30 d’abril 2021

On the impact of pandemic: an interview

Last week I was interviewed by Diario Médico, and this was the result: 

Sáb, 24/04/2021 - 08:00

Casi catorce meses han pasado ya desde que se declarase la pandemia de la covid-19. En este tiempo, son numerosas las preguntas que giran en torno a la crisis sanitaria generada por el coronavirus en España y muchas de ellas corresponden al ámbito de la economía de la salud: ¿qué impacto monetario está teniendo? ¿Qué carencias se han evidenciado en el SNS a raíz de la pandemia? ¿Qué repercusiones tendrá? ¿En qué aspectos urge invertir?

Para ayudar a despejar estas y otras incógnitas, Pere Ibern, economista de la salud e investigador principal del Centro de Investigación en Economía y Salud (CRES) de la Universidad Pompeu Fabra (UPF), en Barcelona, ha hablado con este periódico para analizar cómo está la situación, exponer puntos de mejora y esbozar hacia dónde se debe avanzar. 

Pregunta. ¿Qué impacto está teniendo la pandemia de la covid-19 en la sanidad española en materia económica?

Respuesta. Debemos admitir que en este momento resulta difícil estimar con precisión el gasto sanitario específico a causa de la pandemia. Ahora bien, los datos oficiales indican que el gasto sanitario público ha pasado del 6,1% del Producto Interior Bruto (PIB) en 2019 al 7,6% en 2020. O si lo miramos en gasto medio por habitante en España, hemos pasado de 1.593 euros  a 1.774. Es decir, un crecimiento del 11,3% en 2020. Desconocemos qué parte de este aumento es atribuible a la pandemia, pero podemos pensar que mayoritariamente se ha destinado a ella. Estas cifras son un reflejo de la contabilidad pública; no son los costes de la pandemia. 

El mayor coste de la pandemia resulta de la pérdida de salud y de años de vida. Las primeras estimaciones señalan que la esperanza de vida podría haber disminuido más de un año en 2020. El alcance de los problemas de salud persistentes relacionados con la covid todavía no lo sabemos con exactitud.

P. ¿Cómo valora la utilización que se está realizando en España de los recursos económicos y sanitarios para afrontar la pandemia?

R. Hay dos niveles a considerar: el de la capacidad óptima y la capacidad real de los recursos. Se ha evidenciado que, en términos de capacidad óptima o deseable, estamos por debajo de los recursos necesarios. Las limitaciones en la capacidad instalada a las que se enfrentan los profesionales sanitarios son conocidas ampliamente. Y por ello, hay que afrontar las decisiones atendiendo a la capacidad real, tratando de satisfacer las necesidades en cada momento de la mejor manera posible.

"En términos de capacidad óptima, estamos por debajo de los recursos deseados"

P. ¿Ha evidenciado la pandemia carencias en la sanidad española y la necesidad de invertir en recursos?

R. Creo que muchas de las limitaciones en términos de inversión pública y de recursos profesionales eran y son suficientemente conocidas dentro del sector. Por ejemplo, la fragilidad y obsolescencia de los equipos se ha puesto de manifiesto repetidamente por parte de la Federación Española de Empresas de Tecnología Sanitaria (Fenin). Ahora bien, la pandemia lo que ha hecho es explicar con mayor claridad hacia la opinión pública tales restricciones. Por ejemplo, una cifra que conocíamos y que se ha difundido ahora es que en 2019 gastamos 17 euros por habitante en prevención y en salud pública, un 1% del gasto sanitario público; una cifra claramente insuficiente y que obliga a una revisión en profundidad. En 2021 por supuesto, ya habremos gastado mucho más. Muchas de las previsiones de la Ley de Salud Pública no se han aplicado por falta de decisión y recursos.

La pandemia ha situado como prioridad la creación de reservas estratégicas para crisis de salud pública como la que estamos viviendo y, al mismo tiempo, obliga a algunas tareas para el futuro, como coordinar los recursos ya disponibles en investigación y repensar la escasa oferta de plazas de formación sanitaria especializada en especialidades relativas a la atención de enfermedades transmisibles y atención primaria.

P. ¿Qué aspectos socioeconómicos eran, a su juicio, los que más deficiencias presentaban y los que más han quedado evidenciados por la pandemia?

R. Sabemos que la salud es fruto de múltiples factores, y la asistencia sanitaria es tan solo uno de ellos. Claramente, la transmisión de la infección ha seguido patrones diferenciales según vulnerabilidad clínica, social y epidemiológica, atendiendo a la clasificación que realiza el documento del ministerio Equidad en salud y covid-19. Las personas en situaciones de vulnerabilidad social están asimismo más expuestas a vulnerabilidad epidemiológica, entendida como mayor riesgo epidemiológico debido a una mayor exposición a la infección, retraso en el diagnóstico e identificación de contactos, o mayor dificultad para seguir las medidas de aislamiento o cuarentena. Por ejemplo, las condiciones de habitabilidad en las viviendas han sido un determinante fundamental y a su vez es muy difícil de medir su alcance real.

