Sarah Aiosa oversees the entire Latin America region for MSD, where the global giant is looking to build on its 100-year legacy by better addressing the continent's health inequities and unmet medical needs. Aiosa describes the myriad public-private partnerships that the firm has struck in LatAm across areas including cancer screening, women's health, and vaccine technology transfer; the importance of clinical trials in the region; and why she is optimistic about the future of LatAm healthcare.

 

Sarah, could you start by talking us through your background and the career journey that has led you to becoming SVP and president of Latin America for MSD?

I am an American, born and raised in New Jersey, but with Latina roots; my mother is from Puerto Rico while my father is from Ecuador. My interest in healthcare has been present since my first job at a local neighbourhood pharmacy at the age of 14. On a personal level, my brother passed away when he was a teenager and during the period when he was seeking care, there were times when my parents had gaps in their health insurance coverage. I saw first-hand what inequity looks like in a country like the US, even with such a rich health system.

I then developed my passion for healthcare through studying biology at university which I followed up with a master’s in public health focused on underrepresented groups in cancer clinical trials. From an educational perspective, this again ties into the common theme of trying to close gaps for unmet needs and underserved populations.

All of this has led me to a fantastic career with diverse postings across both strategic and operational roles, first with communication agencies, and then at various pharmaceutical companies. I joined Merck (MSD outside of the US and Canada) in 2016 as part of the global marketing group working on our immunotherapy in oncology which was a phenomenal experience. Following that, I then worked on our collaboration with other players within the industry around some oncology products before seizing the exciting opportunity to take my family overseas during the COVID-19 pandemic to become the company’s managing director for Sweden. Coming back to New Jersey in this role as president of Latin America is a nice combination of all the diversity of experiences and geographies in which I have served throughout my career.

 

There are often big differences between global, country, and regional roles; how have you managed to adapt to this new position and what is on the agenda for MSD in LatAm?

My leadership style is adaptive. To be adaptive in any role – whether at the country, regional, or global level – listening to the people that you serve is crucial. LatAm is home to incredible diversity in terms of geography, culture, and language, and the people that come to work for MSD do so in order to make a difference. It is therefore vital that we, in turn, make a difference for them. This means that people, teams, and building a strong culture of belonging are our leadership team’s topmost priorities.

Finally, we must always focus on patients. The health inequities in LatAm, whereby so many patients have unmet medical needs, are clear to see and mean that making our innovative medicines and vaccines available to those patients is an obvious key priority.

 

What is MSD’s historical footprint and scope in Latin America?

MSD has had a footprint in LatAm for nearly 100 years, and globally has a 135-year legacy. I am currently responsible for the Human Health division, leading over 4,000 employees working in Oncology, Vaccines, Infectious Diseases, and Cardio-metabolic Diseases in over 30 markets, including Brazil, Mexico, and Argentina, as well as Puerto Rico.

 

Globally, MSD had a challenging 2020/2021, shelving its two COVID-19 vaccine candidates to instead focus on treatments for the disease. This was followed by the news of long-serving CEO Kenneth Frazier’s retirement after almost 30 years at the company. How did these global shifts filter down to LatAm?

The entire pharma industry, not just our company, has been navigating through the pandemic for the past few years, including in LatAm. During this challenging period, I was truly impressed by the resilience and commitment of our people to ensuring the uninterrupted delivery of our vaccines and medicines to patients.

In terms of leadership changes, former CEO Ken Frazier had a strong legacy, not just for our company but across the industry as a whole. However, I am proud to now be working under the stewardship of Robert M Davis.

MSD recently held a LatAm regional summit – the first in over a decade – which brought together all the key regional leaders. The support that the executive team is showing to this region is indicative of the value we bring and the contributions we make.

As a recent Pan American Health Organization (PAHO) report showed, the pandemic exacerbated some of the inequities in LatAm, including vaccine coverage, cancer care outcomes, and progress towards the United Nations (UN)’s 2030 Sustainable Development Goals. We are now working hard to close these gaps and make a difference for patients.

