22nd May 2020

The context, of course, is the dual focus on managing the large number of COVID-19 patients appearing in our hospitals and the need to rapidly find a treatment for the illness which will either provide people with immunity (a vaccine) or a suitable therapy for people who have already contracted the disease (at present the focus is on treatments that were developed for other infections). Until these are available, the main weapons in our armoury are good hygiene, social distancing and testing, tracking and tracing.

The biomedical sector has been collaborating in unprecedented ways in the search for a new treatment. A consortium of 15 pharmaceutical companies and NGOs is sharing proprietary knowledge, 25 contract resource organisations are collaborating to build a secure patient database, and public and private sector collaborations are increasingly common[i]. These massive changes have happened in a matter of weeks.

The changes go far beyond pharmaceutical companies to include medical device and diagnostics manufacturers, clinical researchers, public health groups, healthcare systems, and patients.

Innovia’s analysis of these changes indicates that the crisis has, in some cases, merely accelerated pre-existing trends or has, in others, created the conditions for new ways of delivering healthcare. Below we highlight ten important trends that could lead to sustained change even after the emergency is over.

Trends leading to sustained change in healthcare

1. The acceleration of digital and remote solutions: We are seeing the need for digital solutions in almost all sectors of the economy and medicine is no exception. This includes people conducting clinical research (remote trial monitoring), physicians consulting with patients (telemedicine), patients monitoring their own health (apps and wearables), and public health specialists and pharma companies collecting population data to improve their understanding of disease. People are finding these to be positive changes and many will not want to return to doing things as they did them previously. Expect many of these changes to continue.

2. Increased collaboration: The level of collaboration among pharmaceutical companies in search of a vaccine and treatments is unprecedented. In addition, collaboration between the private and public sectors has grown dramatically. Expect some of these collaborations to continue.

3. New entrants: The crisis has opened up the field to new players who believe that they can respond to increased demand and also make a positive contribution. For example, some manufacturers of household goods have used their facilities to make hygiene products such as hand sanitisers and cleaning products; some apparel manufacturers reconfigured their manufacturing lines to create PPE. Some players who do not normally participate in the medical sector have stepped in and created new products. For example, Google and Apple, and also Amazon have collaborated to make a tracking app; Dyson has collaborated with others to design a new ventilator. Expect Google, Apple, Amazon and others to accelerate their existing involvement in health products and services; other outsiders may follow.

4. Increased supply chain resilience: Supply chains have been massively disrupted. Many pharmaceutical and medical device companies will seek to make their supply chains more resilient by shortening or localising them or by increasing dual sourcing. We may also see the emergence of new criteria for selection of preferred partners. For example, OEMs may want ensure that their suppliers are robust to future shocks and will apply new selection criteria to them such as insisting that they are able to provide products reliably despite irregular orders. Expect this to continue in the short to medium term.

5. Servicing pent-up demand: Most elective surgery has been postponed globally. The American Hospital Association has estimated $200bn losses in the US due to cancelled surgeries[ii]. There is likely to be a dramatic increase in demand for surgeries once the lockdown conditions have been relaxed. However, there is a concern that some people will continue to postpone surgery for fear of contracting the virus and loss of income during recovery. Expect renewed demand in the short to medium term.

6. Expectations of speedier delivery: Vaccines normally take around 10 years to deliver. The Ebola vaccine, which took five years to gain approval from initiating human trials, was considered rapid. We are now considering a time frame of 12–18 months to find an effective COVID-19 vaccine. This is unprecedented. Those in the industry worry that expectations for rapid delivery will persist. To develop a vaccine in 12–18 months we may need to run animal and human tests in parallel and we will need to accelerate other phases of development. The demands of this time frame may also catalyse the commercialisation of new technologies, such as nucleic acid vaccines, not only for COVID-19 but then other conditions also. On the likely scale and speed of global vaccination for COVID-19 following approval, careful monitoring and mitigation of adverse events will be critical. Keep a watchful eye on this.

7. New global health priorities: Many organisations such as the WHO are demanding better cross-country co-ordination – for tracking and tracing to be fully effective apps need to work across borders. There may be a shift in the traditional ‘north-south divide’: countries that used to receive aid such as China and South Korea are now assisting the WHO in aiding European countries such as Italy. However, the crisis could also deepen the divide in poorer nations accelerating the need for more humanitarian action focused on making them more resilient to future health crises. Expect medium to long-term shifts.

8. New public health focus: The crisis has highlighted the need for an enhanced focus on prophylaxis and the need to address well-being and mental health issues. Providers may move to a more holistic view of health and there may be less focus on illnesses of the rich and more on general population protection. The population may be expected to take more responsibility for their health and be asked to give up data in exchange for better information and monitoring of their health through apps and wearables. Expect this to have long-term impacts.

9. Differently funded health care systems: The crisis has highlighted deep flaws in healthcare systems, especially those where health provision is not a ‘public good’. Hospitals in the USA are seeing an unprecedented loss of income, especially rural hospitals where three quarters of revenue comes from outpatient visits. One in four rural hospitals in the USA are vulnerable to closure. A number of bankruptcies are expected and there is the possibility that some primary healthcare providers will be acquired by insurers. Telemedicine has taken off in the USA because physicians are being reimbursed at the same rate as for physical consultations. In fact, telemedicine is accelerating globally because the return on investment can now be proven and both physicians and patients like it. In countries where there are national health systems, funds are being poured in to enable resilience to future shocks. Expect this to have long-term impacts.

10. Raised patient expectations: People have become much more aware of health in general as the case fatality rate is higher for those with chronic conditions such as hypertension and diabetes. Many have formed new habits and are cooking fresh food, eating more healthily, and doing more exercise[iii]. In terms of healthcare, patients may have crossed a psychological hurdle and may find that they like remote consultations because they save on travel time and are more convenient. Expect some people to continue with these changed behaviours.

 
These changes are likely to have a significant effect on existing players in the market. For example, how must the healthcare system change to be able to properly control infectious disease in an era of globalisation? Will some parts of the medical consultation have no in-person interactions and diagnoses ? And how different will the medical profession look if the preferred metric was the equivalent of Gross National Happiness not quality-adjusted life years?

In addition, we could see new opportunities in health and well-being. Who will become the designer of choice for spaces that are more hygienic and safer? Will we see the design of new types of equipment for cleaning? Where will the temperature sensors we will need at all transport hubs come from? And who will be the main provider of easy diagnostic devices you can use at home or in the office?
Welcome to the new world of medicine.

[i] Ciger, Ali, Pfizer, Future of Virtual health Summit 30 April 2020
[ii] American Hospital Association Guide May 2020, https://www.aha.org/guidesreports/2020-05-05-hospitals-and-health-systems-face-unprecedented-financial-pressures-due
[iii] Change in exercise habits during COVID-19 pandemic in the United States, April 2020, Statista https://www.statista.com/statistics/1110985/covid-exercise-habits/ and https://www.statista.com/statistics/1110483/activities-since-staying-at-home-due-to-the-covid-19-pandemic/