By Justin Pierce and Tim O’Shannassy

Acknowledgement

Introduction

Dig Howitt reclines on the couch, holding his almost limp six-year-old son in his lap.  Weary from a long day of home-schooling as well as several video calls, he reaches to the side table where a welcoming ice-cold Stella Artois awaits him.  “What a tough year!”, he whispers to himself as he feels the refreshing amber ale descend into his grumbling stomach.  He wonders whether the way he and the rest of the Cochlear Limited (Cochlear) team has been working can go on like this:  “No, seriously, can it go on forever?”

Dig’s son stirs with a fright as the mobile phone rings unexpectedly.  It is Rick Holliday-Smith, Cochlear’s chair.  Exhausted and now off the clock, Dig muses for a moment to let it go to voicemail, but thinks better of it.  He edges his son onto the couch beside him and answers the call with as much positivity as he can muster…“g’day Rick, how-ya-goin’?”

Background

Cochlear is one of Australia’s most celebrated success stories and a global innovation-based manufacturing firm.  Its core product is a series of implantable artificial hearing organs and associated technology.  It counts research and development (R & D) and capital management among its impressive strengths, boasting a strong track record of growing revenue, profit, and dividends, making Cochlear a darling among the investment community.  The balance sheet is conservatively geared, and cash flow is strong.

Cochlear began with a heart-warming account.  In the 1960s, Professor Graeme Clark was inspired by his deaf father’s wish to have greater connection to others.  Research at the time suggested that a deaf person could receive the sensation of hearing through electrochemical stimulation signals but had no way to perceive the sounds, particularly speech.  This prompted Professor Clark to invent an implantable hearing aid.  In 1978, the first cochlear implant surgery was completed, and Professor Clark and the research team then discovered how to encode speech signals to allow speech perception (Cochlear Limited, 2020).

Mass manufacturing began in 1981 with the Nucleus Group and in 1995 Cochlear Limited listed on the Australian Securities Exchange (ASX).  Since then, Cochlear Limited has enjoyed its position as market leader of hearing implants globally, increasing its reach, revenue, and profitability significantly.  Nowadays, Cochlear continues an ambitious R&D program, investing 14% of its sales revenue in the next generation of hearing implant solutions (Cochlear Limited, 2020).  Eventually, it is hoped that a fully implantable hearing loss solution will be available.

Cochlear depends on collaborative relationships with academic-, community-, industry-, health-, and government professionals.  It works with more than 100 research partners to create, protect, and share new intellectual property.  This strategy is bolstered by making investments in early-stage biotechnologies that may complement Cochlear’s operations in the future.  For example, in 2019, Cochlear Limited invested in Nyxoah, a medical device company that specialises in nerve stimulation therapy to treat sleep apnoea (Cochlear Limited, 2019).

The Business Environment

Late 2019 saw a novel coronavirus zoonotically mutate from pangolins to humans, most likely in a wet market in Wuhan, Huabei Province, the People’s Republic of China.  The contagion in humans was swift, leading to a worldwide emergency, and the identification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (CoViD-19).  The World Health Organization [sic.] (WHO) declared a worldwide pandemic and jurisdictions around the world responded in various ways (WHO, 2020).

In Australia, Prime Minister Scott Morrison rushed to secure the rights to locally manufacture a then promising vaccine, made by Oxford University and AstraZeneca.  As infection rates spread, Australian State governments responded by imposing austere restrictions to freedoms, including to movement and mandating people to wear masks where they could not otherwise remain socially distant.  These so-called ‘lockdowns’ led to widespread changes in our social fabric with the sudden news that except for ‘essential workers,’ nobody could go anywhere (Saul, Scott, Crabb, Majumdar, Coghlan & Hellard, 2020).

The lockdowns led to those who were able to be productive from home.  Videoconferencing grew in popularity for meetings, but also classes and staying in touch with friends and family.  Parents juggled videoconferencing-enabled home-schooling with their work commitments and many medium-to-low-income workers were stood down or retrenched.  The Australian Federal government responded with two economic stimulus packages, JobSeeker and JobKeeper to cushion the impact from the worsening economic situation (Knight, 2021).  In more recent times, however, government approval ratings have decreased with lockdown fatigue and the realisation that many businesses that received JobKeeper payments used them to buoy profit margins.

The world economic growth forecast for 2021 is 5.5% and in 2022 it is expected to be 4.2%, however this will vary around the world subject to the impact of Covid-19 on nations and/or regions (International Monetary Fund, 2021). The United States growth forecast for 2021 is 5.1% (Actual 2020 -3.4%) and in 2022 it will be 2.5%. The Euro Area forecast for 2021 is 4.2% (Actual 2020 -7.2%) and in 2022 it is expected to be 3.6%. This compares with China forecast at 2021 8.1% (Actual 2020 2.3%) and in 2022 5.6% (International Monetary Fund, 2021).

