Portugal – the new hotspot for scaling healthtech
Why Portugal’s out-of-the-box thinking and hustling attitude can be inspiring for US healthtech startups looking to expand to Europe
Text: Chris Graeme Photos: Marie Bacelar
The opportunities that Portugal offers for young US health tech companies to grow and springboard into the European market was the theme of an intimate discussion organised by the Californian-Lisbon cross-border business community Redbridge in October.
Shamiram Feinglass, MD, MPH shared her extensive experience working with healthcare companies around the world and in holding government positions in the US.
Visiting from Washington, but hailing from San Francisco, Dr, Feinglass is a Managing Director at Manatt Health with a sophisticated understanding of the business, medical and policy needs of health systems, life sciences, medical device, digital health and diagnostic companies globally.
As a highly respected global leader in health care, Dr. Feinglass has served as an executive and Chief Medical Officer in large multinational life sciences corporations where she builds and scales critical business functions. In these roles, she successfully transforms business systems at scale by integrating and streamlining medical, clinical and reimbursement strategy and operations into product development, commercialisation and M&A preparation and execution.
She gave a valuable insight into the challenges and opportunities in healthcare innovation in the US, and Europe, particularly in Portugal and shared how startups and Pharma can make the most of these opportunities, tapping into Portugal’s strengths such as the quality of its healthcare system, its talented professionals and the collaborative spirit of its ecosystem.
Although Shamiram’s first time in Lisbon, she had heard about RedBridge for a long time and worked with the Aspen Institute which is a group that brings ecosystems together and where she met Craig Ahrens (ShiftMed), an educator and investor who has worked with large health systems in the US and looks at practical approaches to bridging the tech startup world with traditional healthcare to bring about innovation, and discussed how they wanted to foster links and knowledge between Portugal, the EU and the US.
Inspired by happy living and longer lives
Luís Valente gave inspiring insights on his journey as the founder of iLoF, founded after his team joined the Boston-based accelerator Craash. The founder and award-winning business manager and engineer, founded his first company at 18. As a serial entrepreneur, Luís was named one of Forbes’ 30 Under 30 for Science and Healthcare.
He shared his experience with their first US investors Microsoft Ventures and Mayfield, and the dynamics of maintaining a team in Portugal while raising funds mostly with investors in the US and expanding the business there, opening a base in NY.
Luís said he was a strong believer that one of the noblest things one can do is to “help others live happier and longer lives” and healthcare was a very good way to achieve that. And recounted that despite being married to a doctor, he had never had the opportunity to work in the field of healthcare tech innovation until around nine years ago while assisting on an R&D institute tech transfer process when he came into contact with early-stage technologies and startups in the sector using deep knowledge that was stored within Portuguese academia and then tried to take the ideas to market.
“I know this can be a hard process coming from Portugal, which is not a central country in tech like the US or UK. It was my first foray and I knew I wanted to do something with tech and healthcare in my life, and particularly in the US healthcare ecosystem,” Luís explained.
Since 2019, Luís with his company iLoF has been working with pharmaceutical companies, biotechs and leading research institutes in the US, Europe and Asia to bring personalised therapeutics to market faster.
iLoF was born out of a US-based accelerator programme in Boston that forced them in just 10 weeks to go out and interview 100 stakeholders and CEOs of pharmaceutical companies in order to evaluate its business proposition, and over the course of five years the company has grown to become a team of 30 people, has raised US$10 million, and has bases in upstate New York, London, and Porto.
The engaging conversation was moderated by RedBridge member Craig Allan Ahrens who has been leading the initiative to promote the Portuguese ecosystem as a healthcare hub, and who is at the forefront of promoting Portugal’s unique potential to act as a bridge between the EU and the US in healthcare innovation.
Nashville – a burgeoning healthtech hub
Craig talked about his experience of Nashville, Tennessee, which boasts a booming healthcare industry generating US$84Bn in global revenue. Over 4,000 healthcare companies reside in the city, along with two medical schools and teaching hospitals. With this infrastructure, it’s no surprise that healthcare tech startups gravitate toward a city generally known by most people as the capital of country music rather than deep healthtech.
Nashville currently boasts 11 unicorns and many VC funds, while the city ranks among the top 30 global startup ecosystems, and along with St. Louis, Minneapolis, and Austin are all viable ecosystems that have forged strong links with Europe.
