Health Technology Innovation by Indigenous Enterprises in China, India and Brazil

Health Technology Innovation by Indigenous Enterprises in China, India and Brazil by Abdolrahim Rezaie A thesis submitted in conformity with the requirements for the degree of Doctor of Philosophy Institute of Medical Science University of Toronto © Copyright by Abdolrahim Rezaie, 2011 Health Technology Innovation by Indigenous Enterprises in China, India and Brazil Abdolrahim Rezaie Doctor of Philosophy Institute of Medical Science University of Toronto 2011 Abstract This thesis explores health technology innovation within indigenous enterprises in China, India, and Brazil. The main discussions are presented in five papers/manuscripts. The first is a case study of Brazil’s health biotechnology sector. It concludes that systemic tensions between the country’s public and private sectors may be detracting from its overall innovative success. The second paper gauges vaccine and medicinal innovation within enterprises in the stated countries by analyzing new technologies in their pipelines or on the market. It concludes that that a growing number of health enterprises in these countries are tackling more technologically challenging and costly innovations. The third paper explores how national institutions and industry globalization interact to shape commitments to new drug and vaccine innovations by enterprises in the three countries. It concludes that; a) the introduction of pharmaceutical product patent regimes has had a modest impact on entrepreneurial attempts to develop new technologies, b) key challenges that diminish patent incentives tend to be institutional in nature and, c) the increasingly globalized nature of health product innovation limits what countries can achieve independently. ii The fourth paper analyzes key issues and trends in health biotechnology firms’ transition to innovation in China, India, Brazil, and South Africa. It concludes that this transition often entails greater integration into the global system. The fifth paper ponders the implications for global health of the emerging market firms’ transition to innovation. It concludes that these enterprises have the potential to simultaneously address global health needs while exploiting global markets, provided support mechanisms are put in place to enable product development for the poorest market segments. This research suggests that to succeed in biopharmaceutical innovation, nations need to adjust scientifically, sectorally and globally all at the same time. Also, that national governments and the global health community need to enhance engagement of emerging market enterprises in related efforts. iii Dedication To Bahareh with love. iv Acknowledgments I am grateful and indebted to Peter Singer who supported me throughout this endeavor. Despite his always-hectic schedule he was very accessible, helpful, insightful and enthusiastic. Peter’s passion for global health, determination to make a positive impact and openness to new ideas continues to be a true inspiration for me. I was also blessed to have an amazing group of people on my advisory committee, who guided me throughout the process, helped make important mid-course corrections, and contributed in many other ways to improving this work. Abdallah S. Daar, Anita M. McGahan and David A. Wolfe all challenged me intellectually, introduced me to whole new dimensions and approaches, and contributed in many other ways to this work. Stephen M. Sammut who was on my advisory committee over the first couple of years of this project contributed to the Brazil case study, and through his network of contacts was instrumental in identifying some of the candidate companies for this study. Sarah E. Frew made significant contributions by leading the overall project focused on the emerging market companies and is responsible for conducting the initial India and China studies presented in Appendix C and D, and collaborated with me on the Brazil study. Jocalyn Clark’s editorial guidance was instrumental in preparing manuscripts for publication and contributed to my success in this respect. The late Sara Al-Bader conducted a country analysis of South Africa’s health biotech sector as part of her PhD thesis on Africa. Her work forms the basis for the inclusion of this country in one of the manuscripts. Sadly, Sara and her husband Mike Smoughton who came to Canada from v England for Sara’s studies both died in a car accident a few months prior to finishing her thesis. It was a true loss of a friend and comrade. Many colleagues and fellow graduate students at the McLaughlin-Rotman Centre for Global Health (MRC) made this experience more enjoyable and stimulating. Andrew Taylor and other administrative staff at the MRC worked tirelessly to ensure that I had the tools and resources to do my research effectively. Halla Thorsteinsdöttir was always eager to share ideas, brainstorm concepts, or organize a course to fill in knowledge gaps. Fellow grad students Billie-Jo Hardy, Sara Al-Bader, Monali Ray, Dominique McMahon, Ken Simiyu, Andrew Kapoor, Fabio Salamanca-Buentello and Mark Messih all made the experience much more fun and rewarding. I could not have done this work had it not been for the encouragement, support, and sacrifice that I received from my wife, Bahareh Motlagh. When I was unsure whether to undertake this challenge Bahareh encouraged me to follow my passion, fully cognizant of the short-term challenges it posed for our family life. During the time of this degree, Bahareh continued to pursue her own education, do extra work, and gave us two healthy and beautiful children, Eliana and Armin. All this, while I spent weeks on end traveling around China, India and Brazil collecting data for this research. Bahareh, I am inspired every day by your zest for life and your upbeat attitude. I feel tremendously fortunate to have you in my life. Bahare’s parents, Ali Motlagh and Farideh Khosravi, disrupted their own lives for years to help us achieve our goals. I will be forever thankful for their unconditional love and support. My brother Karim made incredible sacrifices in bringing our family to Canada, and opened up the whole world of opportunities that it presents. My late father nurtured my sense of curiosity through countless discussions, and ironically, by occasionally saying that “we shouldn’t ask vi certain questions”. My mom always encouraged us simply to “go to school”, but at the same time embodies the fact that the most important things in life are learnt in the realm of everyday experience, and not formal education. My siblings Simin, Amin and Yasmin each have enriched my life and influenced the course of my life and education. Lastly, a number of ‘strangers’ made a significant impact in important junctions in my life. Irma Vorberge not only gave me a job at the age of 17 that helped me to finance my education for many years to come, but also reinforced the message that “school comes first”. Dr. Michael Filosa mentored me during a research project, told me that “I had a skill in the laboratory”, and remains an inspiration in the way he has maintained his enthusiastic about science and his field of expertise after decades of involvement in it. Diane Allingham-Hawkins guided and supported me to achieve certification as a genetics laboratory technologist, and when I considered moving on for further education encouraged me to pursue my passion. Had I not crossed paths with any of these individuals I would likely be at a different place. I am thankful to the numerous interviewees from companies and other organizations in China, India and Brazil who shared their time, experiences and perspectives. I also gratefully acknowledge funding support from the Canadian Institute of Health Research (CIHR) through a Doctoral Research Award. This project has also been supported by the MRC through grant funding from Genome Canada, with co-funding from the BIO Ventures for Global Health (San Francisco, CA), in-kind contributions from Burrill & Company (San Francisco) and Wulff Capital (Carmel, CA). The MRC is supported by a number of other organizations also, the list of which can be found at www.mrcglobal.org. vii Table of Contents Dedication ...................................................................................................................................... iv Acknowledgments........................................................................................................................... v Table of Contents......................................................................................................................... viii List of Tables ................................................................................................................................ xv List of Figures .............................................................................................................................. xvi List of Appendices ...................................................................................................................... xvii Chapter 1 Introductory Chapter .................................................................................................. 1 1 Introduction................................................................................................................................ 1 1.1 Purpose Statement............................................................................................................... 1 1.2 Overall Research Question ................................................................................................. 2 1.3 Overall

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