"Until everyone is made safe with a vaccine or an antiviral, no one will be"

Aside from betting on innovation and technology, the Director General of the pharmaceutical company MSD in Brazil, Hugo Nisenbom, assures that the pharmaceutical industry’s first objective should be the health of the patient and not the economic benefit, especially during coronavirus times

Photo: The Director General of MSD Brasil, Hugo Nisenbom. Credit: Courtesy of the interviewee

By Patricia R. Guevara

The pharmaceutical industry is making headlines during an unprecedented time in history: never has a vaccine been developed as quickly as those proposed to fight coronavirus (COVID-19). Technology, collaboration, globalisation and funding all come into the equation. The transformation of a sector that is more innovative than ever before continues without return.

Hugo Nisenbom, Director General of the century-old, world-class biopharmaceutical company MSD Brazil, known as Merck in the USA and Canada, reminds us how important it is to always keep the patient at the forefront of our minds during this transformation. This philosophy permeates all areas of his company and translates into successful examples of collaboration and use of technology.

The Director General of the century-old company, Nisenbom, who is also a sponsor for the African-descendant community and four other diversity groups that are active in MSD, as well as being the vice president of the Brazilian Association of Pharmaceutical Manufacturers of Interfarma Research, says that “diversity is essential for innovation.”

Having dedicated a lifetime to the pharmaceutical sector and having worked at MSD for 25 years, what do you think is the industry's role?

One of the company's founding leaders, George Merck, said that we must always do what is right for the patient and that medicine is for the people; profit should only be a by-product of this and not the primary objective. This legacy is very important to us because we believe that every product that solves a medical condition is a real gem and we shouldn't rest until every patient receives it; for this to happen, we trust in innovation.

"Every product that solves a medical condition is a real gem and we shouldn't rest until every patient receives it"

The mission to put the patient at the centre of our industry plays an essential role during this period of pandemic, alongside collaborating with governments and other agents. The industry has come together to solve the problem and is also making efforts to better understand the new normal.

How has MSD Brazil responded to the pandemic?

At our branch, we had three clear objectives, in this order: to take care of the people on our team, to maintain essential services for patients and to protect the business.

We had been working with agile methodologies and our cultural transformation helped us to minimise the impact on people's health. It was very much like what happened in Europe: Brazil, a continental country, with overloaded and potentially collapsed health systems, flight distances of several hours from one end of the country to the other and with 200 cities in which we have a presence to make decisions so that no one gets sick and, if someone did get sick, to ensure that they received the appropriate treatment, and to care not only for physical health but also for mental health.

Maintaining essential production, logistics and research tasks was relatively simple, but in order to maintain the business we had to transform ourselves. We were able to generate the desired content at fantastic speed and reach our customers, doctors and patients digitally.

Photo: Nisenbom states that a pharmacist's mission must always be to do right by the patient. Credit: MSD Brasil.

It is speed, precisely, that is crucial in this type of situation.

Absolutely, and we have a success story that exemplifies it. Many of those who contract COVID-19 require connection to a respirator and for that to happen they need neuromuscular blockers. It's a generic product that we already sell to private institutions, but it's not yet on the mainstream public market. At one stage of the pandemic, we received an urgent call for it and so immediately got to work.

We were able to import products from Australia in record time, regulations had to be adapted quickly and the cost of shipping was greater than that of the material itself, but if you are clear about your mission, it is never an obstacle. We were able to save hundreds of thousands of lives.

In keeping with the theme of speed, the development of the vaccine has been dizzying. How do you see this race unfolding?

I don't think there is a race for a vaccine as such, because each one will be necessary and will be improved. There are some that have new technologies, but also transport challenges; others are more economical. At MSD, we are working on two vaccines with two priorities: that they be single-dose and that they be scalable. We are also progressing with a study of an antiviral that could be taken at the first sign of symptoms and that, as published by the University of Georgia in the United States, could change the game.

"In countries that are able to bring together their education systems, their companies and other players, there are greater results in innovation"

The safety of all patients is essential. Never before in history have millions of people been vaccinated, and that is why the scientific rigour to which industry players, including MSD, have committed themselves is important. Until everyone is made safe with a vaccine or an antiviral, no one will be, which is why we have to give access to everyone and at the same time reward innovation.

