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Long renowned as a sophisticated pharma market and straightforward, reliable host country for multinational drug makers and health technology developers seeking to penetrate East Asian markets, Singapore’s life science sector has managed to hold its own during the ongoing disruption of the global pandemic.
With the city state facing its deepest recession in its 55-year history as COVID-19 decimated other linchpin industries such as construction, shipping and tourism, Singapore’s healthcare and life science sector stands out as having played a vital role in offsetting a seven percent contraction in GDP and helping keep the national economy afloat.
“The performance of our biopharmaceutical industry definitely deserves recognition as a bright spot in 2020 accounting for five percent of GDP and generating about USD 22 billion in total output,” recalls Ashish D. Pal, managing director of the Singapore, Malaysia & Brunei Cluster at MSD and president of the Singapore Association of Pharmaceutical Industries (SAPI).
Indeed, Singapore’s exports of pharmaceutical products actually surged last year as supply chain upheaval prompted worldwide stockpiling of APIs, providing a much needed shot in the arm for an ailing economy that had been encountering significant headwinds. In the end, the entrepôt’s exported medicines registered an impressive trade surplus of USD 3.1 billion as countries turned to the lion city to shore up their inventories.
“The unique characteristics that have historically made Singapore an alluring life science market that rewards biopharmaceutical innovation certainly continue to hold true today,” notes Pal, pointing to the latest forecasts from Fitch that project a CAGR growth rate of around six percent through 2030. “If anything, they resonate stronger than ever.”
“Despite our diminutive size, we are fortunate to be geographically strategically located within easy reach of heavyweight markets in the region and beyond. Our strong transport connectivity and business-friendly operating environment, coupled with a robust infrastructure and regulatory framework, have created a powerful value proposition that continues to entice in and anchor big-brand pharma and medtech companies,” agrees Mimi Choong May Ling, CEO of the Health Sciences Authority (HSA), the national regulator.
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Country Manager, Pfizer Singapore
What, though, is Singapore’s unique value proposition from a life sciences perspective? Clarence Ngui, regional VP for medical education in Asia Pacific at leading orthopaedic products develop Zimmer Biomet, describes the situation thusly: “Singapore is rightly considered by many to be Asia-light or Asia-101 because it’s the most comfortable landing point for Westerners relocating to Asia for the first time. In a region that frankly can be difficult to do business in yet promises high rewards to those who get it right the city-state stands out as a safe haven and somewhat familiar destination; one with genuine rule of law, an unashamedly pro-business government, an attractive tax system. and an English-speaking population.”
Little wonder, therefore, that over 30 of the world’s elite pharmaceutical and medical technology firms – Novartis, Pfizer, MSD, GSK, and Sanofi to name but a handful – have elected to base regional management, manufacturing, and R&D functions out of Singapore. Indeed, a multi-industry study in 2019 by real estate services outfit Cushman & Wakefield found that the number of life science MNCs with a regional headquarters in Singapore was over 1.5 times the figure for Hong Kong, Shanghai, Beijing, and Tokyo combined!
“Singapore undoubtedly occupies a privileged position within Asia Pacific. There’s nowhere else quite like it in this part of the world. Aside from the excellent geostrategic positioning, we’re taking about a wealthy, mature, well-run operating ecosystem that can be truly relied upon and is unwaveringly welcoming. That means you can place big-ticket, long-term, strategic investments without having to shoulder undue levels of risk,” muses Ai Li Siow, managing director of Siemens Healthineers.
“It’s really no coincidence that, as a company, we identified Singapore as the optimum location for situating not just our local and regional sales organisations, but also auxiliary capabilities such as our customer services functionalities,” she adds. “We have even established our Remote Services Center (RSC) for Asia-Pacific here, which deploys a follow-the-sun concept to provide 24/7 remote support for our clients in every time zone across the world.”
For a start, ‘ease of doing business’ is enshrined in how the country operates. “While regulatory requirements in Singapore are still stringent, there are clear pathways to launch a new product with all its paperwork into the market within a six-to-nine-month time period. The process is transparent and the rules themselves clear-cut and applied consistently. You therefore know where you stand and can plan accordingly. This, in itself, constitutes a big advantage,” enthuses Ngui.
Erika Pagani, country manager of Pfizer very much concurs. “This is certainly one of the most business-friendly countries that I’ve ever encountered. The authorities preside over a progressive financing system that promotes both innovation and stability. Most impressive of all, the government is highly efficient and plans upfront, well ahead of time. They understand business owners’ need for predictability and certainty, and even speak our kind of language. It is amazing how Singapore’s policymakers possess the foresight know where they want to be in five to ten years and how they are already managing to proactively build the foundation to realise that vision.”
