With the total value of Asia's 10 key pharmaceutical markets (ex-Japan and Australia) in 2001 topping US$19.5 billion according to global research giant IMS Health's Pharma Prognosis Asia (PPA) lead markets tipped for sustained growth into 2005 include China, Korea, Taiwan and India.
The PPA study also predicts that by 2005, China will have increased its share of the Asian pharmaceutical market to account for 34 per cent of the combined regional pie. India (with 16 per cent), South Korea (15 per cent) and Taiwan (14 per cent) will also factor significantly.
But how does this impact the global consultancies operating in such geographically, legislatively and culturally diverse markets? With today's regional healthcare PR market valued at an estimated US$15million - save Japan, the world's second largest global healthcare market after the US - healthcare specialists are confidently anticipating this to double within the next three years.
No-one said it was going to be easy. And according to Edelman regional managing director, healthcare for Asia-Pacific, Christine Jones, as regional governments curb the spiraling cost of pharmaceuticals through cost containment, consultancies hoping to win over key opinon leaders (KOLs) are having to act knowledgeably and creatively on the client's behalf within restricted, highly-regulated boundaries.
In addition, while governments in developed markets such as Australia and Korea are cutting reimbursement prices and limiting the number of drugs on their free lists, less developed markets such as China and Vietnam encourage the widespread use of generic drugs specifically to keep costs down.
"More and more products are now counterfeits and generics, but if a government is going to fund a drug they want to know why it is better than a 10-times cheaper generic alternative. One of our tasks as the (client's) agency is to assess who's behind the decision for a given product - depending on which government reimbursement group they're from, we find out who's influencing them," says Weber Shandwick senior vice-president, healthcare, Jill Mortensen.
This accent on cost is figuring heavily across all markets, in particular, Australia, Hong Kong, Korea and Taiwan, where healthcare reimbursement is core to government healthcare policy. As costs are cut, subsequent pressure is also put on the doctors who have traditionally been promotional targets but now no longer have the time or, since Sars, the authorisation to receive sales calls. Jones cites that, nevertheless, up to 60 per cent of a pharma company's marketing budget typically goes to supporting the sales rep and medical symposia.
"Doctors continue to have less and less time available to either see reps or attend meetings. Only those (pharma) companies prepared to embrace new and better methods of overcoming the time challenge will succeed in gaining share-of-mind among doctors," she adds.
One positive spin-off of Sars was that it put the onus on the public - as potential patients - to not only be responsible for their own health, but to read up on the treatments that could save lives. In Hong Kong, China and Korea, however, a doctor's judgement is rarely questioned.
"In terms of being more aware of drugs they are being prescribed, people still tend to just do what the doctor says and not query him or her," says Sue Cook, Hill & Knowlton's director, health and pharma for Asia-Pacific. "The PR approach is still mostly one of educating consumers about diseases and new treatments in a more general way and then marketing the drug itself more specifically to doctors."
Given the restrictions governing direct-to-consumer advertising in Hong Kong, pharma clients are looking to alternative patient educators like pharmacists. Fleishman-Hillard's regional healthcare practice head Beth Boswell believes their role is an important one.
"Typically, physicians are the healthcare spokespeople, but we've seen personal care retail chains such as Watson's start to establish their pharmacists as healthcare information providers."
Ruder Finn's executive VP and MD for Asia, Louise Harris, admits that while Asian consumers have some way to go before they reach the levels of prescription drug empowerment of their US and European counterparts "increased knowledge is in the lifestyle areas, such as obesity and erectile dysfunction".
But there are exceptions. Citing a recent project for client Novartis, she highlights the response to its leukemia drug Glivec as "unprecedented in terms of the enormous positive awareness created for a breakthrough cancer treatment", which in turn influenced the speed at which the drug gained government approval in Asia-Pacific.
In Korea, patient support groups, NGOs and a sophisticated healthcare media all contribute to raising public health awareness.
A more health-savvy Australian consumer has also meant an increase in educational campaigns aimed at the general public. Particularly in the case of patients managing a chronic illness - MS sufferers, for example - have access to US websites where legislation permits DTC communications.
The recent Memorandum of Understanding between China's State Food and Drug Administration (SFDA) and Singapore's Health Sciences Authority (HSA) is seen as evidence of China's growing steps to regulate its pharmaceutical industry. And with last December's ruling prohibiting prescription drugs and new drugs launched for less than five years to advertise in the mass media, PR may be the only means available to pharma companies to gain a competitive foothold.
In China, the combination of rising incomes and status-linked Western diets is leading to a whole new kind of revolution. Western health scourges such as heart disease, diabetes, obesity and cancer are, claims WS's Mortensen, "just getting ready to boil in China", and pharma companies want to be able to market their drugs as the optimum choice to fight such pathological aggressors.
Add to this traditional Chinese medicine (TCM) to which 40 per cent of China's masses turn when needing medical attention, and the picture here presents the unregulated thorn in the pharma industry's side. PR consultancies on a regional and global scale have yet to tackle this huge, untapped and unwieldy opportunity.
