MEDICAL TECHNOLOGY
UNLOCKING THE POTENTIAL OF 
LIFESAVING MEDICAL TECHNOLOGIES 
THROUGH THE ITA: 
REMOVING THE BARRIERS TO ACCESS 
AND RESPONDING TO THE COVID 
PANDEMIC
TREVOR GUNN
VICE PRESIDENT, INTERNATIONAL RELATIONS
MEDTRONIC, INC.
WASHINGTON, DC
WTO, ITA EXPANSION DISCUSSIONS  SEP 2021
RD/IT/372
The Medtech IndustryWE ARE THE MEDICAL TECHNOLOGY INDUSTRY
BUT WHAT IS MEDICAL TECHNOLOGY?
World Trade Organization | ITA and the Response to Covid -19 | Sep 2021 3Capital Equipment Implantable/DisposableTherapeutic DiagnosticMEDICAL TECHNOLOGY LANDSCAPE -SIMPLIFIED
World Trade Organization | ITA and the Response to Covid -19 | Sep 2021 4Global Medtech Trade
▪Global Medtech market ~$400 Billion as of 2020, estimated to reach ~ $672 Billion by 
2027 
▪Annual growth rate of 5.2 -5.7%
▪Rising prevalence in chronic diseases, increasing life spans, and increasing per capita 
income in APAC are significant growth factorsMEDICAL TECHNOLOGY LANDSCAPE AND THE COVID -19 IMPACT 
BY THE NUMBERS
$59.0$59.5$60.0$60.5$61.0
Instruments and AppliancesHS Code 9018
$13.0$13.2$13.4$13.6$13.8$14.0
Instruments for
Physical/Chemical AnalysisHS Code 3822
$256$260$264$268$272$276
Total Global ImportsAll HS Codes
World Trade Organization | ITA and the Response to Covid -19 | August 2021▪2019
▪2020
1% increase 2% increase 4% increase$0$2$4$6$8$10$12$14$16
Respiratory TherapiesHS 9019.20
83% increase
5STRIKING SIMILARITIES: IT AND MEDTECH
INDUSTRY AND TECHNOLOGY PARALLELS, FUSION  AND DEPENDENCIES
IT Industry
Based in  Engineering (Mechanical, Electrical) 
and Software
Accumulated Operating Knowledge
Rapid, iterative, software based
Improved product performance: greater 
functionality, higher customer satisfaction
Rapid obsolescence and short life cycle
MedTech Industry
Based in Engineering (Mechanical, Electrical, 
Biomedical, etc.) and IT
Accumulated Operating Knowledge
Rapid, iterative, software based
Improved product performance: greater 
prevention, improved patient outcomes
Rapid obsolescence and short life cycle
Scientific Basis
Intellectual Property
Technology Life Cycle
IT Connectivity
Product Life Cycle
World Trade Organization | ITA and the Response to Covid -19 | Sep 2021 6MEDTECH IS CRITICALLY CONNECTED TO TRADE
Trade Links
▪ITA Expansion includes much medtech duty -free; no Rules of Origin for critical mass of markets
▪Data, diagnosis and treatment information/guidance flows globally
▪Shared clinical and regulatory environments
▪Healthcare systems increasingly investing and operating across borders
▪Response to the Covid -19 (+other health emergencies) demands global response
▪Supply chains are, by their nature, global (amply demonstrated by C19)
COVID -19 has demonstrated the link between health and economic growth 
▪Economic activity and productivity directly linked:  In Covid -19, return to work is critical
▪We need many countries participating in  innovation around tech/care for growth
▪Sustainable and resilient healthcare systems are non -negotiable. 
▪Large healthcare spend as % of GDP; large employment
World Trade Organization | ITA and the Response to Covid -19 | Sep 2021 78
MEDTECH AND UNIVERSAL 
HEALTHCAREWE’RE LASER -FOCUSED ON THE 17 UNITED NATIONS
SUSTAINABLE DEVELOPMENT GOALS (SDGs)
•SDGs drive priorities and funding for the entire UN
•17 goals; 169 sub -goals
World Trade Organization | ITA and the Response to Covid -19 | Sep 2021 9MOST RELEVANT SDG’S FOR MEDTECH
▪Goal 3: Ensure healthy lives and well -being
▪Target 3.4: by 2030, reduce by one third premature 
mortality from NCDs through prevention and treatment 
and promote mental health and well -being. 
▪Target 3.8 :  Universal Healthcare 
▪Goal 17: Revitalize the global partnership for sustainable 
development. 
▪PPPs are a conduit to deliver on sustainable 
development objectives▪Goal 9: Industry, innovation and infrastructure. 
