The Art and Science of Cross Border Business Development and Licensing | LSI Europe '24

Ajay Nair 00:04
All right, everyone. Well, thank you for joining. And you know, a little bit of pressure on us when you say it's the last panel of the day, but we want to make it the fun panel of the day, and remember the incentive after this is wrap up and drinks, right? So welcome to the art and science of cross-border business development and licensing. I think the panel before us kind of did a really nice segue and setup into this, which was more about cross-border investments. Just to introduce myself really quickly, and then I'll introduce my panelists as well. My name is Ajay Nair. I work for The Mullings Group Companies. I actually have a career about split between large medical device firms as well as Asia Pacific for the last 14 years, so my entire career has been cross-border business development, and I'm really excited because we have a fantastic mix of panelists, very esteemed, with great backgrounds, especially in what we're talking about. So Eliane, if you wouldn't mind introducing yourself and what you do.

Eliane Schutte 00:57
Sure. So my name is Eliane Schutte. I'm the CEO of Xeltis, and Xeltis is a Dutch company, and we're developing transformative vascular devices that have the ability to transform into your own healthy tissue and overcome a lot of problems. The core product, the flagship program that we're currently in a pre-commercial phase for, is dialysis vascular access conduits for patients that are facing severe Stage Kidney Disease. Thank you.

Pieter Wijffels 01:27
Yeah, hello everybody. My name is Pieter Wijffels. I am a partner at NLC Health Ventures, and NLC is a venture builder. We are also based in the Netherlands. We essentially license IP, build companies around it, grow them, and sell them to strategics. We built 20 companies last year. In total, we built 150 companies. We license all over the world. We build all over the world. We license in spot A and then build in spot B. So we have a lot of experience, you know, doing the stuff we're talking about today. I also lived in China for six years and in the US for four years, so I'm also a bit of a cross-border person myself.

Jeff Sirek 02:08
Yeah, thank you. My name is Jeff Sirek. I'm the CEO of PRIA Healthcare. I live in Boston, which is cross-border from here, so we can talk about that, the reimbursement kind. But we are a reimbursement services company. We provide reimbursement services from concept to commercialization. We have worked with hundreds of companies in the past to support this type of dynamic. I know reimbursement is a difficult subject to talk about, but a very important one today, and I can't wait to dig into that deeper here during this session.

Sabine Kapasi 02:37
Hi, I'm Dr. Sabine Kapasi. I'm a gynecologic surgeon. In my earlier career, I worked with WHO and the UN. With WHO, I was the head of digital health for ASEAN and Eastern Europe. At the UN, I was the global strategy head for emergency response. Now I run Enira Consulting, which is actually an insurance plus go-to-market service for the India-Asia neighborhood. We have companies that want to look at not just India and Asia as a market, which is two-thirds of the world population today, but also look at the Middle East and the Global South from a different angle to look at business and development in this region.

Ajay Nair 03:28
Thank you. As you can see, we have a really interesting mix of backgrounds and experience. Dr. Kapasi, since you flew in today, I'm going to maybe put you on the hot seat and kick you off. So listen, the first question really is about just business development and our approach to it, right? You've got kind of a multi-hat perspective. What is kind of your approach and your ethos that you use to approach business development, especially when you look at global cross-border?

Sabine Kapasi 03:53
First and foremost, we are looking at multiple geographies. Today, we have representation from several different countries, but largely, when we look at any new geography, the first thing is the need assessment. Part of it, I think technologies need a level of adoption and understanding of a new geography that's very, very important. So I don't really believe in the term, you know, building for global. I think you need to build for local, but then you need to apply it from a need-to-need basis. That is very, very important because every large geography has its own regulatory approaches. So whenever we start, it starts with need. Then you look at, of course, regulations, because we are talking about med technology. Many other technologies do not have as much regulatory burden as medical technology does because of the onus of what we deliver in terms of outcomes. But I think that is the hat that we all wear, and that's the responsibility that we have. So the regulatory approach is the second one: to look at the lay of the land and the best possible regulatory approaches to it. And then I think partnerships are the most important thing. Most people don't understand that you make revenues mostly through partnerships right to begin with. Then you go to market with other things, but those partnerships are very different and look very different in different geographies. So understanding that is the third most important wing. So these are the three ways that we look at it when we look at entry into new markets.

