Building a More Resilient and Sustainable Health System

The COVID-19 pandemic brought together the world and taught health systems how to be resilient and adapt to both predictable and unpredictable changes, said the panelists during the plenary on day 1 of Virtual ISPOR 2021.

The COVID-19 pandemic has taught the world a lot about resilience, sustainability, and the ability to respond effectively during a crisis. During a plenary session on day 1 of the Virtual ISPOR 2021 meeting, panelists representing various global perspectives weighed in on what we have learned from the pandemic and how we can apply those learnings to create a more resilient health care system that can adjust to predictable and unpredictable changes.

Vivian Lee, MD, PhD, MBA, president of health platforms, Verily Life Sciences, focused on 3 specific lessons. The first was something that the pandemic really drove home, which was that “the most important elements of health care don’t take place, necessarily, in the 4 walls of clinics and hospitals.”

She referred to an idea being championed by the Institute for Healthcare Improvement, which is that health is co-produced by individuals, their families, and their care providers. The co-production of health starts with a focus on wellness, prevention, and public health. The pandemic challenged these elements of health, but the pandemic has also shown that digital technologies can make the co-production of health possible.

Second, employers play a critical role in health care in the United States and they really engaged in health during the pandemic. Lee expected that employer interest in preventing employees from getting COVID-19 will extend to the flu, other infectious diseases, and beyond to heart attack, stroke, breast cancer, and depression.

The third lesson has been around the benefits of payment reform. The United States has been talking about payment reform for years, she said, but the move to pay for value has gone slowly.

“But COVID[-19] has dramatically affected the narrative, because who did the best during the pandemic? Those health systems that were paid prospectively, those health systems that have reliable income,” Lee said. “I think we've learned a lot of lessons about how value-based payment models can create a much more resilient health care system.”

Bernardo Mariano Jr, chief information officer, World Health Organization, also had 3 main takeaways. The first was the power of collaboration to strengthen health systems; second was the need to scale up for global impact; third was creating a sustainable environment and accelerating the gains made.

The virus isn’t the only issue anymore, he said, because there are variants now.

“We need to make sure we do better by applying these 3 elements: collaboration, the ability to scale up, and the ability to sustain,” Mariano said.

Now, the world is moving to living guidelines that can be produced faster and change as the evidence changes. In the past, it might take 2 years to change guidelines, but we are now in the Digital Age, he said. However, it is important to remember that approximately 43% of the world is still not connected and does not have access to broadband, Mariano said.

“We need to build partnerships to make sure that in reality we see communities moving into a digital age,” he said.

Following that move, there is a need to build a trusted digital ecosystem, which would be necessary if the world wants to set up a smart vaccination certificate.

While most of the world was surprised by the COVID-19 pandemic, Susann Roth, MD, MPH, PhD, said her organization, Asian Development Bank (ADB), saw this scenario coming. Roth has helped manage trust funds to pilot innovative health sector innovations and pandemic preparedness.

Lee had mentioned that health is created outside the 4 walls of care facilities, and development banks like ADB play a role to create sustainable and resilient social protection systems, Roth said. For instance, paid leave would have helped in developing countries to avoid infections and deaths, according to ADB’s modeling. Without paid leave, people go to work while sick, she explained.

Health economics outcomes research can help better understand management and prevention. For example, in the Philippines, people understand how to manage when they get sick, that they need to isolate, because they don’t want to go to the hospital for various reasons. There needs to be more research on what works and what doesn’t, she said.

“I think the pandemic has shown us, it's more expensive to have a pandemic and to get sick than to prevent it,” Roth said.

Finally, Kylie O’Keefe, vice president, head of global strategic marketing and business intelligence, PTC Therapeutics, Inc, focused on how patients with rare disease were impacted by the pandemic. Throughout the pandemic, these patients faced challenges to being available for clinical trial research and getting access to therapies. Pharmaceutical companies found it challenging to conduct real-world quality-of-life and burden of disease research.

The pandemic did provide some opportunities, such as the ability to pivot and collaborate. PTC had a small molecule therapy being developed for acute myeloid leukemia that is being studied for COVID-19.

Throughout the pandemic, the focus has shifted from process to patient, she said. Adjusting process discussions to move away from a “tick box exercise” has been important for patients with rare diseases.

“We need to apply not a one-size[-fits-all] thinking, but a sort of more tailored and targeted approach to address the needs of the patients that, in many cases, have so far been left unaddressed and bewildered during this pandemic,” O’Keefe said.

An audience member asked the panelists if they agreed with a proposal, which President Joe Biden has since backed, to waive intellectual property (IP) rights for COVID-19 vaccines. While Mariano was in support of the proposal, the other panelists were not convinced that was the right move to boost vaccine supply.

“We have a world problem,” he said, adding that no one can escape the impact of the virus and one sector should not profit from the entire world. Mariano predicted that not waiving the IP rights would mean the pandemic will be around for another 3 or 4 years. “We need to start addressing the intellectual property issues on vaccines, as well as on therapeutics later on down the road.”

For example, if a small village in Mozambique, Africa, does not get vaccinated, a new variant could appear, he said. However, he understands that companies need to generate revenue, but he’s confident there can be a model that doesn’t penalize the private company but benefits the whole world.

“The end result that we would like to see is that every continent would be able to produce vaccine,” Mariano said.

O’Keefe, representing the pharmaceutical industry, had a very different take. For her, the focus should be less on IP and more on distribution capabilities and ensuring that the distribution of vaccines is supported throughout the world in different countries. Manufacturing the vaccines is a complicated process.

“Lifting the patents doesn't necessarily mean there's going to be a transfer of skills with the ability to manufacture these complex vaccines—and therapeutics, in some cases—in certain countries,” she said.

Lee agreed with O’Keefe, adding that manufacturing issues and drug shortages have been common before the pandemic, and even for very common therapies. “This has been a serious issue in the US for decades,” she said.

Roth added that there are many reasons vaccines are rolled out slower in developing countries, and they can be linked back to relevant investments needed with the supply chain, the ability to monitor adverse events, regulatory issues, and more.

“So, these are all kind of the enabling environment aspects, which we haven't really invested in over the last couple of years, which are now kind of biting us in our backside,” Roth said. “So, it's a lot more complicated, I think, than [just] patents.”

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