Read the Conversation
EF: When you were recently appointed Country Managing Director for Mexico, what was the mission given?
AM: The original mission discussed last October, changed dramatically very soon after my arrival in Mexico because two and a half months later we had a pandemic on our hands. We switched priorities and changed the way we worked. Now there are new challenges to face and we must adjust as a company, being flexible and agile. In this sense, I have learned about flexibility from my previous experiences in Latin America (pricing in Colombia, access in Chile and renegotiations every single year in Argentina), in which we had to adjust and ensure the team is very agile. Boehringer Ingelheim is a research-based company launching products in areas where there are unmet medical needs. In this last decade, we have focused on speciality therapeutic areas and continued keeping our efforts on patients through innovative products, as our mission is Value Through Innovation. We must keep learning from the changes of the environment and adapt the company to tackle those changes turning them into opportunities. This is how emerging markets react.
EF: How are you balancing tactic and strategic decision-making to ensure business continuity while achieving satisfying results?
AM: In general terms, Latin America is very attractive to global firms because of the quick reactions to whatever the environment throws at us. All Latin-American countries are geared towards this way of problem-solving; and, in my opinion, there is a beautiful element present in how we all work in the region bringing value to the companies, in our case to Boehringer Ingelheim. The healthcare global companies have very strict rules of what they can and cannot do, but this additional element is a winning combination that creates a huge opportunity. BI is a privately owned health company which has great advantages that have been key to navigating the pandemic. At Boehringer Ingelheim we plan in generations; in this sense, our investments are all long term so we have more flexibility to operate. This is a family-owned, financially strong and with long-term vision company - and with high priorities putting always the patient in the centre. In my opinion, this is an important plus for BI globally, one of the highlights for me was when very early in the year the company decided to guarantee the over 50 thousand employee’s jobs at a global level until June with no salary cuts and now has extended that deadline to the end of the year. The difference in being a privately held company means we have the opportunity to define the priorities we consider important for the company´s development and growth. Our top priorities are to guarantee health for all our employees and their families, guarantee supply in every manufacturing site BI has worldwide and, finally, once the two first were accomplished, figure out how to best help and collaborate in times of a pandemic.
EF: How do you ensure continuity of supply with all the issues and constraints in delivery?
AM: Actually it has been a challenge, very early we realized there were transportation issues; I understand that 40% of containers globally were stuck in China, in February and March, and not only to transport raw materials but to finished products as well. A key management element was the early planning we had in place, realizing what was happening in the East would be moving to the West and the company globally starting working on extra transportation capacity, investing in the different manufacturing sites and on fulfilling our commitments. We have had hiccups along the way but they have been minor in both our businesses (animal health and human pharma). The company has done a tremendous job keeping personnel safe and providing continuity of product, mainly due to BI planning for alternative scenarios.
EF: What are Mexico’s current strategic footprint and therapeutic areas, considering the tactic and strategic decision making involved in continuing operations?
AM: Mexico, Central America and the Caribbean continue to grow very nicely. In Mexico, there was a period in the pandemics early R&D period where sales in non-communicable diseases products (diabetes, respiratory and chronic diseases) had a spike -in February and March- and when the quarantine started, sales fell in the private market. All in all, the demand has not diminished so we are following the expected growth path even if we might be a bit below our target for this year but not to the extent we originally thought we would be. Now BI in Mexico sellouts on demand has 3.4 market share which is the second-highest market share we have had and it is growing. Good decisions have been made, there are a lot of programs focused on patients ensuring that the products reach the patients when they need them, which is critical and that challenge is being currently tackled. The company has defined Mexico as a strategic manufacturing site, especially for diabetes products which supply the local as well as the North American and European markets. This has led to investments in the recent past to make sure Mexico continues to be a strategic manufacturing site globally. For our Animal Health business, we have a manufacturing facility in Guadalajara which exports to Central and South America, as well as to the Middle East, SE Asia and Europe, allowing the BI portfolio to play a strategic role, again due to good strategic decisions made. Our 3.4 market share has made us climb to spot number 8 in private pharma in Mexico and in overall results; BI Mexico continues to be in the top ten for local production. It is the result of a combination of good company decisions and a focus on patient programs in key therapeutic areas, diabetes, cardiovascular and respiratory diseases, that are growing and have positioned us in the market.
EF: With the Covid-19 pandemic, the focus is on communicable diseases. How can you raise awareness on non-communicable diseases such as diabetes, which is still a big deal in Mexico?
