When Pfizer launched Viagra seven years ago, the pharma giant knew it had a winner on its hands. But the little blue pill was also more dangerous than dynamite. This was the world's first drug to cure impotence - an incredibly sensitive subject that came complete with religious and moral undertones.

Pfizer didn't take any chances. The pharma giant first sought - and received - approval from the Vatican and other religious heads for the drug. It next came up with a less embarrassing term for impotence - erectile dysfunction (ED), which made the condition sound more like an illness that could be cured rather than an emasculating failure.

Then came the celebrity endorsements and the sponsorships of typically-male pursuits. Pfizer ran television commercials with US presidential candidate Bob Dole and legendary footballer Pele admitting they suffered from ED.

Viagra also sponsored Nascar and is even now associated with major league baseballer Rafael Palmeiro and Nascar driver Mark Martin. As it turned out, Viagra's was a textbook launch, with the brand soon accounting for a whopping 96 per cent of the US market for ED.

Viagra in India is a different story. Pfizer launched the drug in the country only in December 2005, seven years after its international debut. (The grey market, though, has been awash with Viagra and its clones for some time now.) Viagra is also several times more expensive than other ED medicines - and there are several of those. Those are bitter pills to swallow for a company that single-handedly created the market for ED medication.

Still, Pfizer defends its delayed kick off. "The environment in India is only now conducive to the launch of global brands," points out K G Ananthakrishnan, senior director, pharmaceuticals, Pfizer India, possibly referring to the changes in patent protection laws that took effect from January 2005.

But Viagra's late launch in India is not as big a problem as its cost. At Rs 463 - no, not for a strip of 10, but a single, 50 mg pill - Viagra is 20 times more expensive than the Indian market leader in the category. Mankind Pharma's Manforce, which leads with a 30 per cent share of the Rs 100 crore market, sells a 50 mg pill at Rs 19.

Viagra in the US didn't have to fight off competition. Here, close to 58 brands exist in the ED medication category, beginning with Zydus Cadila's Penegra (launched in 2001). Pfizer's clearly got its work out with Viagra.

But industry watchers are looking at the brighter side. Says Sanjiv Malik, national president, Indian Medical Association, and president SAARC Medical Association, "There is a certain psychological advantage that an original always enjoys." Still, even Malik accepts that Pfizer's not going to find the going too easy. "Most doctors in India have already been using a particular brand; it will be difficult to change this behaviour," he points out.

That means Pfizer has not just lost the first-mover advantage in India, it also needs to wage war against well-entrenched players such as Ranbaxy's Caverta, Zydus Cadila's Penegra and Mankind's Manforce.

Worse, the company can't replicate its American launch tactics. Under Indian law, prescription drugs like Viagra cannot be marketed through mass media - that rules out a high-decibel ad campaign.

But Pfizer is seeing opportunities in the problem. According to the company, the Rs 100 crore ED medication market in India covers only 2 per cent of the population that suffers from the ailment. Remember, ED is a condition people don't like to even acknowledge, leave alone treat.

That point was driven home by research conducted last year by an external agency for Pfizer. The significant takeaway from the study was that it's not just patients - even doctors shy away from bringing up the subject.

The road ahead was clear: Pfizer would concentrate on increasing the rate of detection of ED. Ananthakrishnan points out that ED prevalence is "largely a question of underlying diseases and causes". That means men with existing conditions of diabetes, cardiovascular diseases and hypertension are also likely to suffer from ED - stress is a major cause.

Which means Pfizer need not restrict its Viagra marketers to fertility clinics and urologists. Heart specialists and endocrinologists will form an important contact point for Viagra-related communication and for a better understanding of how many men actually suffer from ED.

Pfizer hopes its past record in taking alternative routes will come in handy. For instance, based on its interactions with medical practitioners, the company had in-depth knowledge of how difficult it is to diagnose clinical depression.

In 2003, Pfizer India introduced Prime MD Today, a screening and diagnostic tool designed to help general practitioners better detect cases of depression among their patients. The company also worked closely with teams of psychiatrists to educate and improve awareness of depression.

The result? From Rs 2.58 crore in 2003, sales of Daxid - Pfizer's anti depressant medication - rose to Rs 4.89 crore the following year. The company claims that Prime MD Today had a huge role to play in the growth.

Now Pfizer is looking to recreate a similar success story with Viagra. The opportunity: drugs like Viagra are commonly mistaken to be pills that increase potency, rather than as cures for an ailment.

Marketing consultant R B Smartha, the managing director of Interlink Marketing Consultancy, spells out the problem. "Till date, pharma companies have not made it clear that Sildenafil Citrate and Tadafil tablets are only for those who suffer from ED and are not for recreational use."

That will now change. Next month, Pfizer will launch a print campaign that aims to create awareness of ED and its medical cure. Globally, too, the company uses a mix of celebrity endorsements and awareness campaigns to get its message across. Agrees Pfizer US spokesman Daniel Watts, "Pfizer has aired non-branded, disease-awareness advertisements for ED, as well as brand-specific advertisements in the US."

Analysts believe that Viagra's premium pricing will help Pfizer India launch a high-profile campaign (even if it isn't brand-specific), since the company can afford generous media spends.

Of course, even if it has lost the first-mover advantage, Viagra already enjoys tremendous brand equity in India. The drug is already almost synonymous with ED medication. Pfizer executives point out that even before the official launch, Viagra sales in the grey market were in the range of $1.5-2 million (Rs 9 crore) a year. Pfizer is hoping to bring over most of those buyers to the legal market and help it reach a 10-15 per cent share of the market in the next two years.

The company is also counting on its wealth of knowledge on ED to help it gain better access to the medical fraternity. Branded communication to registered medical practitioners and the plain vanilla route of medical representatives calling on doctors is, of course, part of the communication strategy. But Pfizer is also bringing in thought leaders to address gatherings of medical men.

Recently, for instance, the company hosted a conference by Peter Ellis, the joint patent holder for Viagra, where Ellis shared current research findings on Sildenafil Citrate (the molecule on which Viagra is based) with the audience.

But even if doctors buy into Pfizer's depth of knowledge, what is in it for the trade? Analysts feel that not many chemists would want to stock the pill because of its steep price tag - they may not get the required sales volume. Pfizer counters that, saying the price will be a major attraction for chemists, given the margins on the drug.

On average, chemists get margins of 20 per cent on the price of a drug. Convert percentages into actuals and Pfizer's commission (Rs 92 on the sale of a single pill of Rs 463) is unparalleled. Besides, Pfizer is attacking only the top layer of the market - the top 29 cities, where chemists stock even more expensive drugs.

Will Pfizer's strategies help Viagra sales rise?