Memic, a startup developing a robotic-assisted surgical platform that recently received marketing authorization from the U.S. Food and Drug Administration, today announced that it has closed a $96 million Series D funding round. The round was led by Peregrine Ventures and Ceros, with participation from OurCrowd and Accelmed. The company plans to use the new funding to commercialize its platform in the U.S. and expand its marketing and sales efforts outside of the U.S., too.

The company previously raised a total amount of $31.8 million, according to Crunchbase, including about $12.5 million raised through crowdsourcing platform OurCrowd.

Image Credits: Memic

The Hominis, as the company calls its platform, has been authorized for use in “single site, natural orifice laparoscopic-assisted transvaginal benign surgical procedures including benign hysterectomy.” It’s worth noting that the robot doesn’t perform the surgery without human intervention. Instead, surgeons control the device — and its robotic arms — from a central console. The company notes that the instruments are meant to replicate the motions of the surgeon’s arms. And while it’s currently only authorized for this one specific type of procedure, Memic is looking at a wide range of other procedures where a system like this could be beneficial.

“The Hominis system represents a significant advancement in the growing multi-billion-dollar robotic surgery market. This financing positions us to accelerate our commercialization efforts and bring Hominis to both surgeons and patients in the months ahead,” said Dvir Cohen, co-founder and CEO of Memic.

It’s worth noting that there are a wide range of similar, computer-assisted surgical systems on the market already. Only last month, Asensus Surgical received FDA clearance for its laparoscopic platform to be used in general surgery, for example. Meanwhile, eye surgery robotics startup ForSight recently raised $10 million in seed funding for its platform.

Memic’s Hominis is the first robotic device approved for benign transvaginal procedures, though, and the company and its investors are surely betting on this being a first stepping stone to additional use cases over time.

“Given the broad potential of Hominis combined with a strong management team, we are proud to support Memic and execution of its bold vision,” said Eyal Lifschitz, managing general partner of Peregrine Ventures.

NGK Spark Plug, one of the world’s largest manufacturers of automative spark plugs, announced a new $100 million fund to invest in startups and find potential merger and acquisition deals. The fund was launched with Pegasus Tech Ventures, the “venture capital as a service” firm that has also worked with corporations like Sega Sammy Holdings, Asus and Aisin Seiki to launch venture funds.

While best known for its automotive components, NGK Spark Plug also manufacturers many other hardware components, including for semiconductor production equipment, cutting tools, medical equipment, industrial ceramics. In recent years, the Nagoya, Japan-headquartered company has begun focusing on new technologies, like solid-state electric vehicle batteries.

NGK Spark Plug’s new corporate venture fund is an opportunity to work with startups and expand into new businesses, said Anis Uzzaman, general partner and chief executive officer of Pegasus Tech Ventures.

The company is looking for software and hardware startups in the United States, Europe, Israel and Asia and will focus on three themes: smart health, decentralized utilities and smart mobility.

“The selection of those areas is based on global trends and data. The global rate of poverty is decreasing and more people need healthy food, clean water, access to energy, mobility and easy access to healthcare,” Uzzaman told TechCrunch in an email.
“NGK is using its material and sensors expertise, as well as its sales channels in automotive, to establish systems and solutions to address major pain points in those areas.”

For smart mobility, this means tech like charging solutions, solid state batteries, ADAS systems, service platforms and power inverters. In decentralized utilities, NGK Spark Plug will look at food tech and agriculture startups, with the goal of creating safer and more sustainable food supplies and reducing pollution. It is also interested in air purification technology.

The fund will invest in early to late stage startups, with check sizes ranging from a few hundred thousand dollars to a few million dollars. NGK Spark Plug plans to work closely with portfolio companies, helping bring their tech to maturation, investing in them at multiple stages and remaining open to potential mergers and acquisitions, Uzzaman added.

Meet Nabla, a French startup launching a new app today focused on women’s health. On Nabla, you’ll find several services that should all contribute to helping you stay on top of your health. In short, Nabla lets you chat with practitioners, offers community content, helps you centralize all your medical data and will soon offer telemedicine appointments.

Nabla’s key feature right now is the ability to start a conversation with health professionals. You can send a message to a general practitioner, a gynecologist, a midwife, a nurse, a nutritionist, or a physiotherapist.

While text discussions are not going to replace in-person appointments altogether, they can definitely be helpful. By increasing the number of interactions with health professionals, chances are you’ll be healthier and you may even end up booking more in-person appointments.

Other French startups have been providing text conversations with practitioners. For instance, health insurance company Alan lets you message a general practitioner — but you have to be insured by Alan. Biloba also lets you chat with a doctor — but the company has been focusing on pediatrics.

Nabla has a different positioning and offers this feature for free — there’s a limit as you can only send a handful of questions per month though. If it’s a common question, you may find the answer from the community. Nabla’s doctors will curate community content as well.

Using a free product to talk about your health feels suspicious. But that’s because the startup is well-funded and plans to launch premium features.

Image Credits: Nabla

The startup has raised $20.2 million (€17 million) and is already working with a team of doctors who are ready to answer questions from the company’s first users — or patients. Investors in the company include Xavier Niel, Artemis, Rachel Delacour, Julie Pellet, Marc Simoncini and Firstminute Capital.

One of the reasons why Nabla could raise so much money before releasing its app is that the three co-founders have a track record in the tech ecosystem.

Co-founder and CEO Alexandre Lebrun previously founded VirtuOz, which was acquired by Nuance, and Wit.ai, which was acquired by Facebook. More recently, he’s worked for Facebook’s AI research team (FAIR).