Ajay Nair 05:35
Jeff, over to you. The science of business development that you use?

Jeff Sirek 05:40
Well, I mean, business development is all about targeting, right? And targeting at the right time because our time is important for our company, but it's important for others as well. On that side of it, I think from a business development standpoint, what partners make sense for them, and what partners make sense for you, and understanding that concept is really important because I think sometimes we want to force that business development because it's good for us, but if it's not good for our partners, it's not going to be a synergistic relationship. We're not going to grow together on that side of it. And you can find that out and realize that through your conversations with the people that you're with. It's just about understanding that and then widening that network of the people that really fit well for you, again, that it's a fit for them as well.

Pieter Wijffels 06:21
Your thoughts?

Pieter Wijffels 06:21
Yeah, so I think it's going to be boring and repetitive. Not sure that's a good idea before drinks, but yeah. So we are all in what is fundamentally a global industry, right? There's no health tech or med tech that is, or very few med tech companies are confined to a certain geography. We're also in Europe, so 27 countries in the European Union alone, if I didn't lose count. So jumping across borders is super hard for many different reasons: reimbursement, maybe the doctors have a different training, maybe, you know, there's a local champion, or there can be many reasons. And then you want to go to the US because that's where the big money is. No single player in this industry can do this alone. So the reason I lived abroad was because of Philips. I worked for Philips. Even companies of that size, or, you know, there's even companies 10 times that size, nobody can do it alone anymore. So the only way to do business development is by creating an ecosystem. We have about 110 active ventures. We have about 80 staff. But the work we do is together with thousands of people that are involved in some way or another. So the only way to do it is to collaborate.

Ajay Nair 07:37
Yeah, thank you. Maybe a slight twist on this repetitiveness right now, but obviously, as the CEO of Xeltis, what was your approach as you came in as CEO and started looking at the landscape in terms of cross-border? I know licensing is something we've discussed, but how did you sort of approach that?

Eliane Schutte 07:56
Well, I mean, honestly, we were at the phase in the company where I was not really thinking about already transatlantic type of commercial deals, to be very frank. We were at a situation in the company where we were thinking about financing the company and finding some creative way of how to finance the company. This was during Corona times when I had to finance the company. One of the things you can look at is traditional types of ways of funding the companies and finding your lead investor. We all know how that works, but when it was growth times, and we were also just changing our strategy from the valve proposition more towards the vascular proposition, you're still a little bit in a more, let's say, challenging phase of the company that you have to fundraise. One of the things that I looked at in the cardiovascular space at that moment in time was a lot of deal flow going on from strategics that were interested in very early and great innovations in Europe, from China. What I did was explore that route: would it be possible to get somebody in as a lead investor while at the same time bringing in, you know, non-dilutive, if possible? And also, is it not hampering your deal flow in the future? And obviously, you know, it's all true, right? Eventually, we can't conquer the world all ourselves. You need partners. For sure, China is super difficult. But what we did do is have serious conversations with banks and the like to see: is this going to damage the deal flow in the future? Is it going to make us less attractive, or is it actually going to be more beneficial to us? Honestly, I think it turned out to be beneficial because even strategics in the space, in the cardiovascular space, know that China is a very difficult market. So this is how we approached it: we needed the lead and we needed to be more creative in finding this lead and also finding some non-dilutive money. So that was the reason.

Ajay Nair 10:10
Wonderful. I'd like to come back to that in a bit, but you triggered something which I'd love to talk about a little bit more. We hear a lot in the early emerging med tech space, which is how early is early, right? Maybe those of you know, Pieter, yourself and Dr. Kapasi, with the portfolio lenses, what have you seen? Good examples, or how early is early? When should companies be thinking about this transatlantic, cross-global perspective? Maybe I'll start with you, Pieter, and then Dr. Kapasi.

