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A Doctor under Your Skin: Wearable Medical Devices in India, Brazil, and China

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From smart glasses that allow a surgeon to operate having his patient’s medical records at sight to an intelligent contact lens that measures glucose levels of its wearer, technological innovations are changing the world as we know it. Wearable medical device market growth has been promising and the industry is expected to reach a value of US$7.8 billion by 2020, growing at a CAGR of 19% from 2015 to 2020. Since 2015, the USA and Europe have been two key markets hosting majority of users of these new technologies. However China, India, and Brazil are expected to increase its demand for wearable devices driven mainly by rapid expansion of smartphone users and an increasingly aging population. Is these emerging economies’ current set-up favorable for medical wearable to maintain a steep growth?

 

The use of wearable medical devices is skyrocketing due to aging populations, fast adoption of new trends, and greater incidence of chronic conditions around the world. An increase in health awareness across the globe and a simultaneous increase in worldwide wearable medical device shipments estimated to reach 97.6 million units by 2021, growing at a staggering CARG 108% between 2016 and 2021, might indicate the industry’s large growth potential.

Wearable Medical Devices in India, Brazil, and China-Global Outlook

Brazil, India, and China (BIC), in particular, have been registering increasing rates of chronic diseases such as heart failure, diabetes, and obesity for the past several years. Therefore, these countries have started to be considered as the next destinations to focus on in search for high growth-potential wearable medical devices markets.

Wearable Medical Devices in India, Brazil, and China - BIC Markets Are Attractive

Regardless of the fact that wearable medical devices are thriving in the USA and Europe, in countries such as Brazil, India, and China, these devices are bound to face challenges that could translate into major roadblocks for the market to grow. For instance, although wearable medical devices have proved to be a significant aid when monitoring and preventing illnesses, these are not yet considered an essential product for healthcare consumers. Consequently, BIC buyers, who tend to also be highly price sensitive, may refrain from purchasing such solutions if the retail price is high in comparison to their purchasing capabilities. As a result, this behavior may lead to a stalling sales volume in these markets and, subsequently, a slowdown in the wearable medical market growth.

Wearable Medical Devices in India, Brazil, and China - Successful in BIC

In addition, the growth of wearable medical technologies in BIC is challenged by deficient regulatory frameworks with regards to categorizing and supervising such devices for their import and commercialization in each market. Currently, regulatory frameworks are mostly outdated and do not include specific category for wearable devices with proper security measures. Moreover, as these wearables are battery-operated, improper testing due to lack of regulation can affect their safety as well as may reduce the trust consumers need to develop in order to accept and use the device. Further, this inadequate regulatory scenario may drive away potential market players (including key providers).

Wearable Medical Devices in India, Brazil, and China - Regulatory Frameworks

 

Wearable Medical Devices in India, Brazil, and China - Challenges

EOS Perspective

Global wearable medical device market is witnessing a steep growth driven mainly by changes in demographic profiles of many populations and a growing incidence of chronic conditions. In developed economies, wearable medical technology is experiencing high adoption rates and its role in the healthcare sectors is strengthening, mainly because physicians already use such solutions during consultations, whether to monitor, diagnose, or treat a patient. In emerging economies such as Brazil, India, and China, wearable medical technology has even more room to continue expanding, however, current scenarios in these countries may partially impede this growth.

Some of the key issues in these markets include the problem of import regulations unfitted for wearable medical devices, and this seems to be an important issue which needs to be sorted out in the short term to avoid driving potential players and manufacturers away from BIC markets. At the same time, the high retail price makes the wearable devices unaffordable for a large percentage of the population causing low rate of adoption among patients, and hindering medical wearables’ market growth.

Further, the fact that healthcare providers are not planning to include such devices in public health insurance schemes and reimburse the cost of wearable devices as part of their health plans, lowers the chance of this technology reaching higher number of consumers. This limited accessibility to wearable medical devices in BIC markets may result in low consumer’s awareness about their benefits, or even their existence.

