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New Global Coalition Will Focus on Improving Value of Healthcare

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The healthcare sector faces major challenges in delivering value for healthcare. According to the OECD, spending on healthcare in 2016 – the most recent year that data is available – increased by 3.4%, the highest rate since 2009. In response, leaders in the $8 trillion global healthcare sector need to embrace value-based healthcare, an approach that defines the goal of healthcare as the achievement of improved health outcomes that matter to patients at the same or lower cost.

Achieving a value-based healthcare system faces numerous barriers. Optimizing its delivery requires high-quality health data, but industry estimates suggest that about 80% of healthcare data is unusable in its current format. Value-based healthcare also requires companies to make major changes to their business models, but such shifts can involve a high degree of risk, and there is often little incentive for the private sector to take on this challenge. From a regulatory perspective, changing the structure of the healthcare system requires strong political will and can generate backlash. The biggest obstacle to the spread of value-based healthcare is that misaligned incentives in current health systems make it difficult for industry stakeholders to act collectively.

As the final report of the Forum’s three-year Value in Healthcare project, Value in Healthcare: Accelerating the Pace of Health System Transformation, released by the World Economic Forum in collaboration with Boston Consulting Group (BCG), describes three major initiatives to address these challenges and accelerate the transition to value-based healthcare in health systems around the world:

A “user’s guide” to health system transformation: The report proposes best practices based on a review of pioneering efforts around the world and on the Forum’s experience with two pilot projects. For example, in 2016, Santeon, a network of hospitals in the Netherlands, launched a joint value-based healthcare programme that resulted in a 17% improvement in positive breast cancer surgery margins. In 2017, about 40 stakeholders came together in Georgia, USA, to create the Atlanta Heart Failure Pilot to improve heart-failure survival in Atlanta by 2022. In 2018, around 35 stakeholders in Canada launched the Ontario Diabetes Pilot to help patients suffering from type 2 diabetes.

A “roadmap” for global health-informatics standardization: This effort lays the foundation for promoting value-based healthcare over the next four years by proposing a global vision and a “digital health bill of rights”, which will be developed in consultation with patient advocacy organizations around the world. This global vision and bill of rights will help governments, patient groups and the private sector ensure that their informatics work is patient-centred and will inform other efforts to harmonize informatics standards around the world.

The Global Coalition for Value in Healthcare: This public-private effort will provide a platform where stakeholders and medical practitioners can learn from one another, develop shared visions and goals, and exchange best practices. The coalition will provide technical assistance and facilitate local partnerships, develop global enablers of value-based healthcare, document and disseminate best practices, and build a global community of practice.

“The coalition will be a global platform for accelerating the development of value-based health systems around the world,” said Vanessa Candeias, Head of Global Health and Healthcare at the World Economic Forum. “It will serve as a source of information and learning about value-based transformation and will convene a global community of healthcare leaders engaged in making value-based healthcare a reality.”

“The World Economic Forum’s initiative on value in healthcare has highlighted the urgent need for multistakeholder cooperation to transform health systems,” said Rich Lesser, Global Chief Executive Officer of Boston Consulting Group, USA. “We are excited for the next phase of this global partnership, where we foresee new levels of collaboration across healthcare – for instance, in the field of health informatics. These initiatives are key to secure the long-term sustainability of health systems around the world and better health outcomes for patients.”

Christophe Weber, President and Chief Executive Officer of Takeda Pharmaceutical Company, Japan, said: “The industry is all too aware how fragmented and siloed it is. Takeda is very proud to continue leading in the space as part of the Global Coalition for Value in Healthcare, with particular focus on the value-based payments work of the coalition.”

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Human Rights

Millions in Yemen ‘a step away from starvation’

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Mobile health clinics are distributing nutritional supplements to children in Yemen. WFP/Saleh Bin Haiyan

The crisis in Yemen, now in its seventh year of war, continues unabated, with thousands of people displaced and millions “a step away from starvation”, the UN Humanitarian Relief Coordinator said on Wednesday during a high-level side event on the margins of the 76th General Assembly.

“The country’s economy has reached new depths of collapse, and a third wave of the pandemic is threatening to crash the country’s already fragile health-care system”, Humanitarian Affairs chief Martin Griffiths told world leaders at the meeting: Yemen: Responding to the crises within the world’s largest humanitarian crisis.

Underscoring that the most vulnerable always “bear the highest cost” of the crisis, he said that females were more likely to be hungry, sick or exposed to gender-based violence and, with little access to essential services, millions of internally displaced people face “a daily struggle to survive”.

