with concrete examples. For instance, vaccination against polio. When I was still at school, I met little children suffering from polio. Today’s kids don’t know what that is anymore. Another recent example is of course covid. I am deeply convinced that vaccination helped us get out of the pandemic and prevented even more damage and economic collapse. If I go back to our company, we also offer a vaccine against infection caused by HPV, which can lead to cancer. Vaccination rate in the Czech Republic is relatively high, but there is still room for improvement, one woman still dies of cervical cancer every day and even more women undergo procedures due to precancerous findings. At the same time, experience from other countries shows that this disease can almost be eliminated. In the end, everyone benefits, including the healthcare system because treatment costs are reduced and lives saved.
We are trying to spread awareness in this direction both among the lay public and our partners from professional societies, the Ministry of Health or health insurance companies. We are quite active in this, also with regard to vaccination against other diseases, such as pneumococcal infections. We generally aim to increase health literacy and public awareness about the importance of prevention, which includes vaccinations, risk factors for diseases, etc. All of this will then help reduce the costs of treatment and health system in general.
As you indicated, we still have a relatively large deficit in vaccination against HPV in the Czech Republic. What should be the target state?
According to the latest published data from 2021, vaccination coverage for girls reached almost 70%, for boys it is 43%. In the case of cervical cancer, we aim at eliminating the disease in accordance with the WHO’s global strategy from 2020, which set as target values 90% vaccination of girls under 15 years of age, 70% participation in screening (HPV DNA testing) and treatment available to 90% of girls and women who need it. These goals have also been adopted by the European Union as part of its European Beating Cancer Plan, which, at the same time, aims to significantly increase the vaccination rate of boys. The Czech National Cancer Control Plan has also adopted these international goals and complements it with the commitment to strengthen support for HPV vaccination, especially with a focus on parents and lay public.
You have a strong cancer portfolio. New innovative drugs are of course expensive. When such a drug enters a large country with many inhabitants, it is advantageous for the producer to agree on an interesting price, or even a discount. For example, MSD made such an agreement with the National Health Service in Great Britain for its best-selling drug. Is this an option for small Czechia too?
This topic is important and, at the same time, very complex. Drug development on the path from the molecule to the patient takes ten to fifteen years and requires high costs of 2.5 billion dollars on average. At the same time, investing in the research of new drugs is very risky because only one molecule out of roughly 5-10,000 makes it to the final product. The innovative pharmaceutical industry thus makes decisions about investments in research for many years ahead.
Our fundamental goal is to make our medicines available to as many patients as possible so that they could benefit from them. We always try to find the best solution in discussion with the responsible institutions of the given country, which corresponds with the specifics of the healthcare system. The British healthcare system stands on a different foundation than the Czech one (i.e. the National Health Service vs. the insurance system), although, for example, ways of assessment and reaching agreements with payers are similar. Yet, our open approach to negotiations and search for an agreement beneficial in its result for both parties is the same.
The question of the value of innovative medicines is a very current topic. You yourself framed the question in such a way that „new innovative drugs are of course expensive“. Where does this belief come from? The value of medicines can vary from the perspective of the individual patient, the healthcare system and society as a whole. Innovative therapy brings a significant benefit as it saves life or improves its quality. For example, the treatment of cancer has witnessed a revolutionary development, and patients who only a few decades ago did not have many options, today, thanks to e.g. modern immunotherapy, have hope for a cure if the tumour is detected in time. Here again, we see how important prevention and the availability of early diagnosis and treatment is. Thanks to modern medicines, patients can return to their work and personal life much sooner, thereby contributing to the economic prosperity of the country.
I would also like to mention that MSD has been long supporting various programmes through which we provide medication free of charge to patients who otherwise would not have access to it. One example is the programme, thanks to which we enable Czech patients in clearly defined cases to have access to our cancer treatment, or the global programme focused on the treatment of river blindness, a rare disease in this country, which is suffered by many patients in Africa, Latin America, the Caribbean, the Middle East, and Southeast Asia and the Western Pacific, or a similar global programme dedicated to patients with HIV/AIDS.
Let’s go back to the financial costs of medicinal products. Payers also run a certain risk when it comes to a completely new drug. And if we want to have drugs on the market quickly, we need to find mechanisms to achieve this, for example, the producer can agree with the payer on sharing risks. Is this an option for MSD too?
A number of mechanisms are already in place between producers and payers that result in risk sharing for both parties. It is always a result of negotiations and it is obvious that with the increase of modern therapies, new ways will have to be found to make them available to the greatest number of patients. This is a topic that most regions in the world are dealing with, so we have a lot to be inspired by.
We haven’t mentioned patient organizations yet.
Patients‘ experience with a disease and its treatment is absolutely essential for us. Without it, we would not be able to work on further improvements of our medicines and their results. We want to listen to them, it is important for us to know what they think. However, patients also assist in finding weak spots within the healthcare system as such, pointing out shortcomings that, often quite unnecessarily, hinder their journey to the treatment. I am very happy to see how patient advocacy has developed in the Czech Republic, patient organizations are important partners not only for us, but also for the Ministry of Health, the State Institute for Drug Control as well as payers, and even, in the case of orphan medicines, they are integral part of the pricing and reimbursement procedure. This is certainly something that is not taken for granted within Europe.
What experience did you bring from Germany and Austria as regards working with patients?
In Germany and Austria, patients routinely communicated with us and shared their experience. However, the regulatory environment for industry-patient relations varies from country to country and needs to be adapted.
According to the consulting company TD Cowen, the American Merck (that is, MSD in Europe) is the only one of the family of big pharma companies to show an average annual decline in sales by the end of this decade, by an average of one percent per year. At the same time, the sales of large pharmaceutical companies will grow by an average of four percent per year until 2030. What is the cause? Investments in R&D, recent major acquisitions?
Let me say that our company continues to maintain a strong position of growth and we are optimistic for the future. We are investing to ensure the health of MSD’s innovation engine which we believe is fundamental to achieving strong, sustainable growth over the long term. We are excited about the significant progress we have made in growing our pipeline and have increased confidence that, for example, our cardiovascular portfolio and pipeline have the potential to generate sufficient revenues approaching the mid-2030s. We are looking forward to launching our new biologic for pulmonary arterial hypertension with a novel mechanism of action that we believe has the potential to become a fundamental therapy for this rapidly progressive and life-threatening disease with a significant unmet medical need.
In oncology, let me mention our pipeline of small molecules and ADCs (antibody drug conjugates) as well as additional innovation around our in-line products, and the individualized neoantigen therapy which we are advancing to phase 3. This is prior to our collaboration with Daiichi Sankyo on three potential first in class ADCs, with each having multi-billion commercial revenue potential approaching mid-2030s (non-risk adjusted). We have also accelerated our presence in immunology with the acquisition of Prometheus Biosciences and its lead program (MK-7240), which we believe has significant revenue potential in both Ulcerative Colitis and Crohn’s Disease extending through the next decade. MSD has a long history of successfully reinventing itself through innovation, and we believe that we are well positioned to do so again and achieve long-term success.
Tomáš Cikrt
