This is a key moment for health systems and opportunity for pharmaceutical companies
In an ideal world, the right to health is a key value. In many cases, it has become a reality, with citizens able to access quality medical care that protects their lives, ranging from prevention and diagnosis to treatment and care, all of which is necessary to guaranteeing the population’s wellbeing.
Health management, often seen as the cornerstone of a healthy life, becomes a challenge for governments and the various stakeholders that come together in search of sustainable models. They need ways optimize resources, based on the logic of cost efficiency, while also achieving results that protect the lives of the largest number of people possible, thus generating maximum coverage.
However, the current international scenario has turned into a sustainability challenge for health systems. There is increased social unfairness and inequality, and it is becoming more difficult for governments to address new pressures. These include current and emerging health problems (such as the current pandemic), the greater burden of noncommunicable diseases, and changing demographics. The increasing number of elderly people who require comprehensive care and drugs is one example of this challenge.
According to the World Health Organization (WHO), a “health system” is the set of organizations, institutions, and public and private resources designed to improve, maintain, and restore health. The WHO has highlighted the importance of health for international development, urging governments to adopt measures to guarantee all citizens access to quality health services.
“The current international scenario has turned into a sustainability challenge for health systems”
A sustainable health system is the basis for socioeconomic development. But how can sustainability be achieved, given the overwhelming need for care and lack of resources? Where should efforts be focused? Can pharmaceutical companies be strategic allies to governments? What role can pharmaceutical companies play in this ecosystem? How can citizens be guaranteed access to medical personnel and drugs that improve, prolong, and save lives?
In this article, we review the need for sustainability within health systems and examine the inescapable presence of pharmaceutical companies in the equation of resolving health problems and contributing to sustainable systems.
Health system sustainability
The COVID-19 outbreak has highlighted the urgent need to revamp health systems. They require a better distribution of human resources, public investment to integrate mechanisms that boost efficiency, and a revision of the regulatory frameworks that led to the evaluation and adoption of each system’s existing ones. The goal should be to create through public-private partnerships (PPPs) that bring individuals, civil society organizations, and companies together to tackle specific health problems and design public policies that take all points of view into account.
Due to the recent threats to public health, we need health systems that guarantee access, universality, equity, and, above all, sustainability now much more than ever. In other words, these systems need to be financially sustainable in the medium and long terms.
Sustainability should not just be evaluated in terms of financing, however. It should also include social and environmental aspects, as provided for in the WHO resolution, even though the economic side has become the main cause of concern and cost analyses among those paying in most health systems.
“The COVID-19 outbreak has highlighted the urgent need to revamp health systems. They require a better distribution of human resources”
“Prevention is better”
We have heard on many occasions that it is better to prevent a disease than to have to cure it. This not only applies to patients, but also to health systems. Imagine how many financial and human resources would be saved if health programs focused their resources on health education and disease prevention, addressing the problem before patients required hospital care or advanced treatment?
Dr. Julio Frenk, from Miami University, shared about a trial published by the Miami Public Health Institute and emphasized the need to strike a balance between promoting health and attention to disease. She also stated that good health systems implement programs and policies to keep people healthy and, in the event of a disease or injury, guarantee access to quality health services. However, most systems prioritize disease care over creating healthy environments and promoting healthy behavior.
The Miami Public Health Institute trial offered a historic analysis of how concern for personal hygiene and public health has moved toward interest in diseases and their care. “The current epidemiological transition has increased concern for the prevalence of curative approaches toward health conditions and their financial consequences,” Frenk stated.
It is alarming to see the figures since, according to the WHO, noncommunicable diseases are responsible for 60% of deaths around the world, most concentrated in developing countries. Treating these diseases is considerably more expensive than treating other, more common diseases, such as diabetes. According to the International Diabetes Federation, the economic impact of the diabetes epidemic in 2010 amounted to $376 billion. If curative care continues to be promoted in combating these diseases, health systems will become financially unsustainable. A balance needs to be struck between healthcare and disease prevention since, according to this analysis, the main challenge facing health systems this century is avoiding reductionist solutions that divide and embrace the multitude of perspectives by integrating actions. It is here that PPPs become particularly important.
“The economic impact of the diabetes epidemic in 2010 amounted to $376 billion. If curative care continues to be promoted in combating these diseases, health systems will become financially unsustainable”
Technology and digitalization
The WHO has designed a global digital health strategy that seeks to speed the adoption of digital solutions to achieve the health targets included in the Sustainable Development Goals (SDGs). New technologies and digitalization support equal and universal access to quality health services and enhance the sustainability of health systems to increase health promotion, diagnosis, and disease treatment.
Among other things, digitalization includes patient information, their state of health, and any services or resources that are shared electronically. Technologies, on the other hand, include telemedicine, mobile devices, cell phones, artificial intelligence, robotics, and genomics. For example, genomics has led to increased knowledge of the human genome and has achieved better patient diagnoses; digital devices are now helping control patient heartrates and monitor blood sugar levels; and remote monitoring devices can help better administer health and reduce the burden on health systems. WHO experts consider new technologies to offer a preventive, not just treatment, focus.