▪Priorities include therapy innovation and this goal 
relates directly
World Trade Organization | ITA and the Response to Covid -19 | Sep  2021 10
Former CEO/Chair, Dr Omar Ishrak
representing the global private sector in the 
UN’s Universal Healthcare meeting, Sep 2019ACCESS TO MEDICAL TECHNOLOGY DRAMATICALLY IMPROVES 
HEALTHCARE ACCESS
▪Non -Communicable Disease accounts for 70% of all deaths 
globally
▪Annually, 15 m die from an NCD between ages 30 -69; 80% in 
low -and middle income countries                                                       
China :NCDs account for 87% of all deaths
Russia : NCDs account for 86% of all deaths
Brazil :    NCDs account for 72% of all deaths
India :     NCDs account for > 53% of all deaths
-WHO-WHO
World Trade Organization | ITA and the Response to Covid -19 | Sep 2021 11COVID -19’S LASTING IMPACT ON MANY OTHER DISEASES
ITA EXPANSION HELPS THE ENTIRE HEALTH ECOSYSTEMGLOBAL GOVERNMENT AFFAIRS
DIABETES
•2ndmost common comorbidity related to 
COVID -19
•COVID -19 can impair insulin -producing 
cells, resulting in  a diabetes diagnosisRENAL FAILURE
•The liver and kidneys are the 2nd most 
affected organs by severe COVID -19
•Up to 30% of COVID -19 cases develop 
moderate to severe kidney injuryRESPIRATORY ISSUES
•COVID -19 can induce lung 
failure/damage, airway injury,  pulmonary 
fibrosis, and hypoxemia
•Patients are at risk of venous 
thromboembolism, especially if they have 
prolonged immobilization
OBESITY
•Disturbed antibody response and T -cell 
dysfunction may decrease vaccine 
effectiveness in individuals with obesity
•Quarantine/ ‘stay -at-home’ measures 
contribute to increases in childhood 
obesity , depression, and consumption of 
processed foods CARDIOVASCULAR ISSUES
•Hypertension care is 2nd highest 
disrupted NCD service 
•Complications  reportedly associated with 
COVID -19 include:
•Cardiac arrest
•Heart failure
•ArrhythmiasNEUROLOGICAL ISSUES
•50% of COVID -19 patients experience 
neurological issues
•Uncertain how long neurological issues 
persist after recovery
World Trade Organization | ITA and the Response to Covid -19 | Sep 2021 1213
Medtech and IT
Practical ExamplesMEDICAL TECHNOLOGY CRITICAL TO THE FUTURE OF HEALTHCARE
▪Medical Technology is 
affecting allareas of 
healthcare
▪These technologies not 
only build upon one 
another, they accelerate
one another
▪Use cases are no longer 
bound by just technologyElectronic Medical 
Records
5G
Virtual 
RealityMachine 
Learning
Artificial 
IntelligenceCyber 
Security
Patient 
ConsentPrivacyBlockchain
BiometricsImaging
Remote 
Care
Internet 
of Things3D Printing
CloudSpeech 
Recognition
Virtual 
VisitsPersonal 
Health 
Record
World Trade Organization | ITA and the Response to Covid -19 | Sep 2021 1415
SAMPLE DEVICES USED
IN COVID -19 TREATMENT
KEY DEVICES IN ITA EXPANSION
CAPNOGRAPHY
World Trade Organization | ITA and the Response to Covid -19 | Sep  2021
DIABETES -EXAMPLE 
▪Background –Type 1 Diabetes impacts huge numbers of people globally and lack of management 
can have dramatic consequences
▪Solutions –Diabetic patients have many –including Connected Devices, AI, Remote Care
▪Result –Improved clinical outcomes and  lower costs
▪Doctors/nurses have “real -time access” to patient data uploaded to the cloud, expediting remote 
diagnosis and response times
World Trade Organization | ITA and the Response to Covid -19 | Sep 2021 16Medtronic Education and Innovation Ctr -
IstanbulVIRTUAL TRAINING AND EDUCATION
MADE POSSIBLE BY DIGITAL INFRASTRUCTURE SUPPORTED BY THE ITA 
•COVID -19 has driven rapid change from in -person
•Training for clinicians and patients
•Opens up huge opportunities for emerging mkt doctors 
•Increased leverage of technology
•Travel not required
•Interactive capabilities
•Access to global experts 
•Reduced burden on healthcare 
•Achieve similar outcomes
•Creates foundation for future 
World Trade Organization | ITA and the Response to Covid -19 | Sep 021 17MEDTRONIC 
COVID -19
