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Lockdowns had a role: they saved lives

There are threats and lists and all manner of abuse aimed at those who promoted or supported measures that saved lives during the COVID-19 pandemic. I…

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There are threats and lists and all manner of abuse aimed at those who promoted or supported measures that saved lives during the COVID-19 pandemic. I just want to make it clear that I supported measures to protect life until we could be adequately vaccinated. And I’ll support them again if a new deadly pathogen emerges tomorrow for which we have no specific treatments or vaccines.

In those countries that effectively used stay-at-home orders (“lockdowns”), closed borders and mandated masks, a lower proportion of lives were lost compared to countries that got on board well after the virus was already established in their jurisdiction.

Even then, many of those countries continued to import viruses through travel. Early and thorough use of a range of restrictions prevented the levels of death seen in countries where the response was slow or partial.

The aim – although not always well stated – was only to do this until understanding improved, and vaccines, drugs and better management of the sick were available and accessible for all. For all? Phah!We’re nowhere near that yet for a large swathe of humanity.

Sixty-four countries in the bottom grouping of 180 based on first and second COVID-19 vaccination dose. But hey, what’s the holdup on my 4th dose?
Graph snipped from the Australian ABC’s website.[24]

Restrictions caused harm but their delay/absence resulted in death

If we can take the heat out of our feelings for a moment, perhaps we can stand back in 2022 and honestly say that are no easy or harmless ways to protect lives during a pandemic. There are only ways of keeping people away from each other and hopefully doing that while minimising all the other harm – hopefully all much less severe than death – that can result from that. A pandemic is just an utterly crappy event. There’s no good. There’s just bad and not so bad.

We needed to be better at explaining why we had to be subjected to the things we were. We needed to be quicker to lift restrictions when they were not useful. We needed to tailor them with more finesse where possible. We needed to be authentic when we could see one restriction contradicted another – discussing why, even though the answer was something like “because we need this to keep being done”.

While lockdowns caused a range of harms [a few recent examples: 8,9,10,11,12,13,15], others have not found such a clear correlation [a few recent examples: 1,4,5,7] and in some cases, there were improvements to health and levels of infectious disease.[6,14,16,17]

Lists, threats and restrictions

I’m not complaining about being singled out, abused or threatened with being put on trial as I’ve had few of those approaches compared to many others. Although I block a lot quicker than I used to as well.

Most recently I’ve been added to a list of 101 people who “pushed for lockdowns”.[2] The premise of this particular article is kinda dumb though. It’s correlating the current lockdowns in Shanghai in 2022 with comments made before good vaccination levels were attained in other parts of the world. From my perspective, I was supportive of Australia’s border closures early in 2020.[3] I wouldn’t be now. But 2020 was a very different and pre-vaccine stage of the pandemic – it just isn’t comparable to the use of lockdowns in 2022 anywhere today.

The false dichotomy that was always a lie

“It’s either health or the economy!” …they told us.

And of course, many believed them. But it was never that. It was health and the economy.

We saw some great evidence to support this back in July 2021 from the Grattan Institute’s report, Race to 80: our best shot at living with COVID.[19]

From the Grattan Institute’s July 2021 report, Race to 80: our best shot at living with COVID.[19]

If we look at those top countries versus countries that were late to lockdown or lockout or to respond with restrictions in general, the death rate tells a standout tale.

Even Taiwan suffered “prevention fatigue” – a term that sums up what happened anywhere there were humans in 2021.[20] But to their credit and that of their leadership, they turned that outbreak around.[21]

Countries that responded quickly and strongly to the pandemic – including Taiwan, Australia, New Zealand and South Korea – did not suffer as high a case fatality rate as did countries that did respond less quickly.
From Our World In Data, Mortality Risk of COVID-19 [22].

In some instances – for example, in Australia and New Zealand – the removal of influenza and other inflammatory respiratory viruses from the winter mix due to the cessation of the global influenza travellator, may have added to a reduction of annual death compared to the average year pre-pandemic.

