Guest editor: Mireia Jofre-Bonet | Vice President
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2021: A course in accelerated learning. The year 2021 has involved an amount of learning and adaptation of all layers of society that must have very few parallels in recent history. We had yet to recover from the 2020 hangover when a new COVID-19 wave hit. Like all waves, it subsided, driven by a race to vaccinate the population. As we head to the end of 2021, whilst in the middle of the latest wave of the COVID-19 pandemic surging in Europe, the Omicron variant irrupts.
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Much success has been achieved in the 'fight' against COVID-19 in the UK, with a current estimation of 83.5% to 89.8% of the adult population across the four countries being double vaccinated. This success has been despite restrictions of the healthcare system capacity, competing healthcare demands, rapidly changing guidelines, and the current need for boosters. In addition, there has been vaccine hesitancy across social and cultural groups, driven by the misleading/mixed messages on social media and wider journalism, lack of understanding, historical precedence, and a distinct lack of trust in governments. Efforts to overcome these barriers have brought up the stick or carrot debate but have also resulted in some positive population-specific strategies.
Whilst the drive to vaccinate and overcome COVID-19 in the UK has moved in a positive direction (with some derailments), there is still a distinct inequality of access to vaccines. Noticeably, poor access to vaccines for LMICs has resulted in seriously low vaccination rates. COVAX was created to allow for equitable access to COVID-19 vaccines, but the current question is whether it is working. This is a multifactual question, addressed to this organisation (a collaboration of CEPI, GAVI and WHO) set up in a time of crisis with a remit to vaccinate an enormous population. This mission has been compounded by numerous factors, including LMICs’ fragile healthcare systems, global vaccine production, country import regulations, vaccine hesitancy and a global refugee crisis.
In 2021, OHE invested much effort to identify vaccines' broader value, as discussed in our October Bulletin. OHE has also continued to contribute to understanding patient preferences - crucial to assessing the benefits of health interventions - and contributed to the methodological issues around HTA given the changing nature of therapies to be evaluated. OHE has finally also provided insights into the eternal tension between regulation and innovation in the pharmaceutical sector, which was the subject of OHE's Annual Lecture.
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“Our findings offer further support to the evidence that (lack of) trust and conspiracy beliefs predict vaccine hesitancy, both generally and for Covid-19 specifically. They also highlight the importance of distinguishing between different types of social and institutional trust (i.e., trust in others, government, media, scientists/experts) (…). Like other studies, we find that trust in science and health organisations is important."
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Lack of Trust, Conspiracy Beliefs, and Social Media Use Predict COVID-19 Vaccine Hesitancy | Vaccines, 2021
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High global vaccine coverage can limit COVID-19 evolution, protect immunocompromised individuals and lower the chance that highly mutated viruses spread. The jury is out on whether the Omicron variant reveals the dangers of uneven access to vaccines. But, while access is a challenge to global health,
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so is vaccine hesitancy. In an increasingly social media-dominated world, a worrying finding in this article is that citizens relying on relatively unregulated social media sources for information are less willing to be vaccinated. Given this, the authors recommend that governments engage with the web to fill knowledge gaps and to balance the information available to avoid misinformation and conspiracy theories going viral.
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OHE's research interest in opportunity cost in health care has been active for many years, with a particular focus on cost-effectiveness thresholds. Following the publication of the first estimates of the cost-effectiveness threshold for England in 2013, OHE explored some of the underlying assumptions of that study. OHE's work led to conclude that as providers in diverse clinical areas might have different levels of efficiency, there is more bias and uncertainty in the estimates than recognised initially. This strand of OHE's research interest is reflected in Chris Sampson (along with Ashley Leech and Borja Garcia-Lorenzo) becoming the editor of a new Research Topic for the journal Frontiers in Health Services. The journal aims to publish methodological, theoretical, and applied research studies to advance policy and practice in this area.
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Given the extreme shortage in this area, this report highlights the need to find ways to make better use of the organs currently available. This includes improving post-transplant care to increase the likelihood of a successful transplant and extending the duration of graft survival, with the ultimate goal of "one transplant for life".
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This report summarises a study that assembled a broad range of stakeholders to work toward consensus on the challenges and solutions which promote better patient access and sustainable health care and innovation. Through an innovative methodology (pre-meeting survey, virtual meeting, and two-week online platform meeting), OHE used a modified Delphi approach to work toward consensus on the principles of the problem and solutions for multi-indication therapies. This was complemented by a payer survey and supplementary research to address the evidence gap. Sixteen experts from eleven countries covered the perspectives of the patient, payer, health technology assessment decision-maker, policymaker, health care provider/clinician, regulator, data expert, health economist and industry. The expert panel considered that differentiating payment based on value at the indication-level represents an important part of the solution for multi-indication therapies.
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Obesity affects one in five children in the UK. Obesity increases the odds of a child developing serious health issues such as type 2 diabetes, liver conditions, and early heart disease, as well as sleep problems, depression, and low life satisfaction. The NHS has launched this pilot initiative that aims to deliver the NHS Long Term Plan ambition to treat children for severe complications of obesity, in order to increase their health, their quality of life, and avoid more costly and invasive treatments down the line.
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As we continue to learn about the properties of the Omicron variant, we see what the virus can teach us about mutation. The variant carries several mutations that are expected to change how the virus behaves. Some of the mutations are thought to be in the regions coding for the features recognised by the immune system, potentially allowing the variant to evade protection given by vaccines. The low vaccination rate in the region where the variant has emerged and natural immunity from contact with previous variants may play a key role, but an article in Nature highlights that researchers still need to measure the variant’s potential to spread globally — possibly sparking new waves of infection or exacerbating ongoing rises being driven by Delta.
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As reported by The Economist, America’s National Institutes of Health has invested over $1bn to fund research on long COVID and the UK is following up thousands of long COVID patients. These efforts will result in a mapping of the biological pathways for breathlessness and brain fog by looking at changes in the brain. The search for treatments relies on deciphering whether a long COVID symptom is caused by damage to blood vessels, the nervous system or other soft tissue. Other areas of research are focused on tracing breathlessness to specific parts of the body (lungs or cardiovascular system) as well as confirming the presence of cytokines, molecules potentially markers for a hyperactive immune response, which is a suspected cause of long COVID.
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9 December | Join OHE’s global thought-leaders and industry experts to discuss the highly controversial issue of value and prices of orphan medicines, and how to set a fair reward to private R&D investments. We will be exploring patient perspective on medicine access challenges, collaborative solutions to address uncertainty and data gaps to accelerate access to promising therapies.
£375
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14 December | OHE's final webinar of the year will be a reflection on the highlights and lowlights of 2021, on which OHE research trends have had the biggest impact in 2021, and a discussion of which emerging issues we have identified for 2022. The webinar will include: a reflection on OHE's research trends and key themes in 2021; a summary of the key findings from the various strands of our vaccines research and lessons for 2022; OHE's methodological work around the measurement and valuation of
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health; a discussion of the key drivers, barriers and enablers to methodological changes by HTA agencies over time, based on recent experiences; and OHE's contributions in 2021 to unpicking the unintended consequences on pharmaceutical innovation of regulations aimed to address rising healthcare spending. Finally, it will conclude by exploring OHE’s perception of some of the major policy issues in 2022 and whether OHE should be focusing research effort to inform these debates.
Free
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