2022.06_AZP logo_COVID-19: How it accelerated the Future of Healthcare
A report from Allianz Partners Health which looks at the impact that COVID-19 has had on the future of healthcare.
COVID-19: *How it accelerated the Future of Healthcare*
June 2022
Preface
Progress is never linear, hence the well-known literary observation “the future arrives unevenly”. In 2019 I developed a series of reports for Allianz Partners that were collectively entitled 'The World In 2040'. The aim of the exercise was to plot likely social trends and technological developments over the coming 20 years in healthcare, the home, travel and personal mobility.
The arrival of COVID-19 has completely changed the timeline of some of my projections. In particular the pandemic has had a dramatic impact on the development of medical science and healthcare. It has also prompted profound changes in our working habits, our choices of location in which to live and our leisure travel plans.
Forecasters, social scientists and futurists regard COVID-19 as a 'Black Swan event'. It is the type of super-rare occurrence which, rather like its eponym, may never be seen in a single human lifetime. Other Black Swan examples would include giant meteorites hitting the Earth or super-tsunamis swamping the land. For these reasons such uncommon events, even if anticipated in general terms, can never be precisely predicted, and they must be disregarded by forecasters if any useful projections of future development are to be made.
Changes in medicine *and healthcare*
Progress in key areas of medical research has been accelerated by a factor of 10x during the COVID-19 pandemic. Methods of delivering public healthcare have also been transformed by the lessons learned as the world continues to monitor and contain the virus. But this progress has come at a terrible cost.
In a little over two years the COVID-19 global pandemic claimed more than 15 million lives and it’s not yet over. It has been a disaster for people all over the world, for healthcare services, for economies and for society. We will be grieving those we have lost, even while suffering the huge economic and social costs of the global blight, for decades to come. In economic terms the International Monetary Fund estimates that the pandemic has already cost the world economy over 12.5 trillion dollars.
The pandemic sparked an unprecedented research drive in an attempt to control a rapidly spreading disease that was so lethal and contagious it led to a near global shutdown. Nation after nation closed its borders and vast sums of public and private money were pumped into research at unprecedented speed (and within a startlingly short space of time). It’s not something that the normally cautious medical world would have wished for, but the significant medical developments of the past two-and-a-half years would not have happened without the arrival of COVID-19.
The pathogen served as a powerful catalyst, ushering in new technologies, data and research that are now offering insights into many other diseases. COVID-19 has turned out to be the mother of medical innovation.
The lessons that have been learned – and the new research norms that have solidified – are transforming medical science. The billions of dollars, euros, yen, etc. invested in COVID-19 vaccines and related research are now expected to yield medical and scientific dividends that will continue to deliver benefits for decades. The world sits on the verge of a number of potentially significant breakthroughs, mostly thanks to the ongoing research into hi-tech, gene-based vaccines, which could now benefit patients with cancer, heart disease as well as a whole raft of infectious diseases.
Meanwhile, new studies into long COVID-19 could shine a light into blood clotting, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and other conditions that have been closely associated with the virus. Obesity and vitamin levels are also under the microscope, while telemedicine, digital medicine (HealthTech) and increased collaboration between healthcare-providers are already reshaping how public healthcare is delivered.
In the last two years the most significant advance in medical science triggered by the arrival of COVID has been the rapid application, development and deployment of genetic mRNA technologies, initially to produce highly effective anti-COVID vaccines at a speed that was previously considered impossible.
Messenger ribonucleic acid (abbreviated as mRNA) is a type of single-stranded RNA involved in protein synthesis. mRNA is made from a DNA template during the process of transcription (the process by which the information in a strand of DNA is copied into a new molecule of messenger RNA).
The vaccines created by Pfizer-BioNTech and Moderna in less than one year employ such mRNA technologies to fight COVID-19. When these genetically engineered COVID vaccines were being tested, it was the first time mRNA therapies had been trialled on humans in vaccine technology. While the concept is new to the public, mRNA research had been around since the early 1990s.
Traditional vaccines train the immune system by introducing it to harmless versions of whole viruses - the body learns to recognize the virus’s key features, such as SARS-CoV-2’s infamous spike protein. Normally, such vaccine development for a new virus takes between ten and fifteen years. These new mRNA vaccines provided a more elegant way to achieve the same goal in less than a year. Using messenger RNA - a genetic molecule found throughout nature that’s used to transmit information within and between cells - the new mRNA vaccines now provide the body with a set of instructions on how to make the spike protein itself, essentially borrowing the body’s internal machinery and turning it into a photocopier.
