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EF: While many people are playing it safe during the pandemic, you assumed your current role just as COVID-19 hit its inflection point in March of this year. What motivated you to make this bold move at this particular juncture?

PC: To be honest, it was more of a talent-management issue. Refreshing the corporate management across each group is a regular process. In fact, the decision was made pre-COVID-19 and for a period of three months, I was managing two regions at once. There was a lot of fun but not a lot of sleep.

EF: How do you differentiate strategies to improve access in a region that is so big and diverse and has so many moving pieces?

PC: The language could be the same or similar, and the culture can be similar, but the markets are very different. There is no one possible strategy for all Latin America. Compare Argentina and Mexico. Speciality products in Argentina, for instance, are endorsed by the government, whereas Mexico has very low access. Similarly in Argentina, when a couple is not fertile, they can go to the healthcare system for help to have a baby and that service is fully reimbursable, while in Mexico, a couple must pay out of pocket which is a significant strain on the family economics depending on their social background. We must adapt to each and every market, capturing the peculiarities of each. There are of course global strategies-but local adaptation must be cultivated. 

Access to medication for the majority of the population in Latin America is clearly a constraint. We reinforce MERCK as a global speciality innovator in Latin America while continuing to serve all patients with our traditional portfolio. Our dual mission will be a strategic point moving forwards in Latin America with the traditional non-communicable disease portfolio and the pace of speciality innovators.

EF: Could you give us examples of how, as a regional manager, you have given tactical or strategic advice to your individual country managers? 

PC: Reaching our patients in emerging markets is not always a straightforward exercise, for the simple reason that often we have no data or incomplete data. Specifically, in Latin America, there are traditional data providers for oncology-number of patients, patients affected by specific diseases, etc.-but there is no standardized incontrovertible information. Such gaps change the messages we deliver. For example, in the case of a specific heart medication, local doctors might have no interest because the condition is maybe not a potential issue in Latin America, so we need to emphasize a different message, i.e. that the drug performs better for a given patient population due to its safety in a local standard of care. In other countries, we may need to upgrade our message on heart-rate efficacy so we create an additional value proposition for the same case. Or in oncology, for example, we observe patients are receiving an alternative treatment, maybe a more specialized and expensive medication and looking at the data, it is clear that the dose of the alternative medication is substandard and on a clinical trial on a comparable basis, this dose was not proven to be as efficacious as the other compound. The patient is receiving sub-standard care for whatever reason and these issues have many factors: the government, the doctors, the payers, the education, etc. Pharma companies must elevate the standard of care and if we have a drug that fits the purpose, that is what must be used on the patients. We have a duty as market leaders and to this end, we have what we call Merck Academies as part of a new design to guide at a high level with data-driven decision-making, making sense of the data and providing a general framework that elevates the standard of care. 

EF: What advice would you offer to new managers in the region-what are the “Do’s and Don’ts” you can offer to your people?

PC: Particularly for the speciality business, I have tried to implement a more data-driven approach, trying to map, in a short and comprehensive way, the key drivers. But this is all part of the continued learning process and the development plan. Secondly, despite some of the preconceived ideas, we are a very young and diverse group, with a non-hierarchical style of management. In Latin America, I see a more traditional and hierarchical management style that seems to be part of the Latin-American culture. I prefer a fresher, more millennial kind of leadership because we are a very young region compared to Europe. I want us to be quick and dynamic in our decisions, data-driven and efficient, agile, and to the point. This will not happen overnight, but we have already reacted in this way during the lockdown. There was a general trend for countries, customers, and even wholesalers to increase drug levels--a sensible conclusion-so as a result, there was a spike in sales which meant our supply chain had to be very agile as we needed supply to respond and manage the peaks at the wholesaler level. We strained our supply, were flexible in our commercial terms and accepted the risks, all of which would have been impossible in a traditional structure and I think that this new style of leadership contributed. I definitely think that the agility we have gained will be a key success factor moving forward. 

EF: Governments are preparing their fiscal budgets after a very complex year health-wise; what advice would you give as they look forward to 2021?

PC: We are all wondering if there will be another lockdown next year, something key to the 2021 budget. If the second wave is big, we are all in agreement that it will have a significant impact on the economies of all countries. Latin American currencies are seriously devalued and this potentially creates pressure on imports but allows a huge opportunity for exports, with countries like Mexico and Brazil which are export-orientated, will be strong and focused. From a healthcare point of view, it is clear that health needs to be a priority in the budgets. Patients are not getting their treatments because they are not going to the doctor or hospitals or clinics, or even to have simple diagnoses, and this could be a matter of concern because we all know the cost of the lack of prevention- impacting the long term with higher costs for all the preventable diseases. Most governments in Latin America appreciate the effort and the complexity of bringing innovative medicines to the market.

EF: What would you like your 2020 tenure to be remembered for, considering that there are still 3 months left? 

PC: I would like my tenure to be remembered for navigating the Covid crisis, bringing the company from conventional face-to-face communication to remote interactions, and a complete shift in how to manage people. We have become an organization based on and driven by outcomes, regardless of employee schedules. In some cultures, this change is revolutionary. Finally, despite the crisis, Merck has been very resilient and after the last four months, I would like to reset the strategy for Latin America, striking a balance between the old way and the new way, although I believe our customers will decide for us. I assume that we will not go back nor stay in this present level of lockdown. I want to be remembered for a new way of managing people, a new way of working which will be outcome-driven, agile and focused on access and to be a global speciality innovator for Latin America.

September 2020
Latin America