Countries that responded quickly and strongly to the pandemic – including Taiwan, Australia, New Zealand and South Korea – did not suffer the high rate of excess death seen in countries that did not respond as quickly.
From Our World In Data, Mortality Risk of COVID-19 [22].

And despite the use of lockdowns, Australia (overall – sorry Victoria, I know you guys suffered extra hard) and New Zealand actually had a lot of time not locked down than did some other countries. We dipped in, and once back under control, we relaxed those lockdowns and went on with life, relying on a hotel quarantine (HQ) system at the border. For a while that was leaky, but then it sealed up as the airborne nature of transmission finally (?maybe) was addressed. We didn’t hear as much about HQ working as we did when it failed though.

From the Grattan Institute’s July 2021 report, Race to 80: our best shot at living with COVID.[19]

Of course, one Australian State (New South Wales) lost control of the virus not long after this and spread it to other sites. It, like Victoria after it, also suffering from the public’s prevention fatigue, couldn’t maintain the martial mindset needed to prevent an efficient virus from transmitting.

Until then, restrictions, including lockdowns, quarantine, testing, tracing, isolation and (eventually) masks, had been working across all of Australia’s States and Territories to keep the virus out and contain the spread when it got in, while vaccines were ordered and administered. Lives were saved. When employed quickly, they were also able to be turned off fairly quickly as their effect allowed contact tracing to get ahead of spread.

But despite our economy bouncing back from lockdowns, once the virus started to spread without restriction, even in an 80% vaccinated population, we have now seen firsthand that businesses, hospitals, aged care, airlines, you name it – they’ve all struggled to field enough staff because of illness. And we’ve seen lots of trouble with unstocked shelves due to supply chain interruptions (something we spoke about in 2020 [23]) both in delivery at this end and production and manufacture at the source. “Oh but that’s just because of the rules to isolate”. That is part;y true, but in case you’ve missed it, COVID-19 can leave you exhausted, mentally foggy and not a little sick. Even before this pandemic, it wasn’t a great idea to go to work sick. You infect others and suddenly the job is more understaffed. But further, operating complex equipment and machinery or performing complex tasks when your mind isn’t all there carries risk. Mistakes cost money and cause injury.

Lockdowns in 2022

Now I sound defensive. But there really isn’t a reason for lockdowns in the post-vaccine age. Before vaccines, we saw a huge number of deaths. And even though we know most COVID-19 deaths occur among the elderly and those with underlying conditions, they were each the death of loved ones and they added to eth anxiety, depression and loss this pandemic is responsible for.

As we now know – even though severe disease and death happen in a relatively small proportion of those infected, when millions are infected that small percentage becomes a big very number of lost loved ones!

What’s my point?

Lockdowns had a role, as did stopping travel, using quarantine and enforcing isolation. Masks still do have a role as does completely revamping our indoor air quality. It’s appalling that during the current election campaign in Australia we have yet to hear any talk from a “leader” about a plan to fund measures to keep us safe from the inherent dangers of contaminated air. So many lessons, so little learned.

The role of lockdowns was to save lives that would have been lost if not enacted quickly. Australia, New Zealand, Taiwan and others observed time and time again that lives were lost due to slow responses. Lockdowns could have been done better but when used surgically – quickly on, quickly off with financial support, communication and enhanced mental and other health support – they reduced lockdown-related harms while also preventing the death they were intended for.

I don’t stand down from my support of these measures in the early stages of the pre-vaccine pandemic. Despite what threatening lists and articles may be trying for.

But to be clear, lockdowns don’t have a place now because we got through that temporary need.

