Since its origin, Winston-Salem has been a city of big ideas and innovation. The city built international brands — BB&T (now Truist), Wachovia (now Wells Fargo), RJ Reynolds (now Reynolds American), Hanesbrand, Krispy Kreme, Piedmont Airlines. But we failed to hold onto them.
Our ability to create is undeniable, but our track record of sustaining what we build? Not so great. Companies born in Winston-Salem have staged a mass exodus over the past few decades.
Now, we’re at another turning point, this time in biotechnology and regenerative medicine. The Wake Forest Institute for Regenerative Medicine (WFIRM) is leading groundbreaking research in organ regeneration, cell therapies, and chronic disease treatment.
Winston-Salem is one of only 10 cities in the nation selected by the National Science Foundation (NSF) as a hub for innovation — and the only one focused on healthcare.
Few people realize that some of the most cutting-edge medical breakthroughs are happening right here. Dr. Anthony Atala, a world-renowned pioneer in regenerative medicine, was the first to create an engineered organ that was implanted into a human. Those patients are still walking around today.
“Dr. Atala really led the scientific discipline of regenerative medicine,” Dr. Tim Bertram, the new chief ecosystem officer of WFIRM, told me during a recent interview. “We have over 600 scientists working on different areas of regenerative medicine.”
The goal? Discover ways to use cells, genes, and tissue engineering to create solutions for chronic diseases that current medicine cannot cure. It’s an ambitious vision, one that could put Winston-Salem on the global map for biotech innovation.
For all its progress in research, Winston-Salem has yet to translate this advantage into jobs, investment, and a real industry. This is a familiar story: we invent, we innovate, and then… we lose it to somewhere else.
Charlotte took our banking. Raleigh took our tech talent. Will we let Boston, RTP, or San Francisco take our biotech industry, too?
But there’s a challenge: scientific breakthroughs don’t automatically lead to economic success. One of the biggest barriers to turning medical discoveries into real-world treatments isn’t the science — it’s manufacturing.
“Manufacturing failures account for 80-85% of the failures in regenerative medicine,” Bertram explained.
That means if Winston-Salem solves the biotech manufacturing challenge, we don’t just attract startups — we retain them.
“The reality is, once you put a footprint down for biotech manufacturing, you’re not moving,” Bertram said.
This presents a massive economic development opportunity for Winston-Salem. Unlike industries like banking or tech, where companies can relocate for better incentives, once biotech companies build manufacturing facilities, they don’t leave.
But manufacturing biotech isn’t cheap.
“The average cost to take a discovery from the lab to a commercial product is well over $2 billion,” Bertram told me. “This is why we struggle to attract venture capital. Investors want exit strategies.”
Winston-Salem has plenty of wealth, but it’s conservative wealth. Families in the city built savings through more traditional industries — agriculture, textiles, and manufacturing. Investors get excited about throwing money into another apartment building at Main and Main — but they won’t take the same risks on biotech startups. The city is full of smart savers, but they cringe at anything short of a sure bet.
Bertram knows this problem firsthand.
“When I started ProKidney, we raised several million dollars from local investors. A year later, they got a 12x return.”
But for a company to grow beyond its early stages, it needs hundreds of millions or even billions in funding.
Venture capital firms in Boston, Silicon Valley, or Austin aren’t going to fund a Winston-Salem company unless it moves to their city. And the wealthy investors in Winston-Salem aren’t comfortable making the kinds of high-risk, high-reward bets that biotech requires.
Bertram is working on a concept he calls “kind capital” — a structured investment platform that pools local capital and de-risks early-stage biotech opportunities.
“We need to help investors understand the real probability of success,” he explained. “In medicine, 95% of things fail. But if we de-risk the science, prove the manufacturing process, and show a clear regulatory path, suddenly we go from a 5% probability of success to 50% or more. That changes the investment equation.”
He believes Winston-Salem’s unique combination of biotech innovation, a skilled workforce, and a history of manufacturing could create a sustainable life sciences industry — if we allow it to flow.
“We have this culture of innovation and entrepreneurship,” I told Bertram, “but we’ve struggled to retain it. It’s like trying to hold water — the harder we grip, the less we have.”
Bertram sees it too.
“The talent is here. The science is here. The workforce is here. But we have to build the capital ecosystem around it,” he said. “We need people to stop looking at this as charity or economic development and start seeing it as what it is — one of the biggest investment opportunities of the next century.”
He’s right.
I’ve been hard on Winston-Salem in recent months. Some might say too hard. My critiques of our city’s economic direction, our struggles to retain businesses, and our inability to cultivate a thriving innovation economy have ruffled feathers. But after this conversation, I see a real path forward.
The only question is — will we take it?
