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EF: If 2020 was the year of prevention and diagnostics, 2021 the year of vaccines, and 2022 getting patients back to care, what will 2023 be about for Mexico?
MG: During the pandemic, worldwide and in Mexico, energy and resources were directed to Covid-19. Mexico was highly impacted, particularly in some health areas, such as neuroscience, as neurologists' capacity was used for Covid purposes. Other therapeutic areas were also affected; diagnostics were reduced, fewer patients were treated, and people stopped going to the hospitals resulting in a higher mortality rate. We are working our way back and have yet to reach pre-Covid levels. The perception of the healthcare sector is still changing; there are new opportunities, and we can concentrate on other diseases. Biogen is focused on Alzheimer's disease; we are big players in multiple sclerosis and leaders in spinal muscular atrophy, our main focus right now. We are looking at other therapeutic areas, such as major depressive disorders, which currently don't have many treatment options. Immunology is a new area under investigation; we are working on neuroscience-related immunologic diseases, such as lupus.
EF: When we spoke a year ago, you told us your mission was to help better Biogen's presence in Mexico, accelerate diagnostics, increase awareness of complex diseases, and educate on treatment options. How do you assess your progress so far?
MG: The balance is positive; we have put much effort into diagnostics and exceeded our investment expectations. Physicians are coming back to request more educational programs. During the pandemic, we offered virtual education; but in 2022, we returned to a hybrid environment, a combination of virtual and face-to-face education based on the content we provide. Many diseases are not diagnosed due to a lack of awareness and education. Physicians don't have exposure to many rare diseases; they don't know about new treatment options for conditions that were not previously treated. Biogen has increased its presence in the Mexican market, in medical forums, with patient associations and payers. However, we are still looking to further expand our presence so people know about Biogen and what we do. We want to position the company as a powerhouse for innovation, focused on neuroscience and soon also on immunology as our main therapeutic areas. We invest in R&D in Mexico and have a special area dedicated to clinical studies, with over 14 centers in four different therapeutic areas, investing over a million dollars in the country in 2022. What we are doing here is no different from what we do worldwide, we are among the first 25 most important international companies in terms of pipeline, and we are researching 66 molecules, and we started the research of 19 of them in 2022. Approximately 33% of our total sales revenue is invested in R&D, reflecting the company's mindset. We are transitioning in terms of our worldwide leadership. I believe the new administration will bring fresh air and new initiatives with positive results for the company.
EF: Considering what Biogen invests in R&D, is there anything specific in the pipeline that you think might have a high impact in Mexico?
MG: We have a debt with the Mexican population: full access for spinal muscular atrophy, which is still in progress. The pharmaceutical industry is committed to patients – in our case, the Mexican people- for them to receive the necessary treatment. We are doing our job to fulfill that commitment. We have a strong presence in MS. Since last year; we have been working on a molecule for Alzheimer's Disease. We have a second molecule, also for Alzheimer’s, as part of a collaboration with Eisai, that was recently approved by the FDA and will be a game changer as it is the first time we have proven that we can modify the course of the disease in an area where there are not many treatment options. A large portion of over 65-year-olds in Mexico are estimated to have Alzheimer's Disease, that is, between 5 and 6% of that population- and the available medication can control the symptoms, but it doesn't go to the root cause of the disease.
EF: Biogen is known for its pioneering work and as an innovation leader, but does Mexico have the potential to be an innovation hub or powerhouse at a Latin America level?
MG: Yes, I believe Mexico has that potential. Mexico is an important country for Biogen for clinical studies; we have the facilities and the tools to continue implementing clinical studies in Mexico in four therapeutic areas. We treat Mexican patients with innovation based on our clinical studies, strengthening our evidence when requesting regulatory approvals, and we will continue to invest in clinical trials. We are generating experience for the physicians and validating data.
EF: How do you see the fragmented nature of the Mexican healthcare system? What benefit could be gained by increased collaboration and partnerships between the different stakeholders of the system?
