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EF: What are ANEFP's current priorities, and what can we expect from the association in 2024?
JP: We are currently at a turning point and undergoing a change in government in Spain. There is currently a huge discussion in Europe about the Pharma Package. This is a major event because the legislation governing our industry changes every 20 years. I think these discussions present a good opportunity for redefining the industry and modernizing our way of working. The Pharma Package is a priority for us because all these rules are going to be translated into our local legislation in Spain. We must work closely with the AGP, which is the European Association, to include the concepts and foundations of consumer healthcare in our legislation.
The Pharma Package has two drivers. Regulators determine how they have to proceed, and the pharma industry needs to contribute to sustainability policies that preserve the environment. In the healthcare sector, we understand that health and the environment are at the same level. If you do not save the environment, you cannot have a good healthcare situation. The regulator and the pharma industry have to understand the need to work for the betterment of overall health.
Green transitions are not easy. They are time-consuming, and we have to understand what is expected. Depending on the way that the regulator wants to regulate, some products may disappear if they do not take our needs into account. This is going to affect accessibility. We are in favor of having a green planet, and we want to contribute to that, but we have to do it in a way that we can adapt to it and maintain the portfolios that we have today. This is an issue of dialogue. Changing an element in a food product is easy. Changing an element in a pharmaceutical product requires a new registration. The product will no longer be the same. This means that the active ingredients inside the product no longer behave at the same level.
The Pharma Package creates a challenge for us. The Spanish package will affect the industry because the government wants to reopen what we call “layoff guarantors.” This is a good opportunity because we can now reveal certain aspects of price, advertising, registration, and exact definitions of OTC drugs. The reopening of guarantors is important for all stakeholders who are willing to stand behind laws like the Royal Decree about drug advertisements. The Royal Decree on Advertising for Medical Devices is another important issue. The Royal Decree about self-testing products is also in our scope. Our scope of healthcare includes drugs, medical devices, supplements, and self-test products.
The Pharma Package will be implemented in 2024, depending on the will of the government. The new government needs to be ready and have the capability to do that. We look forward to the new government carrying out this plan. The European package is different. We are going to discuss the package in 2024. Spain is concluding its presidency of the association, and Belgium and then Hungary will follow it. I believe that the Hungarian mandate will be more focused on the European package.
The directive on sustainability related to drugs, water, and air is one of the things we want to work on. Water has been found to contain microcontaminants from drugs and cosmetics. We need to discuss this issue, and legislators need to know what is important and what scientific criteria can be used to measure the levels of contamination. Our first axiom is, “A green planet and healthcare are at the same level.” There has to be a real dialogue to understand what we are doing and what we can affect. On the other side, they have to understand in what way they can proceed, which means that this process of dialogue needs to be ready.
The Pharma package and the Spanish sustainability package are two important drivers because this is going to structurally affect our activities. For example, ANEFP has an eco-design group made up of more than 20 companies working and thinking about our proposals for achieving a green planet with our products. This is not an easy task because we still do not have suppliers that can give you what you need due to a lack of demand. It is possible that global needs are not going to be met by suppliers. All these things need to be addressed and made known. We are going to need to do that because the regulators are not going to do that. The consumers are going to make the changes. They are going to demand that we do things and put value in them, and then we can speak about the stakeholders who play an important role. This is one of our priorities in terms of legislation.
There are other priorities on our list, and we believe that doctors and pharmacists in Spain play an important role. We are currently working on a project revolving around electronic prescriptions for OTC drugs and self-care products. We are working with a database for this project. Doctors and nurses can prescribe self-care products. Spain has more than 300,000 prescribers. Our consumers can decide whether they wish to opt for self-care products, but they still need a prescription from a doctor or a nurse. Our task is to do all we can to make this a reality. This is the reason why private and public electronic prescriptions are a crucial issue. We need to collaborate with the private sector and the regional governments to ensure that they have the competence to develop and implement an electronic prescription system.
Digital progress and the digital agenda are also on our list of priorities. The association needs to applaud companies for implementing good digital practices. We have an umbrella of certifications that guarantee that the information that our companies produce is compliant with the legislation. This certification is recognized by the Ministry of Health and the European institutions. This part of the certification is another pillar in implementing the digital agenda. Our citizens have access to the internet, where they can search for any information. We are trying to help ensure that they find accurate health resources.
Under digitalization, we are trying to educate younger people about the self-care sector. We developed a video game where they can play and understand the values of healthcare and prevention. We will be working with hospitals and schools to educate the youth. This is a total system. On one side, we have our industry, made up of 92 companies, and on the other side, we have our stakeholders who we want to onboard with these policies. We also have the citizens and the consumers, to whom we have to guarantee the accuracy of the information and knowledge about our sector. All these projects will help make our Green Planet initiative a reality.
EF: Healthcare is shifting from a reactive treatment approach to a preventative approach. How are you working to shift to a preventative model?
JP: Before COVID-19, Spain was not a magnificent example of a culture of prevention. We have since advanced and improved as a society. A good measure of a society's advancement can be seen in the progress of its prevention attitude.