Local governments should reform and adapt their import regulations to fit the wearable medical devices characteristics, allowing a better flow of these products to enter the countries without risking human health. At the same time, for wearable medical devices to healthily grow in these promising and widely populated markets, manufacturers and retailers should aim to lower a wearable device retail price. A way to achieve this could be by adding wearable devices to private health care plans (and encouraging public health insurers to do the same) – especially for chro
nic diseases patients and people over 60 years old. This will most likely allow consumers to purchase such a device at a lower retail price or rely on their healthcare reimbursement policies.

by EOS Intelligence EOS Intelligence No Comments

China’s Digital Single Market – Internet of Things

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Underpinned by immense government support, private investments, as well as the highest number of machine-to-machine (M2M) mobile connections globally, China has potential to get to the forefront of IoT (Internet of Things) development. While most countries are still beginning to understand the benefits of IoT, China already embraced the technology as early as 2010, when it built a national IoT center and aimed to create a market worth US$160 billion by 2020. IoT, with its promise of delivering continuous connectivity, is likely to usher an industrial revolution in China resulting in improved productivity, global competitiveness across industries, and higher economic growth.

IoT is helping China to build momentum and succeed in the digital age, fostering development across various industries by revitalizing manufacturing, boosting connectivity through smart cars and buildings, crafting a new consumer market for wearable devices, enhancing healthcare services, and stimulating energy efficiency.

China seeks to integrate various industries with IoT technology for economic gains and efficient management. Industries such as logistics, manufacturing, transportation, and utilities and resources, in particular, are likely to witness improved efficiency, lower costs, and better-managed infrastructure through real-time information provided by IoT technology.

China’s Digital Single Market – IoT - Revitalizing Growth

 

Chinese consumers are very open to adopting IoT technology, which results in growing penetration of smart devices. Smart home appliances, cars, meters, and retail devices are likely to witness tremendous success in China.

China’s Digital Single Market – IoT - Adoption

 

Industry dynamics are improving driven by launches of new smart devices by private companies, pivotal government support, and several digital drivers (including growing M2M connections as well as smart phone and Internet users). However, there a few factors such as security and infrastructure issues, fragmentation in the market, and lack of standardization that are slowing down IoT development.

China’s Digital Single Market – IoT - Promotors and Inhibitors

 

Despite IoT’s immense potential, several driving factors, and promises of economic gains across industries, a 2015 study conducted by Accenture revealed some deterring factors such as lack of specialized skills, low R&D investments, and substandard infrastructure, which may hold back IoT development in China.

China’s Digital Single Market – IoT - Readiness for Adoption

EOS Perspective

Undoubtedly, China is likely to witness unrivalled opportunities in terms of productivity improvements and economic development as IoT technology spreads across the country. Efforts made by the Chinese government are stimulating the IoT growth – ‘Made in China 2025’ initiative launched in 2015 aims to integrate production with Internet to deliver smart manufacturing and higher manufacturing value. Further, with the ‘Internet Plus’ strategy, China plans to integrate mobile Internet, cloud computing, big data, and IoT with manufacturing.

However, Chinese business leaders and policymakers cannot expect to reap benefits of IoT technology without the right enabling conditions. In order to ensure development, it is imperative for China to overcome the gap in technical skill set, infrastructure, as well as focus on promoting IoT investments. To address the shortage of critical skills, China needs to improve the number and quality of tertiary graduates in science and engineering fields. Beyond that, building a cross-industry ecosystem is also essential for IoT-led growth, which requires development of an integrated communication system along with cluster of secured networks for data transmission.

China’s IoT industry, still at a developing stage, has promising growth potential that could materialize only if the country takes all necessary measures to improve its infrastructure and technological platform, which will allow IoT to diffuse through its industries and completely transform them.

by EOS Intelligence EOS Intelligence No Comments

Traditional Chinese Medicine: Ready for the Global Stage?

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In late 2015, Chinese researcher Tu Youyou was awarded the Nobel Prize for creating anti-malaria drug, using Traditional Chinese Medicine (TCM). Artemisinin, an active compound extracted from an aromatic herb sweet wormwood (which has been in use for treating malaria in China for more than 1,500 years now) was the key ingredient in preparing the prize-winning drug.

