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EF: 2020 was the year of diagnostics, and 2021 was the year of vaccines; what do you think 2022 will bring?
MH: The question on all our minds is if this year will be the end of COVID or if there will be subsequent waves with new variants. We might have to focus on new vaccines as all the vaccines are focused on the original variant. It could be the year of vaccine adaptation to the later variants. We have seen new treatments ease the burden, Omicron might be highly contagious, but it's not very severe and isn't collapsing the health systems. Treatment options if a new variant appears could be vital in 2022.
EF: Could you elaborate on the footprint of BI in Brazil?
MH: We are strong players in both pharma and animal health. We employ just under two thousand people; we have two manufacturing sites, one for pharmaceuticals and one for animal health. We have been outgrowing the market in the past years. The animal health market in Brazil is the third-largest in the world, after the US and China, and is our fastest-growing segment; it grew twice the rate of the pharma market last year.
EF: What were the lessons learned during the last year and managing remotely through the pandemic?
MH: We are in a privileged industry, which gives us additional responsibility. We approached the pandemic prioritizing the safety of our employees, especially at first when we had very little information. We pulled in our field force and sent people home to work remotely. We have a Covid-resistant portfolio, and at the initial stage of the pandemic, some business segments suffered. Chronic patients are our business, and they are high-risk COVID patients who needed a constant supply of medication, which we managed to provide. We also had fewer new patients because everybody was in lockdown. Still, there was a much stronger adherence to treatments because patients were alarmed and worried about the consequences of getting Covid.
As far as lessons were concerned, the pandemic was a time of acceleration; there was an acceleration in digitalization, the R&D process, and a more flexible working environment. It was a time to experiment with new ideas and ways of doing things at a very fast pace. All in all, pharma had positive results. At a time like this, we learn how essential our industry is. Our people worked with a strong sense of purpose and responsibility, realizing the importance of their work for society. The employee level of engagement and passion for what they do increased. The younger generation found working from home difficult with their children at home, and we helped them face these challenges by offering mental well-being advice. The organization worked on a good work-life balance and mental health for the employees. The experience has made us stronger, as people, as an organization, and as a business.
EF: Could you elaborate on your portfolio and what is driving growth now?
MH: As in all BI, our number one growth area is diabetes. We have been pioneering a product for diabetes that has cardiovascular benefits. It has shown a reduction in cardiovascular issues in long-term treatments demonstrating the drug is much more than just a diabetes drug. Our second pillar of growth is rare respiratory diseases. In Brazil, we have served many patients with complex conditions, focusing on the disease and mapping the patient journey. It usually takes about five years for the patient to get initial treatment, but with the services we have put in place, we have halved that time. It still takes too long to start the treatment, but we are attacking the disease earlier. With diabetes, like cancer, the earlier you treat the patient, the better the outcome, and two to three years make a lot of difference. The third pillar of growth is treating acute myocardial infractions, and this is an area we have been doing intensive training because a good treatment by itself means nothing; it must go hand in hand with information and knowledge to make a difference. We are ensuring major health centres have a clear process to react quickly when the patient arrives at the emergency facility. The first 60 minutes are vital to get the diagnostics, attention, and treatment right. We partner with hospitals and train their staff. The pandemic has enabled us to develop remote training; we have set up multi-disciplinary training programs to reach regions we have never had access to before. We have trained over 600 hospitals in Brazil, saving a very significant number of lives. We noticed that death from cardiovascular diseases went up 20% during the pandemic because people were not going to emergencies. So we embarked on a coalition with universities, hospitals, and medical societies to create an awareness campaign to bring patients back to the hospitals, especially in the case of acute conditions, as hospitals were well organized and had separate Covid and non-Covid sectors. These were the hidden costs of the pandemic.
EF: As a person who has worked in various parts of the world, what is your personal definition of access?
MH: Brazil has a reasonably good healthcare system; it offers universal coverage, which is not the case in all markets, especially in emerging markets. Mexico is working on universal coverage, but only those with formal jobs had access for many years, meaning half the population has had no access. Brazil faces financial challenges, of course, but it does offer quite efficient treatment for all major diseases, both chronic and acute. Anybody from the broad population can get access to treatment or surgery, cardiology support, etc. The speed of access to innovation is another matter entirely; rare diseases can be complex. Access is not easy, especially in the case of rare diseases requiring hospitalization. It is a slow administrative process, but it works, and chronic outpatients have access to basic treatment. The period from the appearance of innovation and its potential availability in the public system can take five years or more for obvious financial reasons. There is a discussion of price-value, and because the responsibilities within the system are scattered, it is not easy to convince them all as the benefits don't favour all stakeholders. It is a short-term challenge that must be addressed.
EF: Do you think the pandemic has changed the mindset of the broad population on the value of health, and will it change the way access is perceived in the future?
MH: What has changed within the healthcare system is the sense of urgency. The regulatory bodies have accelerated their reviews, prioritizing any Covid-related treatment, direct or indirect. Time to market has improved, as has the authorization for new clinical trials, although that has been continuously evolving over the last years. It used to be a very lengthy process in the past and has been significantly shortened -even more so if it is Covid-related. The benefits will translate widely, not only to Covid-related treatments, and will accelerate access to the population.
EF: What is the role of digitalization in improving access, what is the adoption rate in Brazil, and how will it affect your products?
MH: Brazil is quite advanced in digital in the financial sector, at the level of some European countries, so the culture is there. Digitalization can help in two main areas: i) the acceleration of R&D time frames (clinical trials, approvals, AI for healthcare data basis) and ii) help improve access in the country through medical education. It is possible to increase the number of people who attend our events, and we can have experts online from different parts of the world to give talks and information. We have built sophisticated digital training programs that accelerate healthcare access. We saw the acceptance and adoption rate statistics and screen level interaction between pharmaceutical companies and physicians on a day-to-day basis was much higher in Mexico than in Brazil. We have been slower to embrace remote interaction as face-to-face is preferred, which is true for all of Latin America. I think this will gradually change, but now that we are not forced to stay at home, the small level of remote acceptance has dwindled as face-to-face is vastly preferred. Some physicians have favourably adopted digital interaction, but they are the minority as most value personal interaction.
EF: When you look back at this period in your professional career, how would you like your tenure to be remembered, considering you navigated a pandemic?
MH: I would have liked to have made a difference in Brazilian society. There has been a sizeable cardiovascular mortality reduction due to our training programs on myocardial stroke, saving tens of thousands of lives. We are working on major diseases for the benefit of the broader population. I believe we have made a difference, improving the patient's experience and making their lives easier by accessing treatments in major disease areas, impacting the patients and their families. We work not only on medical access but on reducing inequalities. Close to my heart is racial diversity within our Brazilian organization; I doubt other multinational companies have a workforce with the racial diversity we have in Brazil. Organizations are evolving but translating a diverse workforce into action still has a way to go. We have launched internal initiatives to foster diversity, and we have partnerships with NGOs that work on access to education for people from favelas and poorer areas. Despite having high schools in favelas, most kids drop out of universities. It is not a question of intellectual capabilities but cultural differences because they don't understand the 'codes' of most university students from other backgrounds that understand the challenges they face, which classes to pick to build the curriculum, etc. We support an NGO that helps them financially for the first year and designates a mentor from a multinational to follow the student throughout his studies. We have had a 100% success rate of kids entering this program, achieving a university degree, and changing the future of these kids. We recruit people to work in our traineeship program and these initiatives, I believe will make a difference. There are many ways to get good results, but it is indeed a powerful engagement when people are emotionally engaged with their work ethic.
