Global Healthcare Concerns

February 11, 2020 Maria Perrin

It’s impossible to address US health without looking at issues affecting the entire world. Healthcare issues transcend international borders, pathogens don’t carry passports; climate change doesn’t care what your GDP is.

Here are some of the issues that keep the World Health Organization (WHO), Centers for Disease Control (CDC), North Atlantic Treaty Organization (NATO) and others up at night.

 Antibiotic-Resistant Microbes

In 1928, Scotsman Alexander Fleming accidentally identified the bacteria-inhibiting properties of the mold penicillium. This absolutely transformative discovery ushered in an era where the biggest killers of the day—smallpox, cholera, diphtheria, pneumonia, typhoid fever, plague, tuberculosis, typhus and syphilis were no longer a death sentence. Now, they could usually be treated quickly, easily, and cheaply with this new class of drugs. As a result, non-communicable diseases such as cancer and heart disease replaced infections as the major causes of death.

Almost immediately it became apparent that certain pathogens were becoming resistant to the antibiotic. Unfortunately, through continued overuse of antibiotics in humans (along with poor patient medication adherence) and animals, we are squandering Fleming’s incredible gift to global health, and diseases that we grew up thinking are “no big deal” are becoming lethal once more.

According to the CDC’s 2019 Antibiotic Resistance Threats Report, more than 2.8 million antibiotic-resistant infections occur in the U.S. alone annually, resulting in more than 35,000 deaths.

In November 2019, CDC Director Robert R. Redfield, M.D. said:

“Simply, here’s what works. Preventing infections protects everyone. Improving antibiotic use in people and animals slows the threat and helps preserve today’s drugs and those yet to come. Detecting threats and implementing interventions to keep germs from becoming widespread saves lives.”

 Vaccine hesitancy

The WHO considers the anti-vaccination movement one of the top 10 threats to global health.

There have been those who worry about negative effects of vaccines since the development of the smallpox vaccine in the 1700s. Members of the clergy called vaccines “the devil’s work” in sermons with titles such as “The Dangerous and Sinful Practice of Inoculation.”

More recent resistance probably began with the 1982 film “Vaccine Roulette,” which wrongly claimed that certain vaccines caused neurologic disorders.

The current crisis was greatly exacerbated by the 1998 publication of a paper in The Lancet (a highly regarded medical journal) suggesting a causal relationship between the measles, mumps, and rubella (MMR) vaccine and development of autism in young children. The author, Andrew Wakefield, secretly received funding from anti-vaccine litigants, his methods and data were flawed, and any causal connection has been thoroughly disproven in subsequent studies. Wakefield was vilified in the scientific community and lost his license to practice medicine. The Lancet issued a retraction—12 years later—calling the study’s conclusions “utterly false.”

In an earlier time that might have been the end of the story, but in the internet age the misinformation spread worldwide and the anti-vaxxer movement was born.

When enough people refuse vaccinations for themselves or their children, it results in a breakdown of “herd immunity”—when a high enough percentage of people in a given population are vaccinated, a disease has a small enough chance of finding a susceptible host that the entire group is safe. Below that percentage (it varies by disease), all those who are unvaccinated are liable to become ill.

In the UK in 1998, the year of publication of the Lancet paper, 56 people contracted measles, in 2006 that number was 449 in just the first five months of the year, and the first death was recorded since 1992.

 In Ireland, there were 1500 cases in 2000 resulting in three deaths. Between 2008 and 2011, France saw 22,000 cases

 There were measles outbreaks in the United States in 2008, 2011, 2013 and 2014/15. In an attempt to stem the crisis, California passed a mandatory vaccination law in 2015, banning personal and religious refusals to vaccinate.

Noncommunicable diseases

Diabetes, cancer and heart disease kill 41 million people each year, accounting for 70 percent of all deaths worldwide. Fifteen million of these deaths are premature (people between 30 and 69).

The WHO calls these diseases a “slow motion disaster,” and while they used to be the domain of developed countries, the primary causes—smoking, alcohol abuse, unhealthy diet and physical inactivity—have now become a global problem.

The WHO is taking steps on multiple fronts in an attempt to tackle this complex problem, both monitoring, developing action plans and coordinating the efforts of several outside agencies and NGOs.

