The global Covid-19 pandemic has exposed the weaknesses of public healthcare systems in both developed and developing countries alike. According to a new report coming out of Swiss bank Julius Baer, this has created an opportunity to make a fundamental change that has not been possible up until now. This change, says Damien Ng, PhD, a Next Generation Research Analyst at Julius Baer, will encompass the entire spectrum of healthcare, from the macro level, where the goals of the World Health Organization (WHO) will be redefined, all the way to the micro level, on which personalized medicine can be adopted.
The World Health Organization: An essential organization, despite the criticism
Let’s start with the macro level. The report describes the difficulties the WHO is currently experiencing, as the organization that has been under scrutiny since the COVID-19 epidemic broke out, which has been so intense that the United States, its main funder, decided to withdraw its membership from the Geneva-based organization.
"The WHO, at the current time, is not only dealing with an ongoing epidemic, but is also facing budget instability, which has led to a battle between powers," the report stated. "Its sphere of control remains largely unclear. The WHO has neither the authority to order member states to follow its instructions, nor the power to order countries to allow access to investigate the origins of disease outbreaks. Put simply, national interests of member states trump the importance of the global public health architecture."
Nonetheless, the report continues, "The Covid-19 crisis reinforces the case for a stronger WHO, which can prepare better responses to other public health crises. Fortunately, support rates for the WHO remains high among respondents polled in Mexico (78%), Brazil (75%), India (76%), Germany (59%), Spain (55%) and even the United States (61%), with the exception of Japan and Russia, where more people disagree with the job done by the WHO."
According to Ng, the WHO should be in charge of: Coordinating steps taken by different countries regarding global public health; Helping to distribute medical resources more fairly; Prioritizing and funding research projects; Identifying new research priorities and critical gaps relating to personal protective equipment; Promoting production of diagnostic testing, vaccines, biomedical treatments and other medical supplies; Carrying out and financing independent clinical trials.
In the report, Ng asserts that the countries that before the outbreak were considered the most prepared for medical disasters were not necessarily the ones that succeeded in dealing with the disease in the best way in real time. According to the 2019 Global Health Security Index published prior to the Covid-19 outbreak by the US-based Nuclear Threat Initiative, the Johns Hopkins Center for Health Security, and the Economist Intelligence Unit, the US and the UK were the countries most prepared for a pandemic, while Switzerland, Germany, Brazil and China ranked 13th, 14th, 22nd and 51st, respectively. In actuality, however, countries that were ranked as most prepared, such as the US and the UK, fared less well in terms of infection and mortality, both in terms of per-capita rates, as well as in absolute numbers. According to Ng, the WHO should cooperate with the scientific community to address the failures, if any, in anticipation of possible future crises.
Personalized medicine: The importance of patients’ unique genetic makeup
"The biggest impact the Covid-19 epidemic has had on healthcare is the leap that has been taken in the fields of telehealth devices, remote monitoring and artificial intelligence. More precisely, it’s not the tools themselves that have made this developmental leap, but the openness of healthcare systems to integrate these products. With the greatly expanded implementation of digital health tools, personalized medicine will also benefit since these devices collect and document an extremely wide range of data from each patient."
"We saw the importance of personalized medicine at the beginning of the epidemic when uniform treatments of Covid-19 patients that followed protocols for treating respiratory diseases failed. It quickly became clear that infectious diseases caused by a specific virus have different and misleading symptoms in each patient, and doctors must take into consideration each patient’s unique background before deciding which treatment protocol to follow. For the first time, doctors had to engage in creative decision-making without being able to rely on previous cases documented in medical literature."
Home health care has enabled health care providers to see up close for the first time the environment patients live in and to learn about the challenges sick people face on a daily basis. As a result, doctors are able to take these issues into consideration before deciding on which treatment to recommend. The importance of personalized medicine has been discussed for years, but it has never truly been implemented. Perhaps it will become easier now for doctors to integrate these tools now that they’ve been put to the test during the Covid-19 epidemic.
In this way, the Covid-19 epidemic has brought us closer to the realization of this vision that had not yet been implemented, in which a patient is actually placed in the center of the picture. The genome revolution, which has been taking place over the last two decades, has made it possible to gather genetic information about patients and to further improve the way treatments are personally tailored for each patient.
If in the past it was customary to distinguish between infectious and non-communicable diseases, some of which result from lifestyle, Covid-19 has brought these two approaches together: Most of the people who have died or have become critically ill due to Covid-19, suffered from background diseases, most of which are the result of lifestyle diseases, such as heart disease, diabetes, obesity, lung disease caused by smoking or high blood pressure. Therefore, the report anticipates that medical care will focus on these areas in the future, primarily through behavioral intervention using digital tools and by paying attention to genetic inconsistencies that make some people more susceptible to contracting these types of background diseases.
Seeing as age has been found to be the most dangerous background disease, the report expects that treatments aimed at slowing down the aging process will likely become more popular in the future.
Access to medical care: A failure to treat the most vulnerable populations
Until we succeed in slowing down the aging process, we must strive to find more suitable living and nursing solutions for end-of-life care. During this epidemic, it became clear that nursing homes have found it difficult to protect their residents during epidemics and provide them with a reasonable quality of life. According to the report, digital health technologies could possibly enable many more elderly people to remain living at home in their old age or to live in small communities with their friends, rather than in hospital-like institutions.
Another failure that the Covid-19 outbreak has exposed is the inequality in medical care. It turns out that in some countries, good medical treatment was not readily available to families and individuals with lower incomes, and that its cost was extremely high, even for those people who managed to acquire it.
The economic and psychological burden that resulted from having to pay so much for medical care was enormous, according to the report. In fact, a recent Ipsos poll, 85% of American respondents identified healthcare costs as their biggest worry. People all around the world are hoping that digital medical care will enable higher quality care at lower costs, as well as reducing attrition among the medical workforce.
In China, because of the unique challenges involved in treating patients in rural communities, most of which do not have functioning medical clinics, 94% of doctors are already taking advantage of digital health technologies, compared with 76% in the US, 64% in Germany and 85% in Saudi Arabia.
"A nation’s propensity to adopt digital-health technologies is likely to be more dependent on its unique set of challenges rather than wealth," the report continues.
China is already using two digital tracking smartphone apps to deal with the Covid-19 crisis that residents cannot travel around without: WeChat and Alipay, both of which use quick response or QR codes. The software integrates information about what neighborhood you live in, an analysis of your symptoms and proximity to people infected with the virus, which determine your status: You are red if you have Covid-19 or are waiting for test results; You are yellow if you’re supposed to be in quarantine; And green if you’re allowed to move around freely. Covid-19 inspectors and police officers can check each person’s code and arrest or fine them if they are not complying with regulations.
The authorities in Singapore have taken a slightly different approach, where everyone receives a device that is not linked to their smartphone or their identity, but signals to you if you’ve been near a device belonging to another person who was later identified as being infected with Covid-19.
Other countries, like Switzerland and Germany, use surveillance apps, but they are rarely used due to privacy concerns.
The Chinese approach has been criticized as being unethical, but the authorities have continued employing this method and will most likely continue to use it for the foreseeable future. At any rate, it is a good indicator of how far technology can take us.
Published by Globes, Israel business news - en.globes.co.il - on August 26, 2020 © Copyright of Globes Publisher Itonut (1983) Ltd. 2020