The Covid crisis and far-reaching societal changes have put the healthcare sector under immense strain. Geopolitical pressures and supply chain disruptions compound the challenges, as do questions of financing and global population aging. It is time for the sector to take a joined-up approach to these many factors and reinvent itself as it responds to the new challenges and questions facing our societies.
Over 750 million infections and almost 7 million deaths. These two statistics starkly illustrate the magnitude of the impact caused by a crisis that the OECD has described as “the most significant public health emergency in more than a century”. What sector besides healthcare could possibly claim to have been more tested by the pandemic?
Crisis compounded by crisis
Across the planet, the Covid-19 pandemic highlighted deficiencies in health systems, exposing inadequate capacity, underfunding and unpreparedness for major health threats. In Europe, the crisis was further exacerbated as disorganised supply chains led to a procurement crisis. According to statistics from the European Medicines Agency (EMA), 40% of medicines sold in the European Union (EU) are imported, and between 60% and 80% of the main active pharmaceutical ingredients (APIs) are manufactured outside the continent, chiefly in China and India, up from 20% 30 years ago. In France, according to the National Agency for the Safety of Medicines and Health Products (ANSM), around 3,000 molecules were unavailable during winter 2022-2023.
These interlocking crises served one useful purpose by putting healthcare back at the forefront of the debate and serving as a reminder that this is a global question with a major bearing on the future of our societies.
Meeting today’s challenge to secure our future
Beyond the recent global pandemic, healthcare also needs to cope with a profound shift in the global health landscape caused by the huge demographic, social, cultural, economic and environmental changes currently underway. According to the World Health Organization, the proportion of people aged 60 and over in the world population is set to nearly double between 2015 and 2050, rising from 12% to 22%. This will bring new health challenges along with increased prevalence of conditions related to ageing, such as neurodegenerative diseases.
Diseases related to diet and lifestyle changes are on a similar trend. More than one billion people worldwide are obese, and by 2025, approximately 167 million people will become less healthy because they are overweight or obese. The WHO has identified obesity as a source of diseases such as type 2 diabetes, cardiovascular disease, hypertension and stroke, and various forms of cancer. Obese people are also three times more likely to be hospitalised for Covid-19. This new situation is already having health consequences: in August 2022, the United States Centers for Disease Control announced that US life expectancy decreased by almost a year between 2020 and 2021. The economic impact cannot be ignored either. A study published in 2022 estimated the amount of global GDP lost due to obesity each year at 2.2%. This could rise to 3.3% by 2060.
The big picture is further complicated by local features that also have a significant impact on care provision. These include key issues such as changes in drug prices in the United States, medical deserts – which exist even in Europe – and the increased share of public finances allocated to health coverage systems.
New policy approaches
In the face of these challenges, governments, health authorities and international bodies are on the same page about what needs to happen next: expand care services through innovative medicines and devices, improve prevention and diagnosis, and shore up healthcare systems. United Nations member states are aiming to establish universal health coverage by 2030 as part of the UN Sustainable Development Goals (SDGs).
Policy responses play a primary role. In August 2022, US President Joe Biden signed a $430 billion Build Back Better investment plan to tackle climate and health challenges. One of the plan’s primary goals is to combat inequality in access to care, notably by reducing drug prices.
In Europe, the health crisis and its fallout galvanised efforts to build a common health policy. In 2021, the European Commission set up the Health Emergency Preparedness and Response Authority (HERA), which is tasked with anticipating health crises and delivering a coordinated response within the EU. For the first time, a European authority placed orders to procure vaccines (against monkeypox) for distribution according to member state requirements. Significant budget resources are in play, with the new EU4Health 2021-2027 programme allocated €5.1 billion, compared with the previous programme’s €450 million budget.
Healthcare has also muscled its way into the highly political debate on Europe’s strategic autonomy. Proposed solutions include supporting the European pharmaceutical industry as part of a broader reindustrialisation and reshoring policy. The EU has also set goals for innovation, the digital transition and biomedicine.
An innovation-driven response
Recent crises have strengthened the belief that innovation will play a decisive role in meeting the health challenges of the 21st century. The pandemic spurred an acceleration in the sector’s digital transition. At the crossroads of tech and healthcare, healthtech, which encompasses biotech, medtech and e-health, is one of the biggest beneficiaries of current trends, as reflected by the fact that the value of European healthtech firms increased more than sixfold between 2016 and 2021, from $8 billion to $41 billion.
From developing new treatments to creating management software for healthcare facilities and enhancing patient support, the heady cocktail of innovation and digital tech is impacting every aspect of healthcare. Artificial intelligence, robots, connected objects, 3D printing – all of these technologies are playing a part in reinventing medicine and care. In terms of practical applications, recent years have seen the emergence of computer-assisted surgery, smart protheses and use of AI and big data to improve diagnoses. These technological advances are being accompanied by a new approach to patient-centred care, aimed at making people active participants in their care journey through connected monitoring devices, assistive robots and personalised medicine.
Research is making great strides too. Innovative research is driving the success of many biotechs, which have found ways to renew therapeutic approaches in fields including oncology, immunotherapy, mental health, genome editing and the treatment of rare disorders. Europe is a global heavyweight in this respect, filing 40,000 biotech patents between 2015 and 2021, behind the United States but ahead of China. One of these biotechnology firms, Germany’s BioNTech, earned a worldwide reputation for developing a Covid-19 vaccine.
The role of the private sector
The example of BioNTech, which had to team up with pharma giant Pfizer to market its vaccine, illustrates one of the key difficulties facing the healthcare sector – financing. Healthcare requires massive investments over the long run, which can be deterrent for those hoping to reap short-term results or profits. The tangible effects of a prevention or vaccination campaign may not be apparent for years or even decades. In innovation, likewise, it can take over a decade to develop, test and approve a new therapy or medical device for market launch, and huge investments are needed.
The scale and multi-factor complexity of healthcare-related challenges make it vital to improve the integration of public and private sector participants, which may be involved both upstream, during the research stage, as well as downstream, by providing companies in the sector with the resources required to innovate. France’s vibrant and promising healthtech sector highlights the pivotal role that private financing can play. In a challenging financial environment, the sector managed to fundraise over €2.6 billion in 2022, up 14% on 2021. Performances like these offer hope that the healthcare sector can tackle the challenges facing it and emerge even more innovative and resilient.
 Economic impacts of overweight and obesity: current and future estimates for 161 countries: https://gh.bmj.com/content/7/9/e009773