References

  1. The impact of Victorian COVID-19 lockdowns on the presentation and management of acute appendicitis
    https://pubmed.ncbi.nlm.nih.gov/35429210/
  2. Who Pushed for Lockdowns? 101 Leading Voices
    https://brownstone.org/articles/who-pushed-for-lockdowns-101-leading-voices/
  3. COVID-19 cases slow a little in Australia
    https://virologydownunder.com/covid-19-cases-slow-a-little-in-australia/
  4. A Global Longitudinal Study Examining Social Restrictions Severity on Loneliness, Social Anxiety, and Depression
    https://pubmed.ncbi.nlm.nih.gov/35418888/
  5. Lockdown surgery: the impact of coronavirus disease 2019 measures on cardiac cases
    https://pubmed.ncbi.nlm.nih.gov/35416983/
  6. The impact of lockdowns during the COVID-19 pandemic on work-related accidents in Austria in 2020
    https://pubmed.ncbi.nlm.nih.gov/35412051/
  7. Risk Behaviors, Family Support, and Emotional Health among Adolescents during the COVID-19 Pandemic in Israel
    https://pubmed.ncbi.nlm.nih.gov/35409535/
  8. Rise in depression and anxiety during the COVID-19 pandemic: results from a cross-sectional national survey
    https://pubmed.ncbi.nlm.nih.gov/35388716/
  9. Adolescents, Suicide, and the COVID-19 Pandemic
    https://pubmed.ncbi.nlm.nih.gov/35417315/
  10. The impact of the COVID-19 pandemic on eating disorders: A systematic review
    https://pubmed.ncbi.nlm.nih.gov/35384016/
  11. Impact of the first national COVID-19 lockdown on referral of women experiencing domestic violence and abuse in England and Wales
    https://pubmed.ncbi.nlm.nih.gov/35291956/
  12. The links of stress, substance use and socio-demographic factors with domestic violence during the Covid-19 pandemic in Portugal
    https://pubmed.ncbi.nlm.nih.gov/35312006/
  13. Women’s mental health: acute impact of COVID-19 pandemic on domestic violence
    https://pubmed.ncbi.nlm.nih.gov/33068161/
  14. Impact of the COVID-19 pandemic and multiple community lockdowns on total live birth rates and preterm births in Melbourne, Australia
    https://obgyn.onlinelibrary.wiley.com/doi/10.1111/ajo.13527
  15. Impacts of COVID-19 lockdowns on frailty and wellbeing in older people and those living with long-term conditions
    https://pubmed.ncbi.nlm.nih.gov/34821484/
  16. Transmission of paediatric respiratory syncytial virus and influenza in the wake of the COVID-19 pandemic
    https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2021.26.29.2100186
  17. Air pollution declines during COVID-19 lockdowns mitigate the global health burden
    https://pubmed.ncbi.nlm.nih.gov/33152273/
  18. Influenza and respiratory syncytial virus during the COVID-19 pandemic: Time for a new paradigm?
    https://pubmed.ncbi.nlm.nih.gov/34644459/
  19. Race to 80: our best shot at living with COVID
    https://grattan.edu.au/report/race-to-80/
  20. ‘Prevention fatigue’ driving sudden COVID surge in Taiwan: Expert
    https://www.aljazeera.com/news/2021/6/9/prevention-fatigue-fuelled-sudden-covid-surge-in-taiwan-expert
  21. Why Taiwan Is Beating COVID-19 – Again
    https://thediplomat.com/2021/07/why-taiwan-is-beating-covid-19-again/
  22. Mortality Risk of COVID-19 – Our World in Data
    https://ourworldindata.org/mortality-risk-covid
  23. So you think you’re about to be in a pandemic?
    https://virologydownunder.com/so-you-think-youve-about-to-be-in-a-pandemic/
  24. https://www.abc.net.au/news/2021-03-02/charting-australias-covid-vaccine-rollout/13197518#region

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I created a ‘cosy game’ – and learned how they can change players’ lives

Cosy, personal games, as I discovered, can change the lives of the people who make them and those who play them.

