The Covid-19 pandemic turned out to completely redesign many activities and markets all around the world. Pharmaceutics and healthcare services have been greatly impacted by the emergency, which boosted the transition towards new models of interaction between healthcare professionals (HCPs) and patients on one side, and the industry and HCPs on the other. A series of reports from IQVIA analysed the different aspects of this transition, as well as the markets’ dynamics during the pandemic.
The impact on the pharmaceutical industry
Some 8,1 million Covid-19 confirmed cases worldwide are recorded while we are writing, with 440.290 deaths (5,5%, WHO data, updated to 17 June 2020). The Covid-19 pandemic seriously impacted the global pharmaceutical product supply chain, affecting both active ingredients, excipients, finished products, logistics, shipping. Multiple origin and destination countries adopted different restrictions and measures against Covid-19 that directly or indirectly had an impact on freight movements.
China was the first country dealing with the new coronavirus in February 2020; about a half (49.3%) of the manufacturing activities in the Hubei province has already reopened as for the end of April, according to IQVIA, and the pharmaceutical sector has recovered 70% of its original capacity. This is of great importance with respect to the regular production of pharmaceutical active ingredients and excipients to be exported in Western countries. Procurement of raw materials greatly suffered in March and April, leading to medicines shortages in many European countries. The problem was also exacerbated by the stockpiling dynamics many chronic patients put in place in the first phase of the lockdown to be sure they had enough of the medicines they need.
Trends in the EU and US pharmaceutical market
Prescription and OTC medicinal products showed a completely different performance in the 5 top EU countries during the pandemic, says IQVIA. Prescription products were characterised by sales decrease, more prominent in Italy (-4.4%) and France (-4.0%), with the exception of some therapeutic classes (antineoplastic and immunomodulating agents ATC L class, nervous system ATC N class) that showed an increase in volume sales in most countries.
On the other hand, OTC products showed a positive performance in all countries apart Germany (-1.7%), with the best results obtained in France (+7.1%) and UK (+5.7%).
A similar trend was observed in the US (see here and here), where the FDA started a collaboration with Aetion to analyse real-world data on the use of Covid-related diagnostics and therapeutics. The FDA also simplified rules on digital therapeutics (DTx), in particular to assist treatment of Covid-related psychological distress. DTx may represent an increasingly useful therapeutic option to treat many conditions in the future digital e-health scenario.
The impact on new launches and clinical trials
The prioritisation of manufacturing activities towards medicines needed to fight the pandemic slowed down many R&D projects; many launches of new products had to be postponed. IQVIA estimates a $ 10 billion underperformance for years 2020-2028, resulting from the impact on the 109 new medicines launched 2018-2019, the 50 products ready for launch in 2020 and the more than 340 planned to reach market by 2028. A complete rethinking of the planning and modalities of these activities is envisaged, pointing towards virtual launches with engagement of opinion-leaders and integration of omnichannel marketing with telehealth data.
Hospitals were almost completely devoted to Covid-19 patients during the last few months, and 88% of them in the Europe, Middle East, and Africa (EMEA) region did not allowed Clinical Research Associate (CRA) visits during the emergency phase. As a consequence, new virtual modalities to interact with clinical centres had been put in place, both to initiate a site and for remote monitoring. Experimental protocols had been simplified to remove critical activities, moving to electronic patient reported outcomes (eCOA) and promoting telemedicine to keep in touch with patients staying at home
Digital promotional activities and healthcare services
The lockdown almost halted sales forces’ face-to-face visits to medical doctors and HCPs in many countries. E-meetings, e-detailing and other remote methods (phone, postal, e-mailing) have emerged as alternatives to maintain the interaction active, especially in the most hit countries (China, South Korea and Italy). This shift required rapid training of sales forces. According to IQVIA, the new KPIs include 4 remote calls per Representative (Rep) and per day as an average, approx. 14 minutes duration each.
The lockdown and the consequent request to retain social distancing while resuming normal activities acted as a main driver for remote interactions between medical doctors and their patients. Digitalisation is due to become the “new normal”, as planned in many roadmaps approved by governments and institutions all over the globe. The transition process is not so simple to achieve and it may present some risks, as many patients would still prefer face-to-face interaction with their doctors, thus postponing diagnostic testing and therapy initiation.
According to IQVIA, an >1500% increase in telehealth claims from pre-Covid baseline has been observed, requiring for future improved attention to patients’ journey, identification of alternative sites of care for therapy administration and rethinking of physicians’ targeting and segmentation. Remote monitoring may support the follow-up of less severe Covid patients, limiting the risk of exposure of the general population. Call centres have also been activated for patients to directly call into manufacturers to ask product enquiries, while their doctors were assigned to Covid-related activities.