Read the Conversation
EF: What are the milestones in your legacy at Boehringer Ingelheim ( BI) Brazil that you are most proud of?
MH: Over the last couple of years, we managed to increase patient access. This includes diabetic patients, and patients with rare diseases, especially those suffering from respiratory diseases such as pulmonary fibrosis. In addition to promoting our drugs with physicians, we achieved more access by working on several "beyond the pill" initiatives and services. We took it upon ourselves to understand the patient journey, identify where the difficulties lie, especially for patients in the public sector, and determine how we can ease the trajectory.
For example, in the past, COPD patients had a lapse of around two years from the first symptoms to diagnosis and treatment initiation in the public system. We reduced this timeframe from two years to five months using different approaches that we developed under an umbrella program called "Abraçar." A big access initiative is our spirometry program in the public system, where we perform spirometries free of charge for patients throughout Brazil and help diagnose respiratory diseases. We were responsible for 25% of all spirometries performed in the public sector in Brazil.
The second major milestone was in rare respiratory diseases, particularly fibrosis patients, where diagnosis and access are difficult. The timeframe from early symptoms to diagnosis and treatment was five years. We reduced this to two years through IRMs and patient support programs. We helped patients get treated faster and improved their quality of life and outcomes.
EF: What is your perspective on the evolution of the pharma sector in Brazil and how is Boehringer positioning itself to ensure competitiveness?
MH: Over the last few years, we've had different dynamics for different market subsegments. The out-of-pocket retail market has continued to be dynamic and maintained steady growth, although it has been influenced by COVID, causing some segments to grow faster than others. We have been very successful in the cardio-renal metabolic segments, which started with diabetes and have expanded to our cardiovascular and renal benefits. Over the past few years, we have treated significantly more patients, with a net increase of roughly half a million.
The public non-retail business is the area where BI is most active. The sector has been suffering because of budget restrictions. The money is limited, but since this is where most initiatives to help patients happen, we stayed in this market.
EF: How can Brazil attract more investment and build up a sustainable life sciences market?
MH: The market continues to be attractive due to its size and ageing population. However, in our industry, it is important to have a market open to innovation. This issue is high on our agenda. We have experienced setbacks in recent years due to patent law. Patent protection for various products has been challenged and as a result of this ruling, approximately 4000 patents have had their lifespans shortened, which has been discouraging for companies looking to invest.
Our responsibility as an industry is to show the importance and benefit of innovation for the Brazilian population and see how we can make it more attractive for the healthcare system.
Another item on our agenda is working on data protection laws where we offer rewards or incentives for incremental innovation. This strategy has been successfully implemented in mature markets such as Mexico and Chile. However, in Brazil, this approach is currently limited to animal health and not yet applicable to the pharmaceutical industry for human use. It will take time, but this is one of the industry's key initiatives to retain this market's attractiveness.
Understanding the goals of the new government is also crucial. They are particularly interested in localizing manufacturing technology transfers and exploring ways to create a mutually beneficial solution for all parties involved. This is a legitimate concern for the authorities as they strive for a level of self-sufficiency in Brazil, which has been further reinforced by the COVID pandemic, where access to some drugs and products has been challenging. While it is reasonable for the government to secure some aspects of their healthcare supplies, it is essential that any such measures make sense for our industry and ultimately benefit patients.
EF: What is BI's approach to data protection?
MH: The data protection topic is two-fold. We are an investment-intensive industry. Last year, we invested $5 billion euros in research and development. This only makes sense if we have a certain perspective on the return on investment. On the other hand, it is indeed a digital world. The more you share and access information, the more innovation opportunities you create.
At BI, we are engaged in various initiatives that we consider proprietary. As we work on these, we also come across additional innovation opportunities that we may not have the time or resources to pursue. Hence, we are making this information available on a platform called "Platform for Open Innovation." This platform is accessible to anyone, particularly researchers working on these topics, who can use our work as a foundation for further innovation. Information is not black or white, and sharing knowledge will benefit the scientific community.
