Milena Organdzhieva (Kostova): Vaccines are One of the Greatest Public Health Success Stories in History

Interview by Desislava Nikolova from “Capital”.

Milena Organdzhieva (Kostova) is the new Managing Director of MSD Bulgaria, North Macedonia and Kosovo as of July 1st 2021. She started her career at the Bulgarian office of the American multinational company in 2000 and for 21 years has been gaining a wealth of experience on key positions in various business functions – Human Resource Management, Customer relations, and projects related to Business Management and Market Access. Milena Organdzhieva (Kostova) was appointed manager of Business Processes for Bulgaria in 2018 and managed to build the department from scratch and successfully develop it. Meanwhile, she took charge of product portfolio development for North Macedonia and Kosovo, where she significantly expanded the strategic portfolio of the company, with a focus on cancer treatment and vaccines. In February 2020, she headed a company spin-off project and successfully directed and coordinated all cross-function activities in Central and Eastern Europe, the Balkans, Greece, Malta and Cyprus. Following the promotion of the former Managing Director, Konstantinos Papagiannis, to Managing Director of MSD Romania and Moldova in February 2021, Milena Organdzhieva (Kostova) took up the position temporarily and was in charge of MSD Bulgaria, North Macedonia and Kosovo for five months.

Milena Organdzhieva (Kostova) holds a master’s degree in Economics conferred by the University of Economy – Varna, and a degree in Industrial Management, and has been awarded a CIPD diploma by the Chartered Institute of Personnel and Development.

“United by the vision of MSD Bulgaria,” Engaging for better life,” MSD is a socially responsible, patient-centered company that invents, develops and offers innovative products and services and will keep improving people’s lives,” is how she comments her latest appointment. “We demonstrate daily our readiness to support our partners and our commitment to improving local health environment. Our values guide us in our actions and decisions and have won us the trust and respect of our colleagues, partners and clients in healthcare,” adds Milena Organdzhieva (Kostova).

It is quite uncommon for Bulgarians, and especially ladies, to obtain such senior management positions at multinational companies – what do you think accounts for your success, besides your undisputed leadership skills that are well known in the pharma sector? How does that happen in a large U.S. company?

I feel like saying that the tendency may have changed, lately. Many Bulgarians now hold similar positions, and not only in Bulgaria – they occupy various other European and international positions. This is a true acknowledgement that we are capable of nurturing exceptionally successful talents in Bulgaria. From MSD’s standpoint – yes, it is true that I am the first local manager in 20 years. I think part of my success is due to the former managers of the company for Bulgaria and it has been an honor and privilege for me to work alongside them – wonderful leaders and individuals who contributed substantially to the development of the company and the entire organization in general. I learned a lot from them. When I addressed my team in Bulgaria, North Macedonia and Kosovo as newly-elected Managing Director, I mentioned something that I sincerely believe in – success is not measured by the position one holds, but by the acquired skills, valuable experience and the ability to share all that with others. If we stick to this mindset, success is inevitable.

You have regard for tradition, having spent that many years in a single company?

I certainly have regard for tradition. I have not changed my workplace, because at MSD I found a value system that coincides with my own. As I said, success does not reside in positions, but in the work on various projects that have literally kept me motivated every single day, and in the enjoyment I get out of going to work.

For quite a while in Bulgaria MSD had not been where it rightfully belonged – among the top 10 pharmaceutical companies, but you turned that around. How is double-digit growth attainable during an unprecedented pandemic?

This is true, indeed. We have changed the focus of the company globally in recent years and the result is tangible. Our major focus is on oncology and this is great because cancer patients now have access to innovative medicines and innovative solutions for their treatment. As evident from the latest data of IQVIA, this is the fastest growing segment, i.e. this is where the healthcare need is the greatest, so our major focus and the vision of MSD to be committed to improving lives, to place patients first is beneficial not only to patients, but to the development of the company. It is our priority to expand our presence in the Bulgarian market not only in the field of oncology, and immunology (also called “immuno-oncology”) in particular, but also in other, socially significant, diseases.

How are you going to achieve it, given the severe price regulations and the restrictive pharmaceutical policy in Bulgaria, what is your opinion of them as a business environment?

Pharmaceutical policy in Bulgaria is shaped by economic conditions and political factors in the country. As such, it reflects the government’s general approach to the development of the country. Over the last decade, Bulgaria has made a tremendous progress in healthcare improvement but still significantly lags behind the countries of Western Europe. Healthcare environment is highly dynamic. Unfortunately, there are no radical healthcare policies despite the clearly defined problems in the sector. The regulatory framework is uncertain. Viewpoints in terms of policies, priorities and future development in the sector keep changing. The GDP percentage allocated to healthcare in Bulgaria is half the average for the EU, and healthcare and pharmaceutical policies are rather oriented towards costs, than value and effect. The healthcare sector keeps being underfinanced and to date pharmaceutical policy is still largely cost-oriented. The country of operation is particularly important to any industry so that it may guarantee predictability and certainty for businesses. Sadly, we are witnessing quite the opposite tendency in the healthcare sector. The shortage of funds at the National Health Insurance Fund (HNIF) is made up for by placing the requirement for companies to provide a few types of mandatory discounts that may go as high as 90% of the prescribed medications, especially if we deal with a product of a new class on the market. Add to that the fact that in Bulgaria manufacturers register the lowest prices of medications in Europe and that new medications gain somewhat slow access to the market, and it turns out that the business environment in the country is getting less and less favorable. It is also worth noting that there are no updated databases and registers in the sector. Patients still co-pay significant amounts in the pharmaceutical sector – up to 48% of the cost of the treatment needed. Last but not least, we need to highlight the urgent need to digitalize the sector and introduce new technologies that guarantee transparency of expenditure management.