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Cosy games exploded in popularity during the pandemic. Takoyaki Tech/Shutterstock

The COVID pandemic transformed our lives in ways many of us are still experiencing, four years later. One of these changes was the significant uptake in gaming as a hobby, chief among them being “cosy games” like Animal Crossing: New Horizons (2020).

Players sought comfort in these wholesome virtual worlds, many of which allowed them to socialise from the safety of their homes. Cosy games, with their comforting atmospheres, absence of winning or losing, simple gameplay, and often heartwarming storylines provided a perfect entry point for a new hobby. They also offered predictability and certainty at a time when there wasn’t much to go around.

Cosy games are often made by small, independent developers. “Indie games” have long been evangelised as the purest form of game development – something anyone can do, given enough perseverance. This means they can provide an entry point for creators who hadn’t made games before, but were nevertheless interested in it, enabling a new array of diverse voices and stories to be heard.

In May 2020, near the start of the pandemic, the small poetry game A Solitary Spacecraft, which was about its developer’s experience of their first few months in lockdown, was lauded as particularly poignant. Such games showcase a potential angle for effective cosy game development: a personal one.

Personal themes are often explored through cosy games. For instance, Chicory and Venba (both released in 2023) tackle difficult topics like depression and immigration, despite their gorgeous aesthetics. This showcases the diversity of experiences on display within the medium.

However, as the world emerges from the pandemic’s shadow, the games industry is facing significant challenges. Economic downturns and acquisitions have caused large layoffs across the sector.

Historically, restructurings like these, or discontent with working conditions, have led talented laid-off developers to create their own companies and explore indie development. In the wake of the pandemic and the cosy game boom, these developers may have more personal stories to tell.

Making my own cosy game

I developed my own cosy and personal game during the pandemic and quickly discovered that creating these games in a post-lockdown landscape is no mean feat.

What We Take With Us (2023) merges reality and gameplay across various digital formats: a website, a Discord server that housed an online alternate reality game and a physical escape room. I created the game during the pandemic as a way to reflect on my journey through it, told through the videos of game character Ana Kirlitz.

The trailer for my game, What We Take With Us.

Players would follow in Ana’s footsteps by completing a series of ten tasks in their real-world space, all centred on improving wellbeing – something I and many others desperately needed during the pandemic.

But creating What We Take With Us was far from straightforward. There were pandemic hurdles like creating a physical space for an escape room amid social distancing guidelines. And, of course, the emotional difficulties of wrestling with my pandemic journey through the game’s narrative.

The release fared poorly, and the game only garnered a small player base – a problem emblematic of the modern games industry.

These struggles were starkly contrasted by the feedback I received from players who played the game, however.

This is a crucial lesson for indie developers: the creator’s journey and the player’s experience are often worlds apart. Cosy, personal games, as I discovered, can change the lives of those who play them, no matter how few they reach. They can fundamentally change the way we think about games, allow us to reconnect with old friends, or even inspire us to change careers – all real player stories.

Lessons in cosy game development

I learned so much about how cosy game development can be made more sustainable for creators navigating the precarious post-lockdown landscape. This is my advice for other creators.

First, collaboration is key. Even though many cosy or personal games (like Stardew Valley) are made by solo creators, having a team can help share the often emotional load. Making games can be taxing, so practising self-care and establishing team-wide support protocols is crucial. Share your successes and failures with other developers and players. Fostering a supportive community is key to success in the indie game landscape.

Second, remember that your game, however personal, is a product – not a reflection of you or your team. Making this distinction will help you manage expectations and cope with feedback.

Third, while deeply considering your audience may seem antithetical to personal projects, your game will ultimately be played by others. Understanding them will help you make better games.

The pandemic reignited the interest in cosy games, but subsequent industry-wide troubles may change games, and the way we make them, forever. Understanding how we make game creation more sustainable in a post-lockdown, post-layoff world is critical for developers and players alike.