EF: What innovation or research opportunities can be developed in Brazil's pharmaceutical sector?
MH: One of our efforts includes creating a more favourable environment for clinical studies. When I first arrived in Brazil, it was not participating in any global clinical development program. Today, as I transition to my new position, we are participating in twelve such programs, reflecting the shift in perception of Brazil's ability to contribute to these. There has been a marked improvement in regulatory approvals for clinical trials, enabling Brazil to have a more significant presence in the global clinical trials landscape. We have seen that when collaborating with local regulatory authorities, Brazil can be remarkably efficient.
We are also working on mental health development programs, where Brazil has been the top recruiter within BI. Recently, we received approval for heart failure indications in our therapeutic area, and Brazil has once again been the top recruiter for this trial. Brazil possesses the capabilities and expertise to conduct these studies. All we require is a regulatory environment that cooperates with the industry.
EF: What does Boehringer’s portfolio entail for the future?
MH: For the future, we are working on strengthening our presence in the cardio-renal metabolic segments. We have a program on obesity and renal protection drugs. We are also expanding our rare respiratory disease franchise focused on pulmonary fibrosis and are working on a compound that could be significantly superior to the ones on the market today.
We are entering the mental health segment, putting our focus more specifically on schizophrenia and deep depression. We are running a number of programs in these fields, and the medical need is high. There's been a lack of innovation in this field for many years, and we are hoping to be able to address this.
The other segment which we have been investing in is oncology. We're going after some rare oncology indications, and so we are hopeful that our programs will contribute to research, especially in the field of liposarcoma and lung cancer.
EF: As a top employer in Latin America, what are the primary insights you have gained as a manager to sustain a positive work culture, and how can these lessons be applied to other global markets?
MH: Understanding the greater purpose behind an organization's actions and how they impact society has become increasingly important. At Boehringer, we emphasize clarifying our purpose to engage our employees. Demonstrating our impact also helps sell the value of collaboration and the importance of sharing rather than protecting. In this sense, collaboration with customers is also easier when we listen to them to build solutions together. In Brazil, we have achieved a high level of engagement by helping people understand how they can make a difference.
Employees must feel well to be more engaged and motivated to contribute to the larger goals. When the daily experience is positive, employees are more willing to pursue their goals. We focus on mental health and creating an inclusive working environment. We are particularly proud of having grown our racial representation from 6% to 16% in the last five years, reflecting the diversity of a country like Brazil.
EF: What are the key items you told your successor to focus on, and what are the expectations for Boehringer Ingelheim in the next couple of years?
MH: My successor will start in June 2023. One of the key missions is to prepare for the future. We have a strong pipeline in rare diseases, immunology, oncology, and obesity, and many of the things that seemed distant in the past are now within reach. We are optimistic that the first product launches will occur in the next two to three years, though some of these are in new fields for us. To successfully enter these new segments and comply with regulations, we need to do a lot of groundwork to understand our customers and regulatory bodies, identify gaps, and collaborate with customers to develop solutions. I believe that this will be our primary focus in the coming year.
EF: In terms of the emerging markets portfolio, could you elaborate on the significance of the Brazilian market for Boehringer Ingelheim's strategic objectives?
MH: After China, Brazil is our second priority market due to various factors such as the market's size, favourable environment for conducting clinical trials, and high acceptance of innovation. Thus, Brazil holds a significant position as our second priority market among other emerging markets.
EF: What was your mission appointed when assuming the new position in emerging markets and what excites you about the future prospects of Böhringer Ingelheim?
This is an exciting time for me to take on this new position as we are on the brink of a new era of innovation for Böhringer Ingelheim. Our company has an impressive pipeline of upcoming launches in various exciting fields, including mental health, further development of rare respiratory diseases, and obesity, scheduled to occur in emerging markets between 2026 and 2029. Therefore, it is the perfect moment to commence preparations for these launches and a great time to join the emerging market team.