Financing and Implementing Innovation in Healthcare Systems: A Component of the Precision Medicine Readiness Principles - WHITE PAPER JUNE 2021

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Financing and Implementing Innovation in Healthcare Systems: A Component of the Precision Medicine Readiness Principles - WHITE PAPER JUNE 2021
Financing and
Implementing Innovation
in Healthcare Systems:
A Component of the
Precision Medicine
Readiness Principles
JUNE 2021
Financing and Implementing Innovation in Healthcare Systems: A Component of the Precision Medicine Readiness Principles - WHITE PAPER JUNE 2021
Cover: Majcot, Getty Images – Inside: Getty Images, Unsplash

3    Foreword

4    Executive summary

6    Introduction

8    Innovation ecosystem overview

9            A Defining the innovation ecosystem

9            B Innovation ecosystem components

11   1 Innovation governance

12        1.1 Precision medicine implementation roadmap from national strategic plans

14        1.2 Open science principles

15        1.3 Precision medicine IP policy and benefit sharing

16        1.4 Adapted health technology assessment processes for precision medicine

18   2 Innovation financing

19        2.1 Public funding and fiscal space usage

20        2.2 Private-sector financial backing

22        2.3 Blended finance and the diagonal approach

23        2.4 Reimbursement conditions and coverage models

24        2.5 Experimentation with value-based care instruments

26   3 Community and partnerships

27        3.1 Entrepreneurship, research and innovation hubs

28        3.2 University-industry collaboration

29        3.3 Learning healthcare system

31   4 Workforce and infrastructure

32        4.1 Foundational health systems strengthening

32        4.2 Economic development

33        4.3 Absorptive capacity

35   Gaps and future research areas

37   Conclusion

38   Appendix

41   References

43   Secondary sources

45   Contributors

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     be reproduced or transmitted in any form or by any means, including photocopying
     and recording, or by any information storage and retrieval system.

                                                            Financing and Implementing Innovation in Healthcare Systems   2
Financing and Implementing Innovation in Healthcare Systems: A Component of the Precision Medicine Readiness Principles - WHITE PAPER JUNE 2021
June 2021   Financing and Implementing Innovation
            in Healthcare Systems:
            A Component of the Precision Medicine
            Readiness Principles

            This white paper highlights the need to bridge
            existing gaps in investment approaches.

                                       Genya Dana                                                 Elissa Prichep
                                       Head of Healthcare                                         Lead, Shaping the Future
                                       Transformation, 		                                         of Health and Healthcare,
                                       World Economic Forum                                       World Economic Forum

            The ability to design and implement targeted and           circumstances of the geographic location, patient
            personalized approaches to screening, preventing,          population, economic situation and political realities.
            diagnosing and treating diseases continues to
            improve. There is great promise in precision               The World Economic Forum wishes to aid policy-
            medicine, with improved outcomes and more                  makers, funders, investors, clinicians and others who
            efficient use of scarce resources.                         are preparing their healthcare systems for a future
                                                                       state that includes precision medicine approaches.
            As precision medicine approaches continue to make          We are pleased to present this instalment in the
            their way into more care systems, we are still woefully    Precision Medicine Readiness Principles, which
            lopsided in terms of who has access to the necessary       identifies capabilities stakeholders can use to
            research, technologies, treatments and skill sets.         benchmark progress in nurturing a system that is
            Trust in healthcare systems’ ability to deliver care in    ready for precision medicine approaches.
            equitable and agile ways continues to be tested and
            found wanting during the COVID-19 pandemic.                This white paper on the financing and
                                                                       implementation of precision medicine approaches
            Many healthcare systems, clinicians and policy-            explores the necessary components to build
            makers who want to harness the power of                    and sustain advanced healthcare innovation
            precision medicine approaches find themselves              ecosystems. While the focus of this paper is on
            faced with the daunting task of determining                the mechanisms that can be used today, as well
            where to begin. This is especially true in places          as case studies describing how different countries
            that are under-resourced or making a transition            have implemented such initiatives, the work also
            from prioritizing basic primary care and infectious        highlights the need to bridge existing gaps in
            disease treatment to treating diseases such as             investment approaches. The white paper offers
            cancer and rare diseases. Investments must be              both a path to innovation in healthcare ecosystems
            made across many areas, including workforce,               and a call for continued investment in delivering
            infrastructure, technology and strategic planning, in      the highest standards of health and healthcare to
            ways that are complementary and responsive to the          people around the globe.

                                                              Financing and Implementing Innovation in Healthcare Systems     3
Financing and Implementing Innovation in Healthcare Systems: A Component of the Precision Medicine Readiness Principles - WHITE PAPER JUNE 2021
Executive summary

In 2016, the National Academy of Medicine                precision medicine innovation ecosystem. Case
published a discussion paper, Realizing the Full         studies from developed and emerging economy
Potential of Precision Medicine in Health and            countries are used to illustrate the implementation
Healthcare, that would respond to the growing            of such capabilities by countries at any (early,
interest in supporting precision medicine through        intermediate, advanced) stage of precision medicine
US health policy by proposing a framework that           readiness. Developed under the Leapfrogging with
leaders in policy, business and healthcare could         Precision Medicine project, this paper also calls
reference for the development and integration of         attention to tools and case studies that can help
precision medicine. Informed by this work and            address inequities in the application of innovation
developed through desk research, interviews              drivers and the accessibility of precision medicine
and a multistakeholder workshop at the 2019              approaches globally.
World Health Assembly, the World Economic
Forum’s Platform for Shaping the Future of Health        Go-to-market strategies for precision medicine
and Healthcare developed a framework for the             innovations remain challenging given the incentive
Precision Medicine Readiness Principles: a               gaps for technology producers, funders and
global roadmap that identifies precision medicine        service provider adopters and payors alike.
capabilities from which policy-makers and others         Forming the necessary enablers and conditions
looking to advance precision medicine in their           for the innovation ecosystem requires novel policy
countries can find benchmarks for readiness.             instruments, financing approaches, collaboration
                                                         models and economic development as explored in
Under the broader faculty of the Precision               this white paper.
Medicine Readiness Principles, the innovation
ecosystem topic aims to address the processes            Figure 1 below summarizes the core discussion
that enable the creation and expansion of a              areas explored in this work – the exemplary
precision medicine marketplace. Specifically,            capabilities and implementation milestones across
this paper discusses the necessary functions             four main categories: innovation governance;
of business producers, resource funders and              innovation financing; community and partnerships;
regulatory governors to encourage, establish and         and workforce and infrastructure. These
build a continuously growing economic marketplace        benchmarks are further positioned along the
for precision medicine technologies. To this end, the    readiness axis to inform the criteria for progress
paper presents: (1) a framework for the capabilities     and capability maturity. “Exploring” health systems
of the precision medicine innovation ecosystem;          are early in their adoption of precision medicine
(2) benchmarks to assess the stage of readiness          approaches, potentially conducting some research
across these capabilities; and (3) outstanding gaps      studies or piloting programmes, but will generally
in the investment approaches needed to drive             not have precision medicine approaches accessible
precision medicine implementation.                       to members of the population. “Activating” health
                                                         systems have some clinical use of precision
Policy-makers and others looking to advance              medicine approaches with limited accessibility,
precision medicine in their countries are invited to     while “implementing” systems have several
use this guidance document to gauge the maturity         precision medicine approaches accessible to a
of the various capabilities that build and sustain a     large number of people.