"La pandemia ha situado como prioridad la creación de reservas estratégicas"

P. De cara al futuro y tras lo vivido desde inicio de la pandemia, ¿en qué aspectos del sistema sanitario considera que urge invertir?

R. En primer lugar, hay que invertir en las personas. El sistema de salud es capaz de dar respuesta porque hay unos profesionales que toman decisiones en momentos clave. Por consiguiente, hay que tomar en consideración tanto el número de profesionales necesarios y el tipo. El desfase entre el número de profesionales graduados, oferta de plazas de formación sanitaria especializada y necesidades reales revela un desajuste que es urgente corregir. La regulación de las profesiones sanitarias y en especial la troncalidad, lleva años atascada.

Asimismo, la compensación de los profesionales requiere una revisión que tome en consideración una mayor flexibilidad y unos criterios más individualizados y relacionados con el esfuerzo por una mayor calidad y creación de valor en salud.

En segundo lugar hay que invertir en equipos, y como siempre, hay necesidades de reposición y de nueva inversión. En la medida que hay limitaciones en ambas cuestiones, se requiere priorizar en función de conseguir mejorar la salud y calidad de vida de la mayor parte de la población. A menudo las prioridades de inversión siguen el criterio de fascinación tecnológica y descuidan las necesidades reales.

Y finalmente, de modo resumido, hay que invertir en innovación y talento. La innovación surge de la aplicación de la investigación y desarrollo en contextos de cultura organizativa que la favorecen. Así pues, no se trata sólo de más recursos económicos, sino de un contexto organizativo que sea más ágil y flexible para adoptar innovaciones que responden a las necesidades reales de salud y que ofrecen una respuesta coste-efectiva.

La pandemia, y en especial las vacunas creadas sobre la base del ARN mensajero, nos ha mostrado que la medicina basada en especialidades necesita tomar en consideración a la medicina molecular. Y este hecho tiene implicaciones profundas para el futuro de la generación de talento y la organización en medicina. Los cambios que se están produciendo fruto de la edición genómica, por ejemplo, afectarán a cómo se traslada este conocimiento a decisiones clínicas y a la forma organizativa de los servicios de salud.


P. ¿Cómo valora, a nivel general, la gestión económica que están llevando a cabo las administraciones sanitarias en España para combatir esta crisis?


R. Al inicio de la pandemia, la flexibilización de las normas de contratación pública permitió avanzar significativamente para conseguir los materiales y recursos necesarios. Esta situación debería analizarse con detalle, porque tengo la impresión de que es un experimento natural del que podemos aprender en el futuro. Las normas de contratación pública actuales no se ajustan a la realidad del sector salud, que requiere mayor flexibilidad y atención a las condiciones concretas de suministro. La pandemia mostró que es posible resolverlo, pero que es necesario garantizar transparencia en la información y responsabilidad en la gestión.

Sobre la gestión económica en su conjunto, sabemos poco porque los datos son escasos o inexistentes. Algunas comunidades autónomas ya están publicando los primeros datos, pero debemos esperar todavía.

"La compensación de los profesionales sanitarios requiere una revisión"

P. ¿Qué consecuencias cree que tendrá para la sanidad española, a corto, medio y largo plazo, esta crisis sanitaria?

R. Tratando de resumir mucho, tengo la impresión de que ha habido un impacto inmediato relativo al acceso a los servicios de salud. Las limitaciones para acceder al médico de atención primaria por motivos de la epidemia han dado lugar a una insatisfacción, que en el origen tenía su argumento fundado, pero que necesita resolverse pronto de forma satisfactoria. La población mayor, sin acceso digital, es la que se ha sentido más desprotegida. Los enfermos crónicos requieren de acceso y las limitaciones en los recursos profesionales disponibles han creado situaciones que necesitan corrección. De otro modo se produciría una pérdida de confianza, algo muy difícil de restablecer.

P. ¿Cómo considera que debe ser la apuesta por reforzar los recursos humanos del Sistema Nacional de Salud?

R. El ejercicio profesional en el ámbito de la salud requiere de unas condiciones que deben ser apropiadas para un nivel de calidad deseable. Esto significa que la cantidad de recursos debe ser la óptima y que los incentivos deben estar alineados con la consecución de la mejora de la salud poblacional. Podemos actualmente identificar áreas donde ni la cantidad de recursos ni los incentivos están al nivel admisible. La reforma organizativa del sector salud tiene que ver con el fortalecimiento de la visión profesional y muy poco con una perspectiva funcionarial.

La visión profesional de la medicina obliga a combinar acceso presencial con acceso digital, ambos necesarios y de forma coordinada. Conviene aprovechar lo digital sin olvidar lo presencial, tanto en atención primaria como en especializada.

P. ¿Y para reforzar los recursos materiales (equipamiento, tecnología, productos sanitarios, equipos de protección, etc.)? 

R. La prevención, el diagnóstico y el tratamiento son los tres factores clave. En prevención, conviene disponer de vacunas y equipos de protección entre otras cuestiones. Y para ello, hay que crear las infraestructuras que garanticen su disponibilidad.