Co-founder and COO Delphine Groll has been heading business development and communications for two major media groups Aufeminin and My Little Paris. And Nabla’s co-founder and CTO Martin Raison has worked with Alexandre Lebrun at both Wit.ai and Facebook.

In addition to text conversations, Nabla shows all your past interactions in a personal log. You can connect that log with other apps and services, such as Apple’s Health app, Clue and Withings. This way, you can see all your data from the same app.

As you may have guessed, the startup truly believes that machine learning can help when it comes to preventive and holistic care. By default, nothing is shared with Nabla for machine learning purposes. But users can opt in and share data to improve processes, personalization and more.

Eventually, Nabla wants to optimize the interactions with doctors as much as possible. The startup says it doesn’t want to replace doctors altogether — it wants to enhance medical interactions so that doctors can focus on the human and empathetic part.

Nabla plans to launch a telemedicine service so that you can interact with doctors in real time as well as a premium offering with more features. That’s an ambitious roadmap, and it’s going to be interesting to track Nabla over the long run to see if they stick to their original vision and find a loyal user base.

When the pandemic unfolded last year, demand for at-home fitness equipment skyrocketed, and Tonal was no exception. The maker of a smart home fitness trainer experienced an explosive increase in sales, and now the six-year-old San Francisco-based startup is gearing up for its next stage of growth. Tonal is adding $250 million of new funding in a Series E round valuing the startup at $1.6 billion.

Participants in the round include Dragoneer, Cobalt Capital, L Catterton, Sapphire Ventures, and athlete investors Drew Brees, Larry Fitzgerald, Maria Sharapova, Mike Tyson and Sue Bird. According to Tonal, the new funds will allow it to spend more on marketing its strength-training product to shoppers to increase brand visibility, grow its catalog of streamed fitness classes, and invest further in operations and scaling its business to meet increased demand. To date, the at-home fitness tech startup has raised $450 million.

“We’re really getting ready to scale the business: we’re pouring a lot more capital into marketing and brand awareness, and we’re pouring a lot more capital into scaling our supply chain to get ready for the next phase, which I really think is the next two holiday seasons,” says Orady.

As part of its efforts to increase staffing across the organization, Tonal also added three new executives to its bench: COO Shannon Crespin, a former Johnson & Johnson executive; Chief Strategy Officer Gregory de Gunzburg, who previously served as Head of Corporate Strategy and Development at NBCUniversal; and CTO Bryan James, whose previous employers include Google, Nest, and Apple. Ostensibly, Crespin, de Gunzburg, and James will be crucial to Tonal’s next chapter, as the startup continues to scale on all fronts, including hardware and content production.

This latest round of funding and set of new hires are all steps the startup is taking as part of a slow march towards an IPO, says Orady, although Tonal’s chief executive declined to give a timeline regarding when the startup may go public.

“We’re going to IPO at a time when it’s best for the business, because being a public company can be incredibly distracting,” adds Orady. “I get SPAC offers, or inquiries almost daily, and our answer is consistently ‘no.’ While an IPO Is a great milestone for the business and gives us access to a certain class of capital and liquidity, we also know that you’ve got to do it at the right time.”

Founded in March 2015 by Orady, who was motivated to start Tonal by his own personal quest to shed weight and strength train, Tonal has since carved out a reputation among fitness enthusiasts for an all-in-one design and digital weights system that enables the device to replicate different gym weight stations. Extra Crunch’s EC-1 on Tonal, published earlier this week, offers a unique deep dive into this rapidly growing fitness startup, exploring Tonal’s origin story, product launch, customer engagement strategy, and future outlook.

Tonal’s Series E follows an extremely eventful year-and-a-half for the startup, which saw sales increase 800% from December 2019 to December 2020, causing delivery delays of between 10 to 12 weeks — an issue the company previously told TechCrunch it’s working to address by ramping up production of devices, increasing employee headcount, and air-shipping equipment from Taiwan to the U.S. to meet demand. This March, Tonal also announced a new partnership with Nordstrom, placing 50-square-foot stations in the women’s activewear departments of at least 40 Nordstrom locations across the U.S., bringing the total number of Tonal physical locations to 60 by the end of 2021.

Men’s health and wellbeing startup Manual has raised a $30m Series A round from US-based Sonoma Brands and Waldencast, and Manual’s existing European investors Felix Capital and Cherry Ventures. FJ Labs and the GISEV Family Office also participated in the round. The cash will be used for product development and international expansion. Manual provides diagnostics, treatments and ongoing care and plans to expand across Europe, Asia and Latin America. The company has already expanded to Brazil.

Manual is competing with Numan (raised $13M), also from the UK (Manual launched a month earlier than them). In the US it is competing with Ro (raised $876.1M) and Hims (listed). All these brands tend to focus on issues like vitamins and erectile dysfunction, with the, often common refrain of, ‘normalizing’ the idea that men should look after themselves better, across a number of fronts and removing stigma’s around sexual health. It performs blood tests and other tests to analyze heart health, gut health, testosterone, sleep, energy, and immunity. They are pushing at a large market, as men historically avoid doctors.

Manual app

George Pallis, CEO and Founder, previously led marketing at Wise and Deliveroo. In a statement he said: “We’ve been encouraged to see men of all ages increasingly turning to Manual to solve multiple health problems, with almost half of our customers seeking help for more than one issue. It’s clear that a health concern may have more than one cause, and we can provide customers with the ability to treat their health in a more holistic way. Using different treatments to understand and improve their wellbeing.”

