BioSpectrum Aisa March 2023

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Go Digital: To request subscription email: [email protected] Taiwan Media Representative: Ms Christine Wu Image Media Services Company 2F-2, No. 35, Sec. 2, Flushing South Road, Taipei 10665, Taiwan Tel: +886-2-87734199 Fax:+886-2-87734200 Mobile: 886-937890533 E-mail: [email protected] website: www.imagemediatw.com China Erika Cheng RFCOMMS E101, East Lake Villas, 35 Dongzhimenwai Main Street, Dongcheng District, Beijing 100027, P. R. China Mobile: +86 17375668063 E-mail: [email protected] India Apoorva Mahajan Key Account Executive “NITON”, Block B, First Floor, 11/3, Palace Road, Bangalore 560052 Tel: +91-80-41131912/13 Mobile: +91-7724025888 [email protected] Photo: Shutterstock Vol 18; Issue 3; March 2023 Publisher & Managing Editor: Ravindra Boratkar Editorial: Chief Editor: Dr Milind Kokje [email protected] Advisor - Content: Vijay Thombre Editor: Narayan Kulkarni [email protected] Executive Editor: Dr Manbeena Chawla [email protected] Assistant Editor: Nitesh Pillai [email protected] Assistant Editor (Digital): Sanjiv Das [email protected] Asst. Manager Content Creation and Coordination- APAC Region: Hithaishi C. Bhaskar [email protected] Social Media Communications: Ankit Kankar [email protected] CFO & Special Correspondent: Manasee Kurlekar [email protected] Operations and HR: Asmita Thakar [email protected] Production & Design: MM Activ Sci-Tech Communications Anil Walunj Cover Design: Dominix Strategic Design Pvt. Ltd. Business Enquiry: Ankit Kankar [email protected] Subscription Services Print Edition: Saradha Mani [email protected] Digital Edition: Ankit Kankar [email protected] News Letter : Sudam Walekar [email protected] Database Executive: Sudam Walekar Subscription Services: Apoorva Mahajan [email protected] Bio Spectrum Jobs: Poonam Bhosale [email protected] MM Activ Singapore Pte. Ltd. Singapore MM Activ Singapore Pte. Ltd. Saradha Mani General Manager #08-08, High Street Centre, 1 North Bridge Road, Singapore - 179094 Tel: +65-63369142 / Fax:+65-63369145 Mobile: +65-90681202 [email protected] Asia Pacific & South East Asia Ankit Kankar DY. General Manager Digital Intell. & Growth 1st Floor, CIDCO Convention Center, Sector 30A, Vashi, Navi Mumbai, Maharashtra-400703. Mobile: +91-9579069369 [email protected] USA BioSpectrum Bureau MM Activ Sci-Tech Communications Mobile: +91-9579069369 [email protected] Europe BioSpectrum Bureau MM Activ Sci-Tech Communications Mobile: +91-9579069369 [email protected] Printed and published by Ravindra Boratkar on behalf of MM ACTIV Singapore Pte Ltd. Printed at Times Printers Private Limited 16 Tuas Avenue 5, Singapore 639340 Tel : +65-63112888 Reprinted in India for private Circulation Chief Editor: Dr Milind Kokje MCI (P) 020/06/2022 Copyright: MMActiv Singapore Pte Ltd. Acknowledgement/ Feedback Thank you BioSpectrum Asia was carrying ImmunoScape’s article about TCR-based therapeutics that are going to the clinic to combat solid tumours. Our machine learning and deep immunomics have been productive at identifying novel TCRs and we are progressing some of these assets. - Choon-Peng Ng, Singapore Thank you BioSpectrum for the special focus on technology in cancer care in your February edition. The domain of cancer care needs special attention as the global cancer incidence is on the rise. Technology interventions can bring about a reduction in the numbers. It is good to see the issue giving out a lot of valuable information on the advances in cancer technology. - Raja Sekhar Kommu, India Thank you for the excellent article with Anticancer Bioscience in your February edition. There are lots of great ideas and truly brilliant people working in the areas of both basic cancer research and cancer drug development. - Dr Jing Zhang, China 4 BIO MAIL BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com

Letter from Publisher Ravindra Boratkar Publisher & Managing Editor, MD, MM Activ Sci-Tech Communications Pvt. Ltd. Dear Readers, On the occasion of International Women’s Day, greetings to all women who have contributed and are still contributing immensely in different capacities and positions for the development of the life sciences sector. Highlighting the concerns of women’s healthcare, we are covering the trending FemTech space which caters to the much neglected health issues, ranging from menstrual, fertility and wellness linked to hormonal dysfunctions. There is sad news also for the biotechnology sector, as the person who created the scientific base for the entire sector is no more. Noted American Biochemist Paul Berg who invented the recombinant DNA molecule passed away last month at the age of 96. As all in the field are aware that the entire biotechnology became possible due to recombinant DNA. BioSpectrum pays high tributes to Berg. On the occasion of World TB day we have looked into the progress made by Asian countries in eliminating TB and the way forward, as a Cover Piece. This review is important since we observed that the pandemic has had an overarching effect on the TB elimination programme in the southeast Asia region, burdened with 43 per cent of TB patients. Until the pandemic, it was the leading cause of death from a single infection agent. The pandemic-induced disruption to healthcare continues to have a damaging impact on access to TB diagnosis and treatment and the burden of TB disease. Post pandemic, this year has brought about waves of layoffs in the life sciences sector. Pharma companies are reducing their product range, restructuring their HR pyramids and handing out pink slips to employees. Layoffs are likely to be a major issue this year. In India, Sanofi has offered retirement schemes for hundreds of staffers at its two vaccine plants. Our content team has looked into which companies have taken the difficult decision to lay off employees. Another interesting topic covered is the booming Robot-assisted intervention space that is expected to touch $3.47 billion this year. I am sure you will find this edition informative and enriching. Happy reading. Thanks & Regards, Ravindra Boratkar Publisher & Managing Editor 5 BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com Looking for a job? See open roles at www.biospectrumjobs.com n Find Talent n Post Jobs n Attract Candidates Find the right people no matter what your hiring needs are... BIOSPECTRUM TALENT SOLUTIONS premier source of pharma healthcare & bio jobs

HOW PLAUSIBLE IS ENDING TB SCOURGE? Tuberculosis (TB) has been the leading cause of death from a single infectious agent, ranking above HIV/AIDS for a long time. And, presently, Asia Pacific is right in the thick of it. South-eastern Asia (SEA) is home to 26 per cent of the world’s population with a 43 per cent burden of TB incidence, according to the World Health Organisation’s (WHO) global TB report 2021. Over the last three years, countries around the world, including in Asia and the Pacific, have faced double pandemics – COVID-19 and TB. Unfortunately, during this time, progress toward TB elimination stalled and, in some cases, reversed. COVID-19 made it harder for people to access TB diagnostics and care, leading to increases in cases and deaths since 2019. Four countries, India, Indonesia, the Philippines, and Myanmar accounted for most of the estimated increase in TB deaths, globally, in 2021. Not all is lost though. The countries in the region, especially India and Indonesia, have renewed their efforts to eliminate TB. India launched the TB Free India campaign – a plan to eliminate tuberculosis by 2025, five years ahead of the target set by the UN’s sustainable development goals. Indonesia received a $300 million loan from the World Bank to improve coverage, quality and efficiency of TB response in the country. When observing World TB day this year on March 24, let’s take stock of the progress made by Asian countries in eliminating this dreaded disease and the way forward. COVER STORY 19 Can India Eliminate TB by 2025? 24 Dr Shibu Vijayan, Medical Director (Global Health), Qure.ai 6 BIO CONTENT BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com

REGULARS BioMail..................................................................04 Letter from Publisher.........................................05 BioEdit...................................................................08 Policy and Regulatory News.............................09 Finance News......................................................11 Company News ..................................................12 Start-Up News.....................................................14 World News .........................................................16 WHO News...........................................................18 Academics News................................................41 People News........................................................42 R&D News ............................................................46 Supplier News .....................................................48 Lets Talk Health ..................................................50 Scan QR code to access BioSpectrum Asia Digizine BIO CONTENT 7 BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com “We would like to see more investment in women’s healthcare R&D that currently accounts for only 4%” Lindsay Davis, Founder, FemTech Association of Asia 28 WOMEN’S DAY SPECIAL APAC FemTech Space Gains Momentum 26 Femtech Needs to Move Beyond the Uterus in Asia Pacific 30 Reenita Das, Partner, Senior Vice President, Healthcare and Life Sciences Chandni Mathur, Senior Consultant, Healthcare and Life Sciences, Frost & Sullivan ROBOTICS Can Med Tourism Industry hit Goldmine with Robot-assisted Surgery? 32 LAYOFFS The New Pandemic of Layoffs 38

8 BIO EDIT BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com Dr Milind Kokje Chief Editor [email protected] DIMINUTIVE R&D SPENDS The Department of Pharmaceuticals, the Ministry of Chemicals and Fertilizers, government of india has reportedly initiated steps for implementing the budget proposal related to promoting research and innovation in the sector. The department has begun stakeholder consultation to identify the relevant projects. The research and innovation projects are to be implemented through centres of excellence (CoE). Seven such centres are being identified. They will undertake the research once the projects are finalised. The concerned department has started moving immediately after presenting the budget for the implementation of the budget proposals, drawing the government’s urgent attention to the issue. An urgent need for research and innovation in the pharma sector has been felt for quite some time and the entire issue has been deliberated several times on different platforms. India, being the world’s largest generic drugs manufacturer, is now recognised as the generic hub. The Indian generic drugs market was $24.35 billion last year and is expected to grow at little less than 7 per cent till 2028. While India’s share in the global supply volume is 20 per cent, it is third in pharma production by volume and 14th by value, placing the pharma sector in the top five. This status has reduced the country’s trade deficit. Despite its strong presence in generics, India lags in research and innovations for molecules. Following the development of such robust growth and exports of generic products, it is a natural sentiment among the stakeholders that the sector should engage heavily in research and innovation to introduce new original formulations and drugs. To remain competitive, the pharma sector will have to improve R&D for new drugs. Unfortunately, that has not been happening. India spends only 0.7 per cent of its GDP on research as against 2.5 to 3 per cent by several other countries. Investment by private companies is also only 7 per cent which is even less than half of global companies. Its spending on research has stagnated since the last three years. A lack of stable pricing and policy environment is hindering the development of original new medicines. That has created an unclear environment for investments in research and innovation. Second important reason is uncertainty in return on investment, and a high possibility of wastage. Fund constraints and lack of academiaindustry linkage is cited as another reason for poor research and development. Intellectual property rights (IPR) regime is also not considered by the industry as favourable for research. Though the industry experts cite these reasons, it is also necessary to examine by the industry if the complacency set in due to high success of generics is also one reason for lack of initiative in the industry for research. It is a good sign that the government has taken note of the issue and showed its commitment to deal with it. But, while promoting research and innovations by setting CoE, it will have to address the other issues related to pricing, IPR, among others for the private sector’s active involvement. Opening up some of the labs of the Indian Council of Medical Research (ICMR) for research by the private sector also appears to be a good initiative to promote research. While promoting research, some goals will also have to be set like a certain number of molecular entities are launched and a certain number of innovations are also launched each year. Maybe, five-year goals can be set up. For that, some regulatory reforms may also be needed for faster introduction of new products. From its side, the government has initiated the process by announcing various steps. It has even initiated subsequent concrete steps. It appeared that the department even heard views of some experts from the industry on how to go ahead. Now, the industry too needs to plan its aggressive research process. The government can only create an environment and some ecosystem. The results will have to be shown by the industry. Effective cooperation between the both will only deliver desired results.

Singapore-headquartered biopharmaceutical company Specialised Therapeutics (ST) has announced that its portfolio therapy to treat rare soft tissue sarcomas has now been approved in New Zealand. Medsafe has approved the use of YONDELIS (trabectedin) for the treatment of patients with unresectable or metastatic liposarcoma or leiomyosarcoma who received a prior anthracyclinecontaining regimen. YONDELIS (trabectedin) is used extensively around the world and has been shown to improve progression free survival. News of the Medsafe registration has been welcomed by oncologists and the New Zealand sarcoma community, who say it means patients whose disease has progressed will have access to a new line of therapy. YONDELIS is already approved and has been available to patients in the United States since 2015, and in Europe since 2007. It was approved by Australia’s Therapeutic Goods Administration in 2021. It is made available in New Zealand by Specialised Therapeutics Asia under an exclusive license arrangement with international partner PharmaMar SA. REGULATORY NEWS 9 BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com China approves AI software to assess symptoms of Parkinson’s disease Chinese startup NERVTEX’s MoDAS (Movement Dysfunction Assessment Software) system, which is a First-in-Class Artificial Intelligence/Machine Learning (AI/ML)- based Software as a Medical Device (SaMD) for the analysis of motor symptoms of Parkinson’s disease and other movement disorders, has been approved by the China National Medical Products Administration, making it the first video-based AIpowered medical device for the assessment of movement disorders. MoDAS uses consumer-level smart mobile devices to conveniently capture video of the patient’s movement status. By adapting AI technologies such as computer vision and deep learning, MoDAS automatically provides doctors with objective and quantitative information for clinical decision support, relieving doctors from time-consuming observation and evaluation, and greatly improving the evaluation and treatment efficiency of movement disorders such as Parkinson’s disease. Compared to wearable motion sensors, MoDAS effectively avoids the interference of physical devices with human movement, eliminates the time consumed by wearing and disinfecting sensors, and reduces the difficulty and complexity of deployment in medical institutes and primary healthcare services based entirely on video analysis. The Australian government has announced plans to shift from two doses to a single dose of the Gardasil9 human papillomavirus (HPV) vaccine for routine immunisation of young people under the National Immunisation Programme (NIP). The free catch-up programme for young people who have missed vaccination has also been extended from the current 19 years of age to people under 26 years of age. Young people (except those who are immunocompromised) who receive a single dose before 26 years of age are now considered fully vaccinated and don’t need further doses. The change is based on the latest international scientific and clinical evidence which shows a single dose gives comparable protection against HPV infection in healthy young people. It is supported by the government’s expert advisory group, the Australian Technical Advisory Group on Immunisation (ATAGI), the World Health Organisation immunisation expert group and the United Kingdom’s immunisation expert group. Australia moves from two doses to one of HPV vaccine for routine immunisation New Zealand approves globally regarded soft-tissue sarcoma therapy

Qvin, a US-based biotechnology startup, has announced the regulatory (FDA) approval in Thailand for its Q-Pad technology. Thailand has a population of 30 million women aged 15 years and older who are at risk of developing cervical cancer. Cervical cancer is the second leading cause of cancer deaths in women aged 15-44 in Thailand. This approval will make it possible for Thailand residents who menstruate to test for high-risk HPV (human papillomavirus) with Qvin’s Q-Pad this year. The Q-Pad will provide an alternative diagnostic test to the Pap smear, providing an accessible and non-invasive way to screen for HR-HPV. It is a novel menstrual pad used twice during menstruation and will help remove additional barriers from traditional pap smear testing, which can be barbaric, not easily accessible, time-consuming, and expensive. Each Q-Pad includes a removable cotton strip which is sent to a laboratory for clinical testing. Users receive their lab report results in the Qvin app, their healthcare provider, or an appropriately trained outreach worker. The FDA Thailand regulatory clearance was accomplished in collaboration between Qvin, N Health Laboratories and Bangkok Health Research Center (BHRC). Thailand gives nod to Qvin Menstrual Blood Diagnostic Device 10 REGULATORY NEWS BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com Gavi, the Vaccine Alliance, and the Government of India have established a new three-year partnership that aims to reach millions of children in the country with life-saving vaccines. Through the strategic partnership, Gavi will provide $250 million in funding to identify and vaccinate children who have not received a single routine vaccine, strengthen existing health systems and help the country introduce the human papillomavirus (HPV) vaccine and typhoid conjugate vaccine (TCV) into the national routine immunisation schedule. To effectively reach the goal of reducing the number of “zero-dose” children in the country by 30 per cent, 143 priority districts have been identified across 11 states. In the districts where immunisation coverage is low, targeted interventions and strategies will be used to ensure children receive the full course of childhood vaccines. Civil society organisations (CSOs) and nongovernmental organisations (NGOs) will also be engaged to help build stronger demand for vaccines and generate better understanding of the importance of vaccination amongst target communities. Lessons learnt from these engagements will be replicated and expanded to other areas in the country and leveraged to strengthen routine immunisation across the nation. Singapore unveils 2023 action plan for successful ageing Gavi and India join hands to protect children with life-saving vaccines The Ministerial Committee on Ageing (MCA) in Singapore has launched the 2023 Action Plan for Successful Ageing to address the evolving needs and aspirations of current and future seniors. To cater to the greater diversity in experiences, aspirations and needs of Singaporeans, the refreshed Action Plan formulates an extensive set of many ground-up responses towards ageing which involves many people-privatepublic sector initiatives. In the process of developing the measures, the Government has engaged over 5,000 Singaporeans through more than 40 engagement sessions starting in 2019 to co-create the 2023 Action Plan and its new initiatives. To enhance care and support for persons living with dementia and their caregivers, the Ministry of Health (MoH) and its partners adopt a comprehensive approach along five pillars, namely, (1) prevention and awareness; (2) early identification and diagnosis of dementia; (3) empowerment of persons living with dementia to age well in the community and support for their caregivers; (4) development of innovative care models; and (5) capability building through training and education.

