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Covid-19 is shaking our world! Some people think, or even prophesize, that there will be a “world after” that will be deeply different and, of course, much better. Some people think it will not be that different, that changes will be minor. Some people think, some even dream, that this is the end of globalization. Some simply believe that globalization will need adaptation. I am more on this side! Excesses of globalization will have to be corrected but internationalization of companies will prevail. After locking our doors, locking our mind and locking our borders who be catastrophic.

This is true for big companies but this is even more true for startups and SMEs for which internationalization is often a true lever of development.

Internationalization is not just about import or manufacturing localisation

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Note that I am talking here about is internationalization, not export (or import). Internationalization is not just about flows of goods or money. It is not only about manufacturing in cheaper sites. It brings much more benefits such as better reputation to clients, attractiveness to employees, new ideas, openness of mind for management…

No need to say, internationalization has to be carefully thought of, prepared and executed. The purpose of this article is not to review the full process. That would be presumptuous and far too ambitious. But this crisis made me think especially of one thing: When thinking internationalization, it is wise to think country prioritization. In order to prioritize countries, Jean Paul David in a book published in 2007 (1) detailed simply and clearly the approach: 1 – Filter, 2 – Prioritize, 3 – Target.

When filtering countries, he introduced the notion of “imperative conditions”. These essential conditions are used to create the initial filter which will guide companies in their search for countries or modes of entry, allowing to gradually eliminate irrelevant options. A number of them are political or geopolitical (e.g. countries forbidden to do business with if you want to do business in the USA), technical (e.g. is the Internet infrastructure strong enough to deploy my SAAS solution), legal or regulatory (e.g. is my company allowed to export patient data outside of a country freely to get them analyzed) or commercial (e.g. is spending per inhabitant superior to some predetermined level). But isn’t healthcare becoming one of these key imperative conditions?

For start-up or SME target country, local Healthcare a is becoming a key point to consider when mapping geographic expansion

Thousands of foreigners trapped in Wuhan when the region was locked down. Japan taking several weeks to close the borders conversely to New Zealand or Taiwan. South Korea tracking people digitally. Seen from the EU, the USA were a mess with the disconnection between the White House’s position and State’ Governor policy (This only reflects the reality of the American governance system that there is nothing wrong). France and Italy were overwhelmed by the sudden number of patients. In many countries, drugs were promoted, used or not even approved without serious clinical trials and a good understanding of the risk / benefit ratio.

Each country reacted differently based on its capabilities, healthcare system and culture. Each country had different results fighting the spread of the disease. So far, based on generally accepted information, Asian countries (e.g. Japan, Korea, Vietnam…) have done much better than most the Western World. There is a lot to learn from this healthcare crisis and how it was handled. More than in the past, a scoring (that still needs to be developed) of the healthcare situation especially vis-a-vis epidemics should be taken into consideration. It should probably include criteria such as:

• What are the major transmittable healthcare risks my people run by doing business in country X?

• How fast can country X react to a new outbreak?

• How did country X cope with previous episodes of outbreak?

• Does the local healthcare infrastructure allow country X to treat properly my people locally (in the country of travelling there)?

Actually, these questions are not new. When talking about the next viral epidemic, WHO and virologists were not asking the question of “if”, only the question of “when”. I read the first articles on the topic when I was still a pharma student. But that was an "expert" discussion and we all oversaw this. Now, reality strikes us badly (And by the way, we are also overseeing the risk of appearance of a widespread antibio-resistant bacterium....)

The world of tomorrow might be more digital, people might travel less, borders might be more difficult to cross. But internationalization will prevail while healthcare issues will need, from now, to be constantly taken into account. To the extend of an imperative condition? Guess what I think…??

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