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EF: How can investors’ confidence be restored to Mexico?
YM: In my opinion, the foundation for restoring confidence to the investor is predictability. When investments are made, there is always an element of risk but there also is an element of stability or predictability in terms of regulations which is at the foundation of a sound decision. Companies are willing to accept the risk of a business decision but not all companies are willing to accept uncertainty and lack of predictability when it comes to frameworks such as regulatory, legal or intellectual property rights.
EF: 2019 was a transition year for Mexico and 2020 has begun with huge change and turbulence still ongoing. What advice would you give to other GMs in managing the time transition?
YM: In these troubling times I would say with courage and faith. 2019 was indeed a transition year for healthcare in Mexico and going into 2020, we had hoped that this year would be less turbulent and more stable in terms of the rules of the game laid out by the government. Sadly, with the devastating arrival of COVID-19, we have all been witnessing the large disruptive impact this has had and will have in the future on our society and especially our healthcare system. It has been hit hard and we can only thank all the brave doctors and nurses for their relentless and courageous effort to save patients in sometimes very worrying conditions. This crisis has shown that the Mexican population is very vulnerable to COVID-19. Not only does Mexico have a high prevalence of diabetes and obesity, but these diseases have shown to make patients even more vulnerable when infected. So, despite the current massive pressure on the healthcare system created by COVID-19, we can see that we need to keep being focused on the unmet needs in the Mexican population because if not met, it will have a devastating impact when diseases like COVID-19 is hitting us. We are here for the unmet needs that will exist in 5 or 10 years, which means for this government and the next. Specifically looking at diabetes and obesity, which is what we do best, our commitment must be for the long run. My advice would also be on the importance of making evidence-based decisions, decisions based on data rather than emotions or sentiments. My advice is to try and have evidence and if there isn’t evidence, make assumptions and scenarios -we operate a lot with scenarios. I tend to always maintain a positive outlook, but I think we can all agree that things will get better given time. Opportunities will be there and we must learn to navigate these emotional periods where uncertainty is high.
EF: At the moment there is a lot of healthcare interest, but what happens after the pandemic passes? What can be done to maintain the level of interest and investment?
YM: What we learn from these extreme and acute situations is that modern society is conducive to spreading modern diseases in a faster way. We all work in offices and use mass transportation means, so we are always getting exposed to new viruses. We shouldn’t minimize the impact but we should act according to the risk by optimizing work and transportation conditions to be more efficient or looking at alternate methods of working. My point is that we should always learn from these situations; we should take them seriously, but also keep our calm. We have probably, if not all of us, have been exposed to a variation of SARS or N1H1 and in the near future, most of us will get exposed to some variation of COVID-19. This situation now is more about crisis management than a long-term health risk.
EF: I understand you have a product launch you are very excited about?
YM: It is a product for diabetes which is probably the most promising medicine which has ever been developed for diabetes. This is not my opinion but the clinical evidence which demonstrates that the molecule allows for a better sugar level control than any other existing product- better than insulin itself, which has been the most potent medicine we have. Our new product also reduces weight and reduces the risk of heart attacks in the people with Type 2 diabetes studied in the trials. It is a triple fit with an excellent profile in all these areas, which is quite something. We launched the molecule in Mexico in March to very prominent global medical experts in diabetes as well as 700 local expert physicians, and I am really excited to see how it works here in Mexico. I am sure we will see a lot of Mexican patients benefit from it.
EF: What is your general growth trajectory looking like for this year?
YM: Over the last three years, Novo Nordisk has practically doubled in size in terms of our strategic products and this is a result of a combination of things: i) we started from a lower base as our presence in Mexico is recent, as we have been here as a dedicated company for only 15 years and ii) we have focused on bringing better solutions to more patients. Even if not everybody in Mexico will have immediate access to the most recent innovation, we want to make sure that they have access to a better option for them and they will have access to our patient support efforts. We have worked on restructuring our business model to serve more patients and to serve them better. For the last three years, we have been very successful with this philosophy and with this business model and with the plans we have currently, we will grow 20% or more in 2020.
EF: As global key leaders in diabetes treatment, what is your clinical research footprint like in Mexico?
YM: I am proud to say Mexico is a stronghold for clinical research, both because we have a fantastic team here and because there are great investigators across the country. In some of the most important and most recent trials, Mexico has contributed up to 10% of the patients. In the latest clinical program called “SUSTAIN” for our new diabetes product, which was a huge clinical program with close to 40 thousand people with Type 2 diabetes participating, Mexico contributed between 5 and 10% of the patients. This was very much appreciated by COFEPRIS as there is always discussion if local data match what is seen globally in the trials, and this time we can say with absolute confidence that it does.
EF: Could there be more invested in reducing complications for diabetes and obesity? What could be done in prevention?