FINANCE NEWS 11 BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com South Korea’s Daewoong Pharmaceutical has secured an exclusive licensing agreement with CS Pharmaceuticals, a UK based multinational company focused on the development and commercialisation of rare disease and ophthalmology products in China, for a first-in-class PRS inhibitor Bersiporocin in Greater China region, including mainland China, Hong Kong, Taiwan, and Macau. Under this agreement, CSP will in-license Bersiporocin for Idiopathic Pulmonary Fibrosis (IPF) and potentially other fibrotic indications for a total consideration of up to $336 million, including up to $76 million in upfront and development milestone payments and double-digit royalties on Net Sales. Under the terms of the agreement, Daewoong will grant CS Pharma exclusive development and commercialisation rights to Bersiporocin in IPF and other respiratory indications. Bersiporocin is a first-in-class antifibrotic agent that is being developed by Daewoong. SK bioscience invests $261M to establish vaccinebiopharma hub in Korea SK bioscience, a South Korea-based innovative vaccine and biotech company committed to promoting human health from prevention to cure across the globe, has officially decided to initiate the establishment of the Songdo Global Research & Process Development Centre (The R&PD Centre). The establishment of the R&PD Centre will be proceeded on a 30,413.8 sq site in Songdo, Republic of Korea with a total investment of $261 million (325.7 billion KRW), including the previous investment of $33 million (41.9 billion KRW). Once the establishment of the R&PD Centre is completed in the first half of 2025, the headquarters and the R&D centre currently located in Pangyo will move to Songdo area. SK bioscience aims to secure the newest technologies covering the entire process from basic research to commercial manufacturing and to ultimately create a global vaccine ecosystem to preemptively respond to new infectious diseases through the establishment. To achieve the goal, SK bioscience plans to operate the ‘Open Lab’ in the R&PD Centre to strengthen a global vaccine network. The Open Lab will be utilised as a joint research space for international organisations and biopharmaceutical companies around the world to develop new vaccines together with SK bioscience. Bengaluru-based digital healthcare firm MediBuddy has acquired the ‘vHealth by Aetna’ business (Indian Health Organisation or IHO). ‘vHealth by Aetna’ is a leader in the B2B healthcare space and offers subscription-based primary healthcare services such as telehealth consultations, an extensive outpatient network, pharmacy, diagnostics and dental among other benefits to customers. Aetna is one of the leading diversified health care benefits companies in the US. Over the next six months, ‘vHealth by Aetna’ business will transition to be rebranded as ‘MediBuddy vHealth’. The existing IHO management team and employees across all functions will continue to be employed by IHO, which is now part of MediBuddy. Both the existing and new subscriber base of ‘vHealth by Aetna’ will have access to MediBuddy’s technology and scale prowess, leading to an enhanced customer experience. The latest acquisition will bring on board ‘vHealth by Aetna’s’ customers to MediBuddy’s platform further strengthening the existing customer base of 30 Mn+. MediBuddy recently concluded its merger with DocsApp and the company raised $125 million in a Series C funding in the first quarter of 2022. MediBuddy acquires India health business of US-based Aetna Daewoong inks $336M deal with CS Pharma for Idiopathic Pulmonary Fibrosis treatment

12 COMPANY NEWS BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com AcuraBio partners with Cytiva to expand cGMP plasmid DNA CDMO services AcuraBio, a leading Australian biopharmaceutical contract development and manufacturing organisation (CDMO), will provide a cGMP plasmid DNA CDMO service to the world using Cytiva’s new process platform technology. AcuraBio expects to produce more plasmid DNA for its customers around the world using Cytiva’s latest bacterial plasmid two-step purification protocol. The new protocol features single-use purification technology which delivers efficiency, high purity level outcome and sustainable process. According to Guillaume Herry, Chief Executive Officer (CEO), AcuraBio, the company intends to bring biotechs and biopharma companies a more high-quality plasmid DNA quicker than before to help the development of new therapies such as viral vectors and mRNA. Clover Biopharma launches COVID-19 booster vaccine in China Clover Biopharmaceuticals has announced that the launch of its COVID-19 vaccine, a recombinant SARS-CoV-2 subunit vaccine, in China has begun with the first doses delivered and administered in Changxing, Zhejiang as part of China’s national second booster dose (fourth vaccination dose) campaign targeting older adults, immunocompromised individuals and individuals with comorbidities. Clover’s COVID-19 vaccine was authorised for emergency use in China in December 2022. Subsequently, the China National Health Commission formally announced its national immunisation plan for a second booster dose campaign and recommended prioritising specified vaccines that demonstrate broad neutralisation against Omicron, including Clover’s, for use. In a global Phase 2/3 clinical trial with over 30,000 participants across five countries, Clover’s COVID-19 vaccine achieved 100 per cent efficacy against severe COVID-19 and hospitalisation caused by all strains of SARSCoV-2 circulating during the trial. In addition to Zhejiang province, Clover has started launch preparation activities in multiple strategically prioritised provinces and municipalities where it expects additional launches in Q1 2023. UK-based Oxford Nanopore Technologies has announced an extension of its collaboration with US-based UPS Healthcare to accelerate the delivery of Oxford Nanopore DNA/RNA sequencing products and consumables across the Asia Pacific region. The collaboration will strengthen Oxford Nanopore’s portable, real-time DNA sequencing devices’ supply chain throughout Asia’s main markets. By tapping on UPS’s specialised healthcare logistics solutions, Oxford Nanopore’s customers will enjoy faster delivery with less complexity, removing many customer pain points and leaving more time to pursue highimpact, time- sensitive genomics research and discovery in areas such as human disease, cancer, and agriculture. Oxford Nanopore’s flow cells will be stored in UPS Healthcare’s temperaturecontrolled distribution facility in Singapore for the first time and be delivered within 24- to 48- hours through UPS’s cold chain distribution capabilities to destinations across the Asia Pacific. Oxford Nanopore will also tap on UPS Premier’s premium tracking, prioritisation, and recovery service for its time- and temperature-sensitive shipments. Oxford Nanopore enhances access of new-gen DNA sequencing across APAC

COMPANY NEWS 13 BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com Taiwan-based Formosa Pharmaceuticals has entered into a collaboration agreement with US-based Eyenovia, for the development of novel ophthalmic therapeutics. The foundation of the collaboration lies in the combination of Formosa’s APNT formulation platform with Eyenovia’s Optejet delivery system. Eyenovia’s Optejet delivery platform for ocular therapeutics utilises Microdose Array Print (MAP) technology to deliver 6-8 microliters of drug product, consistent with the capacity of the tear film of the eye. At less than 20 per cent volume of that delivered by conventional eyedroppers, Optejet reduces the risk of overdosing and unnecessary drug exposure. Furthermore, the Optejet action is both rapid and gentle, ensuring efficient and comfortable delivery to the ocular surface. Formosa’s proprietary APNT formulation platform improves dissolution and bioavailability of active pharmaceutical ingredients via a mild and efficient particle size reduction technique optimised for topical, oral, or inhaler administration routes. Formosa Pharma inks agreement with Eyenovia for new ophthalmic therapies Eli Lilly ensures patient access to high-quality affordable insulin in Bangladesh American pharmaceutical firm Eli Lilly and Company will supply its active pharmaceutical ingredient (API) for human insulin at a reduced price to International Agencies (Bangladesh) Ltd. (IABL) in an effort to increase patient access and improve affordability for high-quality insulin for nearly one million people living with diabetes in Bangladesh by 2030. IABL will formulate, fill and finish human insulin vials and cartridges under its own trademark and brand name by 2025. The IABL-produced insulin will be exclusively for the Bangladesh market. In December 2022, Lilly announced an agreement with EVA Pharma to enhance sustainable access to affordable insulin in 56 low- and middleincome countries, mostly in Africa. Both are part of Lilly’s 30x30 initiative, which aims to improve access to quality healthcare for 30 million people living in limited-resource settings, annually, by 2030. These collaborations are in line with the private sector asks in the World Health Organisation’s Global Diabetes Compact, a global initiative to support countries in implementing effective programs for the prevention and management of diabetes. Google Cloud, Accenture, and the Integrated Health Information Systems (IHiS) in Singapore have announced a collaboration to enhance population health, delivery of care, and patient engagement. The three companies have established an agile and advanced architecture, supported by application programming interfaces (APIs), to make data, applications, and services securely and readily available, when and where they are needed. As the technology agency for Singapore’s public healthcare sector, IHiS has adopted an API-first approach to facilitate data capture across healthcare systems and partners with healthcare providers to deliver analytics tools and mobile applications that are used by healthcare staff and patients. Under a multiyear agreement, IHiS is tapping Accenture’s expertise to deploy Apigee, Google Cloud’s API management platform. Apigee helps to unlock data and services across the systems managed by IHiS, which can then be accessed by developers to create new applications and capabilities. Singapore taps Accenture, Google to drive open and secure healthcare ecosystem innovation

CARsgen Therapeutics Holdings, a biopharmaceutical startup based in the US and China, has announced collaboration agreement with F. Hoffmann-La Roche to evaluate CARsgen’s investigational drug AB011, the first humanised monoclonal antibody against Claudin18.2 (CLDN18.2) that received IND clearance globally, in combination with atezolizumab, Roche’s PD-L1 checkpoint inhibitor, along with standard-of-care chemotherapy in patients with gastric or gastroesophageal junction carcinoma. Under the terms of the agreement, Roche will be responsible for operation and conduct of the trial while both companies co-share the costs of the AB011 treatment arms in the study. As part of the clinical collaboration, CARsgen’s proprietary CLDN18.2 IHC test kit, which showed excellent specificity and sensitivity profiles, will be applied to evaluate CLDN18.2 expression in gastric cancer patients. The co-funded study of AB011 in combination with atezolizumab will be conducted as part of Roche’s Morpheus Platform. The Morpheus Platform is a collection of Phase Ib/II clinical trials in multiple cancers with high unmet clinical needs including gastrointestinal cancer, designed to assess the safety and early efficacy to enable more rapid and efficient development of novel cancer treatment combinations. Guardant Health strengthens partnership with Lunit to enhance cancer biomarker detection CARsgen partners with Roche for gastric cancer treatment 14 START-UP NEWS BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com South Korea-based startup Lunit, in partnership with leading precision oncology company Guardant Health in the US, has announced the integration of its artificial intelligence (AI)-based PD-L1 scoring algorithm into Guardant’s testing workflow to enhance biomarker detection in the Guardant360 TissueNext PD-L1 test for non-small cell lung cancer (NSCLC). The newly integrated algorithm will enable Guardant to offer augmented biomarker assessment for NSCLC patients through AI-based quantification of tissue samples using a scoring system generated by Lunit SCOPE PD-L1. The enhanced Guardant test is designed to support pathologists in diagnosing PD-L1 status with higher accuracy and efficiency. Through the AI software, the test showed improved detection of PD-L1 by more than 20 per cent compared to manual pathologist interpretation in the most challenging cases in NSCLC. Lunit SCOPE PD-L1 is a CE-marked AI solution for detecting and analysing PD-L1, a cancer biomarker. Griffith University partners with health tech accelerator programme Griffith University in Australia has committed to a three-year partnership with a leading health technology accelerator programme based within the Gold Coast Health and Knowledge Precinct. The LuminaX Healthtech Accelerator is a 14-week innovation programme that fast-tracks commercialisation and market-readiness for up to 10 Australian health technology startups each year. Cohort Innovation Space, one of Queensland’s largest innovation spaces and a centrepiece of the Gold Coast Health and Knowledge Precinct, launched LuminaX in 2021. Under the agreement, startups who are chosen through a national competitive process, will be mentored by Griffith’s globally regarded health and science academics and access the university’s cutting-edge research facilities and resources. Since 2021, LuminaX has accelerated 21 Australian startups with $1.2 million in direct capital through its VC partners and mentors network, provided connections to over 200 clinicians and experts, linked 9 startups with access to clinical trials and research projects, and supported raising another $2 million post programme.

US-Vietnam collaboration to improve efficiency in radiology reports US-based Stanford University and Vietnamese startup VinBrain have signed a Data Use Agreement (DUA) to improve the precision of radiology interpretation using a multi-modal “RadGraph” method. To design a state-of-theart artificial intelligence (AI)-enabled platform for more accurate diagnosis and treatments, a tremendous amount of geographically distributed data, medical images, and patient medical records are required for system training. The DUA grants Stanford University and VinBrain the collaborative power to improve efficiency in radiology reports and advance AI in healthcare by sharing relevant de-identified data for model training and testing, while tackling complexity, ambiguity, and limitations in medical image interpretation. Starting with 240,000 anonymised medical images and report pairs provided by Stanford through this DUA, VinBrain will work to improve the accuracy of the RadGraph method through a research collaboration with Stanford to extract clinical entities and relation annotations from a large dataset of full-text radiology reports. START-UP NEWS 15 BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com SwipeRx has secured $10 million in fresh funds as part of a new Series B2 round. This round marks investments from marquee investors such as global pharma Sanofi’s Global Health Unit and Cercano Management (formerly Microsoft co-founder Paul Allen’s Vulcan Capital). Existing investors Susquehanna International Group (SIG), Johnson & Johnson and Patamar Capital also participated. The firm had announced the raise of its $27 million Series B round in May 2022. The prior Series B round was led by Indonesia’s MDI Ventures with participation from other global investors, including the Bill & Melinda Gates Foundation, Johnson & Johnson Impact Ventures, SIG and other existing investors. With the fresh funds raised, SwipeRx will expand its Business to Business (B2B) commerce platform for the pharmaceutical industry in key markets. The firm will also use the proceeds to invest in specialised healthcare logistics and financing, further grow its pharmacy network in these key markets and strengthen its advanced data teams. SwipeRx secures $37M to accelerate B2B pharmacy platform across SEA Anthill Ventures, an Indiaheadquartered startup accelerator fund and growth ecosystem, and SparkLabs, a renowned global network of startup accelerators and venture capital funds, have announced a strategic partnership to enhance the growth of Korean and Indian startups. With this partnership, both companies aim to bring together co-investment opportunities along with worldclass mentorship, resources, and business expansion opportunities for technology-based startups from India and Korea in the Healthcare, Urban Tech, Media tech, and Urban Lifestyle fields. SparkLabs has demonstrated its strengths over the past 10 years by hosting demo days and executing differentiated investment strategies. Based on its market experience and research, SparkLabs will analyse the barriers for Indian startups in the Korea market. On the other hand, Anthill with its vast network of corporates and investors in India will be the gateway for Korean startups to the Indian market. Anthill and SparkLabs to boost growth for Indian and Korean startups

Screening tool aims to help doctors diagnose more people with COPD A new tool shows promise in helping primary care physicians identify adults with undiagnosed chronic obstructive pulmonary disease (COPD), according to research published in JAMA. More than 15 million(link is external) Americans have been diagnosed with COPD, a leading cause of death in the United States, and experts predict millions more have it but don’t know it. The COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease & Exacerbation Risk (CAPTURE), developed with support from the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, was designed to identify adults with COPD symptoms severe enough to treat, but who haven’t received a diagnosis(link is external). After a multi-year-long clinical trial, researchers found CAPTURE successfully identified almost half of participants who had moderate to severe forms of previously undiagnosed COPD. Conducted at seven US clinical research network centers from October 2018 to April 2022, the trial involved 4,325 adults, ages 45-80. By the end of the study, researchers discovered that 110 participants, 2.5 per cent of the study sample, had moderate to severe forms of COPD. The US Department of Health and Human Services (HHS), through the Administration for Children and Families (ACF), is announcing the launch of the new National Early Care and Education Workforce Center (the ECE Workforce Center). The ECE Workforce Center is the result of a $30 million investment to support research and technical assistance for states, communities, territories, and Tribal Nations to improve the recruitment and retention of a diverse and qualified workforce across early care and education programs. As of early 2020, the child care sector has lost almost 80,000 jobs, or about 7.5 percent of its workforce, due to the COVID-19 pandemic. Many organizations that provide early care and education services today say it is difficult to locate skilled candidates to fill vacancies. At the same time, a significant percentage of early care and education workers, who are overwhelmingly women and often have children of their own, live in poverty. HHS Launches the First National Early Care and Education Workforce Center Since December 2022, the Global Fund has awarded $547 million in additional funding to 40 countries through its COVID-19 Response Mechanism (C19RM) and has now initiated the process to award a further $320 million, making a total of approximately $867 million. These grants are focused on supporting both the immediate COVID-19 response and broader pandemic preparedness, while strengthening the underlying health systems. This includes investments in disease surveillance, laboratory networks, community health worker networks and community-based organizations, medical oxygen and respiratory care systems, as well as the rollout of novel therapeutics to scale up testand-treat programs in case of future COVID-19 surges. These investments reflect the deliberate rebalancing of C19RM from the immediate COVID-19 response towards strengthening key components of health systems to counter potential future variants and reinforce pandemic preparedness. The total awarded for C19RM since 2020 now amounts to almost $5 billion. The Global Fund’s C19RM follows a countryled, inclusive, and demand-driven approach to ensure funding goes where it is most needed. Global Fund provides $867M in additional funding for pandemic preparedness and response 16 WORLD NEWS BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com