Pieter Wijffels 10:41
Yeah, I mean, off the bat, you don't ever want to start a med tech company that doesn't have legs globally. So I think, I mean, everybody here has probably already found it. Maybe it may be too late, but you want to think through that type of stuff up front. I think it is very wise to, after that, get back in your shell for a little bit to develop in a local ecosystem. Especially in Europe, there's a lot of attempts by governments to support innovation. I think you mentioned non-dilutive funding that happens in every geography in Europe. There are government programs, for example, to make it attractive for angels to invest. So you can crawl back into your shell, really understand, you know, what it takes because we're deep in the valley of death here. So you need focus, but then at some point, no strategic will be interested in collaborating with you unless you've proven that you can also scale this to other geographies. Again, we come back to, you know, the reimbursement could be different. The training of the doctor could be different. So you're going to have to get out of your shell at some point, and this is probably in the clinical stage. You can do clinical in multiple geographies. What I've noticed, I don't know if there are any strategics in the room, but they really start becoming interested once you actually enter into another market, so into another regulatory geography. Usually for European ventures, that would be the FDA in the US. When they start seeing their sales guys coming back, and they've noticed you, and like, "Oh my god, that doctor is now using this startup solution or scale-up solution," it's very interesting. I'd love to sell that. That's when they really start taking notice, and then you're pretty far advanced. So I think, you know, in summary, take your time, but not too much to grow in your own little shell. Once you get to the clinical stage, that's when you want to start going international.

Jeff Sirek 12:36
Yeah, and I think it's part about choosing the right areas based upon your technology as well. Correct. Very much. Different countries have different needs and how you would present that target.

Sabine Kapasi 12:48
It's hard to give a one-size-fits-all answer. It can be very different. I think your field is again very different from digital med tech or biotech, again very different. So you're very right. I mean, the need, what are you really trying to solve? Answering your question on that thing, that is what defines the geography you start with and where do you want to go? If the need is large enough in your primary geography, then start to go all the way till commercial there. I mean, at the end of the day, I come from geographies that are fiscally conservative, highly fiscally conservative, and extremely competitive. That is an interesting approach to it as well because that makes you take the same dollars a long, long way. Going to the market today is a very, very attractive trait as well. So the scope of the need is very important, I think. And what you said, I reflect that completely. Along with that, entering new markets is very much possible at any stage. But again, it depends on what is your goal as a company, what are you looking at? Are you looking at commercialization as your first bit? Are you looking at validation? Are you looking at a licensing route out? Are you looking at strategic partnerships as your route out or growth? So as a company, what's your goal is what will determine your strategy into any new market because that has everything, resources, cost, and a lot of time and effort involved in it. So these are the factors that have to come into the picture before you define that.

Jeff Sirek 14:35
Some markets are easier than others. There's a registration process and a process there to get your product approved, and that can take months. It can take years. It can take multiples of years, right? As you think about that, we're smiling because we've all lived through this before, so we understand that, right? So choose well based upon your technology.

Ajay Nair 14:53
I'll move it a little bit earlier, or you may argue it's not earlier. IP. Yeah, right. In your experience, maybe we'll start with you, Eliane. How, when do you start looking at and how much do you start looking at IP across key markets that you're sort of wanting to enter?

Eliane Schutte 15:12
Well, I believe very strongly in doing this very early. This is, I think, what our company has done really well. We've looked at Japan, China, and we still are, right? When we're filing patents, we do this very cleverly, and then at a certain moment we could leverage, right? We could leverage the license to IP in China because we simply had IP in China. If you wouldn't, I mean, there's always, you know, cost to it, but you regret it afterwards, right? Because ultimately they can still copy what you do. So for us, it was very important to do this early on.