Intrinsic to that is also a well-earned reputation for cleanliness, openness, trust and good governance. “This is by no means a trivial matter when it comes to medical innovation and healthcare,” explains Shiva Kannan, vice president and commercial chief information officer at GE Healthcare, “if we are to have the confidence to invest deeply in areas like healthcare capacity building, then we are going to want to be assured of proper IP protection and an absence of corrupt practices. Even cybersecurity is nowadays an important factor to think of. “When dealing with sensitive patient data, it’s critical to have an appropriate infrastructure in place that can ensure its security and prevent hacking,” he notes.
Ready access to an abundance of top talent is another key consideration in the calculations of many innovation-driven life science multinationals. “Singapore can be considered a genuine talent magnet… not only does in offer a lot by way of highly-skilled, homegrown science professionals, but from a human resources standpoint, it’s a place where top-table global talent wants to come and work,” observes Johnson & Johnson’s managing director, Guillermo Frydman.
“One of the biggest roadblocks to building a successful healthcare company is being able to source the right calibre of people and, in this day and age where medical science has become ultra-sophisticated and data-driven, you generally have to search globally so it’s a big bonus if the location you’re situated in has the requisite pulling-power to attract in that level of expertise,” reflects Nawal Roy, founder and CEO of Holmusk, an outfit striving to establish data as a core utility to the treatment of behavioural health disorders.
“While the likes of Basel and Boston probably do tempt us, we’ve thus far found Singapore to be a wonderfully supportive and conducive enabling environment for getting our company off the ground. The country’s cosmopolitan culture, connectivity and open-door talent immigration policy have certainly all been major factors in that achievement,” he concedes.
Underpinning such a clear, fair, and pragmatic operating framework is what can only be described as a ‘gold-standard’ regulatory apparatus that appears to have won the respect of much of Singapore’s innovative pharma industry. “As far as our members are concerned, we think the Health Sciences Authority (HSA) does a terrific job, characterised by high levels of efficiency, engagement, clarity, and dialogue,” enthuses SAPI’s Ashish Pal.
“The turnaround times for new drug and new indication applications are generally even faster than the published timelines: approximately 270 working days for the full NDA route or 180 working days for an abridged route. And what’s been especially impressive is that the authorities have somehow managed to maintain these fine levels of effectiveness throughout 2020, despite the pandemic, which really surprised many of us,” he exclaims.
“There can be little doubt that Singapore’s regulator serves as a trailblazer and paragon to the rest of the region creating credible standards and use cases that other countries can leverage. The country’s officials preside over a structured process that runs like clockwork and which other East Asian markets would do well to emulate,” agrees Andrew Frye SVP and president for APAC at medtech multinational Baxter.
At the same time, the HSA has been vigorously proactive in efforts to shape better standards internationally and promote regulatory convergence. For instance, it is part of the US FDA’s Project Orbis for parallel assessments, and has joined forces with its peers from Australia, Canada, Switzerland, and the UK as part of the ACCESS Consortium aimed at condensing approval timelines for diagnostics and vaccines.
Particularly noteworthy has been its adoption of ‘priority adoption routes’ in response to breakthrough therapies such cell and gene, and urgent unmet needs such as Coronavirus vaccines. “In December 2020, we introduced the Pandemic Special Access Route (PSAR) to facilitate early access to critical novel vaccines, medicines, and medical devices during a pandemic, such as the ongoing COVID-19 pandemic,” details HSA CEO Mimi Choong May Ling.
“Using PSAR, our evaluators were able to start reviewing the data of new vaccines, medicines and medical devices from the early stages of clinical studies, as and when real-time data was submitted by companies on a ‘rolling’ or staggered basis, instead of waiting for the full data set to be submitted before starting our evaluation. This gave us more time to review the submitted data while companies could continue with further clinical trials and development concurrently,” she explains.
Even the HSA’s structural makeup marks it out from the crowd. Aside from regulating health products, the multidisciplinary authority additionally runs a national blood service, and an entity called the Applied Sciences Group (ASG), which covers forensic medicine, forensic science, and analytical science.
“The diversity of functions we possess as an organisation is actually a source of great inner strength. Having all these capabilities under one umbrella creates synergy that enables us to perform our work better. Instead of looking for expertise outside when we need it, the regulatory group can find help within,” proclaims Choon May Ling.
This synergy was demonstrated when the HSA claimed the distinction of being the first regulator in the world to recall ranitidine and metformin products following a nitrosamine contamination in September and December 2019. “As there was no existing test method available internationally to analyse for nitrosamine contamination, our ASG itself proceeded to develop a new testing methodology from scratch that was able to deliver a prompt and precise system of identification,” she remembers.
Medical Tourism: The COVID Effect
The past 18 months have been both challenging and transformative for the Singaporean life science community. One of the biggest upheavals has centred around the temporary near-elimination of the country’s medical tourism niche.
