Read the Conversation

EF: You were appointed to head the Brazil operations in April 2021, full swing into the pandemic. What was the mission you were given?

JC: I was appointed on April 5th. The Brazilian subsidiary is Merck’s biggest operation in Latin America. The objective that I received at that time was to reorganize the team and prepare the company for the upcoming launches in Oncology, Neurology & Immunology, and Cardio-metabolism, fostering innovation and addressing unmet needs for Brazilian patients and healthcare professionals. Some medicines were launched during the pandemic, and we have also new products in our pipeline.  

Additionally, we have been working together with the region to optimize Merck’s efforts and to take better advantage of the operations that we have in the Brazilian market.  
EF: We say that 2020 was a year of diagnosis and prevention and 2021 was a year of vaccines. What do you think 2022 will be the year of?  

JC: I hope 2022 will be the post-pandemic year. I believe that the healthcare systems in different countries are wondering about the new budgets and the new conditions to face the challenges with their own populations due to the pandemic. We have a backlog of other diseases, and the governments have the financial challenge to cover all these demands.  

Another different aspect is that private businesses are going through a digital transformation and adapting to new channels that allow them to be in touch with different stakeholders. From a multinational company standpoint, the challenge will be to optimize global strategies aligning those expectations with different cultural aspects from country to country and in the case of Brazil, from region to region. The key always will be the need of understanding the real stakeholder’s needs and approaching them most effectively.
EF: From your experience heading 2 countries, what lessons have you learned from the pandemic?

JC: For three months I was responsible for the Mexican and Brazilian operations simultaneously and the most important lesson for me was to put our people first. Merck has been always very pragmatic in this sense. The message was very clear: to put people first, to keep the business continuity, and to be focused on coming back stronger. It can look aspirational but at the same time pragmatic, guiding us in critical moments and for our daily work. We prioritized the safety of our teams, following all the protocols recommended by the health authorities, in some moments being stricter, without compromising the supply of our medicines for Brazilian patients. All the messages and the actions reflected those guidelines.  

Another lesson was about making decisions to maintain the business and to protect the areas where we could not stop working on, like the manufacturing sites and logistics. To do that, we had to double or sometimes triple-check the protective measures of the teams and therefore the business.  

The third point was to be transparent. We communicated more about the company than its products; how we were dealing with the people and how we were working dedicated to providing the medicines needed for the population, was part of how we differentiated ourselves.  

We learned to treat each other like family; the people around us and our colleagues, that was part of the lesson learned for all of us.  
EF: Brazil is the biggest market in Latin America, and we have seen that the company has had double-digit growth in the last year. What has been the contribution of Brazil to this growth and where is it coming from?

JC: Merck is involved in the production of vaccines on a worldwide level, and Brazil is no exception. We have some partnerships with other companies that are engaged in a tech transfer approach for the Covid vaccine in the country and, for us the level of growth was around 30% in that division. The pandemic taught people that health is the #1 priority on their agenda. Nowadays, people are much more concerned about controlling diabetes, cardiovascular, and other metabolic diseases, therapeutic areas where Merck is a leader.

Merck has a number one diabetes product and, last year, we sold 79,5 million boxes in the retail market (Source: IQVIA PMB Retail - 2021). Probably, the level of awareness of COVID and the fact that people with diabetes are more likely to have serious complications from the virus has impacted the diabetes market growth. It’s an impressive performance for our product. Around 3 boxes per second have been sold in Brazil. At the same time, we also had a good performance in our Cardiovascular Franchise with one of our products. In August 2021, Merck launched this specific product for patients with hypertension, which has a huge opportunity to gain market share.

Although Merck is the global leader in hypothyroidism treatment, in Brazil we have a huge opportunity to gain market share from local competitors and assume market leadership by 2024.

The healthcare system has been recovering in the first four months of 2022 and Merck is doing very well, we are going in the direction of taking back the leadership for the Fertility business in Brazil.  

In terms of launches, we have recently launched a drug for multiple sclerosis (MS). It is important to say that with this option patients can treat MS for up to 4 years, just taking 20-24 tablets for 13 months. That is a life-changing innovation. The product has important outcomes because it reduces and reconstitutes lymphocytes with long-term effects.  

