Read the Conversation
Conversation highlights:
- Brazil represents one of Biogen's top five global markets across rare diseases, immunology, and Alzheimer's, positioning the country as central to the company's future investment strategy.
- The healthcare industry is experiencing its most consequential decade in a generation, with neuroscience and immunology finally catching up with the rest of medicine after 40 years of limited treatment options.
- Success in Brazil's complex healthcare landscape requires delivering comprehensive patient treatment experiences that go far beyond innovative medicines to include full journey support.
- Early diagnosis remains a critical challenge, with only 2,000 of Brazil's estimated 6,000 SMA patients currently under treatment due to misdiagnosis and limited access to specialized care.
- Brazil's continental size and healthcare infrastructure concentration in the southeast create opportunities to develop peripheral regions while reducing patient transport costs to major centers.
- Artificial intelligence has become a fundamental business tool rather than a future innovation, particularly transforming patient identification capabilities in high-complexity therapeutic areas.
EF: Can you elaborate on Biogen's current footprint in Brazil and your key priorities?
RF: Healthcare is in the middle of its most consequential decade in a generation. Within healthcare, neuroscience and immunology are finally catching up with the rest of medicine. For the last 40 years, neurological and many immuno-mediated diseases were fields where you could diagnose but could not truly modify the disease. That era is ending. At Biogen, we are at the center of that shift in Alzheimer's, MS, SMA, rare and neuropsychiatric conditions, and increasingly in immunology, where lupus and chronic kidney disease are about to become the next major frontier of patient impact. The Biogen of 2026 is leaner, more commercial, and more scientifically focused than it has been in a decade. We have reshaped the portfolio, launched new medicines in Alzheimer's, Friedreich ataxia, and postpartum depression, and tightened our operating model so that every investment reinforces a launch in market or a program with a credible path to one. Healthcare does not reward companies that try to be everything; it rewards those that are essential in something. We have chosen to be essential in the brain, and with this intent and discipline, we are extending those standards into immunology. In Alzheimer's, what was previously thought impossible can now be changed. Our therapy is the first to slow the underlying progression in early Alzheimer's, not just treat symptoms. Launches in this category are not normal pharma launches; they require a healthcare system built around them. Brazil is one of the top countries for Biogen and the center of our investment relevance for the future. For all these diseases, rare diseases, and immunology, Brazil is one of the top five countries. In lupus, we are in the top three. In Alzheimer's, we are the top four among big markets. Brazil is living in a special moment, and we are preparing the company to absorb all these opportunities while becoming much more efficient and completely focused on high-level execution.
EF: What opportunities do you see for growth in Brazil, and what conversations need to happen that aren't happening yet?
RF: Brazil is one of the top 10 markets in the world. We have an appetite for innovation and possibilities to bring innovative medicines to this country. We have a healthcare system that is universal in concept, and naturally, we have some challenges in terms of access, like any other country. Brazil has an aging population that is significant and impacts the necessity for high-quality healthcare based on these products. We have an environment with the political and public sectors that is fully open to receiving new opportunities and new discussions in terms of access and incorporation of new technologies. This is not an easy job, but for the first time, there is an opportunity with a very open approach from public stakeholders who are asking for something different in terms of access and collaborative agreements to ensure we are balancing the cost of healthcare in much more sustainable agreements for companies and the public system. Brazil is a mix of opportunities, but to navigate here, it's necessary to understand very deeply our market dynamics and the volatility that all Latin American countries have. That demands full engagement with the most important stakeholders all the time to capture opportunities and create new possibilities. The integration of regulatory, public policy, incorporation, technology, and academia needs to evolve and be much more deeply discussed to ensure better access for patients.
EF: What do you think is most needed when it comes to Brazil's healthcare transformation?
RF: Brazil is living in a substantial transformation in terms of incorporating new technologies and access. What will make the difference in the future for patients and the healthcare system is being focused on the patient treatment experience. This goes beyond the medicine. Delivering an innovative medicine is something any high-level science-driven company can deliver, an innovative medicine, good molecules tested with a deep scientific background. This is part of the core of our business. But the future will be navigating in an environment where support for the patient and the patient experience will make the difference. There is no public or private system available to be fully supportive in addressing all these new protocols and dynamics of these new complex molecules. We need to deliver more than the medicine. We need to be part of the patient journey. We need to collaborate on this process. Not just delivering an innovative medicine, but delivering a perfect patient treatment experience. This means providing all support during the journey, during the program. This attitude will accelerate the healthcare ecosystem, integrate private and public systems much more, and escalate the quality of healthcare systems in high-complexity markets in a different proportion.
EF: What learnings or expectations does headquarters have from Brazil, and what can the world learn from your experience?
RF: Brazil is a big center of opportunities and experimental initiatives. Here we have diversity, complexities, and different dynamics within our country. Brazil can provide experience in terms of volatility and diversification that is very rich for other countries. Global Biogen understands very well the potential we have in our country, not only in terms of the number of patients and epidemiological aspects of diseases, but in terms of understanding new market dynamics that can be extrapolated and scaled for other countries and regions. Brazil will probably become one of the most important R&D areas of the world based on new regulations, the low cost of research compared with other countries, the diversity of our population, and the appetite of the scientific community to bring more innovative medicines to this country and learn this process to make Brazil much more competitive in innovation. The connections among the public sector, private sector, healthcare companies, diagnostic companies, and the system working together can create a much more sophisticated example of healthcare sustainability for other countries and regions.