Two of the more silent impacts of the government lockdowns has been the rise of mental health problems among youth and the impact of increases in domestic violence (Abbott, 2021).  The limits to personal freedoms have ignited a lockdown-related fatigue that manifests in mental health concerns, while being confined to the dwelling with the same group of people can lead to tensions.  The impact of the government-imposed lockdowns have therefore had two dimensions: economic- and health-related.  Many are now angry at the government for the ongoing and sometimes worsening situation.

Elsewhere around the world, where lockdowns have not been as severe, infection rates dwarf those recorded in Australia.  At the time of writing, the UK was experiencing 50,000 infections per day (Morton & Therrien, 2021), the subcontinent is running dangerously short on oxygen (Gettleman, Schmall, Raj & Kumar, 2021) and some nations are dealing with fatalities faster than they can bury their dead (Yangon, 2021).  The seemingly lackadaisical approach of the UK government that has opted to ‘live with the virus’ (Solomon, 2021) further enrages the Australian populace who feel hard done by, even if Australia is relatively well off in health and economic terms in comparison to the rest of the world (Chung, 2021).

However, even before the pandemic began, Australia’s economic credentials were in good shape (Pandey, 2021) and remain so.  With GDP and inflation growing at below target rates, the Reserve Bank of Australia is attempting to stimulate business investment by leaving interest rates at an all-time low of 0.1% (RBA, 2021).  Despite the worrying trend of stand downs and retrenchments, the unemployment rate for June 2021 fell to 4.9%, the lowest rate since Labor was last in power (ABC, 2021).  An additional noteworthy macroeconomic indicator is the wage price index (WPD), which continued to rise 1.5% over the year (ABS, 2021a).  Finally, despite the economic difficulties, Australians are on average quite wealthy, as illustrated in the following table.

Table 1: Australian Wealth Indicators, December 2020 (ABS, 2021b)

Beyond Australian wealth, tax rates are high compared to Australia’s trading partners.  For personal tax, rates accrue on a sliding scale so that higher income individuals pay more real tax, up to 49% at the highest income bracket.  For corporate tax, it is set at a flat rate of 30%, which can make Australian businesses less competitive on the international stage (Tax Foundation, 2020).

Notable technologies that are impacting on commerce include the omnipotent Internet, buoyed by almost all Australians carrying an Internet-connected mobile device in the pocket.  This, together with the rise of social media platforms, allows firms to connect with consumers in ways never imagined before (Butt, 2019).  These handheld devices have also revolutionised computing applications, renamed ‘apps’ that exploit Internet connectivity and allow links not only between people, but other devices that can include watches, homewares such as refrigerators and health equipment such as pedometers (Chantzis, Stais, Calderon, Deirmentzoglou & Woods, 2021).

The speed of technological change has been accelerating since the 1950s (Grinin, Grinin & Korotayev, 2020), and apart from electronic devices, biotechnology product cycles are also fast (ibid.).  Involving the work of many researchers, clinical trials, and regulatory bodies, rapid advances in biotechnology and pharmaceuticals are driving better quality of life for many illnesses and conditions (Bessen, n.d.).  For example, the Pfizer–BioNTech COMIRNATY vaccine was the fastest vaccine to be approved for human use in Australia, with Pfizer entering Phase 3 clinical trials in November 2020 and the TGA approving on 25 January 2021 (TGA, 2021).  It works by encasing virus spikes from SARS-CoV-2 in nanoparticles, which are injected into the muscle, causing the body to learn to recognise and fight the virus with corporeal antibodies (ibid.).  Biotechnology innovations have also been used to find better ways of growing crops, nourish livestock, and prevent pests (Bessen, n.d.).

Isolated from its trading partners, Australia is a large continental nation in the south pacific.  Australia has access to less than 1% of the world’s usable water supply (Lehane, 2014) and has a harsh and dry continent.  Most of Australia is uninhabitable so settlements tend toward the periphery, where river systems and coastal waters provide access to irrigation and seafood.  A small population, relative to neighbouring countries, comprises a proud multiculturalism, multiple small businesses, and an egalitarian culture (Kapferer & Morris, 2003).

Australia is a constitutional monarchy, headed by HM Queen Elizabeth II.  Its governance is by a federation of states that share and separate power between them as well as the coalescing Federal government.  The High Court adjudicates on constitutional matters and is the highest court of appeal in the country.  Various regulators (e.g., ACCC, ASIC, TGA, TEQSA) implement laws passed by the Parliament.  Non-criminal legal activity tends to pursue free market ideals and protecting consumers from unfair trade practices (McCauley, 2018; Murtough, Pearson & Wreford, 1998).