Pandemics

World War I killed approximately 20 million people. The influenza pandemic that immediately followed in 1918 killed several times that many; estimates range from 50-100 million.

Another flu pandemic is inevitable, the question is when it will arrive, and how well are we equipped to control its spread?

With the Wuhan coronavirus very much in the news right now, it’s encouraging that since dealing with severe acute respiratory syndrome (SARS) and other strains of avian and swine flu, China’s early detection and containment systems have been upgraded. Also, the severity of outbreak is not being played down as it was with previous epidemics. In fact, the government has warned that anyone found to be covering up cases of the virus would be met with “severe punishment.” It’s reported that if coronavirus had surfaced just 5-10 years ago it wouldn’t have been detected until many more became sick.

This new virus, like SARS, is thought to have jumped from animals to humans (a “zoonotic” disease).

The WHO works with 153 partners in 114 countries to monitor the distribution of flu strains. They recommend which strains should be vaccinated against each year, and in the event that a new strain develops pandemic potential, they are ready to deliver diagnostics, vaccines, and other treatments worldwide. Additionally, programs such as the CDC’s One Health initiative are working to educate the public about zoonotic diseases, and to coordinate the actions of various experts to improve public health.

Air pollution and climate change

Ninety percent of the world’s population breath polluted air every day. The WHO consider air pollution a top ten risk to global health. In a one-two punch, the predominant cause is the burning of fossil fuels, which itself is a major contributor to climate change. This is a separate issue expected to cause a quarter of a million additional deaths per year from malnutrition, malaria, diarrhea and heat stress between 2030 and 2050. Some studies suggest that climate change will expose 49% of the world’s population to disease carrying mosquitos by 2050.

Scary! What can I do? What are others doing?

It is scary, but there’s a lot being done on many fronts to tackle these issues.

Awareness is the first step, and if you’ve stayed with us this far, you’re on the right track. The CDC, the WHO, and many other non-governmental organizations (NGOs) are doing amazing and brave work to keep us ahead of these global health threats. Learning more through their online resources, and contributing financially are great things to do. Consider having conversations with friends and family to help educate them on the dangers, and the things that can be done to minimize risks.

Many of these issues are starting to be mitigated by new technologies such as personalized consumer engagement to educate and remind patients about treatments. Smart medication containers promote adherence, as do apps that connect consumers to pharmacies so that they can get refill reminders, order refills for deliveries, and connect directly to pharmacists with their questions.

Noncommunicable diseases outcomes are being improved by streamlined access to primary care through services such as CVS’s MinuteClinicsWalmart Care Clinics and access to providers via telehealth technology.

Artificial intelligence and machine learning are being used for everything from diagnosing diseases, developing new drugs, assisting in surgeries for better outcomes and predicting potentially pandemic viruses.

Advanced traps with sensors and AI are allowing researchers to create highly accurate real-time risk maps to control diseases such as malaria, dengue and zika.

Technologies such as renewable energy, electric cars and efficient LED lightbulbs are helping with air pollution and climate change.

We’re committed to doing everything we can to improve the health of all. Through research project with top universities such as Stanford and SMU, and through analytics and technology development, we’re aiming to move healthcare forward. Please partner with us to advance healthcare systems in the U.S. and around the world!

About the Author

Maria Perrin

Maria Perrin is Chief Growth Officer for HMS, where she is responsible for the company’s corporate strategy, marketing, government relations, business development, and oversight of the company’s more than 500 contracts with government and commercial healthcare organizations. She has transformed HMS’ brand and furthered its industry impact through numerous thought leadership and innovation initiatives. Maria rejoined HMS in 2019, after co-founding a successful consulting practice that launched dozens of health tech startups and tech companies in emerging sectors. During her first tenure at HMS, as Chief Marketing Officer and EVP over government and commercial markets from 2008 – 2013, HMS revenue grew fivefold and the company successfully entered the federal market, doubled the volume of state contracts, and expanded services to commercial payers. Prior to HMS, Maria was Senior Vice President, Sales, Marketing, and Business Development for Performant Financial Corp. where she led Performant’s entry into the healthcare market and other sectors. Maria has held financial and operational leadership roles for BestFoods, Nissan and other Fortune 100 companies. She has a BA in Economics from UCLA and an MBA from the University of Miami.

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