Specific ExperiencesTHE GLOBAL  PANDEMIC: A CASE STUDY WE’RE CURRENTLY LIVING
A CATALYST FOR CHANGE
COVID required solutions in days and weeks not months and 
years
By joining forces with other technology companies and 
suppliers, COVID became a catalyst for change and initiated 
new ways of thinking about how we could partner with other 
industriesOUR VENTILATOR CHALLENGES
1500
Components100
Suppliers14
CountriesLOGISTICAL
Constraints
EXPORT/IMPORT
Restrictions
World Trade Organization | ITA and the Response to Covid -19 | Sep 2021 19MDT SUPPLY CHAIN:  EXAMPLE -VENTILATORS
A ZERO -TARIFF ENVIRONMENT IS CRITICAL
Patient
Regional Distribution CentersManufacturing and assembly 
site (i.e., Galway)GoodsFinished Products
Major Distribution CentersSterilization facility 
Accessory 
Supplier(s)Supplier(s)
Hospital/facility
Upstream
DownstreamUSA
Ireland
Malaysia UK 
China
World Trade Organization | ITA and the Response to Covid -19 | Sep 2021 2021
WTO, the ITA 
and Public 
HealthITA EXPANSION
IMPACTS AND PROSPECTIVE IMPACTS ON MEDTECH AND HEALTHCARE
ITA EXPANSION IMPACTS
▪Expanded coverage of Medtech products, 
including but not limited to
▪Pacemakers
▪Diabetes pumps and sensors
▪MRI apparatuses
▪Ultrasonic scanning devices
▪Electro -cardiographs
▪X-Ray tubesPROSPECTIVE IMPACTS
▪Device enablement through critical components
▪Lithium -ion batteries –8507.60
▪Expansion to new products
▪Centrifuge –8421.19
RESULTS
✓ Reduced duty payments
✓ Reduction in acquisition costs for governments and public health systems
✓ Incentives to think more about Low -to-Middle –Income -Countries
World Trade Organization | ITA and the Response to Covid -19 | Sep 2021 22Increase 
understanding of 
the complexity of 
Supply Chains
-Upstream 
-Downstream Vastly improve 
understanding of 
Medtech industry
-Unintended trade 
obstacles
-Tariffs
-Human elementEliminate tariffs 
on Covid -19 and 
other medical 
products
-e.g. 15.2% tariff 
still in one major 
Asian economyWTO: Emergency 
Convening 
Consultative 
Mechanism
-Quickly spot, 
communicate 
globally and deal 
with technical 
barriersElimination of 
tariffs through ITA 
for heavy benefit 
for public health
-Continue pushing 
tariffs to zeroCONCLUDING THOUGHTS: WHAT WE HAVE LEARNED
SUGGESTIONS FOR THE FUTURE –EDUCATE AND TAKE ACTION
TAKE ACTION
World Trade Organization | ITA and the Response to Covid -19 | Sep 2021 23CONTACT INFORMATION
VICE PRESIDENT, 
INTERNATIONAL RELATIONS
MEDTRONIC, INC. 
WASHINGTON, DCDR. TREVOR GUNN
+1 202 442 3655
Trevor.Gunn@Medtronic.com
ADJUNCT PROFESSOR
SCHOOL OF FOREIGN 
SERVICE(IBD, CERES)
GEORGETOWN UNIVERSITYCHAIR
INTERNATIONAL AFFAIRS 
COMMITTEE
MEDTECH EUROPE
FOUNDER /CHAIR
USA HEALTHCARE ALLIANCE
US-AHA.COM   (USAHA)
World Trade Organization | ITA and the Response to Covid -19 | August 2021 24APPENDIX
IN RESERVE
World Trade Organization | ITA and the Response to Covid -19 | Sep  2021 25SCREENED
Shruti
800K
22KTREATED
Shruti -trained community health 
workers (CHWs) use our Screening 
Kit to identify and diagnose patients 
in the community. Our kit includes 
our mobile otoscope, low -cost 
hearing aids and a mobile 
application. Based on the preliminary diagnosis, 
CHWs refer patients to appropriate 
care at Shruti partner clinics. Our partner clinics support Shruti 
patients with discounted 
treatments or therapies including 
surgeries, medicines, hearing aids 
and more. “
“Now I am able to listen to 
the smallest of sounds 
which was not possible 
prior to this surgery.HOW SHRUTI WORKS
Shruti addresses ear disease and hearing loss inunderserved
populations utilizing acommunity health worker -based service
model, enabled bypoint ofcare diagnostics, hearing implants and
digital tools .
SCREENING REFERRAL TREATMENTOUR WORK: ASIA REGIONCASE STUDY:  SHRUTI, CONNECTED HEALTH FOR HEARING LOSS
World Trade Organization | ITA and the Response to Covid -19 | Sep 2021 26CAPACITY BUILDING: VENTILATOR TRAINING IN ETHIOPIA
World Trade Organization | ITA and the Response to Covid -19 | Sep 2021 27