                                                Financing and Implementing Innovation in Healthcare Systems   4
Financing and Implementing Innovation in Healthcare Systems: A Component of the Precision Medicine Readiness Principles - WHITE PAPER JUNE 2021
Insights from this work include the importance of:                               value-based care approaches – e.g. evidence-
                                                                                                                                       based modelling studies, performance-based
                                                      Establishing national innovation policy                                          contracts – may align stakeholder incentives and
                                                      instruments: The innovation policy mix consists of                               invite consensus on precision medicine’s value.
                                                      the initiatives – e.g. intellectual property legislation,
                                                      cluster initiatives, market review processes, federal                            Expanding collaboration and operating models:
                                                      budgets – that build the early national public                                   Various multistakeholder partnership models have
                                                      confidence and market demand for precision                                       emerged across the value chain to advance precision
                                                      medicine approaches that private entities cannot                                 medicine research and development (R&D) and
                                                      build alone.                                                                     commercialization. Further collaborations between
                                                                                                                                       both public and private parties are encouraged to
                                                      Developing novel financing approaches that                                       explore novel operating models such as the learning
                                                      capture value: Novel financing models for precision                              healthcare system and open science for genomics.
                                                      medicine technologies that capture value and
                                                      promote equity and access are encouraged to spur                                 Nurturing incremental innovation and
                                                      private investment activity.                                                     sustainable adoption: Incremental innovation in
                                                                                                                                       precision medicine remains the most prevalent form
                                                      Public funding and philanthropy dollars may be                                   of development. Early initiatives such as systems for
                                                      insufficient or unavailable in the longer term for                               collecting family health history or national disease
                                                      low- and middle-income countries (LMICs) seeking                                 surveillance registries may be initial steps towards
                                                      to develop their precision medicine capabilities.                                precision medicine adoption.
                                                      Cross-cutting diagonal funding approaches that
                                                      support health-system strengthening are particularly                             While this work represents only one part of the
                                                      encouraged to close this financing gap.                                          Precision Medicine Readiness Principles,
                                                                                                                                       it is the hope of the authors that the readiness
                                                      Actualizing value-based care: Coverage and                                       principles are used by policy and healthcare leaders
                                                      reimbursement gaps persist globally, in part                                     as central points of departure from which to build
                                                      because of insufficient data on precision medicine                               robust precision medicine capabilities into their
                                                      value-add and payment uncertainty. Emerging                                      health systems.

                                        FIGURE 1      Precision Medicine Readiness Principles for the innovation ecosystem topic


                                                                     Exploring                                             Activating                               Data

                               80                               National strategic plan                                                        Diverse public
                                                                                                                                                       Data initiative types
  Innovation governance
                                                                                GO FAIR* principles
   Public legislation
          70          and regulatory                                                                                                 Mexico
   considerations in the provision of                        Benefit sharing of genomics IP                              Clear IP ownership decisions
   precision medicine
     Y-Axis (Y-axis subhead)

                               60                                                                                                                                     HTA** adaptations

                                                                                                                                                   Brazil                      Data

        50                                                     Public and philanthropy-driven funding                       Diverse private financiers
   Innovation financing
                                                                              Blended finance models                                           Alternative payment models
   Funding mix to both set up and
          40reimburse precision
                                                                                                                                            Evidence-based modelling studies
   medicine programmes
                                                                                                                                 Data                            Value-based reimbursement
                                                                          Data initiatives
                                                              Innovation cluster                        Data
  Community and partnerships                                                                                                                                                      Data
                                                                                 Academic research
                                                                                              Data consortia                                                       Data
                                                                                                                                       TTOs***/industry collaborations
   Methods by which multistakeholder                                                                                          Data                 Data
   collaboration emerges in an                                South-south collaborations                 Data
          10 ecosystem                                                                                                                 Public-private partnership mix
                                                                                                                          Learning healthcare system
                               0               Data
                                    1                 2                           3                               4                                  5                           6                 7
                                                            SDG 3**** foundational effectors
   Workforce and infrastructure                                                                             X-Axis
                                                              Family health history records                 National patient registries                      Technology-intensive infrastructure
   Health system, human capital and
   economic foundations core to                                 Workforce development                          Precision health upskilling
   precision medicine
                                                                Technology absorption                                     Production-driven innovation

*Findability, Accessibility, Interoperability and Reuse of digital assets, **Health technology assessment, ***Technology transfer organization, ****United Nations Sustainable Development Goals

                                                                                                                        Financing and Implementing Innovation in Healthcare Systems                5

Leaders in policy, business and healthcare,               in the form of “capabilities”, defined as the working
while receptive to the potential of precision             set of key elements employed to drive development
medicine applications, do not have the benefit            of precision medicine approaches within healthcare
of a consistent and standardized framework                ecosystems. These capabilities are neither an
to both evaluate their health system’s current            exhaustive list nor mandatory criteria, but represent
readiness for the practical implementation and            a distillation of critical drivers in developing a
integration of precision medicine and elucidate           precision medicine environment within a country.
the capabilities needed to drive future growth.
Stakeholders in emerging economies, in particular,        This white paper focuses on one pillar of the
indicated that they would value a guidance                Precision Medicine Readiness Principles: the
document that includes case studies and access            innovation ecosystem. Hence, the capabilities
to partner communities as they think about how            described in this paper should be considered in the
to strategically grow the precision medicine              context provided by the foundational elements and
capabilities of their healthcare ecosystems.              other categories captured in the Precision Medicine
                                                          Readiness Principles.
In alignment with this need, the World Economic
Forum’s Platform for Shaping the Future of Health
and Healthcare is developing the Precision Medicine
Readiness Principles: a thought leadership
project, inspired by a National Academy of Medicine
discussion paper, that includes developing a living
document from which those aiming to advance
precision medicine in their countries can find
benchmarks for readiness. Precision medicine offers
a more personalized and targeted approach to
preventing and addressing disease through screening,
diagnosing and treating patients by considering
their genetic and biological make-up, surrounding
environmental factors and lifestyle behaviours.

