Read the Conversation
EF: 2020 was the year of diagnostics and testing, 2021 the year of vaccines; what do you think 2022 will bring?
DL: Mexico's situation was different from the rest of the world over the last two years because the government focused on hospitals and infrastructure around the care of Covid. The government converted hospitals in the previous two years, and now they are reconverting them back to the original scheme. The Covid testing of Mexico's population was low compared with other countries. The rhythm and coverage of Covid vaccination were not precisely according to the initial expectations of 80%; today, we have about 65% population coverage, with two doses. The government is working on returning to the pre-pandemic situation, and Covid testing will decrease over the next 12 months. The good news is there will be a focus on treating chronic diseases. Over the last two years, diagnostics and procedures have been postponed due to hospitals focusing on Covid. This year and possibly even in 2023, we will try and get patients back to diagnosis and care and focus on chronic diseases.
EF: Could you elaborate on Biotech's role in Mexico over the last two years?
DL: As a biotech company, we faced many challenges during the pandemic. We focus on face-to-face relationships with our customers -the patient is the central part of our formula- and without that possibility, we were challenged. Due to the volumes managed in the rare disease market, most of our customers are from the public market. We could not see patients or stakeholders, legislators, key decision-makers, administrators, key opinion leaders, physicians, health professionals, or other people in the health ecosystem. It was a challenge to approach our stakeholders, especially those working in the government. With the focus on Covid and the country in lockdown, it was hard to interview doctors and get the patients diagnosed; it was difficult to develop tools to reach and find patients. We worked on creating links and engagement by sending protective material to the doctors, which were very well received. We assisted patients in getting to their therapies, working with NGOs bringing patients in every week using private transportation. We developed alliances with private companies, hiring private nurses and private infusion centres.
EF: What were the lessons learned from managing during these times?
DL: We learned we have to be ready to renew and adapt our strategy, be flexible to adjust our mindset to the new reality, and most importantly, adapt to our customers' needs. As a private company, we can develop digital tools and apps for doctors, facilitate patient diagnostics, and access medical information data management. But the most important thing is to be close to the patient, and the government patients sometimes don't even have a computer which complicates matters further. To deal with these matters, we learned to be flexible and stayed close by whatever means possible. We worked with my team on issues such as the best moment to approach the customer; the stress of the pandemic has made timing critical. We approached doctors after the consultation or very early in the morning. But the biggest lesson learned was to adapt quickly to new situations.
EF: There has been a massive emphasis on communicable diseases these last two years, but how can the importance of rare diseases be restored?
DL: We are living in transformational times; the topic of the rare disease, in general, has been growing every year with more people getting engaged. I have worked for 15 years in rare diseases, and I have seen many changes and developments and growing awareness. Ten or twelve years ago, very little was said about rare diseases. Now we are at the point where it is rare for people to have never heard of rare diseases; we even have an international day for rare diseases ( February 28th ), which attracts a lot of attention. The real challenge lies in the next step: move forward with the legislative changes; each country has local laws regarding rare disease care, and legislation is the place to impact the care of the patients. We are converting ideas into actions: more access, more approved therapies, more sites to provide treatments, and more budgets to care for the patients. Health currently is very much on the public agenda; pre-pandemic health wasn't a priority in Mexico; security and economy are usually at the top of the agenda, not health. But now, post-Covid, we have an excellent opportunity to leverage the health momentum. After the legislative changes are done, we will have to work closely with the authorities to continue raising awareness and provide families with the tools to encourage early diagnosis. The earlier we can diagnose the patient, the better the outcome –a timely diagnosis makes all the difference. It is a good moment for this transformation.
EF: You mentioned it was a good moment for health; how can we keep this momentum moving forward?
