IMPORTANT changes are underway in the pharmaceutical industry. According to Becker’s Hospital Review, for many years pharmaceutical companies have moved away from researching drugs to treat infectious disease, being lured by the potential profits from drugs used to treat non-communicable diseases. Steph Sterling of the Roosevelt Institute points to this ‘failure’ of what she calls the fully market-based system in which new drugs and medical devices are developed.
In other words, medicines are not like toys or running shoes where producers can develop and produce whatever they think will be most profitable for them. Institutions like hers also highlight concerns about what they call the ‘abuse of patents’ in which some companies charge very high prices, and the possibility of an 18-month wait for a widely available vaccine against Covid-19. In response to arguments like these, there is already greater government involvement in the research and development of new drugs in the US, and new incentives for research which in turn should lead to more new drugs for infectious disease.
So we can see many interesting changes in healthcare coming from developed countries that can potentially shape the nature and delivery of healthcare everywhere. Telemedicine, greater roles for allied health professionals, greater use of ‘big data’, new sources of medical devices and new drugs for infectious disease are some of the changes that we can potentially see spreading to other countries in the near future.
Moving to low income countries, many of their health systems were fragile even before the pandemic. The economic fallout from quarantine in most countries and the disrupted supply chains may well end up leading to reduced aid from the developed world into the poorest countries. Madhukar Pai, of McGill Global Health Programs raises the possibility that health inequality (between developed and poor countries) could be exacerbated if developed countries place priority on restoring their own economies and health systems after Covid-19 by cutting aid. Janez Lenarčič, European Commissioner for Crisis Management, adds that travel restrictions will hamper humanitarian aid, making this even worse.
Julia Gillard, former prime minister of Australia and board chair of the Global Partnership for Education reports that 1.5 billion schoolchildren have been affected by school closures, with several hundred million of them being in low and mid-level income countries. The poorest, most marginalised children (especially girls) in these communities will be hit hardest by the response to the pandemic. From previous epidemics in sub-Saharan Africa, Gillard observes that many of these children never actually go back to school. Many schools that are repurposed never reopen, and many teachers turn to other livelihoods. Teen pregnancy, early marriage and child labour can erase previously hard earned gains.
Professor Karl Theodore pointed to the close links between education, health and development over 25 years ago. Underinvestment in health in one country can create a threat to global health security. The post Covid-19 world is likely to bring new challenges to healthcare in the poorest countries.
Finally, we turn to our region: Latin America and the Caribbean comprises mainly middle income countries. Covid-19 rapidly spread across this region progressing to over 65,000 cases by mid-April. According to Talha Burki, writing in The Lancet Infectious Diseases, there was little or no pandemic preparedness in our region, with the possible exception of Cuba. We are already seeing signs that health systems and communities can be ravaged by this illness. Ecuador is barely able to keep up with burying its dead. Guatemala and Haiti have between them fewer than 100 ventilators with populations of 17 and 11 million, respectively.
Even with the biggest biotech sector in Latin America, Brazil’s current Covid-19 testing capacity is about 6,700 tests per day. The Health Ministry there estimates that at the peak of the epidemic, Brazil will need to be performing up to 50,000 tests per day. There is not much flexibility in this kind of testing throughout most of Latin America—these tests are usually run in centralised facilities. Moving forward, it is clear that these arrangements need to be addressed in most of the region. According to the IMF Blog, many countries in Latin America are already increasing capacity in their health systems to deal with the surge in patients due to the pandemic.
David Shaywitz points to new attitudes towards hygiene both in society and in healthcare. Even in the US, the CDC claims the healthcare providers wash their hands “less than half of the times that they should”. Moving forward we are not as likely to see crowded, poorly ventilated healthcare settings and we can expect to see more effective, visible management of surfaces (like counters, door handles etc) in health facilities.
Thus far in Trinidad and Tobago (T&T), we have not seen the widespread devastation that has occurred in other countries—both rich and poor. We have an opportunity now to avoid a crisis of the proportions seen elsewhere. We also have the opportunity to embrace as many of the positive changes that are likely to emanate from other countries as we desire. To this end, several T&T physicians are already moving towards telemedicine. Internationally, the provision of healthcare is at a turning point. We have an opportunity to use this crisis to move our health system forward in a number of ways. We have many options to not let this crisis go to waste.
The Trinidad and Tobago Chamber of Industry and Commerce thanks Dr Henry Bailey for contributing this article. Dr Bailey is a lecturer in the Department of Economics at The UWI and a researcher at the HEU, Centre for Health Economics, The UWI St Augustine.