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How to create and keep the next Cochlear

By Rick Holliday-Smith

Australia’s holy trinity of medical success stories – ResMed, CSL and Cochlear – turned research into revolutionary products. How can we build the next long-term success, and keep it onshore?

Australia has a well-earned reputation for punching above its weight when it comes to medical and health research. The frequently cited examples – cervical cancer vaccine, spray-on skin, the electronic pacemaker and, of course, the bionic ear or cochlear implant – are known to most Australians and the global scientific community. 


COVID-19 has again seen Australian medical researchers come to the fore, with the University of Queensland partnering with CSL and Coalition for Epidemic Preparedness Innovations on a COVID-19 vaccine candidate based on pioneering ‘molecular-clamp’ technology.

In 2019, the Global Innovation Index (GII) ranked Australia in the top 10 for human capital and research1. Quite rightly, over recent years, the Australian government has sought to capitalise on this competitive advantage by investing billions in medical and health research, primarily through the Medical Research Future Fund, university research funding programs and the R&D Tax Incentive for companies in the clinical trial and commercialisation process. Over the past 20 years, it is likely public support has exceeded $200 billion2.


The impact of COVID-19 on university research budgets must be reckoned with. To those who think about the long-term future it is clear that investing in medical and health research must be a priority for all modern, developed nations. It is also obvious that it is best for long-term viability if these investments lead to quality, well-paid local jobs and a self-sustaining capability, meaning less reliance on the public purse.


Self-sustaining means Australian companies are able to base themselves in Australia while exporting to the world – think of export-oriented success stories like CSL, ResMed and Cochlear. It also means making sure our existing medical-innovation success stories stay in Australia. 


That requires a globally competitive business environment built on the right policy settings to hold our own against the many other countries who know the value of these companies, actively compete for their investment and offer incentives to attract them. We also need the right policy settings to build new success stories that stay located in Australia.


We all should understand the value of medical and health research that leads to medical innovation and improved health outcomes for Australians – and people around the world. It is arguable this virtuous cycle always holds value in and of itself. However, the value to Australia could be increased by many magnitudes if we were better at commercialising this research and building large, successful medical innovation companies that stay in Australia and deliver long- term economic benefits to Australians. 


While Australia is ranked in the top 10 on the GII for human capital and research, it is ranked a lowly 31st for innovation outputs, meaning we rank well behind other high-wage, high-tax economies like Canada, France and Norway. Most worryingly, Australia is ranked 88th for knowledge diffusion – that means measures including IP receipts and high-tech net exports as a percentage of total trade. 


There are fewer than 120 medical-innovation companies listed on the ASX. Only three – the holy trinity of CSL, ResMed and Cochlear – are Australian-founded and significant in size. During the past 20 years, there has been no new CSL or Cochlear, while ResMed has progressively moved offshore to benefit from a more attractive business environment, more supportive policy settings and better investment opportunities. 


Many promising Australian medical innovations and startups have been bought out and/or relocated overseas, including the buyouts of Sirtex by a Chinese consortium and Elastagen by global biopharmaceutical company Allergen (which itself was recently acquired by AbbVie). When these companies leave Australia, well before full value is achieved, our economy loses well-paid jobs, IP, tax revenue and advanced manufacturing, and this undermines development of the local ecosystem to support future growth. 


It is critical for Australia to invest in R&D and we should be doing more, not less, of it. But in medical innovation most of our investment is underwriting the realisation of long-term benefits by foreign companies and other countries.


Why aren’t we benefitting more from what we put in? It is hard, expensive and takes decades to nurture and build strong, sustainable medical innovation companies that ultimately need regulatory approvals that can take, in some cases, more than 20 years to secure. To change this, Australia needs two significant groups of stakeholders to act differently – equity owners/private capital and policy makers/government. 


Looking at equity/capital, two questions come to mind. Can we convince capital to be more patient and understand the risks better? And can we convince them to be more patriotic?


On patience, few investment funds are thinking 15-years plus, particularly in Australia. And High Net Worth investors are offered little by way of upfront tax incentives and are asked to invest highly taxed dollars into these relatively long-timeframe, yet still risky, activities.


On patriotism, if I look at Cochlear’s investor base, the majority of its long-term investors come from overseas pension funds. This was not the case 10 years ago. We need to ask ourselves why Australian super funds are not investing in Australian companies. It must relate to their view of long-term value relative to the views of other major global investors. We need to consider what kind of mechanisms or incentives can be put in place to encourage both patriotism and patience. Which brings me to the second stakeholder, policy makers or government.


Government can help us bridge the gap between broader public interest and capital, providing incentives to stop Australia missing out when companies and IP are sold overseas and/or effectively move offshore. If the companies and the IP stay in Australia, the main advantage of export revenues and high-quality, well-paid, tax-paying jobs stay here. 


Government can play an important role in encouraging capital to invest in Australian Medical Innovation by incentivising business investment in R&D. The R&D Tax Incentive (RDTI) has been subject to multiple reviews in the past 10 years and the trend was toward reducing support for business. Thankfully, as part of the 2020-21 Budget, the Australian Government righted the ship, increasing the cap on RDTI eligible expenditure from $110M to $150M and substantially increasing the benefit for companies with a high R&D ‘intensity’ (the proportion of overall expenditure spent on R&D). 


But perhaps more importantly, government incentives and support along the medical innovation value chain tapers off almost completely at the point of greatest potential social and economic benefit – when products progress closer to commercialisation and manufacture. 

Australia is in a global competition for medical innovation companies with long-term potential, but many other countries offer a more advantageous environment, including better access to skilled labour, a more competitive corporate tax rate and a more generous suite of R&D and commercialisation incentives. 


For example, 15 of the 28 European Union member states currently offer an IP tax incentive (otherwise known as a patent box), which provides a reduced effective tax rate on income from eligible IP. These incentives are available only for IP generated by local R&D, which helps capture the benefit of government support for R&D when it is at its most valuable stage – when it is has been commercialised and is generating tax revenue and creating jobs. 


There are many reasons the medical-innovation sector can be a key driver of Australia’s post-COVID-19 economy and beyond, including our outstanding medical and health research capability. 



If we stop short of making the policy changes we need to enable Australia to compete with other countries, then we have no excuse for failing to achieve our potential. If we are bold and committed, we will not be waiting another 20 years for the next homegrown – and home-based - medical-innovation success story.



Rick Holliday-Smith is chairman of the ASX, and Cochlear.

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