For developers, it’s a reminder that their stories, no matter how harrowing, can still meaningfully connect with people. For players, it’s an invitation to embrace the potential for games to tell such stories, fostering empathy and understanding in a world that greatly needs it.


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Adam Jerrett does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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KIMM finds solution to medical waste problem, which has become a major national issue

A medical waste treatment system, which is capable of 99.9999 percent sterilization by using high-temperature and high-pressure steam, has been developed…

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A medical waste treatment system, which is capable of 99.9999 percent sterilization by using high-temperature and high-pressure steam, has been developed for the first time in the country.

Credit: Korea Institute of Machinery and Materials (KIMM)

A medical waste treatment system, which is capable of 99.9999 percent sterilization by using high-temperature and high-pressure steam, has been developed for the first time in the country.

The Korea Institute of Machinery and Materials (President Seog-Hyeon Ryu, hereinafter referred to as KIMM), an institute under the jurisdiction of the Ministry of Science and ICT, has succeeded in developing an on-site-disposal type medical waste sterilization system that can help to resolve the problem caused by medical waste, which has become a national and social issue as the volume of medical waste continues to increase every year. This project was launched as a basic business support program of the KIMM and was expanded into a demonstration project of Daejeon Metropolitan City. Then, in collaboration with VITALS Co., Ltd., a technology transfer corporation, the medical waste treatment system was developed as a finished product capable of processing more than 100 kilograms of medical waste per hour, and was demonstrated at the Chungnam National University Hospital.

Moreover, the installation and use of this product have been approved by the Geumgang Basin Environmental Office of the Ministry of Environment. All certification-related work for the installation and operation of this product at the Chungnam National University Hospital has been completed, including the passage of an installation test for efficiency and stability conducted by the Korea Testing Laboratory.

Through collaboration with VITALS Co., Ltd., a corporation specializing in inhalation toxicity systems, the research team led by Principal Researcher Bangwoo Han of the Department of Urban Environment Research of the KIMM’s Eco-Friendly Energy Research Division developed a high-temperature, high-pressure steam sterilization-type medical waste treatment system by using a high-temperature antimicrobial technology capable of processing biologically hazardous substances such as virus and bacteria with high efficiency. After pulverizing medical waste into small pieces so that high-temperature steam can penetrate deep into the interior of the medical waste, steam was then compressed in order to raise the boiling point of the saturated steam to over 100 degrees Celsius, thereby further improving the sterilization effect of the steam.

Meanwhile, in the case of the high-pressure steam sterilization method, it is vitally important to allow the airtight, high-temperature and high-pressure steam to penetrate deep into the medical waste. Therefore, the research team aimed to improve the sterilization effect of medical waste by increasing the contact efficiency between the pulverized medical waste and the aerosolized steam.

By using this technology, the research team succeeded in processing medical waste at a temperature of 138 degrees Celsius for 10 minutes or at 145 degrees Celsius for more than five (5) minutes, which is the world’s highest level. By doing so, the research team achieved a sterilization performance of 99.9999 percent targeting biological indicator bacteria at five (5) different locations within the sterilization chamber. This technology received certification as an NET (New Excellent Technology) in 2023.

Until now, medical waste has been sterilized by heating the exposed moisture using microwaves. However, this method requires caution because workers are likely to be exposed to electromagnetic waves and the entrance of foreign substances such as metals may lead to accidents.

In Korea, medical waste is mostly processed at exclusive medical waste incinerators and must be discharged in strict isolation from general waste. Hence, professional efforts are required to prevent the risk of infection during the transportation and incineration of medical waste, which requires a loss of cost and manpower.

If medical waste is processed directly at hospitals and converted into general waste by applying the newly developed technology, this can help to eliminate the risk of infection during the loading and transportation processes and significantly reduce waste disposal costs. By processing 30 percent of medical waste generated annually, hospitals can save costs worth KRW 71.8 billion. Moreover, it can significantly contribute to the ESG (environmental, social, and governance) management of hospitals by reducing the amount of incinerated waste and shortening the transportation distance of medical waste.

