NYC Congestion Pricing, Stem Cell Therapy

Published Jan 6, 2025, 9:16 PM

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Journalist and author Henry Grabar on NYC’s Congestion Pricing and how this could help the Democratic Party. Dr. Silviu Itescu, CEO at Mesoblast, on MESO stock soaring after FDA stem cell therapy approval. And we Drive to the Close with Tony Roth CIO at Wilmington Trust

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Well, if you live in and around, or work in and around New York City, you probably already know this. New York City kicking off its first congestion pricing program in the United States, part of an effort to reduce the number of vehicles in the world's most traffic clogged urban area while also raising money for transit infrastructure. General Lieber is the chief executive officer of the Metropolitan Transportation Authority are Authority, telling our Bloomberg Surveillance team of Tom Keen and Paul Sweeney on Bloomberg Radio earlier this morning, it's all about creating the twenty first century city. But he also cautioned it's not going to happen overnight.

It's going to take a little while, so we're going to be watching it very closely, day by day, week by week. I don't expect to see some dramatic change on the first or the second day. Over time, we're expecting a ten to twenty percent reduction in traffic. That's what we're shooting for. New York is becoming a twenty first century city. We just did you know two train terminals the last couple of years. La Guardie air a total rebuild. It's number one in the country. JFK is getting rebuilt. I know your Newark Airport is getting investment. This is about being a twenty first century city where we don't spend all our time stuck in traffic.

Well, there you have it. JOHNA.

Lieber, the chief executive Officer of the Metropolitan Transit Authority with the Surveillance Team, earlier today on Bloomberg Radio, who also said he anticipates a ten percent to twenty percent reduction in New York City traffic over time. Thinking about New York City congestion, pricing, and the broader politic, especially the future of the Democratic Party, and putting it in an opinion column in The New York Times out early yesterday morning. Henry Gribbar, journalist and author of Paved Paradise, How Parking explains the world hard over, He joins us from Cambridge, Massachusetts, Henry. Good to have you back with us talk about the relationship between congestion, pricing and democratic politics, especially on a day where many Democrats are seeing the certification of president like Donald Trump and thinking to themselves, Wow, we really got to rethink how we handle ourselves over the next few years and what the future of the party looks like.

Right. Sure, Well, when you look at the results of the election for November, you can see that some of the places that move strongest towards the Republican Party were the outer birds of New York City and the suburbs of New York City. So this is kind of ground zero for figuring out why some Democrats decided not to vote or decided to vote for Donald Trump. And I think one of the theories that's been in play here is that Democrats simply haven't done a good job running the places they control, which is to say, big blue cities and blue states like New York, like Boston, like Chicago, like Los Angeles, San Francisco. Right, And so in that sense, this is a pole a pretty bold urban policy gambit to show the Democrats have big ideas about how to improve these places. And one of the things that struck people in particular was the sense of disorder, and congestion pricing is nothing if not an attempt to bring order to the streets of New York City.

And we will see ultimately it does bring order to New York City. Having said that, Henry, is congestion pricing, in your view, a big step toward creating the twenty first century city.

I think one of the things that has been apparent in New York over the last five or ten years is that the amount of traffic in the central Business District is making it really hard for the city to fulfill its basic functions, to say nothing of its reputation as a global city. I mean, a building catches on fire, somebody needs an ambulance, somebody needs to make a delivery. Nobody knows how long those things are going to take because the traffic has become so bad. So I think when Lieber talks about the idea of a twenty first century city, what he's saying is we need to have a kind of liability about the ease of doing business and going about basic tasks here. And that's what congestion pricing is very much designed to do. In addition, of course to raising money for the transit system.

All right, So going back to the kind of political aspect of this or what this means for the future of the Democratic Party, Henry, So, how does if New York City officials and the city kind of get it right in quotation marks if you will, how does it really kind of help everyone along the high end of the economy the lower end of the New York City economy.

Sure well, I think the goals of congestion pricing are pretty clear about that that there's going to be cleaner air, there's going to be faster commute, it's going to be easier to do business, and there's going to be more money for the mass transit system that of course moves the vast majority of people in and out of Manhattan every day. The number of people drive into Manhattan is a small fraction of that. But I think the question about how to ensure its popularity among the constituents in New York City and especially in the suburbs of New York City, that's the difficult question for the Governor of New York at the local right. Because she's up for reelection next year, this has become a subject of intense political debate since she decided to you know, open up the open up the box, and tinker with the pricing, tinker with the implementation date. And so I think what she needs to do is she needs to show that this works. And the challenge is blue cities, right, we know this. They move slowly and they build things at high cost. And so when you implement a program like this, people expect to see results in exchange for the money that's being taken at those tolls. And the challenge is, how can we come up with something in New York to show results from congestion pricing really quickly? Because if the streets are you know, the traffic is down by five or six percent, that's not necessarily something that people are going to be able to point their finger at. I mean, how do you know, how do you even register that kind of decline in traffic without having some kind of infrastructural improvement to show for it. And I think that's what the city needs to accomplish.