What is your idea of the company’s portfolio development in its major categories?

We remain focused on immuno-oncology since morbidity is high in Bulgaria and the time span from diagnosis to treatment is still relatively long. Another key priority in our portfolio are vaccines. We are trying to introduce them on the Bulgarian market but, as you know, vaccine coverage of recommended vaccines is still very low. This is also evident from COVID vaccination statistics. Virology is the third focus area of the company. This year, we launched two new products for the treatment of HIV with a better safety profile and comfortable administration for patients as a single pill routine. One of them won us the award of the Bulgarian Pharmaceutical Union for Innovative Product of the Year.

We are also working for the successful launch of the already formulated National Plan for Elimination of Viral Hepatitis, which is in line with WHO’s priorities. Unfortunately, Bulgaria is not among the first, but among the last countries to introduce such a plan and we have not seen it in motion yet. This is among the few socially significant diseases for which a therapy already exists and results in its total healing, and I believe that together, with the other pharmaceutical companies that offer innovative treatment, we should focus our efforts on helping as many patients as possible.

During the COVID crisis it once again became clear what a global, and Bulgarian, problem antibiotic resistance is. I hope that next year we will expand our antibiotic range by one or two last generation products fighting against persistent bacteria.

What do you think of the introduction of a beating cancer plan in Bulgaria?

The National Cancer Plan has to be a priority for Bulgaria and it should involve a new strategy to eliminate cancer related to the human papillomavirus. This is also a major focus of the European Commission and the World Health Organization. The National Plan has to channel the efforts into a complex approach tailored to the specifics of cancer diseases, it has to include prophylaxis, prevention, early detection, timely access to effective treatment, introduction of an effective cancer register with up-to-date clinical data, follow-up care and, last but not least, promotion of health literacy.

This plan is necessary because we all know that in Bulgaria the disease is detected at later stages, which makes it more difficult to manage. We are very strongly engaged in the campaigns for early detection and treatment and we will continue with our successful campaign for early detection of lung cancer. However, the unresolved issues related to cancer are a huge challenge first to patients and their families, then to their doctors, and then to the rising costs and the burden on the entire healthcare system. Without a plan, without a targeted approach adopted by everyone involved in local healthcare, it would be difficult to make any significant progress.

You mentioned cervical cancer vaccines. As a company operating in a country with very low vaccine coverage in terms of recommended vaccines, what is your strategy to boost this process?

Vaccines are one of the greatest public health success stories in history. They allow for the control or almost total eradication of a number of infectious diseases that were once widespread. When we talk about vaccines and vaccine prophylaxis, we mean health. When we talk about health, we mean culture. When we talk about culture, we mean civilizational choice. When we talk about civilizational choice, we mean the way a community designs its future. I quote a colleague of mine and this is our position at MSD – that as a nation, we have to work to enhance vaccine coverage in Bulgaria, especially in terms of vaccines that are not on the mandatory schedule. That is why prophylaxis and raising the awareness of the public are other key priorities of ours and we, therefore, actively support and participate in such type of campaigns and programs of NGOs and pharmaceutical associations. The objectives of WHO’s Global Strategy to Accelerate the Elimination of Cervical Cancer by 2030 as a public health issue include key 3 stages of fighting cancer – 90% of girls vaccinated with an HPV vaccine by 15 years of age, screening and treatment. This should be a priority of all countries.

I personally think that the Ministry of Health should be a more active player in the process of raising the public awareness. It should actively back up vaccine prophylaxis. We can also draw on the experience of other countries in the region such as Slovenia, Croatia, and the neighboring North Macedonia that included the HPV and rotavirus vaccines in their mandatory calendar.

Is it difficult to manage pharmaceutical markets in countries like North Macedonia and Kosovo? What are the challenges you are facing?

In non-EU countries the procedure of medical product registration is very slow and cumbersome. To register a given medication outside the EU, these countries have to be priorities for the company, so that the registration dossier may be accepted. I personally have been thoroughly aware of the markets of North Macedonia and Kosovo since 2018 when, as an additional project, I took charge of these countries and the promotion of our portfolio therein. Was it easy? No. It certainly was not because pharmaceutical policy there is not even as regulated as in Bulgaria. The budgets that their healthcare funds and ministries of health can afford are even lower than those in Bulgaria. But when you prove the quality and efficiency of a product, identify the right stakeholders and responsible healthcare institutions, and talk to physicians, you can be successful. In two years we have managed to include both vaccines – the HPV vaccine and the rotavirus vaccine, in the mandatory schedule of North Macedonia, and the varicella vaccine – in the list of recommended vaccines. The fight against these diseases has become a priority to that country and this is very encouraging. It is gratifying that not only the cancer patients in North Macedonia, but those in Kosovo as well gained access to immuno-oncology for the treatment of severe cancer diseases.