[*Allbaro System (statistical data from 2021): Unit cost of treatment for each type of waste for the calculation of performance guarantee insurance money for abandoned wastes (Ministry of Environment Public Notification No. 2021-259, amended on December 3, 2021). Amount of medical waste generated on an annual basis: 217,915 tons; Medical waste: KRW 1,397 per ton; General waste from business sites subject to incineration: KRW 299 per ton]

As the size and structure of the installation space varies for each hospital, installing a standardized commercial equipment can be a challenge. However, during the demonstration process at the Chungnam National University Hospital, the new system was developed in a way that allows the size and arrangement thereof to be easily adjusted depending on the installation site. Therefore, it can be highly advantageous in terms of on-site applicability.

Principal Researcher Bangwoo Han of the KIMM was quoted as saying, “The high-temperature, high-pressure steam sterilization technology for medical waste involves the eradication of almost all infectious bacteria in a completely sealed environment. Therefore, close cooperation with participating companies that have the capacity to develop airtight chamber technology is very important in materializing this technology.” He added, “We will make all-out efforts to expand this technology to the sterilization treatment of infected animal carcasses in the future.”

 

President Seog-Hyeon Ryu of the KIMM was quoted as saying, “The latest research outcome is significantly meaningful in that it shows the important role played by government-contributed research institutes in resolving national challenges. The latest technology, which has been developed through the KIMM’s business support program, has been expanded to a demonstration project through cooperation among the industry, academia, research institutes, and the government of Daejeon Metropolitan City.” President Ryu added, “We will continue to proactively support these regional projects and strive to develop technologies that contribute to the health and safety of the public.”

 

Meanwhile, this research was conducted with the support of the project for the “development of ultra-high performance infectious waste treatment system capable of eliminating 99.9999 percent of viruses in response to the post-coronavirus era,” one of the basic business support programs of the KIMM, as well as the project for the “demonstration and development of a safety design convergence-type high-pressure steam sterilization system for on-site treatment of medical waste,” part of Daejeon Metropolitan City’s “Daejeon-type New Convergence Industry Creation Special Zone Technology Demonstration Project.”

###

The Korea Institute of Machinery and Materials (KIMM) is a non-profit government-funded research institute under the Ministry of Science and ICT. Since its foundation in 1976, KIMM is contributing to economic growth of the nation by performing R&D on key technologies in machinery and materials, conducting reliability test evaluation, and commercializing the developed products and technologies.

 

This research was conducted with the support of the project for the “development of ultra-high performance infectious waste treatment system capable of eliminating 99.9999 percent of viruses in response to the post-coronavirus era,” one of the basic business support programs of the KIMM, as well as the project for the “demonstration and development of a safety design convergence-type high-pressure steam sterilization system for on-site treatment of medical waste,” part of Daejeon Metropolitan City’s “Daejeon-type New Convergence Industry Creation Special Zone Technology Demonstration Project.”


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IFM’s Hat Trick and Reflections On Option-To-Buy M&A

Today IFM Therapeutics announced the acquisition of IFM Due, one of its subsidiaries, by Novartis. Back in Sept 2019, IFM granted Novartis the right to…

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Today IFM Therapeutics announced the acquisition of IFM Due, one of its subsidiaries, by Novartis. Back in Sept 2019, IFM granted Novartis the right to acquire IFM Due as part of an “option to buy” collaboration around cGAS-STING antagonists for autoimmune disease.

This secures for IFM what is a rarity for a single biotech company: a liquidity hat trick, as this milestone represents the third successful exit of an IFM Therapeutics subsidiary since its inception in 2015.

Back in 2017, BMS purchased IFM’s  NLRP3 and STING agonists for cancer.  In early 2019, Novartis acquired IFM Tre for NLRP3 antagonists for autoimmune disease, which are now being studied in multiple Phase 2 studies. Then, later in 2019, Novartis secured the right to acquire IFM Due after their lead program entered clinical development. Since inception, across the three exits, IFM has secured over $700M in upfront cash payments and north of $3B in biobucks.

