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EF: If you were to conceptualize a periodic table for Latin America (LATAM), which element would represent you, and where would Brazil be positioned on this hypothetical periodic table?
SC: Definitely one of the four organic elements since these make up most organic compounds and are more closely linked with life, healthcare and well-being. I would put Brazil within the noble gases given its size and importance within Latin America.
The pharmaceutical market totals $85 billion in LatAm. Brazil, at $41 billion, represents roughly 50%. In terms of population, the country holds approximately one-third of the region’s 617 million people. But it’s not just about the size. Brazil is also amongst the regional leaders in terms of regulatory maturity, with ANVISA highly regarded amongst global regulatory agencies. We’ve recently seen interesting moves that demonstrate the agency’s push to modernise processes and increase capabilities. Examples include the approval of analyses from equivalent regulatory foreign authorities, the issuance of best practices for the use of real-world data (RWD) for regulatory submissions and the calling of start-up companies to participate in a pilot program for the development of drugs in Brazil. From a legislative standpoint, the Senate’s recent approval of new regulations regarding clinical trials in Brazil shall, if sanctioned by the president, greatly improve the environment for R&D in the country.
Latin America is not a connected region like Europe. There are few regional stakeholders with significant influence at the country level. There is an opportunity to increase collaboration and proactively benchmark within the region, seeking to raise the bar across Latin America as a whole. This is where Brazil can play an important role, setting the tone and providing examples of best practices.
EF: What are IQVIA's top priorities for 2024 in LATAM and Brazil? How does IQVIA tailor its services to meet the specific needs of different markets?
SC: Our strategy in Latin America and Brazil is very much aligned with our global corporate priorities. We strongly believe in powering healthcare through connected intelligence. This involves connecting not only information but the different stakeholders within the healthcare ecosystem. We have been developing offerings that are consistent and appealing to various stakeholders, emphasizing the importance of connectivity. A decade ago, our focus was primarily on measuring the market within the pharmacy retail sector. Over time we have evolved our offerings to address the changing needs of our clients. We are now directing more resources towards providing information and services in high specialty and non-retail channels across various Latin American countries including Brazil, Mexico, Argentina, Colombia, Chile, Central America, Ecuador, and Peru. We’ve also developed solutions catering to specific niches, including Consumer Health and Rare Diseases.
Today we are connected to a wide set of stakeholders in healthcare. Over the past 5 years, we have invested resources in connecting payers, providers, and pharmaceutical companies, through the use of real-world data (RWD). In Brazil, for example, we’ve developed over 20 partnerships to build an anonymized, data-privacy-compliant RWD datalake that enables a host of analytics to support medical, market access and commercial decision-making. These efforts promote the dialogue amongst stakeholders and support the adoption of new technologies and the improvement of efficiency in healthcare expenditure.
EF: What emerging trends do you observe in portfolio management in Latin America? What key questions should CEOs be asking themselves in this context?
SC: We believe there will be a significant portfolio shift during the next 5-10 years in Latin America, driven by the end of the patent life of several drugs as well as by the more complex nature of global pharmaceutical R&D pipelines. We are observing many global multinational corporations transitioning their pipelines to high-specialty, niche population solutions. Ten years ago, these companies transitioned from retail, generalist-driven portfolios, to specialty. Now we are seeing a second shift, from specialty to high-specialty niche/rare portfolios, addressing very specific unmet needs. This will require the development of new capabilities around disease awareness, diagnosis, market access and patient support.
Another key focus is on launch excellence. We have seen a diminishing number of launches in Latin America and, based on analyses in Brazil, less than 40% of these are considered excellent or good. Launch excellence is not a new topic in the industry, but it is still a very relevant one. The launch environment is becoming more complex – longer patient journeys, more channels of communication (omnichannel), more budget-constrained payers, more complex delivery mechanisms (e.g., cell & gene therapies) and greater evidence requirements are some drivers. Effective launch planning and execution remain critical. Roughly 40-50% of the consulting work we perform in Latin America is for launch planning and execution, clearly demonstrating the importance that executives are giving to the topic.
Another critical element in portfolio management is the so-called patent cliff. We estimate that $11 billion in drug sales in Latin America will face the end of exclusivity over the next five years, with roughly two-thirds in biologics. Payers will certainly benefit from the entry of generics and biosimilars, hopefully driving more access to patients as a result of lower price points. Originators and generic/biosimilar players will seek to maximize their presence in the market, and portfolio & launch planning will play a determining factor in how effectively they do so.