A second new technology was used to produce COVID-19 vaccines at high speed. Oxford University in the UK worked with pharmaceutical company AstraZeneca to produce a highly effective “vector vaccine”. In this type of vaccine, genetic material from the COVID-19 virus is placed inside a modified version of a different virus (on the same viral vector). Viral vector vaccines can't cause the recipient to become infected with the COVID-19 virus or the viral vector virus. An alternative vector vaccine was also produced by Janssen/Johnson & Johnson.
Over a year into the biggest vaccination campaign in history, more than 11.9 billion doses have been administered across 184 countries, according to data collected by Bloomberg. The latest rate was roughly 20.8 million doses a day.
Never before has mass immunisation been carried out so rapidly and on such a gigantic scale.
It is estimated that this astonishingly rapid development and deployment of vaccines has saved at least 750,000 lives in the United States and Europe alone — and many more globally, although reliable data is not yet available from many parts of the world. A study by the WHO and the European Centre for Disease Prevention and Control published in December 2021 estimated that 470,000 deaths had been averted across 33 European countries in those aged 60 and over.
Benefits extend to other diseases *and health conditions*
Today, the new technologies developed to produce vaccines at such high speed are being leveraged to develop further health treatments. As soon as mRNA technology was shown to be reliable in producing effective vaccines, researchers realised that many other diseases and conditions were likely candidates for mRNA-based treatments.
Heart tissue damaged during heart attacks is now being successfully regenerated in animal trials. This startling breakthrough has been made by applying the new genetic mRNA technologies. This is likely to lead to the world’s first cure for heart attacks and it is being developed by researchers at King’s College London.
The scientists have identified key genetic codes - called microRNAs - which produce proteins that stimulate the creation of healthy new heart cells. These microRNAs can be delivered directly to the heart muscle following a heart attack, by deploying mRNA technology similar to that used in the Pfizer and Moderna COVID vaccines.
Without the intervention of mRNA-based therapies the human heart has no natural ability to repair itself and heart attack victims are left with permanently damaged tissue that often leads to debilitating and potentially deadly heart failure. The new mRNA treatment has the potential to transform cardiovascular medicine and it is likely to prevent millions of future heart attack victims developing heart failure.
There are other startling breakthroughs following in the wake of the high-speed COVID vaccine effort. Researchers at the Yale School of Medicine have their sights set on another killer disease, malaria, which is estimated to have killed almost half of all the world’s people who have lived since the Stone Age. It remained a leading cause of global infectious disease death in 2021: more than 600,000 people, mostly young children, died from it.
Yale’s team, in partnership with pharmaceutical company Novartis, has succeeded in developing a 'self-amplifying' RNA (also known as saRNA) jab to vaccinate against the disease. The technology stems from a successful RNA malaria vaccine for mice developed at Yale and is in advanced preclinical testing. It could be trialled for the first time in humans within two years.
Elsewhere, Moderna has begun a trial for an HIV vaccine that relies on the same mRNA technology as the COVID jab. If the company is successful, a one-off jab will offer lifetime protection from the virus that can lead to the development of AIDS. And the same mRNA technology is also being studied to see if it could help control conditions that are normally treatment-resistant such as rabies, zika, cytomegalovirus, herpes and cancer of the colon, skin, breast and other parts of the body. Moderna alone is developing trials for at least 30 other mRNA-based treatments in six different disease categories.
Another area of treatment that has benefitted from the pandemic (albeit indirectly) is the development and use of “liquid biopsies” for detecting cancers. In normal times, cancer treatment can begin only once a biopsy - a small tissue sample taken directly from a tumour - confirms that the suspect tissue is malignant. But when hospital staff were diverted to the COVID response and many more were off sick or isolating with the virus, the colonoscopies, bronchoscopies and other procedures that are necessary to take such biopsy samples were unavailable.