Kudos to the team, led by CEO Martin Seidel since 2019, for their impressive and continued R&D and BD success.

Option-to-Acquire Deals

These days option-based M&A deals aren’t in vogue: in large part because capital generally remains abundant despite the contraction, and there’s still a focus on “going big” for most startup companies.  That said, lean capital efficiency around asset-centric product development with a partner can still drive great returns. In different settings or stages of the market cycle, different deal configurations can make sense.

During the pandemic boom, when the world was awash in capital chasing deals, “going long” as independent company was an easy choice for most teams. But in tighter markets, taking painful levels of equity dilution may be less compelling than securing a lucrative option-based M&A deal.

For historical context, these option-based M&A deals were largely borne out of necessity in far more challenging capital markets (2010-2012) on the venture front, when both the paucity of private financing and the tepid exit environment for early stage deals posed real risks to biotech investment theses. Pharma was willing to engage on early clinical or even preclinical assets with these risk-sharing structures as a way to secure optionality for their emerging pipelines.

As a comparison, in 2012, total venture capital funding into biotech was less than quarter of what it is now, even post bubble contraction, and back then we had witnessed only a couple dozen IPOs in the prior 3 years combined. And most of those IPOs were later stage assets in 2010-2012.  Times were tough for biotech venture capital.  Option-based deals and capital efficient business models were part of ecosystem’s need for experimentation and external R&D innovation.

Many flavors of these option-based deals continued to get done for the rest of the decade, and indeed some are still getting done, albeit at a much less frequent cadence.  Today, the availability of capital on the supply side, and the reduced appetite for preclinical or early stage acquisitions on the demand side, have limited the role of these option to buy transactions in the current ecosystem.

But if the circumstances are right, these deals can still make some sense: a constructive combination of corporate strategy, funding needs, risk mitigation, and collaborative expertise must come together. In fact, Arkuda Therapeutics, one of our neuroscience companies, just announced a new option deal with Janssen.

Stepping back, it’ s worth asking what has been the industry’s success rate with these “option to buy” deals.

Positive anecdotes of acquisition options being exercised over the past few years are easy to find. We’ve seen Takeda exercise its right to acquire Maverick for T-cell engagers and GammaDelta for its cellular immunotherapy, among other deals. AbbVie recently did the same with Mitokinin for a Parkinson’s drug. On the negative side, in a high profile story last month, Gilead bailed on purchasing Tizona after securing that expensive $300M option a few years ago.

But these are indeed just a few anecdotes; what about data since these deal structures emerged circa 2010? Unfortunately, as these are mostly private deals with undisclosed terms, often small enough to be less material to the large Pharma buyer, there’s really no great source of comprehensive data on the subject. But a reasonable guess is that the proportion of these deals where the acquisition right is exercised is likely 30%.

This estimate comes from triangulating from a few sources. A quick and dirty dataset from DealForma, courtesy of Tim Opler at Stifel, suggests 30% or so for deals 2010-2020.  Talking to lawyers from Goodwin and Cooley, they also suggest ballpark of 30-50% in their experience.  The shareholder representatives at SRS Acquiom (who manage post-M&A milestones and escrows) also shared with me that about 33%+ of the option deals they tracked had converted positively to an acquisition.  As you might expect, this number is not that different than milestone payouts after an outright acquisition, or future payments in licensing deals. R&D failure rates and aggregate PoS will frequently dictate that within a few years, only a third of programs will remain alive and well.

Atlas’ experience with Option-based M&A deals

Looking back, we’ve done nearly a dozen of these option-to-buy deals since 2010. These took many flavors, from strategic venture co-creation where the option was granted at inception (e.g., built-to-buy deals like Arteaus and Annovation) to other deals where the option was sold as part of BD transaction for a maturing company (e.g., Lysosomal Therapeutics for GBA-PD).

