Novo Nordisk’s Latin America lead Allan Finkel outlines the “alarming” burden of diabetes and obesity in his region, the progress that has been made via national campaigns against diabetes, and why countries in LatAm need to recognise obesity as the disease it is considering its heavy impact on patients’ lives and its links to many other diseases. Finkel also explains how LatAm is now the firm’s fastest growing region across all international operations and delineates his excitement at bringing next-generation Novo Nordisk products to the continent.
Can you outline your career trajectory up to this point?
My background is as an electronic engineer but, while I was working on my MBA in the US, I made the switch from engineering to pharmaceuticals. Between the first and second years of the program, students are required to take on a summer job and mine was at Bristol Myers Squibb (BMS). I spent almost three years at BMS, in both marketing and sales roles, before moving back to my native Brazil.
In Brazil, I joined Eli Lilly, where I went on to spend 12 years, mostly working to develop and establish a corporate affairs team and strategy from scratch. I had a year working on business development across Latin America before spending my last four years with the company as a sales director for the Brazilian affiliate with additional responsibilities for events and business intelligence.
In 2015 I was approached to join Novo Nordisk as general manager for Brazil. Taking on your first GM role is a big challenge for any executive, but I feel very proud of what has been achieved by Novo Nordisk Brazil since then. As of the end of 2021, the affiliate was six times its size in 2015, making it the fastest growing pharma company in Brazil. The team has been able to rapidly launch a significant number of new products, including in obesity. The affiliate is also a great work environment for our employees
Finally, in April 2021 I was asked to oversee the entirety of Novo Nordisk’s Latin America (LatAm) operations. This represented a great opportunity to take on more responsibility and to learn more about the different cultures, and varying business opportunities across the continent. This region has experienced significant growth for Novo Nordisk over the past few years, and we have high expectations that it will continue to be a key growth engine for the company’s international business.
What have been some of the challenges of transitioning away from a frontline country manager position to taking on responsibility for an entire continent and having to be less involved in day-to-day matters?
I have learned a lot! It is of course great to be on the frontline, but it is also highly rewarding to be able to drive strategy and cross-functional work among affiliates. There are huge opportunities to learn from each other, capitalise on some of our talents, and develop talent. As a very people-oriented person, I spend a significant amount of my time talking to people and – pandemic restrictions permitting – I fill my agenda with meetings to get to know the talents within Novo Nordisk across the region. This people orientation also extends to our customers, who I love meeting to better understand their needs and how we can work to meet them.
I recently gave a presentation to my LatAm colleagues about “frontline obsession” and having an obsessive approach to customer experience. While our sales force who interact directly with customers need this, we feel that every employee’s work touches our customers and that this frontline obsession should permeate all levels of the business. At the end of the day, we are all frontliners.
LatAm is perhaps less often discussed by global pharma leaders than the highly populated Asia region or the dominant US market. What makes the region a relevant place to be, especially for Novo Nordisk?
It must be said that all regions, including LatAm, are important for Novo Nordisk. Across the globe, there are people struggling with chronic diseases and our business is based on helping those people to receive treatment and have a better quality of life. This mission is no different in LatAm. While not the company’s largest region in terms of sales, we are the fastest growing across all international operations.
The impact of diabetes in the region – as it is globally – is alarming. The International Diabetes Federation estimates that 33 million adults aged between 20 and 79 in the South and Central America region were living with diabetes in 2021. This represents a full ten percent of the population and highlights the importance of delivering our medicines here, as well as of the work we do from an education, patient, compliance, and doctor’s perspective. Additionally, the number of adults in the region living with diabetes is expected to grow by almost 50 percent to around 50 million by 2045.
Another important, and alarming, data point is that 33 percent of people living with diabetes are undiagnosed.
Finally, there are several challenges around our other key therapeutic area of obesity. Many countries do not recognise obesity as the disease that it is, despite its heavy impact on patients’ lives and its links to many other diseases, including diabetes. For example, at the early stages of the COVID-19 pandemic, the incoming hospital data showed that a significant number of patients severely affected by COVID-19 were living with obesity.
Our job in LatAm is to ensure that the population in general, as well as healthcare providers and governments, understand the importance of diagnosing and treating diabetes early, as well as recognising obesity as a disease to be able to treat it correctly.
How advanced is Latin America in terms of the rollout of the kinds of national diabetes programs we see in other geographies?
There are several such programs here, including a very well-advanced diabetes program in Brazil. Led by the federal government, this program ensures that insulin – whether human or analogue – is available to everybody that needs it here.
However, the same is not true for obesity, leading Novo Nordisk to undertake a lot of work together with the medical and patient communities to raise awareness of obesity as a disease.
Digital tools and devices that improve the patient journey and adherence are an increasingly important part of Novo Nordisk’s global offering. How would you characterise the level of digitalisation within the key LatAm markets and what work still needs to be done?
Digitalisation is growing rapidly in LatAm. The pandemic showed our ability to go digital, innovate, and do it quickly. Looking back to where we were three years ago, a lot has changed, and the revolutionary power of digital is now commonly accepted globally, as it is in LatAm. Digital tools are becoming essential to the way we live, communicate, and educate ourselves and others.