Speaking to during an interview Pallis added: “We built our own teleconsultation product and have different applications for the blood test offering. When you get your results we will offer a clinician, we’ll walk you through all the data and the learnings. We offer tools where people can monitor their progress and have regular check-ins with our medical team.”

Antoine Nussenbaum, co-Founder and partner of Felix Capital, commented: “There is still much work to be done to remove the taboo when it comes to men looking after their wellbeing and talking openly about health concerns. But we’re starting to see a shift happen amongst consumers.”

Kevin Murphy, Managing Director of Sonoma Brands, commented: “Manual exists to empower men to take better care of themselves and to live fuller lives by doing so. George and his team have the clarity of vision and the skill to make Manual a leader in this exciting and important area.”

Vibrant, a medical technology company that’s developed a disposable vibrating pill to treat chronic constipation, today announced its Series E for $7.5 million. The company is based in Tel Aviv and is lead by Lior Ben-Tsur, a startup veteran. Since its founding in 2007, the company has raised a total of $25 million. This round is being led by Unorthodox Ventures with participation by Sequoia.

Vibrant, which is going through its third and final round of Food and Drug Administration (FDA) testing, plans to launch in the U.S. in the next year. The capsules are about the size of a multi-vitamin, Ben-Tsur said.

“Patients are used to taking drugs day in and day out, so this wouldn’t be a different experience in that regard, but this pill doesn’t have any medication,” Ben-Tsur said. While Ben-Tsur is not a founder, he was brought on about 10 years ago to serve as the company’s CEO.

According to a study published in the American Gastroenterological Association, about 16% of American adults suffer from constipation, and the number jumps to 33.5% in adults between the ages of 60-101. Also, constipation is 1.5 times more common in women than in men.

The most common way to treat constipation is through the use of over-the-counter or prescription drugs, most of which target the nerves in the colon which in turn prompt a bowel movement. The Vibrant Capsule, however, “once swallowed, kickstarts the natural impulses of your intestinal wall to contract, relax and get things moving again — without the use of chemicals,” the company said in a statement.

In addition to being medication-free, the value of Vibrant over laxatives, according to the company, is that the bowel movements are more controlled, whereas laxatives can cause unexpected diarrhea and long-term side effects. Also, while laxatives are meant to be taken on a daily basis, the disposable capsule can be used anywhere from 2-5 times per week. The capsules connect to an app that automatically records when you take a pill, and upon having a bowel movement, the person notes it in the app which then sends a monthly report to the patient’s doctor, allowing them to monitor and adjust the treatment protocol as necessary.

In a 2019 human trial organized by Vibrant, 250 patients were enrolled in a double-blind study (Vibrant Capsule = 133, placebo = 117). The results showed that those who took the Vibrant Capsule were more likely to experience a bowel movement within three hours. The trial details and the results were published in the journal of Neurogastroenterology and Motility.

Several years ago a group of doctors and engineers performed a test in a live pig’s colon, and accidentally pinched the side of the colon wall. As a result, they noticed that the pig promptly had a bowel movement. The test was actually about something totally unrelated to constipation, and the results were a random discovery. To replicate the effects, the team created a vibrating belt that when worn for about three hours, would also cause a bowel movement.

“The problem is no one wants to shake for three hours to have a bowel movement,” said Ben-Tsur. With this information in hand, the group set out to develop a treatment for constipation in humans that would produce similar results but where the vibrations couldn’t be felt. There were other mechanical capsules already on the market such as the Smart Pill, a mechanical diagnostic capsule that reports on generalized motility through the entire digestive tract and aids doctors in diagnosing motility disorders, so the team knew that people could safely swallow and excrete capsules.

According to Ben-Tsur, there hasn’t been any development in the treatment of constipation in the last 20 years — the treatment protocol has continued to focus on medication. When he learned about the market size, the lack of innovation in the space, and the potential, he was convinced that he wanted to lead Vibrant.

Vibrant plans on using this round of funding to take the capsule to market in the U.S. — its first market. The company is currently speaking with healthcare providers and insurance companies so that the capsule will be covered by insurance starting at the time of launch. The Smart Pill, while only used once as a diagnostic test, is still not covered and costs, on average, about $1,400 out of pocket. Ben-Tsur and his team aim to offer a product that is accessible. “From day one we were on a mission to build something that wouldn’t be more expensive than existing drugs,” he said.

The home medical supply market in the U.S. is significant and growing, but the way that Americans go about getting much-needed medical supplies, particularly for those with chronic conditions, relies on outdated and clumsy sales mechanisms that often have very poor customer experiences. New startup Better Health aims to change that, with an e-commerce approach to serving customers in need of medical supplies for chronic conditions, and it has raised $3.5 million in a new seed round to pursue its goals.

Better Health estimates the total value of the home medical supplies market in the U.S., which covers all reimbursable devices and supplies needed for chronic conditions, including things like colostomy bags, catheters, mobility aids, insulin pumps and more, is around $60 billion annually. But the market is obviously a specialized one relative to other specialized goods businesses, in part because it requires working not only with customers who make the final decisions about what supplies to use, but also payers, who typically foot the bill through insurance reimbursements.

The other challenge is that individuals with chronic care needs often require a lot of guidance and support when making the decision about what equipment and supplies to select — and the choices they make can have a significant impact on quality of life. Better Health co-founder and CEO Naama Stauber Breckler explained how she came to identify the problems in the industry, and why she set out to address them.

“The first company I started was right out of school, it’s called CompactCath,” she explained in an interview. “We created a novel intermittent catheter, because we identified that there’s a gap in the existing options for people with chronic bladder issues that need to use a catheter on a day-to-day basis […] In the process of bringing it to market, I was exposed to the medical devices and supplies industry. I was just shocked when I realized how hard it is for people today to get life-saving medical supplies, and basically realized that it’s not just about inventing a better product, there’s kind of a bigger systematic problem that locks consumer choice, and also prevents innovation in the space.”