In response, Professor Nicholas Turne, a consultant oncologist at the Royal Marsden Hospital in London, turned to a technique that has long been touted as the future of diagnostics; the liquid biopsy. For years, cancer specialists have explored the concept of using these highly sensitive blood tests to detect the DNA shed by tumours to diagnose and monitor cancer precisely - without the pain and inconvenience of a physical biopsy. But despite excitement about the prospects of such tests, progress in the clinical use of the technique was slow.
Under COVID conditions, experimental techniques were dragged from the future into the present. The Marsden team started using liquid biopsies to successfully diagnose and treat patients with suspected cancers of the lungs, pancreas, urethra and bile duct. They are now carrying out a clinical trial to try to make the practice routine. While these are still early days, eventually doctors hope to be able to do away with the need for surgical biopsies altogether.
Meanwhile, there has been huge focus on how to tackle obesity since it emerged as a leading risk and mortality factor related to COVID. 78% of US patients hospitalised with COVID between March and December 2020 were overweight. In June 2021, the first obesity medication approved by the US Food and Drugs Administration since 2014 was rushed to the market to aid the fight against COVID mortality. Semaglutide, also known as Wegovy, could be up to twice as effective as previous weight-loss medications after a study of nearly 2,000 patients saw participants lose on average 15% of their body weight.
This synthetic version of a hormone that reduces appetite was already used in much lower doses to treat type 2 diabetes. But amid growing evidence that substantial weight loss reduces COVID severity, its wider use was fast-tracked by regulators. The availability of a drug that can improve both blood glucose levels and body weight could have far -reaching effects for public health beyond the context of COVID, especially for people who have remained overweight despite their best efforts.
COVID-19 has also shone a light on the potential health benefits of vitamin D. In Norway, Finland and Iceland, where sunlight is limited, there’s a public-health emphasis on maintaining healthy levels of the vitamin within populations. Persistently low COVID mortality rates in these nations were observed, compared to other northern-hemisphere countries with less of a public health focus on adequate amounts of vitamin D. Amid the ongoing search to ascertain exactly what makes some people more vulnerable to COVID than others, focus on vitamin D early in 2021 led to the publication of a paper in the Lancet medical journal. Co-authored by dozens of experts, the report suggested that vitamin-D deficiencies could be a root issue in the development of many other diseases.
While these are still early days, eventually doctors hope to be able to do away with the need for surgical biopsies altogether.
Another benefit for the pharmaceutical industry resulting from the COVID-19 pandemic is that clinical trials of new drugs and treatments have been re-designed and speeded up dramatically, without incurring additional health risks for test participants. Normally, clinical trials of new drugs take up to ten years to complete, but the normal process was far too slow to be of help during the COVID tsunami.
In the early days of the pandemic, some doctors around the world were trying any approved drug that had even the slightest chance of tackling COVID. They used antimalarials, antivirals, antibiotics and HIV treatments, despite having no evidence they would work. Most had no effect on the virus.
In the midst of this chaos two Oxford professors, Martin Landray and Peter Horby, designed the Recovery Trial, a programme that would dramatically accelerate that process. The programme dramatically accelerated the process of conducting formal clinical trials. By inviting every NHS hospital in the UK to participate, the researchers realised they could reach a huge trial population very quickly. And instead of trialling each drug one by one, they simultaneously tested five treatments. Some 40,000 volunteer patients took part.
Moderna alone is developing trials for at least 30 other mRNA-based treatments in six different disease categories.
In June 2020, Recovery Trials showed that dexamethasone, an anti-inflammatory drug that costs just £0.50p ($0.65) per patient per day, slashed the risk of death among the sickest patients by a third. It has since saved well over a million lives around the world. In February 2021 an anti-inflammatory called tocilizumab was shown to reduce the risk by another 14 per cent, halving the risk of death to a COVID patient in intensive care. The trial also showed that a drug developed by the US firm Regeneron cut deaths by 20 per cent among the one in three patients who don’t produce their own antibody response when they contract the virus.
The study also revealed that several drugs initially used for COVID-19 - including hydroxychloroquine, which was promoted by Donald Trump - gave patients no survival benefit. Recovery Trial has clearly demonstrated that many types of clinical studies no longer have to take years to complete.
Britain’s wartime Prime Minister Winston Churchill famously observed that “the further you look into the past, the further you can see into the future.” This advice has proved useful for predicting the long-term societal impact of the COVID-19 pandemic.