After COVID-19, many people became conscious of the value of prevention. There has been a decline in prevention consciousness, but the seed is still there. The push in favor of prevention is coming from the industry and the authorities. A good prevention policy is the most important pillar for the sustainability of the healthcare system. Prevention measures and their effects are silent and can rarely be seen, unlike illnesses, which manifest a lot of visible symptoms. This is a complicated issue because our agenda is time-sensitive, and it is not easy to work with stakeholders around the prevention issue. COVID-19 has allowed us to educate people about the importance of prevention.
We have conducted studies about the value of self-care. We can demonstrate that when you increase your self-care attitude by five percent, you can save the healthcare system 3.4 billion euros. An increase in preventive measures reduces the number of patient consultations. Spain has a shortage of good doctors because our healthcare model is still focused on cures and not prevention. Practicing prevention means you will consume fewer drugs and spend less time at the doctor's and pharmacy. Resources can then be invested in people who really need treatment. By focusing on self-care, the healthcare system can be more efficient and use its resources wisely.
I think our regulators need to be more conscious of the value of prevention. I understand that politicians have a short time frame to implement change. This is a structural issue. We did a study about the value of self-care in Europe and highlighted a similar structural issue. We have to develop and implement a prevention culture early in a person's life. We also need to ensure that the self-care products are readily available. For example, I have had COVID-19 three times, and today is my first negative test result. I was able to take my test at home without needing to see a doctor. I self-medicated with paracetamol and other flu medications. This is the kind of empowerment we want to impart to the population. They need access to accurate information and OTC drugs. Should they fail to solve the problem on their own, they can consult with a doctor or pharmacist.
Prevention is important, and we have seen a rise in the consumption of food supplements, OTC drugs, and cosmetics like solar protection. I think there is still room to do more because this is going to directly benefit our healthcare system and our citizens. Our study is done, but we need to reach out to the people who can regulate, educate on, and demonstrate preventive measures. We have been working on this for the last 12 years.
Consumer healthcare is an ecosystem made up of citizens, industry, doctors, pharmacies, and politicians. We must all have the capability to speak about healthcare appropriately. This is a role that the industry has to pursue because we all have a responsibility to focus on prevention. For example, in the first phase of COVID-19, Spanish pharmacies had to play an important role because they were the only health facilities that remained open. The self-care system is complex.
We also have to focus on the accessibility of information and products. We need to ensure that all citizens have equal access. In the case of people who do not have enough resources, the healthcare authorities and economic authorities need to reach an agreement on what can be done. Access is key to a vibrant healthcare sector and economy.
EF: How would you assess the accessibility of medication in Spain compared to other markets in Europe?
JP: Generally speaking, Spain does not allocate a lot of public funds for medication. Citizens pay for their healthcare needs out of pocket. The upside of this arrangement is that the prices in Spain are very low, especially when we compare them with other EU countries. The Spanish healthcare system cannot reimburse everything. Our economy is not ready for that.
The average Spanish citizen can afford basic OTC medicine for short-term treatment. Our industry showed strong resilience during COVID-19. They had to provide a lot of products even when other sectors were not operating. For example, paracetamol was widely available during the pandemic despite the shutdown of other sectors. Our structures and production systems responded well to the crisis. Spain has a large, responsive production system. The level of accessibility of our products is quite high. There are many products on the market, and that creates healthy competition and keeps prices at affordable levels. Our citizens can pay for the OTC products while the system helps them pay for the more expensive chronic treatments.
EF: How have things evolved in the 11 years that you have been part of ANEFP, and what achievements are you most proud of during this time?
JP: The association has evolved and changed completely. We started off with three task forces, and now we have 21. We had no digital agenda, and now we are completely digitalized. There was no electronic prescription. It is now available in 14 regions of Spain.
In the past, healthcare authorities censored advertising. We had a self-regulatory system created by ANEFP and recognized by the Minister of Health and the European Union. This system has changed completely, and times have changed. Whoever will be in charge of the association in the future needs to brace for change and embrace it as well. The rate of change is rapid, and so many things can happen. I've seen recessions, wars, and pandemics.
In 2011, we had 51 members; now, we have over 100 because more companies have expressed interest in joining us. We have developed the network association in all these committees by increasing the recognition of the certification of advertising. We are now a part of a critical success factor. ANEFP has changed a lot due to the complexity of our sector and the regulatory environment. We have developed the ability to quickly adapt to the changes.
I have given ANEFP my managerial experience. I had no history with associations. My prior experience came from companies. I managed ANEFP as a company with the understanding that I was working for an association. In companies, KPIs are set, but when dealing with politicians, KPIs are constantly moving and changing. The association is a complex universe of stakeholders whose needs must be balanced. Managerial experience helps steer the association through periods of rapid change. I work with a high-performance team, and I'm proud of the results they have produced because it is not easy for all sectors.
A good professional in our sector requires four years to be well-trained. They have to learn about drugs, medical devices, food supplements, self-tests, digitalization, and sustainability. Everybody has to have some knowledge because this is consumer healthcare. It is not easy for ANEFP to lose a professional because we need four years to train a new one. I am very fortunate and proud to have the team that I have.
EF: Do you have any final messages for our readers?
JP: Without a strong consumer healthcare sector, we cannot qualify ourselves as a developed country. We still have work to do in the development of this sector because this is what is going to allow us to have a better society, a healthier population, and a happier world.