Cause for hope

In a positive development, the UN official credited the international community for stepping up support to the country’s humanitarian aid operation.

Thanking the world leaders, he said that Yemen’s Humanitarian Response Plan is “among the most well-funded”, with 98 per cent of the pledges made at an event in March fulfilled.

With over $2 billion received, the UN and its partners were able to “prevent famine and pull people back from the brink of despair”, delivering assistance to “every single one of the country’s 333 districts”.

‘Far from done’

Despite these important achievements, Mr. Griffiths acknowledged that the work there is “far from done”, as many sectors still face “alarming funding gaps” and humanitarians are working with less than one-fifth of the money needed to provide health care, sanitation, and shelter.

“Without additional funding, these and other forms of critical life-saving support – including food assistance – will have to be reduced in the coming weeks and months”, he warned.

Three requests

The UN relief chief asked global leaders to continue generously supporting Yemen’s humanitarian operation; respect international humanitarian law and protect civilians; and address the root drivers of the crisis, including restrictions on imports, which elevate the prices of essential goods.

He urged them to do “everything in our collective power to stop this war”, saying, “at the end of the day, peace is what will provide Yemenis the most sustainable form of relief”.

Children robbed

The war has robbed too many of Yemen’s children of safety, education and opportunities.

“Each day, the violence and destruction wreak havoc on the lives of children and their families”, Henrietta Fore, Executive Director of the UN Children’s Fund (UNICEF), told the meeting.

She painted a grim picture of 1.7 million displaced youth, 11.3 million youngsters depending on humanitarian assistance to survive and 2.3 million under-five “acutely malnourished” – nearly 400,000 of whom are at “imminent risk of death”.

“Being a child in Yemen means you have probably either experienced or witnessed horrific violence that no child should ever face”, said the UNICEF chief.

“Quite simply, Yemen is one of the most difficult places in the world to be a child”.

Millions ‘marching towards starvation’

In his address, World Food Programme (WFP) chief David Beasley said that in a nation of 30 million people, food rations are needed by 12.9 million; while 3.3 million children and women need special nutrition, together with 1.6 million school children.

“We’re literally looking at 16 million people marching towards starvation”, he said.

With one thousand people a week dying from a lack of food and nutrition, the senior WFP official warned that if $800 million is not received in the next six months, the need to cut rations could lead to the death of 400,000 children under the age of five next year.

We have a moral, obligation, to speak out and step up”, he stated, appealing to the world leaders to “put the pressure on all parties…to end this conflict”.

“These are our children; these are our brothers and sisters we need the donors to step up immediately otherwise children are going to die. Let’s not let them down. Let’s do what we need to do”, concluded Mr. Beasley.

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Africa Today

South Sudan ‘determined to never go back to war’

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Rebecca Nyandeng De Mabior, Vice-President of the Republic of South Sudan, addresses the general debate of the UN General Assembly’s 76th session. UN Photo/Cia Pak

South Sudan is “ready to turn a new page” towards greater peace, development and prosperity, Vice-President Rebecca Nyandeng de Mabior said in her speech in the UN General Assembly on Friday. 

A decade after gaining independence from Sudan, the country remains “on a path of nation-building” and is working to implement a 2018 revitalized peace deal which led to the formation of a unity government last year.

 “I want to assure our friends and partners that we are determined to never go back to war,” said Ms. De Mabior.

“We must replace the destruction of war with the productive use of our vast natural resources and national assets for the good of our people.”

Prioritize nation-building

The Vice-President recalled that when South Sudan became independent, the international community pledged to build capacity in nation-building, establishing a UN mission in the country, UNMISS, to support this process.

“However, after the outbreak of the war, that vision was abandoned, and priority was placed on protecting civilians and providing humanitarian assistance. As a result, support for capacity building of the State was terminated,” she said.

Ms. De Mabior stressed that supporting a State’s ability to govern responsibly and effectively is essential.  It is also necessary to guard against what she called “the unintended consequences of dependency on humanitarian assistance.”

Given improvements in peace and security, she said it was now time to transition from emergency towards sustainable development.

“It is a painful and shameful situation for a country endowed with vast fertile land to be regarded as poor,” she added.  

“We must ensure peace and security in the country and double our efforts to support our people who want to return, and are returning, to their areas of origin, for them to participate fully in nation-building and contribute to building food security in the country.”

