March 13 2023 | Healthcare & Pharma
Precision medicine: a new era of treating patients, not diseases

"The observation that patients with the same clinical diagnosis or symptoms respond differently to the same treatment has led to the development of Precision Medicine (PM), a novel therapeutic approach that relies on biological information and health data from patient tiers to develop tier-specific treatments that lead to better health outcomes." PM is the evolution of healthcare from a “one-cure-fits-all” strategy to the tailored development of precise medications targeted at specific individuals. It is a holistic approach to diagnosis and treatment in which traditional healthcare plays only a minor role in a patient's health, treating each patient as an individual and using his or her unique clinical data, genomic profile, family history, environmental factors, and lifestyle to more efficiently guide diagnosis, treatment, and prognosis Advancements in PM have been driven by the growing understanding of the biological pathways of diseases at the molecular level and the identification of novel biomarkers (a signature component detected in the blood, body fluids, or tissues, such as genes, proteins, etc.) that signal a normal or abnormal cascade of biological processes within the body. These biomarkers act as specific targets for more accurate diagnosis or more efficient treatment. The concept of PM is not new; oncology has been the main early adopter of this approach in treatment, such as with Xalkori from Pfizer. Wider adoption of PM in other therapeutic areas was limited, owing to the high associated costs and technological limitations in data access and utilization. However, the picture is changing due to rising demands to reduce escalating healthcare costs by reducing reliance on: Unnecessary, non-effective medications, especially for diseases (e.g., psychiatry, oncology, and rheumatology) that are commonly associated with high costs of prescription drugs and low response rates. Traditional diagnostic tools, which are characterized by low accuracy and limited detection of biomarkers, increasing the likelihood of subsequent medical interventions to treat complications. On the other hand, advanced diagnostics can screen millions of circulating biomarkers and detect early signs of diseases.   A paradigm shift in the way drugs are developed and manufactured Pharmaceutical companies are under increasing pressure to justify the return on their R&D investments. A few years ago, they were reluctant to invest in R&D for PM due to the compromised commercial values associated with targeting limited populations. Nowadays, pharmaceutical companies are shifting their profit focus to price, not volume, as new drugs targeting niche populations can achieve higher selling prices with much lower marketing expenditures and more guaranteed sales. Big pharma companies can technically rely on their in-house manufacturing capabilities to produce precision therapies, but this is not economically viable because small batches of precision therapies will result in underutilized time, machinery, and resources. The traditional pharmaceutical manufacturing process relies on the production of several batches of high volumes of products to control costs and benefit from economies of scale. This cannot meet the complex needs of PM to produce a wider variety of batches of temperature-sensitive, complex products at lower volumes to serve a wider variety of patient populations. Flexible manufacturing and single-use technologies are emerging to provide companies and CDMOs (Contract Development and Manufacturing Organizations) with greater flexibility to manage the production of a variety of products in smaller batches by allowing companies to replace disposable single-use reactors for each medication. This not only reduces cross-contamination but also improves operational efficiency by significantly reducing the time needed to clean the reactors between different product lines.   Advances in digital technology are key enablers for realizing the potential of PM For healthcare organizations to realize the full potential of PM, they must be able to collect enormous amounts of genomic, social, and physical data. They must also leverage modern technologies to transform this complex data into structured datasets that generate accurate insights regarding the best treatments while reducing time and errors. The following are key examples of high-potential technologies. Data analytics and AI: Advances in computational power enable the processing of huge amounts of data from various sources and provide valuable insights about the human body’s interactions with drugs. NLP technology: NLP created new opportunities for hospitals to leverage their data, an opportunity that was unattainable with humans alone. NLP can learn and understand the human language within the healthcare context more effectively and rapidly than humans. NLP then extracts valuable information from this vast unstructured data and translates it into more structured data sets ready for analysis. Digital biomarkers: They are physiological and behavioral data collected via digital devices such as wearables and portables. The widespread use of smartphones, along with the rapid development of sensor technologies, has enabled the accurate collection of health and wellness data in real-time. Digital biomarkers can disrupt traditional clinical assessments because objective and specific data is collected in real-life settings without any external bias. This increases the statistical power and increases the accuracy and sensitivity of the clinical results.   A huge promise with challenges ahead Despite the unique potential PM can bring to public health, and how technology is making it more feasible than before, PM is not yet broadly integrated within healthcare systems due to some challenges such as: Quality of data: An average hospital produces around 50 petabytes of data annually (1 petabyte is equivalent to 11,000 4K movies). Most of this data is non-standardized and comes from multiple EHRs (Electronic Health Records) and disparate data repositories, making it very challenging and time-consuming to process and use. Economic value: Building an economic case for PM is not an easy task because advanced diagnostics and screening tests have much higher costs than traditional tests. Still, PM has strong potential to increase the efficiency of treatments, produce better outcomes, and thus reduce the overall costs of care. This is because PM eliminates the need for repeated diagnostic tests and the traditional trial-and-error approaches, which are more costly and less accurate. Capacity building: Physicians lack technological expertise and need to be trained and qualified to be able to interpret the data models built from genetic and biological markers via modern data analytics tools and technologies. Data privacy: PM involves the flow of enormous amounts of data among different stakeholders, and it is very critical to ensure the protection of such sensitive data and maintain patients’ privacy.   Over the past decade, at least 14 countries have launched genomics-based medicine initiatives According to GlobeNewswire, the global PM market size was estimated at USD 65.89 billion in 2021 and is forecast to increase by a CAGR of 12.1% during 2022-2028, reaching USD 146.57 billion in 2028. Governments and insurance companies are strong advocates of PM to bring healthcare costs down and improve the quality of care, which are the essences of value-based healthcare models. In that sense, they have an important role in developing policies, regulatory reforms, and novel reimbursement plans to accelerate the transition of PM from research to clinical application. Over the past decade, at least 14 countries (Australia, Japan, the USA, the UK, Qatar, KSA, etc.) have collectively invested billions of dollars in large-scale projects to collect genomic and demographic data from thousands or even millions of citizens. These initiatives have great potential to accelerate the integration of genomics within healthcare systems and support the development of PM. Also, big pharma and technology companies are fostering strategic collaborations with strong investments to support the development of precision therapies, for example, in 2022: Google participated in a USD 65 million series A investment round for Vicinitas Therapeutics, which is a precision medicine startup for cancer and genetic disorders. Sanofi has entered into a research collaboration with Exscientia to leverage its AI-based capabilities and personalized medicine platform to develop a pipeline of precision-engineered therapies. Like any new disruptive technology, PM still has many hurdles to overcome, and the key to its success is to get all the ecosystem stakeholders (governments, insurers, pharma and biotech companies, technology providers, etc.) working in silos to collaborate, share resources, and establish standardization frameworks for the diverse data out there. Collaboration is also crucial to reducing costs and driving the development of a sustainable PM-based ecosystem. Author: Ghada Selim Sources:

June 27 2022 | Healthcare & Pharma
Unlocking Vital Data: Healthcare Data Analytics