History tells us that every pandemic and epidemic has brought health benefits as well as losses in its wake. Pandemics have ravaged human civilizations throughout history, but global health crises have also sparked progress in culture and society, changing lives for the better.
The 1918 global flu pandemic killed 20 to 50 million people worldwide - more people than died in World War One - but it also resulted in greatly improved patient care. The flu pandemic led to the first uses of non-pharmaceutical interventions such as track and trace, isolation, and social distancing – techniques we’ve recently been forced to reintroduce.
As a direct result of the global flu, Russia, France, Germany and the U.K., among others, for the first time, put centralised healthcare systems in place, while the United States adopted employer-based insurance plans. Both systems vastly expanded access to healthcare for the general population in the years following that particular pandemic.
Water and sanitation systems were also improved, and pandemic experiences led to innovations in limiting disease spread, as well as in treatments and vaccines.
Remote *healthcare delivery*
In my 2019 report 'Future Health, Care and Wellbeing' I identified a trend towards healthcare being delivered remotely and the use of digital technology to monitor patients. COVID-19 has accelerated this trend dramatically. At the height of the pandemic, patients were forced to consult family doctors (GPs) and nurses over the telephone, online or via video link, depending on the patient’s needs. The risk of spreading such a contagious infection was far too great for in-person consultations.
For many patients, phone consultations sufficed and the global use of 'telemedicine', as this type of care delivery is known, was 78 times higher in February 2021 than it had been a year earlier. Surprisingly, it has since stabilised at that vastly increased level, most likely due to familiarity and convenience.
For those patients who needed to 'show' their doctors their complaint (e.g. a rash), low-cost video conferencing using free-to-use software such as Zoom, Global Meet and Microsoft Teams provided a visual link. Luckily, network speeds (cellular and broadband) had increased in most countries before COVID-19 struck and this made video calls easy and effective, while the free-to-use software for video meetings was also mature and easy to operate.
Doctors were forced to 'see' most of their patients using new technological methods, while patients were also forced to get to grips with the technology necessary to consult their doctors. Of course, not every patient was able to access healthcare this way. The very elderly, the disadvantaged and the disabled were often unable to access or work the smartphone or computer technology required for video conferencing. Family members and carers frequently had to step in to help. GPs and nurses prioritised older patients, those patients shielding and patients with poor mental health for the few carefully sanitised in-person consultations that did take place.
Telemedicine, long touted as a huge potential efficiency benefit for primary care, was forced on medics and the community and, as the pandemic ebbs, there seems little chance that primary care providers will revert to seeing their patients in person for routine consultations. The pandemic has performed a feat of social engineering on public health; previously resistant doctors and hesitant patients have been dragged into the future of remote medicine by COVID-19.
Early reports suggest that patient satisfaction with telemedicine has been high – which may come as a surprise to many medical professionals. Patient surveys around the world typically report satisfaction levels above 70%, although many surveys pointed out that previously established trust between doctor and patient was a key component of reported satisfaction.
COVID-19 has stretched healthcare providers almost to breaking point and the future adoption and practice of remote consultations online and via telephone is providing the primary care sector with a lifeline.
Hospitals around the world were overwhelmed by COVID-19. As the number of mortalities grew, governments frantically built extra emergency hospitals and morgues, pulled doctors and nurses out of retirement and scoured the world for supplies of personal protection equipment for front line staff. In tandem, legislators rapidly passed draconian laws restricting public travel, personal movement and socialising. Those workers who could do so were instructed to work from home (a move which is now creating a whole new social revolution on its own).
COVID-19 has stretched healthcare providers almost to breaking point and the future adoption and practice of remote consultations online and via telephone is providing the primary care sector with a lifeline.
Under intense pressure, hospitals were forced to strip back the services they offered. Elective surgery had to wait, routine patient hospital outpatient visits and follow-ups were either cancelled or were carried out remotely wherever possible. As a result of this experience, hospitals have been re-thinking how they will deliver many of their services in the future.
Remote care using a variety of technologies has now become an important goal for all public health services - as predicted in 'The World In 2040'. The long-touted ideas of 'distributed hospitals' or 'virtual wards' are now becoming reality. We don’t yet have widely accepted language or terminology for such developments: the concepts are too new.
