Todor Kesimov: "The true measure of success is the legacy we leave behind"

Todor Kesimov has been the General Manager of Takeda for Bulgaria and Romania since the beginning of 2023. He joined Takeda in 2012, and his professional journey within the company has spanned various positions in finance and logistics, both at Takeda’s representative office in Bulgaria and with responsibilities for several neighboring countries. At the beginning of 2018, he took over as Country Manager of Takeda in Bulgaria, and subsequently assumed management of Takeda for Romania and Bulgaria.

Todor Kesimov has been a member of the Board of Directors of ARPharM since 2021, serving as its Chairman for the 2023–2025 term. Since 2020, he has also been a member of the Board of Directors of the Japan-Bulgaria Business Association, and has served as its Chairman since the beginning of 2024.

He graduated from Regent’s Business School London in 2007, majoring in Finance.

I. STRATEGY, LEADERSHIP, AND SCIENTIFIC PRIORITIES

Your management experience combines working across different markets, teams, and cultures. How does this international context influence the way you lead Takeda in Bulgaria?

Todor Kesimov: International experience helps you view the market not just through local challenges, but through a broader strategic perspective. In different countries, you see various health system models, which allows you to interpret trends more quickly and anticipate changes.

In Bulgaria, this translates into a very practical approach: we make decisions centered on the patient and long-term trust, but we act with entrepreneurial speed and a digital mindset. In other words, we combine lessons learned from mature markets with adaptation to the Bulgarian context, without mechanically copying models.

I believe that strong results come when teams share experience, complement each other, and work through shared values rather than across borders.

Takeda has a deeply rooted philosophy of values and leadership dating back to its founding more than 240 years ago. How do you manage to find the balance between tradition and an innovative approach?

Todor Kesimov: Takeda has a strong heritage and clearly formulated values that do not change over time—they are the foundation. The balance comes from the way we apply them in a modern context. On one hand, traditions provide direction—we decide based on the principle of “Patient – Trust – Reputation – Business,” thus avoiding decisions driven solely by short-term goals. On the other hand, innovation lies in “how” we act—using data, digital solutions, and new models of interaction with institutions and partners to achieve results faster and more efficiently.

Personally, I see the balance in preserving the meaning while changing the approaches. Tradition determines what is important, and innovation determines how best to achieve it today.

Since you took over Takeda in Bulgaria and Romania, what are the three strategic transformations that have led to the greatest improvement in access, partnerships, or the internal efficiency of the organization?

Todor Kesimov: We created a stable integrated team working across both countries; for me, the successful formula for this team’s work is “trust, respect, and autonomy.” I give a credit of trust upfront and expect it to be maintained. I insist that we respect each other as individuals and professionals. We also aim to work as a single entity in both countries—with a unified approach (as much as possible), transferring best practices from one country to the other. Last but not least, we are introducing various digital solutions and multi-channel engagements to help the team achieve our goals effectively.

Where do you see the next scientific breakthroughs in Takeda’s therapeutic areas —for example, in IBD, rare metabolic diseases, neuroscience, or oncology?

Todor Kesimov: The general trend I see is that science and technology allow us to be more precise, faster, and more oriented toward the real needs of the patient—this is where Takeda can lead innovation. Takeda has a unique profile in plasma-derived therapies.

What are the biggest challenges, and what is needed to strengthen patient access to modern plasma products in the region?

Todor Kesimov: Therapies produced from human plasma treat rare, chronic, and severe diseases. It is no coincidence that some of them are included in the WHO Model List of Essential Medicines. However, they have a number of specificities—in terms of production and the patient journey—that create challenges in ensuring access to them. The production of plasma-derived medicinal products uses a specific, highly regulated, and scarce raw material relative to needs—plasma from healthy living donors—which accounts for more than 50% of the value of the finished medicinal product. In comparison, the cost of the starting raw material for conventional medicinal products is no more than 5% of the finished product’s value. The production process and the time it takes for a plasma product to reach the market is approximately 7–12 months, compared to a 2–3 month duration for the same process with traditional medicinal products. For these and several other reasons, many countries have special pricing and reimbursement policies for plasma therapies. In Bulgaria, however, they are subject to exactly the same rules as traditional medicines, which significantly hinders patient access to them.

II. ACCESS, ETHICS, AND HEALTH POLICIES

Patients with rare diseases and severe chronic conditions often face administrative and logistical obstacles to accessing new therapies. What are the most critical barriers in Bulgaria, and how is Takeda working to overcome them?

Todor Kesimov: The issue of access to therapy is complex—starting from the inclusion of the respective medication in the list of medicines paid for by the NHIF (the Positive Drug List) to purely administrative processes, especially for patients with rare diseases. Regarding the inclusion of medications in the scope of NHIF-funded therapies, a major obstacle leading to delays in access is the requirement that the disease be among those for which the NHIF pays, i.e., it must appear on a separate list. This is an issue primarily for rare diseases, and adding a disease to this list often takes years. An obstacle to faster access (for therapies for all diseases) is also the requirement that the therapy be paid for with public funds (i.e., reimbursed) in at least 5 out of an explicit list of 17 countries (for rare diseases—5 out of all EU countries). When a therapy is finally included in the PDL, patients face administrative processes surrounding the prescription of the therapy and its approval by an NHIF commission, as well as the fact that for every rare disease, there are only a few (often only one in the entire country) centers serving patients from all over Bulgaria, including prescribing and administering the therapy. As part of the Board of Directors of ARPharM (the Association of Research-Based Pharmaceutical Manufacturers in Bulgaria), Takeda is in constant dialogue with the Ministry of Health, the NHIF, and all competent institutions to overcome the existing challenges facing patients.