In terms of our work in diabetes and obesity, we are increasingly utilising digital tools in our stakeholder communication and education efforts. The new generation of patients and doctors are digital natives and have different preferences and expectations of what healthcare should be. Alongside this newer generation, the older generations are also switching to using digital tools. Therefore, Novo Nordisk, along with all the players in our industry, needs to make sure it can deliver to drive change.
However, the solutions to complex healthcare problems cannot simply be solved by an app. We need to fully understand the needs of patients and doctors, and create holistic digital solutions to support them.
Additionally, in terms of customer support, the next step is to provide an individualised customer experience, for which digital will be critical. Novo Nordisk is investing heavily in this area and is continually refining and improving its offering.
Several companies in our industry have publicly stated a theoretical shift away from being ‘product-driven’ to ‘customer-driven’ someone changing the way internal teams operate and interact. Where does Novo Nordisk LatAm sit on this paradigm?
It is not a zero-sum decision between the two. For example, market access is not driven by products; but rather, with an understanding of our private and public sector customers’ needs, it is about delivering a holistic overall experience. Sales representatives will focus on specific products, or bundles of products, but pharmacies will naturally have more of a customer focus.
A mix of both a product-driven and customer-driven approach is therefore necessary, as is a great deal of flexibility, to be able to deliver the overall experiences needed.
LatAm, to a certain extent, is synonymous with volatility. How does that factor into your strategy in the region?
As I tell my colleagues, there are things that we can change and things we cannot. Volatility is one of the things that you cannot, meaning that we need to find ways to perform in a volatile environment. I was born and raised in Brazil and so I have experienced this volatility all my life, understanding the need to adapt. Volatility also creates opportunities for growth and teaches our teams to be flexible, experimental, and creative. For this reason, professionals who have experience working in LatAm often perform very well in other geographies.
As Novo Nordisk, our commitment to education and delivery around diabetes, obesity, and chronic diseases is unwavering and will continue, regardless of any outside volatility.
In building your LatAm team, would you advise leaning heavily on local talent that understands local markets and the aforementioned volatility?
Novo Nordisk LatAm is extremely diverse with team members coming from Asia, Europe, and various countries within the region. Diversity is crucial for us, not only in terms of nationality, but also gender, culture, and religion. A more diverse team brings in fresh perspectives, challenges us, and creates greater adaptability and flexibility. Those with a long-term experience of living in a volatile environment can bring a lot, but also those who come from more stable countries can contribute.
How would you characterise market access for Novo Nordisk’s products in your region?
We are quite happy with the speed at which products are approved here. Regulatory agencies across LatAm are improving a lot and in Brazil, for example, we are now able to launch products almost simultaneously with Europe and the US. Similar timeframes are emerging in countries like Argentina, Colombia, and Mexico. The stereotype that LatAm takes a longer time than other regions to incorporate new products is no longer true, and there is real stakeholder willingness to bring innovation to market as soon as possible.
Additionally, I believe that the much-discussed topic of regulatory alignment between countries in LatAm will soon become a reality, further bolstering approval speeds.
LatAm countries are notable for their hybrid of public and private healthcare systems. In your view do such systems bring any notable advantages?
They do, but we should remember that there are still significant differences between countries in the region, with each having its own dynamic. The beauty of our job is being able to understand those systems and how we can best facilitate patient access to our medicines.
Argentina, for example, is much more reimbursement-driven than Brazil, at least for diabetes and obesity treatments. We need to adapt to that and foster a full understanding of the journey taken by doctors and patients.
Presumably Brazil is the predominant driver of Novo Nordisk’s growth in LatAm, but how much are the region’s other countries contributing?
Brazil is, of course, the largest country for Novo Nordisk in LatAm in terms of sales. However, our operations in almost all countries here is growing significantly. The likes of Mexico, many of the countries in Central America, Colombia, and Chile are growing very quickly. Argentina, even excluding inflation from the calculation, is also growing rapidly, at least from a volume perspective. We feel that Latin America represents a great opportunity for our business and to drive a transformation via education and learning.
How significant are Novo Nordisk’s manufacturing and clinical trial footprints in LatAm?
Very significant. We conduct clinical trials in the largest countries in LatAm, and the likes of Argentina, Brazil, Colombia, and Mexico are important global clinical trial sites for the company.
In terms of manufacturing, we have one of the largest insulin facilities in the world at Montes Claros, in the north part of the state of Minas Gerais in Brazil. This is a state-of-the-art facility that not only supplies the local market, and some Latin American countries, but also exports to a significant number of countries around the world.
What is on your wish list for Novo Nordisk in LatAm?
Our aim is to continue to maintain our strong presence here, to maintain our strong growth in diabetes, and to make obesity better understood as the disease that it is. We hope that obesity will begin to be included within public health guidelines and that well-structured programs – as we see for diabetes – are also rolled out for obesity.
Another key priority is product launches. Novo Nordisk will be launching several new products in LatAm in the near future, many almost simultaneously with other developed countries across the world.
So far, Novo Nordisk has primarily focused on diabetes, obesity, and rare diseases. However, with new movements at the global level, we are also now looking forward to entering new therapeutic areas in LatAm, such as NASH, Alzheimer’s, and cardiovascular disease.
