#EAPM – Best use of #COVID-19 battle weapons? Yet another ’value’ argument…

| May 13, 2020

Last week, the European Alliance for Personalised Medicine (EAPM) co-organized a future proofing event, regarding the situation in our particular area and arena of expertise, yet with a lean also towards Asia – which shares many of the same issues and challenges that we’re dealing with in Europe, writes EAPM Executive Director Denis Horgan.

Among the many issues up for discussion during the event were how to allocate resources which, of course, comes partly as a knock-on effect of how we define ‘value’ (and from whose perspective) – in essence, the big question of Who Decides?

EAPM and many others have debated this many times as every stakeholder has their own viewpoint – patients, payers, manufacturers. And, of course, everybody wants the best healthcare for their citizens and themselves. In the meantime, as a huge part of that process, researchers want to produce the best research, patients/citizens want earlier diagnosis, higher standards of care, earlier access and the most cutting-edge and effective of treatments, and industry wants to produce amazing new drugs making the very best of rapidly emerging science. In the case of new science and new uses for science, it must be remembered that personalised medicine in-and-of itself is a serious push towards greater value, in every context, certainly in the long term. By giving the right treatment to the right patient at the right time, personalised medicine is crucial here.

Putting the patient at the centre

It’s all about confidently and scientifically identifying patients who have the best possibility of having a positive response to a given treatment. It’s all about making more informed decisions, which is a key value in itself. As an excellent, specific example, companion diagnostics are invaluable in this context. By helping to reduce some of the uncertainty around treatment, these complex tests are unique even within the field of in vitro diagnostics, or IVDs. They are enormously helpful in shifting health systems from a treatment-centred approach to a truly patient-centric one.

It is a measure of how successful a society is or isn’t that each human being should receive the best treatment available, and it is essential in these times of healthcare reformation and upheaval (wanted or not) – that we keep the person in personalised healthcare. Again, in this respect, it is acknowledged that patients are overwhelmingly in favour of the use of cutting-edge companion diagnostics that can tell them what diseases they have, and the best way to treat them, while payers and lawmakers are much more cautious when weighing cost against ‘value’.

Clearly, over a great many other things, patients place significant value on having the facts. And in respect to ‘value’ in all its aspects, during the Covid-19 outbreak we have seen across Europe certain areas of hospitals taken away from their normal use and certain therapies actually stopped. Now this actually happens virtually every year in some respects as we enter the time of seasonal flu, with more ICU beds obviously required. But it has rarely led to the suspension of chemotherapy treatments, for example, as it has in some instances and locations this spring. Is that actually morally justifiable? Without weighing up the survival rates (especially from this early end of the spectrum) it is difficult to say, but certainly it brings about uncomfortable feelings of ‘fairness’, ‘effectiveness’ and, yes, ‘value’, however you want to define it. In some parts of the world hospitals have made no bones about having to ration lifesaving treatment for patients with the novel cornonavirus.

We are fortunate that most fears that there would not be enough ventilators etc have thus far, proved unfounded, and doctors have rarely had to make the toughest of tough choices in the context of the pandemic, certainly in Europe. Meanwhile, happily, the ‘Nightingale Hospitals’ that have sprung up in places such as the UK are so far underused. It’s doesn’t mean they won’t be used, of course, if a second wave (or even third or fourth) surpasses the first. Initially, the fear was that ventilators would be in short supply. For now, there seems to be enough. But some hospitals are short on dialysis machines as well as the staff members and supplies to run them. It’s excruciating to think of doctors being forced to decide which patients get care and which don’t. On top of that, where was their vital personal protective equipment from Day One? The short answer is ‘absent’.

More EU? Surely?

