2023 is the year of recovery, but it will not reproduce the "madness" of 2019.
Text | Caijing reporter Zhao Tianyu Ling Xin
Edit | Wang Xiao
"There are several interesting projects. Once New Year’s Day is over, the negotiations will go smoothly." Zhang Chen, a partner of Probe Capital, said.
In 2023, many investors who pay attention to the medical and health field found that things began to develop in a good direction. According to the incomplete statistics of Caijing reporters, the opening year is only one month, and as of February 6, the total number of medical and health investment and financing has exceeded 50.
Together with Zhang Chen, many investors are willing to believe that the first half of 2023 will definitely increase, and it will be good, and the secondary market will be good.
Sequoia China predicted that,Investment and financing behavior will accelerate in 2023, because some investors feel that the market price has been adjusted back to a certain stage and are considering whether it is time to take the shot.
In the medical and health industry, what opportunities will appear in 2023?
"Oncolytic virus is a hot spot this year." In early January, Tang Haofu, a partner of Shanghai Chuangrui Fund and Chongqing Dianshi Chuangjian Fund, went to San Francisco to attend the J.P. Morgan Healthcare Conference in JPMorgan Chase, which was one of the trends he observed. JPMorgan Chase Medical and Health Conference, the largest and most informative medical investment seminar in the world, has become the vane of the global medical and health industry once a year.
Oncolytic virus is a kind of virus that can cause cancer cell apoptosis after being integrated into cancer cells, while keeping normal tissues from being destroyed, and can deal with different types and stages of tumors. After nearly 30 years of verification, it has become an important branch of tumor immunotherapy. In 2015, the US Food and Drug Administration (FDA) approved the marketing of oncolytic virus product Imlygic (T-Vec), which treats melanoma by intratumoral injection.
From the medical and health conference in JPMorgan Chase in 2023, small nucleic acid drugs, adeno-associated virus vectors (AAV) and new drug-carrying technologies of liposomes are also hot directions.
For small molecule drugs and antibody drugs, it will be better to have innovative targets. Although the new use of old drugs in oral medicine in COVID-19 was very successful, only one indication was changed, which was not well received at the meeting.
In the field of cell therapy, the fourth generation CAR-T has attracted much attention and has become the mainstream overseas. As for the targets that many local companies are still doing, such as CAR-T therapy targeting CD19 and CD22, few people abroad have done it.
In Tang Haofu’s view, cytokine storm, the number one risk factor in the clinical application of CAR-T therapy, is expected to be significantly reduced in the next three years. CAR-T therapy is mainly used for tumor treatment. Although this technology can remove tumor cells, it will also produce toxic side effects, that is, cytokine storm, by attacking normal cells in the body.
Tang Haofu looked at some projects and found that everyone was doing it in this direction. For example, Elpis, whose core team is from Harvard Medical School, has reduced its data cytokine storm by more than 70%.
In the field of cell and gene therapy (CGT), in 2023, many investors expressed their continued optimism.
Li Yishi, senior partner of Haoyue Capital, said,Cell therapy drugs, for a period of time, are mostly used for back-line patients, that is, those patients who have been resistant to most existing therapies.
The back-end market is relatively small, so it is unlikely to produce a large variety of drugs with sales of 1 billion yuan.
"If you want to say that there is an opportunity, it has to be this kind-if everyone has an opportunity, it is sunny, is it still an opportunity?" Li Yishi said.
As for gene therapy, Li Yishi said that at present, the whole field is dominated by rare diseases, and going to sea is the main commercial path.
"Gold digger" may not be successful, "water seller" still has a chance, but the field has been very subdivided.Zhang Chen is concerned about the mRNA in the direction of tumors and infectious diseases. He thinks that in this industrial chain, the opportunity of "selling water" is the best, such as making cell culture medium, and then looking further, transfecting reagents.
"We want to find some powerful companies and stay with them all the time. If we serve an infrastructure, it will become a profitable position." Zhang Chen said.
He is also optimistic about the opportunities of proteomics and structural biology. The demand for proteomics is increasing, and the financing in China market is accelerating; The contribution of structural biology to pharmacy may appear in the next year or two, especially the continuation of structural biology based on cryoelectron microscopy.
In terms of innovative instruments, Sequoia China said that it would pay attention to globally synchronized cutting-edge technologies such as single cell sequencing and single molecule protein detection.
Some investors favor gene sequencer. Zhang Chen said,At present, there is still room for improvement in mainstream machines. If the signal and noise can be well distinguished, early tumor screening will be more available. Hospitals require high detection speed, which requires machines with more flexible throughput, and the most important thing is the innovation at the bottom of sequencing.
