FT Health: National systems must learn lessons from pandemic

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It is too early to offer a definitive judgment of the best responses to coronavirus, but analysts are already highlighting policies around the world that have helped minimise the costs.

The Health at a Glance report from the OECD, the club of industrialised nations, argues that countries which took rapid action to contain the virus, backed by high levels of trust and compliance from their populations, limited the spread of infection and mitigated its economic consequences.

Asian nations including South Korea and Japan acted swiftly, in part reflecting their past experience with epidemics such as Sars. Finland, Norway and Estonia were among the best performers in Europe, helped by factors including their population structure and relatively low cross-border flows of people.

The UK does not come out well. Having spent more than other European countries to tackle Covid-19 in purchasing parity terms, it suffered the largest cut in second-quarter GDP and the greatest number of Covid-linked deaths, even though it ranked after Belgium by deaths per million population.

But beyond the short term response to the pandemic, the OECD report also identifies significant structural factors in national health systems which bring lessons for the future, such as how the availability of hospital beds affects the capacity to absorb infection surges.

Fresh with hopes that vaccines will help tackle coronavirus in the months ahead, governments need to start reflecting on ways to increase resilience and prevention to tackle a wider range of future health threats.

Covid catch-up

The UK this morning became the first country in the world to approve a vaccine for Covid-19 after large-scale clinical trials. The OK for BioNTech/Pfizer’s jab comes at a critical moment: the recent resurgence in Europe means the global daily average of deaths has now passed the spring peak of 6,800 to hit 10,123. The US — where there are fears of a new surge after family meetups for Thanksgiving — has suffered most fatalities with the total approaching 270,000. Globally there have been more than 61.8m reported cases and 1.4m deaths since the start of the pandemic.

As the one-year anniversary of the reported outbreak in Wuhan approaches, China is stepping up its attempts to change the Covid “origin story” as documents leaked to CNN revealed its initial mishandling of the novel coronavirus. And if one more indicator were needed of the shock effect of the pandemic, the UN said on Tuesday that Covid-19 meant a record high of 235m people would need humanitarian assistance in 2021 — at a cost of $35bn. (FT, Guardian, UN)

Key links
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WHO coronavirus dashboard

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News round-up

Breakthroughs on vaccines . . . Vaccine trial successes from Moderna and AstraZeneca/Oxford university as well as Pfizer/BioNTech fuelled hopes that the pandemic could be defeated in 2021. Astra’s candidate — currently subject to controversy over its efficacy — is easier to store and cheaper than its rivals, making it more attractive for developing countries. Vaccine efforts have also given a beleaguered pharma industry, under fire for everything from price gouging to encouraging addiction, a chance of redemption. (FT)

. . . but questions of access remain G20 leaders vowed to ensure access to vaccines for poorer countries — as well as extend debt relief programmes — but the WHO said an extra $4.3bn was still needed to support Covax, its initiative aiming for “best possible prices, volumes and timing for all countries”. Developing nations, led by South Africa and India, are pushing for Covid-19 vaccines to be free from patent protections. (Politico, PM Live, Devex, WSJ). Chart below shows position as of November 27

Distribution headaches UK introduction of the Pfizer/BioNTech vaccine from next week should be followed by international distribution of the various candidates within the next few weeks. The logistical challenges — especially in poorer countries — are immense: artificial intelligence may be able to help. The WHO said African countries were “far from ready” for a vaccination drive. Washington DC correspondent Kiran Stacey explains US plans. (FT, Deutsche Welle, UN News, FT video)

Global health leadership Many hope that US president-elect Joe Biden — who has already promised to reverse his country’s decision to quit the WHO — will restore America’s leading role in global health, but others caution not to expect too much. China hopes its “vaccine diplomacy” will restore its influence on the world stage. Some fear the UK’s “Trumpian” cuts to foreign aid will damage international health projects. Policy expert Ilona Kickbusch argues a reset is urgently needed in global health financing: “The system that is built on ODA [development aid] and philanthropy is broken and the sooner we address this issue the better,” she writes.  (Devex, Guardian, Politico, Health Policy Watch)

