Dr Annie Theriault is the Chief Investment Officer of Grand Challenges Canada, and the Managing Partner of Cross-Border Impact Ventures, a new impact investment firm partnered with Grand Challenges Canada to launch a health technology venture capital fund focused on women’s, children’s and adolescents’ health. Prior to these roles, Annie spent most of her career investing in private companies as a venture capitalist and lender across multiple sectors and stages, including several impact investments. She is also one of the Global Health Steering Committee members for Proximie.
My career originally began in classic finance; my PhD is actually in derivatives pricing, so I started out as a quantitative person. Eventually, I became involved in situations where the partners at the fund I worked for were investing during the venture stage, primarily series A and B. By 2012, I was working with energy technology companies that enable industries to operate more efficiently while using fewer resources. We weren’t particularly thinking of it as an impact sector for the fund, but it was deeply impactful all the same.
Over the next few years I was recruited as a clean tech deal lead with one of the Canadian Crown Corporations — a government-owned Financial Institution investing in and lending to Canadian multinational companies. For example, I was involved in investing in a transformative clean technology that was going to be able to cut approximately 50% of the resources used in certain mining processes. Ultimately I came to a point in my career where I had a moment of clarity; I knew that I’m the kind of person who no matter what my specific job is, I’ll always be highly motivated to work very long hours — and I knew where I like to play is in the equity space. With those thoughts in mind, I knew that I wanted my future role to have a significant positive impact.
I became aware of Grand Challenges Canada; what’s really quite special about them is that they fund innovation primarily in health — although they have other sectors today — and they measure their performance in terms of lives saved and lives improved, with a strong emphasis on whether the innovations can be scaled. I was hooked, and at the same time I was wondering whether you could have a venture fund that makes money in the conventional way I know how to, but ingrain within it a strong commitment to impact. I pitched to Grand Challenges Canada’s co-CEOs about launching a venture business to run alongside it. It turned out they had been thinking along these lines too. Once we agreed, I essentially took a sabbatical from the investment world to join the organization to immerse myself in learning about deep, meaningful impact investment.
Grand Challenges Canada tasked me with pulling together the Cross-Border Impact Ventures fund to invest in great companies, and ultimately we decided that we should focus on women, children and adolescent health, and that we would do so with a dual market approach — i.e. looking for companies like Proximie that are really high-growth tech products that meet market needs close to home, but at the same time have the potential to make a really meaningful impact in emerging markets as well.
We chose to focus on women and child health because there is a very small proportion of investment capital in this area — if you look at pharmaceutical companies and their research and development around issues of women’s health, you can see very prominently in contraception for example that the proportion of R&D spending is massively lower than you’d see on other drugs or in other sectors. But we also see this in the venture capital industry, where less than 1% of investment is dedicated to new technologies in women’s, children’s and adolescent health.
We opted to invest in the healthcare sector because I began my career as an economist, so I tend to look at macro trends, and one of the consistent macro trends you see across many economies is that the growth rate of spending on healthcare is pretty consistently at least a couple of percentage points higher than the growth rate of GDP. What that tells you is it’s not sustainable if it continues that way, and this trend has been going on for quite a while. So in a very broad sense, it’s an attractive space relative to others, then if you dig down a little deeper and look at women and child health specifically, what you see is that women’s healthcare actually makes up a bigger proportion of growth compared to men’s health, and it’s also growing faster.
“New sectors like femtech are expected to grow ten times larger in market capitalisation by 2025, so our fund is operating in a big sector that’s growing faster than GDP, and our sub segments are also growing very quickly.”
The dual market approach is important too, because the majority of health technologies still emerge from traditional, developed markets like the US, Canada and Europe, and if our own markets are not developing technologies that are accessible across races, age and gender, then how can we expect to see anything different in emerging markets? So that’s one of the key components of the Cross-Border Impact Ventures fund — to start at home, but with innovations that are also applicable in the Global South; we’re very focused on the idea of sharing something innovative and helpful that has been developed in a high-income market, which can be then be used and scaled to become readily available in emerging markets.
One of the reasons I’m very excited to be supporting Proximie as a member of the advisory committee is the potential it has to address the issue of insufficient medical personnel. As a concept, it’s right in the sweet spot in terms of its dual market approach; it can solve some major issues in high income markets, but also has the potential to transform how surgery is delivered in the Global South. That sort of idea is very attractive to us at Cross-Border Impact Ventures.
At the same time, we’re looking at opportunities that are in the supply chain space — for example, a technology that identifies when shelves are empty of certain products and need restocking; so if you’re running out of contraceptives, or medicines for malaria, tuberculosis or ear infections, those can be seamlessly ordered to ensure there is continuous availability. These are not things we often think about in high-income markets but they present a much greater challenge in the Global South. In high-income markets this sort of technology increases efficiency, saves some pennies and ensures systems are optimised. In the Global South, it’s life-saving; the impact is multiplied.
Another area we’re looking at is ways of providing tools to medical professionals of different skill sets so they can do more at their relevant level, so we’re looking at a significant number of different iterations of differential diagnosis tools and diagnostic platforms. Training physicians and updating and maintaining their skills over the course of their career is traditionally very time-intensive, whereas an AI-driven platform using sophisticated machine learning could really supplement a medical professional’s knowledge, increase their capacity and consistency and enable them to consider diagnoses that may not necessarily have occurred to them as their first option.
Applying a gender lens and racial equity lens to these companies will be critical to ensure that they actually are applicable to the whole population. Often, the needs of women and girls are not met by AI-based decision tools not built with gender-specific or race-specific data in mind. Humans are very similar, but there are often subtle differences that make a certain health condition more prevalent or cause it to present differently in different people.
In terms of companies with technologies specific to women’s health, we are also focusing on new models for contraception that are safer, more effective and more appealing for women in the Global South and women generally. As a feminist fund we really do care about a woman’s preference: what fits her better and what she wants to use, as opposed to strictly focusing on cost or other metrics. Furthermore, we see a lot of exciting opportunities in making the process of diagnosing disease more efficient, cheaper and more accurate. For example, ovarian cancer is very rarely diagnosed until it’s too late — the spending is never done ahead of time for prevention. The diagnosis of eclampsia is another area where there aren’t great testing solutions, even though it can be deadly; currently it’s diagnosed by ruling out everything else, so our fund is looking at diagnostic methods that can tell patients in one test whether they have eclampsia, which is then more efficient because it replaces a battery of tests.
“There are many situations like that where due — in my opinion — to lack of specifically designed investment vehicles or policies, we’ve not developed efficient tools to look at women’s health.”
It’s a depressing fact that the technology for doing a Pap test, for example, was invented in the 1800s, and as any woman knows it’s not very comfortable. Couldn’t somebody have come up with a better solution by now? Actually, they have… they just were not able to raise the capital needed to succeed. There has just been too little investment in this sector for much too long, because the majority of people selecting the deals have not been of a gender where it’s relevant to them.
I came across Proximie when we were exploring investment opportunities for our fund, and as I learned more about the company I was very impressed by the motivation and drive of founder Dr. Nadine Hachach-Haram, but also the commitment of the management team to achieving their global health goals. I wanted to ensure that I contributed to Proximie’s success in any way that I could, not just because I believe in the team and the technology, but because I strongly believe in the work they’re doing in Kenya to train doctors to perform C-section surgeries using Proximie — and a lot of the doctors we’ve spoken to feel like this technology is going to be broadly applicable to many other surgeries.
It’s fascinating to see how, through using Proximie, doctors will be better trained, gain in confidence and receive much better guidance — and it’s women who are benefiting as a result.
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