Bioscience is where tech, biology, venture capital, social change and, while we’re at it, the future of humanity converge. I feel privileged in my position as both a Venture Capitalist and a PhD in Biophysics and Synthetic Biology, to share a broad view on the future of Bioscience in the UK, Europe and beyond.
The health of the planet is now a constant conversation. The health of its human population follows closely behind and is perhaps the more optimistic of the two threads. With major advances in biosciences and compute power over the last few decades and the convergence of these technologies, Bio as a sector is primed to drive the next industrial revolution. This will drive seismic shifts across many industries and sectors including energy, materials, pharmaceuticals, chemicals and food as we look to nature to solve some of our existential challenges. Advances emerging from the labs today are not just improvements, they’re paradigm-shifters.
Diseases aren’t just being treated, diseases are being re-engineered and cured at the molecular level. A new biomedical landscape is forming and there are a number of key features and investment implications to this transformation.
Cure, not control
For centuries, medicine has been largely concerned with the symptoms of disease. Chronic illnesses – often the result of modern lifestyles – are dependent on lifetime supplies of drugs. Diabetes, for example, is managed, not cured, with a long-term supply of insulin-managing drugs. Even the common cold is tackled at the runny nose level, rather than the viral.
Our growing understanding of cells, genes and pathologies at the molecular level, is switching us away from symptom management to out-and-out cure. Cell and Gene Therapy (CGT), for example, is a new class of bio-therapeutics that extracts cells, protein or genetic material from the patient (or a donor), genetically alters them, then increases their number before injecting them back into the patient to repair the patient’s own biological system. The implications are huge: cancer, heart disease and AIDS could be not just controlled, but potentially cured by CGT.
There is a catch: the cost of a treatment currently stands at £250,000 to £2m. Many hours of highly technical input by a specialised (i.e., expensive) workforce are required. Unlike scaling a process to produce millions of electronic chips, biology is temperamental and hard to control, let alone scale. Despite this, CGT is a fast-growing market anticipated to reach $25bn.
by 2027. There are currently 1500 clinical trials underway for conditions from haemophilia to Duchenne muscular dystrophy and sickle cell anaemia. In 2018 $1bn in revenues were reached by the first two FDA-approved CGTs (Kymriah from Novartis and Yescarta by Gilead, both approved in 2017) despite lagging sales due to manufacturing issues and capacity.
Ori Biotech, who we invested in last year, is a London-based CGT team with a vision to become the default standard in the industry. The technology they’re developing has the potential to decentralise therapeutic biomanufacturing, ultimately moving the process closer to the patient’s bedside. Ori and companies like them, are on the way to making CGT viable, feasible and accessible to the masses.
Personal, not universal
Treatments, on the whole, have up until now been universal rather than personal. We all take the same range of antibiotics, receive the same chemotherapy drugs, statins and painkillers. But medicine is getting personal. As outlined above, treatments in the CGT field extract then adapt a patient’s, or donor’s, individual cells and genes.
Today’s treatments are tailor-made to a certain extent. Specific combinations of drugs and treatments are used, but tomorrow’s medicine will be bespoke on a different level, combining molecular biology, data science, automation, and ‘omics to treat each patient in a radically unique way. Novel precision diagnostics can provide unprecedented real-time insight into the pathology and physiology of a disease’s progression. The personalised therapeutics will also be responsive in real-time, so rather than administering a course of medication then sitting back and waiting for results, treatment will flex and adapt as it progresses.
Improved access to the human body plays an important part in this. Scans (including MRI and CT) are becoming so sophisticated that intrusive investigative surgery is increasingly bypassed, and advances in liquid biopsies mean that doctors know much better what they’re treating, while patients avoid painful invasive procedures.
New business models
Biologics aside, what kind of market processes are at work here? The move to cure, rather than manage pathologies through lifetime reliance on drugs that make up huge revenue lines for pharma. Humira, for example, an immunosuppressive for conditions such as psoriasis, arthritis and Crohn’s disease, achieved $19.6 billion in sales last year. Therefore, the sector is having to explore novel business models to monetise its therapeutics assets.
The potential is for pharma giants’ deep pockets (deeper even than the tech giants’, who are themselves investing heavily in health tech) to combine with the small but audacious laboratories around the world, fueling the revolution with the large amounts of patient capital and go-to-market expertise and channels needed to get innovations to market. In the future, revenues and profits previously made from lifetime-long treatments may have to be acquired with some kind of subscription model, to fund a one-off cure and we are already seeing interesting activity around value-based therapy pricing.
The issue of cost (these nascent treatments often run into the hundreds of thousands per patient) as relates to access to all levels of society, will no doubt become a major issue. Health and education are two of the most important levellers in society, so the ways in which the new landscape forms will affect us at the societal level.
The market is looking strong for startups in this space, and we have seen strong SPAC, IPO and M&A activity recently: prescription pricing platform, GoodRx’s $12.bn IPO and Illumina’s $8bn purchase of GRAIL being two examples. So far, M&A has been the primary route for large pharma to achieve its edge on innovation. Right now, the top 15 pharmas have a combined $150bn of cash on their balance sheets waiting to be deployed. They are looking to fill the gaps in their future revenues through investment into innovations being driven by university spinouts and startups.
Europe on the rise
The UK’s Bio R&D output in the bio space is second only to the US and China. Where the UK and Europe lag behind is in the translation of its R&D into the real world. However, the last 10 to 15 years have seen a rising entrepreneurial culture in Europe, but more recently also in the Bio space within Europe. Pharma VCs and CVCs such as Merck, Novartis, Sanofi and Unilever are increasingly active at the early-stage level, supporting startups not only with capital but also with unparalleled relevant expertise (such as progressing therapeutics through clinical development) and go-to-market experience within their respective industries.
The big US Bio VCs are also fishing more actively in the European pond. The tough competition we see at Series A onwards from these US funds is a testament to the quality of home-grown R&D output and its increasing strength in translation. Lower prices for talent and lower valuations also account for the US interest, with rumblings that some of them plan to set up offices in Europe.
The funding requirements for Bio far exceed those of regular tech innovation. Seeds of £4m+, Series A of £20-50m and Series B of £100m are typical. This is where the gap in European funding shows as there are very few European funds that can cover cheque sizes that large. This shortfall, in comparison to the stellar Bio R&D coming out of the UK, needs to be addressed, as does the shortfall in European commercial talent in the Bio landscape. As the ecosystem grows and matures, however, these gaps should start to close too.
There’s no question that we’re witnessing giant leaps in what is possible in bioscience. These advances and innovations hold the potential to transform many aspects of healthcare, with enormous benefits to society. Yet they will also reimagine the marketplace itself, with significant implications for funding and revenue structures, and it’s this that will determine how accessible these treatments are to which populations. All of this makes it an exciting time for investors. We just have to make sure that the ultimate end-users (which really, is all of us) receive the ultimate benefits.
By Uzma Choudry, VC investor, Octopus Ventures.