Between 230,000 and 260,000 Russians have Type 1 diabetes.

After the collapse of the Soviet Union in 1991, the market for health care products in Russia has recovered and is now undergoing explosive growth. Working to a goal-oriented strategy, Novo Nordisk has assumed a strong position in Russia, first and foremost in diabetes care.

When the coup in the autumn of 1991 failed, it was not just the Soviet Union that collapsed. With it went the centrally organised health system
In the old days, medicine was sold to a central, national body, but now it has to be sold to the health authorities of each and every region. There are 89 in Russia, vastly different both geographically and economically.
"In the more affluent regions, large sums of money are spent on medicine. In Greater Moscow, for instance, diabetes treatment is of a very high standard, as seen by the fact that pen systems for the injection of insulin have met with great success. But the contrasts are enormous and in the poorer regions, there is a shortage of insulin," explains Harry Itameri, general manager of Novo Nordisk's Health Care representative office in Moscow.
With a market share of more than 50%, Novo Nordisk has established itself firmly in Russia as market leader in diabetes care, winning new market share in a market that is recovering strongly after the recession that followed in the wake of the fall of the Soviet Union. Growth rates on the Russian health care market are high: in 1995, Russia imported medicine to a value of USD 2 billion; in 1996, that rose to USD 2.4 billion and in 1997, the figure is expected to reach USD 2.8 billion. And there is no sign the boom is coming to an end.
Sales of Novo Nordisk's diabetes care products have tripled since 1993, a trend Novo Nordisk expects to continue, along with an increasing shift towards high-quality products such as human insulin and pen systems. The value of the Russian market for diabetes care products in 1996 was USD 114 million, with insulin accounting for USD 54 million and OHAs (oral hypoglycaemic agents) for USD 60 million. The Russian insulin market is expected to grow at an annual rate of approximately 20% in the next five years - twice as much as the world market growth rate.
Between 230,000 and 260,000 Russians have Type 1 diabetes, while the official figure for patients with Type 2 diabetes is two million. However, according to recent estimates, up to eight million Russians may have Type 2 diabetes.

Clear strategy
Novo Nordisk has followed a clear strategy in Russia - the market offers so many surprises and variations that numerous local partners are essential. Particularly in distribution, a key factor for success in Russia. Novo Nordisk works with more than 20 distribution partners, one of whom is the company Ferane. It takes care of some of the sales and distribution activities and is now also beginning licence production in Moscow with the formulation (mixing) and filling of insulin in vials.
Itameri describes the advantages of local licence production in the unpredictable Russian market: "A completely basic thing such as import licences can change from one day to the next. In the spring of 1995, the Ministry of Health imposed a three-month ban on the issue of import licences for insulin, which led to a shortage of insulin in certain areas. We don't want to see that happen again, and therefore local production under licence is a huge advantage." As in other places in the world, training and education are an integral part of Novo Nordisk's sales and marketing activities, allowing the company to offer a comprehensive diabetes management concept, with insulin, pen systems, blood glucose measuring systems and the further education of diabetes specialists and endocrinologists. "We have arranged 15 regional and 20 inter-regional training and education seminars in 1997. Apart from that, we are active in IDP, the International Diabetes Programme in Russia, and next year we will open a completely new Novo Nordisk diabetes training centre in Moscow. It will hold courses targeted at Russia's 7,500 senior endocrinologists. Apart from the actual training, they will be given teaching material for use in their own training schemes for local endocrinologists and general practitioners. In that way, we create a synergetic effect for our own efforts," says Itameri.
Diabetes Care is still the predominant business area for Novo Nordisk in Russia. But other products are on the way. HRT (hormone replacement therapy) products and human growth hormone have been launched and are already beginning to show results. And NovoNorm® and Gabitril® are both undergoing clinical trials in Russia.
HRT products are regarded as being the next growth area outside of diabetes care for Novo Nordisk in Russia. Novo Nordisk's HRT products were launched in Moscow in November last year and are about to be launched in St Petersburg, with the rest of Russia following in 1998 and 1999.