The disruption caused by COVID-19 has created a rallying cry to build sustainable healthcare access for the people. But, before we get into specifics, could you tell us how do you interpret the term ‘Sustainable healthcare access’?
I see it from the patients’ perspective as, ultimately, it is the patient’s health and medical outcomes that matter. COVID-19 overwhelmed hospitals and disrupted the management and treatment of patients who needed care. Patients with long and chronic diseases could not visit doctors or receive treatment. In hindsight, these were the people most vulnerable to developing severe COVID-19 infections. Sustainable healthcare access requires a resilient healthcare system. The world population is growing and ageing dramatically, increasing the prevalence of chronic diseases. Hospitals are unable to cope with this increase and face added global health threats like COVID-19, which overburdens them further. As a matter of fact, we realised that hospitals need help in connecting with patients, in following and managing them when they are outside the hospital space. This is what creates a resilient healthcare system.
Dr. Saba, you were instrumental in the fight against the HIV epidemic, with your work making antiretrovirals (ARVs) accessible to many vulnerable populations across the world. How would you compare that to vaccine accessibility during COVID-19?
Access to ARVs is a long and successful journey. I learned a key lesson that the availability of medicines and vaccines does not imply accessibility. There is more to access than just the availability of the product. During the HIV pandemic, we worked on the delivery of the products, patient records, training of physicians, and follow-up with patients. All these aspects improved patients’ accessibility when ARVs were made available. We seem to have forgotten these lessons. Access to COVID-19 vaccines was very challenging, especially in low-income countries. Initially, high-income countries were criticised for monopolising access to COVID-19 vaccines, but after the initial rush eased, vaccines were in high supply. Yet in March 2022, two years into the pandemic, only over 3 per cent of people in low-income countries were vaccinated.
COVID-19 elicited strong reactions from nations across the world. Many enforced stringent border restrictions and shut themselves off from the world. Do you think this was a justified emergency approach or could the pandemic have been handled better?
We closed borders and locked down populations because we could not do any better, and it didn’t really work. But ultimately, despite all these precautions, people continued to get infected until we began rolling out the vaccine. What could we have done better? In any epidemic or pandemic, we need to focus on protecting the most vulnerable people. In HIV, we began with mass prevention and later moved to targeted prevention, focusing on those most at risk of getting infected.
We knew from the beginning that the elderly and patients with chronic diseases were the most at risk of developing severe COVID-19 infections. These two populations are intertwined. We could have focused on these populations to protect them and ensure they are properly treated. But nearly all our healthcare systems are set up for the patients that come to the hospital or health facility. Once the patient leaves, there is no system to connect with the targeted prevention for COVID-19 as conducted with HIV.
Rising chronic diseases and an ageing population have caused healthcare costs in Asia to rise steeply over the years. How can the region ensure sustainable healthcare access for its people?
Affordability needs to be addressed as a fundamental element in any access strategy to achieve sustainable healthcare access. Given the rising number of cases and the enormous scientific progress, no one person can address the issue of affordability alone. The affordability solutions to equitable healthcare access require multiple stakeholder collaboration between governments, multinational pharmaceutical companies, insurance companies, charities, and civil societies.
Furthermore, lowering the price of a product alone does not and will not achieve sustainable access solutions because it does not look at the patient’s full course of treatment journey to achieve the best health outcomes. What is required is a more holistic solution than just price cuts to enable affordability. As we learned, with HIV and with COVID-19 vaccines, there is a lot more to consider when providing ‘equitable healthcare accessibility’ than the price.
How will sustainable healthcare access be defined in 2023 and beyond? How should Asia prepare itself?
In Asia, we must move our focus toward better health outcomes, starting by looking at the costs of accessibility and adherence to patient treatment from this perspective. More digitalisation and better connection with the patients will also help reduce costs and optimise medical outcomes. After the COVID-19 pandemic, the healthcare community in Asia and worldwide became conscious of the existing gaps. We are on the verge of a digital transformation in healthcare and more sustainable access solutions, but this journey to success will take longer than 2023.
What is the role of digital healthcare solutions in building sustainable healthcare access?
Modern healthcare requires a health ecosystem where hospitals and health facilities are at the centre but are not the only player. There need to be a multi-faceted approach and different stakeholders contributing to patient follow-up and treatment outside the healthcare facility to create sustainable healthcare access. In any ecosystem, connectivity is key. It facilitates patient outreach as a connection between healthcare providers and rapid response to health threats.
If we look around us, the banking, finance, and supply chain industries have embraced digital revolutions. Healthcare is still so much behind. Further, the world is now more interconnected, but healthcare systems are not. We need to transform healthcare accessibility by digitalising healthcare systems within and outside the healthcare facilities and be future-ready to face the next global health threats.