Pieter Wijffels 15:51
Can I? So I lived in China for a long time. I hear a lot of our CEOs say, "Listen, I don't want to go to China because they'll steal my IP." Well, they may. That's true. However, if you don't go, you don't have any business anyway. So the net difference is zero, and they don't generally export IP infringing products. So I completely agree that IP is super important. But whenever people say, "I don't want to go to China because of copy concerns," I disagree.

Jeff Sirek 16:21
I agree, and I've commercialized many products in China. I haven't had a lot of IP issues, but it does take a long time to get it through the entire process between CE, and you've got to find the right channels there, right? The distribution channels become important on the commercialization side.

Eliane Schutte 16:34
For sure. So in China, your channel is your protection.

Pieter Wijffels 16:45
That's right. And generally that is because these are people with very strong government ties, and they will make sure that the infringement stays under control. That is a crucial point because that, in fact, for us also, in order to find the Chinese money and the right partner, this is crucial: find the right one that is credible enough and knows what they're up against. Because then it protects itself. They are your brand, and they will protect from others to enter. This is the best way how you can defend that. There are lots of companies out there that are interested in technology; you have to pick the right one that's credible enough and knows what they're up against.

Sabine Kapasi 17:11
I think that protectability of IP is the key factor. IP is very, very important. Registration of IP is very, very important. But more important than that is being able to protect it in a particular market. As you quite rightly said, in China, your channel partners are the ones who are your mechanism of defense towards protection of your IP. But you can look at other markets. You can look at the Middle Eastern market. You can look at India and the neighborhood market or Southeast Asia as a separate market altogether. I mean, Southeast Asia and India plus the neighborhood, I believe, are very, very exciting. So is the Latin market. Of course, China is an interesting problem to solve, but there are other markets that you can look at where you have a little better defensibility than others.

Pieter Wijffels 18:00
I think people have to realize, I mean, amongst our experiences as well, people have to realize that there used to be a time where regulatory in Asian countries was not as well structured. You know, 10-15 years ago, that's improved a lot. IP has come a long way in terms of protectability. But I agree, there's always this sort of vibe of, you know, not going to enter that country because I'm not really sure how to protect it. Similarly, I'd love to talk about licensing, right? It creates a little stir in people. Maybe start with Eliane because I know we specifically talked about it. If you're able to talk about it, how did you sort of structure that for yourself, and how did you sort of come about that position in your setup?

Eliane Schutte 18:41
Yeah, so that's a good question. It was honestly quite a complex process because it started off with a far too broad type of scope, right? This is where I learned first. I mean, if it's too broad, you really don't understand, well, where is really the interest? Where are they going to drive the product to China first? It was already said by the rest of the panelists, you need to have a common ground. Where is your interest? Does it match the one that is getting the license from you? Ultimately, in that learning exercise, where it went like this, we narrowed, narrowed, narrowed to an indication where we felt, okay, this is it. But we also looked at what does it really take to get it to value on the Chinese end, but also bringing value on our end. We were not trying to do a lot of additional effort that is distracting us from doing our core business. Eventually, you know, this took us quite a number of months. The deal went from this to this. You can think, okay, you know, it went smaller and smaller. But in fact, the deal got simpler and simpler. Because it got so simple, you get like, okay, three milestones, very black and white, very clear in our control. I think the benefit was much better because you get in control. You know what you're up against. It's already complex to talk to Chinese strategics, even though the ones that we had on the phone were well spoken, their English was perfect. They know what they're doing. Very much. Know what you're doing, but also they sometimes, you know, throw words in, "Well, for the NDA, we need this, we need that." Before you know it, you're sort of in the limbo land of stuff that you don't know. So you have to be careful that you're not getting into that type of situation.

Jeff Sirek 20:32
Every area is different. EMR is different than China. Exactly. Australia is different than South America, right? They all have different rules, different partners, and different regulations you need to be aware of when you're focusing on these areas.

Eliane Schutte 20:45
Obviously. So I have a contrary opinion. Let's wake people up.

Ajay Nair 20:49
Let's go. We need to spice it up a little bit.