Our hit rate with the initial option holder has been about 40%; these are cases where the initial Pharma that bought the option moves ahead and exercises that right to purchase the company. Most of these initial deals were done around pre- or peri-clinical stage assets.  But equally interesting, if not more so, is that in situations where the option expired without being exercised, but the asset continued forward into development, all of these were subsequently acquired by other Pharma buyers – and all eight of these investments generated positive returns for Atlas funds. For example, Rodin and Ataxion had option deals with Biogen (here, here) that weren’t exercised, and went on to be acquired by Alkermes and Novartis (here, here). And Nimbus Lakshmi for TYK2 was originally an option deal with Celgene, and went on to be purchased by Takeda.

For the two that weren’t acquired via the option or later, science was the driving factor. Spero was originally an LLC holding company model, and Roche had a right to purchase a subsidiary with a quorum-sensing antibacterial program (MvfR).  And Quartet had a non-opioid pain program where Merck had acquired an option.  Both of these latter programs were terminated for failing to advance in R&D.

Option deals are often criticized for “capping the upside” or creating “captive companies” – and there’s certainly some truth to that. These deals are structured, typically with pre-specified return curves, so there is a dollar value that one is locked into and the presence of the option right typically precludes a frothy IPO scenario. But in aggregate across milestones and royalties, these deals can still secure significant “Top 1%” venture upside though if negotiated properly and when the asset reaches the market: for example, based only on public disclosures, Arteaus generated north of $300M in payments across the upfront, milestones, and royalties, after spending less than $18M in equity capital. The key is to make sure the right-side of the return tail are included in the deal configuration – so if the drug progresses to the market, everyone wins.

Importantly, once in place, these deals largely protect both the founders and early stage investors from further equity dilution. While management teams that are getting reloaded with new stock with every financing may be indifferent to dilution, existing shareholders (founders and investors alike) often aren’t – so they may find these deals, when negotiated favorably, to be attractive relative to the alternative of being washed out of the cap table. This is obviously less of a risk in a world where the cost of capital is low and funding widely available.

These deal structures also have some other meaningful benefits worth considering though: they reduce financing risk in challenging equity capital markets, as the buyer often funds the entity with an option payment through the M&A trigger event, and they reduce exit risk, as they have a pre-specified path to realizing liquidity. Further, the idea that the assets are “tainted” if the buyer walks hasn’t been borne out in our experience, where all of the entities with active assets after the original option deal expired were subsequently acquired by other players, as noted above.

In addition, an outright sale often puts our prized programs in the hands of large and plodding bureaucracies before they’ve been brought to patients or later points in development. This can obviously frustrate development progress. For many capable teams, keeping the asset in their stewardship even while being “captive”, so they can move it quickly down the R&D path themselves, is an appealing alternative to an outright sale – especially if there’s greater appreciation of value with that option point.

Option-based M&A deals aren’t right for every company or every situation, and in recent years have been used only sparingly across the sector. They obviously only work in practice for private companies, often as alternative to larger dilutive financings on the road to an IPO. But for asset-centric stories with clear development paths and known capital requirements, they can still be a useful tool in the BD toolbox – and can generate attractive venture-like returns for shareholders.

Like others in the biotech ecosystem, Atlas hasn’t done many of these deals in recent funds. And it’s unlikely these deals will come back in vogue with what appears to be 2024’s more constructive fundraising environment (one that’s willing to fund early stage stories), but if things get tighter or Pharma re-engages earlier in the asset continuum, these could return to being important BD tools. It will be interesting to see what role they may play in the broader external R&D landscape over the next few years.

Most importantly, circling back to point of the blog, kudos to the team at IFM and our partners at Novartis!

The post IFM’s Hat Trick and Reflections On Option-To-Buy M&A appeared first on LifeSciVC.

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