Japan & Kenya develop biometric-based vaccination management system for newborns Kenya Medical Research Institute (KEMRI), NEC Corporation (NEC) and Nagasaki University, Japan, have developed a digital biometric-based vaccination management system for newborn children in Kenya. Validation of this system is taking place through KEMRI with a clinical trial that began in September 2022 at the Kinango Sub-County Hospital in Kwale and initial results are very encouraging. The digital system being provided by NEC, a leader in the integration of IT and network technologies, and KEMRI, one of Africa’s leading research Institutions, will effectively and seamlessly manage vaccination history and scheduling using fingerprint identification for newborn children and voice recognition for caregivers. This technology marks the first time that biometric identification is being used at a hospital to identify newborn children at the time of vaccination, including those immediately after delivery. As of November 2022, data from more than 300 caregivers and newborns had been registered, including the vaccination histories of more than 150 newborns. WORLD NEWS 17 BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com New funding to expand efforts towards sleeping sickness elimination in African nations CEPI collaborates to advance tools for Sudan ebolavirus vaccine research On World Neglected Tropical Disease (NTD) Day, FIND, the global alliance for diagnostics, together with the French National Research Institute for Sustainable Development (IRD) and the Liverpool School of Tropical Medicine (LSTM), announced an award of nearly $6.8 million from the Bill & Melinda Gates Foundation to extend the work of the Trypa-NO! partnership for a further three years. The Trypa-NO! partnership supports the elimination of the gambiense form of human African trypanosomiasis (HAT), also known as sleeping sickness. To date, the Trypa-NO! partnership has supported Côte d’Ivoire and Uganda to achieve elimination as a public health problem. In addition, the partnership has been working with Chad and Guinea, both of which are on track to achieve this milestone soon. The new funding will ensure that each of these four countries has a sustainable, long-term strategy to independently monitor the disease and achieve full interruption of transmission. The Coalition for Epidemic Preparedness Innovations (CEPI) is supporting the development of an international antibody standard against Sudan ebolavirus (SUDV) – a critical tool which will be used to assess and compare the performance of vaccines against the deadly disease responsible for a recent outbreak of Ebola disease in Uganda which was declared on January 11, 2023. CEPI is providing funding of $562,000 to established implementing partners Integrum Scientific and the Department of Arbovirology, Emerging and Re-emerging Infectious Diseases at the Uganda Virus Research Institute (UVRI) to collect and test convalescent sera from people previously infected with SUDV. These samples will enable the development of, and global access to, an international antibody standard which would standardise assessment of vaccine candidates against the virus. This could contribute to the eventual licensure of vaccines against the disease, for which there are currently no authorised vaccines or therapeutics. In its role as a global convenor of R&D for vaccines against emerging infectious diseases, CEPI is collaborating with international partners to bring the antibody standard to fruition.

WHO publishes two landmark documents on leishmaniasis The World Health Organisation (WHO) has released a new Global Breast Cancer Initiative Framework providing a roadmap to attain the targets to save 2.5 million lives from breast cancer by 2040. The new Framework recommends to countries to implement the three pillars of health promotion for early detection, timely diagnosis and comprehensive management of breast cancer to reach the targets. There are more than 2.3 million cases of breast cancer that occur each year, which make it the most common cancer among adults. The newly published framework leverages proven strategies to design countryspecific, resource-appropriate, health systems for the delivery of breast-cancer care in lowand middle-income settings. It outlines three pillars of action with specific key performance indicators: 1. Recommending countries to focus on breast cancer early-detection programmes so that at least 60% of the breast cancers are diagnosed and treated as early-stage disease. 2. Diagnosing breast cancer within 60 days of initial presentation can improve breast cancer outcomes. Treatment should start within three months of first presentation. 3. Managing breast cancer so that at least 80% of patients complete their recommended treatment. Accelerating the implementation of WHO’s Global Breast Cancer Initiative has the potential to avert not only millions of avoidable female cancer deaths but also the associated, intergenerational consequences of these deaths. World Health Organisation releases new Global Breast Cancer Initiative Framework Launch of global individual patient data platform for tuberculosis treatment The World Health Organisation (WHO) has announced the publicly accessible global individual patient data (IPD) platform for tuberculosis treatment (TB-IPD), an initiative that will increase the knowledge base for normative guidance on optimal treatment modalities for tuberculosis (TB) and stimulate TB research. This secure platform already contains individual records with treatment outcomes of over 5,000 TB patients with commitments from additional data contributors to increase this number to up to 50,000 during 2023 including data on TB treatment in children and pregnancy. The TB-IPD platform provides a powerful opportunity for learning and advancement of the field of TB treatment. Requests for access to data from, or to contribute more data to the TB-IPD platform can be made as of today by following the processes described on the TB-IPD platform website. 18 WHO NEWS BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com In its global efforts to control the impact of leishmaniases, the World Health Organisation (WHO) has published for the first time two key guidance documents for programmes and researchers: a report of a multi-centre laboratory study and WHO expert consultations on determining discriminating concentrations of insecticides for monitoring resistance in sand flies, and an operational manual on leishmaniasis vector control, surveillance, monitoring and evaluation. Leishmania parasites are transmitted through the bites of infected female phlebotomine sand flies, which feed on human blood to produce eggs. The operational manual provides practical tools, techniques and procedures to strengthen sand fly control and surveillance in order to improve the implementation of leishmaniases control programmes. The manual provides a rationale for programme managers in different geographical regions on the types of vector control interventions to be used in different epidemiological and environmental settings & how to measure their impact. Its scope also includes concepts of vector surveillance, methods & procedures, & policy considerations for insecticide resistance monitoring & management.

HOW PLAUSIBLE IS ENDING TB SCOURGE? Tuberculosis (TB) has been the leading cause of death from a single infectious agent, ranking above HIV/ AIDS for a long time. And, presently, Asia Pacific is right in the thick of it. South-eastern Asia (SEA) is home to 26 per cent of the world’s population with a 43 per cent burden of TB incidence, according to the World Health Organisation’s (WHO) global TB report 2021. Over the last three years, countries around the world, including in Asia and the Pacific, have faced double pandemics – COVID-19 and TB. Unfortunately, during this time, progress toward TB elimination stalled and, in some cases, reversed. COVID-19 made it harder for people to access TB diagnostics and care, leading to increases in cases and deaths since 2019. Four countries, India, Indonesia, the Philippines, and Myanmar accounted for most of the estimated increase in TB deaths, globally, in 2021. Not all is lost though. The countries in the region, especially India and Indonesia, have renewed their efforts to eliminate TB. India launched the TB Free India campaign – a plan to eliminate tuberculosis by 2025, five years ahead of the target set by the UN’s sustainable development goals. Indonesia received a $300 million loan from the World Bank to improve coverage, quality and efficiency of TB response in the country. When observing World TB day this year on March 24, let’s take stock of the progress made by Asian countries in eliminating this dreaded disease and the way forward. COVER STORY 19 BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com

20 COVER STORY BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com Despite countries making bold commitments to end TB by 2030, in the Sustainable Development Goals, the WHO End TB Strategy and the 2018 political declaration on the fight against TB, the epidemic shows no sign of slowing down. In 2021, approximately 10.6 million people fell sick with TB, and 1.6 million died. Drugresistance continues to be a major problem with close to half a million people developing drug-resistant TB every year. The burden of drug-resistant TB (DR-TB) also increased by 3 per cent between 2020 and 2021, with 450 000 new cases of rifampicin-resistant TB (RRTB) in 2021.This is the first time in many years an increase has been reported in the number of people falling ill with TB and drug resistant TB. According to Global TB Report 2022, the reported number of people newly diagnosed with TB fell from 7.1 million in 2019 to 5.8 million in 2020. There was a partial recovery to 6.4 million in 2021, but this was still well below pre-pandemic levels. Reductions in the reported number of people diagnosed with TB suggest that the number of people with undiagnosed and untreated TB has grown, resulting first in an increased number of TB deaths and more community transmission of infection and then, with some lag-time, increased numbers of people developing TB. The report notes a decline in global spending on essential TB services from $6 billion in 2019 to $5.4 billion in 2021, which is less than half of the global target of $13 billion annually by 2022. As in the previous 10 years, most of the funding used in 2021 (79 per cent) was from domestic sources. The WHO report reiterates its call for countries to put in place urgent measures to restore access to essential TB services. It further calls for increased investments, multisectoral action to address the broader determinants that influence TB epidemics and their socioeconomic impact as well as the need for new diagnostics, drugs and vaccines. The adverse impact of the COVID-19 pandemic on TB services has brought the urgency of vaccine development efforts into sharp focus. WHO, on January 17, announced plans to establish a new TB Vaccine Accelerator Council that will facilitate the licensing and use of effective novel TB vaccines catalysing high-level alignment between funders, global agencies, governments and end users in identifying and overcoming barriers to TB vaccine development. Currently, BCG is the only licensed TB vaccine. While it provides moderate efficacy in preventing severe forms of TB in infants and young children, it does not adequately protect adolescents and adults, who account for close to 90 per cent of TB transmissions globally. A recent WHO commissioned study, An investment case for new TB vaccines estimates that, over 25 years, a vaccine that is 50 per cent effective in preventing disease among adolescents and adults could avert up to 76 million new TB cases, 8.5 million deaths, 42 million courses of antibiotic treatment and $ 6.5 billion in costs faced by TB affected households, especially for the poorest and most vulnerable. A vaccine that is 75 per cent effective could avert up to 110 million new TB cases and 12.3 million deaths. The study further suggests that every $1 invested in a 50 per cent effective vaccine could generate an economic return of $7 in terms of averted health costs and increased productivity. As a quarter of the world’s population is infected with TB, and, centred on WHO and the UN (United Nations) for funds, experts are pursuing the ambitious goal of ending TB by 2030. Majority of the countries in Asia have a national TB elimination programme. Let’s look at what these are and what the status of these programmes is. Progress so far India India carries one-fourth of the global TB burden and in 2021 notified 21 lakh TB cases. The government of India has developed the National Strategic Plan 2017-2025, which outlines approaches to eliminate TB by 2025. The plan has been divided into the four strategic pillars of Detect – Treat – Prevent – Build (DTPB). The Indian government claimed that the overall notification of TB cases has improved by 55 per cent over the last 6 years. In September 2022, India launched the Pradhan Mantri TB Mukt Bharat Abhiyaan. This has been envisioned to bring together all community stakeholders to support those on TB treatment and accelerate the country’s progress towards TB elimination. The country also launched the Ni-kshay Mitra initiative to ensure additional diagnostic, nutritional, and vocational support to those on TB treatment and encourage elected representatives, corporates, non-profits, and individuals to come forward as donors to help the patients complete their journey toward recovery. The programme has added 3,760 NAAT (A Nucleic Acid Amplification Test) machines across the nation until 2021, building on Universal Drug Susceptibility Testing (UDST) for all diagnosed TB cases, to ensure that patients are diagnosed with

COVER STORY 21 BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com “As the largest international funder for TB programmes, the Global Fund is a critical partner in helping to achieve the goal of ending TB by 2030. At all levels of our action, we need to better include young people, in all their diversity, and facilitate youth-led action at global and national level to ensure that their ideas and perspectives are better reflected in the TB response.” - Dr Eliud Wandwalo, Head of Tuberculosis Programmes, the Global Fund “There is an urgent need to refocus global, regional and national attention back to TB, restore access to essential TB services, and increase investment in new diagnostics, drugs and vaccines. We are seeing promising diagnostic and treatment innovations but too often they do not reach the people who need them.” - Hema Srinivasan, MedAccess’ Chief Access Officer, UK. “Considering past experiences in antibiotics development, we will need at least three drug combinations with novel distinct mechanisms of action (MoA). There are three new drugs in two classes (bedaquiline and delamanid/ pretomanid) developed since 2010 with novel MoA. But there has not been ground breaking change in terms of regimen development since we are still short of new MoA drugs to make up the universal regimen.” - Dr Kiyean Nam, CEO, Qurient, Korea drug-resistant TB at the outset and are promptly placed on appropriate treatment regimens. The programme also launched initiatives to involve the communities and form a Jan Andolan against TB. More than 12,000 TB champions have been chosen through the initiative to support patients in receiving care and to reach out to the disadvantaged and marginalised. In order to enable dialogues between patients, clinicians, and their carers about common concerns in treatment, the initiative is also encouraging the formation of Patient Support Groups (PSGs). The country plans to start sentinel surveillance for drug resistant TB using whole genome sequencing (WGS). Indonesia Indonesia is the third largest contributor to the global TB cases. In 2021, the country contributed around 9 per cent of the total 10.6 million new TB cases worldwide. The current National Strategy of TB Care and Prevention in Indonesia 2020-2024 aims to accelerate the TB elimination efforts in Indonesia by 2030 and to end it by 2050. On December 19, 2022, the World Bank approved a $300 million loan to the Indonesian government to improve coverage, quality and efficiency of TB response. The first area is strengthening Indonesia’s subnational TB response, such as case finding, treatment coverage, and timely response, and the performance in this area will be linked to a fiscal transfer. The second is strengthening TB response among primary health providers, including private healthcare providers. The third is enhancing digital systems for TB and well-informed policies through creating an ecosystem aimed at minimising the reporting burden and improving data availability and reliability. In April 2022, to support the reduction of TB, the country’s health minister prioritised the revision of national tobacco control regulation, with the goal to reduce the prevalence of one of TB’s largest risk factors – smoking. In November 2022, the health minister urged all the stakeholders to find 60,000 cases of TB on a monthly basis in 2023 in order to eliminate TB by 2030. This is aimed at boosting the rate of TB screening that is currently still low in the country. The Philippines The Philippines accounts for 11 per cent of global TB cases, with an estimated 591,000 new TB cases emerging every year. Over the years, efforts have focused on TB treatment, testing, and diagnosis, but

22 COVER STORY BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com prevention has been neglected. From 2018 through 2020, TB preventive treatment (TPT) coverage declined from 11 to 2 per cent The Philippines reacted quickly to COVID-19 and developed a strong comprehensive TB adaptive plan. Home-based testing and treatment had a big impact. Mass TB screening at key locations such as COVID-19 testing sites and vaccination sites to reach as many people as possible also helped. In August 2021, Philippine Business for Social Progress (PBSP), the nation’s largest business-led NGO, signed a Memorandum of Agreement (MoA) with provincial and local government units, health facilities, and TB partners nationwide. Through the ACCESS TB Project, PBSP will provide technical support, purchase drugs and diagnostics, provide laboratory equipment and supplies, and supply. The Global Fund allocated another $35.5 million to support and mitigate COVID-19 effects to the TB programme. Vietnam Vietnam has made significant progress in its commitment to end TB by 2030. However it is estimated that 170,000 people become sick from TB in Vietnam, but only around 100,000 are accounted for in the National TB system, leaving around 50,000 community TB cases undiagnosed, and the remaining 20,000 diagnosed but not reported. In 2019, Vietnam developed the national action plan to end TB by 2030. In 2020,the United States Agency for International Development (USAID) and the Vietnam National TB Program (NTP) expanded the Ministry of Health/NTP’s Double X Strategy for TB case identification, with the goal of ending TB in Vietnam by 2030. Double X is a new strategy to diagnose TB using chest X-rays and GeneXpert, a diagnostic method that detects TB bacteria. New drugs in development There’s a lack of new research and drug development for TB. BCG, (which is almost 100 years old) is currently the only licensed TB vaccine. While it provides moderate efficacy in preventing severe forms of TB in infants and young children, it does not adequately protect adolescents and adults, who account for close to 90 per cent of TB transmissions globally. To boost vaccine development for the disease, On January 17, 2023, WHO announced plans to establish a TB Vaccine Accelerator Council. The Council will facilitate the licensing and use of effective novel TB vaccines catalysing high-level alignment between funders, global agencies, governments and end users in identifying and overcoming barriers to TB vaccine development. The University of Sydney and The Centenary Institute, together with collaborators have been awarded an AU$19 million contract from the National Institute of Allergy and Infectious Diseases, part of the US National Institutes of Health (NIH), to develop the next generation of TB vaccines. Multidrug combination therapy is the standard for TB treatment, so it is not used alone, but at least three tuberculosis drugs must be used together. Patients have to take a cocktail of antibiotics, and even the easiest-to-treat form of the disease, drugsensitive TB, takes six months of treatment and ongoing clinical monitoring. In August 2022, Project to Accelerate New Treatments for Tuberculosis (PAN-TB) collaboration announced the execution of a joint development agreement (JDA) supporting the progression of two investigational TB combination treatment regimens into phase 2 clinical development. The collaboration will evaluate whether the novel regimens, which combine registered products and new chemical entities (NCEs), can effectively treat all forms of active pulmonary TB using substantially shorter treatment durations than existing drug regimens, with the goal of identifying a regimen suitable for phase 3 development. However, one of the biggest roadblock is the increasing prevalence of multidrug resistance (MDR) and extremely-drug resistant (XDR) strains of Mtb. The WHO reported that Rifampicin resistant TB cases are increasing yearly, reaching over 70 per cent of TB cases in 2021. Because of this, the development of novel effective therapeutics is necessary to combat treatment times and drugresistance. “Compounds such as the first-in-class drug candidate Telacebec (Q203), which show activity “Currently, IPK is developing new models of infection to better study the immune regulation of both active and latent TB infection. We hope to identify new pathways and targets which can be applied to the in-house candidate drug screening programmes run by IPK. “ - Dr Connor Wood, Head of Tuberculosis Research Lab, Institut Pasteur Korea (IPK)