Stauber Breckler’s founding story isn’t too dissimilar from the founding story of another e-commerce pioneer: Shopify. The now-public heavyweight originally got started when founder Tobi Lütke, himself a software engineer like Stauber Breckler, found that the available options for running his online snowboard store were poorly designed and built. With Better Health, she’s created a marketplace, rather than a platform like Shopify, but the pain points and desire to address the problem at a more fundamental level are the same.

Better Health Head of Product Adam Breckler, left, and CEO Naama Stauber Breckler, right

With CompactCath, she said they ended up having to build their own direct-to-consumer marketing and sales product, and through that process, they ended up talking to thousands of customers with chronic conditions about their experiences, and what they found exposed the extend of the problems in the existing market.

“We kept hearing the same stories again, and again — it’s hard to find the right supplier, often it’s a local store, the process is extremely manual and lengthy and prone to errors, they get the surprise bills they weren’t expecting,” Stauber Breckler said. “But mostly, it’s just that there is this really sharp drop in care, from the time that you have a surgery or you were diagnosed, to when you need to now start using this device, when you’re essentially left at home and are given a general prescription.”

Unlike in the prescription drug market, where your choices essentially amount to whether you pick the brand name or the generic, and the outcome is pretty much the same regardless, in medical supplies which solution you choose can have a dramatically different effect on your experience. Customers might not be aware, for example, that something like CompactCath exists, and would instead chose a different catheter option that limits their mobility because of how frequently it needs changing and how intensive the process is. Physicians and medical professionals also might not be the best to advise them on their choice, because while they’ve obviously seen patients with these conditions, they generally haven’t lived with them themselves.

“We have talked to people who tell us, ‘I’ve had an ostomy for 19 years, and this is the first time I don’t have constant leakages’ or someone who had been using a catheter for three years and hasn’t left her house for more than two hours, because they didn’t feel comfortable with the product that they had to use it in a public restroom,” Stauber Breckler said. “So they told us things like ‘I finally went to visit my parents, they live in a town three hours away.'”

Better Health can provide this kind fo clarity to customers because it employs advisors who can talk patients through the equipment selection process with one-to-one coaching and product use education. The startup also helps with navigating the insurance side, managing paperwork, estimating costs and even arguing the case for a specific piece of equipment in case of difficulty getting the claim approved. The company leverages peers who have first-hand experience with the chronic conditions it serves to help better serve its customers.

Already, Better Health is a Medicare-licensed provider in 48 states, and it has partnerships in place with commercial providers like Humana and Oscar Health. This funding round was led by 8VC, a firm with plenty of expertise in the healthcare industry and an investor in Stauber Breckler’s prior ventures, and includes participation from Caffeinated Capital, Anorak Ventures, and angels Robert Hurley and Scott Flanders of remote health pioneer eHealth.

Healthcare tech startup Ro has raised $500 million to help fuel continued growth of its hybrid telehealth/in-home primary care platform, which also includes a growing pharmacy business as the company pursues a strategy of vertical integration to optimize delivery and reduce costs for clients. The company’s latest raise is a Series D round, and means it has now raised over $876 million since its 2017 founding.

That may seem like a lot of money, but as Ro fo-founder and CEO Zachariah Reitano told me in an interview, it’s actually “peanuts” when it comes to the healthcare industry – which is part of why they founded the company in the first place.

“Sometimes people talk about how great it is to be in the healthcare arena, in tech circles,” Reitano said. “They say, ‘Oh, healthcare is a $4 trillion market – it’s so massive.’  But that’s the worst thing in the entire world; it’s awful how large it is. And I think what we have the opportunity to cut it in half with technology.”

That’s what Reitano says will be the primary focus of this round of funding: Fueling its efforts around vertical integration of healthcare services and technology, to further the eventual end goal of reducing costs to patients through the efficiencies realized in that process.

“To me, what I’m really excited about is being able to continue to invest in that infrastructure and add even more,” Reitano told me. “We’ll continue to invest in telemedicine, we’ll continue to invest in our logistics and pharmacy, and continue to invest in in-home care, as well as the connection between the three, and then we’ll also invest in additional diagnostics, remote patient monitoring – so collecting and distributing devices to patients to go from reactive to proactive care.”

Ro’s model focuses on primary care delivered direct to consumer, without involving any payer or employer-funded and guided care programs. The idea is to reduce costs through vertical integration and other efficiency engineering efforts in order to get them to the point where they’re effectively on par with your out-of-pocket expense with co-pays anyway. Reitano explained that the insurance system as it exists in the U.S. now only effectively masks individual costs, making it less clear that much of what a person pays out in healthcare costs comes out of their pocket anyway, whether it’s through taxation, or employers allocating more of the funds they have available for compensation to healthcare, vs. take-home pay.

Image Credits: Ro

That’s what’s behind Ro’s recent push into operating its own pharmacies, and growing that footprint to include more all the time. Zeitano told me that the company will have 10 pharmacies by the end o this year, and 15 by the end of next, all placed strategically around the country to ensure that it can provide next-day shipping to patients at ground shipping rates pretty much anywhere in the U.S.

Doing that kind of vertical optimization has enabled Ro to offer 500 common drugs at $5 per month, including treatments for heart disease, anxiety, depression and diabetes — with a plan to ramp it to 1,000 drugs available at that price by year’s end. That’s roughly equal to the co-pay required for many insurers for the same treatments.