EF: Why is $1 invested in Brazil worth more than anywhere else?
SC: Investing in healthcare is important in any country. It’s like investing in education. Every country should invest in building an educated, healthy society to improve the overall quality of life of its population.
From a foreign investment perspective, Brazil is typically seen as a high-potential country. There is an issue of scale, where the size of the market typically covers the fixed costs of the business. Apart from that, Brazil has been the key engine of growth in Latin America for many years and will likely continue to play this role moving forward. We project that Brazil’s pharmaceutical market will grow at an annual compound rate of 9.1% during 2023-28. Brazil’s absolute growth shall represent roughly 50% of the region’s total growth. Key drivers of growth include ageing demographics, unhealthy lifestyle habits, greater government investment in the healthcare sector and continued growth of the private healthcare sector.
New technology adoption also plays a critical role in growth and in foreign investment decisions. Even in Brazil, the adoption of new technologies by public and private payers is still a challenge and typically takes many years. IQVIA and FIFARMA have recently published the 2023 W.A.I.T. Indicator Report for 2023, covering 8 countries and 2 therapy areas (oncology and rare diseases). The report demonstrates that the region faces important drug access gaps. In Brazil, for example, less than 30% of drugs launched globally between 2014-21 have some degree of access to the public system. Our hope is that this report raises awareness of this challenge and fosters dialogue amongst stakeholders to develop solutions to alleviate limited access.
EF: How is innovation being fostered in Brazil, and how are local capacities and preparedness in data utilization and internal innovation being leveraged to advance technology further?
SC: This topic has gained increased interest since the election of the new government in Brazil. Two major programs have been put in place: Industrial and Economic Healthcare Complex Strategy and New Industry Brazil. Both programs seek to drive investments for local production of drugs and medical devices/equipment in the country, as well as foster a better environment for local R&D. The expectation is that over $10 billion will be invested into these programs from both public and private funds.
There is a resurgence of initiatives related to technology transfer and a renewed commitment to onshore the production of essential drugs. Hopefully, efforts will be directed at a smaller number of technologies vis-à-vis the 100+ partnerships signed during the 2010-18 period, most of which have not been concluded. Legal insecurity is also a key concern that must be addressed for these agreements to flourish.
The local pharmaceutical industry is evolving in terms of what it does from an innovation standpoint. Today, many of these companies are active and delivering incremental innovation. We are seeing the launch of new delivery mechanisms (e.g., extended, or rapid release) and new formulations from these players. Many of them are actively pursuing R&D inside and outside of Brazil, and envision a portfolio mix with a greater participation of products resulting from their own incremental or radical innovation.
There is a long road ahead to ensure Brazil has an ideal environment for local production and R&D, but important steps are being taken. The country needs to address the high cost of producing locally to effectively compete against global players in countries like India and China. From a clinical research perspective, we sometimes look at countries like South Korea and China – they were able to radically transform their biopharmaceutical industrial and R&D parks. Maybe there are lessons we can learn from them in order to expedite our own development and avoid pitfalls. This will require significant collaboration across several government ministries, as well as the different stakeholders within the private sector. There is a nascent desire to do that, and many players in the industry are interested in it as well.
EF: What achievements will you celebrate during your time at IQVIA?
SC: Back in 2003, when I joined what was at the time IMS, our portfolio had five key offerings in Latin America. Our engagement with the healthcare sector was also quite limited. Fast forward 21 years, and I’m working in a completely different company – IQVIA.
In the life science industry, we are involved in the entire drug life cycle, starting from pre-clinical and Phase I studies all the way through post-launch and drug LoE (loss of exclusivity) initiatives. Our offerings range from information, technology, analytics, clinical research and outsourcing of services.
We have increased our engagement with the wider healthcare sector – payers, providers, associations and regulators. We help connect the dots through our publications and our efforts in clinical research and real-world evidence generation. We hold conferences throughout the region where we bring together people from many spectrums of the healthcare sector, including pharma, retailers, wholesalers, hospitals, payers, associations and regulators. IQVIA has become more connected as a player within healthcare, and this is part of our connected intelligence approach.
Many people still associate IQVIA primarily with the commercial data we provide, but our role and our offerings have expanded beyond that. This shift reflects a broader goal of enhancing efficiency within the healthcare system overall. It is fascinating to witness the evolution of our company, and we remain committed to further evolving in this direction.