Now, will she be given the chance to actually show the improvement or any improvement, given that Donald Trump has opposed it and has vowed to get rid of it. This was put in a place before he takes office, Does he have the power to get rid of it.

I don't think he does have the power to get rid of it overnight. I mean, the federal role in this was certifying the environmental review, and that part is done, So I'm not sure that the federal government can go in and rescind the approval that they've already given for the program to go forward. Of course, there are several lawsuits pending, so there's a lot of uncertainty about this proposal. But I would just say as far as it's supporters or concerned, they have somewhat rested on the assumption that congestion pricing will be popular because it has been popular in other places that have implemented it after time, Right, And that depends on showing visible improvement, on making real the infrastructure that people expect to use and receive in exchange for that money that's being taken. And they can do that right, and they can do that overnight by creating bus lanes, pedestrians spaded actually emergency vehicle lanes, right, Like, make permanent the improvement that you see before the sticker shock fades and drivers return and realize that in fact, if a lot faster to drive Manhattan.

Henry, last question, just just to kind of the payoff of your op ed in the New York Times. You say that people support the policies and the politicians that they get something out of this concept of deliverism.

Right.

People, if they feel like they're getting something out of it, they're going to be supportive, and that's what shows political change or political sway, and just got about a.

Minute here, Yeah, that's right, And I think the premise of this, right is that these tools are being done in exchange for funding mass transit in around New York City. And the MTA has a list of improvements such as elevators to make subway stations accessible for people with strollers and wheelchairs, et cetera. But that stuff takes time, right, and it costs way more money than it should, as we know, and so reforming the construction process would help. But I think in the meantime, the low hanging fruit here is to create improvements for the vast majority of the people who travel on the surface streets, which is the people who travel by bus, right, And that's that's sort of the opportunity that they have to make these improvements visible immediately before the midterm elections come around, and this becomes the subject of every gubernatorial debate.

Did you say circus streets, surface streets a surface, Okay, because sometimes I feel like a circus and that kind of I could I could jump on that one as well. Hey, Henry, great timing, and really appreciate you coming on and spending your view. Henry Goobar, journalist and author Paid Paradise, How parking explains the world hard over.

So what are you getting a lot of texts about people wondering about congestion pricing. I'm getting all these texts like, hey, can you see a difference? Can you see a difference? I'm inside.

Yeah, I don't know, not yet, I don't know.

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Well, the company closed out last year with a stock price increase of eight hundred percent. No, we are not talking about any Ai Darling here. It's a biomedical services company, miso Blast, which develops drugs for cardiovascular disease on cology, hematology, and more. The company based in Australia, but it's got a market cap of about two point two billion dollars. Shares of the company's ADRs, Carol that trade in the US are aut more than fifty percent since mid December after the company's Ryan sil got FDA OK for pediatric graft versus host.

It's a big development. Doctor Sylvie Etsci is chief executive officer and managing director at Misoblast and he joins us in our Bloomberg Interactive Brokers studio. So nice to have you here. Welcome, Welcome. You founded the company back in two thousand and four, so over twenty years ago. Tell us a little bit about this journey and where we are today and how significant this development is for you.

Thanks for having me. Look.

Royonsal is the first ever FDA approved adult cell therapy regenera of medicine cell therapy in the United States. It has taken us twenty years to get to this point, but that's just how long it takes to develop and commercialize a brand new medicines in a new class of therapies. It's the first adult stem cell product off the shelf. It's been approved for children with a devastating complication called Graphs host disease, which is a complication that occurs about fifty percent of children who have a boma transplant after they've been cured of their leukemia, and as many as seventy to ninety percent of children die from this disease. There are no other approved therapies, and in our face retrial, we showed that we had seventy percent achieved a response rate as early as day twenty eight and overall survival over a five year period seen in fifty percent of children, which is a remarkable outcome, meaning that about.

Fifty percent of children are effectively cured.