COVER STORY 23 BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com against MDR- and XDR-TB strains can be used in new regimens for patients presenting with infections that are resistant to established therapeutics. The Q203 was identified by Institut Pasteur Korea and licensed out to the institute’s spin-off bio venture, Qurient, Co. Ltd. for further development. Recently, Telacebec was licensed out to the TB Alliance after successfully completing Phase IIa clinical trial, increasing hopes for TB elimination. Currently, IPK is developing new models of infection to better study the immune regulation of both active and latent TB infection. We hope to identify new pathways and targets which can be applied to the in-house candidate drug screening programmes run by IPK, “ said Dr Connor Wood, Head of Tuberculosis Research Lab, Institut Pasteur Korea (IPK). Singapore scientists developed a series of chemical-based compounds against MDR-TB. US-based Neuro-Horizon Pharma licensed those promising compounds from NTU Singapore. Additionally, in December 2022, the WHO released guidance on introducing a landmark treatment regimen for drug-resistant TB that will improve treatment outcomes and quality of life for thousands of people around the world. “Considering past experiences in antibiotics development, we will need at least three drug combinations with novel distinct mechanisms of action (MoA). There are three new drugs in two classes (bedaquiline and delamanid/pretomanid) developed since 2010 with novel mechanisms of action. But there has not been ground breaking change in terms of regimen development since we are still short of new MoA drugs to make up the universal regimen. With new drug candidates like telacebec on the horizon the universal regime is not out of reach,” said Dr Kiyean Nam, CEO, Qurient, Korea. The way forward TB is curable and treatment options are available, then why does it remain a global problem and is still not yet defeated? “There are several road-blocks on the path to defeating TB, including diagnosis and the lengthy treatment regimens, as well as poor vaccine protection,” said Dr Wood. Many of the tools we need to tackle – and eventually defeat TB already exist, but they are not available to the people who need them. Barriers such as high prices, limited manufacturing, and slow registration mean that people who would benefit from new, highly effective drugs are never prescribed them. “There is an urgent need to refocus global, regional and national attention back to TB, restore access to essential TB services, and increase investment in new diagnostics, drugs and vaccines. We are seeing promising diagnostic and treatment innovations but too often they do not reach the people who need them. This lack of access is holding back progress against TB in Asia and the Pacific, and around the world,” said Hema Srinivasan, MedAccess’ Chief Access Officer, UK. MedAccess recently reached an agreement with Viatris to lower the price of pretomanid – part of the new WHO-recommended regimen for drug-resistant TB - by 34 per cent, with a volume guarantee agreement expected to be signed in the coming months. MedAccess also provided a volume guarantee to Macleods to reduce the price and increase supply of TB preventive therapy, enabling more people to access the short-course regimen through the IMPACT 4TB partnership, led by the Aurum Institute. There are other key areas to focus on, such as financial needs to scale up implementation and speed up research and development of new tools, including a new TB vaccine, access to new rapid molecular diagnosis and to new shorter and more efficient treatment regimens, TB prevention, TB in children etc. “As the largest international funder for TB programmes, the Global Fund is a critical partner in helping to achieve the goal of ending TB by 2030. In the Asia-Pacific region and everywhere, we must scale up efforts with public and private partners, civil society and communities affected by TB to find and treat all people with TB, mitigate the impact of the COVID-19 pandemic on TB programmes, address the socioeconomic barriers to care, and strengthen resilient, sustainable and inclusive health and community systems that can respond to current and future disease threats. At all levels of our action, we need to better include young people, in all their diversity, and facilitate youth-led action at global and national level to ensure that their ideas and perspectives are better reflected in the TB response,” said Dr Eliud Wandwalo, Head of Tuberculosis Programmes at the Global Fund. Asian countries have upped their strategies when it comes to TB, but there is still much to be done to end the disease for good. Advances in R&D, access to newer drug regimens, public private partnerships and efforts to address broader socioeconomic conditions that propel the disease are all required to reach TB elimination goals. Ayesha Siddiqui

Can India Eliminate TB by 2025? « Dr Shibu Vijayan, Medical Director (Global Health), Qure.ai Tuberculosis (TB) is a severe public health issue in India, accounting for a quarter of the global TB burden. While the World Health Organisation (WHO) has set a goal to end the TB epidemic by 2030, India committed to ending the disease by 2025, a mission backed by Prime Minister Narendra Modi. But the crucial question here is whether it is an achievable target? According to the WHO, only 60 per cent of TB cases in India are notified to the national TB programme. Incidentally, most patients do not seek medical attention at all or are not diagnosed until the disease is in its advanced stages. At this juncture, technology comes in to assist in early and better TB detection. Early detection is a key strategy called out in the Global Plan to End TB. Challenges on the road Despite technological advancements, numerous challenges remain in the fight against TB in India. One of the biggest is the lack of access to healthcare in rural and remote locations. Many people in these areas do not have access to the same resources and technology as those living in urban areas. They may not have the necessary awareness to seek medical attention in time; even if they do, the plight of Primary Health Centres (PHCs) in rural locations abates the situation. The PHCs do not have access to diagnostic tools and suffer from a severe shortage of trained personnel to read reports and guide patients onto the correct treatment pathway. All of these factors, coupled with the rising cost of care, make diagnosing and treating TB significantly tougher. Another challenge is the high number of drugresistant TB cases in India. This type of TB is much harder to treat and requires more expensive, specialised drugs and a longer duration of treatment. Lack of research and an inability to implement measures to cap the treatment and drug costs are aiding the spread of the epidemic. Though India has a detailed National Strategic Plan for TB elimination, its efficient execution depends on the State Health System. Indian states are at varied maturity levels in the health system, so TB service delivery also varies. In many places, it is affected by a lack of skill set to deliver TB services. While the Government of India’s (GOI’s) focus on decentralised, comprehensive Primary Healthcare delivery is now bearing fruit, it will take more time to implement effectively and become a well-oiled system. Way forward to achieving the milestone The GOI is moving to decentralise delivery and pivot to Health and Wellness Centres (HWC). The push to empower HWCs using digital tools and telemedicine will improve the quality of care and reduce costs. Government investment in digital health platforms to improve TB detection and treatment has been on an upward trajectory over the past decade. However, as the TB ending targets were predated in 2025, more investment is needed to speed up the fight against TB. Optimal use of existing digital health platforms can also be a vital stepping stone in the game plan for improving TB detection and treatment in India. India has been a leader in developing innovative programmes that support the goal of Universal Health Care (UHC), including the National Digital Health Mission (now known as Ayushman Bharat Digital Mission or ABDM) and the National Health Systems Resource Centre (NHSRC). For example, ABDM aims to provide a unique health ID to every citizen and link it to their health records, including TB diagnosis and treatment. This will allow for better tracking of TB cases and ensure continuity of care. The industry also has a role to play in eliminating TB in India. India is known as the world’s pharmacy. Pharmaceutical companies must invest in research and development to find new, more effective drugs to treat TB. They can ensure that new and affordable TB drugs and diagnostic tools are developed and made available in India. Partnering with companies that develop Artificial Intelligence (AI) solutions which help in early detection and patient treatment support can ensure a streamlined process for solving patient detection and dropout rates. AI technologies will become essential for case finding and patient support as we reimagine postpandemic healthcare. However, we must also 24 COVER STORY BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com

AI can also help in the early diagnosis of TB by identifying individuals at high risk of contracting the disease. For example, by analysing data on a person’s lifestyle and medical history, AI algorithms can predict which individuals are at the highest risk of developing TB. This information can be used to target screening and prevention efforts, which can ultimately lead to a reduction in the number of TB cases. COVER STORY 25 BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com recognise the need for regulation and oversight to ensure product quality. As we move forward with AI in healthcare, we must ensure that the technology is used in a way that is consistent with our values and safeguards patient privacy. We must work together to ensure that the technology is being developed and deployed safely, effectively, and ethically. We need diverse multidisciplinary partnerships to ensure the adoption of new technology like AI in healthcare. The government should take the lead in constituting these partnerships, which include healthcare providers, researchers and technology companies. At the same time, technologies cannot be parachuted into an ecosystem. Instead, they must be positioned in a way that healthcare workers can value the benefits. Role of deep tech One of the most promising advancements in TB detection is the use of AI by radiology companies that use machine learning algorithms to analyse chest X-rays and identify signs of TB. This technology can potentially improve the accuracy of TB diagnosis and reduce the number of missed cases. Typically, AI in radiology has been used in community-based active case finding, which assists in real-time reporting and triage of presumptive cases for diagnosis. These interventions have improved the turnaround time of diagnosis. New-generation AI tools come with the capability to identify multiple lung abnormalities and detect hidden cases, increasing the scope for incidental disease diagnosis. These features will empower health systems and bridge the skillset gap. Now, these tools are deployed in urban healthcare settings with heavy footfalls, where AI oversees all chest X-rays taken in the facility and scans for varied disease markers. AI-enabled X-ray reading can increase efficiency in remote locations where there is a shortage of X-ray interpretation skills. In addition, integrating AI into healthcare systems can lead to fewer hospitalisations or emergency room visits, improved morbidity and mortality, and more decentralised care that lowers healthcare costs or enhances the effectiveness of healthcare delivery. AI can also help in the early diagnosis of TB by identifying individuals at high risk of contracting the disease. For example, by analysing data on a person’s lifestyle and medical history, AI algorithms can predict which individuals are at the highest risk of developing TB. This information can be used to target screening and prevention efforts, which can ultimately lead to a reduction in the number of TB cases. Can the G20 summit 2023 be the catalyst? The G20 summit is an important platform for world leaders to come together and address major healthcare issues, including universal health coverage (UHC) and more robust health systems to respond to global health emergencies. One area where India has the potential to play a leading role in the G20 is the use of digital technologies to enhance primary healthcare. As India assumes the G20 presidency in 2023, actions must reflect the need of the hour – to promote a human-centric approach to technology, encourage increased knowledge sharing in critical sectors like digital public infrastructure, and strongly emphasize digital health. In addition, AI technologies will be essential for incidental case finding and monitoring as we work to reimagine post-pandemic primary healthcare. Adopting a multi-pronged approach is essential, focusing on early detection, diagnosis, and treatment of TB and addressing poverty, malnutrition and uneven healthcare access. With a concerted effort and collaboration, we can work towards a TB-free India by 2025.

26 WOMEN’S DAY SPECIAL BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com Do you know what takes the blame for a woman’s bad health? Oestrogen, as it is the hormone that plays a central role in women’s health. It is vital for the development and maintenance of reproductive and bone health, cognitive function, and the overall physical and emotional wellbeing of women. Not many women across the globe are aware of the reasons for their ailments, which are mostly associated with the changes caused by the hormone oestrogen. Problems right from menstruation to fertility to cancer, and even to cardiovascular, diabetes, and gut health can be associated with improper oestrogen secretion in a woman’s body. Thankfully, these days the concept of FemTech (Female Technology) has kicked in where women’s health issues, surrounding menstruation and fertility, are addressed by FemTech companies focused on developing valuable solutions that improve a woman’s quality of life. Let’s explore this rapidly growing sector. APAC FemTech Space Gains Momentum The femtech market in APAC is rapidly evolving and growing with a range of innovative solutions being developed to address the unique healthcare needs of women in the region. The market is also seeing increased investment from venture capitalists and other investors, reflecting the growing demand for women’s health technology. According to a report by Frost & Sullivan, the femtech market in APAC is expected to reach $1.1 billion by 2024. The Asia-Pacific region is expected to see the greatest share of the boom in the next five years, according to some market analysts. Japan’s Economy Ministry estimates that by 2025, the market impact of femtech companies in the country will reach $16 billion. Menstrual health is a key area of focus for many femtech companies in the APAC region, with solutions ranging from menstrual cycle tracking apps to wearable devices that monitor menstrual flow. In particular, there is a growing interest in reusable menstrual products and sustainable menstrual care solutions in the region. As more women in the APAC region become aware of and interested in femtech solutions, there is a growing acceptance of these technologies in the market. Governments and healthcare providers in the region are also starting to recognise the importance of femtech in improving

WOMEN’S DAY SPECIAL 27 BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com women’s health outcomes and are taking steps to support the development of the industry. Also, market analysts observe that telemedicine services are becoming increasingly popular in the femtech market in APAC, allowing women to access healthcare services from the comfort of their own homes. Booming femtech The last couple of years has seen a boom in investment in femtech worldwide. Analytical information agency FemTech Analytics counted 1,323 femtech companies globally last year, 41 of which were in Southeast Asia, with 1,292 investors. To quote an example, India-based femtech startup Salad raised $270,000 in pre-seed funding. Founded by Aruna Chawla and Karishma Rathaur, Salad is set out to change the landscape of women’s health using AI/ML technologies. Salad notably is one of the 30 femtech companies worldwide to win Guidea’s Femovate grant. Likewise, Singaporean breast cancer diagnostics AI startup FathomX raised $2 million in a pre-series A funding round recently. Around Jan 2022, Australia’s Fertilis raised $2 million to automate IVF embryo culturing. Fermata Inc, Tokyo- and Singapore-based femtech company, which provides market entry services and sales channels focusing on women’s health, intends to champion the development of innovative solutions to long-standing issues surrounding the health and wellness of women. Fermata provides women with more personalised and accessible healthcare through a mobile app and a platform that uses AI to help women track their menstrual cycle, monitor their reproductive health, and access telemedicine services from a network of healthcare providers. The app uses AI to analyse menstrual cycle data and provide personalised insights into a woman’s reproductive health, including predicting fertile days and potential ovulation, and offering advice on lifestyle changes to improve reproductive health. The company has seen huge success by giving women an opportunity to access wellness solutions and products, especially during the lockdown period. Fermata also brought out a femtech market map of Southeast Asia for the year 2022. The report analysed that in 2022, Singapore secured its position as the leading market and hub for femtech innovations with 32 companies founded and operating in the country, supposedly a 45 percent increase from 2021. Its neighbouring country Malaysia caught up as runnerup with 12 companies; this number is a 500 percent increase from the previous year in the country. The report also highlighted that other South East countries are showing signs of growth of an active femtech market, especially in the Philippines (9 companies), Thailand (6 companies), Indonesia (5 companies), and Vietnam (4 companies). An active persona in the femtech market, Dr Siddhartha Dutta, Practice Head, SG Analytics and Board of Advisor to Femtech India says, “In the next 2-3 years we can expect more menstrual health tracking apps to enter the SE Asian and India markets. Besides these, I also see organic growth of pain segments, especially Cannabis products. Pain during endometriosis is unbearable and cannabis products can be a good supplement. This segment is expected to grow.” Dr Dutta also indicates that more women will foray into femtech increasingly as most of the femtech startups are driven by personal experience. He also says that women are exploring other services and products apart from menstrual health. “Till a few years back, menstrual health was the main focus in APAC, however in 2022, sexual wellness and sexual health have picked up momentum in South East Asia (slow in India comparatively).” To give an example, Singapore-based Valery Tan, Co-Founder of Surety, is behind an aspiring gerontology startup that aims to be Singapore’s onestop, go-to platform for mature women’s sexual health and wellness. Tan intends to destigmatise and raise awareness about perimenopause/menopause and menopause management through talks, workshops, and casual networking events. Ferne Health, touted to be Singapore’s first online sexual health platform, offers consultations and at-home testing kits for cervical cancer and sexually transmitted infections. Founded by an ex-Amazon employee, Xi Liu relocated from the USA to Singapore to fix the gaps in women’s healthcare needs in Asia. Grand View Research, predicts that the global femtech market is expected to grow at a CAGR of 11.1 percent from 2022 to 2030 to reach $13.1 billion by 2030. It also predicts that Asia Pacific is anticipated to register the fastest growth rate over the forthcoming years. Clearly, the Asia Pacific femtech market is driven by increased demand for effective health technology coupled with growing digital infrastructure, increasing smartphone & wearable device penetration, improving internet coverage, and growing health consciousness. In the last 6-7 years, women have become aware of the benefits of tracking and monitoring their health as technology has advanced to allow for more accurate and personalised health solutions. This is probably why the latest Samsung Galaxy Watch5 women users will get to access temperature-based menstrual cycle tracking through the Cycle Tracking feature. This new