DL: The key to keeping the health momentum going forward and on the public agenda is to work together as a community, establish public-private alliances, talk with key decision-makers, and offer new schemes. We have been working with the government for some time to provide tools to facilitate home care treatments, creating different alliances to achieve this. We work on awareness campaigns and meet with legislators to maintain interest high on chronic and rare diseases. First contact doctors must have the tools to diagnose patients. With the hospitals opening, they are more and more potential patients. It is the right moment to stimulate diagnosis through medical education because medical education is the basis of everything. Globally, doctors don't receive much information on rare diseases during their education. They know all about diabetes or hypertension, or other massive disorders, but this is not the case with rare diseases. It is a good moment to stimulate programs that add some rare disease content to the academic curricula of the universities.
EF: How can programs for detecting and diagnosing rare diseases be included (using digital technology) to educate physicians to detect rare diseases even if they only find a few cases per year?
DL: Most doctors will never see specific rare disease patients, but there will be cases, and the doctors need to have the tools to recognize specific symptoms and diseases. Rare diseases are complex because there are different entities in one person, making the doctor suspect other diseases before considering a rare disease. We educate doctors to consider the possibility of certain rare diseases. We organized medical education sessions at hospitals with experts telling doctors how to recognize and diagnose a rare disease pre-pandemic. We kept doing the sessions via zoom during the pandemic, but engaging doctors became increasingly challenging. At first, doctors were very interested and enthusiastic, but now, two years later, very few doctors appear in our medical education sessions; it has just become another zoom meeting on medical education. We try to use innovation in context to keep them engaged and add to the information they can use to detect rare diseases. There are about 30 thousand primary care doctors in Mexico, and as a small rare disease company, it is complicated to have access to all these doctors. Technology, digital content, campaigns, and cellphone apps are fundamental in getting the information out.
EF: Has rare disease prevalence increased over the last three years?
DL: The growth hasn't been in the prevalence but in diagnostics. Genetic changes take a long time to emerge as a new disease and be discovered and understood. We can diagnose earlier today mainly because medical education is growing. Fenilcetonuria -a rare disease- ten years ago had a prevalence of one case in 100 thousand people. Today there is one case every 30 thousand people, so the growth of the disease has tripled in ten years, but the truth is the prevalence has not changed; diagnosis has. There are new newborn screening programs in Mexico today, and we can better diagnose the disease. It is not about an increased prevalence but about better tools to diagnose, and doctors can improve the diagnostic index for rare diseases. Prevalence in rare diseases is dynamic and constantly moving, but it never advances as fast as our improved diagnosis ability.
EF: Do you think the Mexican market is ready for personalized medicine?
DL: Mexico is willing and open to being ready in the coming years. I recently participated in a conversation with a group of experts on this subject, and we agreed it was a good moment to start on this. The products are arriving, and Biotech is not the only industry with these products; we collaborate with AMIIF companies on innovation, gene therapies, and specialized therapies as we prepare to work with the government. COFEPRIS (registration of products) and the Mexican Health Council are open to these therapies being registered; they are open to adapting rules for health technology and evaluations, so it is an excellent moment to begin transforming.
EF: When hiring new talent, what skill sets are you looking for?
DL: I want people with a strategic vision, with technological and professional skills, but I also look at their human skills and how they interact with others. We need our people to resolve issues –when to approach the client, for example- personal skills, in my opinion, are the most valuable assets. Our most important interaction is with the customer, and we need people who can be close to the customers and make them feel comfortable. The company's best asset is its people, especially after two years of working remotely. We have to be creative and have empathy with all the customers in this great opportunity to be face-to-face again.
EF: When you look back at this period in your professional career, how would you like to be remembered as a leader?
DL: I have worked 40 years in the health sector and would like to be remembered as somebody who supported the development of those around me in the health sector. I would like to be recognized as being both smart and warm, to have inspired, by example, a group of people to be better. I would like my legacy to be good management, both professionally and personally, for having a strategic vision and making good decisions quickly and opportunely. I would like to close the interview by saying I am very motivated and have endeavoured to discover new things -an everyday challenge that keeps me full of projects and energy. After 40 years, I feel I still have new opportunities, and this kind of motivation makes everything easier.
