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EF: With COP26 and climate change taking centre stage, what would be your message to world leaders?
GS: If I could address world leaders and people who can change policies, I would mention that this pandemic showcased countries' capacity and lack of capacity to react to a crisis. In the places where historically there had been no investment, there were difficulties. The people and companies that historically invested in high-value innovation and had prepared and invested in installed capacity could react to the pandemic. Within government policy, we need a strategic view of what to support and incentivize -not short term needs, but a strategic view of priorities and potential challenges that might arise.
EF: Could you elaborate on Carnot's role in Mexico over the past nearly two years?
GS: The pandemic showcased what can be achieved in collaboration. Carnot worked in four specific areas, collaborating with others and finding help in unlikely places:
- Carnot was one of the first companies to register essential commercialized testing for Covid-19. Our natural scope looking for product licenses is in the US and Europe; instead, we found partners in Asia, specifically in China, that were able and ready to provide the necessary products in a shorter amount of time. Getting help from our Chinese partners and Mexican authorities to bring the tests forward in a timely manner. Looking beyond our traditional partners was definitely a lesson learned.
- Ventilators: we brought in around 180 ventilators supplied by the private sector. We got together with the companies that conform to the Mexican Pharmaceutical Council (CFM) and Grupo Minero Mexico to work on this in record time. With the help of private companies and NGO's like INCIDE and Fundacion Carlos Slim, bringing everybody together, the private sector ventilators were the first ventilators to arrive in Mexico filling an urgent need at the time. Support came from unlikely places; Foreign Affairs aided and lined the import process and the UNAM through the Instituto de Investigaciones Biomedicas ensured the ventilators complied with the technical requirements.
- Vaccinations: Through Drugmex, one of the companies in our group, we did the first formulation "fill and finish" of a COVID vaccine in Latin America. We had a lot of help; Siegfried Rhine and Silanes lent us equipment free of charge for as long as we needed. Sanfer and other companies which had contracted manufacture of their products in our plant were prepared to forgo revenue supported us regardless. We repeatedly saw industry members getting together to help, and we should learn what can be achieved when there is a priority for society and key players work together to achieve a socially beneficial goal. We should look for mechanisms to continue doing this sort of work.
- Other unlikely friends were the authorities. A Foreign Affairs team led negotiations and coordinated the supply of vaccines from different sources. Their team was always available even giving up personal time to collaborate. As an example, we even spent New Year's Day working with officials from Foreign Affairs in the manufacturing site for the vaccines, as we all wanted to ensure that things were ready in the shortest time possible. While doing the plant's reconversion, we had a lot of technical help, and we benefited from the experience of the regulator, COFEPRIS, with critique coming in the form of advice. The result was highly positive; we have a compliant plant for 'fill and finish' vaccines in a record time.
The different companies' innovative capacity was on display; we all started clinical trials on our available medicines. Carnot ran clinical trials on two products, in different countries, as well as participated in the clinical trial for the vaccine. Results varied, with some proving their safety and efficacy and some falling short, the important thing is that the innovation capacity was there. In record time, we developed and put into the market a product (VR Protect) that prevents or reduces the inflow of small particles in a person's airways. It is a relatively simple technology using the principle of electrostatic.
It was an exciting time for technological changes within the sector; having the right programs, software and infrastructure for a remote medical visit and the right message to reach physicians was critical. Another critical change was the direct consumer channels for people to purchase products from the safety of their homes during the lockdown. I believe many of these changes will remain post-pandemic.
EF: Moving forward, what do you think collaboration will look like?
GS: Many groups collaborated through the pandemic; the Consejo Farmacéutico Mexicano and Funsalud did incredible work on information regarding Covid and setting up the hospitals together with the government. These associations will probably continue to build on their collaborations, as we certainly will. It would be helpful to have guidance on priorities because the model is there, and we know we can work together in difficult situations. Our priorities must be aligned to face the many needs of our wonderful country. The pandemic made priorities very clear, but now we need new ones. An alignment of priorities would resolve some issues that got the government and the private sector into a tricky spot in the first place, such as supply chain dependence. The United States and Mexico and groups such as CFM have to come together to have the essential infrastructure in North America and ensure we have a robust supply chain. With Covid, many borders closed down, and we couldn't access raw materials to produce many critical products. I hope that we will see something of a hub for vertical integration in North America, allowing us to overcome this issue in the coming years.
EF: If you had to create a Master in Pandemic Administration which two courses would you consider mandatory?
GS: None; I would throw the book out the window. The book is not made for this kind of crisis, the book teaches us to be efficient, and in a crisis, we look to be effective, not efficient. The expense doesn't matter in a crisis; a quick result does. If it weren't for Covid, I would have never dedicated a plant exclusively to one vaccine. We would have never got so many resources to evaluate and bring in ventilators so quickly. The book is of no use because crisis management is about execution, not analysis. Execute quickly, decisively and effectively with the clear understanding that it won't be the most efficient use of resources.
EF: How can fast, effective decisions with very little information be taken?
