Both public health systems and pharmaceutical companies must adapt and re-focus on patients

COVID-19 may still consume much of the attention of the global health community, but the challenges facing providers and innovators beyond the pandemic are massive. Cardiovascular disease (CVD) is the leading cause of death worldwide. It kills more people than all cancers combined. While its underlying causes are complicated, one thing is clear: public health systems are not equipped to address the problem at scale.

Much of our global health infrastructure was built in the post-World War II era to address battle injuries, infectious diseases and maternal and child health. But society has changed dramatically since then. People are living longer, creating a disproportionate and unsustainable dependency ratio between those in the workforce and those in retirement. The former category, whose numbers are shrinking in proportion, are financially supporting those in the latter, whose longer life spans require more expensive healthcare. By 2030, most high-income countries are expected to spend 10% of their total GDP on healthcare, with the United States pushing closer to 20%.

Moreover, health systems too often have inverted incentives. Prevention is better than cure, yet heart attacks, for example, are more often treated after they've happened with a stent or blood-thinning medication, rather than prevented through heart-health screenings, healthy diets and moderate cardiovascular exercise.

This trend creates concerning domino effects. Cash-strapped health systems run low on resources, leading to overworked physicians and nurses without proper time to spend with each patient, which leads to patients with a lack of knowledge and incentives to prevent illness. The result is worse health outcomes and greater health inequities.

There must be a collective and comprehensive effort to redesign healthcare systems, orienting them towards disease prevention and measurably improving health at the population level. This process begins with industry and health systems working in tandem, supplementing each other’s efforts as partners with the shared goal of better serving patients.

It’s a big task, but recent research points to how it can be done. A Harvard University Health Systems Innovation Lab study sheds light on how strategic partnerships between governments and private industry can accomplish this in the context of CVD.

Researchers analysed six partnerships between government and industry. They concluded that to improve health on a large scale, these collaborations must first be guided by systems thinking. In other words, leaders in one health field can’t focus narrowly on addressing a particular disease or introducing a new treatment, while ignoring the bigger picture. They must think about how any innovative changes made in one area of the health system have knock-on effects throughout the system, with intended and unintended consequences over the short and long term. Crucially, the research also found that the best expertise and technology can fail in a system where trust, open dialogue, transparency and accountability are lacking.

All of this points to how pharmaceutical companies can be better partners within healthcare systems. The pharmaceutical industry must listen more intently to the challenges that healthcare systems face. We must use what they tell us to design therapies that are not just effective, but are as simple and cost-effective as possible for healthcare systems to administer. Engaged as partners, we must find new ways of working collaboratively to maximise patients’ access to prevention (through education and awareness) and treatment (through access and availability).

These are the principles my company, Novartis, has applied in a first-of-its-kind population health partnership with the National Health Service (NHS) in England to combat CVD (which is among the partnerships studied by Harvard). In the UK, CVD accounts for one in four deaths and costs the health system more than £19 billion per year. It is predominantly treated with initial daily statin regimens to lower cholesterol, but 50% of patients discontinue their statin regimen within two years and 80% of patients don’t reach recommended cholesterol levels.

We knew that realizing the true potential of what we could offer to improve cholesterol management would require us to think differently and develop a unified strategy working closely with healthcare systems. We committed to working with NHS leaders to understand their needs. Over the course of two years, together we designed efficient care pathways to ensure the maximum number of people with CVD and high levels of bad cholesterol could be identified and optimally benefit from cholesterol-lowering therapies. By adapting and collaborating, our partnership has enabled true population-level needs to be met.

We’re also learning from others who have pursued similar approaches to collaboration with health systems. A collaborative partnership between pharmaceutical companies in Malaysia and the Malaysian Ministry of Health, for example, led to vast leaps in the development and distribution of a Hepatitis C drug. On a larger scale, the Innovative Medicines Initiative helps deliver novel treatments by building broad coalitions between universities, pharmaceutical companies, patient organizations and national regulators. These collaborations have led to leaps in some of the world’s biggest diseases, including diabetes and dementia.

Integrated partnerships are key to progress. Healthcare systems and the pharmaceutical industry must work in unison to meet the changing needs of patients. Together, we can – and must – adapt to meet these challenges.