A massive amount of data is generated every second by billions of active users across many devices, such as computers, tablets, and mobile phones. Over the past decade, from 2010-2020, the amount of data created increased by an astounding 5,000%. Data is everywhere, but it is worthless unless it is properly processed and analyzed. Nowadays, data analytics serves not only to formulate business strategies and optimize performance but also to improve the lives of individuals. Data analytics is particularly important in the healthcare sector. The efficiency of healthcare organizations depends on converting clinical raw data into valuable and actionable insights to improve patient and clinical outcomes. For instance, electronic health records (EHRs) and other health-related smartphone apps are now essential to determine the patient’s status, optimize the utilization of resources, and provide efficient solutions.   What is “Data analytics”? In general, data analytics is the process of collecting, transforming, and analyzing data to identify trends and patterns in order to draw conclusions, make predictions, and drive informed decision-making. Data can be analyzed manually or using tools such as software and algorithms. Data analytics can help optimize operational efficiency, increase revenues, enhance customer service, and boost performance. There are four main types of data analytics: Descriptive data analytics uses past and current data to identify trends and relationships and to understand what’s already happened in an organization. One of the common uses of descriptive analytics is the tracking of KPIs to assess the health and value of a business. Diagnostic data analytics uses the insights identified by the descriptive analytics and dives deeper to understand the causes of the outcomes. Diagnostic data analytics answers the question “Why did it happen?”. Predictive data analytics explores historical data and past trends to predict future outcomes. Predictive data analytics answers the question, “What is likely to happen?” Prescriptive data analytics combines the insights of all the previous data analytics types to identify what actions to take to achieve certain goals or outcomes. It suggests the best possible next steps based on simulations aiming to optimize the performance of an organization. Prescriptive analytics answers questions such as “What is the best course of action?” and “What if we try this?”.   What are healthcare data inputs and tools? The healthcare industry is generating a colossal amount of data linked to the health of a patient and the population as a whole. Healthcare data is being collected from a variety of health information systems (HIS) and tools, allowing data to be stored, shared, and analyzed. These tools and systems include: Electronic Health Records (EHR) Personal Health Records (PHR) Electronic Prescription Services (E-prescribing) Patient Portals Master Patient Indexes (MPI) Health-Related Smart Phone Apps Healthcare data is valuable knowledge about the global healthcare system, including patients, staff, and hospitals’ performance. Initially, data inputs are unstructured, uneven, and can be difficult to understand. Data analysts, with the help of several analytical programs and software, clean and validate the gathered data to draw valuable and actionable insights that can help stakeholders formulate decisions.   How could data analytics serve the healthcare system? The main function of healthcare data analytics is to gain better insights and enable healthcare organizations to make well-informed clinical and business decisions. Examples of healthcare applications of the four types of data analytics mentioned above include: Descriptive analytics: analyzing the number of positive tests in a specific area in order to determine how contagious a virus is. Diagnostic analytics: detecting an illness or an injury based on the symptoms experienced by a patient. Predictive analytics: exploring the case data of an infectious disease in order to forecast its spread in the future. Prescriptive analytics: examining the pre-existing conditions of a patient in order to determine the risk of future conditions and implement specific preventive treatments. Healthcare data analytics applications can lead to several benefits. According to ArborMetrix, healthcare data analytics is helping organizations enhance their competitive position, improve clinical quality and patient care, promote research advancement, and optimize internal processes (see image below). [caption id="attachment_8268" align="alignnone" width="579"] Source: ArborMetrix[/caption] These key applications cannot be realized without extensive use of advanced software and tools that transform unorganized data into actionable insights. These include artificial intelligence tools, cloud computing platforms, blockchain networks, health information exchanges, and machine learning models.   Market overview of healthcare data analytics The fast rate of technological advancements, the increase in healthcare expenditures, and the massive digitalization of the healthcare industry are driving monumental growth in the healthcare analytics industry. According to Grand View Research, the global healthcare analytics market was valued at USD 29.1 billion in 2021 and is forecasted to grow at an annual growth rate of 21.5% between 2022 and 2030 to reach USD 167.0 billion by 2030. Now let’s look at some of the leading market players that are constantly innovating and using cutting-edge technology to interpret healthcare data and deliver solutions to healthcare providers and institutions. These leading companies include: UnitedHealth Group McKesson Corporation Health Catalyst Microsoft IBM Corporation Cerner Corporation Allscripts Healthcare Solutions MedeAnalytics, Inc. Apixio Inc. Lumiata Inc.   Healthcare data analytics in the time of COVID-19 The pandemic has had a significant economic and social impact around the world. Disrupted supply chains, medical supply shortages, and the healthcare system's burden are some of the drastic examples of the detrimental effects of the COVID-19 crisis. Big data analytics tools have played a significant role in decision-making to counteract the effects of the pandemic. The enormous amount of data generated by the pandemic incentivized researchers and providers to turn to data analytics and predictive modeling as a means to optimize resource allocation, predict surges and outbreaks, improve patient care, and implement preventive measures. During the pandemic, health organizations started to leverage predictive models to better identify the patients at risk by understanding the factors influencing disease severity and forecasting the number of cases, hospitalization rates, and death rates. In June 2020, Cleveland Clinic researchers developed a predictive analytics model that aims to determine an individual's likelihood of testing positive for COVID-19 and the potential consequences. Predictive models were also useful at a time when patients overwhelmed hospitals and health systems. Many organizations have implemented predictive tools to optimize resource allocation. It has helped hospitals predict staff needs, bed capacity, ventilator usage, and many other metrics. The use of data analytics in the healthcare industry has become crucial. By collecting, processing, and analyzing data, healthcare organizations are able to make more informed decisions. Data analytics in healthcare allows organizations to improve patient care, enhance their competitive position, advance their research efforts, and manage their financial and clinical risk. The global healthcare analytics market is rapidly expanding. This is driven by the monumental rate of technological advancement and the digitalization of the healthcare industry. New technologies continue to emerge at a high pace, driving the healthcare industry toward a major change. From artificial intelligence (AI) to natural language processing (NLP) to machine learning, data analytics is changing every facet of the healthcare industry. While healthcare data analytics has a bright future ahead, there are also major security concerns. Patient data is particularly sensitive, and it is difficult to determine the acceptable uses of data while prioritizing security and patients' right to privacy. Healthcare data, no matter how crucial it is for medical scientific development and the success of healthcare providers, should only be utilized if security and privacy concerns are addressed. Author: Anas Ghoulam  Sources

December 23 2021 | Healthcare & Pharma
Telemedicine: What Does the Future Hold?