28 WOMEN’S DAY SPECIAL BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com Lindsay Davis, Founder, FemTech Association of Asia, is striving to ensure that the femtech industry in the Asian regions can grow exponentially and at the same time women who have been long deprived of quality healthcare, get their due share of attention. Davis shares a few trends that her association has noticed in APAC countries and gives a status update on the femtech industry. Edited excerpts, How is the femtech industry evolving in Asia? Can you share a few market trends and future growth predictions? Though women’s health has historically been under-researched, underserved and underfunded, the femtech industry in Asia is rapidly gaining momentum. In March 2022, Asia Nikkei reported that Asia is home to just 14 per cent of the world’s femtech companies, but is set to make the most of the boom. FemTech Analytics predicts that by 2026 the Asia-Pacific region will see the world’s fastest growth in women’s health apps. FemTech is building momentum and the FemTech Association of Asia is leading the ecosystem across nine countries in Asia through thought leadership, programming, amplification, and community-building. For example, in Q1 2023, FemTech Association of Asia has partnered with the Women’s Health Innovation Series – Asia to bring the largest women’s health and FemTech conference to Southeast Asia. This event will bring together key sector leaders, provide a platform for knowledge share, and will showcase innovation and investment opportunities across Asia. We will be exploring trends at the conference such as the positioning of FemTech as part of overall women’s wellness integrated into day-to-day life with a preventative approach; and the strategic pivot of more FemTech solutions from targeting a B2C audience to B2B, recognising that more companies are prioritising employee benefits – including women’s health needs and demands. We are confident that both trends mean further integration of women’s health solutions, which FemTech companies can support with easy integration, cost-effective solutions and with the expansion of FemTech businesses across Asia, with relevant localisation. What are the driving factors in femtech and which Asian countries do you see more femtech companies coming up? The driving factors for FemTech in Asia are public awareness about women’s healthcare needs; awareness of the commercial opportunities; entrepreneurs founding FemTech companies; and investors funding these companies. We also encourage further integration of women’s health (and technology) into educational curriculums to inspire the next generation of founders. In Q4 2022, 50 per cent of new FemTech Association of Asia member companies were founded in Indonesia. In January 2023, we accepted almost 40 per cent of our members from Singapore and 25 per cent from Hong Kong. We are excited to see founder engagement across multiple markets, along with the many new businesses launching over the past 12 months in Malaysia, Philippines, Thailand, and Vietnam – and we can expect the same for 2023. How do you see Singaporean women making a mark in the femtech industry? Singapore has claimed its place as a hub for the FemTech industry, currently hosting over half of Southeast Asia’s FemTech businesses - and serving as the headquarters of FemTech Association of Asia. Awareness of FemTech is high in Singapore, although awareness of specific companies providing women’s health services is not as common. For instance, according to our 2022 Consumer Survey “We would like to see more investment in women’s healthcare R&D that currently accounts for only 4%” « Lindsay Davis, Founder, FemTech Association of Asia

WOMEN’S DAY SPECIAL 29 BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com capability was developed in partnership with Natural Cycles, a women’s health company and app maker, and marks the first time Natural Cycles’ algorithm has been adapted for a smartwatch. Herbio, founded by Sayuri Tanaka of Japan, has developed a wearable device that measures basal body temperature every 10 minutes while asleep to track menstrual cycles and fertility. Also, ever since COVID happened, remote healthcare using telemedicine has been extensively exploited. Take Sehati TeleCTG, an Indonesian telemedicine company founded by Anda Waluyo Sapardan and her husband, which aims to tackle the high mortality rate of newborns in rural regions of Indonesia. Their low-cost cardiotocograph prototype, which monitors foetal heartbeat and uterine contractions during pregnancy and labour, is linked to a mobile app to track the first thousand days of human life, alerting mothers to risks of early death or intrauterine stunting. The app also provides vital information and standardised recommendations from doctors throughout the pregnancy, with in-app options to book health check-ups and doctor’s appointments. It also works to educate new mothers about health and nutrition for newborns and raise awareness on related issues, including abortion, contraception, and sexually transmitted diseases. While other APAC countries are slowly catching up, Australia is joining the league of femtech players. Until 2022, Megan Capriccio was the co-founder of FemTech Collective, a network concept that she brought to Australia from the USA. Megan led the business strategy of the FemTech Collective in Australia, in order to grow and support the women’s health technology ecosystem throughout the country. “In the next 2-3 years we can expect more menstrual health tracking apps to enter the SE Asian and India markets. Besides these, I also see organic growth of pain segments, especially Cannabis products. Pain during endometriosis is unbearable and cannabis products can be a good supplement. This segment is expected to grow.” - Dr Siddhartha Dutta, Practice Head, SG Analytics and Board of Advisor to Femtech India for Singapore, only ~1/4 of FemTech brands named by participants are Asia- based (with 75 per cent of these headquartered in Singapore). Led by consumer demand for more affordable solutions to complement the trusted healthcare system in Singapore, FemTech businesses offer readily accessible, convenient, and costeffective digital healthcare solutions. The most prevalent FemTech categories in Singapore include: menstrual care and sexual health. Underserved categories include: menopause, chronic illness, and mental health. Women in Singapore are open to a variety of digital healthcare solutions and have the budget to spend, however, they are looking for solutions that are good value for money and integrate easily into day-to-day life. FemTech is a key contributor to the future of women’s healthcare in Singapore. What kind of challenges do women entrepreneurs have to face and overcome in the femtech vertical? Women’s health globally has historically been under-researched, underserved and underfunded. We would like to see more investment in women’s healthcare research and development, which currently accounts for only 4 per cent of overall R&D funding, according to Accenture. With technology bringing more economical solutions; FemTech brands building broader ecosystems; and remote access, at-home delivery and telehealth becoming the norm, women are starting to find solutions that work for their particular needs. FemTech Association of Asia and our members are doing a great job of building awareness of women’s healthcare needs and educating consumers - and investors. Even with investor awareness, however, the funding of FemTech businesses is a challenge. In 2022, DealStreetAsia reported that there were no female decision makers at 77 per cent of SE Asia-headquartered venture firms. Over 80 per cent of FemTech Founders in the FemTech Association of Asia are female. If we compare to the USA where female founders secured only 2 per cent of venture capital in 2021 as Bloomberg stated, we can assume Asia has a similar statistic. According to a 2020 Harvard Business Review article that still holds true, gender bias is present in fundraising, so we continue to support more diversity among investors.

30 WOMEN’S DAY SPECIAL BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com The female technology or femtech industry, which focuses on using technology to advance, monitor, predict and personalise women’s health, is a nascent industry largely focused on reproductive health and menstruation. In 2030, there are expected to be nearly 2 billion women in Asia Pacific, representing 45 -50 per cent of the global women’s population. This will present an enormous commercial opportunity for mainstream healthcare companies to participate, especially in chronic diseases, where the burden is large. Women in this region still lack health awareness, education, access, and affordability, in addition to being highly stigmatised by social and cultural taboos. For instance, in Singapore and Malaysia, women’s health issues, specifically sexual health, cannot be discussed openly in the presence of male family members. This leads to many unwanted pregnancies, abortions, and the spread of sexually transmitted diseases (STDs), as there is still a massive knowledge gap in family planning. The taboo attached to menstruation, reproductive health, menopause, and other women’s health needs makes it difficult for women to seek help. Women residing in the rural pockets of Southeast Asian countries are the most vulnerable as they are financially incapable, victims of stigma, and lack access to healthcare services and solutions. The Asia Pacific femtech market represents approximately 14 per cent of the global business and is largely concentrated in Singapore and growing steadily in India. The number of companies is increasing in Japan and South Korea, and we expect that by 2030, Asia Pacific femtech should represent 25 per cent of the global market in terms of revenues. In 2022, Fermata tracked 21 femtech companies in Southeast Asia. Singapore continued to be the leading market with 32 companies, followed by Malaysia with 12. Research predicts that by 2026, the Asia Pacific region will see the world’s fastest growth in women’s health apps. This growth will be fuelled by greater awareness and openness about female health topics, changing perceptions about women’s health issues, and more capital accessibility for female founders. A key driving force is the penetration of smartphones and the internet in some Asian countries like India and the awareness of their use. All age groups have shown a desire to get advice and care from online forums, healthcare platforms, and experts. The biggest challenge to the growth of female technology is that it is largely a startup culture driven by female founders who find it extremely hard to raise money on topics related to women’s health because proving the scalability of the solution can be difficult. The top five growth opportunities for the region are: 1. The need for screening beyond breast cancer in rural markets. 2. Women-specific clinical research and care standards for cardiac care and diabetes. 3. The need for affordable menstrual care solutions. 4. The need for advanced and affordable fertility solutions. 5. Uterine health (endometriosis, PCOS) solutions, including awareness and education. Femtech Needs to Move Beyond the Uterus in Asia Pacific « Reenita Das, Partner, Senior Vice President, Healthcare and Life Sciences « Chandni Mathur, Senior Consultant, Healthcare and Life Sciences, Frost & Sullivan

WOMEN’S DAY SPECIAL 31 BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com Overcoming challenges It is a known fact that health-tech as such is struggling to keep pace with other industries and for femtech, which is another several years behind health tech, there is a lot of catching up to do. What we have known so far is that the main resistance in femtech founders to foray is the lack of scientific and clinical data specific to women’s health. Funding inequalities need no mention. Grappling with that exacerbates their woes to sustain in this business. Though there are several driving factors to plunge into the femtech business, what Dr Siddhartha Dutta says is “Statistically there are more companies cropping up in APAC, but ideally, there are no patents in this field and that makes it difficult for new entrants to survive. Many women are entering the market with similar concepts and ideas. But most of these companies don’t have a sound business model, no competitive mapping, no pricing analysis, no demand-gap analysis, and no public demand analysis by region (they know that the segment is in demand and they check with a dipstick survey), no publicly available database to collaborate with other visionaries or associations who can promote their product or services.” All the above are faced similarly by women entrepreneurs across Asia. The same condition can be found in Thailand, Indonesia, Singapore, or India. Dutta says most of the femtech companies are happy selling their services and products within a limited geography with no clarity on global expansion. Most of them don’t have a road map beyond one or two years. A typical handholding here is a big ask for budding femtech founders. Dr Dutta lists some of the commonly faced problems by femtechs that require attention - Poor survey results (most women shy away from giving correct responses on their physical and sexual health) hence the results of such surveys are not correct. - Most entrepreneurs are replicating US-based or EU-based femtech businesses, we must remember that one size doesn’t fit all. - More mentoring bodies in every country that can help companies grow from concept to commercialisation. - Venture capitalists and funding bodies (private) are still skeptical in investing in femtech. - There is practically no collaboration between entrepreneurs as most of them are not ready to grow together. There are no common databases, and no association to promote any femtech segment. Only L&D and NGOs to create online content and conferences in the market. We can safely say that if femtech companies must grow in Asia, then, it’s time to collaborate and sail together. Critical to the growth of this niche industry is the coming together of the APAC Governments, its Ministries of women’s welfare, and startup investors who see women’s health as a great contributor to the socio-economic growth of the world. Thus, this year, on International Women’s Day, every woman on this planet is sure to send out a reminder to ‘Embrace Equity’ and give equal importance to a woman’s health as much as it is to a man. - Anusha Ashwin Singapore continues to be the leading market with 32 companies (45%), and Malaysia surpassing to the second lead with 12 companies (500%).

32 ROBOTICS BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com When compared with conventional laparoscopic and endoscopic techniques, robotic surgery allows intricate and advanced surgical procedures to be performed more precisely and with minimal skin incision. To achieve maximum precision impact, robotassisted surgery platforms utilise electrosurgical hardware, instruments, artificial intelligence and data analytics. The robotic surgery minimises tissue damage, pain, and hospital readmissions as it is able to be implanted precisely during the surgery. In addition, with the 3-dimensional visualisation of image (rather than 2-dimensional vision in standard laparoscopy) surgical robotics further eliminates the risk of hand tremors. Advanced models offer voice-activated or manual master controls for demonstrating steady camera motion in addition to ergonomic design and training simulator. Despite the benefits of minimally invasive surgery (MIS), shorter hospital stays, and faster return to normal activities, only about 3 per cent of surgeries are performed robotically in the world. Technological advancements have even enabled The quality of Healthcare is projected to become enhanced in the future, aided by new innovations in technology. Robot-assisted surgery (RAS) has seen significant advancement of late, bringing the promise of much better surgical and postsurgical success rates. In the medical device industry, surgical robots are one of the fastest growing sectors. In addition to providing superior mobility, robotic surgery devices allow surgeons to reach confined spaces and provide extremely advanced imaging capabilities, with better dexterity. Yet, the robotic surgery industry is struggling to thrive in most developing countries. Let’s discover the reasons behind. Can Med Tourism Industry hit Goldmine with Robot-assisted Surgery? effective remote surgeries by demonstrating the tremendous potential of robotic aids and 5G technology. Surgeons and traumatologists are equitably empowered by the surgical robots technologies. Kevin Falzon, Senior Business Director, Surgical Robotics at Medtronic (Asia Pacific), states, “RAS has seen significant advancement of late, bringing the promise of much better surgical and post-surgical success rates. Powered by Artificial Intelligence (AI), robotics and a mix of other modern technologies, RAS effectively enables MIS, which means much lesser risks of complications, smaller scars, reduced hospitalisation time, and remarkably expedited recovery time. With RAS, surgeons can prevent surgical errors and speed up procedure times without compromising patient outcomes”. Reach and scope Surgical robots are designed to overcome the limitations of MIS, and to improve open surgery outcomes as well. Simulation for robotic surgery has become a very strong area for the surgical science businesses, both in terms of market share and technology. Healthcare and medical educational robotics hold the strongest growth pillars in the surgical robot market. GlobalData, in its report (2022)

ROBOTICS 33 BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com on Surgical Robotics Market Landscape, estimates that the surgical robotics market was worth $9.6 billion in 2021 globally and expected to grow across all geographies. North America is the highest revenuegenerating market with APAC contributing to 11.5 per cent of the global revenue. A robust growth of the surgical robotics market is expected globally in the next decade. By 2030, it will have grown at a steady CAGR of 6.6 per cent to $17 billion, bolstered by the use of AI, augmented reality, and virtual reality in robotics. Meanwhile, MarketsandMarkets reports “Surgical Robots Market will be worth $14.4 billion by 2026. North America dominated the surgical robots market, with a share of 63.6 per cent in 2019, while the Asia Pacific region is expected to register the highest CAGR of 18.5 per cent during the forecast period.” Robots in MIS were driven primarily by the complexity of procedures to treat complex medical conditions. The most commonly used robotic surgical system is known as “da Vinci Surgical System”, manufactured by Intuitive Surgical, Inc. headquartered in California, the US. Intuitive Surgical continues to enjoy the benefits of market penetration, being the first major company producing robotic surgical systems for a large variety of procedures. By applying a MIS approach, this system has been deployed in procedures like prostatectomies, cardiac valve repair, and for renal and gynecologic surgical procedures for the last two decades.. Since its inception in 1995, da Vinci Systems have performed more than 6 million surgeries being the default choice for robotic surgeries. A new generation of surgical robotics, influenced by AI and IoT, is driving the market for minimally invasive surgery forward. Companies such as Stryker, Medtronic, and Zimmer Biomet have more recent approvals for robotic orthopedic, spinal, and neuro surgeries. Intuitive Surgical, Stryker, Medtronic, TINAVI Medical, Meerecompany Inc. are some of the major players in the APAC region. The versatility and flexibility in these systems is driving companies to broaden access to this nextgeneration technology. For instance, according to Frost & Sullivan, the global market size of orthopedic surgical robots is expected to reach nearly $8 billion by 2030 at a CAGR of nearly 20 per cent, which indicates a promising market potential driven by the increasing demand for surgical robots in light of their clinical benefits and breakthroughs in key technologies. The thriving sectors The surgical robots market is deployed across general surgery, urological surgery, gynecological surgery, orthopedic surgery, neurosurgery, and other applications. The general surgery segment accounted for the largest share of 29.5 per cent of the market and is in an exponential growth phase due to increased use of surgical robots in general procedures such as bariatric surgery, Heller myotomy, gastrectomy, hernia repair, cholecystectomy, transoral surgery, and pancreatectomy. Notably, minimally invasive endoscopic procedures are rapidly evolving. A large number of new minimally invasive endoscopic techniques, including Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD) have emerged to combat the increased detection of submucosal tumors, early cancers, and precancerous lesions in the digestive tract, a positive outcome of increased health awareness. This approach can reduce post-operative complications such as infections associated with surgical operations. Robotic surgical systems, including general surgery robots, orthopedic robots, and neurosurgery robots, make up approximately 29.8 per cent of the total market. Tina Deng, Principal Medical Devices Analyst at GlobalData, says “RAS will be more popular in the orthopedic operating room in 2023. Orthopedic robotic surgical systems aid in various procedures such as partial knee replacement, total knee replacement, and total hip replacement.

