Global health: Partnering to Stop the World's Biggest Killer

The COVID-19 pandemic has given rise to a syndemic – a confluence of multiple epidemics. The strain on health facilities, social restrictions, and people’s increased hesitancy to seek care have combined to cause severe disruptions in diagnosis and care for a range of health conditions.

Take cardiovascular disease (CVD). More than 18 million people died from CVD in 2019, making it the leading cause of death from disease. People can live symptom-free for years before suddenly experiencing a heart attack, stroke, or other catastrophic health events. Early detection is therefore critical to initiating treatment that can prevent premature death. By any measure, addressing CVD is a global health priority.

And yet, from March 2019 to April 2020 - the first year of COVID-19 - a survey of 909 health facilities in 108 countries showed the number of CVD diagnostic procedures performed dropped by 64%. Experts worry that the long-term outlook on global heart health is potentially worse now than before the pandemic.

As a company, trends like this have moved us to examine our role within broader societies. Historically, the biopharmaceutical industry has created value by developing medicines and other products that prolong and save lives, which will remain true for the foreseeable future. But the potential benefit of any medicine is only as great as the capacity for health systems to make it accessible. In our company’s treatment areas, we have found that only 10% of patients - including in high and middle-income countries - have access to new medicines five years after they launch.

Subsequently, Novartis decided to explore strategic partnerships with healthcare systems around the globe, tailoring our approach to each system’s needs. In England, which has a centralised health system, we’re engaged in a first-of-its-kind strategic public-private partnership (sPPP) with the National Health Service (NHS).

The NHS identifies cardiovascular disease as a public health priority. It causes one in four deaths in England, costing the health system £9 billion per year. From the outset, our objective has been to co-create an integrated approach for reducing the population-wide burden of CVD. NHS leaders and Novartis have collaborated over the past two years to develop efficient ways of identifying individuals who survived one CVD event, such as a heart attack or stroke, and still have elevated levels of LDL cholesterol, putting them at risk for a second cardiovascular disease event.

Our shared goal is to treat 300,000 individuals over three years who might benefit from our new siRNA treatment, which has the potential to significantly lower LDL cholesterol levels with two doses per year (after an initial dose and again after three months).

The partnership is shedding light on how sPPPs can help forge solutions to population-health challenges. In a new study by the Harvard University Health Systems Innovation Lab, researchers analysed six sPPPs of Biopharmaceutical companies focused on cardiovascular health, including the partnership between England’s NHS and Novartis. sPPPs are relatively new in the health sector, and the study holds insights into how they can succeed. The takeaways are that for these partnerships to produce population-level impact, they need to be:

- guided by systems thinking

- designed for large-scale uptake of innovations in health systems

- built on trust among all stakeholders

- supported by high-level leadership

- properly integrated into the health system.

Systems thinking enables partners to explore the short- and long-term impacts of large-scale innovations in health systems, how they might impact other areas of the health system, and how they could cause unintended consequences. In this way, systems thinking helps illuminate opportunities and risks that sPPPs must navigate.

Meanwhile, the success of an entire sPPP of Biopharmaceutical companies depends on leadership and trust. High-level decision-makers must be committed to achieving objectives, while all partners must be committed to transparency, openness, and respect - the three ingredients for maintaining trust.

However, when it comes to the detail of implementation, the success depends on how well PPPs integrate into the broader health system. Otherwise, sPPPs are likely to remain isolated projects, which will never be sufficient to achieve large-scale improvements in population health.

These findings emphasise the importance of today's biopharmaceutical companies to see themselves not just as producers of innovations but as stakeholders that can partner directly with health systems to deliver better health outcomes.

Because the NHS has the data and relationships with patients, it was possible to quickly understand who might potentially benefit from a new cardiovascular disease treatment. Our partnership enabled us to efficiently demonstrate the medicine’s value and bring it to market at a lower cost to the NHS while making it available to a larger patient population, thereby also helping to address health inequalities. Trust remains essential, and Novartis experts meet with NHS counterparts daily to review progress, troubleshoot challenges, and steer activities toward shared goals. Over the longer term, we hope our partnership will serve as a blueprint.

The pandemic highlighted the need for health systems to become more resilient and expand their capacity to address multiple health challenges simultaneously, and CVD is one of them. No company, government, or healthcare system can tackle a challenge of this magnitude alone. sPPPs demonstrate how biopharmaceutical companies can help health systems develop holistic, system-level solutions, working through relationships built on transparency, openness, and mutual respect.

As sPPPs succeed, health systems will be more equipped to assist individual patients and reduce the burdens of cardiovascular disease and other diseases at the population level, helping to shape a more resilient future for all of society.