By identifying best practices and strategic
opportunities for precision medicine adoption
in a healthcare setting, the Precision Medicine
Readiness Principles serve as a gauge that
policy-makers and others looking to advance
precision medicine in their countries can use to:
(1) find maturity assessment benchmarks for
readiness; and (2) identify potential steps forward to
implementation. These benchmarks are illustrated

                                                 Financing and Implementing Innovation in Healthcare Systems   6
FIGURE 2              Precision Medicine Readiness Principles framework. This framework comprises five
                                      core topics that establish criteria that countries or stakeholders can use to evaluate their
                                      progress towards precision medicine

    FRAMEWORK                                                       Actionable                Evidence                                              Innovation
                                         Engagement                 health data               generation                Care integration            ecosystem

    “several precision medicine          Focus: public              Focus: actionable         Focus: evidentiary        Focus: bringing precision   Focus: innovation-
    approaches accessible to a           engagement and             and ethical data          frameworks for the        medicine into routine       oriented
large percentage of the population”      inclusion, provider        collection                evaluation of precision   clinical care               stakeholder
                                         education and                                        medicine approaches                                   communities
                                         relationship building      Capabilities may                                    Capabilities may            for marketplace
                                                                    include:                  Capabilities may          include:                    growth
          Activating                     Capabilities may           biobanking, omics,        include:                  clinical care providers,
     “in some clinical use with          include:                   clinical data and         approval frameworks,      care guidelines,            Capabilities may
        limited accessibility”           patient awareness,         real-world data           outcome                   technologies such as        include:
                                         provider training,         collection, data policy   measurements,             diagnostics and             governance,
                                         diversity and inclusion,   and governance,           value assessments,        treatments, accessibility   financing,
          Exploring                      community                  standards and             ties to reimbursement                                 partnerships,
                                         engagement                 interoperability                                                                workforce and
           “able to pilot”
                                         and trust frameworks                                                                                       infrastructure

                                                               Foundational elements (enablers)
 Include: general infrastructure, basic healthcare systems, regulatory oversight, coverage mechanisms, information technology systems, social determinants

                                                                                              Financing and Implementing Innovation in Healthcare Systems                7
Below: Ipopba, Getty Images

Innovation ecosystem
What are the capabilities that build and
sustain a precision medicine marketplace?

                              Financing and Implementing Innovation in Healthcare Systems   8
A    Defining the innovation ecosystem

           The innovation ecosystem topic aims to address         to the various forms of novel developments in
           the processes that pave the way for the creation       precision medicine and includes new products,
           and expansion of a precision medicine marketplace      firms, technology, business models, behavioural
           and its enabling conditions. Specifically, the         changes and policies. Such forms of precision
           white paper discusses the necessary functions          medicine “innovation” manifest differently in a global
           of business producers, resource funders and            context; innovation may range from the preferential
           regulatory governors to encourage, establish           introduction of incremental, marginal improvements
           and build a continuously growing economic              in process to significant technological adoption
           marketplace for precision medicine technologies.       or novel product development. Hence, while this
           The guiding research question for this topic can be    white paper provides capabilities that may serve
           framed as “What are the capabilities that build and    as a preparatory model for the implementation
           sustain a precision medicine marketplace?”             of a precision medicine innovation ecosystem,
                                                                  it excludes specific, prescriptive guidelines as
           Under the broader umbrella of precision medicine       programmes almost always require modifications
           implementation, the innovation ecosystem refers        and adaptations to fit local contexts.

      B    Innovation ecosystem components

FIGURE 3   Innovation ecosystem framework. This topic area in the Precision Medicine Readiness
           Principles covers four foundational areas: innovation governance, innovation financing,
           community and partnerships, and workforce and infrastructure

                      Innovation                                                      Innovation
                      governance                                                      financing
                     Open science principles                                         Public funding
                     IP ownership and benefit sharing                                Private funding
                     Market approval process (HTA)                                   Blended capital
                     National strategic plan                                         Reimbursement and coverage
                                                                                     Value-based care instruments


                      Community and                                                   Workforce and
                      partnerships                                                    infrastructure
                     Research and innovation hubs                                     Health systems strengthening
                     University R&D and tech transfer                                 Economic development
                     Learning healthcare system                                       Absorptive capacity

           The innovation ecosystem white paper was               financing; (3) community and partnerships; (4)
           developed through a multistakeholder workshop on       workforce and infrastructure. For the purposes of
           the sidelines of the 2019 World Health Assembly,       this paper, these areas and their corresponding
           desk research, the compilation of a Precision          capabilities are defined below.
           Medicine Readiness Principles: Innovation Loop
           Resource Guide and individual consultations with       Innovation governance refers to public legislation
           approximately 40 professionals across international    and regulatory considerations in the provision
           health systems representing a range of industries,     of precision medicine. These include mandates
           organizations and governments. This research           set forth by ministries of health, market-review
           pointed to the four foundational areas outlined in     processes and policy-driven initiatives enabled by
           Figure 3: (1) innovation governance; (2) innovation    the country’s governing bodies.

                                                         Financing and Implementing Innovation in Healthcare Systems   9
Innovation financing refers to the funding mix           Workforce and infrastructure describes the
to both set up and regularly reimburse precision         broader health system, human capital and economic
medicine programmes. This may range from                 considerations necessary to support a precision
stand-alone public or private financiers, public-        medicine marketplace. Such foundational elements
private funding partnerships and specific financing      are necessary to power the discovery and economic
mechanisms for precision medicine.                       sustainability of precision medicine innovations.

Community and partnerships refers to the                 The following sections will explore these four areas
methods by which multistakeholder collaboration          and their attendant capabilities. The discussion of
emerges in an innovation ecosystem. In the               each area will reflect how capabilities mature as
precision medicine context, this area explores           health ecosystems adopt and incorporate more
the changing role of various stakeholders and the        precision medicine approaches overall. Each area is
conditions needed to enable innovation.                  supported by illustrative ongoing case studies.