MG: Of all the Latin American healthcare systems, Mexico is possibly the most fragmented. Normally for a private employee, there are two options either they have private insurance or are affiliated with IMSS. Public employees are affiliated with ISSSTE unless they work for the national oil company, the army, or the navy, and then they are affiliated with different systems. Each health system has different rules, and medicines must undergo an approval process in each institution. To enter the public healthcare market, we first have to obtain a code from the National Health Council and then work with each institution, bringing different proposals that must be aligned in a single bid. Full access to a molecule in Mexico can take up to five years. More collaboration is needed; the funding of each system is completely different and is one of the biggest challenges we face. ISSSTE is fully funded by the public sector, whereas IMSS is partially funded by the employees, employers, and the public sector, and the funds cannot be mixed with the public sector system funds. The main objective is to make sure patients can have their treatments; at some point, they will have to work together.
EF: Biogen is developing technology for personalized and digitalized medicine in neuroscience, and adopting these latest technologies is rather slow in Mexico. How can the speed of adoption be increased?
MG: Technology already plays an important role in healthcare and will be more critical in the future. Biogen's digital health unit is working on different initiatives (collaborations and acquisitions), not focusing on the commercial side. We have a site called BiogenLinc, exclusive for physicians, where we provide education on diseases, treatment options, and conferences with different speakers. It works like a complete library for doctors to access information. We also have Neurodiem, covering all neuroscience-based diseases with unbiased information. We have an unbranded App called Cleo for the Multiple Sclerosis communities: physicians, patients, caregivers -anyone can access it- for example, for physical therapy exercises to have better treatment results. We also use music for physical therapy (music and movement), which is good for patients as it helps them complete their physical therapy exercises. We also have an education program for physicians on spinal muscular atrophy that teaches how to inject medication in patients correctly using a dummy and a 3D model.
EF: Biogen is 45 years old but just over four years in Mexico. Looking back at these four short years, what are you most proud of achieving?
MG: It is important to have a direct presence, to have a bigger impact on the distribution and commercialization of Biogen products, have direct contact with the physicians for whom we provide education and tools for diagnosis in the different therapeutic areas where we play a role. We support the patients and work directly with stakeholders within the system (physicians, payers, legislators) to ensure patients have full access. Every year more patients are treated for multiple sclerosis, an area where we are pioneers. In Mexico, we were the first to offer a unique portfolio for MS; today, more treatments are available, which is good as patients benefit from different options.
EF: If you had to create a startup in the Mexican healthcare sector, what would it be and why? Where do the opportunities lie, in your opinion?
MG: The sector needs more multidisciplinary treatment for patients, and not only for the public sector. Even in the private sector, when patients need multidisciplinary treatments, they must deal with multiple physicians, sometimes in the same hospital, but none of them are necessarily connected. Secondly, the industry needs a sustainable environment where all patients can be treated, focusing on the cause and the outcomes. We should measure if patients are successfully treated, with the right therapy and a multidisciplinary approach, instead of focusing solely on the treatment or the budget to pay for it. All stakeholders must work together to achieve the best outcome: patients treated at optimal costs and with good results.
EF: What three pillars should support a road map to the healthcare system's future?
MG: One pillar would have to be innovation; the system is constantly moving forward, patients are treated differently today than ten years ago, and new patient options are critical to moving forward. Many diseases still don't have treatment options, and innovation is fundamental. Secondly, everybody must have access to the treatments they need when they need them; we must work together as a healthcare system to achieve this. Thirdly, we must all be patient-focused; even if stakeholders have different interests, we should focus on improving patients' survival and quality of life.
EF: Is there a final message you would like to share?
MG: At Biogen, we want to be recognized for all our work. We must continue innovating and accelerating patient diagnosis and access for all patients. At the end of the day, as a company, we will be recognized for our work for the healthcare system, not just in therapeutic areas but in how we improve patients’ lives and how we can transform the healthcare system in Mexico.