“Over the years, Singapore has managed to harness the high level of trust in its healthcare system to cultivate an excellent reputation as a health tourism hotspot with wealthy patients flying in from all over to Asia, and even beyond, to receive elite care art premium prices. With countries closing their borders in the wake of a global pandemic, supply to this lucrative niche was all but cut off overnight,” explains Praful Chakkarwar, country manager of Novo Nordisk. “Pandemic-related restrictions triggered a dramatic reduction in elective cases and in medical tourism,” agrees Johnson & Johnson’s managing director, Guillermo Frydman. “To put it in perspective, surgeries plummeted by between 60 to 70 percent.”
This was bad news for many innovative pharma companies that had been using the medical tourism channel as an important pillar of their go-to-market launch strategies. “In 2020, we launched new oncology drugs, but I must admit it has been a pretty difficult process. Owing to the prevalence of medical tourism, many of the therapies we launch are initially through the private setting with the plan to later expand their availability in the public system. With travel limitations, doctors are not having that same accelerated experience with the new drugs and we have been having to radically rethink our market access and roll out strategies,” confides Erika Pagani, Pfizer’s country manager.
“I think a lot of people were maybe unaware just how heavily dependent Singapore is on medical tourism,” reflects EY’s Abhay Bangi. “This is a niche that makes up a significant portion of the revenue for most big pharma players so the fact that that vanished for most of last year will have been a considerable blow. While the segment will most certainly rebound, you can still expect that there will be a de-premiumization of pricing in the near term as clinics try and tempt health tourists back and this is something that companies will have to adapt to.”
One of the main supporting pillars of Singa-pore’s pharmaceutical industry is, of course, its magnificent manufacturing base. Not only does the city-state rank as one of the few countries on the planet that manages to export more medicaments than it imports, but it also plays host to over 50 pharmaceutical manufacturing facilities, including plants owned by eight of the world’s ten biggest drug makers.
“Being in Singapore, you can enjoy a level of manufacturing expertise and standards that you would be hard pressed to find replicated elsewhere across the region,” explains MSD’s Ashish Pal. “There are good reasons why our company maintains over 1,000 dedicated production staff based at a state-of-the-art facility in Tuas. Moreover, three of MSD’s six globally leading products are manufactured in-country right here,” he confirms.
The elevated reputation of ‘made in Singapore’ pharmaceuticals is widely acknowledged. In fact, over the past three decades, there have been zero major observations by overseas regulators such as the US FDA and EMA who habitually inspect and audit local facilities. “As a country, we’ve managed to assert ourselves over time as a hub for best-in-class manufacturing that is renowned for its superior technical quality and compliance with GMP and which then interlocks with the very highest standards of logistics and distribution network integrity,” reflects Ching Kiat Lim, managing director of Airhub Development at Changi Airport Group.
Meanwhile the medtech industry has also been ramping up its slice of the action. Courtesy of more than 30 dedicated medtech fabrication sites, Singapore today enjoys the distinction of being the producer of over 70 percent of world’s microarrays, ten percent of global contact lenses, and 50 percent of the planet’s thermal cyclers and mass spectrometers!
It is not just the sheer volume of Singapore’s manufacturing output that catches the eye, however, but also the rising sophistication of what is being produced. To develop flexible capacity options, the Singapore government has been busy partnering with CDMOs with a view to expanding the country’s capacity for commercial and clinical-scale production, as well as for novel modalities, such as cell and gene therapy, for pharmaceutical companies that wish to outsource their manufacturing needs.
“Singapore’s mature biomanufacturing industry didn’t just appear spontaneously overnight but is the product of years of careful strategic planning,” explains Lucas Chan, scientific founder and CSO of CDMO player Cellvec, a company that has been helping to advance gene transfer technologies through the manufacturing development of viral vectors. “There has been a concerted and cohesive effort on the part of the authorities to support each and every part of the value chain. No stone is left unturned. At one end of the spectrum, they have been investing in state-of-the-art production hardware. At the other they have been quick off the mark to design bespoke Cell and Gene Therapy (C>) product registration guidance so that there is a definite pathway to market for any product produced.”
Indeed, to ensure that Singapore’s medical science community manages to keep pace with the very latest developments in regenerative medicine, the government has invested SGD 80 million to establish three C> manufacturing technology research programmes. Meanwhile some 280 hectares of land has been set aside specifically for high-level pharmaceutical manufacturing at Tuas Biomedical Park (TBP).
Ng Huck Hui, assistant chief executive of the Biomedical Research Council within the Agency for Science, Technology and Research (A*STAR) sheds further light on the logic of this process. “Singapore is a small country with limited resources, which means that we have to be more focused in where we direct our resources to guarantee maximal impact. All investment must be precisely targeted, and stakeholders must be encouraged to join forces for the benefit of all. By bringing together state-of-the-art facilities and co-opting top talent, especially in areas like R&D, from both the private and public sectors, we aspire to stimulate innovation and to help industry scale the value chain,” he reasons.
