The American Advantage:
In addition to their sheer size, there are three things that sets the USA ahead:

• IP and Commercialization is Constitutionally protected
• Their funding mechanisms demand Commercialization of the innovations
• Non-dilutive funding is seen as a back-stop to equity and debt…not the primary source

Moreover, this is ingrained into their innovation psyche.

USA health innovation landscape
The USA is steeped in commercialization as a primary goal. It starts with the US Constitution which enshrined the protection of intellectual property (IP) from the country’s inception. This was later backed up by the Bayh-Dole Act of 1980 which mandates the commercialization of patents that were attained through the use of federal funding.

In addition to federal grants through the SBIR/STTR program, there are three other federal entities including higher education institutions (in 2022 there were 3,542), teaching hospitals per AAMC (260) and federally funded research and development centers (FFRDC) at 46 in total.

As for the SBIR, the structure and commercialization requirements are; (SBIR Phase 1 -- $150K (for 6 months), Phase 2 – $1.0 million (for 2 years), needs a Commercialization Plan in the application and up to 1/3 can be subcontracted) combined with an STTR the amounts increase to Phase 1 – $295.9K and Phase 2 – $1,972.8K HHS-SBIRs (FY 2019 - $1.020 Billion 40% Phase 1, 60% Phase 2). Moreover, all SBIR and Phase 2 STTR applications require a Commercialization Plan.

Also, there are two other federal sources of funds for health innovations; BARDA Ventures ($500 M Global Impact Fund) and ARPA-H ($2.5 Billion in FY25 Budget).

Lastly, most states match SBIRs, at least in part if not in total.

From personal experience, USA innovators are tactically laser focused on what needs attention and how it will impact their overall development, especially the deployment of funds for commercial purposes.

Canadian health innovation landscape
The number of programs and overall volume of dollars pale in comparison to the US. Likewise, NONE of the funds are either targeted or mandated for commercial purposes. In fact, they are effectively precluded from anything other than R&D.

Federal funding per 2024 Budget ($748.3 million per year ongoing to SSHRC, NSERC, and CIHR) SR&ED ($150 Million per year)

Provincial funding is usually based on a program-centric basis from such entities as the Ontario Centres of Innovation OCI. Other provinces and territories have their own resources.

As well, there are specialized funds from such government run organizations as Intellectual Property Ontario IPON. And, there’s also the Global Innovation Clusters/Centres (e.g. Superclusters).

For a Canadian historical perspective read “ Canada's Culture Myth: Getting Tangible about Canada’s Intangibles Gap” by Laurent Carbonneau, CCI Director of Policy and Research