How do you balance scientific innovation and economic sustainability, especially for treatments with high clinical effect but also a high price— such as plasma products or therapies for rare diseases?

Todor Kesimov: For us, balance means ensuring access to therapies with proven clinical effects while working with health institutions on sustainable solutions. We invest in partnerships and access programs so that patients receive a timely and fair opportunity for treatment, even when it comes to rare diseases or high-value products.

In your opinion, is there a need to increase awareness of healthcare issues? What partnerships and communication approaches do you use to raise awareness and trust, especially on sensitive topics such as rare diseases?

Todor Kesimov: We must categorically speak about the problems patients face—because problems in the healthcare system ultimately reflect on people—current and potential patients. Therefore, Takeda, together with ARPharM, invests efforts in sharing issues regarding the financing of the system and its sustainability, as well as access to innovative therapy. However, patients face other problems besides access to treatment—getting a diagnosis. This is particularly true for rare diseases; patients often receive an accurate diagnosis more than 5, or even 10 or more years after the first symptom. The reasons are complex, but it is important to raise public awareness of these diseases and the need to see a doctor. In this regard, Takeda has carried out numerous information campaigns over the years—both for rare diseases in general and for specific conditions. We are now launching another campaign together with the Angioedema, Urticaria, and Asthma Association—this time in the field of hereditary angioedema. This is an insidious disease characterized by unusual swelling in various parts of the body, resembling an allergy. The swelling can also occur in internal organs and is especially dangerous if it is in the throat area—in such cases, the outcome can be fatal. The campaign aims to improve the recognition and early diagnosis of this disease.

What is the role of digitalization, real-world evidence, and AI for Takeda—in predicting needs, tracking effectiveness, interacting with patients, or ethical assessments in healthcare?

Todor Kesimov: It is a cliché to say that digitalization is an important and indispensable part of the future of healthcare. But it truly is—the implementation of many sustainable healthcare models (for example, pay-for-performance models or qualitative cost-effectiveness assessments) is possible only in the presence of high-quality and structured data, as well as the necessary infrastructure for processing it. In this regard, AI can help significantly with data processing for specific purposes. Also, increasingly in Europe and globally, AI is used to support diagnostics, especially in rare diseases, by screening records based on certain criteria to identify specific symptoms and connections between them. Takeda follows these trends. We invest heavily in generating real-world data, as well as in various innovative models to improve diagnostics. We also apply new technologies in our daily work to optimize various processes and improve the quality of our communication with all our partners.

III. ON THE EVE OF THE EURO – SCIENCE, ETHICS, ECONOMICS

How will the introduction of the euro in Bulgaria affect pricing and the provision of treatment in key therapeutic areas such as rare diseases, IBD, and oncology?

Todor Kesimov: For Bulgaria, adopting the euro is an important step forward in increasing confidence in our country’s stability, including among the headquarters of pharmaceutical companies. A single currency is definitely an advantage in price referencing, as well as in adhering to the price levels established internally for all countries in the region. Although we have had a fixed exchange rate to the euro, which also put us in a better position than Romania, for example, currency conversion always introduces a certain sense of uncertainty. Beyond that, we do not expect significant changes related to the transition to the euro regarding drug pricing and access to therapies.

From an ethical point of view, how do you define a fair price for innovation under a common European currency, and how can Bulgaria accelerate access without compromising the sustainability of the system?

Todor Kesimov: The question of a fair price for innovation in the light of sustainable healthcare is always a topical and sensitive issue. Significant investments lie behind the creation of an innovative therapy, especially in the field of rare diseases. At the same time, we fully understand the difficulties of national financial systems, especially those with limited budgets like Bulgaria, in providing a sufficient budget for medicines. Therefore, the industry and the state must work together, and in recent months and even years, we at Takeda, together with ARPharM, have demonstrated our partnership and readiness for dialogue with the Ministry of Health and the NHIF to create conditions for predictability and sustainability in the healthcare system. Takeda, like all innovative companies, pays a significant amount in rebates to the NHIF, often resulting in sales at a “negative” value; this is the price we are willing to pay to ensure Bulgarian patients have access to modern achievements in science and medicine.

Which leadership practice has helped you most in translating Takeda’s global values—integrity, fairness, honesty, and perseverance—into real results for the team, partners, and patients?

Todor Kesimov: The values themselves describe the leadership model I believe in—being upright and honest within the team and externally toward our partners, guided by a sense of fairness and persistently pursuing our goals for the benefit of the patient. For this to happen, I believe it is important to challenge yourself and serve as a good example. One of the biggest challenges has been keeping myself and the team sufficiently motivated. For me, it is important to have the right environment in the company so that every employee steps out of their comfort zone, sets their own priorities, and is responsible for their own success. And when we achieve this, we also achieve the most important thing—the legacy we leave behind for patients and for society. It is the true measure of success—the therapies provided, the lives saved or extended, and what has been built for the benefit of our entire society through our corporate social responsibility initiatives.