by Robert Verkerk, PhD 

It’s the third consecutive year that a news machine – POLITICO EU – with an indefatigable interest in health has convened, alongside the Swiss newspaper “Le Temps”, a healthcare summit in Geneva. The aim of the summit is to illuminate thorny issues by using POLITICO journalists and an engaged audience that interact with leading influencers in the healthcare sector. This of course implies a major turnout for pharma, but also regulators, such as the European Medicines Agency and European Commission.

Pharma was very much present in this week’s third summit, in the form of contributors, sponsors and exhibitors. Leading players were Ferring Pharmaceuticals, Roche and the pharma’s big daddy, the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA). The latter made available a report entitled 50 Years of Global Health Progress’, as well as a series of posters that celebrated the association’s 50-year anniversary.

Geneva, Switzerland was chosen because it’s the home of the World Health Organization (WHO), the global body tasked 70 years ago with guiding the human race’s approach to managing public health.

This year’s summit was one we couldn’t miss. The theme? Sustainability and upstream health care. The title of the event: “Going upstream: Assessing the promises of preventive medicine in health care reform.”

Rather than giving you a blow by blow run down of the event, you can go direct to the streaming page for the event and view the three opening interviews by POLITICO’s Senior Health Reporter Sarah Wheaton which includes:

• Interview with Professor Guido Rasi, Executive Director of the European Medicines Agency, on the subject of: Restoring trust to drive prevention

• Interview with Dr. Soumya Swaminathan, Deputy Director-General for Programmes at the WHO on: Going upstream in health care: what’s at stake?

• Interviews with Ambassador Carlos Foradori of Argentina to the UN, Ambassador Elisabeth Tichy-Fisslberger of Austria to the UN, and Ambassador Adrian Vierița of Romania to the UN on the subject of: Leadership and vision – prevention in all policies.

Following this was two series of roundtable discussions, with each delegate being able to participate in one from each group, as follows:

Roundtable discussions 1: Vaccines, Data, Chronic diseases,

Roundtable discussions 2:Antimicrobial resistance (AMR), Value, Healthy Living

No surprises, I selected: chronic diseases from the first and healthy living from the second, as much as I wanted to be at least a fly on the wall in all the others!

A Dozen Take-Homes From The Summit

Of the 100 or so in attendance, different attendees would have likely had vastly different perceptions on what points were most noteworthy. Dr Aseem Malhotra and I were (as far as I was aware), the only two in attendance who came from a non-drug, non-vaccine perspective. Aseem was also a speaker in the Healthy Living roundtable alongside Alana Officer, senior health advisor on ageing and life-course to the WHO.

Here are 12 overriding impressions I got from the mainstream representatives in attendance, these largely representing the views of pharma, the UN and regulatory authorities:

1. The burden of chronic, preventable diseases will create monumental (if not fatal) problems for existing health care systems, so reform is urgently needed

2. There is recognition that upstream health care is required, meaning that intervention by the individual, by doctors or other health care professionals, needs to occur much earlier in the disease cycle, preferably before disease has even manifested

3. There is no solid view on what business model pharma will use to engage in such systems, but it’s clear that vaccination is viewed by pharma as a major pillar of disease prevention

4. There is recognition that social and commercial determinants of disease are now the biggest drivers of the global disease burden and governments must take major responsibility for dealing with these (as they did with water sanitation, hygiene and the regulation of antibiotic drugs in times gone by). The UN’s sustainability development goals (SDGs) provide a framework for this

5. Sustainability must be the central platform moving forwards, but this concept has vastly different meanings to different people and sectors

6. Sustainability solutions will need to be multi-sectoral and involve public-private and NGO partnerships as well as sustained advocacy

7. Don’t expect immediate results: If society starts to invest in prevention and wellness creation today, the benefits might be expected in 20 years or more from now. But that doesn’t mean delaying!

