While market factors can vary by geography, it is crucial to have a global understanding of the market. Research advances, clinical trial findings, and technology advances do not know international boundaries. The cord blood market is global in nature and understanding dynamics limited to your region is not sufficient for making strategic, informed, and profitable decisions.
Below, geographical differences in cord blood banking are explored within key regions of the world.
Under current People’s Republic of China (PRC) government regulations, only one licensed cord blood banking operator is permitted to operate in each licensed region and only seven licenses have been authorized as of the date of this report. In each case, the company must function as both a public (donation-based) and private (for profit) bank.
China Cord Blood Corporation (CCBC) became the first cord blood banking operation in China when it began operations in 2003. It was also the first cord blood bank in China to receive ISO900 certification and is now also AABB accredited. In addition, it is now the largest cord blood banking operator in China in terms of geographical coverage and is the only one operating with multiple licenses. It holds the exclusive license for 3 of the regions (Beijing, Guangdong and Zhejiang) and has partial ownership in a 4th region through its 24% share in Shandong Cord Blood Bank.
It entered Beijing in 2003, Guangdong in 2007, and Zhejiang in 2011. Within the regions that the company operates, there are approximately 2 million new births every year, allowing for a large potential market. Each of the other licensees in China hold only one license. CCBC is the fastest growing cord blood bank worldwide, according to its CEO, Mr. Chen.
The company has also experienced very robust and consistent revenue growth for 2009 through 2014, with a CAGR of 25%.
China Cord Blood Corporation’s public division has also been very successful, with the CAGR for its public blood banking division at 26.6% for 2009 through 2014.
The other operating regions where China Corp Blood Corp does not hold permits are Tianjin, Shanghai, and Sichuan, which are responsible for only 3%, 5%, and 19% of annual births in China, respectively (total of 27%).
Another company that has received a permit from China’s Ministry of Health for cord blood storage is Shanghai Stem Cells Technology Co., Ltd., which is a public interest company granted jointly by Shanghai Red Cross Society, Shanghai Blood Center, and other facilities under the Shanghai Municipal Bureau of Public Health. An operating division, the Shanghai Cord Blood Bank, holds the government license for cord blood banking in the Shanghai region and is affiliated with the Chinese marrow donor program.
France and Italy
In Italy and France it is illegal to privately store one’s cord blood, which has fully eliminated the potential for a private market to exist within the region.
According to The French Network of Cord Blood (RFSP), while there were only three cord blood banks operating in France in 2009, as of 2012 there were 10 banks with about 70 hospitals collecting cord blood units.  Such an increase in cord blood banks illustrates the RFSP’s attempt to meet its goal of collecting 30,000 cord blood units by 2013,  when only 7,000 public cord blood units were stored within France in 2008. “Although the French network of public banks is demonstrating a strong commitment to reorganize and scale up its activities, the revision of France’s bioethics law in 2010 has sparked a debate concerning the legalization of commercial autologous banking.”
“France is one of the leading exporters of cord blood units worldwide, but ranks only 17th in terms of cord blood units per inhabitant, and imports 64% of cord blood grafts to meet national transplantation demands.”
Italy has a network of public cord blood banks that is maintained by their equivalent of the U.S. National Marrow Donor Program (NMDP). It is called GRACE, which stands for “Gruppo per la Raccolta e Amplificazione delle Cellule Ematopoietiche.” Literally, this translates to mean “Group for the Collection and Expansion of Hematopoietic Cells.”
In February of 2003, Italy’s Ministry of Health published in an official government announcement (Gazzetta Ufficiale 27) the following laws regarding cord blood:
- Cord blood banking is only authorized as a public conservation structure.
- Each bank is also subject to approval by the regional government where it is located.
- Private banking is forbidden.
- The import or export of cord blood must be authorized by the Ministry of Health.
- These provisions are believed necessary because therapies using stem cells from umbilical cord blood are still under study.
Interestingly, while private banking in Italy is forbidden, the exportation of cord blood has been allowed since 2007, “and an increasing number of women are requesting this collection of umbilical cord blood at delivery to enable storage of stem cells for autologous use.” 
In addition to anonymous public banking, Italy also has a family banking program for parents who already have a child with a disease considered treatable using cord blood transplantation. This is the Italian equivalent of the Sibling Donor Cord Blood Program operating within the United States. These families are offered “dedicated storage” where the blood is reserved specifically for them in the event that the older child is scheduled for a transplant. The family-directed cord blood banking is supported by a national program (Ministerial Decree of November 18, 2009). The Centro Nazionale Sangue (CNS) reports on the number of cord blood units banked by the Italian public bank network. 