Based on herbs and other natural ingredients, the traditional medicines in China treat a range of health conditions, including common cold, pain, gastrointestinal ailments, and chronic illnesses, among others. TCM sector, fully supported by the Chinese government, has its own ecosystem in the country comprising dedicated practitioners, educational institutes, and the pharmaceutical companies manufacturing traditional medicine products.

1-TCM

Despite having been in use for more than 2,000 years (as claimed), domestic market for traditional medicines is smaller in comparison to that of conventional prescription and Over-The-Counter (OTC) drugs. The sector requires competitive TCM products for market expansion. However, this looks a distant possibility, as TCM-based clinical trials account for only about 5% of all trials (open studies) in China at present. This can be attributed to dearth of large organized TCM players with enough funds to invest in R&D. It also suggest that majority of Chinese consumers of traditional medicines rely on time-tested legacy preparations.

The State Council (the highest administrative body in China) meeting held in February 2016 asked for strengthening the sector through policy initiatives, such as increasing the number of traditional medicines in national essential medicine list, ensuring higher quality supervision (farm-to-factory), promoting modern production techniques, and consolidating a largely unorganized sector at supply side. The plan is also to support research and development and to look for ways to hasten industrialization and export of TCM.

Amid the urgency shown by the State Council, and in the light of recent Noble Award, it would be interesting to see if traditional medicines have the potential to provide alternative to conventional medicines at global stage, or will they largely remain a domestic (Chinese) phenomenon.

EOS Perspective

Though policy makers in China see enough potential still waiting to be tapped, the traditional medicines sector needs to overcome challenges in overseas as well as domestic market.

It is apparent that the Chinese government’s efforts to promote traditional medicines overseas in foreign markets have not yielded desired results. For instance, to boost TCM trade, the government announced a program in 2012 to establish 10 TCM trading centers worldwide. While there are no updates available on proposed plans to set up these TCM trade centers, in 2015, the first center of traditional Chinese medicine in Central and Eastern Europe was opened in a Czech hospital, as a pilot project.

The policy makers in China need to work around the fact that the expansion of traditional medicines beyond China is constrained due to doubts about their efficacy and possible side effects. One of the ways to allay fears of non-Chinese consumers (in order to ensure wider acceptance) is to get recognition through Western regulatory bodies, such as FDA. However, this can be a time consuming process, as evident from the history of TCM registrations outside China.

2-TCM Challenges

At present, the best approach seems to be to strengthen domestic TCM sector while identifying the TCM-friendly overseas markets and the therapeutic segments with potential to be successful abroad.

For competing at global level, TCM sector requires more TCM-focused companies, such as Dihon, Chinese herbal and OTC manufacturer (which was acquired by Bayer in 2014 with Bayer’s intent to strengthen its position in Chinese OTC market that currently consists of about 50% of herbal medicines). Dihon boasts of a strong TCM portfolio, including its star product Dan E Fu Kang, which is marketed as a gynecological medicine for women’s health indications. Dihon-like companies that have a few best-selling TCM drugs under their belt are exactly what the Chinese TCM sector needs in order to develop and expand abroad.

If successful, the envisaged state policies might lead to creation of a number of large TCM companies, with enough financial power to invest in research and development, thereby creating a robust traditional medicine portfolio. At present, only few known large players, such as Traditional Chinese Medicine Co. and Jiangsu Kanion Pharmaceutical, are operating in the Chinese market.

TCM sector’s international expansion should focus on OTC drugs with safety and success record proven in China, and introducing these drugs in markets where regulatory requirements for market approval are less stringent e.g. in Asia and Africa. Manufacturers of TCM can also look for complementing the existing conventional medicines (instead of replacing them) for life threatening diseases e.g. cancer. While not treating the actual disease, traditional medicines can contribute to providing a wholesome treatment. For instance, past studies in China suggest that TCM is effective in treating side effects, such as radiation injury and inflammation, nausea, and gastrointestinal disorders due to radio/chemotherapy.