When applied to the manufacturing segment, Singapore’s policy makers clearly understand that retaining future prowess in fabrication entails pushing into ever higher forms of complexity, technical sophistication and process innovation. After all, the city state is a comparatively expensive place where space is at a premium and cost of labour is high. “Manufacturers operating here need to bear in mind the associated cost factors and appreciate that there is little room for complacency… in the long-term, the business case only works if it involves advanced levels of automation, well-skilled manpower, niche competencies and a high degree of productivity,” posits Tim Philippi, executive director of the Singaporean-German Chamber of Industry and Commerce (SGC), who identifies certain parallels between the microstate’s value offering and those of DACH markets such a Switzerland and Germany.
“It’s always about striking balance between risk and payoff, and the inherent nature of innovation means there is no sure-fire bets. Despite the limitations of our market size, we have nonetheless so far proved able to consistently punch above our weight in scientific excellence. This is reflected in recent global innovation reports such as the Bloomberg 2020 Innovation Index, where Singapore leapt three spots and was ranked 3rd globally,” adds Ng.
Research, Innovation and Enterprise (RIE) 2025: Supercharging Enterprise
Singapore has an overarching Research, Innovation and Enterprise (RIE) strategy, which is evaluated and renewed every five years. The current plan focuses upon 3 main target areas: namely driving social growth with advancements in science and technology, strengthening the innovation capabilities of home-grown enterprises, and investing in the scientific base of the nation.
“It’s fair to say that, over the past couple of decades, we have concentrated as a nation on building clusters like the Biopolis, scientific universities, institutes and so on. Now we are going to double down on translation and fortifying our enterprises. The time has come for new scheme to think about how we channel all our ideas and research into a translational engine and to develop end-to-end capabilities in drug discovery and development,’ declares Ng Huck Hui, assistant chief executive of the Biomedical Research Council within the Agency for Science, Technology and Research (A*STAR).
Another eyebrow raising feature of the Singaporean life science ecosystem is the way in which the country has seamlessly managed to pair its robust manufacturing platform with an equally high standard of logistics capabilities. In recent years, actors such as Changi airport have been proactively setting about supporting the development of the sector by ensuring the reliable handling of delicate pharmaceutical shipments.
“Back in 2017, a number of critical steps were taken that really served to differentiate the country from its neighbours,” explains Ching Kiat Lim. “Firstly, we established the Pharma@Changi community to enhance the airport’s pharma handling capabilities. This proved to be an effective platform in engaging specialised pharmaceutical shippers to ensure that the community was able to cater to their requirements in terms of temperature-controlled environments, humidity levels, data transparency and so on.”
The second step was to ensure that the air cargo community in Changi was certified to common quality standards, which in turn provided pharmaceuticals manufacturers with reassurance over the handling processes. “This served to transform us into the largest IATA’s Center of Excellence for Independent Validators in Pharmaceutical Logistics community in the entirety of Asia Pacific, which really put us on the map,” he proudly recalls.
“The third step was to extend and deepen our collaboration efforts with like-minded airport communities on the global front. Together with Brussels Airport and Miami International Airport, we co-founded the Pharma.Aero organisation, a cross-industry collaboration for Pharma Shippers, CEIV certified cargo communities, Airport Operators and other air cargo industry stakeholders with the aim of attaining mastery in reliable end-to-end air transportation. This has firmly cemented our thought leadership in pharma logistics at a global level and kept us on the front foot, and ahead of the game,” he declares.
Such features have consequently opened the door to Singapore becoming a major component of innovative drug makers’ global supply chains and distribution networks. “It’s fair to say that Singapore has matured into a genuine biopolis and a vital transit location for healthcare products, intermediates, and finished goods. Moreover, this extends well beyond simply transportation to encompass the management of regional distribution centres, support for the global supply chain for manufacturing, as well as enabling our customers to innovate and optimize,” observes Bee Lim, UPS’ director for healthcare strategy and marketing.
Testament to this has been the gusto with which pharma and healthcare multinationals have set about building their own in-country logistics bases and distribution hubs to service the region. “Alongside our API plant, manufacturing technology development centre and our scientific laboratory services, we’ve also been building up a huge logistical operation here capable of serving the whole of emerging Asia. Given the standards in place and proximity to where we need to be sending large quantities of product, it’s frankly a no-brainer,” explains Pfizer’s Erika Pagani. Siemens Healthineers meanwhile has come to much the same conclusion. “Our Customer Service Material Logistics (CSML) Hub in Singapore now serves as a redistribution centre for our spare parts and helps streamline our operations across all of Asia-Pacific,” reveals Ai Li Siow.
Moreover, while the onset of COVID-19 last year wreaked havoc with supply chains the world over, the global pandemic in many respects validated many of the enhancements that Singapore had been putting in place beforehand. “Because of all the steps that had already been taken, we were able to react more swiftly and efficiently,” recounts Changi Airport’s Lim. “For example, we were prompt in recognising that vaccine distribution – especially for products like the Pfizer/BioNTech vaccine, which was developed on a new platform and requires ultra-low product temperatures of minus 70 – was going to present a challenge.”