8. Current evidence suggests that the quality of diets and the air we breathe, along with how much we move, are the three most important social and commercial determinants of health

9. Many people on the planet don’t have access to or can’t afford high quality food. They also may not have access to green spaces and exercise facilities, both being important for physical health and mental wellbeing

10. Electronic devices, artificial intelligence (AI), self-care, remotely guided care (including telemedicine) are likely to play an ever-bigger role in health care in the future, but there will be no substitute for empathy and compassion offered in face-to-face consultations with suitably trained and qualified doctors and other health care professionals

11. There is a growing emphasis on individual responsibility, but governments and corporations cannot dump all responsibility on citizens

12. There is a need to adapt health care systems for individual needs, as well as to regions, cultures, ethnicities, socio-economic groups and other factors. Yet there is no consistent view on what needs to be done to create sustainable health care systems at the community level.

Some Noteworthy Remarks

I was busy on my notepad through the event, that opened on the Monday evening and finished in Geneva yesterday afternoon. Here are some quotes from various people I scribbled down on my POLITICO notepad. I apologise if they are not, in all cases, verbatim, but they are certainly close and represent accurately the intended meaning:

Prof Guido Rasi, Executive Director, European Medicines Agency (EMA)

On quinolone and fluoroquinolone antibiotics: “The EMA has stopped their use following pharmacovigilance showing up serious side effects…..we could have perhaps done this 5 years ago.”

On vaccine distrust: “I wish I knew where it was coming from but we have to build more transparency.”

On Brexit: “We can expect some [drug] shortages will happen.”

On HPV: “HPV [vaccine] induces a specific reaction….there has been a lot of emotion…there has been intervention of doctors who make casual associations [between HPV vaccination and the development of specific disease symptoms]….The EMA must stay [focused] on benefit/risk…and clinical effects.”

Dr Soumya Swaminathan, Deputy Director-General, WHO Programmes

On responsibility: “It’s a collective, social responsibility. That includes a balanced diet, exercise every day, no smoking, open spaces … not only good for your physical health but also for your mental health.”

On taxation:“Governments should tax sugar, tobacco and unhealthy foods.”

On policy: “Air pollution is among the biggest threats to health.”

On how to achieve greater sustainability: “It needs a multi-sectoral approach and partnerships …. equires sustained advocacy.”

On champions: “We need champions. In Thailand, there have been amazing champions in the area of exercise and tobacco.”

Dr Tedros Ghebreyesus, WHO Director-General, WHO

Who needs to be involved: “Finance, trade, agriculture, food….”

Which party needs to play the stewardship role: “The Ministry of Health [in each country].”

On human capital: “If you don’t have a healthy nation, you don’t have a healthy economy.”

On timeframes: “Invest today, and you’ll start reaping the benefits in 20 years.

Regarding the last (third) high level meeting on non-communicable diseases (NCDs): “Many are a bit skeptical because we haven’t seen much action.”

On UN sustainable development goals (SDGs): “The third billion is about healthy lives … housing, safe roads, healthy foods, controlling air quality …t he social determinants of health.”

Thomas Cueni, Director General, International Federation of Pharmaceutical Manufacturers & Associations (IFPMA)

On disease prevention in Switzerland (remember the Swiss rejected a full ban on smoking in public spaces): “We had a referendum on prevention a few years ago – but it failed as the Swiss hate a nanny state.”

Prevention and the precautionary principle: “Be healthy, be mobile” in reference to the WHO/ITU initiative.

On personal preferences: “I stopped eating chickens as I don’t trust the chicken farmers in this country”. Clearly Mr Cueni trusts chickens less than the drugs his association members make, despite them being the third leading cause of death after heart disease and cancer.

On other concerns: “Now they’re injecting antibiotics [to reverse greening disease] into citrus trees. Should we now stop eating lemons?.”

Elisabeth Tichy-Fisslberger, Austrian Permanent Ambassador to the UN [Austria presently holds the EU presidency]

On vaccination: “[It’s difficult] trying to find alignment on vaccination among EU member states.”

On the role of tech: “There’s a huge revolution going on in the health sector including in artificial intelligence and there’s huge money in it … but also huge research that needs to be explored.”

Dr Rangarajan Sampath, Chief Scientific Officer at the Foundation for Innovative New Diagnostics (FIND)

On responsibility: “There’s a growing emphasis on individual responsibility.”

On tech: “To convert data into something meaningful, you need some kind of artificial intelligence or algorithms … you need to find a way of empowering the individual and allowing them to be the recipient of meaningful information.”