34 ROBOTICS BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com There are multiple manufacturers competing in the orthopedic robotics market, unlike the general surgery robotics market, which is dominated by Intuitive Surgical”. Several technologically advanced model segments such as in-vivo robots, nanobots, and capsule robots, are equally popular for domains of neurology, urology, gynecology, orthopedics, and more. There is an increasing demand for minimally invasive laparoscopic surgery and increased use of surgical robots in cancer-related procedures. Nevertheless, general surgery, urology, and gynecology account for more than 80 per cent of all RAS procedures performed globally. General surgery is the fastest growing segment within robotic surgery. “Surgical robotics, haptic-enabled augmented reality, sensor technology, GPUs, miniaturisation, cloud computing, simulations, and data analytics, are converging as the next logical step in the refinement of traditional open surgery into that of MIS”, explains Dr W Scott Melvin, surgical chief of the NYC-based Montefiore Medical Center. APAC market The rising incidence of chronic diseases, increasing geriatric population, growing demand for MIS and miniature robotics, technological advancements in the field of medical surgeries, and substantial funding provided by various governmental organisations to conduct research and development (R&D) activities in next generation surgical robotic systems are expected to fuel the demand for the surgical robotic systems in the near future, according to BIS Research report that forecasts Asia-Pacific surgical robots’ market to top $8.49 billion by 2025 (valued at $4.6 billion in 2018). The market is growing at a CAGR of 8 per cent in the forecast period 2018 to 2025. The rapid development of robotic technology in APAC is driving the market in this region to expand, making it the fastest-growing. Increasing demand for MIS is driving APAC’s government to increase funding for the development of medical robots. The Asian Surgical Robotics Market is forecast to grow from $4 billion to $8 billion in the next decade due to aging populations and increased acute and chronic diseases. “APAC will be a major growth engine for surgical robotics where rapid digitalisation, rising demand and access to healthcare innovation will drive further adoption of health technology and innovations,” comments Kin Cheung, Head of Far East of CMR Surgical. Increased focus on medical robotic development across APAC, mainly driven by China, South Korea, and India, will fuel innovation in the region over the next five years, reports GlobalData. Its latest report, ‘Robotics in Healthcare’, reveals that APAC has the highest patenting activity for robotics in healthcare globally. Indeed, China leads the world with over 2,800 patent applications between January 2016 and December 2022. Nearly 9,000 applications were filed globally during that period, with around 2,600 coming from the US, over 560 from Japan, and South Korea filing more than 370. Jemima Walker, Thematic Intelligence Analyst at GlobalData, says “The APAC region is the third largest market for surgical robotics behind North America and Europe. Increasing healthcare expenditure markets such as India and China are driving the demand for robotic surgical procedures, as are other government policies. However, high device prices and lack of healthcare facilities continue to hinder market growth, particularly in developing countries in the region.” “APAC will see a reduction in imported surgical robotics. Rapid urbanisation and population growth across APAC will increase the number of patients requiring surgical intervention. Healthcare providers will increasingly invest in surgical robots to meet patient needs. The cost of current surgical robotic systems is out of reach for most developing economies. However, there are efforts across APAC to supply affordable surgical robots, such as India’s SS Innovations, which aims to provide a locally produced alternative to importing expensive surgical robots”, adds Jemima Walker. GlobalData’s Patent Analytics reveals that although China leads in patent applications, South Korea accounts for all granted micro-robotic patents for healthcare in the region, with Chonnam National University’s affiliated Robot Research Institute being the top assignee. Elaborating on APAC region’s ability to lead the nascent micro-robotics for healthcare, Jemima Walker adds, “Micro-robots could provide breakthrough treatments, including the delivery of targeted drugs for cancer. While US-based companies have a higher profile, APAC is the origin of most microrobotic patent publications for healthcare. Increasing R&D budgets will ensure that APAC becomes the most innovative region in medical robotics.” Collaborations and mergers Developing capabilities, forming partnerships, and bringing together business organisations are essential

ROBOTICS 35 BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com aspects of medical technology and digital health collaboration. Medtech pioneers in APAC are set to coordinate to further enhance the region’s surgical robotics capabilities and potential. For instance, Singapore headquartered medtech firm, NDR Medical (NDR) has been expanding its presence in APAC by establishing subsidiaries in Japan along with Malaysia and China. Speaking about NDR’s robotic applications in Japan with the first multi-site trial for Automated Needle Targeting (ANT)-X with two university hospitals, Alan Goh, CEO, NDR Medical explains, “Japan currently has the highest number of computed tomography (CT) machines per million population in the world. It is a mature medical technology market, and healthcare facilities and staff in the country are adept at tapping technological solutions to improve treatment outcomes. Getting early adoption in Japan helps to validate our technology, and affirms our approach for interventional procedures. The new office and our activities in Japan are important steps in our future business growth strategy.” Further, CGBIO Inc. Korea’s Regenerative Medicine company, has partnered with NDR Medical Technology, to introduce an ANT-X system that combines AI and medical image processing to assist surgeons during MIS fostering bilateral collaboration as its globalisation strategy expands around medical technology. Japan is the third-largest market for RAS globally. In October 2022, International University of Health and Welfare collaborated with Tokyo’s Mita Hospital to deploy Philips’ augmented reality (AR) surgical navigation solution bringing minimallyinvasive spine surgery to Japan’s aging population for the first time. Furthermore, Biobot Surgical, a Singaporebased RAS system company, has entered into an agreement with Europe’s BEBIG Medical in March 2022 to provide a high dose rate (HDR) brachytherapy solution for prostate cancer. Biobot Surgical developed the iSR’obot Mona Lisa 2.0, a robotic-assisted percutaneous surgical system to guide clinicians on needle positioning during automated image-guided diagnostic and interventional prostate procedures. For an optimal treatment plan, the robotic arm allows angulated needle trajectory to avoid critical anatomical structures. “The future trend of medical device technology is moving toward digitalisation, automation and artificial intelligence. The joint partnership is a vivid display of these orientations to achieve clinical excellence”, states Source: GlobalData Medtronic, Inc. Intuitive Surgical Inc. CMR Surgical Ltd. GE Healthcare Ethicon, Johnson & Johnson Medical Devices Stryker Corporation Smith & Nephew PLC Terumo Medical Corporation Venture Medical ReQuip Toshiba America Medical Systems, Inc. Siemens Medical Solutions USA, Inc. Hitachi Medical Systems America THINK Surgical, Inc. Philips Medical Systems, Inc. Medicaroid Corporation Japan, Sytrker Corporation Mako robotic surgery system TINAVI Medical Meerecompany Inc Han’s Robot Point Robotics Some of the leading global robotic surgical systems’ companies George Chan, Chairman and CEO of BEBIG Medical. Similarly, in January 2023 Terumo and Siemens Healthineers India announced partnership to strengthen cardiac care in India through collaborative interventions in the areas of physician training and development, access to advanced medical technologies, and improved penetration of Tier 2 and 3 cities. “To pioneer breakthroughs in healthcare it’s imperative to create platforms for collaborative growth. Through this industryacademia alliance, we aim to create holistic growth opportunities for specialised healthcare professionals”, says Vivek Kanade, Managing Director, Siemens Healthcare. Taiwan is another pivotal hub for surgical robots owing to the involvement of the Ministry of Science and Technology’s Biomedical Development Board and the Central Taiwan Science Parks to create the platforms such as ‘Future of Surgery’ to allow medical companies showcase ‘smart’ surgical machines. Ministry data show the nation’s medical device sector is generating revenue of over

36 ROBOTICS BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com NT$146.3 billion ($4.99 billion), which is nearly 30 per cent of the biomedical industry’s total revenue. “The ministry has been working to promote the integration of local brands and the industrial innovation of businesses,” said Chen Liang-gee, Minister of Science and Technology, at Bio Asia- Taiwan 2022. A growing number of wellestablished healthcare companies are focusing on M&A to expand their surgical robotics portfolios. Ethicon, a subsidiary of Johnson & Johnson, purchased the robotic technology platform developer Auris Health to enhance its lung cancer digital surgical portfolio. Consequently, such industrial initiatives are expected to accelerate the uptake of robots and the growth of the market for surgical supplies. Overcoming constraints High spending on medical devices and equipment by hospitals is expected to further boost the market for image-guided and RAS procedures. Yet, lack of skilled surgeons acts as a limiting factor for the market. Robotic surgery equipment, however, has its own dimensional limitations and complex operating modes. Medical industry is looking for more portable and user-friendly models that are easier to operate in tense surgical environments. For instance, CMR Surgical has leveraged a small, modular, and portable next-generation robotic system, called Versius, with advanced technology that can perform sophisticated keyhole surgery procedures. Integrated into existing busy hospital workflows, it gives surgeons the versatility to operate robotically without disrupting current clinical practices. While, CUHK Medical Centre and Gleneagles Hospital, in Hong Kong have adopted Versius multidisciplinary robotic programme, Dr Patrick Lau, Deputy executive director of the Hong Kong Trade Development Council says “A novel robotic system such as Versius will positively impact patients fits perfectly into this mould. CMR has chosen Hong Kong as the launchpad for the APAC region as we believe that Hong Kong offers biotechnology companies an ideal springboard from which to expand into rapidly growing markets in mainland China, Asia and around the world.” “The introduction of Versius in Hong Kong follows CMR Surgical’s expansion into a number of markets across Europe, Middle East, India and Australia where the system is being used to perform surgical procedures across a range of surgical specialities including gynecology, colorectal surgery, thoracic, general surgery and urology”, added Kin Cheung, head of Far East of CMR Surgical. Similarly, Brain Navi Biotechnology, a surgical robot manufacturer in Taiwan, has developed a Neurosurgical Navigation Robot, NaoTrac which combines Surface Mapping Auto-Registration Technology (SMART) technology, robotics, AI and machine vision to streamline RAS procedures with real-time imaging and minimal invasive outcomes. In September 2022, Brain Navi expanded its reach throughout the Gulf Cooperation Council (GCC) regions, Jordan, Egypt and other countries in the Middle East and Philippines, Indonesia, Malaysia, Philippines and Singapore. “The device works as a high-precision alternative surgery assistant even for endoscopic brain surgery and cell implantation” adds Dr Tsung-Lang Chiu, a consultant at Hualien TzuChi Medical Center. Further, ample practices are required for a medical student or even a doctor to become a skillful surgeon operating robotic surgery machines. But Robotic surgery simulators are available only in medical schools or hospitals, as these simulators are bulky and expensive. In addition, availability is also scarce due to unproportionally high demand over supply. Taiwan based Smart Surgery Technology addresses this problem with their VRequipped interactive application, providing the visual experience and tactile feel from operating on 3D organ models through affordable personal VR gear, making practice available to almost every student and doctor. “By utilising the Ubitus solution, Smart Surgery Technology can stream high-quality 3D anatomical models to All-InOne VR headsets without needing a high computing power device onsite, further reducing the barrier to practice” says Julie Lee, CEO, Smart Surgery. Likewise, Singapore’s National University Health System (NUHS) has partnered with a local telecom agency to deploy a 5G indoor network at NUH operating theater and wards to enable mixed reality applications, robotics surgeries and internet of things. The high-speed connectivity of 5G would address current limitations in latencies and bandwidth, and open up possibilities for better healthcare experiences, such as augmented surgical navigation using mixed reality devices and robot AI

ROBOTICS 37 BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com capabilities using cloud and edge computing. Prohibitive cost concerns The demand for robotic surgical procedures is driven by increasing healthcare expenditure markets such as India and China, as well as government policies. Nevertheless, high device prices and inadequate healthcare facilities continue to hinder market growth, particularly in developing countries. A robotic surgery typically costs about $5,000 more than a doctor-led procedure, rendering the physical-intervention of the surgeon a cost-effective and reliable alternative. A da Vinci surgical system costs $2 million, and each system has a handful of disposal parts that need to be replaced after each surgery. Funding from the private sector and venture capitalist is however encouraging the area to bolster aiming at the evolution of economically viable and sustainable approaches. A high device price and a lack of healthcare facilities continue to impede market growth in developing countries. Furthermore, a highly-trained expert must operate the machinery and healthcare institutions have to adapt to maintenance costs, disposable materials, and longer operative times. However, robotic surgery is increasingly becoming available for a wide range of procedures. Eventually, this might lead to costeffective procedures. However, most healthcare providers in the south-east Asian regions like Malaysia, Thailand, Vietnam, Philippines remain uncertain about robotic surgery due to concerns about its high cost, reliability, and liability on technology adoption over on-hand surgeries. In March 2022, Malaysia’s Sunway Medical Centre became the first healthcare provider in the country to acquire a robotic surgical system, the latest third-generation da Vinci Si system. Nevertheless, sustainable policies and increasing healthcare expenditures by APAC government’s are driving the market for robotic surgical procedures in the region’s markets. The transition largely depends on the regulatory environment and reimbursement policies of a country. The Hong Kong-based Agilis Robotics (Agilis), a leading provider of flexible robotic instruments for endoscopic surgery, released its proprietary robot Agilis Robotics in January 2023 to overcome the challenges associated with conventional endoscopic surgery in order to perform advanced endoscopic minimally-invasive procedures. Recovery time is short for these robotic minimally invasive procedures, and the cost of treatment is only 1/3 to 1/2 of a general surgery. If a general surgery costs between 20,000 and 40,000 yuan, then the endoscopic minimally-invasive procedures can be managed for as little as 20,000 yuan. Overall surgical robotics improve compliance, consistency, and operational excellence which will complement the associated cost. Further, GlobalData analyst Jemima Walker said that the price of surgical robots is set to decrease as the cost of the underlying technology decreases and as more competitors bring cheaper alternatives to the market. For instance, Indian startup SS Innovations, is revolutionising the industry, allowing cheaper access to cost-effective medical robots, and reducing India’s dependence on imported expensive surgical robotic systems. In addition, remotely assisted robotic surgeries coupled with 5G technology, in particular, appear to be a credible investment because they can reduce travel costs for both patients and surgeons, making the entire process more sustainable. Specifically, in medical education, robotic surgery can revolutionise remote teaching by training multiple students simultaneously. With new robotic assistance, procedures can be performed more precisely, with greater flexibility, and with greater control, as well as leaving much smaller and less invasive scars, shorter hospitalisations, reduced pain, faster recovery times, quicker return to normal activities, smaller incisions, reducing infection risk, blood loss, and transfusions compared to traditional surgery. Promoting medical tourism Asia Pacific is magnificently expanding the medical tourism industry by promoting robotadministered MIS. Surgical robots are expected to leverage the lucrative medical tourism business as the global medical tourism industry is worth upwards of $55 billion annually and is growing by up to 25 per cent each year. The medical tourism industry sees more than 11 million consumers annually, nearly four million of whom travel to Southeast Asia. Hithaishi C Bhaskar [email protected] Global surgical robotics market -2021 Source: GlobalData

38 LAYOFFS BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com Employees across various sectors have been hit hard due to various restructuring measures leading to layoffs. It is quite detrimental for an employee to lose a job, however, various factors play a role in a company to take the harshest possible measures. Globally pharma companies have been going in for layoffs and the Asia Pacific region is no exception to this. We will take a look at the layoffs in pharma companies across the globe. The New Pandemic of Layoffs The word layoff is accustomed to us and many companies across the globe take part in this exercise. Excuses like global recession, the so-called term ‘restructuring’ etc. are often used when companies take part in this exercise. Bad management policies and inability to sustain in a competitive environment are some of the other factors leading to layoffs. The pharma sector is no exception and according to media reports, there have been quite some layoffs happening now and then. Though in a company hierarchy, the top management usually remains hardly affected by this exercise, it is the middle and low-rung employees who suffer the most. Adding to it, the COVID-19 pandemic led to many openings in the healthcare and pharma industry. With the pandemic weaning off, a lot of companies have gone back to the drawing board to analyse the drop in COVID-19 tests, vaccines, hospitalisations etc. Geopolitical chaos, including the Russia-Ukraine war, the resurgence of COVID-19 in China, climate change, etc., further impact the market dynamics. War-associated sanctions have raised energy and commodities prices, alongside constantly increasing costs of essential raw materials and API, labour, packaging materials, and intermediary costs, impacting overall production timelines and prices. Impact on the Asia Pacific region Chinese company Zybio, which specialises in R&D, manufacture, sales and technical services of in vitro diagnostic reagents and equipment, with the headquarter and manufacturing centre located in Dadukou District, Chongqing, recently laid off nearly 8000 workers leading to violent unrest in office premises of the company. Contract manufacturing giant Catalent has wrapped up the expansion of a clinical supply facility in the Waigaoqiao Free Trade Zone (FTZ) in Shanghai, China. The company is also cutting 400 temporary and full-time workers in Bloomington, Indiana and more than 210 workers in Texas and Maryland. India did not bear the brunt of mass layoffs in the pharma sector. However, French drugmaker Sanofi was planning to review its operations at two of its vaccine-making facilities in Hyderabad. The company plans to let go of all 800 employees at the plants. The company is offering a voluntary retirement scheme (VRS) to all its employees at two sites near Hyderabad. The drug maker employs a total of 5000 employees. Switzerland-based Novartis plans to go in for a huge makeover. There are reports that the company is going in for a new organisational model and Despite layoffs, the Asia Pacific region is witnessing a simultaneous surge in drug discovery & development outsourcing activity, as well as a growing focus on advanced therapies. Across the APAC region, in both developed & emerging markets, there are several TEDD companies, such as Standigm, Intuition Systems, XtalPi, NEC, AI Dynamics, Baidu, etc., which provide AI-enabled drug discovery services. In this regard, jobs across AI/ ML, cybersecurity, and data analytics are especially attracting large-scale hiring in the pharma IT sector.