Eliane Schutte 20:52
I don't, but so, you know, our business is based on licensing, right? We see about 2000 licensing opportunities per year from all over the world. About 70% of our ventures are based on IP licenses from universities, 30% from the large strategics. Within the university bucket, it's all over Europe. We've done Oxford, we've done charity, we've done all the Dutch and German ones. Then there's also Mayo Clinic, Cedars-Sinai, and all the guys. My observation is that the deal terms for IP licenses from universities are pretty much globalized and standardized, so I don't see big differences there. I'm not sure that's what you were referring to, but it's a pretty standard deal, and there's usually royalties, you know, down the line once you start doing sales. Some universities will ask for some equity. We don't really like that because they're not strategic partners in the long run, but it's become a pretty global world. There are conferences where all the details gather, and they share best practices, and it leads to a fairly uniform landscape, which is fantastic for us. I think you probably all heard the statistic that 95% of health tech never makes it to the patient, which is, I think, something we're all here to solve. So there's a lot of patients not being served well or as well as they could be because of that. Also think about, I don't know how many trillion is the market cap of all health tech companies combined? That only represents 5% of the entire opportunity. So we have 95% of opportunity still out there.

Jeff Sirek 22:34
Licensing and licensing and commercializing are completely different. Yes, approaches for use more planar. I think that commercialization is a little bit different, right, from country to country.

Eliane Schutte 22:45
That's absolutely true.

Pieter Wijffels 22:48
You mentioned that globally, universities now have the same structure of licensing, and you spoke about Western Europe and North America. I mean, less than one-third of the world population. This is the problem that we are facing right now. In the Global South, we are working with over 80 different universities, from NTU and NUS to Peking and all the way to universities in India and Brazil, and they do not have standardization. In fact, that is one of the major challenges that we face with innovations happening in these regions, which are meant for these regions too.

Sabine Kapasi 23:28
I mean, the world is slightly different down there.

Pieter Wijffels 23:28
You're fully right. We have looked at IP from places outside of Northern Europe and North America. It's hard to find stuff that meets the clinical quality levels. But it's also a fact that these universities aren't solving the problems of the Global South, at least not to the right degree, I think. It's a major problem. We have a few ventures that are targeted to the Global South, and it also for us, it's an enormous challenge because the investor base, for example, is completely different. There is serious money, but they're very different. Investors to go to market is different. The channel is different. So we are unable to solve those challenges.

Ajay Nair 24:13
This brings me up to a question I want to ask, and perhaps biased being I'm also located in the APAC region, as there's incredible growth of med tech activity, as you all know. Let's talk about diligence right in your experience, and maybe I'll start with you, Dr. Kapasi. What advice might you give as companies are looking for partnerships, commercialization, licensing, especially in the emerging countries, emerging markets of the world? What advice would you give in terms of the diligence that they should be doing? And how do you do that? Right? I mean, the US is vastly different diligence versus like India.

Sabine Kapasi 24:48
So first is that in today's day and age, you cannot ignore the Global South because there is where the market lies at the end of the day. You cannot ignore three-quarters of the world. So first is that either way, you have to figure out a way into that space. That is one. Second is when we are talking about diligence. Yes, the structures are not as well defined as in the US market or in Western European markets. That being said, the structures are being formed. One of the best ways I would suggest to go is now these governments are fairly open and open to suggestions. The kind of government ecosystems we thought about 10-15 years ago, things have changed drastically since then. There is a very warm, very welcoming approach. So go through official government channels, is what I would say. When you are looking at diligence, there are structured, very open, and extremely accepting solutions that are designed by government organizations specifically for the growth of industry in the region. If you are able to access those, and they are very easy to access, they are pretty much on their website. Everything is listed. If you are able to trust just that much, I think then it's an easy way forward.

Pieter Wijffels 26:11
Great insight. Pieter, your thoughts as you sort of talk about advice and diligence?

Pieter Wijffels 26:16
Yeah, I appreciate the advice, and I think we have a lot to learn on how to unlock those markets. I know there's a lot of passion for this with innovators across the world, but I also just, you know, want to acknowledge that we have a long way to go and that we're listening.