En diagnóstico, los laboratorios clínicos han tenido un papel crucial en la pandemia y hay que reforzar su papel en el ámbito de la salud pública y las enfermedades transmisibles. Nunca el valor de la información fruto de los resultados del laboratorio había sido tan evidente para la población general. Hay una necesidad profunda de abordar una reforma de la estructura y una inversión en equipos para los laboratorios clínicos. Al mismo tiempo, hay una exigencia de repensar la troncalidad y especialidades disponibles en el ámbito del laboratorio clínico, así como el número de profesionales. Algo similar sucede con el diagnóstico por la imagen, si bien no ha llegado a nivel popular. Sabemos que las decisiones que aporta son fundamentales para cambiar el curso diagnóstico de la covid-19. Las necesidades de inversión en modernización de equipos e instalaciones son una asignatura pendiente a la vista de la capacidad instalada actual.

Y finalmente, considerar el tratamiento, tanto en el nivel de acceso mediante la atención primaria como en los hospitales. Se impone la necesidad de revisión de las infraestructuras y equipos, y crear capacidad extra para situaciones de emergencia.

"La pandemia obliga a coordinar los recursos ya disponibles en investigación"

P. Y por último: a su juicio, ¿cuáles son las principales lecciones que debemos aprender de la pandemia?

R. La respuesta a esta pregunta podría acabar siendo un libro. Únicamente señalaré que hemos tomado en consideración con mayor énfasis el valor de la salud en términos comunitarios. Se ha evidenciado la importancia de los comportamientos individuales y cómo condicionan la salud de los demás. Hemos aprendido del valor de la información, de cómo los profesionales son capaces de aprovechar esta información para decisiones clínicas que crean valor en salud. 

Durante la pandemia hemos sido testigos del profesionalismo en su máxima expresión. Esto significa altruismo, compromiso de mejora y capacidad de colaboración para afrontar la más compleja de las crisis de salud pública. Deberíamos situar el valor del profesionalismo en el fundamento de nuestras reflexiones sobre el sistema de salud que deseamos, y necesitamos hacer esto precisamente en un momento en el que el mercantilismo trata de abrirse paso y diluir el profesionalismo.





29 d’abril 2021

What you should know about the Covid-19 vaccines?

 The Covid-19 Vaccine Guide. The Quest for Implementation of Safe and Effective Vaccinations

A book that explains all the details of one of the greatest achievements in medical research,

In the United States, in just over 11 months, two mRNA vaccines were developed and manufactured in parallel, tested in phase 1, 2, and the phase 3 large clinical trials, found to be safe and efficacious, and distributed initially in December 2020 to healthcare workers and residents of long-term care facilities, followed by those over 65 and with underlying medical conditions in January 2021. The story of that remarkable scientific and manufacturing accomplishment is described later in this chapter.

Why do these vaccines work? What is an immune correlate of protection? Vaccines are designed to induce a human immune response that prevents individual disease and may prevent or shorten individual infections. Much of the background for SARS-CoV-2 vaccines was initially based on the research on SARS-CoV infections, which in 2003 caused a global outbreak in 26 countries, the work on another novel coronavirus MERS, the long-term studies of other coronaviruses, and the work on other respiratory viruses such as respiratory syncytial virus (RSV).

In addition to individual protection, vaccines may also induce community or “herd” protection by decreasing transmission of the virus from one individual to another. We know that the two initial mRNA vaccines prevent illness with 94–95% efficacy in individuals. However, we do not yet know if they prevent infection or transmission.



27 d’abril 2021

The narrative behind vaccine hesitancy

 VACCINE HESITANCY. Public Trust, Expertise, and the War on Science

The message:

The dominant framework that currently shapes scholarly and popular discourses on the problem of vaccine hesitancy employs a war metaphor to capture the intractability of the problem. The war metaphor also entrenches an “us” (science) versus “them” (publics) division that is not conducive to engagement and resolution. The “war on science” metaphor described a scientized (chapter 4) captured in three popular explanations for vaccine hesitancy: public misunderstanding of science (chapter 1), the influence of cognitive biases on the publics’ reasoning about vaccines (chapter 2), and antiexpertise and science denialism among the publics (chapter 3). All three narratives point to the publics as the problem (and even the enemy), with little attention to “us,” the courageous defenders of science. Yet, as I have shown, the scientizing force of “evidence-based everything” and the linear model of science-to-policy contribute to antagonizing science-publics relations

Take care... 




25 d’abril 2021

The impact of social differences in epidemiological vulnerability

 Equidad en Salud y COVID-19

El informe, que es un resumen del documento Equidad en Salud y COVID-19. Análisis y propuestas para abordar la vulnerabilidad epidemiológica vinculada a las desigualdades sociales, identifica tres tipos de vulnerabilidad, que están interrelacionados: vulnerabilidad clínica, vulnerabilidad social y vulnerabilidad epidemiológica.