“The distribution of these products requires high levels of complexity and collaboration between various stakeholders, but with our prior experiences, superior capabilities and elevated know-how, we were able to rapidly mobilise a ‘Changi Ready taskforce,’ a local public-private partnership taskforce comprising both local logistics companies and government agencies like customs and border control, and airport security,” he elaborates. No surprise, then, that Changi has subsequently become the primary point of entry for Coronavirus vaccine batches into the region.
Meanwhile, life science companies that had already established logistics hubs out of Singapore generally found themselves able to get their networks up and running again swiftly. “COVID-19 highlighted the importance of having a diversified supply chain management (SCM) system. This has a direct impact of costs as we have thousands of fleets in hospitals that operate 24/7 which cannot be interrupted. Despite the circuit-breaker period last year, we registered almost zero incidents of spare-parts delays courtesy of our Singapore-based CSML. Having this capability ensured our customers operations were not interrupted during that extremely difficult period when many competitors fell by the wayside,” muses Ai Li Siow.
Looking ahead, in view of the prevailing trends, Singapore’s function as a logistics hub might become even more pronounced over the years to come. “One of the emerging trends we’ve identified in the wake of the Coronavirus has been an increased tendency towards near-shoring,” says Leonora Lim, vice president of life sciences & healthcare, customer solutions & innovation at DHL. “Having witnessed the fragility of their supply chains being cruelly exposed by the pandemic, many firms are beginning to look at how they can bring their suppliers closer instead of sourcing from multiple suppliers in different parts of the world, far away from where the manufacturing is.”
“From my own experience, when it comes to the pharma and medical device industries, a lot of the existing products tend to be made in the US and Europe and then get imported directly into Asia Pacific so there’s going to be a lot of fresh demand for a country within APAC that possesses both the manufacturing and the logistical clout to act as a near-shore substitute or staging post. If Singapore is not already on their radar, it’ll surely only be a question of time,” she predicts.
Chronic Disease: A Gathering Storm
Singapore is one of the healthiest countries in Asia with a life expectancy in excess of 82 years buttressed by one of the most robust healthcare apparatuses in the world. “It’s important not to overlook the strengths of this system and just how strong healthcare delivery, affordability and access is compared to much of the rest of the region. Out here, we enjoy internationally recognised healthcare, explicitly designed to ensure that everyone has access to different levels and types of care, which tends to be quite a rarity in East Asia,” remarks Johnson & Johnson’s Guillermo Frydman. “One shining light is the MediShield Life insurance scheme which provides protection against large medical bills and expensive outpatient treatment,” he elaborates.
That said, Singapore currently spends only around 4.8 percent of its GDP on healthcare, significantly below the OECD average of 8.9 percent, while a growing disease burden and the demography of an ageing population are combining to ramp up pressure on the public health system. Pharmaceuticals meanwhile account for a mere 5.8 percent of total healthcare spending, versus about 16.5 to 17 percent in many developed western economies, which means that Singapore will have to act smartly if it is to keep its healthcare system sustainable in the long run.
Of particular concern is the rise in chronic diseases such as diabetes and cardiovascular complaints. “8.6 percent of the Singaporean adult population is suffering with diabetes today, with 8.7 percent already living with obesity and some 1.7 million people are at risk of developing obesity related complications in the coming years,” warns Praful Chakkarwar, the country manager of Novo Nordisk. “The challenge is going to be about raising awareness of this emerging threat and reconfiguring care pathways, because obesity management requires a multidisciplinary approach to be properly effective,” he stresses.
Companies like Sanofi have therefore been explicitly positioning themselves to help surmount these kinds of challenges. “Our core focus is to reverse the course of the chronic disease epidemic by 2030 through radically transforming and reconceptualising healthcare. We’re looking to drive better diabetes management and really assume leadership in those areas where we are confident we can dramatically improve chronic disease patient outcomes, including cardiovascular and thrombosis.” explains the company’s general manager, Marine Queniart-Stojanovic. “This entails transitioning beyond being a mere purveyor of pills to becoming a provider of holistic healthcare solutions and collaborating with stakeholders right across the healthcare continuum,” she stresses.
Siemens Healthineers has come to similar conclusions from a medtech angle. “We’ve been moving away from selling conventional products and services to focussing on developing genuine Value Partnerships,” outlines Ai Li Siow. “This is especially true for Singapore, where there is a push for consolidation between single hospitals towards a cluster and enterprise-based hospital management systems. We want to facilitate a standardisation of processes, which will enable healthcare providers to control quality outcomes, to shorten turnaround times and to achieve better utilisation and optimisation of the various technologies in the healthcare setting. For instance, we believe making better use of remote patient monitoring, digital apps, telemedicine, and home-based outpatient care can make a considerable difference in combatting some of the big public health challenges of our time such as lifestyle-related chronic disease.”