LAYOFFS 39 BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com restructuring where some top executives and about 8,000 employees are likely to lose their job. Novartis India, in a bid to improve drug access for the pain relief drug Voveran, made a sales and distribution agreement with Dr. Reddy’s. However, it resulted in the layoffs of about 400 employees. More recently, Johnson and Johnson announced the de-prioritisation of certain therapy programmes, including those of COVID-19 vaccines, which will have a direct impact on several existing jobs. Back in June 2022, Pfizer India announced the layoff of over 200 field forces with the claims of ‘redundancy,’ despite earning huge revenues. The Federation of Medical and Sales Representatives’ Associations of India (FMRAI) demanded the revocation of the decision, owing to a lack of strong reasons for the layoffs. However, the company responded to a changing go-to-market strategy, resulting in several changes in the workforce. Says Aarti Chitale, Senior Industry Analyst, Healthcare & Life Sciences, Frost and Sullivan, “Owing to all constant changes and issues, the Asia Pacific region was also strongly hit by pharmaceutical industry layoffs. Whilst companies are working towards reducing the impact of the ongoing geopolitical changes, such as the adoption of digitisation across crucial activities like distribution, track and trace, clinical research, manufacturing and many more, it is directly impacting the manual labour requirement, making it redundant by the day.” Worldwide scenario US-based Finch Therapeutics has cut 37 per cent of its workforce and halted a preclinical programme as part of a restructuring triggered by Takeda’s recent decision to cut ties with the microbiome drug developer. Amgen, which has around 24,200 staff members in over 50 countries, recently laid off between 300 and 500 US employees, about 1.2 per cent of its total workforce, citing organisational changes to its commercial team. One of the speculated reasons according to the California-based drugmaker is adopting digital marketing tools for the long run. Following this Darmstadt, Germany is letting go of 133 jobs in Billerica, Massachusetts, US as part of a restructuring effort. According to a report in Boston Business Journal, the recent layoffs equate to an approximately 26 per cent decrease in staff in Billerica, consisting of about 500 employees, and an 11 per cent decrease in its US-based EMD Serono employee base. Thermo Fisher is seeing a two-thirds drop in sales of its COVID-19 tests in 2022 and began laying off hundreds of workers at three manufacturing sites in California. According to media reports, Thermo Fisher is permanently eliminating a total of 230 jobs at the sites, all of which are in San Diego County. Thermo Fisher reasoned that the staff reduction will allow the company to improve efficiency and remain in line with current manufacturing volume demands. UK-based CDMO Abzena recently laid off 66 employees in San Diego. The company recently hired a new CEO before the layoffs. News is that Johnson and Johnson and its subsidiary Janssen Biotech are going in for an overhaul of operations for the infectious diseases and vaccine groups and ultimately lying of employees. According to Mayank Chandra, Managing Partner, Antal International, a global recruitment firm, generally, layoffs include underperformers and help in streamlining the talent pool. At one MNC, the therapies or businesses that have become redundant, With the pandemic weaning off, a lot of companies have gone back to the drawing board to analyse the drop in COVID-19 tests, vaccines, hospitalisations etc. Geopolitical chaos, including the Russia-Ukraine war, the resurgence of COVID-19 in China, climate change, etc., further impact the market dynamics. Warassociated sanctions have raised energy and commodities prices, alongside constantly increasing costs of essential raw materials and API, labour, packaging materials, and intermediary costs, impacting overall production timelines and prices.

40 LAYOFFS BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com or low revenue businesses for the company, there has been restructuring in those business units, on the basis of which there have been substantial lay-offs. Some solace Amidst the layoffs, Massachusetts mRNA star Moderna is staffing up big time, and the company’s new chief technical operations officer figures this is just the start. Eyeing potential launches beyond its COVID-19 vaccine Spikevax, Moderna will hire roughly 2,000 new employees in 2023. There are instances of labour shortage and going in for skilled employees. Labour and skill shortages are among the second most important external factors disrupting business strategy. Says, Rituparna Chakraborty, Co-Founder & Executive Director, TeamLease Services and Chief Executive Officer, TeamLease Digital, “The workplace is evolving so rapidly that 76 per cent of the global workforce is not equipped with the requisite skills to function in the new digitally focused workplaces. As organisations across the globe adopt new pedagogies for skilling, it would serve them well to look upon skill development as an integral step to creating long-term value for the organisation. HR Leaders need to assess their Skilling Strategy and come up with a democratic, long-term plan integral to creating sustained value for the organisation.” Despite layoffs, the Asia Pacific region is also witnessing a simultaneous surge in drug discovery and development outsourcing activity, as well as a growing focus on advanced therapies. Across the APAC region, in both developed and emerging markets, there are several TEDD (tech enabled drug discovery) companies, such as Standigm, Intuition Systems, XtalPi, NEC, AI Dynamics, Baidu, etc., which provide AI-enabled drug discovery services. In this regard, jobs across AI/ML, cybersecurity, and data analytics are especially attracting large-scale hiring in the pharma IT sector. Frost & Sullivan’s upcoming Asia Pacific Pharmaceutical Industry Outlook suggests a rise in data management, analytics, and data collection roles in the APAC region, alongside a surge in core drug discovery technology expertise in the form of biotechnologists, biotech engineers, cell biologists and many more, in line with the growing drug discovery and development activities in the region. Hence, despite ongoing layoffs, there will be a demand for newer roles in the pharma sector including those of specialised IT roles, paving the way for better opportunities. Sanjiv Das [email protected] Whilst companies are working towards reducing the impact of the ongoing geopolitical changes, such as the adoption of digitisation across crucial activities like distribution, track and trace, clinical research, manufacturing and many more, it is directly impacting the manual labour requirement, making it redundant by the day. - Aarti Chitale, Senior Industry Analyst, Healthcare & amp; Life Sciences, Frost and Sullivan Generally, layoffs include underperformers and help in streamlining the talent pool. At one MNC, the therapies or businesses that have become redundant, or low revenue businesses for the company, there has been restructuring in those business units, and resultantly there have been substantial lay-offs. - Mayank Chandra, Managing Partner, Antal International The workplace is evolving so rapidly that 76 per cent of the global workforce is not equipped with the requisite skills to function in the new digitally focused workplaces. As organisations across the globe adopt new pedagogies for skilling, it would serve them well to look upon skill development as an integral step to creating long-term value for the organisation. - Rituparna Chakraborty, Co-Founder & Executive Director, TeamLease Services and Chief Executive Officer, TeamLease Digital

SingHealth Duke-NUS Academic Medical Centre (AMC) in Singapore has announced a transformational gift of $50 million from the Lee Foundation that will support the advancement of innovation and research through programmes and initiatives in the AMC Health Discovery District – an ecosystem of innovation centres connecting each SingHealth campus, including the upcoming Eastern General Hospital. The Academic Medicine Innovation Institute that was established in 2021, will oversee the fostering of a vibrant innovation culture in the ecosystem. The Lee Foundation’s gift will boost the AMC’s efforts to design and strengthen frameworks to hasten advancements in healthcare innovation, seed the potential for discovery and innovation through funding and pilot grants, and push the boundaries of medicine through novel research programmes. Cheng Wai Keung, Chairman, SingHealth, presented a $9 million gift in support of the “Ecosystem for Dementia” programme at the National Neuroscience Institute (NNI). A total of 30 donors contributed towards this gift. To be launched in April 2023, this three-year programme aims to deliver vital life-transforming services and provide compassionate support across the continuum of care for dementia patients, their caregivers and families, ranging from community care and screening to rehabilitation and intervention. SingHealth Duke-NUS AMC gets $50M funding from Lee Foundation Springer Nature has entered into an exclusive partnership with Birla Institute of Technology and Science (BITS) Pilani, a renowned institute offering higher education in the fields of science, engineering, pharmacy and management in India. The partnership will advance knowledge and accelerate research by providing services such as author workshops, mentoring sessions and community engagements for the students and faculty of the institute. It will also provide students and researchers at the institute paths to publish quality research, build research communities, incubate ideas and drive open science and open access through collaboration. More than 2700 students and researchers will be benefit from these services and will be able to engage in interactive discussions with editors and researchers. Springer Nature and BITS Pilani partner to advance discovery and research in India The Hong Kong Polytechnic University (PolyU) and The Education University of Hong Kong (EdUHK) have signed a Memorandum of Understanding (MoU) to establish the Centre for Immersive Learning and Metaverse in Education (CILME). This collaboration between PolyU and EdUHK aims to develop a collaborative infrastructure for conducting interdisciplinary research to impact education. CILME will also serve as a powerhouse in the study of technology-enhanced learning and teaching. The Centre will specifically focus on how immersive experiences, including those from virtual reality and the metaverse in general, can enhance students’ cognitive processing, attention, memory, brain function and ultimately learning outcomes. Combining the strengths and expertise of PolyU and EdUHK in cross-disciplinary research, learning sciences and pedagogical innovation, CILME will nurture researchers, incubate technologybased innovations in education, and facilitate knowledge transfer in teaching and curriculum design at both institutions and for the benefit of the community at large. Hong Kong to build Centre for Immersive Learning and Metaverse in education ACADEMICS NEWS 41 BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com

Agilex Biolabs selects Stephen McIntyre as new CEO Renowned scientist Dr Raghunath Mashelkar conferred Suryadatta National Award 2023 to Ravindra Boratkar, Managing Director, MMActiv Sci- Tech Communications to recognise his excellence in the field of Economic Development at the Suryadatta National Award 2023 function held in Pune (India) on February 7. Boratkar has successfully established the flagship event of Indian Science Congress and has strengthened all other initiatives in R&D, Agriculture and other cutting-edge technologies. He also serves as a board member of Solvent Extraction Company and A composite project of Sugar, Power, Ethanol and Bio-Fertilisers Boratkar is a visionary leader and has contributed actively to promote and provoke reasoned thinking in matters of socioeconomic development at both the state and the national levels. He is a Science Graduate with a Masters in Business Administration. He started his career with Newspaper as a Management Trainee and then set up his own Advertising agency in 1988, which has won many awards and accolades. He is the Publisher and Managing Editor of B2B Publication and Portals namely BioSpectrum, nuFFooDS Spectrum and AgroSpectrum. BioSpectrum Publisher & Managing Editor Ravindra Boratkar receives Surydatta National Award 2023 Daiichi Sankyo appoints Hiroyuki Okuzawa as new President and COO Daiichi Sankyo Company has announced the appointment of a new President & Chief Operating Officer (COO) effective as of April 1, 2023. The current Chief Financial Officer (CFO) Hiroyuki Okuzawa will be promoted to the post of president and COO. Sunao Manabe, current president and CEO, will become chairman and CEO. With the aim of enhancing management structure to further strengthen execution in order to successfully achieve the 5YBP and realise the 2030 vision, “Innovative Global Healthcare Company Contributing to the Sustainable Development of Society,” a new Representative Director, President & COO, was appointed at the Board of Directors meeting based on the recommendation of the Nomination Committee. Okuzawa joined Sankyo in April 1986. In 2017, he was appointed as the Vice President, Business Planning Department. Later in 2018, he started serving as the Corporate Officer, President. In 2021, he became the Executive Officer, Head of Corporate Planning & Management Division and CFO of the Company. Agilex Biolabs, Australia’s largest and most technologically advanced regulated bioanalytical and toxicology laboratory, continues its global expansion and corporate evolution as part of the Healius network, with Stephen McIntyre being selected to take the position of Chief Executive Officer (CEO). McIntyre has a proven record of success in executive leadership, producing transformational expansions and enabling Australian companies to establish and refine their global reach in the pathology and healthcare sectors. His background working in complex and highly regulated markets, both in Australia and globally, paired with a strong track record for facilitating successful mergers and acquisitions, makes him uniquely qualified to lead Agilex towards continued growth and success. Jason Valentine will remain in an executive leadership role as Chief Operating Officer (COO). Valentine is an original founding member of the company (est. 1996) and as such has been celebrated as the driving force behind Agilex Biolabs’ ethos of excellence in customer service and dedication to staying on the leading edge of bioanalytical research in Australia. 42 PEOPLE NEWS BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com

Obituary Nobel Prize winner and recombinant DNA pioneer Paul Berg dies Paul Berg, an emeritus professor of biochemistry who won the 1980 Nobel Prize in chemistry, died on February 15. He was 96. Berg, the Robert W. and Vivian K. Cahill Professor of Cancer Research Emeritus, shared the prize for creating the first recombinant DNA molecule by combining DNA from two different organisms. That work set in motion the field of genetic engineering, which has led to lifesaving drugs and opened new avenues of genetic research. Berg authored a 1972 paper in the Proceedings of the National Academy of Sciences in which he revealed that he had inserted DNA from one organism — in this case, the bacterium E. coli — into the DNA of another. As his test case, Berg and his colleagues inserted three genes involved in glucose metabolism into the genome of the animal virus SV40. That accomplishment eventually earned him the Nobel Prize. PEOPLE NEWS 43 BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com Stryker, a US-headquartered medical technology company, has announced the appointment of Aman Rishi as its new Vice President (VP) and General Manager (GM) for India, effective March 1, 2023. In his new role, Rishi will lead the India organisation with a goal to drive sustainable business growth and accelerate healthcare professionals’ access to medical technology and innovation that can help impact patients’ lives. With a decade of experience at Stryker, he has spearheaded initiatives that have enabled Stryker to establish its presence in today’s reshaped medtech industry environment regionally and grow in India. Rishi started as finance controller and advanced through a series of increasingly senior commercial and functional leadership roles. In 2018, he was appointed to lead the MedSurg business in India where he turned the business around by reenergising the product portfolio, the culture and the team. Most recently, he was appointed senior director of strategy and business development for Asia Pacific where he helped strengthen Stryker’s market and category leadership in the region. Stryker appoints Aman Rishi as new VP and GM in India Vani Manja takes charge as MD of UK, Ireland biz at Boehringer Ingelheim Vani Manja, former Country Managing Director (MD) for India at Germany headquartered biopharmaceutical firm Boehringer Ingelheim (BI), has moved to a new role- as the Managing Director for the company’s UK and Ireland business and Head of Human Pharma. Until her successor is announced at Boehringer Ingelheim India, Sandip Agrawal, Director – Finance and Administration has taken on the additional responsibility of Interim Managing Director. Vani was appointed the Country Managing Director for India, on January 1, 2021. In this role, she assumed responsibility for the company’s businesses in India, Bangladesh, Nepal and Sri Lanka. She was formerly the Global Head of Boehringer Ingelheim’s Go-To-Market and Business Steering organisation, based in the company’s headquarters in Germany. She joined Boehringer Ingelheim in the US in 2011, working across Strategy & Operations, Marketing and Sales leadership roles before moving to Ingelheim in 2016 as Regional Business Manager for Japan.