AM: In my opinion, both go hand in hand. The pandemic has shown us the relevance and all the areas of opportunity of the healthcare industry globally. It has shown the importance of having efficient healthcare systems and the relevance of a global health strategy to contain and manage human beings when these situations occur. Very early on, the data on Covid-19 showed that people with non-communicable diseases acquiring a communicable disease were the ones with worse outcomes and we shared this information with every single one of our employees globally. We are not only responsible for our own health or that of your family and colleagues in this pandemic because we manufacture what our patients need to manage their diabetes or hypertension, etc., and they need these products to be controlled to have a better chance if they happen to contract a communicable disease. Therefore, there is a symbiotic effect of non-communicable and communicable disease treatments, which cannot be ignored.
EF: But the system right now is geared for a non-communicable scenario, so how can we plan for healthcare treatments or budgets that cover both communicable and non-communicable diseases?
AM: All the data and statistics on diabetes globally and the effect it has on people is undeniable, for example, a diabetic person has 2 to 4 times higher risk of dying from cardiovascular events. At the moment the attention is focused on communicable diseases and rightly so, but we all know the other diseases will not go away. We are more prone to see communicable diseases in the short term having less of an impact on health over the next months and I think it is critical to control them but, the core path of health globally continues to be on non-communicable diseases. When there are hypes, like now, they deserve attention and more of the budget but at the end of the day, the backbone of health issues are in non-communicable diseases. According to statistics just in Mexico, one in eleven people has diabetes and this has a huge impact on the budget.
EF: Exposed as you have been to different healthcare systems in different continents, what is your personal definition of access?
AM: I think there is a fundamental conflict in health systems throughout the world among four different players which is becoming more apparent, and I am sure I am not the only person that has observed it. Research-based companies continue researching for innovative products making the different therapeutic areas more specialized and the patient groups of each area smaller, addressing a very specific kind of patient. Thereafter, funds for future research need to come from smaller numbers of patients; so new products for very specialized therapies and diseases may cost more than previously. On the other hand, governments have, on a global basis, more restrictive budgets but want broader access to reach a greater number of people with their increasingly challenged budgets, globally. The third player in that equation is the physician who knows there are great new therapies available but is also aware of the budget issues of public health systems and in the middle of these three stands the patient. This issue needs to be addressed to better help and support societies with improved health systems and it is my belief that the solution can only be achieved through the collaboration of all the players: government, pharma industry, doctors and society. It is a complex situation that has been evolving over the years, heightened with the pandemic, causing huge discussions globally. Indonesia, for example, has a population of 230 million people living in over 16 thousand islands and needs a strong healthcare system, but it is very difficult to control because the country is huge and difficult to manage; on top of that, there is a lack of infrastructure, which doesn’t allow the fulfilment of the needs of 230 million people. Singapore, on the other hand, has 5 million people with excellent infrastructure but the people may not have the same needs as those living in Indonesia. The countries in Central and South America, like in most of SE Asia, truly need strong health systems but they lack in infrastructure; and those that have the infrastructure and allow a strong healthcare system do not actually need it as much. To conclude, my definition of access is ensuring that every patient who needs our product, gets it at the right time.
EF: Is digital transformation changing the pharmaceutical industry and does it affect relationships between physicians, companies and patients, particularly in how companies can approach patients?
AM: As a computer system engineer, I am convinced that technology can shape cultures more often than the other way around. Technology can shape the way we behave, process and understand life, but I do not think we necessarily use technology in its best fashion. The pharmaceutical industry has historically done very well, allowing us for years to be comfortable not using technology as we should be using it. I think we are now not far from the moment when technology could reshape our business dramatically; and we should better start soon because if we don’t, someone else will. We have seen this in the retail industry, in the hospitality business, in music and in the entertainment business. We have been lucky to be in a segment where it takes a long time from research to have products for patients with established traditional processes as a background for our industry, but that is definitely changing.
EF: Coming from Asia, do you think the Mexican market is ready for a digital transformation?
AM: I think it is, depending of course on the level of transformation we want to achieve. In Singapore for example, 10 years ago we had optic fibre reaching my home router which worked smoothly and excellently and then I came to Argentina where there were fundamental infrastructure differences. To establish a business based on technology, clearly, investments must be made in infrastructure, something that is generally lacking in South America, except perhaps in the case of Colombia or Chile, as our countries do not have what is needed to establish strong digital businesses. The pandemic has heightened the need for digitalization and the companies that did not understand early on its importance struggled much more during the pandemic. At BI, we started investing in implementing virtual tools that allowed interaction a couple of years ago, so we have emphasized a lot on the use of technology, especially in South America and in Mexico. In Argentina, we developed an App which allowed veterinarians to offer consultations for pets virtually. When we launched it in the US in January, there were very few people connecting via this app at first; however, with the pandemic, numbers of people connected grew enormously by April because of social distancing regulations and it has become a key element for our US business, allowing people to consult their veterinarian even through the pandemic. There has been a change of mentality and I am sure this trend will continue.
EF: What would you like your 2020 tenure to be remembered for?
AM: I would like 2020 to be remembered as the year we transformed the company despite the huge challenges we have faced.