The Biotechnology Industry

Competitors in the hearing industry include Sonova Holdings AG, Danish firm Demant A/S, the Australian government enterprise Hearing Australia, Danish firm Widex A/S, and privately-owned Starkey Hearing Technologies from the US.  Cochlear and Demant lead this very competitive industry, boasting huge revenues and R&D expenditures.  Although large capital expenditure is needed to establish a biotechnology firm, start-ups are common, thanks to new models of venture capitalism (Booth, 2019) and can rise quickly with plentiful government grants available for technological innovation (Department of Industry, Science, Energy & Resources, 2021).

The biotechnology industry (of which the hearing industry is a part) is run on innovation.  Product cycles are driven by imaginations of the human condition and large investments in R&D (Su & Minsuk, 2015).  Some projects will never yield results and so it is important that a firm’s portfolio of research projects eventually hits a breakthrough so that it can repay the investment of all the other failed projects (Quelch, 2008).  The promise of successful clinical trials makes this industry attractive for research investment, as well as attracting some of the best and brightest minds in the world (Bennett, 2001).

The WHO forecasts hearing loss to affect 900 million people around the world by 2050 (2019).  Those that experience hearing loss become progressively isolated.  Since people tend to trust medical practitioners (Morgan, 2021), hearing solutions are expensive and never discounted.  With the limited number of providers in the marketplace and the specialist nature of the product, buyers are not able to barter on price.

Suppliers of physical aspects of the product include healthcare providers, component manufacturers, and distributors.  However, the industry also relies on providers of intangible aspects of the product, which include scientific and medical expertise.  The industry relies on networks of collaborating partners, including university- and government departments.  Much of the labour force in biotechnology and related fields (i.e., medicine) work not for the money, but for a calling they experienced to their line of work.

While there are no substitutes for biotechnology overall, when focusing in on implantable hearing solutions, substitutes can include automated audiometry, and sound amplifiers.  However, these current substitutes are technologically inferior and do not counter hearing loss like the Cochlear implant does.  Future product cycles may produce an alternative, which is another reason why the industry must commit to its R&D agenda.

Company Overview

Cochlear Limited is the global leader in hearing implant solutions.  As it has done since it was first listed on the ASX, it separates the roles of chair and CEO (Cochlear Limited, 2020).  This demonstrates alignment the ASX Council of Corporate Governance recommendation 2.5 (ASX, 2019, p.15).  Rick Holliday-Smith was appointed to the board in March 2005 and was appointed Chair in July 2010.  Dig Howitt was an insider CEO and President appointment in 2018, having joined the company in 2000 (Cochlear Limited, 2020).  During the 2020 financial year, Cochlear Limited appointed two new directors with specific experience in medical devices and health services communications (Cochlear Limited, 2020, p.8).

Cochlear Limited’s operating and financial review (2020) extols its mission, which is (p. 15):

We help people hear and be heard.

We empower people to connect with others and live a full life.

We transform the way people understand and treat hearing loss.

We innovate and bring to market a range of implantable hearing solutions that deliver a lifetime of hearing outcomes.

While anchoring to its mission, Cochlear Limited has three strategic priorities that include retaining market leadership, growing the market for hearing implants and delivering consistent revenue and profit growth (Cochlear Limited, 2020, p. 21).  It engages in significant R&D programs, investing around 14% of revenue.  Collaborating with Cochlear Limited is an alliance of network partners, which assists it to deliver 61% of its sales via implants, 29% via services and 10% via acoustics (ibid. p. 16).

Cochlear Limited’s sales and net profit growth throughout the years has been enviable.  The following Figure 2 and Table 2 respectively illustrate the growth. It boasts that AUD $1,000 invested at the time of listing would be worth approximately AUD $140,000 at the end of the 2020 financial year (Cochlear Limited, 2020, p. 17).

The 2020 financial year saw Cochlear Limited’s activities severely impacted by the CoViD-19 pandemic as implant surgeries around the world were deferred.  Yet, they continued to exercise prudent financial management, keeping costs in line with the sales in Table 2 below (Cochlear Limited, 2020).

Table 2: Cochlear Limited Financial Summary 2017-2020 (Cochlear Limited Annual Report, 2018, 2019, 2020)

The net profit after tax (NPAT) loss posted by Cochlear Limited is due to legal proceedings brought against them in the US for patent infringement (Cochlear Limited, 2020, p. 3).  In March 2020, the US Court of Appeal awarded damages to Alfred E Mann Foundation for Scientific Research (AMF) and Advanced Bionics LLC (AB) of US $280 million.  Cochlear Limited declared they would appeal the decision, as it was awarded based on an expired patent (op cit., p. 8).