  • La vulnerabilidad clínica está influida por características individuales (edad, problemas de salud crónicos, etc.) que conlleva una peor evolución de COVID-19.
  • La vulnerabilidad social se relaciona con la inseguridad y la indefensión que experimentan algunas comunidades y familias en sus condiciones de vida y con su capacidad para manejar recursos y para movilizar estrategias de afrontamiento. La pandemia ha puesto de manifiesto el peso de los determinantes sociales de la salud, es decir, de las circunstancias en que las personas nacen, crecen, viven, trabajan y envejecen, incluido el sistema de salud.
  • La vulnerabilidad epidemiológica es el mayor riesgo por una mayor exposición a la infección, retraso en el diagnóstico e identificación de contactos o mayor dificultad para seguir las medidas de aislamiento o cuarentena.

El documento destaca como determinantes sociales que influyen en la vulnerabilidad epidemiológica en la COVID-19: Empleo, vivienda, situación económica, entornos residenciales, sistema sanitario y socio sanitario, en la provisión de cuidados y, finalmente, por el estigma y discriminación hacia algunas poblaciones por motivos de identidad de género, orientación sexual, origen, clase social, etnia, dependencia a drogas o comorbilidades.



24 d’abril 2021

Voluntary health insurance in Europe

 Private Health Insurance and the European Union

These are the topics of this new book:

Introduction: The European Union, the Insurance Industry and the Public-Private Mix in Healthcare

Insurance Directives and the Single Market: Towards a Trivialisation of Private Health Insurance?

Solvency II, the European Government of Insurance Industry and Private Health Insurance

The Uncertain and Differentiated Impact of EU Law on National (Private) Health Insurance Regulations

An Increasing Homogenisation of Private Health Insurers Under Solvency II?

Private Health Insurance in Belgium: Marketization Crowded Out?

Europeanized, Marketized but Still Governed by the State? Private Health Insurance in France

Ireland: The Ambiguous Role of the Health Insurance Market

The Dutch Way: Experimenting with Competition in the Healthcare System

In Between the Market and Public Health Insurance: A Place for Occupational Welfare in Europe?

I specially recommend chapter 9 on The Netherlands. Too often I hear misguided claims over the dutch system. This book will help.





23 d’abril 2021

Vaccine equity

 From Vaccine Nationalism to Vaccine Equity — Finding a Path Forward

From NEJM: 

Vaccinating the world is not only a moral obligation to protect our neighbors, it also serves our self-interest by protecting our security, health, and economy. These goals will not be accomplished by making the world wait for wealthy countries to be vaccinated first. By investing in multilateral partnerships with a sense of shared commitment and employing a global allocation strategy that increases supply and manufacturing, we can meet the urgent challenge of Covid-19, while creating sustainable infrastructures and health systems for the future. Getting the world vaccinated may well be the critical test of our time.



 Anna Billing

20 d’abril 2021

How do we choose to do the right thing?

The Power of Ethics. How to Make Good Choices in a Complicated World

The message

Ethical decision-making tethers us to our humanity. I see ethical decision-making as perhaps the greatest human connector. It binds us in a common optimistic project of benefiting and protecting society and humanity. Of crafting great stories for ourselves and others. Of continuing to probe what it means to be human in a technology-infused world.

But ethics on the edge require using our power and voices, seizing responsibility, taking action, and committing to truth. We all can actively choose ethics, rather than passively let ethics happen (or not). We all can prioritize humans over machines. We all can make decisions reflecting to future generations what we will tolerate for ourselves and demand of our legacy—rather than submitting to whatever trajectory that morally questionable leaders, innovators, and rogue actors define. We all can seek solutions and not just point out where others have fallen short.

The summary,

Four easily recallable steps, and the questions derived from these four words, will keep us focused: principles, information, stakeholders, and consequences.

Question #1: What are my guiding principles?

Who are you, as an individual or an organization? What do you stand for?

Question #2: Do I have the information I need to make this decision?

And what important information lies in the gap between the information you should know and the information you can know?

Question #3: Who or what stakeholders matter to my decision?

Who or what could influence, or be affected by, your decision?

Question #4: What are the potential consequences of my decision in the short, medium, and long term?

Have you considered the immediate and future impact of your decision at the time of the decision?


The book


and a video,




 

19 d’abril 2021

A better public health after COVID-19

 ¿ Será mejor la salud pública tras la COVID-19?

A must read op-ed.

La COVID-19 nos ha cuestionado sobre múltiples aspectos relacionados con la toma de decisiones en salud pública, desde la comunicación en salud hasta las bases jurídicas de las medidas de prevención, pasando por la monitorización de las conductas relacionadas con la infección o la aplicación de los modelos epidemiológicos.