Meanwhile, Zeitano says Ro has seen big changes in the healthcare system generally that favor its model and accelerate its hybrid care plans owing to the COVID-19 pandemic.

“I would say that there are two most profound impacts of the pandemic on the healthcare system,” he said. “One is that it simultaneously shed light on all of the inequities for the entire country to see, right at the same time where we all cared about it. So those things were sort of known for the people impacted day to day — the geographic inequity, the financial inequity, the racial inequity. If someone felt that that inequity, then they would talk about it, but it wasn’t something everyone cared about at the same time. So this massive spotlight was shed on the healthcare system. And the second was that everyone’s healthcare journey now starts online, even if it is going to end in person, it will still start online.”

Ro’s model all along has espoused this time of healthcare delivery, with remote care and telehealth appointments handling most day-to-day needs, and follow-up in person care delivered to the home when required. That obviously generate a lot of efficiencies, while ensuring that older patients and those with mobility issues also don’t need to leave the house and make a regular trip into their physician’s office for what amounts to a 15-minute visit that could’ve been handled over video.

Ro co-founders Rob Schutz, Zachariah Reitano and Saman Rahmanian (left to right)

According to most industry observers, Zeitano is likely right that healthcare probably won’t go back to the old, inefficient model of favoring primarily in-person care after the pandemic ends. One of the positive outcomes of the COVID-19 situation has been proving that telehealth is more than capable of handling a lot of the primary care needs of a lot of people, particularly when supplemented with remote monitoring and ongoing proactive health measures, too.

While Ro doesn’t work with insurance currently, Zeitano points out that he’s not against the concept entirely – he just says that health insurance as it exists now doesn’t actual work as intended, since it’s meant to pool risk against an, expensive, uncertain and rare outcome. Eventually, he believes there’s a place for insurance in the overall healthcare mix, but first the industry needs to face a reckoning wherein its incentive structure is realigned to its actual core customer – patients themselves.

More details have emerged today about the European Commission’s legislative proposal for a pan-EU ‘digital green pass’ to show verified COVID-19 status. The plan is controversial from a human rights and civil liberties perspective, given the clear risk of discrimination. But privacy and security experts are also raising concerns about the technology architecture that will underpin the system — which has yet to detailed in full.

“The proposal does not yet meet the requirements of data protection and protection against discrimination,” said German Pirate MEP Patrick Breyer in a statement today. “It does not ensure that the digital variant of the certificate is stored decentrally on devices of the person concerned and not in a central vaccination register.”

The European Union’s intention for COVID-19 vaccine passports — or rather what it’s branded a “digital green pass” or a “digital COVID-19 certificate” — will show whether the holder has been vaccinated against COVID-19 or had a recent negative test or if they have recovered from the disease and have antibodies, Commission president, Ursula von der Leyen, said today during a press briefing to give more details of its legislative proposal for the “common instrument”.

“The certificate will make sure that the results of what it shows — the minimum set of data — are mutually recognized in every Member State,” she also said, adding that the aim for the system is to help Member States reinstate freedom of movement “in a safe, responsible and trusted manner”.

Justice commissioner Didier Reynders said the intention is for every EU citizen to be able to receive the certificate free of charge and ask other Member States to accept it. He said the Commission will largely not be regulating use of the pass. Rather it will be up to Member States to set specific requirements related to the common instrument.

He gave the example of a European country being able to specify that they would accept a vaccination status of a person who has had a vaccine that’s not yet been approved for use in the EU, for example. But Reynders said the Commission will be obliging Member States to accept pass holders who have been vaccinated with an EMA approved vaccine.

The Commission wants the system to be ready to use “before the summer”, he also said. However that timeline looks incredibly ambitious for what is a complex technical project that involves sensitive personal data being used for a purpose which is inherently controversial, given the clear risk of COVID-19 status being used to discriminate or unfairly infringe on individuals’ civil liberties.

The digital certificates being ready means not only the Commission implementing/procuring any central components and ensuring Member States implement the necessary technical pieces at a national level for the system to work as intended but also getting the required legislation approved by the EU Council and Parliament — and doing all that “maybe” as early as June, per Reynders.

Asked during the press briefing if there was a ‘plan b’, given how ambitious the questioner suggested the Commission’s plan is, he said there is no other plan — as the only plan is to avoid fragmentation by implementing a common instrument to prevent Member States making unilateral choices over COVID-19 at their borders.

Still, the proposal currently leaves room for European countries to apply different rules, according to Breyer — who has also warned it could lead to discrimination by allowing freedom of travel to be linked purely to vaccination if Member States choose not allow negative tests to be accepted as an alternative, for example. “This needs to be improved,” the MEP suggested today.

“On the other hand, I welcome the fact that the retention of medical information after showing the certificate is excluded,” he added.

EU lawmakers avoided too much discussion of what Member States might do with the common tool but they confirmed the digital pass would be available in both a paper and digital form (although, again, Breyer expressed concern counties may choose not to implement the paper form, thereby discriminating against those who do not have access to a smartphone).

Reynders also confirmed the digital pass would incorporate a QR code to verify what’s on the certificate and check if it’s validated.

The Commission scheme shares at least one component with a system that was recently reported by Spiegel as under procurement in Germany — which it said involves QR codes but also blockchain technology (with IBM and a local company called Ubirch winning the tender) — and which is intended to be compatible with the EU’s digital pass requirements.

There was no mention of blockchain during today’s Commission press briefing. Internal market commissioner Thierry Breton said only that the technical solution “is also part of trust”.