YM: We have been working on this front in the last years with different stakeholders because the healthcare system will unfortunately not live up to the strain of diabetes the way we have been doing it up to now. Primary prevention of new cases is very important but also difficult, and we will only see results long term; it could take up to two or three generations, but it is worth doing. The immediate need is to prevent diabetes complications, which drive more than 90% of the total diabetes cost to society. To do that, we have to invest in building up skills, diagnostics, and knowledge for the physicians and the patients, as well as invest in better treatments. Obesity is an even more complicated issue as most people aren’t aware of the cost to society obesity has. It could be as costly as diabetes, as almost 75% of the population in Mexico is either overweight or obese; we have one of the highest rates in the world. It is also hypothesized that a significant percentage of specific types of cancer are due to obesity. The disease itself is serious and its complications even more so, but as obesity is not treated as a disease in most countries, we aren’t aware of the magnitude of its impact. We need to speak about this health issue in human terms, as there is probably no other disease that touches so many people in Mexico.
EF: You mentioned primary prevention?
YM: For almost 100 years, Novo Nordisk has been a leader in providing diabetes treatment and we are the biggest investors in R&D in diabetes globally, but we have to recognise that collectively as a society, we have failed to bend the curve. We are proud of the science and the work we do, but we cannot say we have succeeded in our mission when every year millions of new diabetic patients appear. We have to do even more in that area -not just offer the best treatments- we must also reduce the burden of the disease. To tackle Type 2 diabetes, which is 95% of the cases, we have decided to tackle obesity because it is the biggest driver for Type 2 diabetes. We must start early on in the life of the person and to this end, we have partnered with UNICEF which is the global organization which has done the most worldwide for the well-being of children. We have picked two countries, Mexico and Colombia, mainly because they both have very high rates of childhood obesity; we will start a program which, over the next three years, will impact 500,000 families with children or parents that are predisposed to obesogenic environments. The main focus will be on the most vulnerable people in society who do not have access to high-quality healthcare or education. UNICEF has full autonomy of the programme, whereas we only provide funding and expertise. UNICEF will accompany the mother and child from the early stages of the child’s life to educate both mother and child to eat better. The first objective is to construct favourable lasting health habits, the second is to better understand what are the causes and key drivers in this environment, and the fast pace the disease has taken, and thirdly, to propose policies to reverse the trend. We are very excited that it will happen in Mexico, it’s a great country to start with and if it works, we will replicate the model in more regions of Mexico as well as in other countries.
EF: What are the changes you are hoping to achieve with all the information you are gathering?
YM: The three key words to an obesity change of mindset are Nutrition, Education and Habits. Nutrition is key as the consumption of high-calorie food and unhealthy soft drinks in Mexico are among the highest in the world. It is a controversial topic, but any action taken to educate people to eat better is favourable although it is difficult to know the best way to go about it. We can either make healthy food more accessible or penalize unhealthy food. I personally lean toward making healthy food more accessible, but whatever we do, we must act soon; any action would be better than no action! Nutrition must go hand in hand with education and awareness- if a person with obesity is asked if she or he is obese, half of them will answer no. There is a trauma, a denial, where obesity is only related to very extreme cases and not with their image of themselves. There is also a lot of psychological stigma regarding obesity so education is necessary so it can be seen as a disease not only for the people that suffer obesity and their families but for the whole society. We now have very good evidence that obesity has very clear genetic associations. If a person has a couple of genes of the gene pool identified as associated with obesity, apparently the person has an approximately 15% chance of being obese. And if they have 5 genes associated with obesity, the chances of them being obese rises to about 70%, and if there are more than 10, there is an almost 100% chance of being obese. If a person has a high genetic predisposition and that person is also exposed to a very high-calorie diet, there is no doubt that that person will become obese. So, there is a lot we must learn and understand in this area, mainly that will-power has no say in the matter especially when one’s own body works against one. Finally, what must be achieved is behaviour modification and this can be fostered through psychological support and different rewards systems which trigger the generation of healthier habits. I think we will see more effort and science dedicated to constructing better habits. We have started to integrate this thinking into our patient support program, “Nuevo YO”, which offers different services to help the patient do better in their treatment. The better you do the more you want to continue your efforts, and the more you continue your efforts, the better you do; it’s a virtuous cycle, which could happen in other disease areas, not only obesity and diabetes but in other chronic diseases as well.
EF: After having been officially in Novo Nordisk for 15 years, what is the impact of decisions taken 10 years ago and what would you like to raise your glass of champagne to?
YM: I am very happy that very early in my professional career and life, I found meaning in what I do, that I found a company with values that represent my own very closely, and that my life has more meaning working for Novo Nordisk. I am both proud and grateful to be living during this surge in science which has resulted in so many medical options to treat diabetes and other diseases and where through our work, we can make a difference in patients’ lives. When I started in the company as an intern almost 20 years ago, I worked with haemophilia and I had the chance to travel to various countries in Africa where having haemophilia was a death sentence. In these countries, children with haemophilia would never see adulthood and now, one generation later, I see patients in developing countries living an almost normal life. That to me is an impressive advancement, that through medicine treatments and mainly innovation, things once thought impossible, are now very possible. We live in an exciting era where the pace of change is enormous, where we can prove that changing people’s life is possible.