    Amidst the growing global coronavirus caseload, and the saturation of healthcare systems across the world, the concept of telemedicine has seen a rapid and pronounced rise to prominence.  But just what is telemedicine? The World Health Organization defines it as “The delivery of health care services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries […]”.  Telemedicine is not a new phenomenon, however, having registered one of its first applications in the early 20th century when electrocardiograms were transmitted at a distance using the telephone line. The technology would go on to find one of its most famous applications in the 1960s, when it was used by NASA to monitor astronauts’ biometric data away from Earth, with the aim of providing remote support in the event of a medical emergency.    Telemedicine and the COVID-19 Pandemic With the advancement of ICT, and its ever-increasing penetration rates, telemedicine has seen its possible applications multiply over the last few decades. Before the outbreak of the COVID-19 pandemic, however, there was very limited investment in telemedicine and remote patient monitoring solutions by most countries.  Instead, there were only experimental projects that met with limited physician adoption. In Italy, for instance, 2019 research by the Polytechnic University of Milan’s Digital Innovation in Health Observatory showed that only 5% of specialist doctors and 3% of family doctors used these solutions, although more than half were interested in doing so ( In response to the pandemic, governments and healthcare providers were forced to resort to telemedicine in an effort to counteract the shortage of available hospital rooms, beds, and medical staff. Private practices were forced to act similarly as they sought to avoid in-person visits where possible, in a bid to limit further spread of the virus. Telemedicine saw a further surge in adoption as countries pushed their healthcare systems to fill the technology gaps impeding its wider adoption.  Looking again at Italy as an example, new data published by the Observatory clearly shows the extent to which the pandemic has brought telemedicine into the spotlight. Three out of four specialist physicians reported believing that telemedicine was critical during the peak of the crisis, with 36% reporting that they were convinced of its benefits and intended to use it in the future. On average, according to general practitioners (GPs), 30% of chronic patient visits and 29% of visits by non-chronic patients could be carried out using digital tools, while for specialist providers these proportions dropped to 24% and 18% respectively.  According to McKinsey, by April 2020, overall telehealth utilization at the global level for office visits and outpatient care was 78 times higher than the level registered in February of the same year. By July 2021, that figure had stabilized “at levels 38X higher than before the pandemic”  (McKinsey, 2021).     Telemedicine in a Post COVID-19 World Given the above figures, it is clear that telemedicine is undergoing something of a renaissance in various parts of the world. Less technologically advanced countries have rushed to pave the way for its development just as eagerly as their more advanced counterparts.   But what will the future of telemedicine look like once healthcare resources are no longer so thinly stretched? Will it continue along the trajectory it has followed thus far?  Or, will it find itself instead relegated to the theoretical realm, as is so frequently the case with such innovative ideas?   The issue needs to be examined from two different perspectives: that of the consumer, on one hand (patients, clinics, hospitals), and that of the providing structures, companies, and governments on the other.  Regarding the former, recent surveys carried out by various institutions indicate that both patients and physicians see great value in telemedicine, with many intending to continue using it once the pandemic subsides.(These results vary greatly depending on the type of care provided – psychiatric care witnessed the highest rate of telemedicine uptake, while specialties such as surgery and ophthalmology, quite logically, saw much less significant uptake rates). (McKinsey, 2021).  Regarding the latter, we need to consider the profitability of telemedicine to the companies supplying the technologies. Viewed from this perspective, telemedicine is unlikely to spur significant market interest if it remains simply a method to conduct remote patient visits.  Analysts seem to agree that videoconferencing visits seem unlikely to disappear any time soon, but that they will have to become more than just a tool to facilitate calls between doctors and patients. Instead, companies active in the sector will have to combine their services with both digital therapy technologies, as well as more traditional treatments. Only vertically integrated players who provide end-to-end solutions will be able to survive.   A Good Strategy: Adding Digital Therapeutics to the Package For telemedicine to be profitable and hence attractive to the market, companies providing this service will need to integrate it with other functions. Digital therapy technologies serve as a prime example of the type of additional services that could make a company more competitive in the ever-growing digital healthcare sector. Also known as "digital therapies" (or "DTx"), digital therapy technologies are those that offer therapeutic interventions guided by high-quality software programs. These programs are based on scientific evidence obtained through rigorous clinical trials with the aim of preventing, managing, or treating a broad spectrum of physical, mental, and behavioral conditions. Digital therapy, then, does not refer simply to telemonitoring interventions, nor does it refer to the types of systems offered by pharmaceutical companies to help patients in the management of their diseases (such as Patient Support Programs to monitor adherence to drug treatment). Rather, it represents a host of validated curative interventions, capable of improving clinical results. Whereas pharmacological treatments interact with the patient's biology, digital therapies interact with the thoughts and behaviors of those who use them. They can take the form of apps, video games, websites, or wearable devices, and work by spurring behavioral or lifestyle changes, as well as the application of cognitive-behavioral interventions through the digital creation of guidelines and programs. There are already various examples of digital therapeutics in the market. In 2017, The FDA approved ReSET, an app that offers cognitive-behavioral therapy to those suffering from addiction and opiate abuse issues. That was followed by the June 2020 approval of Endeavor, the first video game for therapeutic purposes, designed for children with attention deficit hyperactivity disorder (ADHD).   From Telemedicine to Digital Care to Value-Based Healthcare The deployment of telemedicine, coupled with the addition of other digital health services such as digital therapeutics, goes hand in hand with an approach that has been gaining traction in recent years; that of Value-Based Healthcare (VBHC).  This approach recognizes the importance of putting the patient at the center of the healthcare discourse, urging policy-makers and healthcare providers to build a system in which the human side of the patient is not only acknowledged but pushed to the forefront of all considerations.  In this context, telemedicine, digital therapeutics, and digital care, in general, can help to create a more holistic and personalized approach to healthcare.  Considered alongside the more obvious benefits of telemedicine, such as the decentralization of health interventions and the increased reach of, and accessibility to medical care, it would seem that telemedicine is destined to thrive, becoming a fundamental element of care in the years to come – but only so long as it is accompanied by a general evolution towards more patient-centered, cost-saving and socially sustainable healthcare policies. Author: Pietro Morabito   Sources

September 13 2021 | Healthcare & Pharma
Placebo and Nocebo effects in Healthcare

. COVID-19 Vaccines and the Nocebo Effect Ever since Covid-19 vaccines were approved in December 2020 (if not before) public opinion has been strongly polarised between supporters of the life-saving drug (which include the vast majority of the medical and scientific communities) and skeptics.  While most of the skeptical positions regarding the need or efficacy of the vaccine can be traced back to a misunderstanding of epidemiology and public health, misinformation, or even political bias, the conversation surrounding the vaccine’s side effects is more complex. For one, vaccines actually have officially recognised and common side effects. These are the now-ubiquitous headaches, fever, body aches, nausea, and general tiredness that we’ve come to know. However, as vaccination rates grow beyond high levels (>70%) more cases of rare severe side effects (such as an allergic reaction) will emerge. This is not because vaccines are more dangerous than initially estimated, or because of some nefarious governmental conspiracy,  but because of a “paradox effect” where the absolute number of severe side effects increases because of the growth of the vaccinated population. In this case, correlation really is not a causation.  This issue, especially when it encounters a hypercharged media environment, can cause quite a headache for governments who are trying to anticipate public anxiety and encourage people to take the vaccine. This was the case last March when viral-vector-based vaccines, like the Oxford-AstraZeneca and Johnson & Johnson vaccine, became temporarily associated with rare, but dangerous and even fatal blood clots. Countries were too fast to react, with some completely banning these vaccines, or restricting them to the 60+ population. Further investigation showed that the cases of blood clots were in fact consistent with rates in the general population, and the vaccination campaign has resumed. However, the structural growth of side effects (whether they be real or only correlated) is a major factor contributing to vaccine hesitancy worldwide. What’s worse is that social apprehension surrounding vaccination may even be inducing adverse effects unrelated to the chemical properties of the drug. For example, the following phenomenon occurred in vaccination centers in the US: cases of “fainting, excessive sweating, nausea, and vomiting” were reported in vaccination centers across the country, after individuals received their dose of the Johnson & Johnson vaccine. The CDC noted that for most individuals, fainting, nausea, etc. were indeed anxiety-induced events. Why do individuals experience such effects after receiving the new COVID-19 vaccine? The answer lies in the phenomena known as the placebo and nocebo effects.   What is a Placebo or Nocebo Effect? The previously mentioned (indirect) effects of the COVID-19 vaccine on individuals, causing dizziness, fainting, nausea, etc. is a clear example of an altered nocebo effect. Literature defines the classic nocebo as “a substance without medical effects but which worsens the health status of the person taking it by the negative beliefs and expectations of the patient”.  For example, as proven in many experiments, patients are given a sugar pill as a treatment for a certain condition and are told to expect side effects such as nausea, drowsiness, or pain. Although they are merely given a sugar pill, patients still reported experiencing such side effects.  It’s easy to understand how powerful this effect can be for a treatment like the COVID-19 vaccine, which has been the source of daily discussions and media coverage for the better part of a year.  On the other hand, a placebo is the exact opposite of a nocebo. Defined as “a substance without medical effects, which benefits the health status because of the patient's belief that the substance is effective”. Like a nocebo, a placebo sees patients experiencing a clear improvement of symptoms and general advancement of wellbeing.  In conclusion, whether interlinked with positive or negative health outcomes or experiences for individuals, both effects are the result of psychological and physical reactions to non-active ingredients and most often occur due to expectations, conditioning, idea framing, and individual psychological state.     Clinical Management and Reversing (or Fortifying) of Both Effects The question remains as to how both effects can be clinically managed, or if they even should. Recent research and experiments, especially regarding the nocebo effect, highlight the importance of managing patient expectations, providing a comprehensive overview of the treatment plan, clearly discussing possible side effects as well as double-checking with each patient on an individual level if all parameters associated with the treatment are understood and accepted. Additionally, the method of “counterconditioning” has also been proven to be highly effective in the case of nocebo effects. By “turning previously negative learned associations into positive ones”, nocebo effects can be drastically reduced and even converted into a (sometimes) useful placebo effect. By definition, a nocebo effect is always undesirable as it produces negative effects in a patient. It is not always possible to completely reduce or prevent nocebo effects, however, they can be countered by combating false rumors of unfounded side effects, and improving effective communication between doctor and patient, etc.  On the other hand, placebos pose a slightly different type of problem as they produce effects that to a certain extent can be beneficial to patients. In fact, a placebo effect may even be desirable if it occurs within the context of an appropriate treatment since it reinforces the positive outcome. On the other hand, a placebo is dangerous when it occurs within the context of inappropriate treatment and it only provides the illusion of an improvement convincing the patient to insist on an ineffective or even dangerous therapy and to ignore better ones.  Placebos therefore should be carefully examined and managed, following a “Minimize, Maximize, and Personalize” approach. Research indicates that during clinical trials, the placebo effect should be minimized as far as possible to correctly evaluate the efficacy and success rates of a drug still in the clinical research phase. However, once a drug is approved, physicians should aim to maximize placebo effects by managing patient expectations. This can be optimally achieved by personalizing care to a patient's genetic predispositions, personal preferences, personality, and medical history. In sum, both effects are very common globally, and the COVID-19 pandemic has exacerbated them tremendously. In this period of public health crisis, policymakers face the double task of suppressing nocebo effects which undermine national vaccination campaigns while at the same time also contrasting placebo effects associated with alternative and unproven Covid treatments (such as hydroxychloroquine, ivermectin, or homeopathic remedies) which may even be dangerous to individuals or prevent them from seeking proven medical help. In both cases, the only instrument is transparent and coherent communication especially from physicians which aims at educating the public on these phenomena. Now more than ever public relations play a fundamental role that directly affects our wellbeing, determining even whether we may get a headache or not. Sources Information and Data:,_minimize,_or_extinguish_nocebo.23.aspx

July 05 2021 | Healthcare & Pharma
Healthcare: Is the industry ready for Big Tech disruption?