 

Post-pandemic, many governments seem to be prioritising health more than ever. Do you feel a greater openness on the part of LatAm governments to engaging in dialogue with private industry on creating health solutions?

Thanks to COVID, there is increased recognition from government stakeholders of the importance of having health systems that can manage and navigate both health emergencies and routine care.

Unfortunately, LatAm still lags behind the Organisation for Economic Co-operation and Development (OECD) average on healthcare spending as a percentage of GDP (3.5 percent in LatAm compared to 6.6 percent across the OECD). There is therefore an opportunity to increase our prioritisation of healthcare investment.

I was proud to represent our company at the ninth Summit of the Americas in Los Angeles this year where we, together with many other companies, announced the Americas RISE for Health initiative. RISE stands for resilient, inclusive, sustainable, and equitable health economies and systems. We know that healthcare and economic growth go hand in hand; a healthy economy needs a healthy population. Through this mechanism we are bringing together government stakeholders, the private sector, and important civil society groups to ensure that we build a resilient healthcare system.

 

Given the size of its population and the broad sweep of both low- and middle-income countries, how does MSD choose which elements of its portfolio to prioritise in LatAm?

Our portfolio is quite diverse. However, we do prioritise oncology and vaccines in LatAm; two areas where our company has deep roots and commitment. As part of the Latin American Federation of the Pharmaceutical Industry (FIFARMA), we recently partnered with IQVIA to create a Patients Waiting to Access Innovative Therapies (WAIT) Indicator, looking at access to innovative oncology and rare disease therapies in LatAm’s major markets. We found that across 185 innovative therapies, patients in LatAm could only access around 13 percent of them. The gap is very wide, which is why mechanisms like the Americas RISE for Health initiative and other partnerships are so important.

Speaking of cancer care, in November I was happy to hear that the American Society of Clinical Oncology (ASCO) has announced plans to offer free membership to oncology physicians in low- and middle-income countries, which will also impact physicians in several markets in LATAM. This is a good example of the growing recognition among stakeholders like ASCO of the need to work together to close inequity gaps.

Moreover, I’m proud to say we have strong partnerships and collaborations to expand access and support health systems, such as the alliance with City Cancer Challenge, that supports improving screening and cancer services in the cities of Cali in Colombia, León in Mexico, and Porto Alegre in Brazil. Another example is our impact investment in Mamotest, a company working to reach thousands of underserved women with mammography services in Argentina and Mexico.

In the vaccines field, we are engaging with partners for important tech transfers, as well as to build confidence in vaccination and contribute to the development of resilient vaccination programs that help to achieve and maintain high vaccine coverage rates. Vaccination programs are an investment in current and future generations; however, vaccines can only work when people get vaccinated.

 

What do you see as the primary causes for this delayed access scenario in LatAm and are you optimistic that it can be improved?

It is a combination of factors, which – as part of FIFARMA – MSD is working to address along with other key actors in the healthcare continuum. One significant challenge is the lack of a central regulatory body like the European Medicines Agency (EMA) in Europe. However, we have seen some great achievements in LatAm, such as the Brazilian regulator ANVISA’s participation in Project Orbis, a programme which provides a framework for the concurrent submission and review of innovative oncology products among international partners. I am excited to see how the learnings from pilot projects such as this can be scaled up elsewhere.

Another cause for optimism is the progress of the Cancer Code in Mexico and Cancer Laws in countries like Chile, Peru, and Argentina, which could provide a framework for faster access in the future, if governments, the private sector, civil society, and advocacy groups can work together.

Multi-stakeholder partnerships are already having an impact. For example, MSD recently launched its ‘Alianza para la Vida’ initiative in Colombia with the aim of improving women’s health, cancer care, and strengthening the capacities of health professionals in the country in collaboration with universities, advocacy groups, and the Colombian government. This shows that our priorities are aligned with those of governments and that there is a willingness on both sides to collaboratively transform healthcare for the better.

