Read the Conversation
EF: From your perspective and Lundbeck's, do you see 2023 as a challenge or an opportunity?
SM: I see 2023 as an opportunity for sure. Mexico is a huge country with a huge population, and we have an opportunity at the institutional and retail levels. Every year the pressure on generic drugs increases, but there are still people who want an innovative brand with secure data systems, more safety assurances, and products that can guarantee a cure. So, I see it as an opportunity for us to continue growing in this market.
EF: How is your portfolio evolving in this region, and is there anything exciting coming up from Lundbeck?
SM: In the last three years, we have launched different products and presentations in the region. We operate in various countries across the region, and the stages of the launches are different. Four years ago, we launched an antipsychotic drug in Mexico that treats patients with schizophrenia and is indicated as an adjuvant in depression. This year we are launching that product in other countries in the region as Guatemala, Honduras, and Panamá. Brexpiprazole for Agitation in Alzheimer’s disease (AD) launch in the US ready upon FDA approval. In Mexico, we expect to launch in mid-2024. It comes down to life cycle management. We have three pillars: new products, new indications, and new SKUs for the products we are currently commercializing.
EF: What is the strategic significance of Mexico, Central America, and Andean countries market for Lundbeck, and how do you attract resources and explain the strategic significance of this market?
SM: Lundbeck is one of the unique content pharmaceutical companies worldwide exclusively dedicated to R&D, launching innovative drugs for brain diseases with the objective of covering the needs of patients who have depression, schizophrenia, bipolar disorder, Alzheimer’s, Parkinson’s, migraine, etc. And mental health is becoming more important every year: there is a higher incidence of anxiety disorders, people have been isolated, and rates of depression have increased. In Mexico, it is estimated that the prevalence of such conditions multiplied seven-fold following the pandemic, so the disease burden is clear. For people to lead healthy and productive lives, good mental health is necessary. In Mexico, suicides continue with a significant increase (7% per year during the last few years).
At Lundbeck, we are fully committed to recovering the full health of the brain through our commitment and consistent investment in R&D. Seventy percent of the company is owned by the Lundbeck Foundation. Every year since 2011, we have been awarded what we call the “Brain Prize,” which is the first award in R&D related to the brain, for 1,3 million Euros to support and promote research on pathologies related to the brain.
Although the company is based in Denmark, we have a presence in more than 50 countries. Mexico is one of the 12 hubs and is the hub for Mexico, Central America, and the Andean region is named Lundbeck MAC, and it is a very strategic region for the company. It is one of the biggest countries where Lundbeck has operations, after the United States, China, Canada, Brazil, and the three big countries in Europe. Advocating for investment in the region is not a concern because the company actively looks for affiliates to find products that fit the administrative needs of the country. In principle, we launch all the products that the company offers worldwide. Product licensing can vary slightly between countries, but in general, the company will launch a product across all the countries where we are present.
EF: How would you assess access in Mexico?
SM: Here, in a country of 130 million people, we have the same number of psychiatrists as Spain, which has a population of 50 million approx. We have approximately five thousand Psychiatrists to cover the entire population. Another challenge is that Psychiatrists, in general, are concentrated in large metropolitan areas like Mexico City, Monterrey, and Guadalajara, so there is a big gap in care outside of the major cities. Many people in other areas of the country are being treated by General Practitioners; it is positive to know that they have access to this general level of care, but we must do more to ensure the availability of mental health specialists outside of big cities.
EF: How do you assess the availability of resources in Mexico to tackle mental health issues, given the increased health awareness but lack of investment in health?
SM: Mental health drugs are one of the most significant shortages in the market, along with oncological drugs. In other countries, governments have increased their investment in mental health since the pandemic. Unfortunately, the same cannot be said about Mexico. The government should invest more in mental health and in innovative products which have fewer side effects and better efficacy. For example, in depression, they address not only mood but also physical and functional symptoms and are a much more holistic approach. There is significant room for improvement in the investment in mental health. Awareness has increased, but Mexico is one of the countries with the highest stigma around mental health; culturally, it is much more difficult for men to be open about mental health issues.
EF: In our previous interview, you said, “When we communicate, we can subconsciously criminalize or create more stigma against mental health.” What is Lundbeck doing to tackle this stigma?
SM: We have several initiatives to create awareness and combat stigma because supporting our employees and society is important. For example, each June, we host a seminar for journalists, where we train local journalists to write about and explain mental illness in their articles. Several years ago in Europe, there was a plane crash, and all the headlines used the term “a schizophrenic man” to describe the person responsible for the death of many passengers; such phrasing stigmatizes this group of people even more. To help combat this tendency in the media, we bring in physicians to talk about diseases, and we also bring in patient associations to them to explain how they feel and how they manage their mental health challenges. We do not use the language of “problems.” We talk about mental illnesses.
It is the same issue of stigmatization when you refer to someone as a drug addict or an alcoholic—because alcoholism is also a mental health disease. Additionally, there are still a lot of issues around phrasing, such as, “This person is crazy,” and without wanting to, we are stigmatizing. I have never had a person in a job interview tell me that they are depressed or that they are schizophrenic. It is still something that you hide, whereas we do not have that same stigma towards diabetics or someone with a prosthesis. We must work to tackle this level of criminalization and stigmatization around this topic.
On World Mental Health Day, we have a lot of different initiatives; we sponsor a road race with our employees and their families, and we illuminate many of the main buildings in Mexico and the region in honor of these specific days. World Schizophrenia Day is recognized on May 24th; we show videos and hold training courses to facilitate conversations with our employees. Three times a year, we invite a patient who has been anxious or depressed to talk about what has changed. We train our employees not to talk about pills but to understand the proposals of the company and the real people behind the diseases.
We also have a wellness program in our company to support our employees. When I say wellness, I am not just about diet or nutrition but also about mental health because there is no health without mental health. We also hold seminars for physicians; we just did one for Psychiatrists in March, one for General Practitioners in April, and one in Panamá for physicians from all over the region also last April. Through these seminars, we have trained more than 1,000 physicians in mental health, inviting international leaders to talk about depression, schizophrenia, anxiety, and so on. We also participate in communication campaigns; we do press events with the Danish embassy and media outlets to help society understand the importance of recognizing mental illnesses and their importance in global health.
EF: How can we shift to a more proactive approach for earlier and more accurate diagnoses in Mexico, particularly in the case of mental health and psychological disorders where delays are common?
SM: There is very little health prevention in Mexico. It has been shown that if you invest resources in prevention, you spend less money in the long term. The government ends up paying more if people go to the hospital with acute problems and more advanced illnesses. Because of this, it will be important to continue to work with the government in the future, to invest in new molecules, in new treatments, in new hospitals, in new facilities, and in having more specialists. In Mexico, mental health is not covered by insurance; it is the only thing not covered.
EF: Do you have a final message for our readers?
SM: We have a responsibility to talk about mental health, to train the people around us, to not criminalize, to not stigmatize the people around us, because mental health is part of health. It is important that people can be more aware. It is important that people can talk about these topics with those around them. When you talk with people who have suffered from mental health diseases, you understand the importance of these diseases. It has a huge impact on the economy of countries. Those who suffer often cannot attend work. We must consider the impact on society and families, as well as the economic impact on the GDP of countries. If young people are more aware, it is a good platform to drive the importance of this work together.