“That’s why we have worked with Member States so that we are now all together on the same page. We share exactly the same technology,” he went on, adding: “We keep of course the GDPR at very high level. We will not exchange data and the good news is that all Member States have shared this view now. And this is extremely important because of course trust is also when you will move from one country to the other one that everybody will know just with a QR code you will know what is on your certificate and if it is validated.”

Asked after the briefing whether or not the pan-EU system will incorporate blockchain components a Commission spokesman sidestepped the question, saying only: “The gateway will link the national public key directories for the signature keys.”

“We cannot yet tell you who will implement this technically,” he added.

The spokesman went on to say that the “trust framework” (provided for by article 4 of the draft regulation) will be developed by the Commission “based on the outline on which Member States agreed in the eHealth Network on Friday” — referring to the voluntary network of Member State representatives which was established by EU directive in 2011 to facilitate cross-border data sharing for an e-health purpose.

On a related webpage the Commission also writes: “The eHealth Network has published an outline of the trust framework needed for [e]stablishing the Digital Green Certificate infrastructure, and continues to develop mechanisms for the mutual recognition and interoperability of vaccination, test and recovery certificates.”

“Further work is being conducted by the eHealth Network in collaboration with EU agencies, the Health Security Committee, the World Health Organization and other institutions,” it adds there.

The eHealth Network’s current outline for the “trust framework for the interoperability of health certificates” is available here — as a 16-page PDF (v.1.0, dating from March 12, 2021).

The document discusses some design choices and intended outcomes but does not provide details of the chosen technical solutions as decisions appear to have not yet been taken — despite the Commission’s goal of the whole thing being wrapped up and ready to run in a little over two months’ time.

Pressure from southern European nations worried about the impact of the coronavirus on heavily tourism-dependent economies is one driving force for the Commission to scramble to roll out a common approach for mutual recognition of vaccination documentation. Although fear of fragmentation of the bloc’s Single Market is likely the bigger accelerant for the Commission. (It’s notable, for instance, that other Member States, including France and Germany, have previously expressed concerns over linking the right to travel to a pass. So how ‘on the same page’ European countries are on this issue looks debatable.)

Also questionable is how trusted the technical underpinnings of the digital pass will be — as plenty of detail is still to be confirmed.

In the eHealth Network’s outline, a section on “data security by design and default”, for example, asserts that the trust framework “should by design and default ensure the security and the privacy of data in the compliant implementations of digital vaccination certificate systems, ensuring both security and privacy” — but it does not explain how this will be achieved.

“The design should prevent the collection of identifiers or other similar data which might be cross-referenced with other data and re-used for tracking (‘Unlinkability’),” it goes on before adding: “Further discussions are needed as to the technological aspects and timeline for the incorporation of these features in the trust framework.”

Another section offering an “overall description” notes that the EU trust framework is designed to be “largely decentralised”. However it confirms there will be “some centralised elements”: Namely “roots of trust” stored in a common directory/gateway (aka “EU Public Key Directory/Gateway”), and the “Governance model” — raising core questions of trust over those key elements. 

On the EU Public Key Directory the document envisages the gateway “shall be provided by a public sector body, such as the European Commission”. But evidently there’s still room for alternative bodies to take on that role.

Elsewhere, the outline confirms that offline verification will involve the use of 2D barcodes containing a digital signature used in conjunction with dedicated verification software that will periodically fetch verified public keys. While it states that online verification “will rely on the UVCI [Unique Vaccination Certificate/assertion Identifier] and it will be incorporated in the next version of the specifications (V2)”.

A section on presentation formats confirms that 2D barcodes will be used — but also raises the possibility of “W3C Verifiable Credentials” being utilized, stating only that a decision “will be made later”.

Harry Halpin, a CEO and research scientist (and formerly a staff member at the W3C) — who has been critical of the lack of openness around the technical design of the Commission’s digital green pass, and who presented a paper last year critiquing immunity passport schemes that involved what he describes as “a stack of little-known standards, such as Decentralized Identifiers (DIDs) and Verifiable Credentials (VCs) from the World Wide Web Consortium (W3C)” — is concerned the Commission is considering incorporating what his paper describes as “questionable use of blockchain technology” into the digital green pass.

He argues that use of W3C Verifiable Credentials in immunity passports would be dangerous to privacy and security.

“Technologically there’s ways to prove test results digitally without involving any global identity at all,” he told us. “If you really just want to prove with medical authenticity that I have ‘A attribute’ — where this attribute is I have negative COVID-19 test in the last 72 hours or I’ve been immunized with a vaccine in the last year, whatever it is that you want to prove, there’s another form of identity… called attribute-based credentials. Which is a perfectly fine way to do it. Attribute-based credentials just prove attributes without revealing identity. You don’t need a global identity for any of these use-cases.”

“Maybe the metaphysical angle is that because of corona all my previously private health data should now be public but then just come out and say that — don’t hide it behind some blockchain nonsense,” he added.

Discussing the eHealth Network’s outline, security and privacy researcher Dr Lukasz Olejnik — who has also written about the privacy risks and wider ramifications of vaccine passports — said the document raises some questions such as who will be the source of trust and whether there’s a risk of function creep related to the proposed design.

“This technical document confirms that the user’s ID will be bound to the certificate. This may mean that the passport would mediate a proof of ID,” he told TechCrunch. “Considering today’s proposal of a regulation it is pertinent to wonder whether a function-creep-like expansion couldn’t lead to these passports becoming actual proofs of identity in the future.

“Other than that, the eHealth document is descriptive but contains no details as to the future solution. The source of trust in this system will be the key problem of interest,” Olejnik added. “It seems that we will need to wait longer for the details.”

