Unlike US startups serving one large market, Legora's Swedish origins necessitated immediate expansion into different countries with unique languages and laws. This built a core competency in multi-market operations, making global expansion a natural next step.

The CEO of Korean startup Apollon, who moved his family to Cambridge, argues that sending a representative is insufficient for US expansion. He advises that the CEO must be physically present "on the ground" to build trust, navigate the ecosystem, and demonstrate commitment—a crucial lesson for any international startup targeting the US.

The rapid pace of Chinese clinical trials and deal-making is forcing European biotechs to reconsider their traditional US-centric partnering strategy. China is now viewed as a legitimate, alternative partner for development and funding, a perspective that US players may be underappreciating.

For ambitious projects like surgical robotics with long development timelines, relying solely on traditional VC is risky. RoboCath found that bringing in corporate investors provided a long-term strategic vision and reassured other shareholders, which is critical for survival.

Instead of raising large sums to hire a direct sales force, SmallTap partnered with regional specialty distributors. This strategy minimized equity dilution and leveraged existing sales relationships for broad market access without the high fixed costs of full-time employees.

European firm Permira successfully entered the US not by just opening an office, but by relocating its top talent, empowering local decision-making, and accepting years of minimal activity to build relationships and market knowledge before scaling.

To overcome the difficulty of running clinical trials in China, Zymeworks partnered with a local company, B1. This provided crucial access to a large patient population for indications like gastric cancer, significantly speeding up its global drug development program.

A comprehensive go-to-market plan requires more than direct sales or GPO contracts. Companies must develop specific approaches for different channels, including direct contracting with Integrated Delivery Networks (IDNs), using distributors for fragmented markets like ASCs, and forming strategic partnerships.

A common clinical need doesn't mean a one-size-fits-all commercial strategy. To scale globally, companies must appreciate the technical, clinical, and commercial differences in each healthcare system and invest in local resources to navigate them successfully.