In 2008, a Taiwanese company, HealthBanks Biotech Company Ltd. became the first company to offer cord tissue storage. It was not until July 2010 that the first private U.S. cord blood bank began offering the service (Cord Blood Registry). Since then, the trend of cord tissue storage has had a significant impact on the cord blood banking industry, with a large percentage of cord blood banks worldwide offering the service.
Currently, Taiwan is served by three private cord blood banks: BabyBanks, HealthBanks Biotech Co. Ltd., and Sino Cell Technologies, Inc. The banks are located in Taipei, Taiwan, and Hsinchu City, respectively. HealthBanks is the only cord blood bank in Taiwan that has twice received silver medals from the National Biotechnology and Medical Care Quality Awards (in 2007 and in 2008). HealthBanks Biotech Group is the most established Asian cord blood bank, with headquarters in Taiwan and sibling branches in Hong Kong, Macau, Thailand (Thai HealthBaby), and the U.S. (PacifiCord).
Taiwan also has a public cord blood banking program. Specifically, the California-based company Stemcyte operates the StemCyte Taiwan National Cord Blood Center, which has been a participating member of the United States National Marrow Donor Program (NMDP) since 2004.
The Taiwanese cord blood market is highlighted in this section for three reasons:
1) The Taiwanese market is deeply invested in cord blood banking and represents one of the highest rates of cord blood banked per birth globally.
2) According to a recent survey, 20% of mothers in Taiwan would prefer to privately bank their children’s cord blood than donate it for free.
3) It is a geographic area that has been responsible for significant innovation within the cord blood market, leading the way with the first company to offer cord tissue storage in 2008 and bringing to market other types of stem cell biobanking more recently.
While Taiwan has not been subject to the shifting government support, it is an important region to watch because of the degree of support within the country for cord blood banking and industry innovation.
In Ecuador, the government is now creating the first public cord blood bank and has instituted laws such that private cord blood banks cannot approach women about private cord blood banking options during the first six months of pregnancy. This has created a crisis for the private banks, and there are now only
two remaining in Ecuador (Biocells Discoveries, established 2005) and Cordon De Vida (partner of Family Cord, a California Cryobank Company).
Ecuador’s first public cord blood bank is predicted to open in the Spring of 2015. The National Institute of Donation and Transplantation of Organs, Tissues and Cells (INDOT), under the Ministry of Public Health is responsible for regulation, coordination, monitoring, advocacy, and evaluation of all storage and transplant activity.
Currently there are two private umbilical cord blood stem cell banks in South Africa, but due to the cost, much of the public remains without access. Therefore, a feasibility study is underway to determine the viability of a public cord blood banking system within South Africa. Below are the major findings from the study: 
- In addition to the affordability barrier, “cultural differences, religious practices, traditions, and superstitions, language constraints (South Africa has 11 official languages), and educational disparities” play a role in limiting access and discouraging use of cord blood banking services.
- The high prevalence of HIV/AIDS and the subsequent need for highly sensitive and rigorous testing of cord blood prior to adding to a stem cell bank is another consideration. “The objective of the social feasibility pilot study was to gage public reaction towards and support for umbilical cord blood stem cell donation and banking, as well as their perception of the processes of donation and subsequent HIV testing of umbilical cord blood (necessary for compliance with international regulatory standards).”
- Although the sample size was small (n=77) and all participants were patients at a ante-natal clinic located in an urban area, the results were favorable towards further research and education of other populations’ reactions towards umbilical cord blood banking in order to capture the feasibility of creating and sustaining a public cord blood bank in South Africa.
In summary, there is substantial evidence that establishing a public stem cell banking system within South Africa would increase the range of cord blood units available for a highly genetically diverse population.
Currently, there are 16 cord blood banks in Brazil, with 9 being established enough to be considered significant competitors. Due to unfavorable media coverage toward the cord blood industry, several of the larger banks joined together in 2014 to form the “Associação Brasileira de Bancos de Células Tronco (ABBCT),” which translates tothe “Brazilian Association of Cord Blood Banks.” Currently, about 45-50% of the Brazilian cord blood market participates in this association, with the market share determined by approximate number of cord blood units banked annually.
Financial dues that are required to be a member of this association are $1,000 per month for banks with more than 2,000 cord blood units, and $4,000 per month for banks with more than 15,000 cord blood units. Fees go up approximately every 4,000 units from there. While these fees are very expensive, they are used to improve public perception and understanding within Brazil about the value of cord blood stem cells. Members of the association are also held to very high ethical and regulatory standards, which can add additional operating expenses for participating cord blood banks. Interestingly, the largest cord blood bank in Brazil elected not to participate in the industry. This is the Banco de Cordon Umbilical (BCU), which is a Mexican company that owns laboratories in Mexico City and also operates a laboratory in Brazil.
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To learn more, view the “Complete 2017-18 Global Cord Blood Banking Industry Report.”
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