Soon after reaching its 60th anniversary, in 2015, the largest hospital in Catalonia and a group of sister institutions began working on the creation of a new type of campus. The idea was to follow the footsteps of world-leading healthcare hubs.
The idea of strengthening the cluster was an undertaking by the regional government and private stakeholders in an effort to position the Vall d’Hebron Barcelona Hospital Campus in the international arena.
Leveraging a public hospital with an annual budget of nearly one billion dollars as its foundation, plus a couple of world-renowned research institutes and a top Spanish school of medicine, the campus was to accommodate five organisations in different paradigm.
Each of the five organisations took a different role – healthcare provision by the hospital, medical education by the Autonomous University of Barcelona, cancer translational research by the Oncology Institute, multiple sclerosis treatment by the CEMCAT centre, and broader health research by the Vall d’Hebron Research Institute – and accelerated their collaboration.
In theory, a young student could obtain their medical degree, practice at a leading hospital, become an internationally published researcher and spin-out a next-generation discovery, taking it to the market and the patients he used to treat, without leaving the Vall d’Hebron Campus.
In the following years, however, the difference between theory and practice proved to be a barrier; the American or Swedish models they were following operated under different economic, academic and industrial realities. The Vall d’Hebron Campus, located less than a mile north of the city’s famous Park Güell designed by Antoni Gaudí, had to stop following.
A market approach
“The task of adapting the Boston model to their own context fell, in part, to the Vall d’Hebron Research Institute (VHIR), which, after the hospital, is the campus organization with the largest budget – approximately EUR 45 million per year”, comments Dr Joan X Comella, VHIR’s director.
Ironically, VHIR turned to a familiar American ally to keep up: the markets. “Our strategy to improve was market-oriented… Years ago, [VHIR] moved away from being a traditional technology transfer office in favour of collaboration that aligns knowledge-creation with new business opportunities. However, since this is a public institution, it was not easy to speak about business at the beginning,” Laia Arnal, the director of business development for VHIR, told PharmaBoardroom in a recent interview.
Through academic success, new internal opportunities and more funding, the institute was able to conduct what Laia describes as a great cultural transformation. “Today, we are more used to talking about business, about value creation, about having economical returns that will eventually make our society healthier.”
Last year, the majority of VHIR’s funding – 60 percent – came from the private sector, the remaining 40 percent of public competitive fund calls from Catalan, Spanish and European governments. Only 2.6 of the 45 million euros were guaranteed by public structural funding, the rest had to be achieved through competitive grants, contract research, donations, beyond others.
As Dr Josep Tabernero, head of the Vall d’Hebron Institute of Oncology (VHIO) – the campus’ additional research arm – explained to PharmaBoardroom in a separate conversation, matching the investment opportunities currently available to organizations in the United States dollar-by-dollar is not realistic, but there is a way for Spanish institute to compete. “The investment is superior in the United States, broadly speaking, but [Catalan research institutions] have advantages since our healthcare system is more integrated… US centres are very competitive, but, from the perspective of translational science, we are not behind.”
A clinical trials hub within a hub
The level of integration highlighted by Dr Tabernero – made possible by the universal healthcare systems characteristic of EU countries – might explain to some extent Spain’s position as a global leader in clinical trials. “The integration and security of our network is the reason why the proportional number of patients we include in clinical trials is superior. We should be very proud about that,” he says.
In 2019, Spain ranked fourth globally by number of active clinical trials, according to ClinicalTrials.gov and SIRIS Academic, behind the US, France and Canada. From the country’s total, Catalonia maintains a disproportionate share with 45 percent. If considered a country, Catalonia would have ranked number 13th in the world, above Switzerland and Denmark.
Located in the hotspot of a global hub, Vall d’Hebron leveraged its geographical position and expertise to succeed in clinical development and looked at oncology as the key. Trials are jointly managed by VHIR and VHIO from a centralised structure. “One of every three new diagnosed oncology patients gets into a clinical trial, which gives them access to innovation not yet available in the market; it is an advantage when alternatives are scarce,” opines Xavier Cañas, VHIR’s director of Promotion of Clinical Research.
“The Vall d’Hebron Campus has strong activity in clinical trials; in 2021, we were involved in at least 1,500 active clinical trials with more than 2000 new patients who benefited from participating in such clinical trials and raised over EUR 26 million from the activity”, adds Xavier Cañas. Of that revenue, more than half derived from phase I and II studies, reflecting the campus’ involvement in early phase development; most of the total revenue was brought in by oncology trials, according to internal data shared with PharmaBoardroom.
Not surprisingly, Vall d’Hebron has been highly involved with COVID-19 vaccine trials. In 2021, the campus participated in four different programs, including those from Pfizer-BioNTech and Janssen, and was selected as a key centre for the most advanced Spanish vaccine, that of Hipra, a Catalan multinational private company predominantly dedicated to the research, production and marketing of animal health products.
