Read the Conversation

EF: What was your mission when appointed and has it been adapted to the pandemic? What have you managed to accomplish last year?

RK: I was the CFO of the Global Pharma Business of Novartis, well used to managing risk, volatility, and uncertainty, when I came to join this great region (Latin America and Canada) about 6 months before the pandemic. Originally, my focus was on how to do business with a very large population and I have always felt, from a global perspective, the region has been somewhat underrepresented in its contribution to sales, clinical research, and talent and I came to the region with a purpose of accelerating these contributions from a regional perspective. Then the pandemic hit and I had to build on my experiences as a global CFO to manage. My emphasis is on providing a strong purpose for the company to keep the organization engaged, motivated, and inspired in time of crisis, for our people could feel comfortable while having the courage to look for opportunities and solutions on how to address the health problem. The purpose was a big point, as was a clear strategy to move forward and past the pandemic, to adapt as fast and easily as possible to this change affecting thousands of people in a very volatile market with a lot of economic challenges. We are working on our access strategy to reach the big pool of patients that have healthcare through public funds, this has not been the strategy in the past where the focus was on what I call the smaller parts of the income and the population pyramid but we are trying to expand and are looking at the entire population. In Mexico, we have launched our Entresto heart failure medicine, a company blockbuster worldwide that now has access through INSABI (ex-Seguro Popular) covering a huge population. We are working collaboratively on education programs and monitoring programs for cardiovascular patients to make this product more easily available and so achieving better outcomes for a bigger part of the population. We are becoming less product-centric and more outcome-focused, more customer and population-focused. Put simply, we are no longer selling products but outcomes, improving the outcomes of a large part of the population –an important strategy for Latin America for obvious economic reasons- as well as improving the distribution within the markets while working to participate more within the public healthcare system, which in Mexico we have done with some success and we will be further pursuing this strategy.  

EF: What is your personal definition of access? 

RK: In my opinion, what matters in access is finding the addressable part of the population in need of medicines and attention. Access can be defined in many ways and have many different connotations, it can be financial -if the patient has or have not the means- reimbursement or it can be about access to products or those rural areas don’t have physical access to medical care services and attention. It is important to look at the population of a country, its fatality rate, and then find ways to provide access to medication to patients to cost to the entire pyramid. The need for the bottom tier is very different from the top tier but we want to access them all and that is our main strategy. 

EF: Novartis has an access program developing 15 molecules which I understand offers tools to engage with the public system in a very different way due to the benefits it is bringing. 

RK: Digitization is the backbone of business continuity and is the tool connected to the Novartis access program which is particularly focused on low-income patients parts of the population. If we take a step away to visualize the pyramid, we can see that this program might work best on neglected parts of the population, on neglected diseases like Chagas or Zika or Lepra, which we are looking to support with global programs, and on neglected countries that are not even close to an adequate level of healthcare and medicine, like Paraguay, Bolivia, Haiti and among others. We are working with the ministers of health of Bolivia and Paraguay on an access program, not just for select products, but to bring them an entire portfolio.

EF: One of the challenges with the pandemic is the focus there is now on communicable diseases, but non-communicable diseases must not be neglected so how can the focus be brought back to chronic diseases?

RK: Health companies have to look at both sides of the healthcare arena. We certainly continue investing in R&D for NCD´s because there are so many unmet patient needs, cardiovascular is the number one cause of mortality in Mexico, as in most other countries, so clearly we will continue to work in the area. But at the same time, with the present global crisis, we have to pledge to address the needs arising from Covid-19, doing R&D, and putting the medications we have into phase 3 trials to see if they address the symptoms of Covid-19 patients. We are also looking at collaboration, we signed a deal with a company called Molecular Partners looking at two antivirals for therapies designed for the potential use against Covid-19 which are promising. We are helping other companies -vaccine manufacturers with whom we have just signed a deal (Pfizer) - to support them with manufacturing so they can increase their capacity. We have also worked a lot on access and pricing, providing 15 non-profit products for the lower and middle-income countries globally -a few in Latin America- that will treat Covid-19 symptoms. The generics division has decided not to to raise prices for all products used in the treatment of Covid-19 patients. We have also invested USD 40 million in communities across the world, so we have a dual strategy, running investments and initiatives at the same time, looking to cover Covid but taking care not to neglect NCD´s because if we ignore that aspect there will be a high price to pay.

EF: Healthcare (and productivity) has been top of the 2020 agenda, so how could we use the healthcare momentum moving forward? Could health be necessarily included in budgets as a result of the pandemic?

RK: That is exactly the lesson society is learning from the health crisis and as a result, we are talking with Ministers of Health, of Finance, and even of Innovation in some countries to think of the long term future and how to change the way medicines are offered to the different segments of the population and how to improve health outcomes. This will address productivity and economic success because health is the foundation of the economic success of a company and a country. We have just launched a big program in Colombia on cardiovascular health, taking different segments of the Colombian population and with the collaboration of the industry –Novartis, public healthcare, and other players- address the needs of the cardiovascular patients to extend their lives and make them productive thus contributing the Colombian population. Ten years ago I would have just said we were launching a new product but today, we are thinking about a product we don’t even have yet to be part of an ecosystem that will help to improve the health outcome of the population. These are subjects of priority for all Ministers of Health and health companies must understand their motivations. We already know that they can’t increase costs, but the main concern is to find the way to improve the health of the population through collaboration, using better tools, monitoring, diagnostics, implementation science, etc., to create an ecosystem that helps us offer better health to the population at large. That is the key to the future.

EF: There is a lot of new blood in management roles, what do you think will be the new skill set needed moving forward for general managers?

RK: I wouldn’t say there is a shift yet but it is becoming more complex. Sales marketing skills will of course always be wanted in any business but in the future, the ability to collaborate across the company will be more important, almost like an account manager who will leverage the medical information, digital info and data, the product, and the human capital. I believe that what worked in the past will not work in the future, it will be more of a product-in to a product-out to the client perspective and this model is unlike the one in the past where the physician took decisions. It will be a much more holistic healthcare system covering the physician or practitioner and patients and it will be about managing the ecosystem and the Manager will need to bring all these skills to manage generally. It will be exciting and different.

EF: What keeps you motivated? 

RK: At the end of the day it has to be the people, the sense of achieving something special, basically having a purpose. I think the ability to create something special and have an impact is what keeps most of us motivated. A clear North Star for the long term and to have an impact is a very good reason to keep moving forward. 

EF: Anything you would like to add?

RK: I am quite optimistic about the region’s future. It has a lot of potentials, great people, and dynamic economies that look to become more stable and which I think will do well as players in the health system. Incidentally, the typically existing volatility in Latin America creates enormous talent in the workplace and for the business and it should be used locally.

February 2021
Latin America