Cochlear has a focused value proposition, providing hearing solutions to those who experience moderate to profound hearing loss.  The main product is the CochlearTM Nucleus® implant, which provides patients with a variety of options to improve hearing quality.  This product is comprised of two components: the external sound processor and the internal implant.  The external component is available in a variety of wearable options and can be connected to an iPhone or Android app (Cochlear Limited, 2020, p. 14).

Another category of product includes the ‘acoustics’ range, which make use of bone conduction for hearing solutions.  The leading product here is the CochlearTM Baha® 5 system, including the SoundArc and smart app.  The final component of Cochlear Limited’s offering is called ‘services’ and includes sound processors for replacement or in different colours.

Priority market segments for Cochlear Limited in the future are direct-to-consumer marketing, hearing aid channel programs, the adult and seniors’ market in developed markets, children in emerging markets, and China, which is seen as a great opportunity for future growth (Cochlear Limited, 2019).  Indeed, Cochlear Limited established a Chinese manufacturing facility in Chengdu, Sichuan Province, expected for completion toward the end of 2020 (Cochlear Limited, 2020, p. 7).  Finally, it enjoyed pleasing news from the US Food & Drug Administration (FDA) that approved Cochlear’s Nucleus® implant for use in children from nine months of age with bilateral, profound sensorineural hearing loss (op cit., p. 6).

During financial year 2019, Cochlear Limited acquired intangible assets associated with the expanded GN Hearing alliance, including licence fees for the existing technology and investment in the development of further intellectual property.  Cochlear Limited also moved to establish its own direct distribution channels in several emerging markets in 2019, which involved acquisition of some distributors.  Cochlear Limited continues to strengthen the alliance with GN Hearing during the 2020 financial year (Cochlear Limited, 2019; 2020).

Cochlear has a diverse global workforce of over 4000 people in 180 countries (Cochlear Limited, 2020, p. 10). Cochlear’s workforce accounts for two thirds of its operating expenses (op cit., p.4).  They come from all walks of life and must demonstrate a passion for the industry and Cochlear’s mission.  Many of the workforce are scientifically trained, engineers or other technical personnel who work to implement the powerful Cochlear Limited vision.  Notwithstanding the previous financial year, Cochlear is a fast-growing organisation.  People management challenges for Cochlear include attracting, retaining, and motivating qualified staff who have the passion and ambition to change lives.

Cochlear Limited also established diversity targets for the Board and Senior Leadership positions, to support its Diversity & Inclusion Framework, launched in 2018.  They take an innovative approach to gender diversity, prescribing targets of between 40-60 per cent of either gender (notwithstanding alternative gender identities).  This is supported by the talent acquisition approach as well as succession and other people-related policies (Cochlear Limited, 2020, p. 8).

Cochlear’s global headquarters is situated at Macquarie University, Sydney, which it assumed in 2010.  In 2017, it acquired its long-term manufacturing site at Lane Cove, that had been previously leased.  During financial year 2017, it invested in manufacturing facilities in Brisbane, Australia (Cochlear Limited, 2017) and, as noted above, finalised construction of the Chengdu, Sichuan Province manufacturing facility toward the end of 2020.  The Chinese facilities are set to significantly increase its output capacity, but it will have to await Chinese regulatory approvals, which could take two years to secure (Cochlear Limited, 2020, p. 7).

Cochlear Limited increased capital expenditure in information technology (IT) infrastructure and systems significantly in 2018 (Cochlear Limited, 2018).  The purpose of this investment was to improve connectivity of health, cybersecurity, and digital health capability (Cochlear Limited, 2019).  It developed smart apps to complement its range of products and data analytics to improve service quality.  R&D is significantly important to future product offerings and will continue to be in the future.

The Future

After what can only be described as a very tough year—and, perhaps more urgently, a brutal day of home-schooling—Dig suffers through the old man’s ramblings, swigging on his beer as he paces the lounge room.  When it seems Rick finally takes a breath, Dig says, “hey, Rick, I’ve been thinking.”  He goes on to explain his idea to capitalise on the lockdowns and the changes it has brought to the way Cochlear can seize on current and future opportunities. Covid-19 has had an impact on the Cochlear business and the executive will need to turn this around.  A commitment to R & D will remain important going forward. The recent patent ruling in the United States also needs to be challenged in court and finalization of the settlement made – this is a significant financial cost and will require considered judgement by the board. Workforce retention and development remains a priority looking to the future. There is much for Rick and Dig to consider – what will be the best recommendations to improve shareholder and stakeholder value and make a better business?

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