 

 

18 d’abril 2021

Covid and social perspectives

 THE COVID-19 CRISIS. Social Perspectives

In Chapter 13

13 Post-pandemic Routes in the Context of Latin Countries: The Impact of COVID-19 in Italy and Spain by Anna Sendra, Jordi Farré, Alessandro Lovari and Linda Lombi

In terms of health and risk communication, the COVID crisis has emphasised the lack of specific training in crisis and emergency communication of many public sector organisations, including health institutions. This first social media pandemic has been a major challenge for health communicators; individuals often failed in effectively communicating data and numbers to counteract the infodemic and thus reduce the impact of false narratives. With the increasing diversification of social media platforms, ‘individuals’ health […] will be shaped by a multitude of social forces, each of which can mediate different kinds of health contagion processes’ (Zhang and Centola, 2019). Mitigating the spread of fake news seems to involve coordinated efforts between authorities, mass media and digital companies, but it also appears crucial to invest in education and digital literacy for developing a critical awareness of the use of digital technologies that could be useful for facing future health crises. In other words, the strengthening of comprehensive population-centred responses lies on finding answers concerning how the mechanisms of public concern will operate to engage in coherent protection rules or in what ways the forms of interaction will change

Outline of the book:

PART I: INTRODUCTION

1 COVID Society: Introduction to the Book

Deborah Lupton and Karen Willis

2. Contextualising COVID-19: Sociocultural Perspectives on Contagion

Deborah Lupton

PART II: SPACE, THE BODY AND MOBILITIES

3. Moving Target, Moving Parts: The Multiple Mobilities of the COVID-19 Pandemic

Nicola Burns, Luca Follis, Karolina Follis and Janine Morley

4. Physical Activity and Bodily Boundaries in Times of Pandemic

Holly Thorpe, Julie Brice and Marianne Clark

5. City Flows During Pandemics: Zooming in on Windows

Oimpia Mosteanu

6. The Politics of Touch-Based Help for Visually Impaired Persons During the COVID-19 Pandemic: An Autoethnographic Account

Hidi Lourens

PART III: INTIMACIES, SOCIALITIES AND CONNECTIONS

7. #DatingWhileDistancing: Dating Apps as Digital Health Technologies During the COVID-19 Pandemic

David Myles, Stefanie Duguay and Christopher Dietzel

8. ‘Unhome’ Sweet Home: The Construction of New Normalities in Italy During COVID-19

Veronica Moretti and Antonio Maturo

9. Queer and Crip Temporalities During COVID-19: Sexual Practices, Risk and Responsibility

Ryan Thorneycroft and Lucy Nicholas

10. Isol-AID, Art and Wellbeing: Posthuman Community Amid COVID-19

Marissa Willcox, Anna Hickey-Moody and Anne M. Harris

PART IV: HEALTHCARE PRACTICES AND SYSTEMS

11. Strange Times in Ireland: Death and the Meaning of Loss Under COVID-19

Jo Murphy-Lawless

12. Between an Ethics of Care and Scientific Uncertainty: Dilemmas of General Practitioners in Marseille

Romain Lutaud, Jeremy K. Ward, Gaëtan Gentile and Pierre Verger

13 Post-pandemic Routes in the Context of Latin Countries: The Impact of COVID-19 in Italy and Spain

Anna Sendra, Jordi Farré, Alessandro Lovari and Linda Lombi

14. Risky Work: Providing Healthcare in the Age of COVID-19

Karen Willis and Natasha Smallwood

PART V: MARGINALISATION AND DISCRIMINATION

15. The Plight of the Parent-Citizen? Examples of Resisting (Self-)Responsibilisation and Stigmatisation by Dutch Muslim Parents and Organisations During the COVID-19 Crisis

Alex Schenkels, Sakina Loukili and Paul Mutsaers

16. Anti-Asian Racism, Xenophobia and Asian American Health During COVID-19

Aggie J. Yellow Horse

17. Ageism and Risk During the Coronavirus Pandemic

Peta S. Cook, Cassie Curryer, Susan Banks, Barbara Barbosa Neves, Maho Omori, Annetta H. Mallon and Jack Lam




17 d’abril 2021

The world (dis)order after COVID-19

 COVID-19 AND WORLD ORDER. THE FUTURE OF CONFLICT, COMPETITION, AND COOPERATION

A free book of interest:

Part I. Applied History and Future Scenarios

Chapter 1. Ends of Epidemics

Jeremy A. Greene and Dora Vargha

Chapter 2. The World after COVID: A Perspective from History

Margaret MacMillan

Chapter 3. Future Scenarios: "We are all failed states, now"

Philip Bobbitt

Part II. Global Public Health and Mitigation Strategies

Chapter 4. Make Pandemics Lose Their Power

Tom Inglesby

Chapter 5. Origins of the COVID-19 Pandemic and the Path Forward: A Global Public Health Policy Perspective

Lainie Rutkow

Chapter 6. Bioethics in a Post-COVID World: Time for Future-Facing Global Health Ethics

Jeffrey P. Kahn, Anna C. Mastroianni, and Sridhar Venkatapuram

Part III. Transnational Issues: Technology, Climate, and Food

Chapter 7. Global Climate and Energy Policy after the COVID-19 Pandemic: The Tug-of-War between Markets and Politics