Eliane Schutte 26:37
On this topic, what was your approach to diligence as you started working with partners?

Eliane Schutte 26:43
Well, obviously, we worked with a boutique firm that knew a lot about, you know, credible Chinese companies, and we did a real phased approach where we looked at a lot of companies. Honestly, I think where for us, what was important? Do they really know the market? Do they understand it? But also, do they understand a bit, you know, what it takes to get this also into China, manufacturing-wise, clinical, regulatory-wise? So what is their competence? That was more or less first, you know, and how much are they selling, obviously, already in the space. The second thing that I have done is basically checked out: okay, if we want to sign up with this partner, and you know, this is a long-term collaboration, then I need to know how they are doing the deal flow. But also, once you're into it, are they really living up to expectations? What is their way of collaborating? When you learn, actually learn. The way how I learned was talking to two CEOs that did deals with the same company. I said, "What, how is this company behaving? What is how they work? What are really things that I need to be, what are the watch outs? What are the benefits? What are the lessons learned?" To be smart enough as you start in negotiation, but also understanding what you can expect from a partner like this. Because I got, honestly, you know, you get also an observer on the board, or suddenly, that's Chinese. You need to understand all of this and not be completely naive. So just talking to the field and CEOs.

Jeff Sirek 28:24
I think finding the expertise in these areas to help you do all those things is important, right? The one or two people in China, the one or two people in the MEA or South America that have the expertise, understand the government regulations, and understand how to navigate these paths are going to be really important for people that are considering this, right?

Pieter Wijffels 28:40
Yeah, so for the US, so that's probably the first place many of the European ventures want to go. It's no different. You can, you know, so people think, you know, they over assume their knowledge levels on the US market, but once you get there, it's actually quite different. So I'd always recommend to do exactly what you did, do your diligence, but also get some people on the team, hopefully also on the board that know what they're talking about, that have done it.

Jeff Sirek 29:08
I think, I think you were my perfect plant because I was going to ask Jeff that question about the US. So that was like a perfect segue. But obviously, I mean, whether you're in Asia or in Europe, a lot of the med tech companies talk about the FDA, regulatory-wise reimbursement. What are you seeing in terms of diligence? I mean, in terms of your sort of the clients that you work with, how well prepared are they when they come to how to access the US market?

Jeff Sirek 29:35
Well, I heard it four times in the previous discussion, which was, start early, right? This previous discussion, yourself say the same thing to this group, is to start early on because you need to really understand the market landscape that you're dealing with and how your product fits into that landscape. Because I've been a part of companies who've done it right and done it wrong. When you do it wrong, it's very, very painful, very costly on that side of it. So very important to understand the landscape and get partners that can drive you through the whole entire process from commercialization to or from concept to commercialization. How those partners can help you along the way?

Ajay Nair 30:09
Let's twist a little bit into just again, the cross-border perspective, but specifically, I've heard this in other conversations as well. There's a rise, if you look at the regulatory body, there's also a real rise in cybersecurity policies, patient privacy, you know, all of that. What sort of advice, or what sort of, you know, what are you telling the companies that you work with in terms of, and I'm going to use a word I heard a lot today, pivoting, right? What advice do you give to companies in terms of how to change strategy when it comes to cross-border business development? Dr. Kapasi, since you had an interesting look on your face, would you like to comment?

Sabine Kapasi 30:50
No, I think interestingly, a lot of geographies are talking about data security, data privacy in a very different way. All of them have a different approach to it. It's not the same. Personal data is not viewed in the same way across. I believe it's not about pivoting; it's just about understanding and tailoring the solution slightly better. So you don't really, in med technology, I believe, especially in this case, when it comes to data security, a major pivot is not necessary as long as your basic structures are built on the right value systems of using the right primary data that you require and going for the right sources for the same. So I think that it's not, in my understanding, a challenge that requires a massive pivot.

Pieter Wijffels 31:47
Your perspective from a portfolio lens?