Essentially, the pandemic is forcing healthcare providers to seek to adopt working practices that were not expected to be in general use until the mid-2030s. In the UK, the government is recruiting retired doctors and nurses to come back into service, some to work in hospitals and some to work from home, monitoring patients in 'virtual wards'. The aim is to keep non-acute patients at home in their own armchairs and beds using wearable and ambient sensor technology to monitor patients’ health status and care requirements online.
Non-critical patients treated at home in a virtual ward will have an array of on-body sensors, including finger-tip oximeters which will measure the important metric of oxygen levels circulating in their blood. Other sensors will detect and record pulse rates, body temperature, sleep patterns, blood glucose levels, respiration levels and the heart’s electrical activity. Patients with respiratory problems can use a wireless stethoscope which will allow doctors to listen to lung performance remotely. For babies, there are even smart socks which will keep track of vital signs. At the beginning of treatment, nurses will visit patients to setup the sensors and to instruct families/carers in their use, battery recharging and general trouble shooting.
Unlike existing hospital equipment, home patient technology will be wholly wireless and will transmit results via the networks to the doctors and nurses who are remotely monitoring the patients. For nearly all patients this would be preferable to lying on trolleys in hospital corridors, as so many patients had to do during the COVID-19 crisis.
The goal is to distribute hospital services out into the community. HealthTech – as the digital healthcare sector is known – has evolved from wearable fitness trackers such as FitBit and Garmin wrist devices, the Apple Watch and dozens of other specialist products such as Withings health watches and Samsung wrist devices.
Today, HealthTech devices offer consumers and medics virtual snapshots of a body’s vital signs, with such data stored on devices for weeks (and with permanent storage available when the data is transferred to an external device such as a smartphone).
As the virtual ward develops and more 'hospital patients' are treated at home in their own living rooms and beds, other sensors and monitors will provide additional information about the health and well-being of the patients to medics (and carers). These wireless sensors will include mats which can detect changes in a patient’s gait, cameras for patient observation (with permission from patients and families), motion sensors, electric plug and switch sensors, door sensors, humidity sensors and ambient temperature sensors.
Taken together with the patient’s personal vital sign information and general bio-data, this information will provide an even better view of how a patient is doing than can be achieved in a traditional hospital ward. Regular phone calls from nurses and doctors to discuss patient progress will provide human monitoring while physical nurse and doctor visits to the patient will be scheduled by routine and as required, according to the patient’s needs and health progress.
In the near future, monitoring patients in such 'virtual wards' will become less time-consuming and onerous for medics as artificial intelligence systems (AI) assume the role of monitoring the patients 24 hours a day. If an AI system detects an unexpected change to a patient’s temperature, heart rate, gait, respiration, blood oxygen level or blood pressure, the AI monitor will alert human medics who will intervene as required.
It may sound like science fiction, but such 'virtual wards' will become the normal experience for 'hospital patients' suffering from non-urgent chronic conditions in just a few years (and 58% of in-patients in hospital in the developed world today suffer from chronic rather than acute illnesses).
“.. virtual wards” will become the normal experience for “hospital patients” suffering from non-urgent chronic conditions in just a few years..
This is the future of hospital care in the developed world and, for those lucky enough to have a carer support system which facilitates care provision in the home. Medical treatment in such 'distributed hospitals' will provide even more detailed care than that now provided by today’s crowded and overworked physical hospital wards. And the risk of patients at home contracting C-DIF or MSRA infections during treatment is virtually eliminated.
HealthTech adoption *accelerated*
The wider HealthTech sector also offers new smartphone apps which provide virtual access to a family doctor on demand - a trend accelerated by the arrival of COVID-19. During the pandemic, many patients found it difficult to consult their usual family doctors (GPs) when needed: the primary care system was totally overwhelmed by the pandemic (and in many countries this problem was exacerbated by a shortage of primary care doctors).
In response, dozens of pay-as-you-go apps have appeared, offering the opportunity for almost immediate consultation with a fully qualified family doctor. There are many of these apps on the market and the list includes Babylon Health, Doctor on Demand, LiveDoc, Health at Hand, LiveHealth, Dr Now, MeMD, Doctoconsult, Qare, Medicitus, Livi, Eutelmed and many more. These apps are usually specific to a nation or region in which the participating doctors are licensed to practise.