Wow, you know this is going to say so off taste a little bit because when you talk about market size of a potential drug or development, if you have a child who has this, having one as a market size is enough right to have a development like this because it's a game changer potentially. But having said that, you know you are a publicly held company, you're a small cap company or a smaller market cap company, and I do wonder about the run up what is the potential market size for a drug, this particular drug.

So this is the first indication for this particular drug. It has many applications and we will be developing it for other adult indications. Fundamentally, it addresses major inflammatory.

Diseases, which is so many diseases.

Many diseases right, inflammatory lung disease, inflammatory vowel disease like chrohns, and ulstrip of colitis.

And that's adults.

There are many pediatric inflammatory diseases that are not well addressed either. So this is the first of its kind. It's taken a number of years. We've now demonstrated that we understand what the FDA is looking for in terms of regulatory milestones, in terms of manufacturing, in terms of consistency, in terms of reproducibility, so that we can now show that every vial that goes out is the same as the one before. And so we have a product that we can show that it's effective and it's safe, and it's reproducible, and I think that has a fundamental value proposition and that's why we're the first to have been approved.

So how does it work? What were you able to find? What did you and the team discover that makes this work.

So inflammation is caused by many path pathways, of the immune system, and traditional medicines small molecules and monoclonal antibodies target individual pathways, and that's why they're not really very effective at turning off severe inflammation. And COVID Odds, for example, was an example of severe inflammametry cytokine storm. And what we've shown is that our cells, which are living packages of multiple factors that orchestrate an anti inflammatory response, are able to turn off a multi pronged immune response in a way that small molecules cannot. And that's why we achieved such a significant outcome in these children who otherwise have.

A fatal disorder.

But that is the mechanism by which these cells generally will act in these other diseases.

So it's a tip of the iceberg for us.

This product is of course it's life saving, but it's also a has a halo effect because it demonstrates that the FDA is working with us, understands that we understand the mechanism and that we can rise to a threshold as a benchmark if you like, for how cell therapies need to be developed, manufactured, and ultimately brought to the market. So the market opportunities are very large you mentioned earlier that so easily.

You are assuming or guessing that it's going to be a billion dollar plus drug.

For this indication. Yes, definitely, just for this indication, just for this indication.

But we have Phase three assets now that either have completed or incompletion for kativascuar disease and inflammatory back pain, and those have multi billion dollar potential.

It's interesting because I actually have a sister who's been involved. She's a nurse and she's an engineer, and she's been involved in the world of cancer for a long time, and increasingly the conversations I have with her is, you know, how we are finding out that inflammation causes so much, whether it's cancer or otherwise, right, so much that ails us. Having said that, I'm curious when you're dealing with stem cells, any boddy stem cells are used to create this, like, how is it actually made? And I'm just curious, does each drug have to be very specific to the individual using their own stem cells?

This is a very important question that you're wise now. Actually, these are unique type of cells they called the miss ankam or stromal cells that have a unique property that they're not recognized as foreign when they're treated from one individual to another, and they have the other very important characteristics that can be expanded in very large numbers through the culture manufacturing process. So we start with a tiny number of very highly purified concentrated cells from a given donor an FDA approved donor screening program. Would that be an embryo, No, no, no, these are all adults out. This is from young healthy, eighteen to twenty four year old adults screened. We take a little bit of their bone marrow and isolate these cells, purify them, and then under GMP good manufacturing Practice facilities, we manufacture them. We scale them up, and we can we can make thousands of therapeutic doses from one donation. They're frozen, their cry preserved, and as through a supply chain, we we ship them from the manufacturing site to to a distributor that that warehouses them effectively at at minus one hundred and forty degrees and they shipped to the hospital and the rejection there's no there's no rejection is there's there's minimal side effects if any, very safe, very effective, and they they're an industrial way of making therapeutic stem cells in a vial where every vial is exactly the same as the vial before, and we can we can show it's the same, it's potent. We have potency essays that that allow us to quality control every every vial that goes out the door.

How do you find the donors, young healthy volunteers. We screen them for any any potential Is there.

Is there any sort of when you're doing this for a for profit company, Is there any sort of compensation that they get or is that not allowed?

No, it is allowed. It's totally allowed, and they do get compensations. They're fairly compensated, no different than many other blood products that are also donated, plasma derived products, et cetera.

What is this drove cast.

Well, you know, we only got approval a couple of weeks ago, so we're right in the process of working with all the rest.

I'm sure you have looked at this.

Yeah.