44 PARTNER CONTENT BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com Dynamic fast-moving, entrepreneurial economies! Dynamic bio-industries with globallyconnected production and value chains! Dynamic innovators, investors, and visionaries! BIO Asia–Taiwan 2023 Onsite + Online will be held July 26-30, in Taipei, Taiwan. Jointly organized by the global Biotechnology Innovation Organization (BIO) and the Taiwan Bio Industry Organization (Taiwan BIO), the event aims to build on the success of recent years’ gatherings to bring together biotechnology and pharmaceutical executives and investors from North America, Europe and Asia, explore business opportunities and engage with Taiwan’s emerging biotech sector. This year’s theme, Embracing Asian Dynamics, highlights the incredible opportunities that exist within Asia’s fast-moving economies, its dynamic and innovation-generating biomedical ecosystems, its globally-connected bio-industry production and value chains, and its abundance of investors, entrepreneurs and nimble startups. The five-day event will feature a three-day conference with 100+ internationally-renowned speakers, company presentations from Asia and Embrace Asian Dynamics at BIO Asia–Taiwan 2023 SPEAKER around the world, BIO One-on-One Partnering™ meetings, symposia and workshops, and an international exhibition. Each element will also be accessible online in either live or on-demand formats; ideal for repeat viewings or for delegates unable to attend in person. Showcasing the latest advances from the therapeutic, diagnostic, medical equipment, and service sectors, BIO Asia–Taiwan 2023 Onsite + Online is notably hosted in Taiwan, recognised worldwide not only for its efforts in successfully fighting the spread of COVID-19, but also in cultivating a high level of innovation and production, leading to increasing engagement with the international biomedical community. Event programme

Johnsee Lee Chairman, BIO Asia–Taiwan Organizing Committee “BIO Asia–Taiwan 2023 will focus on the supply chain and CDMO [contract development and manufacturing organization] opportunities that our region has to offer. We’re embracing Asian dynamics at BIO Asia–Taiwan 2023; won’t you join us?’’ Wallace Lin Secretary General, Taiwan Bio Industry Organization “BIO Asia–Taiwan not only provides the platform for Asia to engage with the global biomedical community, but also allows the world to see Asia.” Ed Jager Director, Canadian Trade Office in Taiwan “It’s a fantastic event, there’s lots of people here, there’s lots of things happening! There’s lots of opportunities for collaboration and partnership.” Pei-Jiun Chen CEO and President, Mycenax Biotech Inc. “Over the last few years we’ve been working hard developing CDMO capabilities and are building a strong international footing in this field. We’re very happy to participate in BIO Asia– Taiwan and share our growing CDMO experienceand our services-with everyone. We hope we can participate in this event every year and witness the exciting growth of this industry.” Porta Lin VP, Marketing and Sales and Chief Strategy Officer, ScinoPharm Taiwan Ltd. “Over recent years CDMO has become an important business driver for Taiwan and is also the key business for our company. That’s why we’re here, to provide and offer CDMO services to our customers. This year there were more attendees than we expected. We’re so happy to meet up with old friends and customers that we haven’t seen for a long time!’’ Chin-Ming Chang CEO, TaiMed Biologics Inc. “Every year BIO Asia–Taiwan is a perfect stage to allow international biomedical companies, whether sellers or buyers, to get together and share successful experiences, and develop business opportunities and cooperation.’’ PARTNER CONTENT 45 BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com BIO Asia–Taiwan 2023 Onsite + Online – Focus Areas Innovation – covering precision health, AI and digital health. Market & Supply – including biosimilars, vaccines, contract development & manufacturing, APIs and generics, among others. Investment – covering earlystage financing, cross border investment, capital markets, and more. BIO One-on-One Partnering™ BIO Asia–Taiwan 2023 Onsite + Online will again feature the renowned BIO Oneon-One Partnering™ platform, an easy-to-use online meeting scheduling system to search for and identify potential partners, collaborators, investors and inand out-licensing opportunities. Face-to-face meetings will be held over private and secure video links 24 hours a day during the event period. With over 4,500 meeting requests made via the system during BIO Asia–Taiwan 2022, we expect to exceed that number during the 2023 event. BIO Asia–Taiwan 2023 Onsite + Online will showcase Taiwan’s growing digital advantage in the biomed sector, and spotlight biotech, pharmaceutical, medical devices, precision medicine advances, as well as AI applications, ICT and IoT technologies, and new healthcare/medical investment opportunities. From any point on the globe, make sure to join us at BIO Asia–Taiwan 2023 Onsite + Online, and take the step towards embracing Asian dynamics! For more information visit www.bioasiataiwan.com

Singapore robotics firm AiTreat will be embarking on a new product evaluation in the United States for their massage robot powered by Artificial Intelligence (AI) at Mayo Clinic, USA. At the same time, a randomised controlled trial (RCT) comparing the efficacy of the massage robot with existing therapies such as manual Tuina – a massage used in Traditional Chinese Medicine (TCM) – in managing chronic low back pain is also being planned in Singapore. The RCT will be jointly led by the Biomedical Sciences and Chinese Medicine programme at Nanyang Technological University, Singapore (NTU Singapore) and Singapore General Hospital (SGH). The above two research projects will be using EMMA – short for Expert Manipulative Massage Automation – the flagship product of AiTreat, a startup incubated by NTU Singapore through its innovation and enterprise company, NTUitive. EMMA aims to alleviate the manpower shortage of skilled massage therapists and possibly to augment the work of physiotherapists in managing less complex cases in Singapore and other countries, thus helping bring down treatment costs while providing consistent high-quality treatment to every patient. Singapore uses robots to alleviate manpower shortage of chronic low back pain therapists Applications of new molecules as drugs are expected to be effective in treating diseases that are difficult to cure with currently used conventional drugs. Peptides are one such type of molecule. They are well studied, and several drugs have been developed by the modification of different peptides. Modifying and testing new peptide structures is a timeconsuming process, so any method that could reduce the time required for this process would rapidly accelerate drug development. Researchers at Hokkaido University in Japan have developed a “scanning and direct derivatisation” method for targeted modification of polymyxin, an antibiotic of last resort. While the modification of peptides to enhance and alter their properties and biological effects is quite common, the process of making these changes in a targeted and deliberate manner is still very difficult. Japan develops method to design new peptide therapeutics for combating antibiotic resistance Australia uses machine learning to advance Alzheimer’s research Scientists from Commonwealth Scientific and Industrial Research Organisation (CSIRO), Australia’s national science agency, in partnership with Queensland University of Technology, have used artificial intelligence to develop a world-first benchmark for measuring brain atrophy – or thinning - in neurodegenerative diseases, including Alzheimer’s disease. Advanced machine learning techniques are routinely used in brain research to assess changes in cortical thickness, but until now, a lack of a clinically accurate ‘ground truth’ dataset meant we could not evaluate their sensitivity to the detection of small atrophy levels. Prior to this breakthrough, the only way to get a ground truth measure of cortical thickness was by studying the brain post-mortem. However, brains begin to shrink immediately after death resulting in inaccurate readings. The synthetic dataset images have been made publicly available so clinicians and scientists can use the synthetic images to conduct their own assessments of cortical thickness quantification methods. 46 R&D NEWS BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com

Researchers from the Indian Institute of Technology Delhi (IIT-D) have taken a step forward towards nextgeneration vaccines for COVID-19. Unlike currently used vaccines, which use synthetic materials or adenovirus to package and deliver antigens, the IIT-D researchers used the body’s own immune cells in developing a nano-vaccine. This naturally derived nano-vaccine developed by the researchers could have several advantages over currently approved vaccines. It will minimise the chance of blood clotting, which was otherwise observed in vaccinated individuals. Prof. Jayanta Bhattacharyya, Centre for Biomedical Engineering, IIT Delhi, said, “This approach to vaccination can be used for various other infectious diseases, such as dengue.” The Indian Council for Medical Research (ICMR) has approved a research grant to the group for the development of a nanovaccine against dengue. India to design next-generation vaccine against COVID-19 & dengue A research team at Pohang University of Science and Technology (POSTECH) in South Korea has developed a smart contact lens by combining an intraocular pressure (IOP) sensor and a flexible drug delivery system to manage IOP measurement and medication administration in glaucoma patients. Glaucoma is a common ocular disease in which the optic nerve malfunctions due to the increased IOP caused by drainage canal blocking in the eye. This condition narrows the peripheral vision and can lead to vision loss in severe cases. Glaucoma patients have to manage IOP levels for their life-time. Automatic monitoring and control of the IOP in these patients would significantly improve their quality of life. The new smart contact lens is expected to make possible a personalised glaucoma treatment with maximum efficacy and minimal side effects. In addition, the feedback system would be applicable to various wearable devices other than smart contact lenses as well. Researchers hope early commercialisation of the newly developed theranostic smart contact lens for diagnosing and treating glaucoma intraocular pressure to provide glaucoma patients. Korea designs smart contact lens for diagnosing and treating glaucoma The age-old quest for immortality has taken a step forward with the results of a New Zealand study recently published by the researchers at the University of Auckland. The trial demonstrates that long-term treatment of healthy mice from middle-age (one year) with a drug currently used to treat cancer can increase their lifespan by an average of ten per cent to around three years. In this study, mice were fed a control diet or the same diet with the addition of a drug called alpelisib. Not only did the mice fed the drug-containing diet live longer, they showed some signs of being healthier in old age such as improved coordination and strength. However, the researchers are cautious about application to humans since the mice treated with the drug also had some negative markers of ageing like lower bone mass. According to research fellow Dr Chris Hedges, ageing is not only about lifespan but also about quality of life. Scientists in New Zealand identify drug that could extend lifespan R&D NEWS 47 BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com

Waters Corporation, a leading provider of lab equipment, supplies and software for scientists across the world, has entered into an agreement to acquire Wyatt Technology, a pioneer in innovative light scattering and field-flow fractionation instruments, software, accessories, and services, for $1.36 billion in cash, subject to certain adjustments. The transaction is expected to close in the second quarter of 2023, subject to regulatory approvals and other customary closing conditions. Bioanalytical characterisation for new modalities including cell and gene therapies is a significant market opportunity, with a $1.8 billion total addressable market and 10-12 per cent projected annual growth. By applying Waters’ well-established business model, Empower informatics software, global reach and scale, Waters and Wyatt are well-positioned to build a high-growth bioanalytical characterisation business. Based in the US, Wyatt is a privately held family company with 2022 revenues of approximately $110 million. Waters buys Wyatt for $1.36B to advance bioanalytical characterisation biz Thermo Fisher Scientific has launched a new Cell Therapy Collaboration Centre Programme in Singapore to accelerate cell therapy development across the Asia Pacific region. The new centre will serve as the Asia Pacific hub. The new portfolio of integrated solutions and services will support cell and gene therapy developers from clinical research to commercial manufacturing. The programme was officially launched in October, 2022 at the Cell & Gene Therapy Expert Forum Event with over 50 leading developers and thought leaders across the Asia Pacific region. This collaboration programme will allow cell therapy innovators to accelerate the accessibility of potentially curative therapies to patients, from process development to technology transfer and scalability. The programme offers multiple opportunities to researchers and developers as in, ‘access to state-ofthe-art Thermo Fisher technologies, protocol and process optimisation, product-specific regulatory support to facilitate and expedite clinical translation. Furthermore, the support is extended to product and process scale-up to supply chain readiness and de-risking, as cell therapy programmes advance to commercialisation. 48 SUPPLIER NEWS BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com Japan-headquartered Shimadzu Corporation has announced the release of the world’s smallest MALDI-TOF imaging solution, available as an option on the successful benchtop MALDI-TOF mass spectrometry series: the MALDI-8020 for positive ion analysis and the MALDI-8030, which features a dual-polarity ion source. Suitable for users starting out in the world of biomolecular imaging, the compact format of the Shimadzu benchtop MALDI-TOF system provides a welcoming platform by combining the ease of MALDI analysis with extremely intuitive software in an all-inclusive imaging kit. The system can serve as an ideal teaching tool to introduce users to MALDI imaging. In addition, it offers a low-cost entry point to users who would like to see what MALDI imaging can offer for their workflow. Experienced users will also benefit from the Shimadzu benchtop MALDI imaging solution. Benchtop imaging is an ideal platform for method development and routine imaging analyses. Shimadzu opens door to biomolecular imaging with new compact MALDI-TOF solution Thermo Fisher launches Cell Therapy Collaboration Centre Programme in Singapore

SUPPLIER NEWS 49 BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com Sciex expands protein characterisation capabilities US-headquartered firms Bio-Techne Corporation and Cell Signaling Technology (CST) have announced the addition of Simple Western validation to CST antibodies. This will allow researchers in various disciplines an easier way to study important molecular signaling pathways on a trusted and validated platform. Obtaining accurate data efficiently and fast is key to advancing drug discovery and development. This ongoing partnership will allow for an expanded menu of Simple Western validated antibodies for various targets across multiple disciplines. Simple Western systems from ProteinSimple, a Bio-Techne brand, are the only fully automated western blotting solutions for protein detection and characterisation, providing results in as little as 3 hours. CST is a leader in the development of antibodies and other related reagents used to elucidate cell signaling pathways that dictate cellular behavior and impact human health. Bio-Techne and CST partner to validate simple western antibodies Agilent invests $725M in expansion of therapeutic nucleic acids manufacturing in US Leaders from Agilent Technologies Inc. joined Colorado Governor Jared Polis and local government officials to break ground on Agilent’s $725 million investment to double manufacturing capacity of therapeutic nucleic acids in Frederick, Colorado in the US. The investment will create more than 160 life science jobs in the Frederick area; contribute to the state’s rapidly growing biotechnology ecosystem; and increase US manufacturing for active pharmaceutical ingredients (API) that are essential to treating a growing number of diseases, including cancer, cardiovascular disease, and rare and infectious diseases. Agilent’s manufacturing facilities in Colorado produce siRNA, antisense molecules, and CRISPR guide RNA molecules. The company’s therapeutic nucleic acid contract development and manufacturing organisation services offer superior customer service, the highest quality oligo API material, and cGMP (Current Good Manufacturing Practices) to produce high-volume oligos efficiently and cost effectively from early-stage clinical development to commercialisation. Sciex, a US-based leader in life science analytical technologies, has announced the launch of the Fast Glycan Labeling and Analysis kit for quantitative glycan analysis and an update for Biologics Explorer software to enhance critical protein therapeutic analysis workflows. With these new additions, Sciex continues to expand its ability to support the characterisation of complex and next-generation biopharmaceuticals in different parts of the drug development pipeline. Biologics Explorer software, part of the Sciex OS ecosystem, allows scientists to harness the full potential of the rich spectra produced from the ZenoTOF 7600 system. This release of Biologics Explorer software 3.0 enables streamlined middle-down protein analysis in combination with single electron activated dissociation (EAD) fragmentation to yield high sequence coverage and provide better insight into the important modification sites of the protein. Data are easily translated to support quick and confident decisions about the most important critical quality attributes for biopharmaceuticals. In addition, the Fast Glycan Labeling and Analysis kit enables fast glycan heterogeneity characterisation and identification while retaining sample integrity and delivering consistent, accurate results.

50 BIOSPECTRUM | MARCH 2023 | www.biospectrumasia.com Strategic Elimination of Measles & Rubella by 2030 I n September 2019, the countries of the SouthEast Asia Region of World Health Organisation (WHO) have adopted the goal of measles and rubella elimination by 2023. The countries have worked well with strategies towards achieving this target as five of the 11 countries– Bhutan, DPR Korea, Maldives, Sri Lanka and Timor-Leste - have eliminated measles, and two countries - Maldives and Sri Lanka - have eliminated rubella as well. Countries have been administering two doses of measles vaccines as part of their childhood immunisation programme and some are rolling out mass vaccination campaigns. All the countries in the region have adopted the following strategies - providing two doses of measles containing vaccine (MCV) and at least one dose of rubella containing vaccine (RCV) under National Immunisation Programme; Established laboratory supported case-based surveillance for measles and rubella; Have access to one or more proficient laboratories for measles and rubella diagnostics and Have functional National Verification Committee for measles and rubella elimination. Measles and rubella elimination is a flagship priority programme of WHO South-East Asia Region. Between 2014 and 2021, the region recorded 73 per cent reduction in measles deaths and 64 per cent reduction in measles cases. In 2022 the region witnessed 97 per cent reduction in the estimated deaths due to measles. However, as the pandemic hit, measles vaccination coverage, which had reached an all-time high of 94 per cent coverage for first dose and 83 per cent coverage for second dose by 2019, declined to 86 per cent and 78 per cent respectively in 2021, leaving nine million children unvaccinated for measles and around 5.3 million children partially vaccinated against this highly infectious and killer disease in the last two years. The decline in vaccine coverage, and interruptions and delays in immunisation and surveillance activities due to COVID-19, left the region susceptible to large outbreaks and off track for the 2023 target of measles and rubella elimination. The countries need to urgently close immunity gaps with tailored approaches for highest impact, such as through catch-up campaigns and strengthening routine immunisation with better microplanning. The countries must also ensure adequate investment in laboratory supported case-based surveillance for timely detection of measles cases and outbreaks, to facilitate an appropriate response. Since 2001 (i.e. from the formation of Measles Initiative) huge strides have been made. The Initiative has helped deliver measles vaccines to children worldwide, contributing to saving over 56 million lives globally since its formation and invested more than $1.2 billion in measles and rubella control activities, in partnership with Gavi, the Vaccine Alliance and the Bill & Melinda Gates Foundation (BMGF). The impact of these investments is significant. From 2000 to 2021, the annual number of estimated measles deaths decreased 83 per cent, from 761,000 to 128,000. While much progress has been made, the goal is to collaborate with countries and partners to achieve the Immunisation Agenda 2030 (IA2030) target to save another 50 million lives through access to essential vaccines by the end of 2030, with measles immunisation contributing a large percentage. Towards that end, all founding partners adopted the Measles and Rubella Strategic Framework 2030 (MRSF 2021-2030), which is fully aligned with IA2030, an ambitious global strategy to maximise the lifesaving impact of vaccines. In alignment with IA2030, the MRSF 2021- 2030 has seven Strategic Priorities (SPs)- Primary Healthcare and Universal Health Coverage; Commitment & Demand; Coverage & Equity; LifeCourse & Integration; Outbreak & Emergencies; Supply & Sustainability and Research & Innovation. The MRSF 2021-2030 also describes how the four core principles (CPs)- People-focused; Country-owned; Partnership-based and Data-guided of IA2030 will be applied to each of the priority and focus areas within the context of measles and rubella elimination. This framework will guide all stakeholders at country, regional and global levels to plan and implement more effective measles and rubella elimination and control activities and to raise the ambition level towards achieving ‘A world free from measles and rubella’. Narayan Kulkarni Editor [email protected]