It would be mistaken, however, to imagine Singapore merely as a recipient of cutting-edge innovation and not as an originator and wellspring of new medical science in its very own right. “Singapore has already fashioned a world-class infrastructure for biomedical research and has been steadily improving access for translational research to the healthcare system within the major university hospitals through initiatives like the Singapore Translational Cancer Consortium,” opines Ashok Venkitaraman, director of the Cancer Science Institute of Singapore; distinguished professor of medicine at the Yong Loo Lin School of Medicine, National University of Singapore (NUS); director of the NUS Center for Cancer Research; and program director at A*Star’s Disease Intervention Technology Laboratory. “Many talented researchers and clinicians already work in internationally renowned institutions here, and the ecosystem is managing to draw in a number of internationally recognized experts from abroad who are attracted to the fact that the country shares the ethnic and genetic diversity of larger East Asian neighbours while being endowed with well-regulated clinical research frameworks similar to those in the UK and other Western states.”
Representatives of Big Pharma – such as Novartis, Bayer, and Roche – already possess substantial in-county clinical trials footprints for precisely these reasons. “One of the hot topics these days is the insufficient ethnic representation in global clinical data so we have been working hard to ensure diversity across our clinical trial operations: so much so that in some of our most recent clinical trials, APAC constituted one of the leading regions in terms of patient enrolment,” exclaims Kevin Zou, head of oncology Asia Pacific and country president at Novartis. “We are proud to be able to reveal that we currently register the largest number of clinical trials in Singapore out of all the pharma companies present on the market… it’s a natural choice because the healthcare infrastructure here is extremely efficient and conducive for testing and studying innovative breakthrough therapies. We are staunchly committed to raising the representation of Asians in our global trials,” he elaborates.
Vincent Ruland, the country division head at Bayer Malaysia, Singapore & Brunei recounts a similar story. “We decided to situate one of our six global innovation centers in Singapore because we realized that we couldn’t develop clinical programs without having a significant focus on Asia. Singapore seemed to be the best resourced location for carrying out reliable trials in that part of the world,” he explains.
“A*STAR has been doing an excellent job to put in place the right enabling context. Our confidence in the clinical trial infrastructure is such that we also recently invested USD 4.1 million in a Center of Excellence for cardiovascular studies in Singapore in a five-year collaboration with the National Heart Center, where we will focus on data from patients from right across the region. The intention is very much to assemble databases that generate actionable insights in drug development and disease pathogenesis,” he insists.
Some smaller outfits have even relocated the bulk of their operations to the Lion City to exploit Singapore’s growing prowess in ethnic Asian trials. Cerecin is a case in point, having been founded in 2000 in the United States before transferring its HQ to Singapore in 2018. “Three things drove that move. Firstly, we were conducting an increasing number of clinical studies, a sizeable proportion of which needed to be carried out in Asia; therefore, it made sense for us to start up a clinical base here. Secondly, logic dictated that we establish a manufacturing and supply network here given that one of our key raw materials comes from Southeast Asia and we spotted the value-addition of having these different parts of the value chain more closely integrated. And thirdly, we recognized that there is a growing hub of biotech activity within Singapore, with good access to capital and talented individuals. Looking back, three years down the line, we certainly don’t regret this decision at all,” confidently asserts the company’s president and CEO, Charles Stacey.
The authorities have also had the foresight to press home the advantage by making sure that their country is positioned at the vanguard of ongoing efforts to conduct genomic mapping for non-Caucasian populations. “In genomic research, we noticed that there was disproportionately little Asian representation. That is why we have established the SG10K project where we sequenced the genomes of 10,000 people of different ethnicities in Singapore,” explains A*STAR’s Ng Huck Hui. “We’ve simultaneously instigated a National Precision Medicine program, which aims to sequence our genomes and connect them with our health record data. We hope to be able to link genetic variants to phenotypes and answer other important questions. It’s actually a huge advantage for us that Singapore’s healthcare records are already fully digitalised and we need to capitalize upon that,” he adds.
Beh Kian Teik
Singapore’s homegrown cadre of biotechs is also belatedly coming of age according to Baxter’s Andrew Frye. “These days the city state appears to be managing to do a good job of rounding out a fully-fledged bio-science ecosystem that encompasses academia as well as small businesses and start-ups. For the first time, we are seeing local life science entities getting to the point where they are gearing up to launch onto the global stage,” he reckons.
As of 2019, there were more than 350 biotechnology and medical technology companies present in Singapore and this growing pool of local players has continued to mature especially within specific therapeutic niches such as oncology and infectious disease. “I sense that there’s a real momentum gathering. It’s clear that steps are being taken to become a forefront global biotech nation and the chance of success in the decade to come is very high. We just have to remain patient and remember that Biomedical R&D has a long gestation period and consumes significant amount of capital,” reflects Holmusk founder, Nawal Roy.