Look, the way to look at this is there are a number of gene therapies that have recently been approved. Those gene therapies give you at best fifty percent cure rates. We've now done five years survival studies and the children from our face retroth then we get about a fifty percent complete response and survival out to five years, which effectively means currerates. So I would say that we're in the same sort of ballpark as the gene therapy.

Which is why this is no judgment.

We have no idea.

It's liked to understand.

I'll look at this in a different way. We save hospitals about a million dollars in effectiveness of what they have to spend on patients in the intensive care unit. And that's, you know, putting it in a very calculated way. It's separately from the fact that we're saving children's lives. So when you look at it that way, I think if you save a million dollars in healthcare, then you can justify pricing in that order of.

Magnize around a round a million dollars.

We haven't yet gotten those prices, but we're in discussions with various payers.

Because gene therapy treatments can cost between hundreds of thousands of dollars and several million dollars per treatment. This isn't judgy, it's just like trying to understand the marketplace. And again, if I have a child and.

It's the cost doesn't matter, it doesn't matter.

I would expect this all costs incurred for this treatment for this disease are going to be reimbursed by all the major.

Healthcare right absolutely.

How do you know that?

We've had already multiple conversations with all the major insurers and we've been welcomed. The data supports what I'm saying.

FDA approval obviously a huge deal. But what about outside the US.

Well, you already have a partnership in Japan.

This similar product to this has been already in use for the last five years. It's safe, it's effective, it generates a sustainable revenue stream. Beyond Japan, we will be looking at Europe in due course, but our primary focus is the US without without doubt.

Just real quickly, So I don't know, take me six months, twelve months, three years, what might this replace as a current treatment for whatever ailments?

Like?

How are you thinking about it?

So for this disease, gevisual are there are no approved.

Treatments for each other as you branch out.

So other two big areas that we're focusing on our inflammatory disease and heart failure. OK, And we've completed a large face retrial of more than five hundred patients published in some major Kadiovasca journals, and what we've shown is surprisingly an eighty to ninety percent reduction over a three year period in heart attacks and strokes and mortality in patients who have the highest risk for those actors, on top of already taking all the various drugs that are available for heart failure. In addition, we've also recently published the study and Children with Congenital Heart Disease, where a single injection of ourselves into the left entricle has has almost doubled the size of the left ventricle, which allows the surgeon a whole different approach to an outcome.

Stay in touch. We'd love to hear more.

Thank you very for having me.

Doctor Sylvie Etesk, chief executive Officer Managing director of Miso Blast joining us right here in studios. You are listening to Bloomberg Business Week.

You are listening to the Bloomberg Business Week podcast. Catch us live weekday afternoons from two to five pm Eastern Listen on Apple CarPlay and the Android Auto with the Bloomberg Business app, or watch us live on YouTube.

Marcle, I'll bet you let me drive.

Oh no, no, no, no, this is not a toy, honey.

Please gravel. Great, I want to drive.

A good question.

This is the drive to the clothes now plunks for music Well Briar, Jon and Don on Bloomberg Radio.

All right, TikTok, everybody, eighteen minutes to go until we wrap up the Monday trade. Definitely off our best levels of the session. In fact, the doubt a little bit in the red here, but you're still looking at a gain of about more than two hundred points. I heard that from Charlie and Bill Maloney. Up about one percent on that Nasdaq one hundred, just up about half a percent on the S and P five hundred. But there is a lot coming out investors, and a lot more to come this week in terms of economic news. Fed minutes, So strap in everybody.

I mean, we started this first Monday of twenty twenty five with quite a bit of news. President like Donald Trump denying that Washington Post report that his aids are considering narrowing as tariff plan so that it would only apply to limited, specific critical imports. Carol Our next guest, says that tariffs from China could pose a big risk to the economy if they're actually implemented.

No, it's a really important point time for our drive to the closed guest with us as Tony Roth, he's chief investment officer at Wilmington Trust and he joins us from the greater Philadelphia area, of course, in the great state of Pennsylvania. Hey, Tony, good to have you here with us. Timely guest to have on since we've been so focused about what may or may not be when it comes to the presidle x tariff plans. Talked to us though, specifically about tariffs from China and the risk to the economy.