Johannes Urpelainen

Chapter 8. No Food Security, No World Order

Jessica Fanzo

Chapter 9. Flat No Longer: Technology in the Post-COVID World

Christine Fox and Thayer Scott

Part IV. The Future of the Global Economy

Chapter 10. Models for a Post-COVID US Foreign Economic Policy

Benn Steil

Chapter 11. Prospects for the United States' Post-COVID-19 Policies: Strengthening the G20 Leaders Process

John Lipsky

Part V. Global Politics and Governance

Chapter 12. When the World Stumbled: COVID-19 and the Failure of the International System

Anne Applebaum

Chapter 13. Public Governance and Global Politics after COVID-19

Henry Farrell and Hahrie Han

Chapter 14. Take It Off-Site: World Order and International Institutions after COVID-19

Janice Gross Stein

Chapter 15. A "Good Enough" World Order: A Gardener's Manual

James B. Steinberg

Part VI. Grand Strategy and American Statecraft

Chapter 16. Maybe It Won't Be So Bad: A Modestly Optimistic Take on COVID and World Order

Hal Brands, Peter Feaver, and William Inboden

Chapter 17. COVID-19's Impact on Great-Power Competition

Thomas Wright

Chapter 18. Building a More Globalized Order

Kori Schake

Chapter 19. Could the Pandemic Reshape World Order, American Security, and National Defense?

Kathleen H. Hicks

Part VII. Sino-American Rivalry

Chapter 20. The United States, China, and the Great Values Game

Elizabeth Economy

Chapter 21. The US-China Relationship after Coronavirus: Clues from History

Graham Allison

Chapter 22. Building a New Technological Relationship and Rivalry: US-China Relations in the Aftermath of COVID

Eric Schmidt

Chapter 23. From COVID War to Cold War: The New Three-Body Problem

Niall Ferguson




16 d’abril 2021

Vaccine diplomacy

 PREVENTING THE NEXT PANDEMIC. Vaccine Diplomacy in a Time of Anti-science

Throughout modern history, vaccines have surpassed all other biotechnologies in terms of their impact on global public health. Because of vaccines, smallpox was eradicated, and polio has been driven to near global elimination, while measles deaths have declined more than 90%, and Haemophilus influenzae type b meningitis is now a disease of the past in the United States and elsewhere.

I define one part of vaccine diplomacy as a subset or specific aspect of global health diplomacy in which large-scale vaccine delivery is employed as a humanitarian intervention, often led by one or more of the UN agencies, most notably Gavi, UNICEF, and WHO, or potentially a nongovernmental development organization

 Do vaccines really deserve their own designation for a special type of diplomacy? Yes, I believe so, especially when we consider that between the past century and this one vaccines have saved hundreds of millions of lives [2]. In this sense, the technology of vaccines and their widespread delivery represent our most potent counterforce to war and political instability in modern times. Vaccines represent not only life-saving technologies and unparalleled instruments for reducing human suffering, but they also serve as potent vehicles for promoting international peace and prosperity. They are humankind’s single greatest invention.

The greater issue is that in each of these four cases—smallpox, polio, Ebola, and COVID-19—the global health community had to respond to a crisis and scramble to rapidly develop, test, license, and distribute these vaccines. Could we also implement an anticipatory system in which nations prioritize vaccine diplomacy and routinely employ it to improve international relations? The Global Health Security Agenda does not currently emphasize vaccine development, although new organizations like CEPI and start-up innovation funds from the Japanese and South Korean governments represent promising steps toward global vaccine diplomacy. I am an enthusiastic champion of their efforts. However, I also believe that an opportunity exists for a more comprehensive effort to tackle the world’s most prevalent poverty-related neglected diseases while simultaneously expanding international scientific cooperation as a core element.

The answer might be found somewhere in the G20...


 


15 d’abril 2021

Regulating AI in healthcare

 Approval of artificial intelligence and machine learning-based medical devices in the USA and Europe (2015–20): a comparative analysis

Timely article. A must read to understand current situation.

A helpful document with the current approved technologies

Radiology leads the ranking:



Comparison of the situation between USA and EUROPE.



14 d’abril 2021

Pandonomics

Pandemic Economics

Key take-aways from the final chapter:

• Pandemic preparedness starts at home.
• Firms cannot rely on bailouts and need to adjust their business
strategies to pandemic risk.
• Financial pandemic preparedness can help with other disasters
and vice versa.
• Cost-efficient adjustment and investments in preparedness
require a sustained long-term approach.
• City planning and (re)construction should be focussed on
resilience and based on citizen and community engagement.
• The organization of the access to health care facilities during
pandemics is a local task; national governments need to set
uniform standards and rules that govern access to health care.
• Governments should use the adjustment potential of the economy
and focus support on sectors that need to and can grow.
• Outbreak management teams and scientific councils that advise
governments on pandemic response need a stronger basis in all
relevant sciences.
• The nation state is only the optimal health care area in very
special cases.
• International organizations should make the assessment of
pandemic preparedness a standard element of country studies,
monitoring and surveillance.
• Pandemics have not yet received the explicit attention they need
in the Sustainable Development Goals (SDGs).
• Strengthening global governance is an elementary step in proactive
pandemic preparedness.



