In an exclusive interview with BioPharma APAC, Alexandre de Muralt, Senior Vice President of Asia Pacific for Merck’s healthcare business, shares his insights on the dynamic healthcare landscape in the Asia-Pacific (APAC) region. He highlights Merck's strategic approach in the region, and the company's initiatives to address unique healthcare needs and opportunities in these diverse markets. He also delves specifically into Merck's Fertility Counts initiative, highlighting its significance in addressing the region’s current demographic challenges.

The APAC healthcare market is diverse and complex. In your opinion, what are the key challenges and opportunities in the region?

Reaching from Pakistan to Australia, the APAC healthcare landscape is extremely varied, and comprises countries with advanced healthcare systems, and others that are still emerging. This variation extends beyond the healthcare systems, and spans to cultural habits, disease profiles, and healthcare needs.

This environment makes the APAC region an incredibly interesting yet challenging market to navigate. Merck's approach is not one-size-fits-all; it is tailored to each country's needs, potential, and healthcare coverage mechanics. In essence, we aim to deliver a portfolio of services in line with the healthcare needs and opportunities on a country-by-country basis.

Diverse business segmentation

The type of diseases encountered can vary significantly between countries like Pakistan or Cambodia, with lower life expectancies, and countries like Australia or Korea with very sophisticated healthcare systems and more resources. We therefore take these factors into account when considering our business segmentation. For example, in markets with advanced healthcare systems we focus on more specialty care solutions (about 30-35% of our sales) and in markets where healthcare systems are still emerging, we focus on primary care or Noncommunicable diseases (about 40% of sales). Our Fertility business, however, is spread across all markets reflecting the ubiquitous need for these solutions.

Digital solutions to boost diagnostic rates

A key challenge in the APAC region is low diagnostic rates for many diseases. For example, the diagnostic rate of hyperthyroidism in highly developed countries in Europe is pretty good, allowing for effective treatment. However, in emerging markets such as Indonesia, the diagnostic rate is as little as 3-4% meaning many people may be suffering undiagnosed. Consequently, it is essential for us to focus on addressing this issue.

We do that through partnerships – for example by partnering with medical device companies that enable earlier diagnosis, or through public private partnerships to drive awareness. As part of our commitment to thyroid disease, we have introduced digital solutions in emerging markets for pre-screening, which helps avoid unnecessary diagnostic expenses for patients and health authorities.

Facilitating patient access

Affordability is a crucial factor when entering the APAC region. We work hard to balance access to our high-quality products with the reality of scarce budgets in low- and middle-income countries. By focusing on increasing speed to market in major markets with reimbursement, and providing patient access programs in emerging markets, we can facilitate both affordability and accessibility across different markets. But it’s a struggle and the truth is that affordability remains a barrier to access in APAC.

The Merck Healthcare Mission is to create, improve, and prolong life. In the APAC market, what makes Merck stand out and differentiate itself from its competitors?

At Merck, we are committed to contributing both to society and to the scientific community, and I think our partners see and appreciate this commitment. We aim to innovate in drug development as well as via our approach, to distinguish ourselves in our practice through principles such as:

• A Purpose Driven Approach: During my travels around the region, I have observed that there is a high sense of purpose among the Merck teams. What I mean by this is that everybody is aligned to the same mission: Patients come first. We call this “As One for Patients” and work to ensure the right drug for the right patient at the right time.

• Science-Driven Engagement: We engage with healthcare professionals in a science-driven manner, promoting best practices and peer-to-peer interactions. Our customers often give feedback that they appreciate how at Merck we work to address the science gap. We aim to achieve this by educating around the diseases we offer solutions for, in order to allow for deeper understanding and best use of our products.

• Societal Contribution: Our aim is to contribute to societal challenges by creating debates and offering solutions. This includes bringing stakeholders together to discuss challenges, such as low fertility rates, and find comprehensive solutions. For example, our Fertility Counts initiative seeks to address the social, economic, and societal challenges of low-birth rates within the APAC region. Many countries across the region are grappling with this topic – and for some, it is already an existential question. We want to talk about how to make our societies more family-friendly and how to enable those people who want to have children to do so. To be clear: This includes fertility patients, but it’s a much broader topic. We want to remove those barriers that are currently forcing couples to delay or forego family-building even if they might want kids: childcare issues, financial concerns, challenges of combining careers and family, and others.

Demographic change and the low fertility rates are expected to significantly change the face of Asian societies over the next few decades. Does it worry you? Is this something that needs to be addressed or managed?

This demographic shift already has a big effect on north-east Asia such as Korea, Japan, and Taiwan. Birth rates are the lowest they have ever been in these countries. In Korea, this is deemed a national emergency. Ageing populations have serious implications on the economic infrastructure of a country due to less contributors and a greater burden on healthcare and social care systems. Ageing also changes the fabric of society and the vitality of a country.

Other countries are following the same trajectory. Thailand’s population began shrinking last year and the country is ageing rapidly. Vietnam, Indonesia, and Malaysia all have total fertility rates below the replacement rate (2.1 children per woman) but since they are not in crisis mode yet, they can act now before it’s too late.

The demographic shift will fundamentally change these societies and will raise big questions about how to care for our older population. And: It may impact innovation. After all, it is the younger generation who often comes up with new ideas and fresh thinking, and a reduction in the younger working population may impact how we innovate.

Let’s not forget that one in six couples struggles to conceive – and some of them will require medical intervention to become parents. As leaders in the field of Fertility, Merck has a unique ability and responsibility to make sure the voices of fertility patients are heard.  Being able to contribute to the journey that couples go on to become parents is something I am very grateful for.

Reversing this demographic shift requires a multifaceted approach involving various stakeholders. What role can the private sector, specifically Merck, play in addressing the challenges of low-birth rates within the Asia-Pacific region? 

All decision makers need to have a robust understanding of the barriers that stop people from having children, and what options exist to make societies more family friendly. There is already a lot of noise about this topic, and we don’t want to contribute to glib headlines. Instead, we want to help kickstart discussion by providing evidence-based analysis and tools for change. There is no singular solution to low birth rates, and no country has found a magic antidote on it. But through our Fertility Counts initiative, we provide evidence to support decision makers who want to tackle this issue.

For example, the report titled 'Fertility Policy and Practice: the APAC Fertility and Family Scorecard', commissioned by Merck and developed by the Economist Impact, assesses measures implemented by different countries to identify best practices. I feel immensely proud to be part of a company that isn’t solely focused on generating profit, and instead is committed to supporting society as a whole.

Through the launch of this Scorecard and other literature, we are continuing our mission to deliver valuable evidence to drive fertility-focused dialogue and promote solutions-based policy change in the APAC region. Ultimately, these findings highlight the need for policy makers to act now to slow population decline and prioritize sustainable, societal growth through socioeconomic incentives that enable and support people who want to have children.

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Alexandre de Muralt's insights provide a comprehensive overview of APAC healthcare landscape, highlighting the region's diversity in healthcare systems, cultural habits, and disease profiles. Merck's strategic initiatives are designed to address these unique challenges through a tailored approach that considers the specific needs of each market. As the APAC healthcare landscape continues to evolve, Merck's adaptive and purpose-driven strategy positions it well to make a meaningful impact in the region, addressing both current and future healthcare challenges.