Pieter Wijffels 31:49
Yeah, I think the answer is, as usual, is not black or white. I don't think you can assume that your model is globally scalable and that you see people stick to this is it and, you know, take it or leave it, and that's never going to work. The flip side of that is you don't want to compromise stuff like data, like privacy, security, or quality, etc. So I believe in giving teams, you know, freedom within a box to pivot to the local market need, which can mean quite a lot of different things. But as an example, I always advise our ventures, when they go to the US to appoint somebody locally and give them a certain amount of freedom to do what is right for the US market because otherwise you're going to fail. I don't believe in, you know, building up a US business with people behind Zoom from the Netherlands; it's never going to work.

Ajay Nair 32:42
Now, I think we've sort of been edging towards commercialization, right? We've talked about it quite often, and obviously, there's no cross-border activity without commercialization. Maybe Eliane, we'll start with you. How did you sort of approach not just your funding, but now commercialization across the world? The second piece I'm really curious about is the people behind it. How did you approach the talent that would be associated with it?

Eliane Schutte 33:07
I mean, that's echoing what was said. You need to respect that others might know stuff better than you do. If you think about sitting on your island and think, okay, commercialization can do it from the chair. I know all of this; this is not going to work. Even in China, you have to have the respect and the understanding to the other side that they really know what they're up against, and they know their business, right? When you hire people, I mean, we're now in a pivotal stage in the US, but already thinking a little bit ahead, you hire people with that type of expertise. You also need to trust that what they're doing is the right thing to do. That's how you set up a team. I think, yeah, I mean, that goes for not just commercialization; it's for any type of activity that you do. As you grow as a company, you need to, at a certain moment, expand, hire the right people that have done it before, that have the credibility. At a certain moment in time, you will have to trust that what they're doing is the right thing, right?

Sabine Kapasi 34:11
Your perspective, and you see a lot of companies, you know, coming to the Asia Pacific Middle East. Are they always thinking of people, or are they thinking channel? How are they approaching things?

Sabine Kapasi 34:22
I'll give you a short example for that. We worked with Roche on this product called Sugar View, right? It's a card that you can scan. Of course, after you put the, you actually have a small micro break, and you scan the card from your phone, and that's a proprietary algorithm that gives you serum RBS value, a quantifiable serum RBS value, which for the entire region is important because it's the Diabetes Center of the world right now, unfortunately. What we were able to do for some program like that is design large-scale screening solutions that were backed by non-profits, governments, and also then partnered with larger pharmaceutical companies, which are not just Roche because that then became a conflict of interest situation if you are looking at not-for-profit engagements. So create a multi-stakeholder situation where we were able to not just give them access to the market but also a larger impact value and access to data and people, which was a long-term engagement for them. One more thing in that space, we were able to not just look at India but the India neighborhood as a market. People don't always realize, but like, the FDA has huge respect across the world in terms of regulation, especially in the Middle Eastern market. Indian regulatory systems also have a lot of acceptance in the neighborhood markets, which are seven other countries, which total to about 2.2 billion people. Access to that understanding is something that I believe through strategic partnerships works very well.

Ajay Nair 36:10
Nice. We're just about three minutes into almost wrapping up, so I'd like to ask one of my favorite questions: culture. What are your thoughts on, and this is something we in the recruitment business see a lot, right? A founding company that is now trying to enter another market, and they've got their founding culture, and they are trying to figure out which culture they should be as they enter another market. I told you it was my favorite question.

Jeff Sirek 36:35
What do you have a leader that understands that culture in that particular market?

Ajay Nair 36:40
Right? So, I mean, obviously, that's, you know, that's what I want to get into, is your thoughts on that founding culture and the entry culture. Maybe, Jeff, you've led the way.

Jeff Sirek 36:49
You need to find people who have the expertise that understand that because they will be disjointed from your area, whether in the US or somewhere else in England because that culture in China or that culture in South America is different. So hire somebody that really understands it because it will be separated from your team, and that individual continues to communicate the results and the success of that, but it is a little bit disjointed. You need somebody who really understands that, an expert in that area for sure.