                                                Financing and Implementing Innovation in Healthcare Systems   10
Below: 101cats, Getty Images

1   Innovation governance
    The public legislation and regulatory
    considerations in the provision of
    precision medicine.

                                   Financing and Implementing Innovation in Healthcare Systems   11
1.1 Precision medicine implementation roadmap
                                                from national strategic plans
                                                            Summary: Some level of government-driven implementation builds the national public confidence and
                                                            market demand for precision medicine approaches that private entities cannot build alone. The national
                                                            strategic plan is created based on country-specific population health burdens and a shift to preventative care.

                                                            A precision medicine national strategy consists                                 first adopted at the private health provider level.
                                                            of both: (1) the aspirational metrics of the ministry                           Even in this latter scenario, performance evaluation
                                                            of health (or equivalent government decision-                                   of such private activity may provide compelling
                                                            making agencies) to incorporate precision medicine                              cases for national precision medicine programmes.
                                                            approaches into care; and (2) the steps and                                     These national initiatives have taken a variety of
                                                            partnerships outlined to achieve such targets within a                          approaches: rare diseases, oncology, population
                                                            certain time frame. Top-down policy entrepreneurship                            health surveillance and infrastructure development
                                                            from key government leaders inspires the early activity                         are among the many focus areas of the 36-plus
                                                            of the precision medicine innovation ecosystem                                  formal national or international strategies for precision
                                                            through large-scale national initiatives, barring specific                      medicine developed as of 2019. A snapshot is
                                                            cases in which precision medicine approaches are                                captured in Figure 4 below.

                                    FIGURE 4                Ongoing government-funded national genomic-medicine initiatives



                                                                                                                                                             Data        Data

                           70                                                                                                             Mexico
Y-Axis (Y-axis subhead)

                                                                                                                                                    Brazil                        Data

                                                                              Data                          Data
                          Source: Stark et. al (2019)                                                                                                                                 Data
                                                                                                   Data                                                                Data
                                                                                                                                   Data              Data

                            0                      Data
                                1                           2                         3                                4                               5                            6                          7
                           United Kingdom                             France                                       United States of America                          Qatar
                           Genomics England 2012 – 100,000            Genomic Medicine Plan 2016-2025 –               National Human Genome Research                 Qatar Genome 2015 – Infrastructure,
                           genomes: rare disease, cancer £350M        Rare disease, cancer, diabetes                  Institute 2007 – Infrastructure and            population cohort
                           ($485M)                                    €670M ($799M)                                   clinical cohorts $427M
                           Scottish genomes: £6M ($8M)                                                                All of Us 2016-2025 – Population
                           Welsh Genomics for Precision                                                               cohort $500M (first two years)                 Japan
                           Medicine: £6.8M ($9M)
                           Northern Ireland Genomic Medicine
                                                                      Switzerland                                                                                    Japan Genomic Medicine Program
                           Centre: £3.3M ($4.6M)                      Swiss personalized health network                                                              2015 – Infrastructure, clinical and
                                                                      2017-2020 – Infrastructure CHF68M               Brazil                                         population-based cohorts, drug
                                                                      ($69M)                                          Brazil 2015 – Brazil Initiative on             discovery JPY10.2B ($90.05M)
                                                                                                                      Precision Medicine
                           Netherlands                                                                                Infrastructure, disease and population
                           RADICON-NL 2016-2025 –                                                                     cohorts                                        China
                           Rare disease
                           Health Research Infrastructure             Estonian Genome Project 2000 –                                                                 Precision Medicine Initiative –
                                                                      Infrastructure and population-based                                                            1,000,000 genomes CNY60B
                                                                                                                      Saudi Arabia
                                                                      cohort 2017: €5M for 100,000                                                                   ($9.2B)
                                                                      individuals                                     Saudi Human Genome Program
                           Denmark                                                                                    2013 – Infrastructure, clinical cohorts
                                                                                                                      and population-based cohorts
                           Genome Denmark 2012 – DK86M                                                                                                               Australia
                           ($13.5M)                                                                                   SAR300M ($80M)
                                                                      Finland                                                                                        Australian Genomics 2016-2021 –
                           FarGen 2011-2017: DK10M
                           ($1.6M)                                    National Genome Strategy                                                                       Infrastructure, rare disease and cancer
                           Infrastructure, population-based           2015-2020 – Infrastructure €50M                 Turkey                                         AUD$125M ($95M)
                           cohort, pathogen project                   ($59M)                                                                                         Genomics Health Futures Mission
                                                                                                                      Turkish Genome Project 2017-2023 –             2018-2028 – AUD$500M ($372M)
                                                                                                                      Infrastructure, clinical and population-
                                                                                                                      based cohorts
Initial use cases      The readiness of a national strategic plan will            as to the value of such initiatives. In countries
may be prioritized        rest heavily on the government’s prioritization of         where precision medicine is further embedded in
based on: (1)             precision medicine in its health system. In countries      clinical care – more commonly occurring in high-
                          where precision medicine implementation is                 income countries – there is greater opportunity
disease burden;
                          low – typically in LMICs – the ministry of health          to implement public-driven initiatives given the
(2) applicability to
                          (or equivalent) will likely have existing strategic        increased resourcing and established foundation.
population health         programmes for other disease areas such as                 As markets develop and more research and funding
surveillance; and (3)     infectious or neglected tropical diseases, given           are able to drive discovery, the national strategy
a shift to preventative   other national health priorities. If precision medicine    may include additional initiative types or enter
care, particularly for    is included in the national strategy, however,             other disease areas. A table of illustrative initiative
non-communicable          initial use cases may be prioritized based on: (1)         types are presented in Table 1, referenced from the
diseases, and             disease burden; (2) applicability to population            Global Alliance for Genomics and Health (GA4GH).
provision of              health surveillance; and (3) a shift to preventative       Greater private-sector participation is also observed
information to the        care, particularly for non-communicable diseases,          alongside maturing markets, which is further
government.               and provision of information to the government             discussed in the innovation financing section.

