This year, World Health Day marks 76 years since the World Health Organisation (WHO) was founded. The theme for 2024 is “my health, my right”. The message comes in light of recent health disasters such as famine, conflict and dangers created by climate change to health.
Looking back at recent responses to global health issues and disasters, one important aspect of the response to Covid-19 was the way it accelerated developments in science and digital technology to address urgent health needs. This resulted in the rapid production of vaccines and therapeutic agents and a very rapid increase in the use of a variety of digital health services. This experience has led to a recognition of the major contribution that recent innovations in science and technology can make to the availability of effective and affordable health services.
Many years of experience have shown that the availability of a new technology, on its own, does not necessarily lead to its rapid incorporation into goods and services. Nor, does it ensure equitable access to the benefits. In addition, there is a risk of harmful unintended outcomes. That is why it is important to establish governance arrangements to ensure that the benefits from innovation are made available at scale on an equitable basis. IDS is involved in two programmes that illustrate different aspects of this issue.
Towards digital transformation for universal health coverage
The Mutual Learning for Mixed Health System Platform, is a research partnership between the Centre for Sustainable Health Innovations, Public Health Foundation of India, Amref Health Africa and the Institute of Development Studies. It undertook a series of consultations with government officials, private companies, politicians and funding agencies over several years, including during the pandemic.
One issue that was consistently raised was the rapid spread of digital health and the need for strategies to ensure that these innovations contribute to national strategies for making rapid progress towards universal health coverage. There was broad agreement on what a digitally-transformed health system might look like, but there was much less agreement on the practical steps needed to make this happen.
There was also a concern about the danger of undesirable outcomes that could emerge because of unequal access to digital services, excessive influence by suppliers of drugs and diagnostic devices on the kinds of treatments recommended, and the possible domination of health systems by large digital platforms.
The incorporation of digital innovations at scale will involve new kinds of partnership between the health and digital technology sectors and between the government and private companies. One challenge is that many digital health innovators are small and large private companies, with relatively little experience of working with the public health system, while most managers of government health services have little knowledge of the technology sector.
Another challenge is the need to ensure that the kinds of innovation that are prioritized for wide-scale use meet the needs of different social groups, including the poor and vulnerable. There are no blueprints for the governance arrangements that will support a process of digital transformation to make the benefits of digital health widely available and discourage undesirable behaviour.
Towards Digital Transformation for Universal Health Coverage, a report published by The Mutual Learning for Mixed Health Systems Platform in June 2023, outlines an inclusive and iterative approach for the management of digital transformation. It calls for the organisation of transformation labs that bring together a wide variety of stakeholders to build mutual understanding of the health and digital health innovation ecosystems, define social objectives for digital transformation and identify the roles and responsibilities of each stakeholder in the implementation of an agreed intervention. The lessons from the implementation of this intervention can contribute to a learning approach to the management of change.
Although much of the focus is on national strategies, it is important to recognise the global nature of the digital health industry. National initiatives will need to be complemented by global agreements concerning issues such as the development of treatment algorithms, or rules that enable countries to take advantage of the economies of scale in the analysis of data on the part of large international companies and also ensure national autonomy and local control of the use of data.
Building capacity for the discovery and development of new antimicrobial agents
Growing anti-microbial resistance is a major threat to global health, responsible for the deaths of 1.3 million people in 2019. Many countries have published national action plans that include measures to reduce the use of existing antibiotics and develop new ones, but implementation has been slow.
For many years there has been a sustained decrease in the number of companies actively developing new antimicrobial agents. This reflects a lack of markets due to the need to limit the use of new drugs and delay the emergence of resistance. The number of people with expertise and experience in this field has fallen dramatically. The main approach for addressing this “market failure” has been to fund a combination of “push” and “pull” incentives. Although a lot of progress has been made, global financial commitments are still not sufficient. In addition, it has become clear that complementary measures will be needed to improve the performance of a country’s drug development ecosystem. These measures will need to take into account the following broad trends.
Major investments in high technology scientific infrastructure, such as synchrotrons (circular particle accelerators) have created new possibilities for scientific research. Measures are needed to mobilise these developments for the discovery of antibiotics, especially those that address the health problems of the global poor.
Several governments have designated bioscience as a strategic sector for future economic development. This will involve large investments and the mobilisation of expertise in universities, large science infrastructure and large and small private companies. The challenge is to ensure that antimicrobial drug discovery is incorporated into these strategies.
There are international commitments to build capacity to respond rapidly to future disease outbreaks. It is important to ensure that efforts to respond to viral and bacterial diseases do not compete but are complementary. This has implications for funding strategies and for the kinds of partnership for drug discovery and development that are established.
The Sustainable Development Goals (SDGs) include a commitment to help low and middle-income countries make progress towards universal health coverage. This needs to include measures to ensure that investments in drug discovery address local problems of treatment resistant infections, especially amongst the poor, and that new drugs are made widely available. Scientific institutes and pharmaceutical companies from those countries need to be included in efforts to build global capacity to discover, develop and produce new antimicrobial agents.
Moving forward
A renewed effort to build capacity for the discovery and development of new antimicrobial agents cannot be the sole responsibility of governments. It requires new kinds of partnership between scientific institutes, large science infrastructure, public health agencies, private companies and a variety of funding agencies (government, philanthropic and corporate social responsibility).
A new Japan-UK partnership aims to build innovative approaches for strengthening the discovery and development of new antimicrobial agents in this rapidly changing context. The consortium is led by Warwick University in the UK, and the National Centre for Global Health and Medicine, in Japan, with IDS and the National Graduate Institute of Policy Studies (GRIPS) in Japan helping to build mutual understanding of the antimicrobial discovery ecosystems in the two countries and develop partnership strategies based on this understanding.
Moving forward, over time the partnership will be extended to low and middle-income countries, aiming to demonstrate new approaches for tackling major global public health challenges. It is clear, though, that the global effort to tackle anti-microbial resistance needs to be stepped up. To this end, the second-ever UN High-level meeting on AMR which takes place this September promises to be an important moment for countries to make ambitious commitments to tackling this issue.
