Across disciplines and sectors, experts say it will take treating health care as ‘ecosystems’ and a greater focus on access and equity to achieve solutions to critical health challenges of tomorrow and beyond.

DAVOS, Switzerland – In the wake of the COVID-19 pandemic, huge inequities in access to health care have been exposed that demand more multi-sectoral cooperation to solve, a roundtable of leading health experts agreed.

The discussion among a small group of leading experts in health care focused on equity in health care – finding ways for everyone to attain their full health potential regardless of race or ethnicity, age, disability, gender identity, sexual orientation, nationality, socioeconomic status, or geographical background.

“I’m afraid to say the whole ecosystem needs to be cured,” said Dr Victor Dzau, a 1989 Nobel Prize winner who is president of the National Academy of Medicine and co-chair of the National Research Council in the United States.

“Equity needs to be central to it,” he said. “Whatever the technology is, it has to address that.”

Building access and equity from the start into health care ‘ecosystems’

Beth Thompson, director of strategy for the London-based Wellcome Trust, one of the world’s largest providers of non-governmental funding for scientific research, agreed.

“We have a strong science pipeline in lots of ways, but we really struggle with that leakiness in terms of actually putting it into practice,” said Thompson.

“We have to know where we’re going at the start and build that sense of access and equity from the very beginning into the science where it’s very first done,” she said, “because otherwise we won’t get there.”

Held on the sidelines of the World Economic Forum’s annual gathering in the Swiss resort town of Davos, the discussion was moderated by Seema Kumar, CEO of CURE., which operates a New York City-based “innovations campus” hosted by Deerfield Management Company.

Kumar framed the discussion as an opportunity for change makers, entrepreneurs, and thought leaders to consider how to foster a health care ecosystems approach to solving the health care puzzle. Some called for a more people-centric approach.

“We’ve got to put not just the patients at the center and listen to what they have say, we’ve got to listen to people before they become patients,” said Katja Iversen, an executive adviser, author, board member and advocate.

Health care ‘ecosystems’ puzzle needs diversity of data

Francis deSouza, CEO of Illumina, a US developer, manufacturer, and marketer of life science tools and integrated systems for large-scale analysis of genetic variation and function, took the point about equity – including a need to improve data – a step further.

“Equity is not just a nice-to-have,” he told the group. “If you don’t have equity in the very beginning of the process, you may not even have the right solutions.”

DeSouza said he’s more optimistic than ever that humanity is entering a golden age of biology – in some ways accelerated by the pandemic – that will lead to new screening modalities starting with newborns and lasting for a lifetime of health services.

“You’ll see more sophisticated screens emerge like we have for cancer now,” he predicted, adding it will encourage a more proactive, preventive approach.

“We’ll see therapeutics that leverage your own immune system and are much more powerful than any chemicals you could put into your body,” he said. “We’re seeing that emerging already.”

But some big challenges remain in reforming health care ecosystems, particularly in confronting a lack of diversity in data.

“That’s a huge risk, because we risk systematizing racism into our medicines and diagnostics because those are the datasets used to deliver the future of medicine,” said DeSouza.

“And we need to change that,” he said. “We’ve seen the access issues and, you know, bringing costs down. We’ll do that. But that’s not the whole solution.”

Post-pandemic health care ‘ecosystems’ approaches

More patient advocacy and data sharing might create pressure to change health care ecosystems, according to Rick Bright, an American immunologist who directed the U.S. Biomedical Advanced Research and Development Authority (BARDA) from 2016 to 2020.

“We’ve seen it change somewhat and the pandemic is opening these databases,” he said, adding that there has been an “extraordinary” evolution in partnerships with private companies that also has resulted in more data sharing.

“We’ve seen private sector companies partnering in different ways and sharing information very openly and transparently,” said Bright, who also served as CEO of the Pandemic Prevention Institute (PPI) at The Rockefeller Foundation.

“And the risk now is as the attention focuses and shifts to other things, and as we see these panic-and-neglect cycles constantly for pandemic or the outbreaks, everyone’s recoiling it back and retracting back into their business as usual,” he said. “And how do we keep some of those threads active?”

Daniella Foster, an executive board member and senior vice president for public affairs, science and sustainability for Bayer, said she worries about the billions of people who lack basic health care.

“What keeps me up at night is the half of the world that doesn’t have access to the basic essentials,” she said. “And it’s the basics. It’s heart health and cardio. It’s the lifestyle components. There’s a nutrition component to this. So how do we really pull that through so we don’t have half of the world that’s left behind?”

During the pandemic, much of the world has also been left behind despite the public-private partnerships and increased data sharing that contributed to the rapid development of safe and effective COVID-19 vaccines.

Rich nations mostly benefited because of the inequitable distribution of those vaccines – another prominent topic at the World Economic Forum – due to a “complete collapse of global cooperation and solidarity,” Dr John Nkengasong, director of the Africa Centres for Disease Control and Prevention (Africa CDC), told a panel on vaccine equity at Davos earlier in the week.

“We have to remain optimistic in Africa that, as a continent, we should strive to get to the 70% [global vaccination] target, but we are on 10%. How do we get from 10% to 70%?” he asked.

Image Credits: John Heilprin.