In Australia, the marketing practices of pharma companies are self-regulated through the Code of Conduct, which is administered by Medicines Australia.
Changes to the code in January has meant that healthcare PR practitioners are operating in a stricter environment and one that pharma companies in Asia look towards to benchmark their own campaigns.
Section 9.4 of the code makes three key statements: that prescription products can only be promoted to healthcare professionals; any information provided to the general public must be educational; and any activity directed towards the public which encourages a patient to seek a prescription for a specific prescription-only medicine is prohibited.
John Bertolini, director of DDB's healthcare arm DDB Remedy, said that the new guidelines have made it more challenging to target doctors directly.
Materials sent to doctors now have to have an educational component; entertainment must be on a modest scale; and any give-aways must not exceed A$10 (US$7). Changes to the privacy guidelines also mean doctors must be informed that they can opt out of receiving material.
This has resulted in direct mail pieces to doctors becoming more important.
Restrictions on DTC promotions has meant pharma companies focusing on getting patients to go to the doctor to request details on a particular ailment.
According to Ruder Finn's Harris, the internet is also having a profound effect on the way healthcare PR divisions work with clients, as it becomes a key information channel and behavioural driver.
"Anecdotal feedback from GPs in Australia indicates they are approached by patients seeking a script for a certain product ... patients often visit them armed with health information they've downloaded from the internet."
Disease awareness campaigns, says Bertolini, are often funded by the category leader - knowing that if a patient goes to the doctor they'll be given that brand. Such campaigns came under attack from the medical industry on the grounds that advertising symptoms or certain ailments creates artificial demand with the cost of drugs then picked up by the community through the Pharmaceuticals Benefit Scheme (PBS).
In Australia too, Government cutbacks have meant that drug companies are taking longer to get PBS approval for drugs.
"The success (of the drug) is determined by whether you get PBS rating, as there are few cases of drugs surviving without it," he says.
Anne-Marie Sparrow, MD of healthcare at Burson-Marsteller Sydney, cites one of the biggest challenges as achieving reimbursement for products, which is getting harder to secure, even in life-threatening categories.
Reflecting a regional trend, government relations has become a huge priority for pharma companies locally too.
The recent Pan Pharmaceuticals scandal, in which multiple vitamin brands were recalled after substandard manufacturing processes were uncovered, has also put the focus firmly on issues and crisis management, with companies preparing for potential minefields ahead.
Jennifer Stojic, account manager, Professional Public Relations, agrees.
"More companies are seeing the value in building relationships with KOLs, as well as alliances with stakeholders and consumer groups in an area that is so regulated. In the ethical products arena, many companies are looking beyond traditional advertising to reach their prescriber market and are allocating bigger budgets to PR activities aimed at these audiences."
Miles Fisher-Pollard, who set up a healthcare division for Weber Shandwick Australia in February this year, adds: "Brand and campaign managers are being a lot more careful, but funds are available for a good programme that works."
In India, the recent development of fast moving health goods (FMHG) companies, an expansion of the over-the-counter (OTC) segment, and the imminent era of product patent protection - scheduled for 2005 - indicate that the role of healthcare PR is on the rise. Already, there is a growing demand for visibility and saliency by pharmaceutical brands and healthcare services in the public domain .
"Healthcare PR (in India) is at a very nascent stage. A lot of pharma companies have started seeing the value of PR and have allocated budgets for brand-building and patient outreach programmes. Pure-play OTC companies have been the first to have aggressive PR programmes to promote their products and brands to consumers," says Genesis PR founder Prema Sagar.
According to Veena Gidwani, COO of Madison PR, marketing and sales tie-ups and mergers are propelling the growth. Pharma companies are also gearing up for the post-2005 Product Patent Regime, where, for drugs that have had patents filed on them since 1995, it could take up to 15 years after patent approval and testing to enter the market. For the first time, local and global pharma companies launching drugs in India will need to invest in R&D and PR with it.
Restrictions such as the Drugs and Magic Remedies (Objectionable Advertisements) Act are also paving the way for growth opportunities.
"Healthcare PR spend has gone up by at least 30 per cent compared to last year," states Shefali Kotnala, head of Corporate Voice/Weber Shandwick's healthcare practice, adding that pharma clients in India are just starting to recognise the possibilities of addressing issues at regulatory, prescriber, trade and patient levels.
"We worked on a campaign which raised acceptability of the hepatitis B vaccine by healthcare administrators and prescribers. Through scientific lectures, parent contact programmes and media advocacy, the campaign gained Government recognition of the disease situation and the need to include hepatitis B in a childhood vaccination programme," Kotnala adds.
One drawback highlighted by Sagar is that PR consultancies operating in India are prevented from developing world-class healthcare initiatives because of a general lack of (client) understanding about the industry and the healthcare specialists required.
Ethical PR here is also coming from an evolutionary base, and unlike the rest of Asia, outreach to doctors remains disengaged from broader PR strategy.
"Apart from half-yearly seminars, symposia or conferences which are organised by PR consultancies, direct doctor interactions continue to be the responsibility of the pharma company," says Gidwani.