“Singapore is ultimately a tiny island, so from a scale perspective, it’s imperative that we look beyond our shores and plug ourselves into the global market to attain success. Many companies are becoming wiser and starting to look towards the US market early on because of the reimbursement and funding mechanisms that are available for categories such as diagnostics,” ventures Beh Kian Teik, deputy CEO of the National Research Foundation (NRF), an entity specifically designed to set the national direction for R&D by developing policies, plans and strategies for innovation.
He points out that there has been demonstrable progress made and predicts a rosy future for the country’s biotech scene. “Right now, there are over 3,600 start-ups and venture capital groups within the country and in the last three-quarters of 2020, these companies participated in over 450 deals worth over 5 billion dollars – a 16-fold increase as compared to 2010. There is an inherent snowball effect because the success of any start-up acts as a lighthouse for other seed enterprises. They can look ahead and see what is possible with success. This not only creates a competitive environment, but also attracts and nurtures a virtuous circle of talent. Equally, successful companies invest back into start-ups, and this nourishes a positive cycle of liquidity,” he believes.
Abhay Bangi, Partner and Life Sciences Lead for the ASEAN region at EY, however, foresees a series of formidable barriers. “As I see it, there are three main challenges. The first is the ability of Singaporean start-ups to develop products that are fit-for-market. Unlike their counterparts in India, China, or Indonesia, Singaporean entities do not have a big local population, which makes testing products more difficult. The Singaporean government offers sandboxes to companies which are typically built in a fashion where all the regulatory and compliance aspects are taken care of. However, for these companies to be successful, the product must be appealing to a mass market in the bigger countries,” he argues.
The second challenge relates to talent. “Tech start-ups need data scientists and, on the biotech side, the country needs to continuously churn out biochemistry PhDs, which can be a challenge for such a small population,” says Bangi.
The third challenge is a longstanding issue to do with funding. “These days, Singaporean companies tend to experience little problem accessing Series A and B funding, but Series C funding and beyond are an altogether different matter. When a company becomes revenue generating, it cannot be limited to the Singaporean population alone, meaning that companies must implement an international focus from the outset if it is to stand any chance of long-term success,” he suggests.
“We are realists and understand that Singapore is not the market for many, if not most, of the companies that we are endeavouring to support and nurture,” admits A*STAR’s Ng Huck Hui. “The fundamental question is: how can we move the needle from value creation to value capture? We’re keen that the foundation must be built and based in Singapore but accept that the companies themselves will need to be able to go international if they are to become properly profitable. That is precisely why we are promoting open innovation and encouraging collaboration.”
One area where Singaporean start-ups might be primed for a promising future is the digital life science space. “Let’s not forget that Singapore is a pretty unique place within Asia and possesses all the requisite characteristics needed to become a digital health pioneer: a small, educated and digitally savvy population coupled with a modern infrastructure and the high level of interest in telemedicine,” points out Aileen Lai, CEO and founder of HealthBeats, a Remote Vitals Monitoring (“RVM”) subscription-based global platform. “I am convinced Singapore constitutes an ideal setting for the digital revolution and the adoption, fine-tuning and showcasing of this type of disruptive technology,” she proclaims.
Her company is one of a number of homegrown digital health start-ups that have been generating a high level of industry and media interest. Another, Holmusk, is striving to assemble none other than the world’s largest Real-World Evidence (RWE) platform for mental health. “With data at its core, Holmusk’s data science and digital therapeutics provide the capacity to drive a leapfrog-change in the provision of care and pioneer research into new treatments in neuroscience. Our suite of digital health apps, a specialty electronic health record (EHR) system and a deep AI platform can together generate vast sums of real-world data and enrich it into a real-world evidence base that can support companies with patient selection, trial design, label expansion, as well as market access studies,” proudly affirms Nawal Roy.
Then there is Guardant Health, a 50-50 joint venture backed by SoftBank that is purporting to be able to do away with invasive tissue biopsies in instances of suspected cancer through a combination of blood tests, vast data sets and breakthrough analytics. “We are unleashing a next generation sequencing in-vitro diagnostics (IVD) that deploys big data sets and biomarkers to deliver precision medicine and maximal patient benefit in place of traditional tissue biopsy,” declares Simranjit Singh the firm’s CEO for AMEA. “The previously unthinkable is now becoming possible, and this is where it’s all happening!”