            TA B L E 1    Selected precision medicine innovation types drawn from the 221 initiatives categorized
                          by the Global Alliance for Genomics and Health (GA4GH) Catalogue

                                               Initiative type                                           Description

                                                                                    Biological material repositories that collect and store
                                                                                    biospecimens for medical research

                                                                                    Operational or infrastructure collaborations with
                          Consortium/collaborative network
                                                                                    multiple partner organizations

                                                                                    Storage of organized health and genomic-relevant
                                                                                    information, often for catalogue and research use

                                                                                    Collaborative partnerships with industry
                                                                                    stakeholders such as health providers, payers,
                                                                                    pharmaceutical companies or diagnostic/
                                                                                    sequencing companies

                                                                                    Standardized vocabularies and terminology of
                          Ontology or nomenclature tool
                                                                                    biological or clinical information

                                                                                    Knowledge-generating and sharing initiatives, often
                          Research network/project
                                                                                    through academic-driven partnerships

                          Standards                                                 Common, shared-information frameworks

                                                                                    Other frameworks, platforms, architecture or
                                                                                    programmes relevant to precision medicine

                          Case study – Nigeria’s Cancer Control Plan by              guidelines for cancer management from the
                          the Ministry of Health formalizing support of              National Comprehensive Cancer Network (NCCN)
                          precision medicine implementation: In 2015,                Clinical Practice Guidelines in Oncology, which is
                          the Nigerian Ministry of Health announced its new          now taught in Nigeria’s medical training curriculums.
                          Cancer Control Plan (CCP), which lends formalized          The CCP outlines measures to support the Nigerian
                          support for country-wide implementation of                 government’s screening programme, with the goal
                          approaches such as DNA-based cancer testing.               of screening half the eligible Nigerian population
                          Supported by the Clinton Health Access Initiative,         by 2022. Over the long term, the Ministry of Health
                          the American Cancer Society and the US National            aims to incorporate routine screening of eligible
                          Cancer Institute, the CCP established updated              cancers into existing clinical programmes.

                                                                            Financing and Implementing Innovation in Healthcare Systems   13
Case study – US NIH All of Us initiative: In                   that include data and research centres (DRCs),
                                            2018, the US National Institutes of Health (NIH)               biobanks, patient participant centres, healthcare
                                            launched the All of Us initiative (formerly known as           provider organizations and community engagement
                                            the Precision Medicine Initiative Cohort Program)              partnerships. Specific steps exist through the data
                                            with the objective of collecting genomic and                   collection process (consent forms, survey modules,
                                            health data on a longitudinal basis from 1 million             partner protocols) and particular attention is paid
                                            volunteers in the United States. The initiative acts           to strategic enrolment of demographics under-
                                            as a consortium with 100-plus programme partners               represented in biomedical research.

                             1.2 Open science principles
                                            Summary: Policy applications of open science can inspire data-driven research and development (R&D) of
                                            precision medicine innovations. The guiding principles are described by the international GO FAIR initiative,
                                            and should be considered alongside relevant biodata standards.

                                            In contrast to the more proprietary intellectual               Open science for precision medicine research may
                                            property ownership models based on trade secrecy               manifest in various initiatives – e.g. international
                                            and competition, open science – as defined by                  multistakeholder genome research consortia,
                                            the Organisation for Economic Co-operation and                 centrally accessible databases for research and
                                            Development (OECD)’s Making Open Science                       clinical use or collaborative efforts that avoid
                                            a Reality paper – is a movement enabled by                     duplicated work. In moving towards implementation,
                                            information and communication technologies                     various open science guiding principles described
                                            towards transparent data sharing, rapid knowledge              by the international GO FAIR initiative enable
                                            dissemination and broad research accessibility.                researchers to find, access, interoperate and reuse
                                            Emerging policy applications of open science                   each other’s research objects. These are described
                                            have particular relevance in the field of precision            in Figure 5 below. Readiness benchmarks for
                                            medicine as they are: (1) changing how genomics-               innovation can be found in: (1) the extent to
                                            related research is conducted and disseminated;                which countries follow the FAIR principles; (2) the
                                            and (2) reducing the otherwise high costs and                  agreed-upon standards for exchanging genomic,
                                            uncertainty risk of precision medicine if actors were          phenotypic and clinical data attributes; (3) the
                                            to invest resources in R&D as stand-alone initiatives.         recognition of participant consent and privacy; and
                                            Importantly, the access to higher volumes of data              (4) the extent to which open science principles are
                                            as a result of open science principles can improve             implemented alongside proper intellectual property
                                            both the granularity of information for stratified care        (IP) ownership regulations.
                                            delivery and the applicability of clinical research
                                            discoveries to increased patient populations.

                 FIGURE 5                   The FAIR Guiding Principles

  To be Findable:                                                                        To be Interoperable:
  F1. (meta)data are assigned a globally unique and persistent identifier                I1. (meta)data use a formal, accessible, shared and broadly applicable language for
                                                                                         knowledge representation.
  F2. data are described with rich metadata (defined by R1 below)
                                                                                         I2. (meta)data use vocabularies that follow FAIR principles
  F3. metadata clearly and explicitly include the identifier of the data it describes
                                                                                         I3. (meta)data include qualified references to other (meta)data
  F4. (meta)data are registered or indexed in a searchable resource

  To be Accessible:                                                                      To be Reusable:
  A1. (meta)data are retrievable by their identifier using a standardized                R1. meta(data) are richly described with a plurality of accurate and relevant attributes
  communications protocol
                                                                                         R1.1. (meta)data are released with a clear and accessible data usage licence
  A1.1 the protocol is open, free and universally implementable
                                                                                         R1.2. (meta)data are associated with detailed provenance
  A1.2 the protocol allows for an authentication and authorization procedure,
  where necessary                                                                        R1.3. (meta)data meet domain-relevant community standards

  A2. metadata are accessible, even when the data are no longer available

Source: Wilkinson et. al (2016)

                                                                                               Financing and Implementing Innovation in Healthcare Systems                          14
Early collaboration with large-scale research groups       environment, policy-makers may note inefficiencies,
                         and involvement in international human genomics            with current access restrictions to scientific and
                         initiatives may accelerate the formation of a country’s    research data (e.g. isolated research groups/health
                         precision medicine innovation ecosystem. To start this     systems, data-sharing restrictions across country
                         process, policy-makers have a greater opportunity          borders), which limits the potential for holistic
                         to design early opt-in incentives for institutionalizing   precision medicine R&D advancement for all involved
                         open science and set a precedent for national,             participants. The Canadian government’s Roadmap
                         centralized biorepositories with interoperability and      for Open Science provides an excellent model
                         collective contribution requirements. Such early           to move beyond such restrictions. The Canadian
                         attention to open-science principles can prevent           roadmap outlines the steps they took to make federal
                         the emergence of the potentially ad hoc or isolated        science open to all, while respecting privacy, security,
                         genomic research programmes more common in                 ethical considerations and appropriate intellectual
                         existing precision medicine programmes. In this latter     property protection.