Ajay Nair 37:14
How often do you see that with companies outside the US working with you as they're coming into the US?

Jeff Sirek 37:24
A lot, the disjointed part. Well, I mean the understanding part certainly. But I think people are really, you know, they're educated now. They know that they need to bring in this expertise to help them through their journey, where they're going and how to navigate their pathway moving forward. That's the biggest takeaway here: find somebody that can help you get there because you could take a really strong person and put them in the wrong market, and they won't be successful in that area, right? I've seen that a lot, actually.

Ajay Nair 37:44
So I want to take a specific angle here. I think 40% of the world's health tech IP is generated in Europe, but only 10% of the world's health tech capital is deployed in Europe. So there's an enormous funding gap. We also see, I don't know, you know, looking under the hood that the European VC landscape is not in a happy place at the moment. In fact, businesses are scaling up, meaning the early tickets become less and less available, or they're dying. There's a lot of VCs that are in deep trouble or have already died. We need to get more US money here, and it will partially solve this cultural problem. Because if there's money here, they'll give you advice, they'll help you, they'll solve the cultural problem for you. We need to, and we talked about this before, we need to team up as an industry to make this happen. If we don't solve that problem, how to get because when the US investor looks at Europe, it's really scary: seven different countries, everybody has their own culture and their own language. How can we create platforms together to make it easier for the US money to come into our ecosystem?

Eliane Schutte 38:48
Anything to add or thoughts?

Sabine Kapasi 38:50
No, not really. I mean, clearly, we run a company with multi-international people, but then also, of course, working with the Chinese. I mean, it's always when you work with other people that you need to try to understand them, but also realize that you never will, right? So I said, right, we make sure that if you really want something in a certain area, then you have to have somebody there that is local. It can be as simple. I mean, when we did the Chinese deal, we just hired a process engineer that spoke Chinese specifically because just to understand a bit the subtleties is important. Even bringing in the right Chinese food when they're coming in, and not the Chinese food that we offer the Dutch, for example, is important to do. I think those are the nuances that well, it's important to understand the cultural differences.

Ajay Nair 39:37
Wonderful. Well, we're just about to wrap up. Maybe a last round robin in order to make cross-border business development an art. Just a quick, you know, round robin thoughts from Dr. Kapasi, your side, Alder.

Sabine Kapasi 39:52
Zeros. Do we have another hour?

Ajay Nair 39:55
I'm holding everybody from cocktails, basically. So your thoughts on how to make this more of an art.

Sabine Kapasi 40:01
I think it's about understanding. At the end of the day, it's about understanding the need of a particular region and acting accordingly. What you said about culture is true. Culture and sensitivity begin with need assessment. I think that was the first thing I mentioned earlier as well. So when you understand the need of everything, from the need of the region to the need of the market, to the need of the partners, to the need of the commercial market and commercial partners that you are going with, that is when you build that sensitivity into the ethos of your organization. That is the art that you have to look into.

Jeff Sirek 40:40
Yeah, I think she's nailed it, but I think it's really understanding this is the Colors of Benetton, right? Every country is different. How can you find the right expertise? How do you support that expertise, and how do you build that within your organization? The culture, I think, is really, really important to simplify it.

Pieter Wijffels 40:54
Yeah, so nothing beats a balanced team. And team isn't just your own team. It's also your investors and your partners. If you get that right, then it's easy.

Eliane Schutte 41:04
Yeah, and you need a certain drive. I mean, nothing is ideal, and you always see, you know, it's a rocky ride, always. This certainly if it's outside of your territory. I mean, this is not easy. So don't be naive, or hire the right expertise. Be patient and continue on your journey, right? Eventually, you succeed and listen well.

Ajay Nair 41:22
Well done. Thank you so much for being an amazing panel. Thank you everyone for hanging tight. I know it's been a long day, but you've definitely earned those cocktails. So appreciate your time. Thanks. Applause.