You have mentioned innovation as being a transversal element several times. How does MSD approach open innovation?

At MSD Brazil we use the word partnership, which means cooperation and this is a key term when it comes to how we operate in every field and how we act in relation to our stakeholders.

When we began our transformation process, we established four or five strategic priorities. One of these was to start with how we worked, and change was initiated by the leadership committee and the management model of the future. For example, the days of making a long-term strategic plan every year are over; we started doing shorter reviews and created agile squads (teams). These squads make decisions autonomously, are data-driven, are in a state of continuous learning, and are in frequent contact with the leadership team.

As a result of all this cultural change, we saw that we could build a better relationship with the ecosystem to connect with the innovation hubs and accelerate the delivery of solutions; not all knowledge is at home.

In particular, how do you advocate the transfer of scientific and technological knowledge between ecosystem players?

MSD has placed research laboratories near science and innovation hubs, for example in Boston and California (USA). There is a conjunction between universities, large companies, small companies and start-ups. It is not new, but it is accelerating. In countries that are able to bring together their education systems, their companies and other players, there are greater results in innovation.

What practical examples of collaboration has this whole strategy resulted in?

In Brazil we have several projects. For example, we are working with the Butantan Institute to develop a vaccine against dengue fever. For the first time there has been a two-way transfer of knowledge with a public company: not just in the traditional north-south direction, but also in the south-north direction. We hope that together we can develop a global solution for the prevention of this disease, a need that has not yet been met.

Photo: MSD bets on innovation in the digital field to improve maternal health. Credit: MSD for Mothers.

As part of our social action, we run the MSD for Mothers project to reduce mortality rates due to complications in pregnancy and childbirth. In 2018, in collaboration with the Albert Einstein Hospital in São Paulo and the Ministry of Health, we analysed procedures and through simple measures such as increasing nursing staff training or providing medicine at the right time, maternal mortality in childbirth was reduced by 54%. Also 20,000 unnecessary caesarean sections have been avoided. We carried out this pilot with the Agamemnon Magalháes Public Hospital and are now replicating it in 24 other public maternity centres.

We are also working on the danger of superbug resistance to antibiotics. Working in cooperation with hospitals and start-ups we are progressing to make more efficient use of them, and to ensure that the right antibiotic is used for the right length of time. We employ artificial intelligence for this purpose. This technology can help doctors improve their hospital practice by analysing data from each hospital and, depending on the type of bacteria, indicating which antibiotic to use and in what quantity, in order to reduce bacterial resistance.

One of the MIT Technology Review's highlights in 2020 is hyper-personalised medicine for the development of patient-tailored drugs. What role does technology play in these case studies and in the pharmaceutical industry?

It doesn't change the core of our business, which is scientific research, but it does transform how we do it and how we will achieve our goals. For example, let's think about all the genetic data we know about people, together with data from mobile and wearable devices; it is going to be possible to predict and individualise people's medicine.

Artificial intelligence will continue to improve and help to diagnose from an image and optimising, as I said, the use of antibiotic treatments. For example, there are already machines for reading melanomas: the machine reproduces what thousands of doctors do, learns and helps to reduce errors. The doctor's role will continue to be crucial, but technology will be increasingly present as an element of improvement.

Photo: MSD using advanced technology to optimise the use of antibiotics and thus reduce bacterial resistance. Credit: MSD.

Technology has no limits. In our case, it is also a vehicle that allows us to reach all parts of the country much more efficiently. We are now entering a time when decisions are going to look more and more like scientific decisions, not only in the science sector, but also in the business sector.

What is your vision for the future of the pharmaceutical industry?

I believe it will continue with its vital objective of finding unresolved medical solutions, with a focus on global data and multi-stakeholder operations. But there is one thing I consider essential: diversity. It is not just a small issue in these times, we have seen what happened in the US, and we have a mission and responsibility as companies to work on it. Diversity is critical to innovation.

"Decisions are going to look more and more like scientific decisions, not only in the science sector, but also in the business sector.”

Regarding technology and collaboration, I do not think we will be masters of every technology or experts, so we have to be in permanent contact with the ecosystem, work in partnerships and share knowledge. Who wins? It should always be the patient who wins.