During today’s briefing Reynders raised the spectre of future expansion from another angle — saying that while the digital pass would be a “temporary” instrument, and the legislation would provide for the system to be “suspended” at the end of the pandemic, it would also bake in the possibility of re-activation at a later point if necessary, such as in the event of another pandemic.

“We have the possibility to suspend the certificate when the WHO declares the pandemic over. So this is dedicated to COVID-19,” he said. “I’m saying ‘suspend’ but through a delegated act and with the European Parliament we could use this instrument if there were another pandemic. But basically we’re talking about a temporary solution with the Member States and with the European Parliament.”

“We don’t want to prolong that,” he added. “When it will be possible for the World Health Organization to say that we are at the end of the pandemic we’ll stop with such an instrument. And of course we are just thinking about the possibility to reactivate the instrument later — but I’m not hoping that — if we have a new pandemic in the future. But that will be with a dedicated act — always with the Parliament involved in the process.”

On the issue of function creep, Reynders conceded that European countries might seek to use the digital pass for other purposes, i.e. outside the Commission’s target of facilitating the free movement of EU people.

But he suggested it’s no different to Member States requiring masks be worn or a rapid test taken as they may already do in certain situations — while emphasizing any such uses would need to comply with wider EU laws and fundamental rights.  

“If there are other uses well it’s already the case you can perhaps use other things like masks that are also imposed. There are also test, self tests which are used by people. But if we go into using the certificate in other ways we have to see if that use is necessary proportional and non discriminatory and also compatible with EU legislation,” he said.

“Of course we will examine the situation on a case by case basis but I don’t think we necessarily need to draw a distinction between the certificate and other measures for example rapid antigen tests, masks and so forth. These are other tools that have been used… We need to make sure that any further use is proportional and non-discriminatory and obviously in line with the rules on free movement.” 

The EU’s digital COVID-19 pass has been in the active mix since January when the Commission said it was pushing for “an appropriate trust framework” to be agreed upon by the end of the month “to allow member states’ certificates to be rapidly useable in health systems across the EU and beyond.”

It followed up earlier this month when it announced it was coming with a legislative plan for the pass, emphasizing its hopes of facilitating safe cross-border travel this summer. Albeit, those hopes look more fragile now — given the slow pace of the EU’s vaccine rollout in the first quarter.

The Commission president also warned today that some Member States are on the cusp of a third wave of COVID-19.

The EU executive’s plan to speed full-steam ahead with a digital pass to verify COVID-19 status remains controversial — not least in light of the still highly limited access to vaccinations across the bloc which only underlines the risks of the tool being unfairly applied.

Civil liberties concerns can’t be disconnected from ‘vaccine passports’. Nor will they be swept away by an anodyne rebranding to a ‘digital pass’. But there are now additional questions stacking up around the Commission’s technology choices for the common instrument — and whether the architecture of the system will live up to Von der Leyen’s tweeted promise that the EU digital green pass “will respect data protection, security and privacy”.

For EU citizens to trust in that claim full transparency is essential. 

Amazon is apparently pleased with how its Amazon Care pilot in Seattle has gone, since it announced this morning that it will be expanding the offering across the U.S. this summer, and opening it up to companies of all sizes, in addition to its own employees. The Amazon Care model combines on-demand and in-person care, and is meant as a solution from the search giant to address shortfalls in current offering for employer-sponsored healthcare offerings.

In a blog post announcing the expansion, Amazon touted the speed of access to care made possible for its employees and their families via the remote, chat and video-based features of Amazon Care. These are facilitated via a dedicated Amazon Care app, which provides direct, live chats via a nurse or doctor. Issues that then require in-person care is then handled via a house call, so a medical professional is actually sent to your home to take care of things like administering blood tests or doing a chest exam, and prescriptions are delivered to your door as well.

The expansion is being handled differently across both in-person and remote variants of care; remote services will be available starting this summer to both Amazon’s own employees, as well as other companies who sign on as customers, starting this summer. The in-person side will be rolling out more slowly, starting with availability in Washington, D.C., Baltimore, and “other cities in the coming months” according to the company.

As of today, Amazon Care is expanding in its home state of Washington to begin serving other companies. The idea is that others will sing on to make Amazon Care part of its overall benefits package for employees. Amazon is touting the speed advantages of testing services, including results delivery, for things including COVID-19 as a major strength of the service.

The Amazon Care model has a surprisingly Amazon twist, too – when using the in-person care option, the app will provide an updating ETA for when to expect your physician or medical technician, which is eerily similar to how its primary app treats package delivery.

While the Amazon Care pilot in Washington only launched a year-and-a-half ago, the company has had its collective mind set on upending the corporate healthcare industry for some time now. It announced a partnership with Berkshire Hathaway and JPMorgan back at the very beginning of 2018 to form a joint venture specifically to address the gaps they saw in the private corporate healthcare provider market.

That deep pocketed all-star team ended up officially disbanding at the outset of this year, after having done a whole lot of not very much in the three years in between. One of the stated reasons that Amazon and its partners gave for unpartnering was that each had made a lot of progress on its own in addressing the problems it had faced anyway. While Berkshire Hathaway and JPMorgan’s work in that regard might be less obvious, Amazon was clearly referring to Amazon Care.

It’s not unusual for large tech companies with lots of cash on the balance sheet and a need to attract and retain top-flight talent to spin up their own healthcare benefits for their workforces. Apple and Google both have their own on-campus wellness centers staffed by medical professionals, for instance. But Amazon’s ambitious have clearly exceeded those of its peers, and it looks intent on making a business line out of the work it did to improve its own employee care services — a strategy that isn’t too dissimilar from what happened with AWS, by the way.