It may take long for TCM to challenge conventional medicines and make commercial impact at global level. Till it happens, the traditional medicine market will remain China-centric. Only disruptive policy interventions will make the sector dominant at domestic level, thereby setting the stage for a global take-off.

by EOS Intelligence EOS Intelligence No Comments

BREXIT: First Thoughts

Streit ums Haus

In a landmark decision, UK’s citizen expressed their preference to leave the European Union. While the process is not straight forward, and will take at least two years to complete, Britain could struggle to lift the markets sentiment in a short to medium term.

Sterling Pound, probably one of the strongest currencies in the world, immediately suffered the largest drop in the past 30 years. Stock markets across the world have also responded to the news, with most stock exchanges witnessing a significant drop in share prices. This only reciprocates the negative market sentiment currently dominating the market. Some even feel that announcement of BREXIT could be a dawn a new recession period, similar to the 2008 crisis.

Britain will have to undergo massive negotiations over the next two years – not only in terms of their relations with other EU member countries, but also at a more granular level. Most companies will have to renegotiate their EU-wide contracts, to enable provisions for a separate/independent Britain. A major challenge will be addressing trade with EU member states, as well as countries with which EU has signed free trade agreements, which according to estimates puts about £250 billion worth of trade at risk.

Several companies, especially the ones which use Britain as the base to serve other EU markets, have been left in the midst of turbulent waters, unsure of what pans for them in the future. All will again depend on how negotiations go among the 27 EU member states during a long drawn process, after Britain enforces the Article 50 of the Treaty on European Union, for officially exiting the EU.

China, already suffering from the stock market and debt crisis in early 2016 following a crash in crude oil prices, could see its trade with European countries taking a hit. UK is the second largest customer for China in Europe. Weakening of the Sterling Pound and Euro is expected to erode the competitive advantage that China sought by devaluing its currency several times since August 2015. Moreover, the negative market sentiment is also likely to drive the crude oil prices further downwards, which could add the pressure on the debt-ridden country.

The knock-on effect will also be felt in other emerging markets in Asia. Nomura’s analysts predict growth rates in other Asian emerging markets to drop by up to 1.0 percentage point.

EOS Perspective

While many expect the impact of BREXIT to be felt gradually, the short terms scenario certainly seems to point otherwise. All will depend on how the exit process progresses, along with the negotiations, which might leave Britain in a slightly less advantageous position. Even if all goes well, it will take several years to attain normalcy.

by EOS Intelligence EOS Intelligence No Comments

Raising Customs Duty – The Right Prescription for India’s Bulk Drug Industry?

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Prescription and stethoscope.

India’s Drugs Technical Advisory Board (DTAB) has long expressed concerns over growing import of bulk drugs and over the challenges in ensuring the quality of the imported drugs. Hence, it came as no surprise when earlier this month (June 2016) the DTAB endorsed the Ministry of Health and Family Welfare’s (MoHFW) decision to increase customs duty on import of bulk drugs (APIs).

This also comes in the backdrop of India’s excessive reliance on China for its bulk drug requirement (including that for essential medicines) — ~70% of India’s bulk drugs come from China.

Chinese imports have already driven some Indian producers of bulk drugs (e.g. penicillin) out of business, and there are fears that Chinese producers may hike prices after destroying competition. China’s import influence is so strong that any event (such as Beijing Olympics of 2008 when several bulk drug plants in China were shut down to control pollution) could trigger tightening of supply to India, thus impacting domestic production.

The feeling in Indian government bodies is that unless China’s influence on India’s bulk drugs industry is curtailed, it might severely impact domestic growth prospects. By increasing customs duty, MoHFW’s aims (and hopes) to de-incentivize imports and create a level-playing field for domestic manufacturers of bulk drugs.