Incubating the next Spanish big start-up
Accessible by two metro and eleven bus lines, the campus functions as the workplace of 9,000 professionals and receives 1.2 million patients per year; of the total workforce, 2,000 are involved in research activity. “Hundreds of professionals, physicians, clinicians, nurses, or administrators, participate in research activity. 70 percent of our principal investigators are at the same time clinicians, which is a key seeing point for us since the people leading our research are also in charge of the hospital’s clinical services,” reveals Dr Comella.
“Every single research activity we do has the purpose of generating new knowledge directed at understanding diseases and developing new solutions, products, services and treatments for patients”, he adds.
Occupying a multi-story building on the left side of the campus, called Meditarrània, Laia Arnal’s office is tasked with overseeing and promoting more than a dozen spin-offs and startups. In 2021, those companies raised more than EUR 40 million, which benefited Vall d’Hebron directly. Modis, for example, recently gave EUR 1.3 million to VHIR in returns after being acquired by Zogenix for 250 million, a milestone that, according to Laia, is a rare and exceptional example in the Spanish science ecosystem.
Another success story can be found in Mosaic Biomedicals, which was created with patents from both VHIR and VHIO, and acquired by a Canadian company, Northern Biologics, that eventually sold its portfolio to Bristol Myers Squibb and AstraZeneca in what Laia describes as a very satisfactory outcome.
“One of our latest spin-offs, Frontwave Imaging, is developing a new non-invasive ultrasound technology that will be used in diagnostic in breast cancer patients. The project was developed in collaboration with the Barcelona Supercomputing Centre and the Imperial College London. This is the type of companies we want to foster, ones that innovate with great partners and raise competitive private and public money.”
As for the business models being offered to spin-offs, the business developer director explains that it all depends: “We negotiate with each of them independently, and much depends on if the company is a Vall d’Hebron creation or a collaborative project. Sometimes we have a license deal, a co-development structure, raise money together, or, of course, milestones, upfront and royalties.”
Welcoming the industry to the living room
Seated in his office of the Meditarrània building, as he listed the medical procedures and therapeutic areas where Vall d’Hebron excels, Dr Comella pointed to the building across the street. “You cannot see it, but there is a helipad on the roof which will probably receive four or five helicopters with emergency patients during this interview.”
One of those emergencies is likely to have been a stroke since, as Dr Comella said, the hospital is regarded as a top centre in Spain. “We are also excellent in oncology, neurosciences, transplants, paediatrics, rare diseases, and general surgery, which is why we excel at traumatology and rehabilitation.”
The wide range of Vall d’Hebron’s expertise is probably why Big Pharma and some of Spain’s largest health companies have chosen the campus to carry on development projects, some even installing a permanent space.
“My job,” Laia says, “is to identify and create new collaborations. We know each other and have a permanent channel of communication at different levels, from medical directors to CEOs. We show them new assets under development, new research lines, that might be of interest to them to decide whether or not we go together. In collaborations, sooner is always better.”
Multinational players in that list include Phillips, Sanofi, and Novartis, which has a global digital health hub in Barcelona. “Vall d’Hebron would like to become a natural permanent partner so they can create predictive algorithms here. Why? Because they have access to key opinion leaders, patients, students, physicians, scientific and technological facilities, samples and much more in one place. There is not another place in the city with such concentration of assets,” Laia contends.
But, given their public nature, the campus cannot solely focus on international innovators. Which is why they have been partnering with leading Spanish and Catalan healthcare companies like Werfen and Ferrer, the Barcelona-based specialty pharma mid-cap.
“To really achieve the ecosystem I described, we must have a proactive attitude, introducing partners to different authorities like the infrastructure director of the hospital or the person in charge of our digital transformation, to identify mutual areas of interest. So, when there is an open call at the European or national level, we go together… [With Ferrer] we have done innovative projects to license or co-develop assets,” says Laia.
In fact, Ferrer was one of many organisations that donated funds for the newest and very modern VHIR building, set to be completed in 2023. The premises, designed BAAS Arquitecture and Espinet / Ubach, will reserve the third floor for two important activities. As Dr Comella explains, “one is to incubate and accelerate spin-offs and startups, and the second, which will have around 2,000 square meters, will be devoted to public-private collaboration.”
“Our goal is to transform this huge campus into a thriving and competitive innovation ecosystem. Hospitals are, yes, the home of healthcare services, but also places to generate knowledge… I am absolutely convinced that they can become areas of intense economic activity. Vall d’Hebron’s campus was inspired by those in the Boston, Massachusetts, area, but adapted to Barcelona’s reality,” the VHIR director insists.