In recent years, Big Tech companies’ interest in the healthcare industry has strengthened. The global pandemic accelerated Big Tech’s march into a sector experiencing a digital revolution and generating an ocean of data. Today, after making vast fortunes from processing data, these companies are orienting their expertise to healthcare and are very keen to offer their services to overwhelmed healthcare systems. The current state of healthcare The rise in the number of wearable sensors, the digitization of patient records and expansion of virtual healthcare services formed digital biomarkers, this type of biomarkers is expected to have the biggest impact on medicine because of the vast amount of data it’s creating. Benefiting from computing power and expertise in data analytics, Big Tech is entering a $3.6 trillion market in the U.S. just by utilizing the same tools that have allowed them to disrupt other industries.   GAMA’s interest in healthcare Accelerated by the Covid-19 pandemic, the digitization of healthcare fueled investors interest in digital health companies raising a record $14.8 billion in VC funding in 2020 and amplified big 4 tech firms’ collaboration with healthcare industry and support of startups and new innovations. The chart below showcases the considerable interest in Telemedicine which increased by 140% compared to 2019. At the same time, Big Tech companies are accelerating their presence in the healthcare market with different strategies. Below, we break down the tools and efforts of these players to disrupt healthcare. Amazon Amazon launched a health care service called ‘Amazon Care’ for its own employees allowing them and their families to get in touch with health care providers within a minute of their requests. Amazon is also leveraging its delivery capabilities to make headway into the medical supplies’ distribution space. Microsoft In 2021, Microsoft announced that it had struck a $19.7 billion agreement to purchase Nuance Communications. This company’s technology is used by almost 80% of hospitals in the US and helps automate the process of taking notes during patient consultations, reducing the time doctors spend on administrative work. Apple Apple enables the collection of healthcare data via apps and wearable tech through the Apple Watch. The company has teamed up with various institutions to establish the clinical accuracy of Apple Watch features. One of the most recent ones showed that the cardiac metrics it monitors is as good as clinical tests. The results suggest that the Apple Watch could be adequate for remote monitoring of elderly patients with cardiovascular disease. Google (Alphabet) Google uses artificial intelligence to read electronic health records and then try to predict or identify medical conditions. The company uses machine learning to analyze a vast array of health records collected by hospitals and other medical institutions. The matrix below showcases Big tech companies’ strengths, weaknesses, opportunities, and threats in the healthcare industry.   Challenges in Digital Healthcare Infrastructure As the virus spread and safety concerns grew, virtual interactions became a necessity exposing weaknesses in healthcare infrastructure. Healthcare systems around the world have been quite slow in using modern technology to revolutionize their sector as revealed by a study conducted by OECD on 23 countries. The study indicates that many members of OECD have a high proportion of digitized health data but only a small percentage of them are regularly linked with other sources of information making vast quantity of data redundant. In other words, Big Tech companies need to assemble and link datasets to give insights and identify patterns and trends. However, digitization of healthcare systems around the world is slowed by the technological readiness of some countries and lagging of regulatory legislation. Privacy Evidently, governments play a crucial role in facilitating Big Tech’s entry in healthcare especially allowing access to patients digitized health records, a very sensitive subject considering tech companies’ spotty track record regarding privacy and use of personal data. A survey conducted by Rock Health shows that patient’s willingness to share health data, with technology companies is predictably low with only 11% of respondents willing to do so. By contrast, patients were more willing to trust their doctor as the study indicates that 72% of patients are willing to share health data with their physician. This is not happenstance, Apple’s and Google’s previous mishandling of user data is slowing their progress in healthcare markets as they need to rebuild their public image before gaining patient’s trust back. Outlook of Digital Health market Big Tech giants are targeting a growing market armed with $500 billion in cash giving them a substantial force for disruption. A Roland Berger forecast predicts an estimated 24.7% CAGR in the global digital health market reaching $657 billion in 2025. As tech companies move into healthcare, it is necessary for legacy players such as hospitals and pharmacies to adapt their strategies and embrace new technology like telehealth and remote patient monitoring tools. Products and solutions from tech companies will increasingly become more distributed and sophisticated as the quality and volume of data improves. It goes without saying that the future of healthcare will be told outside the hospital. In a future where healthcare is embedded into all aspects of everyday life, it will be crucial for Big Tech to win over consumer trust with their solutions and digital advances to make primary health care more convenient, accessible, and helpful to the general population. Sources Google to Store and Analyze Millions of Health Records