                         Case study – Structural Genomics Consortium                precompetitive principles adopted by the SGC
                         (SGC): A charitable open science public-private            translate into other open science conditions
                         partnership, the SGC was started in 2003 with              imposed on its researchers and collaborators via
                         the core mandate of determining 3D structures              a trust agreement that prohibits the patenting of
                         of human proteins and parasite proteins that are           research outputs using SGC data and stipulates
                         of biomedical importance (e.g. potential drug              fast dissemination and prepublication sharing
                         targets). It is recognized as one of the earliest and      of its structural and chemical biology outputs.
                         largest pioneers of open science and releases              The current collaborators with SGC include
                         structural genomics data into the public domain            pharmaceutical companies, governments,
                         through the Protein Data Bank annually. The                academic institutions and NGOs.

                         Case study – Estonian Genome Center of the                 as the Biobanking and Biomolecular Resources
                         University of Tartu (EGCUT) Biobank: Estonia’s             Research Infrastructure (BBMRI), the European
                         biobank initiative, the EGCUT Biobank, has been            Research Infrastructure Consortium (BBMRI-ERIC)
                         funded by the Estonian government since 2000               and the Public Population Project in Genomics
                         and includes a collection of health and genetics           (P3G). The EGCUT maintains a data-sharing policy
                         data from 5% of Estonia’s adult population. The            in which collaborators accessing EGCUT resources
                         EGCUT actively collaborates with many universities,        must send any scientific results obtained from the
                         research institutions and consortia given its              research project using EGCUT data or samples back
                         membership in various international networks such          to EGCUT for addition to the Estonian Biobank.

                 1.3 Precision medicine IP policy and benefit sharing
                         Summary: Clear intellectual property (IP) policy for precision medicine technologies acts as a market
                         incentive for precision medicine innovators. These policies may not be so effective in all locations,
                         particularly those with little precision medicine infrastructure, and require other push-and-pull measures.
                         Benefit-sharing models aim to close the gap regarding equitable distribution of value from international
                         precision medicine projects.

   Policy-makers         The core question to be addressed by policy-               awareness of the risks and rewards associated
must assess the          makers for precision medicine IP can be                    with an innovation, such as when conducting
strength of this         summarized as: “Do current national patent regimes         freedom-to-operate searches. Likewise, it may
                         promote R&D and innovation in precision medicine           offer similar risk-and-reward insight to public-sector
‘pull’ incentive
                         while also benefitting the collective interest of public   organizations considering opening their databases
on private-sector
                         health?” While IP protections are critical incentives      to commercial parties.
engagement relative      for precision medicine innovators, policy-makers
to the benefits of       must assess the strength of this “pull” incentive on       However, the incentive effects of IP policies may
open innovation          private-sector engagement relative to the benefits         be limited or non-existent for precision medicine
principles that aim to   of open innovation principles that aim to collectively     innovations addressing health problems mainly
collectively advance     advance precision medicine in the long term.               affecting LMICs due to the small and uncertain
precision medicine in                                                               market demand for such innovations. The World
the long term.           A recommended benchmark for readiness is                   Health Organization states that there is a need
                         the clear articulation of IP policies for precision        for other governance responsibilities, financial
                         medicine innovations. Clearly defined rules provide        mechanisms and multistakeholder partnership
                         researchers and technology producers with an               models to fill the IP incentive gap.

                                                                           Financing and Implementing Innovation in Healthcare Systems   15
IP incentive gaps are also observed among LMIC-           used by LMICs; or (2) arrange country-specific
                       based researchers participating in international          socially responsible licensing via negotiations with
                       open genome projects; while data is contributed by        respective government agencies if their citizens
                       and accessible to all involved countries, wealthier       provided data. To be sure, this does not address
                       nations are more likely to patent innovations             mechanisms to overcome the lack of representation
                       from such projects. The MalariaGEN case study             of LMIC populations in large genomic datasets.
                       illustrates an early use of benefit-sharing models        More work on equitable collaboration models is
                       to close this gap in its international open science       encouraged, particularly for genomics IP and locally
                       initiative. Under this model, the IP owner can: (1)       relevant data. This topic is further discussed in the
                       provide differential access or pricing for innovations    “workforce and infrastructure” section.

                       Case study – Malaria Genomic Epidemiology                 types (including genetic data) across collaborators.
                       Network’s (MalariaGEN) data release policy:               Under its online data release policy, the website
                       MalariaGEN is an international open science project       states that “the owner of the IP agrees to license it
                       to identify the specific genetic underpinnings of         on a reasonable basis for use in the developing world
                       malaria funded by the Grand Challenges in Global          and on a preferential basis to the countries whose
                       Health Initiative through the Bill & Melinda Gates        citizens are the subject of the database”. This acts
                       Foundation and the Wellcome Trust. Thirty-nine            as a benefit-sharing mechanism for LMICs that can
                       countries currently participate in the MalariaGEN         more equitably gain from participating in MGEN’s
                       research consortium, sharing and integrating data         open data project in the event of royalty flow from IP.

               1.4 Adapted health technology assessment
                   processes for precision medicine technologies
                       Summary: The integration of precision medicine technologies into standard market-review processes
                       remains a gap in both high- and low-income countries. If traditional health technology assessment
                       methods are unable to properly evaluate precision medicine, novel refinements must be adopted by
                       pharmacoeconomic groups globally.