 

How well-developed are patient advocacy groups in LatAm and how does this affect MSD’s interactions with them? 

Some groups are certainly more advanced than others, but I look at the lack of development in certain groups as an opportunity. One example of a well-developed group is Fundación Cáncer Warriors de México, which works around the legislation in Mexico to advocate for cancer patients and their families. We can take the learnings generated by a group like this and share it with others. Our LatAm people and teams have an entrepreneurial and creative mindset, approach, and commitment. They always find a solution.

 

What is the relevance of LatAm to MSD as a clinical trials destination, and what are the region’s key selling points as a location for global studies?

As a company, we invested USD 12.2 billion in R&D last year globally. A region like ours serves the entire globe, and I am proud to say that our global clinical trials operations team in LatAm is leaving a lasting mark on both our region and the world. MSD is currently sponsoring almost 200 clinical trials at nearly 2000 active sites across LatAm with almost 16 thousand randomized patients, which is bringing diversity to the global research and development (R&D) programs of which they are a part. Indeed, two LatAm countries – Colombia and Mexico – are the top patient enrollers worldwide, and LatAm makes up approximately 15 percent of our total active trials. Moreover, MSD holds important clinical trials data management centres and pharmacovigilance centres that service the entire world from Argentina, Colombia, and Costa Rica.

 

As a representative of one of the planet’s leading vaccine companies, what is your perception of the vaccination landscape in LatAm and what are your plans for vaccines as a priority area alongside oncology?

Vaccines are an investment in current and future generations and a key priority which we partner globally, regionally, and locally to advance. 52 national immunisation programs in LatAm include at least one MSD vaccine and our vaccine portfolio covers children, adolescents, and adults in many diseases. We are very proud of the contribution we have made in helping eliminate some diseases and vaccines will remain a focus.

One example of how we work in collaboration with other stakeholders to achieve this goal was our participation in the signing of the proclamation for the elimination of HPV-associated cancers in Puerto Rico, in alignment with the World Health Organization (WHO)’s call to eliminate diseases such as cervical cancer based on three key pillars: vaccination, screening and treatment.

On March 4th, when the International HPV Awareness Day of Human Papillomavirus (HPV) is celebrated and during one of my first assignments as president of the region, I had the privilege of joining the Puerto Rico team and the government to sign the proclamation. It was humbling and very personal for me to take part of such a powerful initiative.

While the pandemic did create a coverage challenge for non-COVID related vaccines, we have a renewed focus on bringing coverage rates for routine immunisations back up to pre-pandemic levels. Educational and awareness campaigns, in collaboration with government stakeholders, will form an important part of this push.

 

Given the changes in governments in Brazil and Colombia and the economic uncertainty in countries like Argentina, what are your hopes and expectations for MSD in LatAm in the coming year? Is the cluster well placed to sidestep some of the region’s political and economic volatility?

While there is a degree of volatility in LatAm, this is not unique to the region and is something the whole world is currently experiencing. In times of uncertainty and ambiguity, the steadfast commitment of my colleagues is a great source of pride. They are always focused on what they need to do to deliver for patients and customers, and how they can keep each other safe, as shown throughout the pandemic.

In 2023, MSD will remain committed to oncology; for example, we are in the process of launching new therapies for breast cancer, where there remains a huge unmet need. Beyond oncology, we will continue to expand access to vaccines and recover the vaccination rates, which will take time. Internally we will continue building a strong culture of belonging. As the first woman chosen by our company to lead this diverse region, I have a responsibility not just to other women, but also to diversity, inclusion, and equity more broadly.

I have full faith that, despite some uncertainties, our team will continue to find a way. Our vision for LatAm is to transform healthcare so that people can live better lives. Everything we do is under that vision and builds on our long legacy in the region.