“There is a broad recognition now that something is stirring in Lisbon” he said, and “Nashville is a healthcare ecosystem that is unrivalled, and we’re bridging Nashville and Lisbon to create a US to EU and EU to US healthcare ecosystem and a roadmap for the EU to bring companies into the US and vice-versa,” he said.
Shamiram Feinglass agreed that as a doctor, Nashville “holds a spot for many of us who are doctors in the US because one of the critical pieces that they have is a bio bank – a large-scale biomedical database and research resource containing de-identified genetic, lifestyle and health information and biological samples – and Portugal too, of course, has the ISPUP biobank, created in 1995 to foster research in different aspects of human health and stores hundreds of thousands of biological samples.
“For many of us in the US for years we leveraged the UK Biobank as it was the largest facility that we could access, and the Vanderbilt Rivals Bank in Nashville, and the fact that we’re building bridges between Nashville and Lisbon is quite important,” she explained.
“Working in large companies, many of us are looking for new locations where we want to develop products and people and take companies with innovative ideas from the beginning and scale them,” she added.
Portugal’s Incredible healthcare system
One common excuse or complaint Craig Ahrens hears about Portugal is that it is risk adverse and capital poor which can be viewed variously as true, a demonstration of humility or a lack of confidence.
But is it true and what is the flip side of the coin, and why would an investor risk on an EU or Portuguese healthcare startup in the first place?
“We know Portugal and Europe have incredible healthcare systems. In the US we also have a good system, but our outcomes are not so good. We have reputable institutions that are doing good science, have great clinicians, and understand how to do research, and that’s a bonus for us. It’s easy for us to carry out trials in the EU because we understand the ecosystem,” Shamiram reflected.
“This enthusiasm in Europe to do something from a different perspective is also a bonus and that is interesting to me when I am looking at companies. It’s important to know what the workforce and scientific talent are and how that gets leveraged,” she continued.
Another plus, having served on a European board, was that the collaborative spirit was deeper in Europe than in the US. “People actually want to solve problems together” which in some cases was very different from US companies.
Portugal’s make-it-happen attitude
But what can Portugal and other EU countries do to better help companies coming from the EU to the US?
Luís Valente encountered the same question regarding Microsoft Ventures and wondered why it was interested in being in Portugal and discovered part of the answer.
“Of course, we were very focused on building our company and team around a Portuguese nexus, but the quality of the talent is outstanding, and even when money is no longer a problem, like in the beginning, we chose to hire people who have this Portuguese ability to ‘rustle up’ or ‘pull things together’, which in Portugal we call ‘desenrascar’ which is part of our ‘I’ll find a way and make it happen’ culture”, he explained.
“This attitude is very intrinsic in Portuguese culture and echoes well with startup founders who share this philosophy,” he added.
Another reason why US healthtechs might want to consider Portugal, notwithstanding the proximity to the US, the tax incentives for relocating startups through the Portugal Tech and Startup visas, and the great climate and excellent food and wine, is the access to data.
“I’m very proud to say that today we have more data in some places like the UK Biobank and to be able to acquire it through the Portuguese and Spanish ecosystems too. We have data collection studies running in almost all major hospitals in Portugal, and the fact we could access it ‘pro bono’ in the beginning when we didn’t have access to much funding was something you don’t necessarily find in many countries,” he reflects.
Lastly, there are “good things about being based in a small country, and people, businesses and teams are very mobile and adaptable, so it’s a lot easier for us to relocate someone from Portugal to the US than it is from the UK or Spain”, he pondered.
Luís points out that the Portuguese are used to working and doing business abroad, so this formula of building Europe and selling in the US has been a notion ever since the times of the discoveries, and in the iLoF case it was how “we were able to grow even though the majority of our capital is American and it’s our biggest market.
“We have been able to convince all the stakeholders that the Portuguese nexus is a critical one, and we were able to grow iLoF to the size it is today.”
The event, which took place on Tuesday, 22 October at the Tribe Social Club in Lisbon, highlighted the many startup founders and investors from Portugal and the US who are members of Redbridge, but also the combined knowledge and expertise around healthcare and healthtech which was shared at the event.
RedBridge, which holds regular events and meetings throughout the year, is about connecting the Portuguese and American startup communities to promote synergies, as well as creating initiatives for Redbridge members.
Photo: L-R: Luís Duarte iLoF, , Shamiram Feinglass, MD, MPH and Craig Ahrens (ShiftMed)