The second drug is immunotherapy for oncology, and we have its launch in urinary cancer. We aim to address the unmet needs of doctors and patients with UC after chemotherapy, during a period of maintenance, and with this treatment, you can prolong the life of the patients for more than a year which is fantastic.

I think that with these two products, and the mix of products and therapeutic areas that I mentioned, one can clearly see the engagement of the team once we understand that we are delivering new solutions for the patients and the doctors.  
EF: With your experience in different countries, how would you define access?  

JC: When someone looks into Latin America, they see a huge market where everyone speaks Spanish, except for Brazil. Seeing it as one single block is misreading the region. Every region and country has different access programs and challenges.  

Access for me is the capacity of a country and the private sector to join efforts to provide innovation, coverage, and solutions for healthcare systems and the population.  

We have a different standard of access in all of Latin America. Argentina and Mexico, for example, have their own particularities considering their economic issues and current needs. Brazil is a continental country, served by one of the largest public health systems in the world. Millions of people depend exclusively on this system, which is extremely complex and fragmented, due to the different characteristics of the country. And it has been a journey to get to each one of those checkpoints to get the product to the patients.

My perspective is that in the last two years, most of the attention has been set on dealing with the pandemic and its financial management. The government had to prioritize investments to face the pandemic and try to minimize its impacts on the Brazilians’ health.
We now are starting to see the government, federal or provincial authorities, trying to catch up with patients. In some cases, it is possible to do this, but in other cases, unfortunately, it is not possible because we are talking about oncology or diseases that progress and change the line of treatment.  

But it's important to understand that in the upcoming years the allocation of resources for vaccination will be something interesting to pay attention to both at the global level and, of course in Latin America.

I think there have been interesting learnings when it comes to managing chronic diseases in a communicable disease scenario, and the realization of the importance of prevention. This will become increasingly relevant moving forward, how all portfolios balance budget allocations and financial resources.

I think we have a good composition here in Brazil and in Latin America in general. An important part of our sales revenue comes from metabolic care products, and we will be launching products in the area too. We have been growing in the speciality care business in the last few years. We have a strong internal market for private products, and at the same time, we keep looking for opportunities to expand access, providing innovation for Brazilian patients in the public arena.  
EF: What do you think is going to be the impact of ‘digital’ in what our industry is going to look like in the future in terms of human resources, processes, and launching products?  

JC: I think that is an incredible revolution, considering that a key opinion leader that in the past was sitting in an important hospital in São Paulo, today can be a “health influencer” on YouTube or Instagram. The mechanisms of how to engage with patients are completely different, and they are digital too.  

We are looking at the profiles of the professionals that we are bringing to the company since they need to understand the trends. Right now, we are in the middle of a journey. We have experts in the market, and we have experts in digital. We need to put them together, transfer the knowledge of the customer’s needs, and develop solutions together. It's part of the activities that we are running with our teams.  

We needed to contact the doctors with two different approaches, in balance, the digital and face-to-face initiatives, in different moments of a pandemic. The goal was to deeply understand the real needs of our stakeholders and balance that with the peculiarities of people living and working in a megalopolis like São Paulo or small cities in the countryside.  
EF: Do you have any special KPIs that you like to look into when you're looking into digital?  

JC: I like to look into CTR, LTV, CPC, and other metrics, but I am more interested in knowing that we are really impacting the market and people's lives, providing valuable digital content and services, instead of just generating buzz and showing big numbers.  
We have seen doctors and other healthcare professionals that are more enthusiastic about digital than others, but at some level, all of them have some kind of digital service or online interaction, with patients, colleagues, or someone from the industry… Part of our learning process is to have relevant resources both for a virtual and the face-to-face reach. It’s a different strategy in each world.

Digital also brings us the opportunity to raise the attention of undiagnostic patients and leverage quality information about important lifestyle changes to prevent diseases. A great example is Merck's recognition by GUINNESS WORLD RECORDS™ in 2021 for setting the record for most online pre-diabetes and diabetes tests performed as part of an awareness campaign in Latin America.  
EF: Fast forward 10 years from now, what would you like to remember from this period of your career?  

JC: I would like to see that we were able to face an unprecedented challenge together as a team, guided by the Merck values, putting people in the first place, protecting our business, and surging stronger after the pandemic.

May 2022