   The inclusion of    Novel precision medicine technologies may not             ways through the approval process and may
precision medicine     fit traditional evaluation and market approval            include, but is not limited to, faster regulatory review
in clinical practice   processes for biotechnologies. While conventional         timelines, clear pricing standards and relevant
                       HTA aims to evaluate the social, economic,                medical feedback. However, in creating robust
has been recognized
                       organizational and ethical issues of a health             frameworks to formally evaluate precision medicine
to ‘impact each        intervention, its systematic evaluation varies from       technologies, HTA bodies may struggle to keep
stage of the           country to country and often does not cover               pace or may attempt some level of ad hoc review
Health Technology      novel scenarios posed by precision medicine               processes on such technologies. Nonetheless,
Assessment             technologies. The inclusion of precision medicine         these traditional review processes may not fully
(HTA) process,         in clinical practice has been recognized to “impact       account for accurate end points that capture the
from scoping and       each stage of the Health Technology Assessment            value-add of a precision medicine innovation.
modelling through to   (HTA) process, from scoping and modelling through
decision-making and    to decision-making and review”. For instance,             To date, only a few HTA bodies internationally
review’.               pharmacogenomic tests (PGx) that assess the               accommodate specific considerations or traditional
                       adverse event (AE) risks of certain therapeutics          evaluation methods for precision medicine – e.g.
                       may not fit into traditional assessment models            the Diagnostic Assessment Programme at the
                       given their indirect effect on patient outcomes if the    National Institute for Health and Care Excellence
                       resulting information gain from the PGx diagnostic        (NICE) in the UK, the Health Interventions and
                       changes the course of care. This variability in the       Technology Assessment Program (HITAP) in
                       patient pathway may be more difficult to capture in       Thailand and the HTA Access Point in Australia.
                       standard HTA analyses.                                    Australia’s entry point for companion diagnostics
                                                                                 (CDx) is illustrated as a case study below. The
                       Refinements to various components of HTA are              conduct of enabling studies to collect the necessary
                       encouraged, so as to adapt to the influx of precision     data for HTA processes is further discussed in the
                       medicine algorithms, digital health applications and      “reimbursement conditions and coverage models”
                       “omics”-based tests. This may manifest in various         section under innovation financing.

                                                                        Financing and Implementing Innovation in Healthcare Systems   16
Case study – Australia’s HTA Access Point for          to be assessed by more than one expert advisory
Co-dependent Diagnostic Technologies: The              committee. The latter is particularly relevant for
Australian government’s Department of Health           designated “co-dependent technologies” such
established a “single entry point”, the HTA Access     as targeted therapies that require companion
Point (HTAAP), that assists specific applicants for    diagnostic technology, in which HTAAP will work
HTA and reimbursement if they are uncertain about      with the applicant to form a tailored assessment
the funding programme for which their technology       methodology for the eligible technology in the hope
may be eligible, or where their technology may need    that assessment timelines may be reduced.

                                              Financing and Implementing Innovation in Healthcare Systems   17
Below: THANIT, Getty Images

2   Innovation financing
    The funding mix to both set up and regularly
    reimburse precision medicine programmes.

                                  Financing and Implementing Innovation in Healthcare Systems   18
2.1 Public funding and fiscal space usage
    Summary: Government spending on precision medicine programmes demonstrates national support and
    encourages private-sector funding for the innovation ecosystem. LMIC settings with constrained fiscal
    space may seek to prioritize precision medicine initiatives when relevant to other national health priorities.
    Expansion of targeted budgetary allocations over time remains necessary for sustainable public funding of
    precision medicine.

    Public funding is often vital in spurring precision       financing involvement from private innovators as the
    medicine programmes and such investment                   precision medicine market matures. This funding
    will depend on the fiscal space – defined as the          shift from top-down public spending to greater
    budgetary allocation for a targeted investment            private investment activity is commonly observed
    area – available from the ministry of finance or          as the innovation ecosystem supports further
    respective treasury agency. While constrained             translation of R&D.
    by limited resources, especially relative to private
    funding, public spend can either fully establish or       While LMICs may not have the available fiscal
    partially underwrite early innovation programmes via      space for precision medicine due to the focus
    an initial mix of grant-based and/or loan financing.      on other national health priorities (e.g. infectious
    Additionally, public grants are often used to finance     disease or neglected tropical diseases), public
    research initiatives in both academic institutions        funding is crucial in the early stages of the
    and relevant private projects. These government           innovation ecosystem. In such scenarios where
    investments often take the form of milestone-based        precision medicine is a national investment
    tranche payments or upfront disbursements but will        interest, precision medicine programmes may
    depend on the project arrangement.                        be incorporated into related health initiatives of
                                                              national focus with already ongoing fiscal spending
    While national precision medicine programmes may          (e.g. infectious disease surveillance or genomic
    ultimately be financed by a variety of public- and        studies of rare disease prevalent in the country). For
    private-funding sources, the readiness criteria for       emerging and more developed economies able to
    public funding are defined by: (1) the fiscal space       consider greater public investment, the fiscal space
    allocation to precision medicine from existing            remains particularly important to de-risk a reliance
    budgets or new funding channels; and (2) the              on private aid. The World Health Organization
    diversity of investment partners supporting the           (WHO) notes that creating fiscal space expansions,
    project portfolio. The former is based on the ability     often driven by macroeconomic growth, budget
    of a government’s budgetary leadership to audit           reprioritization and efficiency improvements,
    the return on investment (ROI) of potential precision     enables the long-term financial sustainability of
    medicine efforts, measure the national priority level     precision medicine approaches. The government
    and understand the value from precision medicine          of Thailand case study below demonstrates
    approaches. As the innovation ecosystem matures,          the effective use of public funding for precision
    a greater evidence base of early precision medicine       medicine approaches as an upper-middle-income
    initiatives can provide traction for further public       country, first within Stevens-Johnson syndrome
    funding. Similarly self-perpetuating, the latter          and toxic epidermal necrolysis (TEN) in 2004,
    benchmark highlights the diversity within types of        now into larger-scale five-year genome catalogue
    precision medicine innovation and the growing co-         initiatives (2019).

    Case study – public financing of the Genomics             syndrome (SJS) and toxic epidermal necrolysis
    Thailand Initiative and pharmacogenomics                  (TEN) screening, with investments from the Thai
    (PGx) studies: In early 2019, the Thai government         Ministry of Science and Technology. The project
    approved a $150 million five-year initiative to           used genetic testing to identify epilepsy patients
    catalogue the genomes of 50,000 citizens. This            at risk of developing these severe responses to a
    project, named the Genomics Thailand Initiative,          widely prescribed generic medication, and ultimately
    aims to expand the understanding of South-East            reduced such cases by 80% in 2018. Continuing
    Asia’s under-represented genomic composition              its precision medicine efforts, the most recent
    and advance Thailand’s genomics capabilities              Genomics Thailand Initiative falls under the broader
    in personalized diagnostics, drug selection and           remit of the Thailand 4.0 government campaign
    treatment in various disease areas. Thailand pursued      to close the middle-income country gap towards
    precision medicine research as early as 2004              an innovation-driven economy, starting with a
    through the Thai PGx Project for Stevens-Johnson          competitive genomic medicine industry.

