It can be eerie to note just how much has taken place in the past three years. At times, the spring of 2020 feels like it was yesterday. And yet when all the developments since then are totted up, it seems like a different world altogether.
In healthcare, we have seen key services completely reorganise themselves to deal with an unprecedented threat, not to mention mass vaccination drives and intensive research into potential treatments for Covid-19.
One area that has seen quantum leaps in the past three years has been acceptance of the concept of seld care, as PAGB president Bas Vorsteveld says when he speaks to P3pharmacy in mid-March.
Bas, who is also vice-president and general manager of OTC manufacturer Haleon, which broke off from GSK in 2022, says that since taking the helm at the trade body (he replaced Perrigo managing director Neil Lister in December), he’s been immersed in “intensive” talks about issues like supply chains. This involves addressing “a lot of very detailed regulatory challenges”, he says.
Originally hailing from the Netherlands, Mr Vorsteveld started his consumer health career in 2006 when he joined Novartis. He went on to become country manager there, before his career took him to a number of markets, including Portugal, Belgium and then the entire EMEA region. He says that when the Great Britain and Northern Ireland role came up, he leapt at the opportunity.
“I love this industry because it’s about the consumer and about driving every day health. There are always opportunities to keep on innovating,” he says. “I’ve seen so much change in how we connect with our customers.”
In the months since becoming PAGB president, Mr Vorsteveld has been “very busy” getting to know the team and board members and “continue what I think is world-leading work, especially within Europe”. He says he feels “very privileged” to hold his role with the trade association and to help “drive more self care in the UK”.
We speak just after the Windsor Framework was agreed between UK negotiators and the European Union. While at the time of going to press it appears the framework does not have the support of the Democratic Unionist Party, when Bas speaks to P3pharmacy, he appears optimistic: “I think the findings are very positive for the OTC sector; of course, we have to look into the details.”
This involved active lobbying on the part of the PAGB. “We needed to ensure we got the right policy on the supply of medicines and medical devices in Northern Ireland,” says Bas. “Michelle (Riddalls, PAGB chief executive) went to a session with the health select committee to raise the concerns we had as an industry.”
On other issues, Bas says talks have yielded “more clarity” around the post-Brexit rules affecting the UK as a whole, such as “when the Department of Health and Social Care wanted to change how we import products into the UK”. Bas is referring to Government proposals to introduce an additional batch testing phase when importing medicines.
“They came up with four different options, three of which we felt were not favourable for UK consumers,” he says. “So we spent some time explaining what we view as the needs of the industry, in order to ensure we maintain the model whereby, when we import from a list of approved countries, there is no need for a UK Qualified Person certification.”
From these recent examples, it appears the consumer health industry has the Government’s ear when it comes to medicines supply issues. Is the same true for self care? “There’s been a lot of improvement here, but still there is work to do,” says Bas. “It’s a journey we’ve been on for some time. Before Covid, it was never really on the agenda; right now it is because governments – not just here, all across Europe too – are starting to see the importance it has.”
There are a number of factors driving this change, he says, including a necessary shift in habits from many consumers as GP appointments became scarce, as well as a growing awareness of the intense pressure health providers are under. “I find that now the Government is much more open to listening, taking our views into account and factoring them into policy.
“Whereas in the past, self care may have been the last point on the agenda, we now have so much evidence that it can help deliver better health outcomes. During Covid, patients couldn’t do anything else, because they were unable to see a doctor; that’s where we’ve seen a big shift in public willingness to actively self care. What’s also helped is that the importance of pharmacists has come to the fore,” he adds.
I ask what needs to be done to maintain that momentum now the dust has more or less settled post-pandemic. It’s partly about driving home the message that self care takes pressure off the health system, he suggests: “Around 1.2 billion minor illnesses are currently self managed across Europe. If you were to bring that back to the doctor, you’d need hundreds of thousands more doctors.”
He also says it’s important to link the self care message to the wider disease prevention agenda, claiming: “Eighty per cent or more of heart disease, stroke and diabetes cases can be avoided using preventative measures, as well as 50 per cent of cancers.”
How should PAGB members get behind the prevention agenda? The public – and policymakers – may not immediately link heart disease prevention with the manufacture of OTC medicines.