Support youth and women

South Sudan is also “a youthful country”, and the Vice-President called for continued efforts to develop the skills of its youth and women “to provide an alternative to picking up the gun again and engaging in destructive behavior.”

Encouraging developments have included joint efforts by the national security forces and their UNMISS counterparts to promote rural peace and security, while the Government is set to unveil a national youth service programme.

“To fulfill the vision of our liberation struggle, we must use our oil revenues to fuel economic growth through investment in agriculture,” she said.  

“We will invest in infrastructure to connect our rural communities to the markets. We need the public and private sectors, including foreign investors, to join hands in turning South Sudan’s potential wealth into a reality.”

Glass ‘half-empty’

Ms. De Mabior reported progress in implementing aspects of the Revitalized Peace Agreement, particularly in the creation of state and national bodies and public financial management reforms

However, “the glass remains half-empty” in implementing a permanent ceasefire and transitional security arrangements, she said, noting the urgency for a unified army.

“The security sector reform is the most challenging part of the Agreement as it contains elements at the center of the violent conflicts in the country,” she said, calling for continued dialogue.

“Building sustainable peace requires inclusivity, collective investment, determination, diligence, and patience.”

Meanwhile, relations with Sudan have also improved, though outstanding issues remain over the oil-rich Abyei border area.

Ms. De Mabior stressed her country is determined to learn from the past.

 “We must make the Revitalized Peace Agreement succeed, and we can only do that with the support of our regional and international partners. Simply stated, South Sudan desires and is ready to turn a new page,” she said.

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Health & Wellness

WHO backs Regeneron COVID-19 drug cocktail – with equal access, price cut

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A technician carries out an experiment in the Regeneron laboratory. © Regeneron

The Regeneron antibody drug cocktail – casirivimab and imdevimab – has been added to the World Health Organization’s (WHO) list of treatments for COVID-19 patients, the UN agency said on Friday, before underscoring the need for lower prices and equitable distribution. 

“This is a major breakthrough in the care of COVID-19 patients”, said Dr. Janet Diaz, WHO head of clinical care. “This is our first recommendation for a therapeutic for those patients with mild, moderate disease,” she said, because it reduces “the need for hospitalisation if they are at high risk”. 

Effective ‘reduction in mortality’  

WHO’s conditional recommendations are for use of the drug combination on patients who are not severely ill, but at high risk of being admitted to hospital with COVID-19, or those with severe cases of the disease and no existing antibodies.  

“Giving them this additional antibody seems to show an effect. And what effect is that? A reduction in mortality” Dr. Diaz told a briefing in Geneva. 

The antibody therapy was granted emergency use authorization in the United States November last year after it was used to treat former President Donald Trump when he was admitted to hospital with the virus. The United Kingdom has also approved Regeneron, while it is under review in Europe. 

‘Meaningful’ benefit 

The WHO recommendations were largely based on data from a British study of 9,000 patients in June which found that the therapy reduced deaths in hospitalised patients whose own immune systems had failed to produce a response. 

“We are taking the information (from the UK study) and generalizing it to other persons,” said Dr. Diaz. “We saw there was a benefit we thought was meaningful.” 

The treatment has been on the market for decades to treat many other diseases, including cancers. It is based on a class of drugs called monoclonal antibodies which mimic natural antibodies produced by the human body to fight off infections. 

Equity, price cut call 

Swiss drugmaker Roche, has been working in partnership with Regeneron, which holds the patent, to produce the antibody treatment. 

Dr. Diaz urged Regeneron to lower the drug’s price and work on equitable distribution worldwide: “We know that the life-saving benefits and the benefits for patients with COVID-19 is significant and requires action.” 

She added that WHO-hosted health agency UNITAID, has been negotiating directly with Roche for lower prices and equitable distribution across all parts of the world, “including low and middle-income countries”. 

WHO has also been in discussions with the company for a donation and distribution of the drug through UN Children’s Fund UNICEF, following an allocation criteria set by the health agency. “We are working together with the company so we can address these very important issues so we can have equitable access” she said. 

Call to manufacturers 

In a statement, WHO said in parallel it had “launched a call to manufacturers who may wish to submit their products for pre-qualification, which would allow for a ramping-up of production and therefore greater availability of the treatment and expanded access. 

ACT-A partners are also working with WHO on an equitable access framework for recommended COVID-19 therapeutics”. On that subject, Dr Diaz added that “there are bottlenecks and we are aware of those. 

WHO has launched the pre-qualification expression of interest call so that the manufacturing companies can start to submit their dossiers to WHO”. 

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