Google earlier this year announced an update to Google Maps to help people find Covid-19 vaccination sites nearby, and now Apple is doing the same. Apple device owners can either ask Siri or search within Apple Maps to find nearby Covid-19 vaccine providers within the U.S., the company says. These results will include key information, like operating hours, addresses, phone numbers and links to the provider’s website.

To access this information through a voice command, users can ask Siri something like “where can I get a Covid vaccination?,” which will direct them to Maps.

In addition to Siri or searching directly within Apple Maps for vaccine info, the option “Covid-19 vaccinations” will also be available in Apple Maps’ “Find Nearby” menu.

Apple says its vaccination location data is being sourced from VaccineFinder, an initiative led by Boston Children’s Hospital. This data has also been helping to power Google Maps’ vaccine finding capabilities, Google earlier said. Apple notes that healthcare providers, labs and other businesses can also choose submit their information about either Covid-19 testing or vaccination locations via the Apple Business Register page. After doing so, Apple will validate the information and then display it to users who are searching for Covid-19 resources in their local area.

At launch, there’s information about over 20,000 vaccine locations being provided through Apple Maps. Apple says more sites will be added in the weeks to come.

Throughout the pandemic, Apple has integrated other Covid-related health resources into Apple Maps both in the U.S. and internationally. Last year, for example, it updated Apple Maps to display Covid-19 testing sites in Australia, Canada, France, Germany, Japan, the Netherlands, New Zealand, Portugal, Singapore, Taiwan, Thailand, and the U.S. It also added Covid-19 modules to business pages, and updated Siri with more knowledge about Covid-19, testing sites, and, now, vaccination locations.

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Meet Resilience, a new startup that wants to help cancer treatment institutes as well as cancer patients at every step of the treatment journey. It’s an ambitious project founded by two well-known French entrepreneurs. They want to leverage their tech skills for this new healthcare startup.

Behind the scenes, there are two co-CEOs — Céline Lazorthes and Jonathan Benhamou. Nicolas Helleringer and Matthieu Pozza are the two remaining co-founders acting as CTO and CPO respectively. Lazorthes previously co-founded Leetchi, the leading money pot company in France. She also started MangoPay, a marketplace payment solution, as a spinout company. Crédit Mutuel Arkéa acquired both companies.

Benhamou co-founded PeopleDoc, a cloud-based HR service. In 2018, his company was acquired by Ultimate Software. Following the acquisition, he served as an executive in the publicly quoted company. Shortly after, private equity firm Hellman & Friedman Capital Partners acquired Ultimate Software.

Last year, they both spent a lot of time working together on a nonprofit called ProtegeTonSoignant. Along with 140 people, they raised €7.4 million ($8.8 million) in donations to buy personal protective equipment and deliver it to hospitals in need. It was a fundraising and logistics challenge.

After spending a lot of time talking with healthcare professionals, they decided to “dedicate at least the next ten years to those who save lives,” Lazorthes said.

It seems like an ambitious bet, and they’re aware of that. “We don’t know anything about healthcare just like we didn’t know anything about HR and finance. We’re entering a market that is highly regulated,” Benhamou told me.

That’s why they chose to focus on one area in particular — cancer care. While research institutes have made some tremendous progress over the past few years, it has become increasingly more complicated to treat cancer. For instance, Benhamou says he expects to see 300 new treatments over the next three years. Treatment is slowly evolving from broad spectrum treatments to targeted treatments.

Cancer treatment facilities face three issues. First, “a human brain can’t assimilate all this data,” Benhamou said. Second, as life expectancy increases, there are more cancer cases every year. A tumor board is going to spend a minute and a half or two minutes on a specific case to make a therapeutic decision.

Third, as a result of the first two problems, patients are left on their own. For instance, they suffer from side effects because there’s no dosage adjustment in their treatment.

Image Credits: Resilience

Starting from there, Resilience wants to become a full-stack software solution for cancer treatment for both the medical team and patients. When it comes to practitioners, Resilience will be a software-as-a-service solution that can augment therapeutic decisions. The company will categorize scientific literature, use machine learning to find some similarities with past cases and surface clinical trials based on various criteria.

When it comes to patients, there will be a web and mobile app to access content and information about their cancer. In particular, Resilience could help you understand side effects and treat them.

“Our goal is to prove that the app can improve the quality of life of the patients,” Lazorthes said. Resilience also wants to leverage its app to ask questions and collect data to improve treatments.

The startup is already putting together a data science team. It will use natural language processing to parse scientific literature. It will also work with a medical team to double-check everything.

When it comes to finding similarities between patients, the company is signing partnerships with various hospitals to get data from past cases.

Resilience has raised a $6 million funding round (€5 million) led by Singular, the VC firm founded by former Alven partners Raffi Kamber and Jérémy Uzan. Tech business angels Nathalie Balla (La Redoute), Xavier Niel (Free), Jean-Charles Samuelian (Alan), Roxanne Varza (Station F) and more are also participating.

There are also some healthcare investors in today’s funding round, such as Charles Ferté (AstraZeneca), Philippe Dabi (Bioclinic) and Thomas Clozel (Owkin).

Resilience is a mission-driven company — the company is partnering with a scientific board and a patient board. Gustave Roussy, one of the leading cancer research institutes in the world, is also acting as a co-founder in Resilience.

That’s a lot of stakeholders, but it’s the right thing to do when you’re building a healthcare company. Resilience now has the right system of checks and balance to iterate on its product and roll out a product that has a chance of actually improving cancer treatment.