The legalization of Cannabis in Morocco

On the 2nd of December 2020, the Commission on Narcotic Drugs (CND), the UN's main decision-making body on drug control, removed cannabis from its list of most dangerous drugs, which includes heroin and synthetic opioids. Cannabis is subject to the 1961 Single Convention on Narcotic Drugs and was, until December 2020, included in a category allowing it to be banned because of its "particularly dangerous properties". This amendment was based on a recommendation by the World Health Organization (WHO). In fact, in January 2019, the WHO unveiled six recommendations for the inclusion of cannabis in the UN drug control treaties. Among the many points made by the Organization, it has been clarified that cannabidiol (CBD), a non-toxic compound, is not subject to international controls and it has, in fact, become a prominent part of wellness therapies in recent years, sparking a billion-dollar industry. The decision made by the WHO was supported by 27 countries against 25. The decision is not in favor of a legalization of cannabis worldwide, which remains among the "highly addictive and liable to abuse substances”. However, it implies that its production and marketing remain reserved for scientific and medical use under international law. According to this decision, Morocco has raised the issue at the Government Council level. In fact, the Ministry of Interior has drafted a law on the legalization of Cannabis for medical use, in order to regulate the activities related to the cultivation of cannabis, its production, manufacture, transport, marketing, export, and import for medical and therapeutic purposes, subject to authorizations issued exclusively by a specialized agency. What is the composition of the Cannabis Plant? Cannabis is a type of hemp, which is a plant used in the yarn industry. As for its composition, the most important part of the plant is its “flower”, it is responsible for producing the so-called “Resin”, this material contains 2 molecules, “THC” and “CBD”. THC contributes to altering the consumer's state of consciousness making them “high”. It is also used for anesthesia purposes as in the case of cancer patients undergoing chemotherapy. Meanwhile, CBD does not have the same purpose. In addition to its sedative effect, it works against THC to limit its properties, particularly by calming the nervous system. CBD has major therapeutic virtues, according to the U.S. National Centre for Biotechnology Information (NCBI), such as anti-inflammatory properties, it alleviates anxiety and depression, it can calm the symptoms of epilepsy, and it can even contrast certain psychotic disorders (such as schizophrenia), etc.…. Studies conducted by NCBI even suggest that at high concentrations, CBD inhibits the proliferation of tumor cells from certain cancers and that it could reduce the risk of necrosis of the arteries after a heart attack. That’s why the debate about the advantages and disadvantages of Cannabis has risen again, and some countries have realized that maybe they are missing out on the benefits of this plant and its potential for both healthcare and the economy. Cannabis, what is the potential for the Moroccan economy? Globally, according to the report released in 2019 by New Frontier Data on the global cannabis industry, the global total addressable cannabis market (regulated and illicit) is estimated at USD 344 billion in the top five regional markets: Asia ($132.9 billion), North America ($85.6 billion), Europe ($68.5 billion), Africa ($37.3 billion) and Latin America ($9.8 billion). On the other hand, the global legal marijuana market size according to a recent research study by Precedence Research was valued at USD 17.5 billion in 2019 and predicted to reach a market value around USD 65.1 billion by 2027 expanding at a compound annual growth rate (CAGR) of around 17.8% during the period 2020 to 2027. A report has been published as a result of a study conducted in Morocco in 2003 -2004 by the United Nations. According to this report, the area dedicated to the cultivation of cannabis in Morocco was estimated at 134,000 ha in 2003 with a turnover of USD 15 billion in 2003 and 13 billion in 2004. At that time, the total Moroccan production was estimated at 98,000 tons and its conversion into resin (hashish) at about 2,760 tons, with almost half of it originating from the region surrounding Chefchaouen. However, these numbers have been reduced drastically thanks to the "cannabis-free provinces" campaign that Morocco conducted in 2007. As a matter of fact, the area cultivated for cannabis resin in Morocco amounted to 47,000 ha in 2017 for only 1,147 ha destroyed (2.4%), according to the United Nations Office on Drugs and Crime (UNODC). With this area, the Kingdom would have an estimated open air production around 38,000 tons, and 760 tons from indoor production. Morocco thus, retains its position as the world's largest producer of cannabis resin with a market value of USD 9 Billion in 2017. The illegal market takes the lead over the legal one, of course. As stated above, the total global market is valued at USD 344 billion in 2019, of which only USD 17.5 billion is legal. Therefore, the illegal market is valued at USD 326.5 billion. Even if the legal market is very limited, the study by Precedence Research predicts an expansion at 17.8% CAGR and a total value of USD 65.1 Billion in 2027. Morocco will be in a prime position to exploit this legal market if more widespread legalization occurs. What would be the legal frame of Cannabis legalization? The country acknowledges that legalization should have clear rules to regulate the cultivation and production of Cannabis. In fact, last February the Ministry of Interior presented a draft law on the legalization of Cannabis for medical use which was adopted by the House of Representatives in May. The proposed law contains 56 articles, a third of which establishes clear rules to regulate this activity which will be conditioned by an authorization granted by a national agency that will be created for this specific purpose. The law covers cultivation, production, exploitation, export/import of seeds and plants,  processing, transportation, marketing, and the export of final products. The authorizations would be granted only in areas indicated in a dedicated decree. They will be issued within the limits of the quantities necessary to meet the needs of medical, pharmaceutical, and industrial production. Similarly, authorization will not be granted to produce THC (tetrahydrocannabinol) which is the main molecule of cannabis whose content must not exceed a level set by a regulatory text. On top of that, it is to be specified that the applicant for authorization must be of Moroccan nationality, has the legal majority, domiciled in one of the douars (villages) of the identified provinces. He also must be a member of a cooperative that will be created for this purpose and must own the land or have permission to grow cannabis on it. Additionally, authorized producers must comply with the provisions of the specifications to be prepared by the National Agency, in coordination with the relevant government authorities. In conclusion, the legalization of Cannabis will unlock great potential for the Moroccan economy, especially since the market is estimated to reach USD 69 billion by 2027. Not to mention that many countries are currently conducting massive research regarding the uses of Cannabis in the medical field. However, the country must not rely on local market’s demand only, efforts should be oriented to exploit global markets and partner with global pharmaceutical firms to build strong exporting business models.   ***Numbers are not completely reliable since the scope is illegal Sources:

May 26 2021 | Healthcare & Pharma
Covid-19 vaccination: Is the world winning the war?

Today some countries are progressing more rapidly than others in terms of covid-19 vaccinations. In this article, we will look at the cases of Israel, the UAE, and Morocco, and how successfully they have administered their inoculation campaigns. Then we will cover the issue of vaccine access inequality, and the reasons behind the gap between various nations. Countries with the most successful and rapid vaccine rollout are the smaller ones in terms of population: Israel, UAE, etc. These countries’ advanced digitized and centralized healthcare systems allow for a quick and effective roll-out. With a Covid-19 vaccination drive that has reached more than half of the population, Israel has pulled far ahead of the rest of the world, becoming a world leader in vaccinations per capita, and in return, it supplies BioNTech/Pfizer with valuable data and information from its campaign. Israel has started to reopen its economy since the Health Ministry data showed that the two-shot regimen has reduced COVID-19 infections by 95.8% since February and that it was 98% effective in preventing fever and breathing issues and 98.9% in preventing hospitalizations and death.   In the UAE, Dubai has also decided to take the risk of gradually reopening its economy on New Year’s Eve, as it relies on international tourism for nearly a third of its GDP; by the end of January, with coronavirus cases spiking, hospitals had reached their limit and cases quadrupled to almost 4,000 a day. The currently approved vaccines in the country are Sinopharm, Pfizer/BioNTech, and Sputnik V. The Emirates are one of the first countries to start vaccinations, having administered at least 11 million shots as of May 9th. Thanks to this early action, the economy of the UAE, is forecast to grow by 1.3% this year according to the IMF, after contracting 6.6% in 2020. In Morocco, the vaccination campaign started on January 28th and has benefited some 4.5 million people (fully vaccinated), making it the most advanced African country in Covid-19 vaccinations. It currently uses the British AstraZeneca and Chinese Sinopharm vaccines and intends to further diversify its supplies with the Russian vaccine Sputnik V. The Kingdom is emerging as a model country that seeks to vaccinate, free of charge, 80% of its population aged over 17, including foreign residents. On March 3rd, The World Health Organization congratulated Morocco and announced that it is among the first 10 countries that have “successfully completed the challenge of vaccination against COVID-19.”   Success of the Covid-19 vaccination campaign One of the key factors of the success of the Covid-19 vaccination rollout is the population’s attitude towards it. Both the UAE and Israel have invested resources in reassuring their population that the vaccine is effective and safe. In many countries, health authorities relied on faith leaders to make sure their communities are getting their vaccines. In the UAE the Fatwa Council issued a Fatwa (Islamic ruling) allowing the Covid-19 vaccines to be used in compliance with Islamic Sharia’s objectives, and its chairman, Shaykh Abdallah bin Bayyah, was vaccinated in public.                                                                                                      Religious leaders are also spreading the word in Israel: ultra-Orthodox media and community leaders are taking part in the vaccination campaign, as a significant minority is still resistant and suspicious of the mass vaccination campaign.  In Morocco, the government has successfully managed the response to the pandemic by acting quickly and preemptively as the first cases appeared: through strict application of quarantine, acquisition of masks, and all the necessary PPE, early involvement in vaccination, and securing multiple doses of the vaccine. This effort has reduced the number of fatalities per day, from 92 deaths in November to only 5 in April.    How fair and equitable is the vaccine distribution plan? So far, the richest countries have been prioritizing their own population and have been able to buy far more doses than the poorest ones: high-income countries hold a confirmed 4.2 billion doses, while low-middle income nations only hold 670 million. In Africa, the delay appears to be playing out across the continent, which raised doubts about the effectiveness of political leadership. The delayed arrival of doses in some African nations could regrettably add more hospitalizations and deaths and increases the risk of multiplication of dangerous variants. Led by the WHO with the Coalition for Epidemic Preparedness Innovations CEPI and Global Vaccine Alliance GAVI, the Covax initiative is aiming to focus on the 92 poorest countries: more than 49 million vaccine doses have been delivered through Covax so far. The World Health Organization approved the AstraZeneca vaccine to be rolled out globally through the Covax program and Ghana became the first to receive the Covid-19 vaccines in February.    A country with no vaccination plans: Tanzania For months in 2020 the Tanzanian government, then led by the late John Magafuli, has insisted the country was "Covid-19 free". And without providing any evidence, the government also expressed doubt about the efficacy of Covid-19 vaccines and instead promoted unfounded remedies like steam inhalation and herbal medicines, neither of which have been approved by the WHO. The health minister even went so far as to announce that the country “has no plans in place to accept COVID-19 vaccines”. The deceased President opted to maintain strict control over public discussions of Covid-19 issuing a directive that only himself, Dr. Gwajima, and three other top officials could give information about Covid-19 in the country. But in an unusual move, some leaders of the Catholic church broke their silence and warned the public to observe health measures to prevent the spread of the virus. WHO's Africa director Dr. Matshidiso Moeti said that the vaccines work and that he encourages the Tanzanian government to prepare a Covid-19 vaccination campaign, adding that the WHO is ready to support them. As the country has not published any data on the virus for months, it is difficult to say how well Tanzania’s approach has worked; the last time the country published data on its Covid-19 numbers was 29 April 2020, when it reported only 509 cases.    Why are such disparities allowed?  Since Covid-19 vaccines are not a public good, the market decides who gets it first. Wealthy countries are racing to have their population vaccinated this year, but in most developing and poor countries, the vaccine remains unavailable, undermining the efforts for global immunization.  The choices made by the wealthiest nations will determine which future takes hold: a global community unified to bring the virus under control, or a world divided between the wealthy and immunized and the vulnerable and poor.  Boutaina Benaboud Sources:'s%20rejecting%20the%20vaccine,-6%20February&text=For%20months%20Tanzania's%20government%20has,of%20having%20had%20the%20disease. 