While DTAB’s move is welcomed by certain sections of India’s pharmaceuticals industry, the fact of the matter is that China still enjoys about 30-40% cost advantage vis-à-vis India in bulk drug manufacturing, making it a preferred import source, especially for manufacturers of essential medicines intending to save margins due to caps in retail pricing. It is unlikely that this advantage will change soon enough for India’s bulk drug industry to become self-sufficient.

In recent years, the Indian bulk drug industry has seen robust growth opportunities on account of off-patenting of several blockbuster drugs. The Associated Chambers of Commerce & Industry of India (ASSOCHAM) expects the bulk drugs industry to record a 12-14% CAGR growth during 2016-2019, driven by demand from manufacturers of off-patent drugs. So, while this move of increasing customs duty might boost growth of the local bulk drugs industry, this is only a small step towards promoting domestic production of bulk drugs.

On their part, India’s bulk drug manufacturers need to decide the basis of competition (specifically with their Chinese counterparts) i.e. cost vs. quality, niche vs. general formulations, regulated (markets with strict regulatory requirements and strong IP regime) vs. semi-regulated markets. Indian manufacturers stand a better chance by playing to their strength and focusing on developing quality products for regulated markets.

Government intervention is also required in the form of incentives, as recommended by the Katoch Committee (established in 2013 to look in to bulk drug industry issues), e.g. tax holidays, land for manufacturing at affordable rates, soft loans, etc., to enable cost-competitive domestic manufacturing. In December 2015, the government vowed to implement the Katoch Committee recommendations within 100 days (i.e. by April 2016). Since then there is no news (on public domain) regarding any development on this front.

It would be an overstatement to say that time is running out for the Indian bulk drugs industry. However, a time-bound action is the need of the hour to compete with China, which has a first-mover advantage (as far as favorable policies and pricing are concerned).

by EOS Intelligence EOS Intelligence No Comments

McDonald’s – Facing the Heat Globally

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With more than 36,000 outlets globally, out of which 14,000 are located in the USA alone, McDonald’s is rightly known as the fast-food giant. After decades of expansion that saw the brand conquer leading markets across the globe, McDonald’s seems to have been losing its sheen across leading markets since 2014, with the biggest challenge arising in its home market. Growing health consciousness among consumers, new diverse competition, legal hassles, and supply chain troubles have kept McDonald’s in the news for all the wrong reasons, while dropping profitability has forced this leading fast-food chain to shut down about 700 outlets globally in 2015 and further 500 in 2016. With a change in management and a proactive approach to upgrade its offerings, at least in its home market, the chain does seem to have a plan of action in place, however, it is yet to be seen if it is enough for damage control.

In an unprecedented step, McDonald’s (McD’s) shut down 700 outlets globally (350 outlets in the USA and 350 outlets in its remaining countries of operations) in 2015, and it expressed plans to shut down further 500 outlets globally in 2016. While the company maintains that this will help weed out unprofitable stores, it definitely does spell trouble for the world’s largest burger chain. The biggest concern, however, remains that the slowdown does not stem from poor performance in any one economy but an amalgamation of issues faced by the brand across the globe.

1-McDonald’s Struggles

2-McDonald’s Struggles

3-McDonald’s Struggles

As McD’s strides through one of its worst times, the company looks to tackle the dim outlook with a head-on approach. As one of the first steps, in March 2015, the company changed its management, appointing Steve Easterbook as CEO in place of Don Thompson (who served the company as CEO since July 2012. Since taking charge of the driving seat, Steve Easterbook (who was previously responsible for turning around the company’s business in the UK), has introduced several initiatives that seem to reinvent the brand offerings and reprise its lost reputation.

In the USA, the company introduced all day breakfast and introduced a new customizable menu called ‘TasteCrafted’ in nearly 700 outlets in the USA. The new menu is the company’s attempt to follow the Chipotle strategy of personalization of meals and presents consumers with the choice of three buns, three different meats, and three different styles of toppings. The company has also tried to tackle the minimum wage issue by raising wages in company-owned outlets in the USA, however, this created dissatisfaction among franchised outlets employees. However, even as a start, these measures have helped the company improve sales at home (US sales witnessed the first rise in two years in Q3 2015).