It has been three years since the epidemic, and the detection in Covid-19 has fluctuated greatly. Both nucleic acid detection and antigen detection are betting on a policy window period, which leads to the concern of IVD (in vitro diagnosis) industry. Zhang Chen said frankly that because he was not sure what products would sell well in the future, he chose to look upstream.
Cardiovascular, neurosurgery, orthopedics and ophthalmology are the departments frequently mentioned by investors.
Although cardiovascular and orthopedics have been targeted by the national centralized procurement, they are still the departments that bring the most cash flow to hospitals, and the consumption of consumables is large and the demand is large, which promotes the emergence of new technologies and materials.
How to make doctors more labor-saving is a big product direction. Zhang Chen pays attention to small active medical devices (plugged in) and hopes that the higher the intelligence and complexity, the better.
Some instruments used in departments such as gastroenterology and cardiology will continue to develop into software and nano-scale miniaturized products. Interventional robots and interventional materials are the highlights.
Tang Haofu observed at the JPMorgan Chase Medical and Health Conference,The interventional robot is taking the route of miniaturization and software, and it is expected that there will be some progress in one or two years. There is also a self-driven gastrointestinal mirror, which is driven by its own propeller, and its technical content is much higher than before.
As for the open surgical robot, it is not a big focus in the short term. The typical product in this field is Da Vinci surgical robot, which consists of three parts: surgeon console, bedside manipulator system and imaging system. By enlarging the field of vision and defibrillating the hand, it helps doctors to complete the operation and reduce the trauma caused by the operation to patients.
Some companies continue to optimize this kind of surgical robot with different structures, but in the eyes of investors, it is "too heavy" and some actions are quite barbaric and not smart enough to operate.
Although surgical robots are not so popular, xenotransplantation, in Tang Haofu’s view, will become a hot investment in two or three years.
In 2022, the Medical College of the University of Maryland transplanted a pig heart to a 57-year-old man. In a few weeks after the operation, the transplanted heart in his body worked well and showed no signs of rejection. It lasted for 63 days until the illness deteriorated and died. This is regarded as a major breakthrough in the field of xenotransplantation, and it is expected that there will be companies mainly engaged in xenotransplantation within two years.
Hou Xuchao, founding partner of Zhuozhi Consulting, proposed that,There are three factors to grasp the opportunity of the industry: breakthrough and development in technology; The market demand and unmet demand are huge; It can improve the performance-to-price ratio or efficiency at some levels.
For 2023, "recovery" is felt by many investors, although the degree is different.
Hou Xuchao believes that on the whole, there will be a great recovery in 2023, but the "madness" in 2019 should not reappear. At present, the overall fund-raising form and exit channels have changed greatly, and the investment strategy and style of private equity funds have also changed greatly, so there will be new local hot spots and explosions, but it will not "raise chickens and dogs to heaven."
Sequoia China observed that,In fact, since October 2022, the biomedical industry has entered a slow recovery process, especially for companies with good fundamentals, and they have also seen many positive improvements.
However, after four years of epidemic tempering, investors’ mentality has become more cautious, the overall investment action has slowed down, and the difficulty of raising funds for companies in the market has also increased.
Li Yishi told Caijing reporter,For the heat of investment and the possibility of financing in 2023, it should be a tentative spiral upward trend.
For the key words in the field of health in 2023, Sequoia China is still an "early investment".
In the past few years, the capital market has made great strides, and the valuations of many primary market companies have soared. For investment institutions, if the investment is not early enough, the multiple of return may decline. From this dimension,In fact, all funds will gradually realize that whether it is active choice or passive choice, it is an inevitable trend to invest early.
Hou Xuchao’s key words are "innovation, efficiency improvement and cost performance". The medical and health field has returned to normal, and the industry continues to emphasize the value of innovation and technology.
Tang Haofu believes that the key word in 2023 is "deep innovation". With the opening of information channels, the communication between investors and overseas countries is getting smoother and smoother, and deep innovation will be valued.
Zhang Chen’s first thought is to consider long-term value, and new technology is the focus.
In Li Yishi’s view, "restart" is the key, and 2023 should be regarded as the first year of real departure after restart.
However, a private equity person in the secondary market said that in the short term of 2023, there are still uncertainties and there is no particularly clear conclusion. In the long run, we are still optimistic about China’s health field, because the problem of aging is more and more prominent, and we spend more on health expenditure.