November 23 2020 | Healthcare & Pharma
Artificial intelligence, a key tool to improve the African health system

According to a new report by Novartis Foundation and Microsoft, investment in data and artificial intelligence (AI) will be a key tool for improving health systems during and after the COVID-19 pandemic in Africa. Released on September 9, 2020, the report "Reimagining Global Health through Artificial Intelligence: The Roadmap to AI Maturity"[1] concludes that low-income countries may soon outperform high-income states in the adoption of AI-based health technologies. It also points out that African countries could be the fastest adopters of AI-based health technologies due to the lack of existing systems. However, it also warned that these countries stand to lose the most if governments don’t seize this opportunity and invest more in AI. According to the 2020 Partech report, the health technology sector attracted 189 million dollars to Africa during 2019 which is equivalent to 9.3% of the total amount allocated, all sectors combined, to startups operating in Africa. This amount represents a growth of +969% compared to 2018. Hence, the health technology sector is not only growing but also mobilizes significant financial capital. Strengths driving AI adoption in Africa Technologies such as mobile trading platforms, e-banking, e-commerce and even Blockchain applications have often been adopted faster and more comprehensively in low and middle-income countries than in high-income countries, and health technologies are likely to follow the same trend, the report said. In addition, a major advantage for low-income countries is their exemption from the difficulties now faced by rich countries. Rich countries already have different types of data hosted by systems that are not always able to communicate, whereas they need to be interoperable[2] to be "effectively" used for AI.  The opportunity therefore lies in the fact that low-income countries, not yet having these different systems, can once and for all develop a single ecosystem so that all data systems have the same structure and are interoperable. However, there are several constraints and challenges that must be addressed by the African continent in order to take advantage of the emergence of the digital in general and AI in particular in the health system. Pain points hindering AI adoption in Africa The lack of medical personnel is the primary challenge facing the African continent. Currently, sub-Saharan Africa accounts for 12% of the world's population but faces 25% of the world's disease burden, while housing only 3% of the world's health workers. This is expected to worsen with a projected global shortage of health workers estimated at 18 million by 2030. In addition, the lack of data storage infrastructure available to health facilities represents a barrier to the rapid adoption of AI in the health sector. Thus, African governments need to put in place policies that promote data acquisition readiness and investment in AI development infrastructure such as data centers. AI as a driver for rebuilding health systems Many African countries are poorly prepared to deal with a new emerging disease such as Covid-19, in addition to the current burden of infectious diseases and the ever-increasing tide of chronic diseases. AI is therefore coming to rethink archaic health systems by shifting from reactivity to proactivity and then to prediction and even prevention. To successfully implement AI, a whole sustainable ecosystem must be developed to ensure equity and access to healthcare services for all. As healthcare systems rebuild during the pandemic, technological innovation must be at the heart of the agenda. Below are examples of companies leveraging the power of AI in the health sector across several African countries. This shows that the continent is building and developing a strong AI startup ecosystem for the healthcare sector. Nigeria: Nigerian startup Aajoh uses artificial intelligence to help individuals that send a list of their symptoms via text, audio and photographs, to diagnose their medical condition. The business was launched in 2015 and allows personalized medical diagnosis and treatment through predictive analytics. Founded in 2012, Ubenwa developed an AI app that analyses a baby’s cry to give warning signs of asphyxia, which is the third leading killer of infants worldwide. This machine learning tool provides instant diagnosis of birth asphyxia based on 1,400 pre-recorded baby cries that are analyzed by looking at factors such as amplitude and frequency pattern. Ghana: Founded in 2016, Minohealth introduced an innovative Medical Health System to democratize duality healthcare with AI for medical diagnostics, Cloud Medical Records system for hospitals, health ministries and patients, and big data analytics for health. Kenya: AfyaRekod is a digital health data platform that focuses on the patient and allows health facilities to capture, store, have real-time access and mobility of the patients’ health data. Developed as a patient driven platform, the patient maintains the sovereign right of ownership to their health data. The platform leverage AI and various blockchain modules to make insightful data driven decisions that allows doctors to provide better healthcare for patients. Rwanda: Though headquartered in California, Zipline operates in Africa leveraging drowns in order to to deliver blood to transfusion centres in remote areas. The team are delivering fresh blood and medicines to hard-to-reach rural areas across Rwanda daily. Zambia: Founded in 2017, Dawa Clinic is an Artificial Intelligence-based web-mobile platform which is aimed at facilitating remote healthcare service for pregnant women and early mothers. The App works with a self-monitoring kit that empowers mothers to receive remote maternal health. Through the App, mothers are able to monitor parameters like blood pressure, Urinary Tract Infections (UTIs), blood sugar levels, and other pregnancy-related complications. The information is wired remotely to a doctor for early intervention in case of any complications. Tunisia: SPIKE-X is a startup specialized in AI offering intelligent software packages that provide decision support solutions allowing to better understand, predict and influence human decision making of large groups and populations. SPIKE-X is a leader in innovative quality healthcare, e-Health and m-Health, and, Intelligent Security such as Intrusion Detection System, Access Control, Automatic Number Plate Recognition (ANPR) and Retail Analytics. For the healthcare sector, the company’s solutions help in Breast Cancer Detection, Skin Cancer Detection and Alzheimer Disease Classification. Examples of AI use during the COVID-19 era Rwanda: Rwanda probably has the most connected health system in Africa. The country has a virtual consultation service with over two million users, one third of the adult population. In March 2020, the Rwandan government and the private actor Babylon Health, operating in the East African country under the name babyl, entered into a ten-year partnership to give every Rwandan over the age of 12 access to digital health consultations. The consultations are paid for by the Mutuelle de Santé, the government's community health insurance scheme. The new partnership will also see the introduction of a platform for triage and verification of symptoms, powered by AI. Guinea: In Conakry, Tulip Industries, a startup created by Mountaga Keïta and specializing in technological innovation, is another example. Named "Health Scan", the startup has designed this tablet able to detect the symptoms of Coronavirus. The device is equipped with a thermal camera and sensors that measure a patient's body temperature, blood oxygen level and heart rate. According to the designer, Health Scan helps to better target the hottest part of the body and to obtain more reliable data than the thermo flashes commonly used on the forehead. This information is stored in a local database and artificial intelligence comes in to federate this information and try to draw inferences to help doctors better determine if the patient needs respiratory assistance upon arrival at a health center. Kenya: Launched in 2017, Tambua Health arms medical practitioners with an app that helps doctors and health practices spend less time and money diagnosing and treating cardiopulmonary diseases using lung and heart sounds analysis through machine learning. During the covid-19 pandemic, Tambua Health invents a patent-pending technology called T-sense. T-sense generates images of lungs by detecting the vibration of sound as air moves in and out of the lungs. It is able to do this by using sensor arrays placed on the back of the patient. With these sensors, T-sense can generate dynamic images of the lung like this using sound imaging. Using spatial distribution algorithms that have been trained from the company's proprietary database of lung sound images, Tambua's T-sense can detect healthy and unhealthy lungs with a high degree of accuracy. Egypt: Rology is a startup of the AUC Venture Lab (V-Lab), Egypt’s first university-based accelerator. Established in 2017, it is an on-demand teleradiology platform solving the problem of radiologist shortages and high latency in medical reports through artificial intelligence by remotely and instantly matching cases from hospitals with the optimum radiologist. Rology operations follow three main steps: upload, match and report. the hospital uploads the patient’s medical images onto the system. Based on the first auto analysis, Rology then matches the scan with the optimal radiologist, depending on availability and subspecialty. Afterward, the radiologist writes the final diagnostic report and sends it back to the hospital through a quality control process. During the COVID-19 pandemic, Rology helped solving the problem of shortage of radiologists, by proposing a diagnosis of Covid-19. In short, artificial intelligence will help bridge the gap in Africa's health systems. However, its use cannot substitute for the development of effective health infrastructures and the setting up of strict systems and protocols for examination and monitoring. It is also important to keep in mind that secure and privacy-friendly data governance must be part of ensuring a sustainable AI-based infrastructure. Finally, the countries that will fare best will be those that combine a good level of medical infrastructure with innovative technological solutions ! [1] The report "Reimagining Global Health through Artificial Intelligence: The Roadmap to AI Maturity" was authored by the Commission on Digital and AI in Health, created in 2010 by the International Telecommunication Union (ITU) and UNESCO to expand broadband access to accelerate progress towards national and international development goals, and jointly led by the Novartis Foundation and Microsoft. [2] Data interoperability is the ability of systems and services that create, exchange and consume data to have clear, shared expectations for the contents, context and meaning of that data. Safae Laghmari - Senior Research Analyst Sources:

May 22 2020 | Healthcare & Pharma
Two COVID-19 testing strategies for two Italian Regions: A history of success and failure

From being the first two Italian regions with COVID-19 cases, Lombardy and Veneto followed two very different trajectories in the coming months of the pandemic. Lombardy became unfortunately famous for being the most-hit region in Italy, by both numbers of infections and deaths. Veneto instead, managed to contain the infection, and has now very low numbers compared to Lombardy. Both regions have allegedly good regional healthcare systems (better functioning than many other Italian regions and other European countries), so what did Veneto do that Lombardy did not?      The Beginning   COVID-19 cases in Italy started rising towards the end of February 2020. There were two initial epicenters of the outbreak, one in Codogno, in the province of Lodi in Lombardy, and one in Vo’, in the province of Padua in Veneto. The two towns were put into lockdown in order to contain the virus, but this did not prevent it to expand to other provinces and regions. In the last week of February cases were confirmed in neighboring regions such as Piedmont, Emilia-Romagna and soon the virus reached almost all regions in Italy from north to south. In the coming weeks, Lombardy’s cases started to soar, together with the number of people hospitalized in intensive care and the number of deaths. Ever since, up until today, Lombardy is the most hit region, by the number of infections, intensive care hospitalizations, and casualties. Veneto instead, from being one of the first two epicenters of the virus in Italy, with tens of people being infected in the first days of the epidemic, followed a very different evolution.   The numbers today   As of May 21, 2020, according to official government data, Lombardy has 85,775 total cumulative cases, with more than 15,600 casualties whereas Veneto has so far 19,030 total cumulative cases and about 1,800 casualties. It is clear that the two regions have very different numbers. There is however a figure for which Lombardy and Veneto have a much similar value: the number of tests carried out. As of today, Lombardy performed a total cumulative of 607.863 tests, whereas Veneto carried out 536.798. Considering that the population of Lombardy is two times that of Veneto, this means that overall, Veneto implemented a test-intensive strategy, while Lombardy did not. [caption id="attachment_5198" align="aligncenter" width="532"] Figure 1 Cumulative positive cases in Lombardy and Veneto, MoH Data, My Elaboration[/caption] Testing Strategies   Lombardy As the number of cases began to soar and hospitals’ ICU beds started reaching capacity, the president of the Region, Attilio Fontana, decided to test only people with serious symptoms due to the limited diagnostic capacity of the region. This was backed by the recommendations published by the Ministry of Health on March 9, which read “people with symptoms should be tested”. Up until late April, Lombardy denied testing to people who requested it, unless they had significant symptoms. GP were instructed to do a triage over the phone and if the patient did not have a respiratory crisis or symptoms that would require hospitalization, the doctor would just suggest they’d keep them informed on the evolution of the symptoms. In addition to this, articles from trustworthy newspapers, have recently stated that Lombardy did not test people with symptoms (even serious ones), thus implying that Lombardy’s authorities have been concealing the truth and that they have not actually followed the Ministry of Health guidelines.   Veneto When the first patient affected by Covid-19 was identified in Vo’ on February 23, the region supported the proposal of a group of professors and researchers from the University of Padua, to carry out an epidemiological study on the entire population of Vo', testing everyone in the town. The results obtained provided a fundamental input in the medical research on the nature and ways of spreading of the virus, since the study was carried out on a population with statistically significant size. But most importantly, this study produced some crucial information to design a containment strategy more suited to the nature of this new virus. Among the results obtained, the study showed a very high share (45-50 percent) of asymptomatic infected people able to transmit the virus. With this result in mind, Veneto developed the so-called "active surveillance" strategy. The important aspect of this strategy is the planning of the tests: at the first appearance of symptoms (even mild) the patient is tested (together with the people living with her/him). Then a reconstruction of all the people that the patient came in contact with during the previous days is put together, and once these people are identified, they are also tested. Each time a new positive case is found, the procedure is repeated. In this way Veneto proceeds by concentric circles to identify the potential carriers of the virus- even if asymptomatic- with a higher probability.   [caption id="attachment_5199" align="aligncenter" width="621"] Figure 2: COVID tests carried out by region from February 24 to May 14 (per 100,000 people). Data from MoH, my elaboration.[/caption] Conclusions   Veneto: A winning Strategy: The two regions opted for two opposite testing strategy: Lombardy tested only the symptomatic patients (with already advanced symptoms), while Veneto proceeded to test symptomatic AND asymptomatic people, by mapping the contacts of the infected individuals. Veneto seems to have followed an approach more similar to Germany and South Korea. These are two countries that have managed to limit both the number of new cases and deaths, by recognizing the importance of testing asymptomatic patients. Scientific opinion leveraged: While Lombardy (allegedly) followed the guidelines of the Ministry of Health, based on the WHO recommendations, the region of Veneto, from the very beginning of the crisis, resorted to a team of scientists and epidemiologists to build a strategy that would best suit the situation. Does this mean that the MoH recommendations are flawed? Or being recommendations, they should be contextualized and tweaked based on the specific needs and capabilities of each region? Public debate and Lombardy’s defense: In the last few weeks a public debate started in Italy on whether Lombardy should be held accountable for the mismanaging of the crisis. The region’s authorities argued that the lack of testing resources and of laboratories forced them to reduce the number of tests and limit them to urgent cases only. They also point at the latest Ministry of Health recommendations from April 4, in which there is a list of people that should be tested in order of priority (in case there is a limited capacity of tests and a state of necessity), in this list, asymptomatic people figure only if they are healthcare staff. However, the same document states also that “if the diagnostic capacities are not sufficient, it is allowed to further expand the number of additional laboratories identified by the Regions and coordinated by the regional reference laboratories, considering the possibility of using mobile labs or drive-in clinics”. Has Lombardy taken advantage of this last point? Lombardy’s mismanagement, are there causes rooted in the regional healthcare policy? It is still early and rather difficult to assess to what extent Lombardy’s failure was inevitable or if it was the result of flawed and possibly completely wrong decisions of its authorities. However, as a recent review of an Italian newspaper suggests, Lombardy’s healthcare system malfunctioning could be attributed to Lombardy’s healthcare policies over the last decades, which highly incentivized the private sector. Nowadays about half of the region’s HC structures are private. Private structures in Lombardy over the years have specialized in profitable services, such as surgical operations and specialists’ visits, while emergency services- being less profitable- were not developed and left to public structures. As a result of this, even though private health care weighs about half of the entire Lombard healthcare system, it has just over a quarter of the intensive care unit beds in the region. Moving forward in the analysis, this aspect should be taken into consideration in order to understand what could have been done better, especially in the face of future emergency situations. Is the testing strategy the ultimate culprit? It is still unclear the extent to which Lombardy’s testing strategy contributed to its high numbers of cases and deaths. This article aimed at comparing two regions that have many similarities, such as healthcare system advancement, favorable economic conditions, and developed technology. With this in mind, since the two regions’ approaches varied substantially in terms of testing strategy, it is fair to attribute some degree of importance to this, while the research continues to assess responsibilities in order to avoid further mistakes in the future. Pietro Morabito - Senior Analyst Sources

Is UAE an easy-win market for Health & Beauty companies?