Many industry insiders believe that, following on from the pandemic, the momentum is now with this new breed of healthtech pioneer. “The widely repeated joke that COVID is the best chief digital officer definitely holds true for healthcare. I have been working on digitalisation in health for many years and, more often than not, the technology was not at a level to really match our ambitions. The healthcare landscape had been digitalizing, but in a rather uncoordinated, sluggish, and piecemeal fashion characterised most by one-off, point solutions. From what I can ascertain, the past 18 months have changed all that. COVID-19 has accelerated uptake and adoption and the digital revolution is in full swing. Even the biggest sceptics now understand that patients’ needs can be far better met with data and technology,” observes Marine Queniart-Stojanovic, general manager for Thailand, Malaysia and Singapore at Sanofi. “The big question is whether Singapore can fully grasp this historic opportunity and become a leader and shaper data-driven medical science.”
What certainly stands the micronation in good stead is the fact that the HAS has been quick off the mark to roll out a bespoke regulatory framework specifically dedicated to digital health technology. “In April 2020, we published comprehensive regulatory guidelines explicitly for innovators of software medical devices. Aside from providing clarity on our regulatory requirements and licensing, it covered risk management topics such as cybersecurity, continual learning algorithms, as well as additional process controls and risks that should be carefully considered in designing and validating these medical devices,” discloses Mimi Choong May Ling.
She is adamant that this should give the new niche a leg up and boost the chances of Singapore’s upstart digital health entrepreneurs ultimately making it into the big league. “To date, we have evaluated and registered over 30 AI-based medical devices with a significant number of them being first-in-world approvals, including Selena+ deep learning system for eye screening, See-Mode Augmented Vascular Analysis software and Kronikare Wound Scanner. After receiving our scientific and regulatory advice during consultation and obtaining HSA regulatory approval, many of these devices have successfully gone on to receive regulatory approvals in other markets such as Australia, America and EU member states,” she observes.
What then are multinationals to make of such a petite, but dynamic and well-rounded market at the heart of a region that has become too big to ignore? For a start, Singapore continues to act as the number one gateway and springboard into East Asia at a juncture when that part of the world is flourishing. This is largely because of the sheer heterogeneity of Asia Pacific – a geographical area comprising up to 50 countries, administrative territories, and island chains with wildly differing cultures, economic regimes and market dynamics.
“APAC is, without doubt, one of the most diverse regions on the planet for doing business,” argues Zimmer Biomet’s Clarence Ngui. “On one end of the spectrum lie mature, well-regimented, high-performance economies such as Australia and Korea, while at the other end are considerably less developed states like Cambodia. In between sit fast paced megamarkets such as China and Indonesia with ballooning populations. We’re talking of economies at very different stages of the growth cycle and development trajectory, each one with thoroughly different cultural orientations and political complexities,” he exclaims.
Annie Tan, general manager for Singapore, Thailand & Malaysia at BMS, very much concurs. “In contrast to regions such as Europe where similarity between markets allows for a high degree of tactical and strategic convergence, the diversity of the populations, healthcare systems and official procedures in East Asia are such that you have to define bespoke go-to-market strategies for each and every territory… maintaining a strong base in a stable and reliable country such as Singapore can be incredibly useful for coordinating all of this and managing the complexity,” she insists.
Just as importantly, the city state serves as an excellent testing ground for experimenting with initiatives on a small scale prior to rolling them out in some of the more consequential East Asian markets. “It’s all about executional excellence. The superior quality of Singaporean healthcare, clinicians and regulatory regime bestows a unique value on the territory because it allows us to launch latest-generation technologies at pace, trial pilot projects and attain proof of concept before scaling up in bigger geographies,” contends Johnson & Johnson’s Guillermo Frydman.
Pfizer’s Erika Pagani makes a very similar case. “Singapore is often the first market for product launches in Emerging Asia, new regulatory strategies to optimize launch timelines, and digital innovations. We tend to treat it rather like a laboratory for the region, especially as the in-country range of authorized products is pretty representative of the Pfizer global portfolio at large, which certainly can’t be said for many of the neighbouring markets,” she remarks.
Siemens Healthineers, for its part, has even gone as far as to establish a dedicated Asia Reference Center which serves as a hub to support the needs of other countries across APAC. “Our Singapore-based Asia Reference Center can provide remote scanning assistance wherein medical specialists are able to access our radiological systems from any location to provide support to the personnel using the system, particularly for complicated clinical examinations… For instance, if there is the need for a specific examination to take place in a remote location, which does not have access to qualified medical professionals, our team of qualified experts can step in and provide remote access support,” details Ai Li Siow.
Ultimately only time will tell whether Singapore can truly make the leap from being a magnet and enthusiastic recipient of breakthrough medical science to also becoming a prolific creator in its own right. For the moment, however, it continues to fulfil and important regional function, producing nearly six percent of the world’s over the counter (OTC) drugs and serving as a welcome multifaceted hub for the industry. ‘There’s certainly a great deal to admire, respect and cherish about this market,” concludes Sanofi’s Marine Queniart-Stojanovic.
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2021. Healthcare & Life Sciences Review was produced by Pharmaboardroom.
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