EF: How do you assess the current level of diagnostic readiness in Brazil, and where are the opportunities?
RF: This is a very critical topic and challenge in our country. If you consider that we have in Brazil approximately 6,000 patients suffering from SMA and only 2,000 patients are under treatment, we have 4,000 patients who are probably misdiagnosed or have not yet reached a final diagnosis or conclusion of their problems. This is a reality we have in several different diseases around our country. Diagnosis challenges come from access to medicine, which in some parts of the country is very poor. Part of this is medical education, the capability to identify completely new diseases and neglected diseases that until this moment had no possible treatment. Also, disease awareness in a country where we have completely different social and cultural levels is a challenge for all healthcare systems. We need to ensure that the right information reaches all populations across states and the country. The other side is that technology and access for diagnosis are very concentrated in big centers. This is an aspect where we, as an industry, as companies fully connected with patients through patient centricity, need to facilitate and collaborate with private and public sectors to accelerate and engage patients through disease awareness to identify alternatives for what they are suffering. This combines economic aspects, cultural aspects, and initiatives to accelerate and facilitate the diagnosis of these patients.
EF: How do you see the acceptance of innovation in terms of value for Brazilians, and how can we raise awareness about its importance?
RF: First of all, everybody needs to understand that healthcare is an investment and not a cost. This is a very trigger point. Innovation naturally brings together some costs and investments that, in the first instance, can impact the system. But what would happen to our country or humanity without the possibility of the pharmaceutical industry addressing so many solutions for so many diseases? We had a great example with COVID recently, humanity was practically saved through investments and innovation based on the pharma industry. The relevance of innovation and the appetite to invest and see healthcare and new technologies as a philosophy in terms of quality of life, instead of healthcare costs, is crucial. All the time we discuss healthcare, it's very common for people to say the cost of this medication is high. We need to understand and discuss much more about the value of the product. Innovation has a very high cost in the beginning; this is natural and part of any business. But partnerships and collaborations can address this kind of primary impact on the system. We have examples in our country and other countries where, when all stakeholders sit together to discuss putting patients at the center, naturally all parties will meet in a right and appropriate way to facilitate access. Biogen has a great example in SMA in Brazil, when our treatment was incorporated, we had robust discussions in terms of risk sharing and volume of patients to speed up diagnosis. There is a conjunction of aspects in favor of bringing innovation to real life for patients. This mindset can change significantly when Brazil starts experimenting with much higher investments in R&D. R&D can change the perspective and understanding of the real value of innovation. Biogen, for example, invested significant amounts in Brazil over the last three years in clinical trials, phase two and phase three, and perspectives for the future include keeping much more investment. This generated support for patients who participated in these trials but also created much more knowledge and appetite for local development of new reference centers that can become essential for the country's future.
EF: How do you see leadership evolving with new technologies like AI and future employees?
RF: First, it is important to set a clear vision about the future. The vision and perspective, this is a mantra I have in my mind all the time. The past is impossible to change; the unique thing we have about the past is to learn. But the future is today, is now. We can do everything, make incredible changes. Positivism, vision, and positivism are aspects that are really important in my view and style that I hope to reflect in my team and make a difference. The other aspect is that I try to have people working with me who I'm sure are better than I am. When I attract or recruit professionals to work with us, I need to be sure this professional is better than me or has the potential to be much better than me. Nobody works alone; I am fully dependent on my team, and I learn every day with my team, much more with my team than with my boss. In such a volatile, complex scenario, having a positive, clear vision about the future and a very well-structured and capable team working together is amazing. Another aspect is to work with people who are fully focused on thinking out of the box and avoiding living inside paradigms we have in our industry that limit our growth and view of the future. We are using AI not only in research and development, accelerating identification of new molecules or clinical trial efficiencies and methodologies, but AI is part of our routine in operational aspects and possibilities to think differently. For me, using AI is like speaking Portuguese or English; it's necessary. Each one will navigate into AI in a very specific, tailored way. For example, patient identification, something that's a challenge for all companies that work in high complexity, AI is transforming this aspect because we can navigate much more into specialties and physician specialties that were previously impossible to navigate. For the biotechnology industry, AI is basic, not differential.
EF: Do you have any final message for global healthcare leaders?
RF: We are living in a very special moment, a disruptive moment in Brazil, in healthcare in Brazil. I usually say that I have the pleasure of working in the right segment, biotechnology, in the right country, Brazil, and in the right company, Biogen. I am very happy to be living this momentum in my life. For me, the future is based effectively on patient centricity. To live the density of patient centricity is to think about not only innovative medicines but how we'll be creating an amazing treatment experience for the patient journey. This is the future. I am sure we have a lot of innovative medicines coming to address neglected diseases and much more to improve the quality of life of patients. But to be fully engaged with this patient experience and truly live this patient experience will make the difference in the future.