Internationally, and especially in Asia, the company is working towards stricter supply chain auditing to rebuild its brand image. In the Chinese market, the company has launched several healthier options such as apple slices, veggie cups, and multigrain muffins to attract the health-conscious consumers. McD’s is also looking at massive expansion in China, with plans to open about 250 new outlets each year over the next five years. It wants this next wave of growth to stir from the franchising model. Similarly, the company is looking at the prospects of selling a stake in its Japanese operations to a local investor, who could help the company turnaround its Japan business.

EOS Perspective

As McDonald’s woes seem to arise from a mix of dissatisfied stakeholders – consumers, partners, and employees across the globe that vary for each economy, it is not far-fetched to say that the company stands the risk of losing its leadership position across its top markets (as it already has in India). Several strategic decisions are being made by the brand to return to its past glory, however, these seem more long term in nature and therefore will have a significant gestation period before their results are visible.

While the company is largely looking to lean on franchising to spur growth and streamline operations, such as dependence on franchising can act as a double-edged sword especially in times when the company is facing tarnished reputation in several of its leading markets.

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Solar Rises in the East

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The international solar arena which was once dominated by the developed countries in the West is now flaring in the emerging markets of Asia. We are looking at a holistic view of solar PV market across selected Asian countries – the finale of our series focusing on solar photovoltaic market landscape across selected Asian countries.


Our previous articles of the series took a detailed look into current scenario and future prospects of solar PV market in China (China’s Solar Power Boom), India (Solarizing India – Fad or Future?), Thailand (Utility-scale Projects to Boost Thai Solar Market), as well as Malaysia (Uncertainty Looms over Future of Solar PV Market in Malaysia).


 

Solar Rises in the East - Markets Overview - EOS IntelligenceSolar Rises in the East - Markets Are Moving Towards Solar Power - EOS IntelligenceSolar Rises in the East - Growth Drivers - EOS IntelligenceSolar Rises in the East - Growth Challenges (1) - EOS IntelligenceSolar Rises in the East - Growth Challenges (2) - EOS IntelligenceSolar Rises in the East - Opportunities - EOS IntelligenceSolar Rises in the East - Our Perspective - EOS Intelligence

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Anatomy of a Bubble – Case Study: China

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For years, China has been seen as a shining beacon amidst the global crisis, growing at a stunning pace while other countries reeled under the pressure of the global economic downturn of 2008-2009. However, Chinese stock market crashes, first in August 2015, and now at the start of 2016 have let people to question whether China is as immune to crisis as initially thought.

As per estimates by the Economist, Chinese equity market only impacts 15% of households. Therefore, the possibility of a widespread depression was quickly ruled out. However, there are other forces which are likely to be a greater cause of concern for the Chinese government, and possibly everyone around – the most prominent of them being the huge government and corporate debt bubble.

Looking at recent developments, there seems to be a striking resemblance between the increasingly swollen and inflated Chinese debt bubble and a simple spherical bubble, one that is impacted, shaped, and molded by a range of forces, as studied in school science books.

Slide1 - Forces Driving the Chinese Debt Bubble

Slide2 - Surface Tension

Slide3 - Government Measures

Slide4 - External Factors

EOS Perspective

China is under pressure in the face of rising labor costs, industrial overcapacity, falling prices, and weak global demand. Combination of economic slowdown, excess production in manufacturing, and rising debts at the macroeconomic level may cause a massive wave of firm closures and bad loans.

While China has expressed its intentions to reform its debt situation, internal and external market factors have forced the government to plunge more money into the market to finance economic growth and sustain the entire economy. These initiatives may diffuse the situation getting out of hand on a short-term basis. But the repercussion of a future debt crisis could be more severe. The scenario would not only be severe for China, but several other economies in the region, which are key sources of raw materials to China.

From a procurement point of view, while increasing price competition could make China still feature as an attractive proposition, buyers must consider the suppliers’ debt situation before making any decision. No one knows when, or if, the Chinese debt bubble will burst. With the situation still unclear, short-term contracts could be the way forward.

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