November 2022
Guest editor: Charlotte Ashton | OHE Director
From silence to solutions: Tackling health care challenges together
There are many ways to characterise the COVID-19 pandemic, but 'silent' is not one of them. From public health announcements blaring through televisions to standing on doorsteps clapping for health workers, COVID-19 was a pandemic no one could ignore.
Writing from the UK, the noise has remained overwhelming. Health workers are calling for strikes, journalists are shouting out headlines, and politicians are arguing in the Commons. Amongst all this, it is hard to imagine anything creeping up on us, yet we are amid a silent and ever-growing pandemic.
Declared by the World Health Organization as one of the top ten global public health threats facing humanity, the consequences of Antimicrobial Resistance (AMR) are set to be catastrophic.
Almost 100 years after Sir Alexander Fleming discovered penicillin at St Mary's Hospital Medical School, this same setting may also be the place this pandemic becomes impossible to ignore. AMR is not destined to burst into our lives like other pandemics. It will not enter our every day with shouts of the many hundreds it is hospitalising, nor will it show itself in crashing economic charts and falling GDP figures. Instead, AMR will present itself in hospitals full of patients unable to reap the benefits of modern medicine as once-treatable infections become untreatable and procedures like hip replacements and chemotherapy, current foundations of modern medicine, become increasingly deadly. AMR is threatening to turn back a century of medical progress and yet remains the 'silent pandemic.'
Globally, at least 700,000 people die each year from drug-resistant infections; without effective interventions, this trend is set to rise exponentially. By 2050, we could see drug-resistant infections responsible for 10 million deaths annually. Up to 90% of these deaths will happen in Africa and Asia. Working in global health for the last decade, I have heard the murmurs. From operating theatres in Ethiopia to paediatric oncology wards in Ghana, AMR is finding its voice.
The UK has long played a central role in improving AMR globally. In 2015, in response to the UK AMR Review and the WHO Global Action Plan on AMR, they launched the Fleming Fund. A multi-million-pound programme supporting dozens of countries across Africa and Asia, strengthening surveillance systems and AMR awareness.
In my former role at the Tropical Health and Education Trust, I saw first-hand the effects of these programmes. From Cambridge to Kampala, partnerships have been working to develop pharmacy expertise and capacity. Many of these learnings were crucial in the UK's response to COVID-19.
Despite its central role globally, the UK is still experiencing the damaging effects of AMR itself. In the UK at least 70% of antibiotic prescriptions are written by GPs; however, less than 20% of these prescriptions benefit patients. The reasons are manifold but include diagnostic uncertainty, problems in accessing diagnosis, and a safety net for GPs fearing something more serious. To combat this, in 2020, the UK became the first country in the world to trial the use of the volume delinked payment model for antibiotics, assessed, and reviewed by my colleagues in the latest OHE blog series.
With World Antibiotic Awareness Week just days away and the WHO calling for us to address AMR together, we are reminded that in health, nothing and no one is an island. As the pandemic demonstrated, the links between your health and mine are inextricable. At the beginning of the pandemic, a growing body of international literature began warning us of just this. Our response to COVID-19 pandemic has hastened other "long looming public health threats" – AMR is one of them.
The lessons are clear; public health is more than just medicine and science. Bigger than any individual, it cuts across borders, relying on robust health systems and thoughtful leadership.
Expanding partnerships across all sectors globally helps ensure that strong threads of knowledge and cooperation can be brought together to create solutions in our most urgent of times. Since the first quiet steps of the COVID-19 pandemic and the eery and progressive march of AMR, the need to keep our highways of shared research clear of obstacles and diversions has become even greater.
As OHE continues to impact major policy debates and global health issues, I am excited to have joined this incredible team as we work to support better health care. Providing policymakers with perspective on innovations and generating economic analysis that drives cross-cutting reforms.
From NCDs to monkeypox and from AMR to climate change, we as a global community face complex and seemingly overwhelming challenges. But they are not insurmountable. If we learn today’s lessons we can respond to tomorrow’s challenges and solve the silent health threats of the future.
MY TOP READ OF THE MONTH
“Taking learnings from COVID-19, an access mechanism enhanced with education and other tools, including diagnostics, could ensure the appropriate use of novel antibiotics globally. With combined action, valuable new antibiotics could then be shared equitably around the world.”
The Economics of Antibiotics - What Does the Antibiotics Market of the Future Look Like? | October 2022
OHE colleagues commissioned by Pfizer Inc. have produced a four-part blog series answering the key questions raised by the NICE-NHS England AMR model and discussing what it means for the future of antibiotic development.
Antibiotics are vital medicines, and it is clear that not enough of them are being developed. Novel models to pay for antibiotics have been suggested for many years to incentivise companies to increase their investment in antibiotic development.
Recently the UK has become the first country in the world to test a so-called ‘fully delinked model’ to pay for antibiotics.
This engaging and globally focused series argues that whilst a bright future is possible by taking learnings from the COVAX facility, disjointed action will likely fail to prevent antibiotic resistance from increasing.