Ebola victory If an example of the power of vaccines is still needed, look no further than their role in the Democratic Republic of Congo’s final victory over Ebola. Here are some lessons for the fight against Covid-19. (New Scientist, Africa CDC, Lancet)

Fighting fake news The Covid crisis is forcing us to consider whether free online expression, when used to spread distortions and falsehoods, carries an unreasonable cost to public health, writes science columnist Anjana Ahuja. As worries grow that antivaxxer sentiment is gaining ground, here are some lessons from history. And here are some tips on how to read Covid-19 research papers. (FT, The Conversation)

Focus on . . . HIV/Aids United Nations agency UNAids marked World Aids Day with a report outlining how Covid-19 has set back progress against the disease, with additional new infections between 2020 and 2022 hitting up to 293,000 with up to 148,000 additional Aids-related deaths. The funding gap (see chart) has also widened, with finances for HIV in poorer countries in 2019 at about 70 per cent of the UN target. Many people on HIV treatment are still dying and Europe needs urgently to step up its testing. Good news included data showing a substantial reduction in US deaths since 2010 as well as renewed hopes for new treatments in South Africa, home to the biggest epidemic in the world where 7.7m people are living with the virus. (UNAids, The Conversation, ECDC, CDC, AP)

Antibiotic alert A coalition of world leaders aims to bolster the struggle against antimicrobial resistance. Institutional investors meanwhile are taking up the fight against the overuse of antibiotics, targeting food, retail and pharma groups, while concerns are mounting that winter surges of Covid-19 could lead to their inappropriate prescription. UK farming post-Brexit is also under the spotlight. The pharma industry says new financial models are needed to encourage the development of new products. Watch our new film on how we can stop the next great global health crisis and catch up with our special report: The Future of Antibiotics. (FT, Stat, Alliance to Save our Antibiotics, Project Syndicate)

Malaria progress dented The World Malaria Report revealed 229m cases of the disease in 2019 with 409,000 deaths. Despite some bright spots such as south-east Asia, progress in countries most affected is flatlining, with disruption from Covid-19 likely to add to malaria deaths this year. A separate WHO report assesses ten years of data on the effectiveness of antimalarial drugs. New research pinpoints children as “superspreaders” of the disease. (WHO, Devex)

Combating cervical cancer The WHO published a new plan to eliminate the disease which could prevent the deaths of 5m women and girls by 2050. The combination of vaccines, screening and treatment will have a strong economic effect, it says, returning an estimated $3.20 for every dollar invested, thanks to improved women’s participation in the workforce, rising to $26.00 when the wider impact on communities is taken into account. (WHO)

Covid measures could help fight against pneumonia New research shows pneumonia each year leaves 42m under-fives in poorer countries fighting for breath. Measures put in place to combat Covid-19 such as mask wearing and improved hygiene could however — at least in the medium and long-term — help reduce the prevalence of pneumonia, still the biggest infectious killer of children, and other viruses. (Unicef, Lancet)

Water and sanitation Unicef/WHO’s “State of the World’s Sanitation” highlighted the fact that more than half of the global population has to endure big threats to health stemming from untreated human waste. Another study shows finance to fund climate-related water projects is not reaching the most vulnerable countries. A new UN fund aims to raise $2bn over the next five years to improve sanitation and hygiene in badly-affected countries. (Unicef, Devex, UN News)

Lives versus livelihoods Why is the cost of coronavirus — estimated by one study at $96tn — so huge, when — in historical context — the pandemic is a relatively “mild” affair? The answer, argues FT chief economics commentator Martin Wolf, is “because it could be”. “Prosperous people can easily dispense with a large proportion of their normal daily expenditures, while their governments can support affected people and businesses on a huge scale. This is also what people expect from governments. The response to the pandemic is a reflection of economic possibilities and social values today, at least in rich countries. We are prepared to pay a vast price to contain pandemics. And we can do so far better than before.”