Michelle Rohrer, Senior Vice-President and Global Head of Product Development Regulatory and Policy at Roche

On ways forward: “We have a knowledge of biology like we’ve never had before, plus digital …how do we take all of this information and harness to do good.”

On big data: “We need to curate the data so it becomes meaningful data at scale … we need advanced analytics to really uncover the truth that lies within all these data.”

Rachel Dunscombe, CEO of the NHS Digital Academy

On what data should be collected: “It’s possible to collect too much data. …you shouldn’t collect data which will not be used for healthcare or wellness … .citizens’ own data is most interesting.”

On whether digital healthcare should be universal: “You need to segment. Some patients need a more individualised approach, others are very happy to have a more digital relationship with us [the NHS].”

On responsibility for data entry: “The onus is on us to make sure people contribute their data for their benefit…better to do it on a regional basis as the public already has a regional political conversation.”

Prof Klaus Dugi, Executive Vice President and Chief Medical Officer, Ferring Pharmaceuticals

On public-private partnerships: “People say the [pharma] industry hasn’t done well with these partnerships. But the Innovative Medicines Initiative [IMI] is the biggest in the world, with a budget of €3.3 billion [2014-2020] with half paid by the EU through [represented by the European Commission] and the other half by the industry [represented by EFPIA, the European Federation of Pharmaceutical Industries and Associations].”

Jayasree Iyer, Executive Director, Access to Medicine Foundation

On the business model: “Money’s starting to run out and we need to find new ways of raising money.”

On AMR (antimicrobial resistance): “Many companies have left the space as it’s not profitable but a few have stayed on and are investing.”

Ann Hasslberger, Swiss Mission to the UN

In response to an Eli Lily manager who said, “the majority of our employees don’t even know a single SDG [sustainable development goal]…they don’t really matter”,

she responded: “SDGs really do matter, it’s becoming a movement.”

On affordability: “We need to address the triple bottom line: financial, social and environmental.”

Amanda Hosken, Head of Life and Health Hub for EMEA at Swiss Re

On affordability of new drugs and treatments: “It needs to be cost effective, if not profitable.”

Nina Renshaw, Director of Policy and Advocacy, NCD Alliance

At the roundtable on chronic diseases, talking about the recent 3rd UN High-level Meeting on NCDs: “…a tsunami of preventable disease….SDG 2.4 aims to reduce deaths by one-third by 2030 plus SDG 3 is pushing for action on mental health…there were 23 heads of state in government and ministers there…there’s a shift from the 4 x 4 approach [4 major risk factors and 4 major diseases] to increasing focus on mental health and junk foods …there’s also recognition that we need to think about not only social determinants of disease, but also commercial determinants.”

Cristina González, Minister Counsellor, Mission of Uruguay to the UN in Geneva

On responsibility: “It’s about building an enabling environment for the citizen to make appropriate decisions – as individuals, as consumers … being an actor in taking responsibility for their health, but with our removing the responsibility of the government.”

On prevention: “Prevention needs to go beyond the health sector. You don’t need much money, but you need to make a case for how other sectors need to work with health.”

Prof Mukesh Kapila, Professor of Global Health and Humanitarian Affairs at the University of Manchester

On how to tackle chronic diseases: “The last thing you want is a global solution, like it was with AIDS. You need a long-term, sustainable programme. NCDs are not amenable to quick fixes … .the biggest problem you have is with scale-up. You just design by intent a fully-scale system …. that involves capacity building, community-based scale-up … and you need to de-medicalise, democratise and decentralise.”

On tech solutions: “You can’t reduce it to a technical solution. In medicine you also need compassion.”

Alana Officer, Senior Health Adviser, Ageing and life-course, WHO

On challenges to healthy living: “One of the biggest factors is the border environment of the individual and communities – the policies, systems and services needed to help people make the right decisions.”

On key factors driving (un)healthy choices: “Social connection and the environment around the individual.”

Dr Aseem Malhotra, Consultant Cardiologist, author, influencer

On key factors driving (un)healthy choices: “Ultra-processed foods.”

On best fixes: “If we could just go back to cooking at home with fresh foods we would solve over half of the obesity problem even before taking into account more complex issues like saturated fat.”

On the evidence base: “The real problem is with eminence-based medicine [not evidence-based medicine].”