Boston Roadshow: The Connection to the US
On November 17th, Tech4Eva organized the fourth roadshow of 2021, but this time to meet the Boston ecosystem! This last roadshow of the year brought together investors, entrepreneurs, research experts, VCs, and start-ups to discuss and highlight equity in women's health research and opportunities to scale health and FemTech start-ups via investments in the US.
The future is to find equity in women's health research
Around the world, we are increasingly aware that keeping women healthy and empowering them to take control of their health is crucial to equity. While some critical steps go in the right direction, there is still much room for improvement in making health research truly gender-inclusive and, therefore, improving medical diagnostics and treatment for women.
Women make up over 50% of the population in the world, yet they are not well represented, not only in clinical trials but also in research. “There is a systematic under-treatment, under-diagnosis, and under-reporting of women in not just cardiovascular trials, but many clinical trials that make the basis for our guidelines and treatments,” explains Roxana Mehran of Icahn School of Medicine, Mount Sinai. “As women continue to be under-represented, it limits the potential for developing the essential sex-specific strategies and recommendations.”
According to Nicole Woitowich of Northwestern University, this issue extends beyond clinical research, but the matter is a detrimental problem that begins at the bench in the most basic science research when looking at cells. “What people seem not to be aware of is the fact that the majority of our basic science research, those done on cells and animals, is conducted on a predominantly male model. Therefore, even in the early stages of drug design and development of therapeutics, we are taking this information and translating it to clinical research from the basis of a male focus perspective. This explains the huge gaps of knowledge, and while we are making some improvements towards sex and gender inclusion research, we are still not there.”
While there is a trend towards incorporating women in research, there is still a significant sex and gender base gap.
“Events like the one today help shape our understanding of women’s health and Femtech and bring us closer to building the ecosystems that will best support the health of all people fairly,” explains Martina Hirayama, State Secretary for Education, Research, and Innovation in Switzerland.
The US healthcare system needs a new women-centric design
The panel on “Towards Equity in Women’s Health Research” convened Roxana Mehran, from Icahn School of Medicine at Mount Sinai, Christa Moss, from Maven Clinic, and Nicole Woitowich, from Northwestern University for a discussion on what is happening in the United States concerning women’s health research and where it might be going. They discussed that the gender gap is even more exacerbated, as when looking at pregnant women, almost ¾ of the drugs approved by the FDA since 2000 have no data on the impact on women’s pregnancy, and on average, it takes 27 years for a drug approved in the US to move from undetermined category for use and pregnancy to some more specific risk categorization. It has also been shown that companies that receive funds are almost always those who do not consider women in their research. “We are hoping that some level of a metric will be implemented as a push back on not giving funding to those organizations who are not working to involve women and who do not track records,” explains Roxana Mehran.
It is clear that to build a responsive overall healthcare system; it needs to place women at its core. Women are the decision-makers not only in their health but the health of their families, “women roughly make not only 95% of their healthcare decisions, but also 60% for others”, shared Christa Moss, “Women are making more than ¾ of the healthcare decisions in the US.”
Besides increased investment in women’s health research, the solution also lies in the training of healthcare professionals.
“All of us need constant implicit training, we need to have legislation, we need to have a collective effort to develop a whole new social construct for women and their health.” declared Roxana Mehran.
Nicole Woitowich added that to build this new social construct, we need to 1. Train the next generation of leaders in science and medicine, 2. Increase the economic investments in sex and gender-based research, 3. Rethink the culture of science and medicine on how studies and findings are reviewed and selected.
FemTech investment in the US and the road to an IPO
The panel discussion on “Towards finding investment in the USA and the road to an IPO” convened, Elizabeth Gazda, from Embr Labs, Emi Gonzalez, from Joyance Partners and Ataraxia, Oriana Papin-Zoghbi from AOA Inc., and Alice Zheng from Rhia Ventures for a discussion moderated by Brittany Barreto from Coyote Ventures and Femtech Focus. Here are some of the main takeaways from the exchange:
FemTech investments on the rise
The transformation of FemTech investments has been taking place in the last five years. Today, the sector has increased excitement, with angel groups focusing on female founders and explicitly investing in FemTech. “In terms of leading investors, we are seeing more and more dedicated teams, and we as specialized investors will have regular touchpoints with these other funds, which is very exciting to see,” explains Alice Zheng.
Funding for women-focused digital health start-ups rose by 105% in 2020 to $418 million spread across 22 companies, which corresponds to twice the number from 2019. Moreover, funding for the women’s health sector represents 7% of total digital health funding in 2021. As the average was closer to 2%, this is the second-highest proportion since 2011. The average FemTech Exit Value is $301 million, and this number is quite significant as the average exit value of tech companies is $240 million. Therefore, as an investor, investing in FemTech is a good bet as you can get an attractive ROI. Finally, 50% of the FemTech exits happened in the last five years which shows a growing interest for the sector.
Europe is the new frontier for FemTech
According to Emi Gonzalez, Joyance Partner, more and more early-stage companies are coming from Europe, which is a significant indicator that Europe will become a very central hub to women’s health.
For this reason, start-ups should not necessarily only look towards the US to get investment. The European market is vast, and one can expand to other geographical areas, such as Asia, which has substantial unmet needs and needs to be targeted. Another reason is that there are also US funds expanding and building hubs in Europe.
Balancing international investors
Finding international investors can be tricky, but according to Elizabeth Gazda, there is no difference between having international investors compared to investors from the same geographical area other than culture when negotiating or relationship building. When taking money from abroad, one thing to consider is “how are you going to manage this relationship if there is board participation?”. Elizabeth shared, explaining that “If you have an international investor in a different time zone, are you going to be expected to accommodate that investor during business hours or not. It might sound as insignificant, but people’s feathers get ruffled when it comes to issues like that.” Being part of a few accelerators can bring interest from investors who might reach out for fundraising themselves.
Exit strategies for FemTech start-ups
As a founder, it is essential to think about your exit strategy in advance as you expect to leave your company in the hands of somebody who sees its value while making sure this person and current investors have an aligned vision.
Exiting can take many different forms, such as being very attractive to many founders and acquisitions. “When we started this journey together, looking at Embr Labs, we initially thought that a potential acquisition would be from a traditional pharmaceutical company that may want to bundle a device with a therapeutics. We have been approached by a lot of CPG’s companies in spaces that we could never have anticipated taking an interest in Embr Labs,” explains Elizabeth Gazda.
As an early-stage start-up, what seems to be most important concerning exits is that investors want to know that the start-up is thinking about it and their strategy, as investors want to know they are aligned with the company in the long run.
In summary, the Boston Roadshow 2021 shed light on the field of women's health research in the United States, focusing on past policies, current practices, and the processes that will lead us to a better gender-equity future. Women are still under-represented in clinical trials compared to men. Founders also highlighted the different ways of approaching investors and the exit strategies to consider to be aligned with their investors.