Brendan Shaw looks ahead to the rest of 2023, identifying five key trends to watch out for in the healthcare and life sciences sector. With the worst of COVID-19 now in the rear-view mirror for much of the world, Shaw questions whether the lessons and progress that the pandemic brought will be built on in the coming year.
Some dance to remember, some dance to forget
The Eagles, ‘Hotel California’
A bit like the lonely traveller who tries to escape from the ‘Hotel California’, the world will spend 2023 trying to work out whether it wants to be trapped in the way things were before.
After the first pandemic in human history where large swathes of the world’s population were vaccinated against the offending pathogen within a couple of years, we have an opportunity to adopt to a new way of working in global health.
Or will we revert to the old quarrels, slogans and occasional name calling that has sometimes characterised debates about medicines policy through the ages?
A key business issue for life science companies in 2023 will be how they contribute and position themselves in these health policy debates as we get a glimpse of the post-COVID period in the 21st century.
Valuing medicines and vaccines in the future
The global response to the pandemic was a demonstration of the value of vaccines and medicines, more powerful than anything a drug lobbyist and their slide deck could hope to achieve.
2023 will be the year when some countries, at least, try to return to some sense of normality. Not everywhere and not all at once, but it’s a start.
These first tentative steps towards normality are possible in no small part due to our ability to treat and prevent COVID-19 through medicines and vaccines developed by the life sciences industry.
The point is: will anybody care or remember?
The risk for life sciences companies today is that the politicians, policy makers, payers, regulators, key opinion leaders and experts who frame the business environment may quickly forget about the lessons from COVID-19.
In a year where the global community’s attention is now very much focussed on the cost of living, high prices, rising interest rates, budgetary problems, war, broken supply chains and expensive airfares, life science companies are going to have to find a nuanced approach to issues like medicine pricing, access to medicines, health care spending and environmental protection.
For example, with inflation running at its highest level in decades in many countries and cost of living pressures featuring as a major political issue the industry could expect more, not less, political arguments about the price of medicines in the future.
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Recent developments like reforms in the United States to give Medicare the power to negotiate medicine prices through the Inflation Reduction Act, unexpected company mandatory rebates under the administration of the United Kingdom’s Voluntary Agreement for Branded Medicines Pricing and Access, AMNOG drug pricing reforms in Germany, and the introduction of health technology assessment in Japan, are all going to be interesting debates in the aftermath of the pandemic. Recent issues with valuing emerging cell and gene therapies in Europe are a case in point, with several companies withdrawing new therapies after disagreements with local payers there.
There is a bitter irony here that political pressures about pricing come hot on the heels of a pandemic which proved how much the world has undervalued health, medicines, and vaccines for decades.
At the global level, players in debates about investment in health care and medical technology run the risk of reverting to the old pre-pandemic name-calling and fist fights about patents vs access, affordability vs innovation and so on. There have been some good recent discussions at G20 meetings, the World Bank and others highlighting the economic value of medical technologies in treating the pandemic. Whether this translates into a better dialogue about future valuation of medical technology and investment in health systems remains to be seen.
Supply of and access to medicines in all corners of the globe
The global community has become more attuned to the importance of ensuring supply of medicines. For example, in China right now there are stories of people giving COVID anti-viral drugs as gifts to friends in the latest COVID surge there – a demonstration of the value and importance of medicines if there ever was one.
The industry’s approach to emerging markets is also going to be important. The latest Access to Medicines Index suggests pharma companies have done a good job in evolving their access strategies, but could do more to think about access in low-income markets. Meanwhile countries in Sub-Saharan Africa are continuing to become more important in global markets as they develop in scale, size and standards. The work this year to develop the new African Medicines Agency based in Rwanda will mark an important moment in the growth of Africa’s place in the global pharmaceutical market.
And while the industry has done, frankly, an amazing job building the supply of vaccines around the world in the last three years, there are still major discrepancies in global COVID vaccination rates with low-income countries seeing much lower rates than other countries. This might not be the industry’s fault, but the problem is going to persist into 2023.
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Against this backdrop, ‘ESG’ (Environment, Social and Governance) issues could – and maybe should – take centre stage in company business strategies this year. Be it social issues about pricing strategies for new medicines and access to medicines initiatives, ethical and governance issues around engaging with patients and governments, or environmental issues ranging from climate change through to pollution through medicine packaging and manufacturing residue, the issues are complex. After many years of talking about ESG and its variants, 2023 may be the year when all of this becomes central to broader life science company strategies to grow their businesses, not just protect them.
The post-pandemic health policy agenda
2023 is also likely to see several health policy issues on the agenda in the aftermath of the pandemic.
The first drafts of the new Global Pandemic Accord will be considered at this year’s WHO Executive Board and World Health Assembly meetings in February and May respectively. This will be an important process to ensure the world finally starts learning lessons to better manage future global pandemics. However, the signs are already there that this process risks becoming bogged down in the old battlelines of drug pricing, patents and open access, ‘evil Big Pharma’ and the usual palaver, rather than finding a genuine way to step up global cooperation.
The next version of the World Health Organization’s Essential Medicines List is due for consideration in April in the first year proper since the pandemic has receded. If past years are any guide, we are likely to see several important medicines proposed for listing that will invoke some of the broader policy issues in global health.
In September, on the margins of the United Nations General Assembly in New York there will be a UN High-Level Meeting on Universal Health Coverage – a political level meeting to examine progress on achieving UHC. This will be timely given that by September we will be at the halfway point in the 15-year timeframe to achieve the UN Sustainable Development Goals by 2030, with UHC being one of the key health Goals. There are already signs that progress to implementing UHC for the world’s population has stalled or even gone backwards. WHO Director-General, Tedros Adhanom Ghebreyesus, has already said that the COVID-19 pandemic has set back country progress and is only one-quarter of what it should be.
Post-COVID disease burden and health policy
Another likely topic to gain more attention in 2023 is the accumulated burden of disease and health system issues in a post-pandemic world. The hangover of long-COVID, years of neglected non‑communicable disease management and testing, and the mental health impacts of the pandemic are likely to feature in global health debates.
A topic of conversation that will also be discussed is the loss of staff and capacity in health systems around the world still struggling to cope with COVID and its aftermath. It’s one thing to clap and applaud your local health workers during the pandemic to say thank you, but it’s another to make sure they’re appropriately resourced and paid so they can do their job properly. Investing in the future of health systems is going to be a big issue.
This doesn’t mean that pandemic preparedness and COVID management goes away. The sudden but delayed opening up of China – which represents nearly one-fifth of the world’s population – is an example that shows the management of COVID is going to be an ongoing issue for the world through 2023.
Evolving public-private sector partnerships
The pandemic saw something of a watershed in the way the public and private sectors collaborate to help overcome COVID-19. At a national level, there were many stories of new public-private sector initiatives to rapidly develop and distribute COVID vaccines and medicines to the world. Governments, industries and companies found ways to work together in ways that had been inconceivable before the pandemic. The cooperation on things like the prioritisation of investment and research into COVID vaccines and medicines, and the degree of voluntary licensing to get products developed and out the door was phenomenal.
What should dominate discussion in 2023 is how these ways of public-private collaboration can be adapted in other areas of health policy. This is an example of how the pandemic could provide guiding paths forward for companies, industry, governments and the global health community to invest and develop our health systems for the 21st century.
History shows that pandemics have a habit of sparking changes in society that weren’t appreciated at the time.
It might be that 2023 is the year we learn to move on together, dancing to a new tune in global health.
Brendan Shaw is Principal of Shawview Consulting, a consulting firm specialising in global health, pharmaceutical policy and strategy (www.shawview.com).