13 d’abril 2021

Allocating vaccines

 Public Perspectives on COVID-19 Vaccine Prioritization

US adults broadly agreed with the National Academies of Science, Engineering, and Medicine’s prioritization framework. Respondents endorsed prioritizing racial/ethnic communities that are disproportionately affected by COVID-19, and older respondents were significantly less likely than younger respondents to endorse prioritizing healthy people older than 65 years. This provides reason for caution about COVID-19 vaccine distribution plans that prioritize healthy adults older than a cutoff age without including those younger than that age with preexisting conditions, that aim solely to prevent the most deaths, or that give no priority to frontline workers or disproportionately affected communities.

Beware.

 


Parov Stelar

12 d’abril 2021

Conflicting views on human heritable genome editing

 Heritable Human Genome Editing: The Public Engagement Imperative


Now limited to preclinical research by a prohibitive federal statute, the conduct of HHGE in the United States may well be at the mercy of the mutable arc of public opinion, the trajectory of which is unknowable.44 Eventual public acceptance of HHGE may well follow if it can be shown to have a unique and favorable impact on the global burden of incurable genetic disease. Such a trajectory would be further buttressed by the plight of parents and their children, which is universally resonant and hard to ignore. Medical science has, after all, been down this road before. Standing in opposition to the prospect of HHGE are deep-rooted misgivings over runaway technological progress that is liable to shatter millennia-old societal norms. Additional concerns draw on the prospect of liberal eugenics, access inequities, imponderable impairment, and progeny-related harm. Reconciling the conflicting views of the current steady state will require time, perhaps generational time, before the dust settles. In the interim, it is nothing short of imperative that HHGE be subjected to the rigors of public deliberation along the lines applied to MRT and related reproductive technologies.45 What is called for is informed public judgment that has accounted for both the relevant concerns and the potential to advance human welfare.



 

10 d’abril 2021

On value (once again)

 From value for money to value-based health services: a twenty-first century shift

VBHS cannot be achieved without reorienting existing fragmented models of care towards one that rests on a strong primary health care foundation (19) with an integrated community care component and underpinned by the principle of people coproducing health. This may encompass a shift from inpatient to outpatient and ambulatory care, where appropriate. It requires investment in holistic and comprehensive care, including health promotion and prevention strategies that support people’s health and well-being (20). It further requires effective referral systems, flexible and multidisciplinary provider networks, and participatory monitoring and evaluation strategies.

Nothing new. 


Joaquim Mir

09 d’abril 2021

Economic evaluation of vaccination

 Evaluating Vaccination Programs That Prevent Diseases With Potentially Catastrophic Health Outcomes: How Can We Capture the Value of Risk Reduction?

Why QALYs doesn't fit for CEA of vaccination?

In the last 5 years, guidelines have been developed for performing cost-effectiveness analyses (CEAs) for the economic evaluation of vaccination programs against infectious diseases. However, these cost-effectiveness guidelines do not provide specific guidance for including the value of reducing the risk of rare but potentially catastrophic health outcomes, such as mortality or long-term sequelae. Alternative economic evaluation methods, including extended CEA, the impact inventory, cost-benefit analyses, willingness to pay or the value of a statistical life, to capture the value of this risk reduction could provide more complete estimates of the value of vaccination programs for diseases with potentially catastrophic health and nonhealth outcomes. In this commentary, using invasive meningococcal disease as an example, we describe these alternative approaches along with examples to illustrate how the benefits of vaccination in reducing risk of catastrophic health outcomes can be valued. These benefits are not usually captured in CEAs that only include population benefits estimated as the quality adjusted life-years gained and reduced costs from avoided cases.


 


08 d’abril 2021

We all require care

The Care Crisis,What Caused It and How Can We End It?

Interesting book about care and what it means, 

Care is conceived as all the supporting activities that take place to make, remake, maintain, contain and repair the world we live in and the physical, emotional and intellectual capacities required to do so.1 In this sense, care is at the heart of making and remaking the world. The propensity to care and the work of caring are the lifeblood of our social and economic system. Care is central to the reproduction of society and thus one of its bedrocks, part of a fundamental infrastructure which holds society together. Without care, life could not be sustained.

What happens to affective relations and caring activities when they are subsumed under market forces and turned into services that are sold? As ever more areas of social life and work are directly commercialised, the affective investments of care come into conflict with logics of measure, profitability, time constraints, cost reduction, standardisation, and economies of scale in multiple ways

However, instead of considering efficient ways to provide care, the political views surpass efficiency, a well known paradigm.

Valuing care means allocating resources, not taking them away. There is an urgent need to dismantle the apparatus that allows private wealth extraction from society’s care structures, so that any new funds made available for the public care infrastructures do not simply prop up profits. Care needs to be shielded from the volatilities of financial markets, not be drawn deeper into them. Therefore, the realms of care should not be available to high-risk forms of financial investment, including private equity and debt-based forms of financial engineering, where expectations of high returns on capital are upheld at the expense of quality of employment and quality of care. Nor should public services and the care sector be exposed to free trade agreements that undermine labour, consumer and environmental protections.9 This is a pressing issue in the wake of Britain’s departure from the European Union.