The cost of a private consultation with an online family doctor is similar across the developed world: UK-based Babylon Health charges £49 per consultation, Doctor On Demand charges $75 and European apps charge roughly equivalent amounts for consultations. For patients trying to access advice from an overloaded primary healthcare system these 'on-demand' apps provide the reassurance of same-day consultation.
Another strand of COVID’s impact of healthcare has been the rapid development of public testing and disease tracking methods, a new facet of public health, the development of which could have wider implications for the future of medicine.
Prior to the imposition of the pandemic lockdown in 2020, the UK health network (for example) had the capacity to perform no more than 5,000 COVID tests a day. Since then, a vast diagnostics network has been created at a cost of £10 billion and up to 1.9 million COVID tests are now carried out daily.
Some doctors believe that if this testing structure were maintained and repurposed, such national testing capacity could lead to an era of efficient personalised healthcare.
Much of today’s medicine is based on educated guesswork. For example, the elderly are given a flu jab because they tend to have weaker immune systems. But instead of assuming there is a drop-off in immunity for all over-50s, why not test for antibodies on an individual basis and administer vaccines only where needed? This logic could be extended to all communicable diseases (e.g. shingles, pneumonia, measles, hepatitis etc.) and the cost savings achieved by the health service would more than pay for the expense of maintaining the testing network.
Preparing for the *next pandemic*
Even though the COVID-19 pandemic is far from over, researchers’ attention is now turning towards devising new and better ways to fight any new variants of COVID-19 that might evolve. They are also trying to find methods of preventing future emerging viruses developing into completely new epidemics and pandemics.
At the Walter Reed Army Institute of Research in Maryland U.S.A., scientists have been working on developing a universal vaccine against new variants of COVID-19. The new multi-variant vaccine is currently undergoing the first phase of human trials.
This universal vaccine includes multiple coronavirus fragments that could trigger immune responses to different strains of COVID-19, with the hopes of boosting immunity against more variants. It would also be stable at room temperature, potentially making it more globally accessible.
Meanwhile, the U.S. government has launched a new Pandemic Preparedness Plan to better defend against new viruses that might cause the next pandemic.
As part of this plan, the National Institute of Allergy and Infectious Diseases will focus research efforts on two areas, 'prototype pathogens' and 'priority pathogens'.
By expanding knowledge of these types of viruses, the Pandemic Preparedness Plan aims to shorten the time it takes to develop medicines or vaccines effective against future variants that may emerge.
But in the search for methods to halt pandemics before they start, many public health professionals agree that national efforts to head off future pandemics is inadequate. Global problems require global solutions.
It is clear that the world does not yet have the political structures nor organisational capability to efficiently monitor and identify new global health threats as they emerge. There will undoubtedly be new pathogens emerging capable of developing into a global pandemic; our modern lifestyle makes such events extremely likely.
Global population growth, climate change, intensive farming (deforestation), increasing demand for meat consumption, the growing wildlife trade, greater personal mobility and easily available international travel, enable new diseases to emerge and spread across the world faster than ever before.
The initial global response to the arrival of COVID-19 was poor, uncoordinated and, sometimes, a point of dispute between nations. In a few countries, the response was distorted and hijacked for political purposes. With the human cost of COVID exceeding 15 million lives and the economic cost of more than $12.5 trillion, the world cannot make the same mistakes again.
Accordingly, the task facing world leaders now, even as they continue to deal with COVID-19, is to work together to ensure that the world is better prepared for the next pandemic threat.
Billionaire philanthropist Bill Gates has recently published a book entitled: 'How To Prevent A Pandemic'. He argues that what is needed for the future is a supra-national body, 'a global fire department'. Gates suggests a name for this — GERM, the Global Epidemic Response and Mobilisation Team. In fact, we already have the World Health Organization (WHO), which in the 1980s achieved a global reduction of 99.9 per cent in polio cases. But there is no way the WHO alone could provide the 24-hour vigilance Gates requires of GERM or any similar body. The cost to fund such an agency would, he reckons, be $1 billion a year.
The Welcome Trust (a global charity that funds medical research) has a similar proposal to deal with emerging pandemic threats in the future. It suggests: “A new Global Health Threats Council or Board should work with existing groups like the World Health Organization, the Global Fund, Gavi, CEPI (The Coalition for Epidemic Preparedness Innovations) without duplicating their current work or activities. We also need governments to build collective financing mechanisms to transform the world’s ability to prepare for and respond to pandemic threats.”