                                                     Financing and Implementing Innovation in Healthcare Systems     19
2.2 Private-sector financial backing
                                      Summary: Private funding provides the funding scale and expertise to support precision medicine
                                      initiatives. Engagement by different types of financiers (innovation producers, investors, aid donors and
                                      service providers) may shift as the innovation ecosystem grows. Private financing of precision medicine is
                                      scarce in LMICs, even from development assistance for health (DAH) groups.

                                      In tandem with the public fiscal space, private                                                                                specific funds and development assistance for
                                      funding provides the funding scale and expertise                                                                               health (DAH) groups (e.g. foundations, family
                                      to support the continuous development of the                                                                                   offices or high-net-worth individuals [HNWIs]). As
                                      precision medicine innovation ecosystem. These                                                                                 the marketplace develops, producers – ranging
                                      private-sector financiers range in funding size and                                                                            from biopharmaceutical to diagnostic/sequencing
                                      involvement – examples may include development                                                                                 companies (and investors), including private equity
                                      aid agencies, global health philanthropies,                                                                                    and venture capital (PEVC) groups – actively deploy
                                      biopharmaceutical companies, technology                                                                                        financial and in-kind advisory/expertise resources
                                      manufacturers and impact investing groups among                                                                                for precision medicine projects. Such private-sector
                                      various other NGO and corporate investors. The                                                                                 stakeholders enter as the innovation ecosystem
                                      expansion of the precision medicine marketplace                                                                                grows to provide lower-risk operating environments
                                      is often supported by increased public-private co-                                                                             and tenable investment exit opportunities. At
                                      financing partnerships and individual private-sector                                                                           advanced stages of readiness, service providers
                                      activity (further discussed as a readiness benchmark                                                                           such as private provider systems are able to self-
                                      under the “public funding” section above).                                                                                     finance precision medicine approaches within their
                                                                                                                                                                     clinical practices.
                                      Readiness benchmarks for private-sector financing
                                      activity can be viewed as the extent to which                                                                                  Private financing of precision medicine technologies
                                      private stakeholders are able to participate in and                                                                            in the LMIC context remains scarce. Attention
                                      fund projects in the innovation ecosystem. Policy-                                                                             from DAH groups and global innovative financing
                                      makers are encouraged to conduct a stakeholder                                                                                 mechanisms (IFIs), including The Global Fund, Gavi,
                                      analysis of relevant private actors in order to                                                                                the Vaccine Alliance and Unitaid, have historically
                                      map potential collaboration opportunities and                                                                                  focused on preventing and treating infectious
                                      current funding gaps in the precision medicine                                                                                 diseases such as HIV/AIDs, tuberculosis and
                                      marketplace. Private funders for precision medicine                                                                            malaria. As such, non-communicable diseases
                                      can be broadly categorized into: (1) innovation                                                                                (NCDs) including cancers and cardiovascular
                                      producers; (2) investors; (3) aid donors; and                                                                                  disease – areas in which precision medicine
                                      (4) service providers. Importantly, the mix of                                                                                 approaches are currently most applicable – remain
                                      stakeholders shifts depending on the maturity of                                                                               underfunded through traditional global health DAH
                                      the innovation ecosystem. For instance, countries                                                                              and IFI channels. This remains a notable gap that
                                      in the early stages of private financing activity                                                                              is further highlighted in the DAH financing disease
                                      primarily attract aid donors in the form of disease-                                                                           area breakdown in Figure 6.

           FIGURE 6                   Development assistance for health (DAH) by financing channels

                                      Development assistance for health by channel of assistance, 1990-2018

                                                40             Regional development banks                              UNICEF, UNFPA, UNAIDS, Unitaid, PAHO
                                                               World Bank                                              Other bilateral development agencies
                                                               US foundations                                          China bilateral
                                                35             International NGOs                                      Australia bilateral
                                                               US NGOs                                                 Canada bilateral
                                                               Gates Foundation                                        France bilateral
                                                               CEPI                                                    Germany bilateral
                                                               Global Fund                                             UK bilateral
                                                               Gavi                                                    USA bilateral
                           Billions of 2018 $





Source: https://www.                            5
6736(19)30841-4/fulltext                        0

Case study – series A financing of 54Gene by            has predominantly taken a private-financing approach
Adjuvant Capital: Founded in 2019, 54Gene is an         to grow its capabilities and positioning in the wider
African genomics research, services and development     precision medicine marketplace, with a total of $21.5
company established with the aim of including           million raised venture capital funding stimulated by
under-represented African genomic data in health        initial participation in accelerators (Y Combinator
research and drug development. In April 2020, the       and Google Developers Launchpad). While servicing
US- and Nigeria-based genomics company 54Gene           more than 100,000 participants in its biobank to
announced a $15 million series A financing round        expand African representation in population genetics
led by Adjuvant Capital, a global health-focused        as of 2021, 54Gene has also been able to build up
investment fund for life science technologies backed    infrastructural gaps on the African continent by both
by the Bill & Melinda Gates Foundation, Novartis and    upskilling the workforce and strengthening genomics
the International Finance Corporation (IFC). 54Gene     R&D capabilities.

Case study – private equity financing of largest        oncology treatments alongside an array of imaging
precision medicine provider in Morocco by               and genomic diagnostic services. In addition
Alta Semper: Frontier markets private equity firm       to financial capital, Alta Semper aims to help
Alta Semper has invested in Morocco’s largest           ODM’s expansion strategy by providing operating
oncology, radiology and diagnostics services            expertise across north and sub-Saharan Africa,
platform, Oncologie Diagnostic du Maroc (ODM).          alongside access to its existing healthcare holdings
The provider owns and operates five facilities for      in Morocco.

Case study – UBS $500 million Oncology Impact           Foundation will manage any such generated capital
Fund: Swiss multinational bank UBS Group raised         from initial early-stage oncology investments and
~$500 million from HNWIs for investment by MPM,         specifically direct this flow to: (1) academic grants
a healthcare venture capital firm with oncology         to promising oncology-related research; and (2)
expertise. The fund serves as an impact investment      health access initiatives in developing countries.
initiative that invests in early-stage cancer           This combination of HNWI impact investors
treatments and, in turn, manages the royalties          (scale) and VC expertise (domain knowledge and
and performance fees from successful drug               experience) presents a potential replicable financing
sales of such investments for impact-based key          model for private-driven impact investing in
performance indicators (KPIs). The UBS Optimus          precision medicine technologies.

                                               Financing and Implementing Innovation in Healthcare Systems   21
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