GS: i) Have an objective even if it is a bit fuzzy, ii) Find people with the best information even if it isn't the fullest information and take it with a grain of salt. For example, Sanford had the hydroxychloroquine product in Mexico but couldn't get the raw materials to supply the demand. As they didn't know if it was effective, Sanford collaborated with a University to do the synthesis in Mexico, and it turned out it wasn't the answer to Covid. My point is that with the best information at hand, we make decisions and move forward, knowing that some of our decisions will be right and others won't. The quicker we move forward, the more resources and options we will have to deal with the crisis the sooner we can find solutions that work.
EF: Did you introduce any new KPIs when managing the pandemic, and if so, which ones?
GS: We significantly introduced more KPIs for home-office, on the work done, and regarding physician visits and physician productivity as we were visiting physicians remotely. Many of these new KPIs will remain; we are now looking for structures that will stay in place, eliminating those that won't make sense in the future.
EF: How will the working model evolve in the future; will there be a hybrid model, or will we go back to the pre-pandemic model?
GS: As executives, we have realized certain jobs can be executed more efficiently from home, time and resources are saved by having some people work from home. I think certain analytical jobs will probably remain in a hybrid model. On the other hand, some jobs perform better in a presidential capacity, such as manufacturing and quality. I believe that new rules need to be developed around home-office because people working from home are more effective because they work 24/7. The borderlines of work and personal time do not exist. The system was great for companies in the healthcare space that needed all the resources at that specific time, and I can't thank my team enough for working around the clock to get the things done, but that is not sustainable in the long term. Rules will have to be applied to hybrid models, drawing lines between office life and personal life that allow us to take advantage of the efficiencies, in a way that is positive for both the companies and the workforce.
EF: How has the company portfolio performed or shifted over this past year? Did you see new trends?
GS: During the pandemic, we saw a shift in acute infectious disease in our current portfolio. People were no longer getting recurring respiratory infections; they were no longer eating out or getting gastro infections. Also, people became more aware of the importance of being healthy and started taking care of their health. As a result, sales for chronic disease products went up primarily due to patient compliance as they became more consistent in their treatments.
We are looking at adding a new business line, the vaccine business, starting with the Covid vaccine, but we are already working on a pneumococcal vaccine and a meningococcal vaccine to bring to the market. We are working with an American company to develop a polyvalent Covid influenza vaccine and an influenza vaccine. Hopefully, what was born of an opportunity will become a strategic company line, and we will be leaders in vaccines in Latin America in ten years.
Those who have prepared for the future will be the ones to react and take advantage of future opportunities. I am pleased that we have taken the initiative to invest in these unmet needs and can therefore position ourselves to serve them. We are not alone in having done this, others like Liomont, that built a beautiful plant for biologics, have seen the unmet needs, taken the risk, invested, generated the infrastructure, and like us are now in a good position. I am proud to be part of Carnot, and I hope it serves as a lesson to build the infrastructure for complex technologies such as biologics, novel anti-infectives or vaccines. The Covid pandemic was caused by a virus, but the next pandemic could be a bacteria; all these things need to be considered today to be ready to take action.
Additionally, some unexpected collateral effects like the impact the quarantine had on the mental health of the population, highlight the importance of effective treatments in other treatment lines like Neuro Psiciatric. Carnot is also seeking to position itself as a leader in this area.
EF: When you look back on this period in your professional career, how would you like your tenure to be remembered?
GS: In some sense, this pandemic will be the war for this generation, a war of science, with scientists, physicians, and laboratories as the soldiers on the frontline, and I would like to be remembered as one of an extensive group of people who fought the war at all levels. And it's important to remember that it is not the generals that win the wars, it's their leadership and work along with that of lieutenants and foot soldiers. It is this full group that waged war on Covid, and the work and sacrifice deserve to be remembered. Particularly that of the thousands of physicians that risked, end even gave their lives, to treat the disease. What was done over a short time was amazing, vaccines take seven to ten years to be developed, and they were produced in less than a year. My admiration for the creators of mRNA is huge, using technologies that had never been approved in humans before. We were on the front line in this battle, and I think we did a good job developing vaccines and new therapies for Covid-19. Unfortunately, I doubt this will be our last challenge. We have been very fortunate in not having to fight a pandemic for a very long time, but I believe there is a possibility we may have to do this again in our generation; it may even happen more than once. Our role now is to be the shepherds or stewards in ensuring we are prepared for the future.
Companies in the healthcare space have an additional responsibility toward public health. To move forward on open source requires making technology available; under normal circumstances, we would not have been given the CanSino technology to be manufactured outside China. The Beijing Institute of Technology manufactured the CanSino technology, and they would have never accepted transferring their technology outside China, but the sharing of information has become critical and necessary to overcome the pandemic in a short time.
It would have been excellent to see this same principle happen more broadly with retroviral. Some patented products were the only drugs that seemed effective, but the supply was so restrictive that it was not readily or cheaply available for society. Companies that hold these patents should have sought to make agreements with local or regional companies to make the products available. This would probably have made both social and economic sense. As pharma companies, we need to understand that we have to act on what is socially required beyond our shareholder value, and I saw many companies do this exceptionally well.