As the frequent disagreements among the United Nations’ member nations testify, arriving at global agreements between all nations is exceptionally difficult. Nationalistic instincts seem to be at odds with the concept of effective 'global governance'.
But the risk of a newly emerging virus creating a future global pandemic (perhaps far more lethal than COVID-19) is exercising minds. It is possible that even while world leaders are struggling to stop or contain wars, to combat deadly climate change and to reconcile or contain national differences and rivalries, a way might be found to organise and fund an international anti-pandemic organisation of some sort.
In the meantime, the scientific community is itself working on a way to mitigate future threats. One Cambridge University spin-off company in the UK is hoping that genetic sequences of viruses discovered in animal faeces will give vital clues for creating a vaccine to help prevent future pandemics. DIOSynVax, a start-up founded by Jonathan Heeney, a veterinarian-turned-vaccinologist, is working on two vaccines that it believes will outlive the current crop of COVID-19 jabs.
Dr Heeney, who first became interested in coronaviruses when he diagnosed them in cats and cheetahs, says scientists are learning about future threats from the guano-covered floors of bat caves and waste from other animals including civet cats and pangolins (popular meat sources in the wildlife trade).
DIOSynVax uses the genomic sequences of coronaviruses in all species to identify their 'Achilles’ heel'. The scientists then use computational biology tools to locate regions of the virus that cannot change without it killing itself.
The Indian government-backed consortium The Coalition for Epidemic Preparedness Innovations (CEPI), has invested up to 42 million dollars in DIOSynVax. It is one of several teams that CEPI is backing in a quest for a vaccine that could beat future variants of Sars-Cov-2, and any future virus in the related families of Sars and Mers, known collectively as beta coronaviruses. Other recipients of the charity’s funding include Japan’s NEC corporation. CEPI is now busy raising billions of dollars to fund its plan to cut the time from the discovery of a potential pandemic pathogen to an effective vaccination down to just 100 days.
COVID’s impact on the *longer-term future*
The arrival of the COVID-19 pandemic brought out the best in the world’s scientists. The development of highly effective vaccines in a period of 320 days (measured from the first publication of the COVID-19 genome to the first mass public inoculations) was a record feat that will surely be recognised with several Nobel prizes.
The techniques of applying mRNA technologies to create these vaccines are now being duplicated to repair hearts after a heart attack, banish malaria, and conquer many other scourges of humankind that have blighted populations throughout human evolution.
The cost of the COVID-19 pandemic has been terrible, but the benefits that are emerging from this 'silver lining' will last for many decades. These benefits will, in time, be recognised as the legacy of the global pandemic which started in 2020.
While the pandemic has accelerated the uptake of digital medicine, work in the other transformative areas of medical research that I identified in my 2019 report has continued unabated. Research into DNA-based medicine, gene-therapy, gene editing, stem-cell medicine, robotics and nano-scale medicine remain likely to yield further positive results in the next couple of decades.
Lifestyle changes *accelerated by the pandemic*
The pandemic has also accelerated the trend towards home working for office staff. In many nations, such staff are unlikely to revert fully to pre-COVID working patterns and many major companies including Deloitte, J.P. Morgan, Amazon, Morgan Stanley and Allianz Partners have established a hybrid office/work-from-home policy for the future.
This model is likely to become the norm as digital communications continue to improve. Accordingly, people are reconsidering where they choose to live and, in turn, society’s future requirements for schools, hospitals and other social services are changing. Local development building plans will also have to be rethought.
Commuting has been reduced significantly in most advanced economies, with beneficial effects for the environment. The requirement for train line upgrades and new rail routes are having to be reconsidered along with plans for further road building.
Long-distance travel has also changed because of COVID-19, with the public currently showing a hesitancy to return to long-haul air travel for vacations. This reaction is unlikely to last for long and by 2025, if not sooner, international travel will probably have re-bounded to its pre-COVID levels.
As a result of the pandemic, some trends I identified in the 'World In 2040' have been accelerated while entirely new trends have started to shape our lives. The future has suddenly become a lot closer - particularly in terms of medical science and healthcare provision - and we are even reconsidering where we choose to live and the way in which we work.