Therefore, international, and intergovernmental organisations like the WHO and a G20 Ministerial Health Declaration are essential to coordinating efforts across countries.
NEW OHE LITERATURE
OHE, supported by Professor Alistair McGuire of the London School of Economics (LSE), was
commissioned by the British Generic Manufacturers Association (BGMA) to carry out a study looking at what the impact would be on NHS medicines costs over the lifetime of the next Voluntary Scheme for Branded Medicines Pricing and Access (VPAS).
The analysis shows that the rising VPAS rebate rate - which is estimated to increase to 23.7% next year but could be even higher than 30% - is having a significant negative impact on branded generic and biosimilar manufacturers. As a result, competition risks being seriously eroded.
Health systems internationally must prepare for a future of genetic/genomic testing to inform healthcare decision-making while creating research opportunities. High-functioning testing services will require additional considerations and health system conditions beyond traditional diagnostic testing.
Based on a literature review of good practices, key informant interviews, and expert discussion, this article, with OHE contributions, attempts to synthesize what conditions are necessary, and what good practice may look like. It is intended to aid policymakers and others designing future systems of genome-based care and care prevention.
Rapid technological advancement calls for the consideration of real option value (ROV) in value assessment; nevertheless, methods for quantifying ROV remain exploratory and lack consensus.
ROV was included as an element of value in the ISPOR US Value Assessment Task Force Report. A review identified several ROV estimates, and Li et al report others. Nevertheless, payers and health technology assessment bodies have, to date, shown limited interest in the concept.
In this new article, an OHE author provides commentary on a recent "pragmatic guide to assessing real option value for medical technologies", contributing to a growing literature on augmenting conventional cost-effectiveness analysis with novel elements of value.
NEWS HIGHLIGHTS
To date 1.79 billion doses of COVID vaccine have been delivered to 146 countries through the GAVI led COVAX initiative. Almost 186 million of those doses have been Moderna's original shot.
While at first the initiative struggled as wealthy countries snapped up limited supply, 2022 has seen a glut of the original vaccines, prompting negotiations to try to better align supply with demand.
Responding to this, Moderna has agreed to provide its new variant-adapted COVID-19 vaccine to the global scheme aiming to deliver shots to the world's poorest people.
The biotech company and vaccine alliance GAVI will cancel their existing supply deal for vaccines based on the original coronavirus strain. Instead, Moderna will supply up to 100 million doses of its new, variant-adapted vaccines at its lowest available price from 2023.
In the UK, the healthcare sector is one of the biggest contributors of greenhouse gas emissions.
A peer-reviewed study of 11 UK health organisations has for the first time compared climate credentials by ranking them on four key aspects of their response to the crisis: internal operations, education and training, divestment, and advocacy.
The Royal College of Paediatrics and Child Health (RCPCH) scored the highest at 41.75 out of 64 (65%), with the College of Paramedics scoring the lowest with a total of 13.
Commenting on the results, RCPCH president Camilla Kingdon said, “As paediatricians, we need to be at the forefront of climate activity, given that the impacts of the climate crisis will be predominantly borne by children around the globe.”
Since 2016, widespread outbreaks of hepatitis A virus (HAV) infections in the US involving person-to-person spread reveal a shift in the disease’s epidemiology that requires a new approach to curb transmission, according to a new report from the US Centers for Disease Control and Prevention (CDC).
The report has found that the majority of infections from 2016 to 2020 occurred almost exclusively among adults and were related to drug use or homelessness.
As a result of focused efforts, from 2017 onwards, through a large-scale multifaceted response targeting populations most affected, in September 2022, 24 states officially declared their HAV outbreaks were over, the report said. Currently, outbreaks remain active in 13 states, although these states report decreased case counts.
UPCOMING EVENTS & ON-DEMAND
Vaccines, Antivirals, Lockdowns and COVID: Learnings from the pandemic
On-demand | Virtual
This webinar brought together a collection of some of the leading decision-makers and eminent policymakers from the UK Government’s COVID-19 response through the world-leading vaccination programme and extensive antiviral rollout. The speakers discussed their experiences in government and how to handle risk, uncertainty and imperfect information in emergency situations and key lessons that should be applied for future pandemic preparedness.
7 December | Virtual
In our final webinar of the year, we are reflecting on the highlights of the past year, which OHE research trends have had the biggest impact and discussing the emerging issues in 2023.
Join our industry-leading experts as they reflect on; 60 years of OHE, the 'silent pandemic', Caring for carers, and Innovation, precision and value. The final presentation explores major policy issues including sustainability and digital health technologies, that OHE predicts will lead the field in 2023.
14 December | Virtual
'How can policymakers design a system to generate fair prices that balances access and innovation throughout the lifecycle of medicines?'
Join us for the 2022 OHE Innovation Policy Prize award ceremony, where the winner will present their solution – an original, globally feasible, and theoretically grounded piece of research. You will also hear from our expert judging panel who will discuss the challenges we’re facing regarding ‘fair pricing’ and the broader range of ideas and solutions we received.
Register your free ticket today.