Well, if we have an amount of incremental tariffs heral that equaled the amount that we had with the first Trunk presidency, it would be about fifty billion dollars of incremental revenue. But if we had an amount, and that's not a lot, by the way, and it's not a lot of tariffs. On the other hand, if we had an amount of tariffs that was consistent with what the President has described, we would see total imports from China drop from currently fourteen percent of total imports to probably over course of his presidency, to five percent of total imports, and we would see a very significant increase in CPI over a one year basis. It would not constitute structural inflation, so it would happened one time as these tariffs took hold. When they took hold, it probably take some time for tariffs of that significance to take hold. But because those tariffs would be so large, if in fact they happened along the lines of the former president has described, we would see a pretty significant impact to GDP, to the point where we could even have a recession. Because our baseline is for only around one point seven one point eight percent growth for this year, which is lower than the overall Street. So there's not as much margin for the economy in our view as the Street thinks. And if in fact the President goes that hard on these tariffs, you could really see that inflationary impact on the economy, on consumers, and you could see the economy slide into recession.

We've spoken to some guests over the past couple of months after the president, one in November who reminded us that the tariffs that the former president wanted to put into place during his first term when he said it, the tariffs were implemented, i e. What he says goes when it comes to tariffs is the market taking into account the full risk of tariffs.

Here, Clearly they're not taking the full risk. If the measure is what he's described in this election, which is to say, one hundred percent tariffs on China up to twenty five percent tariffs on most of our other trading partners, that's not remotely taken into account. I think that the dynamic that we saw, however, in the market today is a microcosm for what we're going to experience over the course of at least the first half of the year, which is to say, you're going to see this president act as a negotiator. He's not going to want to give up any of his leverage. And so when stories come out that suggests perhaps in practice he recognizes the risk to economic growth and inflation that tariffs pose, he's going to push back hard on that, and that's going to cause volatility in the markets, much like we saw today. And so while the markets are not pricing in the degree of tariffs that he's talked about, probably aptly so, because the degree of tariffs that he's talked about this time around are so much greater than they were the first term, is very unlikely that he would in fact move to implement tariffs of that scale.

However, it is also an individual, the president elect, that watches the financial markets pretty closely, and he doesn't necessarily, or at least many have told us, doesn't want to see them fall apart on his watch. So how might that be a bit of a checks and balances in terms of Trump policy. It's not like he's looking to get re elected at the end of this term.

Yeah, that's a really great point. And what I would say is I would keep a very close eye in the ten year yield because right now we're around four to sixty maybe a little bit less at this time of day. Were over four sixty yearlier today. But the ten year is really a great proxy for how the markets are viewing the overall program economic program from this new administration. And if we move to a level that starts getting into the four seventy five to five percent range, that's going to really scare this president, and it's going to really cause the president to pull back on whatever it is that may be causing bond yields to rise in that direction, likely probably an excess of fiscal spending and increasing the deficit, so on and so forth. The bond Midgetlantis come out and onward from there, it's going to be inflationary and it's going to cause the FED to non in fact be able to look to lower rage further from here. And so I think that yes, he's going to be sensitive to the stock market, but he's also going to be a lot more sensitive to the bond market than he has been in the past as well, given that we have this scenario now where if the long term bond goes much above where it is today, you're going to have a crushing impact on the deficit.

And you are definitely seeing a buifurcation between like the two and the ten right now. In terms of expectations, I just want to kind of follow up. While the president elect doesn't necessarily look to get reelected, folks in Congress will look to get re elected and so they're not going to want policies that maybe, you know, kill markets or kill the economy. So it's just something you know to impress to keep on.

Our That's a good point, hey, Tony. One thing I didn't hear you say in terms of risks was anything related to mass deportations or immigration policy and sort of what that does or what that.

Could do to the economy.

How are you looking at that?

Yeah, it's a great point.

In fact, we just came out with our we're coming out with our outlook for the year tomorrow in fact called investing in a shoot and Ladder's economy, and the basic idea is that we're in an environment where we're moving gradually upwards. We do have a baseline forecast of around one or three quarter percent out for growth, but there are these ideas of these long shoots you could you could you could hit if you if you get these big tariffs, say that the shoot for the immigration scenario is probably not as great because we have a baseline forecast in any event, to see unemployment move upwards this year at around four point seven percent, and immigration is going to take notwithstanding all of the noise around immigrating millions of people, deplorting millions of people, it's going to take some time for that to all take effects. And we're in an environment right now where the labor market is not doing so great. So I don't think that the immigration for twenty twenty five anyway, or the deportation issues are going to present the biggest shoot. I think the biggest shoot is really going to be around the terrif issue that we've already covered, although I certainly would keep an eye on that deportation issue as we get into next as we get closer to next year, and as we get into potentially a stronger economic cycle.

Again.

No, you're right, and there's a lot of employers who say we need these workers. I'm going to leave with there, Tony. Thank you so much. Tony Roth, Chief Investment Officer at Wilmington Trust.

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