Bas replies: “PAGB is a combination of the industry with a lot of different companies all working on driving everyday health for consumers and giving them clarity – not only on how to use a product, but also on prevention and things they can do differently in their lives. There’s a lot of work the PAGB can do around giving insights to the Government and showing them why providing access to healthcare is important.”
A spate of high profile POM to P switches has also helped boost awareness, says Bas, highlighting the potential to go further. “We’ve done a survey of 2,000 British consumers, and 74 per cent felt more medicines could be available over the counter. We’re having those discussions with the MHRA on reclassification and explaining the opportunities to Government. This will help us deliver more products to help the consumer self care, and it’s a clear priority for us.”
What are the key priorities when it comes to reclassification? “I think the biggest part is probably POM to P, but there are also some POM to GSLs. If you’re talking about P to GSL then, depending on the risk profile of the product, in the end the only real benefit for the consumer is that you can take it off the shelf instead of asking the pharmacist.
“We’re already leading in the UK; we have many more products available than any other market. I think we sell around 1.2bn OTC products a year in the UK; prescriptions will be in the region of 1.3 to 1.4bn, so there is not that much difference. I think the UK is one of the countries that is more progressive than others.”
“You’re also seeing some pharmacists experimenting with opening up the back wall a bit more for the consumer now, which helps those who know exactly which brand they want.”
Supply chain stresses
Supply issues have dominated headlines at various points over the past few years, but apart from a run on paracetamol in the very early days of the pandemic, they have almost always concerned prescription medicines. However, in recent months, there have been numerous reports of pharmacies struggling to source cough and cold medicines amid a worse than usual flu season and panic over an outbreak of Strep A in the UK. What does this say about the robustness of OTC supply chains?
“We will always have demand spikes in certain periods, but it was very extreme this winter,” Mr Vorsteveld says. “I think in the last week of December there were 10 million units sold; you would normally sell three or four million.
“It was a higher peak than we’ve seen, and while we were delivering a lot of products on a weekly basis, we couldn’t fulfil everything that was requested. Consumers were always able to buy within the category, although some products they would usually buy were not available. There were challenges, and I recognise it wasn’t easy for pharmacists, but we have always been delivering products.”
The pandemic period also put strain on supply chains, he says, adding: “Overall, I’m proud of what we delivered as an industry – we kept on producing. Sometimes, staff numbers were down 10-15 per cent, but we kept working to meet massive demand.
“I think we have shown that our supply chains have been robust, although we also were impacted like any other industry with severe global shortages, and things happening at a global level – for example, when the manufacture of active pharmaceutical ingredients in China was disrupted for several months. One of the big global suppliers going out, you can’t plan for that.
“In the last months, things are better – I see it stabilising. We have been working to serve as much as possible to our pharmacies, although I realise some have had issues.”
What else should pharmacies be doing? Bas recognises the severe pressure many teams are under from a number of fronts, but encourages them to think about how they can ensure their business remains sustainable. “I think self care will be an important part of that,” he says.
Should businesses who are concerned about income from NHS prescriptions focus on boosting their OTC business instead? “Every Saturday, my daughter plays hockey and needs to arrive one hour in advance,” he says. “I always use that time to go into the villages where she’s playing and visit the pharmacist, and you see a range of approaches to OTC – some devote a lot of space to it, others are more restrictive.
“My recommendation would be for pharmacists to really think about the consumers in their area: how can I help them, what are the best possible offers I can provide?
“Pharmacists already play such an important role in the healthcare system; self care is an opportunity that can take this even further, I think. It’s an important growth area.”
Are there policy levers that Government might pull to help this along? Pharmacy First has become a central talking point for sector representatives in England as they see the benefit of minor ailments services in Wales and Scotland.
“I think so,” says Bas. “We also encourage the wider use of the Community Pharmacist Consultation Service (CPCS) in England, and the fact that pharmacists can already prescribe some products is going to be significant – that’s a big step forward.”
He adds that the PAGB is working on a toolkit to support primary care networks with enabling self care in their area. “We need to be creative and think about what we can do differently,” he says. “How can we help take pressure away from GP surgeries and give pharmacies the resources they need to play a wider role? Because if there’s more work going into the pharmacy, we must recognise there has to be a sustainable model for them.”