If the crisis has thrown anything into relief it has been a clear need for a governance framework across the whole EU. We can see the lack of it even now. There is no joint decision-making between even bordering countries about when lockdowns are stepped back, and it all looks just as messy as what is going on in the United States – no cohesion, individual states acting as they see fit etc. What can we do to fix this now and going forward, because it certainly needs fixing. Well, among items that will be discussed at EAPM’s next major video conferencing event at the end of June – will be whether the EU should have a bigger role in public health, particularly in the provision of health technology.

Registration will be open on Friday (15 May) for the upcoming Croatia-Germany EU Presidency bridging conference entitled ‘“Maintaining public trust in the use of Big Data for health science in a COVID and post-COVID world”, taking place on 30 June, which certainly covers a multitude of topics but, even so, is still not a big enough title to cover all we’ll be discussing!

Another session coming on 19 May, which discusses many of these data elements is the following, taking place at HIMMs, entitled: ‘Accelerating Health Systems’ Digital Transformation: Why Digital Health Must Be the New Standard in a Post-COVID-19 World’ You can click here to see more details.

Multi-stakeholders find a way

A key role of any EAPM conference is to bring together experts to agree policies by consensus and take our conclusions to policy makers. On whether the EU should have more influence in healthcare, such a reality would of course impinge upon the closely guarded member state competence in healthcare. So if this were to happen, how would that be? Clearly we need to move on this fundamental quickly. We should have already done so, in fact, but perhaps the pandemic will (eventually) focus minds. It will have to, because linked to this question is how can the now very evident gaps be bridged in order to better protect Europe’s health ahead of another crisis?

What are the priorities?

The broader question, as mentioned above, is whether it’s time to give the EU a bigger role in protecting you, me and all of us. As the pandemic has unravelled and lethally struck at the heart of Europe and the global community, the deficiencies in availability and supply of necessary assets for responding have become overtly clear. As mentioned above, there have been huge shortages of personal protective equipment (PPE), such as face masks, as well as near misses in basic ICU equipment that should have plenty, and a lack in less well-provisioned countries, and much scrabbling around for key devices and within infrastructure constraints.

On top of this, there has been inadequate provision of high-tech procedures and processes, for testing (both for infection and for immunity), a shortage of medicine for symptomatic treatment, for any curative therapy, and (not surprisingly given the timescale) for preventive vaccines. Systems have broken down at many levels and have not been totally salvaged in most cases. While not delaying the hunt for a vaccine, Europe must produce an administrative system to support the public’s ability to live with COVID-19. We can’t simply sit and wait. Europe has lacked and – given the haphazard ways the lockdowns are being dismantled right now – still lacks coordinated, sustained efforts by the EU and member states to build capacities and rise to challenges. Watching this all unravel bit-by-bit is nail-biting, to put it mildly.

Testing one, two, three…

And, of course, we have the questions surrounding testing and (often controversial) contact tracing. Some democracies seem to have helped to keep their death tolls low by using a combination of social distancing, tight travel restrictions, mass testing and the aforementioned tracing. Not all have managed, though (the UK notably hasn’t, thus far, but is not alone). Testing is the big deal of the day.

Who to test, when to test, how to test…?

Time is of the essence, decisions need to be made, and there needs to be an upswing in capacity. This is quite apart from the fact that the crisis in which we find ourselves has given us all a reminder of the ongoing challenges of emerging and reemerging infectious pathogens. We need to observe constant surveillance as these will become more common, not less. Prompt diagnosis is vitally important. Not least because, in the early stages of the outbreak, COVID-19 certainly spread faster than Europe could detect it. It seems that as this (still relatively early) stage, containment of the novel coronavirus may rely heavily on early case detection and contact tracing. In fact, it seems far to say that it can be deemed crucial to an effective response. As ever, there are so, so, so questions to be answered, with the above and more set to be debated at this conference.We sincerely hope you will be able to join us and play your much-valued part in helping to answer the key questions of the day. Registration will open on Friday for our 30 June conference.

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Category: A Frontpage, coronavirus, EU, European Alliance for Personalised Medicine, European Commission, European Parliament, Health, Personalised medicine

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