 Instead of considering public funding as the main option, and access according to need and not to willingness to pay, she proposes to dismantle private services...


07 d’abril 2021

Connected health

 Improving Access to Care: Telemedicine Across Medical Domains

Access to health care relies on the use of available resources in attempts to achieve optimal health outcomes. It is composed of three main components: entry into the health care system, an adequate supply of services available, and timely provision of care

The article provides some useful views on telemedicine. It says,

 Frequently cited clinical limitations of telemedicine include the inability to perform comprehensive physical examinations, sacrifice of patient–provider relationships, fragmentation of care, and the potential for overprescribing/excess health care utilization. These concerns are often unsubstantiated, and while it is important to anticipate the potential shortcomings of telemedicine, innovative solutions are continuously being adopted to overcome potential barriers to implementation. Examples of such solutions include the use of user-friendly devices to gather vitals and data to facilitate remote clinical assessment, as well as utilization of interchangeable electronic health records to enable sharing of information among various providers.

Overall, the promise of telemedicine seems encouraging, and we look to further examine notable examples of its efficacy through the lens of four diverse, prototypical medical conditions with the goal of recognizing common themes and identifying areas of needed improvement. These medical conditions include stroke, heart failure, diabetes, and pregnancy.




L’home que sabia mirar el món, Manuel Castro Galeria Jordi Barnadas de l'11 de març al 9 d'abril de 2021

 


04 d’abril 2021

Mobile medicine transformation

THE TRANSFORMATIVE POWER OF MOBILE MEDICINELeveraging Innovation, SeizingOpportunities, and Overcoming Obstacles of mHealth

Eleven topics in a book reflecting current mhealth:

1. Innovations in mHealth Part 1

2. Innovations in mHealth, Part 2

3. Exploring the Strengths and Weaknesses of Mobile Apps

4. Mobile Apps Critique: Heart disease and hypertension

5. Mobile Apps Critique: Diabetes and asthma

6. Mobile Apps Critique: Mental health/Depression

7. Reinventing clinical decision support: Is there a role for mobile technology?

8. Telemedicine: Opportunities and Challenges

9. Patient Engagement must be our Top Priority

10. Security and privacy concerns

11. Designing the ideal mobile medical app



03 d’abril 2021

The value of life

 The Value and Meaning of Life

Deep topic,

Christopher Belshaw draws on earlier work concerning death, identity, animals, immortality, and extinction, and builds a large-scale argument dealing with questions of both value and meaning. Rejecting suggestions that life is sacred or intrinsically valuable, he argues instead that its value varies, and varies considerably, both within and between different kinds of things. So in some cases we might have reason to improve or save a life, while in others that reason will be lacking.

Therefore qaly is not always a qaly?. So.... 

 This book is about the value and meaning of life. Its focus is on several questions of current and widespread concern, and its aim is to provide answers to at least most of those questions which, as I hope, many will fnd compelling. So we can ask – is life valuable? Or better – which lives, if any, are valuable, and to what extent? What does their being valuable consist in? What sort, or sorts, of value do they have? How, if at all, does this value enjoin us to, or constrain us from, acting in relation to those lives? And then similarly – is life meaningful? But, again, there are better questions to be asked. Can lives have meaning? What sorts of lives? And what sorts of meaning can they have? How is this meaning arrived at? How might it be lost? The two sets of questions are, of course, not altogether distinct. And we can ask both whether a valuable life is, or is likely to be, a meaningful life; and also – different question – whether meaning is itself among the things that we should value.

Economists in need of philosophy.



 


02 d’abril 2021

Risk-adjusted Cost-effectiveness Analysis

 Health Technology Assessment With Diminishing Returns to Health: The Generalized Risk-Adjusted Cost-Effectiveness (GRACE) Approach

Cost-effectiveness analysis (CEA) is widely used to evaluate new medical technologies—for example, by the UK’s National Institute for Health and Care Excellence or by the Institute for Clinical and Economic Review. Standard methods calculate the average increase in treatment cost per average quality-adjusted life-year (QALY) gained, also known as the incremental cost-effectiveness ratio (ICER). 

Researchers have raised concern that traditional CEA discriminates against the severely ill or disabled.5,6 The U.S. Affordable Care Act forbids using CEA that discriminates against persons with disabilities, both by the Patient-Centered Outcomes Research Institute and in determining Medicare coverage and reimbursement. To address this concern, the Institute for Clinical and Economic Review now calculates the equal value of life-years gained in parallel with standard CEA analyses,7 and other departures from CEA have been proposed as ad hoc ways to repair this problem.6

These exceptions, exclusions, and prohibitions call for deeper examination of CEA’s theoretical foundations. In a new analysis, we develop a generalization of standard CEA methods that resolves many of these issues.

This is precisely what I call it risk-adjusted cost-effectiveness.