Period poverty first Scotland became the first country in the world to make period products — already available in its schools, colleges and universities — free for all who need them. Some US states and countries including Kenya, Nigeria and India have lowered or scrapped taxes on such items. (BBC)

Simulating the struggle A mobile phone game developed with the help of experts from the WHO and the Coalition for Epidemic Preparedness gives a small-screen taste of the fight against the pandemic. Players of Plague Inc: The Cure must track the disease, control the outbreak, boost testing capacity and find a vaccine while keeping the support of local communities.

Best from the journals

Diabetes dangers Indian cities could be devastated by a jump in diabetes. Some 77m Indian adults currently have the disease, a number expected to almost double to 134m by 2045. Urbanisation, poor diet and lack of exercise are all contributors. A new Lancet commission on diabetes urges a data-driven approach to combating a disease that affects 463m people, with 80 per cent from low-and middle-income countries. (Diabetologia, Times of India, Lancet)

Midwives save lives Investing in midwives could save more than 4m lives a year by 2035, says a new study. Two-thirds of maternal, newborn and neonatal deaths could be prevented if current levels of care were scaled up to allow interventions such as family planning, assisted delivery and breastfeeding support worldwide, it says. (Lancet Global Health)

Healthcare access in Africa Despite suffering from multiple communicable diseases and conditions such as high infant mortality, much of sub-Saharan Africa’s population lives more than two hours from a public hospital. This study identifies gaps in healthcare access and where new facilities are needed. (PNAS)

Tobacco control How do tobacco control advocates in low- and middle-income countries counter interference in policy from the industry? (BMJ)

Keep on moving New WHO guidelines on physical activity and sedentary behaviour aim to prevent 5m deaths each year. One in four adults and four out of five adolescents do not get enough exercise, the WHO says, creating $54bn in direct healthcare costs and another $14bn to lost productivity. A new study says adherence to the WHO suggestion of at least 150 minutes of moderate-intensity exercise each week could boost global GDP by up to 0.24 per cent or $446bn a year by 2050. (WHO, British Journal of Sports Medicine)

Graphic medicine Whether for instructional or therapeutic use or to tell personal stories, the pandemic has led to an explosion in comics-based material. Here’s Jama’s round-up of the year’s best.

Pick of the pods

Fighting fake news World Economic Forum podcast discusses the fight against coronavirus misinformation. (WEF, 32m)

Prepping against HIV What is the role of pre-exposure prophylaxis — PREP — for girls and young women in countries with high levels of HIV? (CSIS, 21m)

Global collaboration An investor’s view of how international partnerships between drugs companies, universities, doctors and patients have driven the search for Covid-19 vaccines. (Citywire, 43m)

Yemen’s ‘hunger wards’ Already home to the world’s worst humanitarian crisis, Yemen is now suffering from acute famine. A new film documents local health workers’ efforts to fight acute malnutrition among children. (Global Dispatches, 26m)

PPE problems Why is the UK government being sued over PPE contracts? The BMJ talks to Jolyon Maugham of the Good Law Project which is highlighting concerns over procurement. (BMJ, 48m)

The month ahead

Dec 3 Lancet Countdown on Health and Climate Change 2020

Dec 3-4 Coronavirus summit at UN General Assembly

Dec 4 WHO global cholera update

Dec 7 FT series continues: The Future of AI & Digital Healthcare

Dec 8 FT series continues: The Future of Antibiotics

Dec 8 Young Innovators for Health award launched at Galien Forum Africa

Dec 10 US FDA set to discuss Pfizer/BioNTech vaccine

Dec 12 World Universal Health Coverage Day

Dec 15 NHS annual health survey for England

Dec 17 US FDA set to discuss Moderna vaccine

Dec 29 European Medicines Agency set to give opinion on Pfizer/BioNTech vaccine

Dec 31 First anniversary of coronavirus being reported to WHO in China

Jan 5 Next edition of FT Health

End notes

Previous issue The dangers of data

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Final thought

“We used to work at home. Now we live at work”. Noting the increasing strains on workers forced to toil remotely, the FT Editorial Board pointed out that “if there were ever a time for policymakers to address the structural and societal roots of poor mental health, and thus cut the longer-range costs of treating its symptoms later, this is surely it”.

Take part in our survey about how remote working has affected your own mental health.