Novo Nordisk gives specialist training to 200 Chinese doctors a year

Of all the new insulin markets in the world, the one with the greatest potential, without any doubt, is China. But it is a market which needs to be built up from scratch. In the last few years, Health Care has seen explosive growth in the sale of human insulin in China. This growth has been driven primarily by the investment made in building a sales network as well as training activities within the two core business areas of Diabetes Care and Women´s Health Care.
"Our investment at the moment lies in the accelerating process of creating the market. Our long-term objective is to be market leader in both diabetes care and HRT. Our intention, already agreed with the Chinese authorities, is to start our own production of pharmaceuticals when the market is of a size that will justify it," says Lars Rebien Sørensen, corporate executive vice president, Health Care.

Diabetes school
General manager for Health Care’s 60 staff in China, Henrik Glarbo, says, "We have to create the market from scratch ourselves. There is a grotesque disparity between the size of the population of China, the rising incidence of diabetes and the estimated total consumption of insulin today.
"We are facing a unique opportunity to build an insulin market up from nothing, based on our human insulins. This is a situation Novo Nordisk has never been in before. It requires strategic and operational focus and stamina that exceeds anything the company has done before in similar markets.
"What we are doing is to focus on specialist training of doctors interested in endocrinology. We are financing a number of activities, including a diabetes school in the province of Shandong where doctors from all over China can attend courses and be given a better understanding of the illness. Together with the Chinese ministry of health, we expect that the school in the town of Yantai will be able to train some 200 doctors every year."

Local barriers
"Considering the enormous population of China, there are very few doctors who specialise in diabetes. So even if we manage to make more of an impression in the larger towns and provinces, there is only one effective path to follow - we must negotiate our way round the structural barriers on each of the regional markets. We are doing this by installing sales staff who can work on a local basis to tackle structural problems. Only then can we begin training and informing doctors and patients of our insulin products, even though they are not price competitive with local animal insulins. Our goal is to become market leader in China in insulin therapy."

Women’s health care
"The situation in Women’s Health Care is not all that different from Diabetes Care. The present market for HRT bears no relationship to the number of women going through the menopause. Later this year, Kliogest® will be launched in China and we are working hard to make sure that launch is as effective as possible. The entire range of Novo Nordisk HRT products is expected to be on the market in the next few years."

Health sector undergoing change
Glarbo points out that there is a general structural problem in the area of public health in China. The country has an urgent need to update its knowledge and awareness of the progress being made in western medicine.
"Until Deng Xiao Peng’s market reform in 1978, the country was completely closed. Today, China is in the middle of a process of dramatic change in its health sector. Since 1991, the percentage of the national budget earmarked for health has fallen, whilst the economy is booming.
"Market economy, for example, has presented the state-owned companies with great problems in adapting to the new times. It is a fact that there are 170 million employees in these companies today not covered by the health insurance to which they are officially entitled. There is simply not enough money in the coffers to pay for their health insurance. Therefore, the current reforms in the Chinese health sector aim to reduce the financial burden on the state-owned companies and let users pay for a larger part of public health costs. A similar situation exists in agriculture, where the state and collective farms used to cover public health costs. No longer. And in many rural districts, the primary health system has broken down."

As part of their traning, doctors and nurses receive information on Novo Nordisk's products.

Single packs
Glarbo emphasises that patient contribution to medicine has risen across the board and is expected to continue to rise. "Our Novolin® human insulin is on most of the so-called ‘positive lists’, drawn up by the local provincial health authorities to define which preparations are subsidised. Nonetheless, we have had to develop special package sizes specifically for the Chinese market so we can meet the limitations of the individual patient, who has a fixed sum to buy medicine for, either on a monthly basis or by the receipt." As an example, Glarbo names the Novolin® 3 ml Single Pack Penfill®, recently launched on the Chinese market. Package design and sizes were adapted to conform with the special local requirements. "Normally we supply Penfill® in packs of five. Here in China we have changed to ‘single packs’ to meet the special medicine subsidy demands and to reduce the burden on those patients who have to meet some, or all, of the cost themselves."