The WHO’s vision acknowledges the importance of innovation and sector collaboration, also providing for new business models regarding service provision.
Two examples of this collaboration include:
a) A chance to eradicate Hepatitis C
There have already been developments within some PPPs toward addressing certain health problems, such as campaigns to improve Hepatitis C diagnosis. These PPPs have been developed between industry, the medical community, and governments in some countries.
Treatment breakthroughs have ensured this disease can be cured in 98% of cases after drugs are administered for just a few weeks. According to the WHO, 71 million people live with this disease around the world. Many of those who have it do not know, which is why diagnostic campaigns encouraging citizens to undergo tests and receive treatment have been decisive.
Thanks to these PPPs, fewer patients have required specialized medical attention from health systems, reducing the burden on the provision of care. This disease may even be eradicated in the future.
b) COVID-19 and the value of PPPs
One of the recent challenges has been preparing for pandemics. COVID-19 has shown the tremendous impact collaboration can have on public health, and one of the finest examples of this is the Coalition for Epidemic Preparedness Innovations (CEPI). This multi-party coalition, headquartered in Oslo (Norway), was launched in 2017. Since then, it has specialized in responding to epidemics and pandemics such as the one we are now facing.
CEPI is made up of governments, international organizations, foundations, civil society organizations, and private sector companies, as well as the WHO. Vaccine development has historically been a long, risky, and expensive process, but CEPI has meant that health sector representatives, authorities, companies, and governments from all around the world have come together to collaborate on a COVID-19 vaccine.
At the frontline of the fight against COVID-19, this alliance between the public and private sectors has been clear. Other collaborations have been forged between sectors to meet the needs of different countries around the world. In Brazil, a continental country with its own regional peculiarities, 62% of the 430,000+ existing hospital beds are in private institutions. Of these, 52% are now available to the public sector.
With the outbreak of the pandemic, collaboration between the public and private sectors intensified. The private network devoted itself to building and operating field hospitals, acting quickly to develop procedures to handle the disease. This provided a major contribution to COVID containment, though it still persists in the country.
Opportunities for pharmaceutical companies: Six key points
- A new narrative: Innovation and collaboration
It is no longer enough to research and develop new treatments. A focus on collaboration and actions that bring innovations to those who need them is necessary. This context represents a unique opportunity to build a narrative that confronts negative social perceptions and emphasizes the value of the pharmaceutical industry as a fundamental stakeholder. It can be a strategic partner in improving health systems, which can then achieve sustainability through these collaborations.
- Transparent communications about health problems
It is necessary to have strategic communications and transparent positions in place. These help improve understanding of the contributions and impacts companies can have on potential solutions to health problems.
- Relationship planning and alliances
It is essential to have a relationship plan tailored to both the current political and social context and the health sector ecosystem, allowing companies to act proactively and identify government and health system points of interest and needs. This proactivity can help forge alliances with governments and health organizations that anticipate long-term health risks and problems.
- Digital transformation
Some companies have made significant progress toward digitalization, and it is clear that health systems supported by digital technologies can better reduce inequalities. One example of this is telemedicine, which guarantees access to health services for people who cannot travel to hospital, whether due to living in an isolated area or any other reason.
Health professionals must improve their digital skills, and they should even consider training and interacting with patients. This would help improve doctor-patient relations and generate a shared decision-making process. Furthermore, companies can propose digital tools and technologies that make health systems more reliant on prevention than cure.
- Corporate activism and alliances
The times when company CEOs went unnoticed are long gone. We are now seeing a high degree of corporate activism, and how it generates confidence and credibility. Companies now must strategically boost this to better generate a healthier environment for relationships, in turn allowing alliances to be forged.
- Comprehensive proposals for decisionmakers
In addition to innovative models for drug access, decisionmakers must have comprehensive proposals that include actions to raise awareness and prevention, tools for better diagnoses, and programs to sign up for treatments. This will generate a better understanding of the value companies offer in resolving health problems.
Never before has health been under such close scrutiny by so many people, including large research centers, governments, multilateral bodies, the medical community, pharmaceutical companies, journalists, and society at large. Never before has so much attention and money been invested in health, or the impact of health on economic and social development so highly valued. That is why now is the time to revise and plan the health system we need to tackle chronic diseases, ageing, and large demand for pharmaceutical spending. We must consider how these challenges can be tackled through public-private alliances and, above all, how we can move from a curative to a preventive system.
Pandemics will probably never be eradicated, but tools to control and prevent them will always exist. Now is the time to invest in health, research, development, and technology, and for pharmaceutical companies to revise their communication and relationship strategies. Interest in the number of media mentions has long gone. Now, we need strategies that allow regulators, patients, decisionmakers, the medical community, the public, and all relevant audiences to see the social value in attributes such as commitment, innovation, pharmacological advances, and medical devices. These will help us tackle current and emerging health problems, and the companies developing them must be viewed by governments as not only suppliers, but also as strategic partners. Together, they can design public policies that not only strengthen health systems, but also make them more sustainable for the future.