How did patient trends shift during the pandemic? “Penetration of some of the categories like painkillers increased; this is still much bigger than before the pandemic.”
It has been the same with vitamins, he says, as patients sought to “take care of their own disease prevention”.
“You see that it did slow down a bit last year, but it has started to grow again from a higher level,” he adds.
Another notable trend during Covid was a huge dip in cold and flu products – “sales were down 70 per cent at the start of the pandemic because no one went out any more”. The 2022-23 winter season has seen the category roar back to life, putting pressure on manufacturers and pharmacies (see ‘Supply chain stresses’ panel, above).
Bas also highlights the rise of digital channels. “More points are available for consumers to buy the products and that for sure has impact,” he says. :”What you have seen massively changing over the pandemic is the digital transformation. PAGB research shows people are now looking up products and symptoms much more frequently than they were pre-Covid, and that digital is becoming much more relevant in the consumer journey. This adds value to the overall OTC environment, when it’s used in the right way, and it can help get more consumers in and cross-sell more products.
“This poses challenges as well as opportunities – consumers need to have guarantees that any information around health is going to be reliable. If it’s coming out from a PAGB member company then you know it’s been checked and approved, but sometimes I see things on Instagram and wonder ‘where is this coming from?’”
This is another point the PAGB discusses with the MHRA, he says. “A lot of consumers also say they would like to see even more information on self care on NHS websites… there are some challenges around health literacy, for example, with people really understanding the patient leaflets that come with their products. They can ask their pharmacist, of course, but they’re not always doing that – so how can we help them?”
Providing patient information electronically is one area the industry is actively looking at, says Bas. When it comes to changing consumer behaviour, I ask how important top-down measures like government policy are, and how much of a role bottom-up, organic attitude shifts play.
It’s a complex interplay, Bas suggests. “Bottom-up behaviour is pretty slow,” he says. “Before you change a habit, you have to have repeated the changed behaviour for around 60 days.
“I think with self care, it’s a combination. We do need to do a push and explain there are different ways to look after your health, and on things like prevention, the Government can do much more to explain that. This forces manufacturers to get those healthy living messages out.
“When we talk about brands in our company, we help consumers to think about not just using products, but also thinking differently. If you have back pain, are you sitting in the right way? Are you active? A more holistic approach is usually better than just trying to resolve things with medicines alone. I think the Government is more and more looking into that – I’ve seen it work in some of the other European markets.”
Bas cites smoking cessation as an area where a holistic approach has shown particular dividends, with health messages working in concert with available products and government interventions like raising taxes on cigarettes.
It’s not just public attitudes that are changing – drugs companies are too. Bas’s own company is the result of a demerger from an established pharma player, one of several such moves to be announced in recent years.
While he can’t say a lot about Haleon’s commercial strategies, Bas does say that focusing solely on consumer health “allows businesses to activate their products in a different way… what you are seeing now is something new”.
“As well as being science-based, we bring that deep knowledge of the consumer and their healthcare journey,” he says. “We believe that being fully focused on that will help us to better meet their needs.
“Over the next five to 10 years, you’re going to see even more innovations and more products coming to the market.”
What about marketing – are OTC companies having to step up their game in response to new technologies and changing consumer priorities? “It’s a very broad question, because there are so many things happening,” says Bas. “In the past, you would mainly have been on television and in stores, whereas nowadays, it’s much more complex.”
Marketeers work at mapping the entire patient journey “from the moment they have a problem”, he says and now use a combination of traditional and digital media, as well as learning platforms for health workers.
And what about the PAGB itself – why is it needed? “The PAGB is as relevant now as it was in 1919 when it was established to prevent misleading advertising,” says Bas. “We have a leading role in self care and explaining why it’s important for the whole country – consumers, government and health providers.
“We have a very important relationship with the MHRA when it comes to regulation and product reclassifications and are committed to promoting consumer choice, particularly as we make use of digital technology.
“I’ve worked in five different markets, and in every country I worked I was on the board of the industry organisations. We were always looking to the PAGB as a beacon of innovation, and I’m proud to help carry this work forward now.”