Ranked as the 5th among developing countries for future potential growth, the retail sector of the UAE keeps expanding beyond expectations. Despite recent signs of saturation, Dubai was still expected to add around 717,000 sqm of new retail space in 2018, while more 467,000 were expected to be added in Abu Dhabi. The overall market was estimated to be worth around USD 55 billion, with up to 16% of annual growth forecasted for the next years, surely benefiting from the Expo 2020 effect. [caption id="attachment_4854" align="alignright" width="384"] Retail market value (USD mn)[/caption] The sector is evolving. From one side, it is adapting to external stimulation such as the recent introduction of the VAT, that has led retailers to increase the value offered to shoppers. From the other side, the sector is innovating from within, given the increasing relevance of online shopping, direct selling and home shopping (6.5% of total market in 2023, from 4.2% in 2018). The Emirates are indeed considered a shopping destination by international tourists, and their spending patterns are quite higher than the average tourist (USD 1,671 against USD 1,105 on average). [caption id="attachment_4855" align="alignright" width="267"] Foreign tourists spending (USD per tourist)[/caption] The country welcomed more than 21 million tourists in 2018 and this number is expected to grow up to 33.5 million by 2028. The expected amount spent by these tourists will exceed USD 55 billion, which will be a conspicuous boost for retail, among other side sectors especially given the traveler propensity to purchase and consume Luxury goods. Many sectors are benefiting and boosting at the same time this general growth, establishing a virtuous circle that serves the entire economy of the country. Among them, the sales of Health & Beauty products almost doubled in the period between 2012 and 2019, when they overall value of product sold is expected to exceed USD 6 billion. With the 46% of market held by the top 6 players, the sector in not particularly concentrated. However, the big pharmacy chains have the lion’s share of this market, with the top 3 retailers recording double digit yearly growth in the last five years. [caption id="attachment_4867" align="alignright" width="895"] Health and beauty - Retail market value (USD mn)[/caption] The sector is regularly attracting further investors, such as O Boticario, the Brazilian retail chain specialized in cosmetic, skin care and fragrances, that recently invested in the country. In parallel, long-lasting players still have to innovate to match the continuously evolving customer demands, replacing non-performing brands with other that match the current client trends. A 2017 survey shows how 43% of customers are spending more than USD 135 on skin care every month, and the spending is forecasted to grow further. While large and expanding figures do attract players from everywhere in the world, success in this market is far for being granted To be able to differentiate their offer from competition, cosmetics and skin care operators need to accurately channel their investments and to establish a bilateral communication with more and more educated customers. [caption id="attachment_4868" align="alignright" width="1198"] Top 3 health & beauty retailer sales (USD mn)[/caption]       For instance, most famous international brands leverage brand reputation and already well-known quality, still need to invest millions on product advertisement, press engagement and new social media (ex. by collaborating with Instagram influencers). On another hand, more niche brands need to focus on specific customer segments, engaging them through demo or through a network of doctors able to appreciate and recommend the products to their patients. A deep understanding of the market mechanisms becomes then a must-have to successfully compete in a very promising and dynamic market. Sources: Euromonitor International A.T. Kearney - The 2017 Global Retail Development Index Journal of Cosmetics, Dermatological Sciences and Applications, 2017 Ardent report, 2016: Press: Press:    Antonio Pilogallo – Research Manager at INFOMINEO  

July 24 2017 | Healthcare & Pharma
The Kingdom of Saudi-Arabia’s Vision 2030

Establish an Empowering Healthcare System In April 2016, Saudi Arabia presented its vision for a “vibrant society, a thriving economy and an ambitious nation.” The Kingdom wants its citizens to live longer – from now expected 74 years to 80 years. It wants to “optimize and better utilize hospitals and healthcare centers, and enhance the quality of preventive and therapeutic health care services.” It wants to promote preventive care and reduce infectious diseases, and encourage citizen’s use of primary care. Doctors are to be given better training. The public sector is to focus on planning, regulatory and supervisory duties. Public corporations are to provide healthcare, enhance its quality and compete. Private medical insurance is being developed. Privatization is on the horizon. The agenda is long and ambitious. This reflects the complexity of the Kingdom‘s current health care challenges. Its healthcare expenditure is rising to more than $B 40 by 2020, with $B 5.5 required for non-communicable diseases while oil revenues have dropped sharply. Hospital beds and doctor quotas still rank below global levels after years of investment. Public healthcare for nationals and the private system for expats operate separately, with little synergies and efficiencies. The Ministry of Health and other government institutions are financing institution, legislator, operator and controller in one. Corporatization is the “empowerment” cited in Vision 2030 to address systemic and operational issues. The Ministry of Health will limit its role to regulator and supervisor. Hospitals and clinics will be transferred into a network of public companies that compete against each other and against the private sector. While this move might seem mostly conceptual, it actually represents a seismic shift in philosophy. The relinquishing of operational control at the central government level and the streamlining of traditionally abundant services have the potential to send ripple waves across every cog and wheel of healthcare in the biggest market in MENA. This is where fact ends and speculation begins. The timeline for corporatization is still firming up. The degree of autonomy and the budget process of the future public corporations remain open for now. However, the necessary increases in efficiency and quality would mandate a few likely effects: National health standards, KPIs and value measurements. The possibility of private operators for public facilities. More efficient use of hospital beds and shorter hospital stays. The eventual shift of treatment from hospitals into more primary care settings. Regionalization of healthcare structures into regional hub-and-spoke systems. The possible fragmentation of centralized tenders. Eventually, privatization. Already, the government has identified more than 30 opportunities for public-private partnerships. It has initiated first public dialogues with providers and suppliers. In the next steps of the reform, the change in governance will need to be broken down into operational decisions.  Private providers,  life sciences and medical technology companies, academia and service specialists have the opportunity to shape and support the evolution of the Kingdom’s health care system now – by generating data, making treatment more avaulable across the Kingdom, providing higher quality services, developing value-based approaches and market access models, offering expertise, reviewing their growth models and operations and in myriad other ways.   Claudia Palme, Managing Director, 55east Consulting Tel:  +971503968598

June 07 2017 | Healthcare & Pharma
African Hospitality Market Attracting New Investors

For many decades, the African hospitality market has been exclusively reserved to private investors, of which the majority are hotel chains and property companies. Looking at the market today, it appears that the Sub-Saharan African hospitality sector, excluding South Africa, is now rising as a key investment opportunity for both international hotel chains and institutional investors such as private equity firms. With the tourism sector being a key target for most African governments, hospitality investments are strongly supported by public authorities who offer incentives to attract the world’s largest brands, making the continent the new battleground of major international hotel groups. According to EY’s Africa Attractiveness Survey, the African hotel and tourism sector was forecasted to grow by almost 17%, with accommodation demand increasing from the business travelers connecting to big African cities and many other African commercial capitals, as a reflection of strong economic growth. As the continent remains attractive to investors for business, trade and capital investment, it leads to an increasing demand for accommodation and hospitality products. The hospitality sector is developing at a fast pace with large investments planned in sub-Saharan Africa. It has shown a 29% average yearly growth rate between 2012 and 2016 in terms of room capacity, according to W Hospitality Group 2016 survey. At the end of 2016, hotel developments are planned for 35 of the 49 sub-Saharan African countries, with western Africa absorbing 45% of the capacity of rooms planned, followed by Southern Africa with 26% and Eastern African capturing 24% of the planned rooms. The offer covers all hotel’s segmentation, with an emphasis on 4-star hotels, mainly targeting business travelers and tourists with specific requirements when visiting Africa. In terms of the number of investments, they are largely focused on the southern region of the continent, with South Africa absorbing the highest amount of investments. Kenya attracts the highest amount of hotel investments in the east Africa region, followed by Uganda, as the countries are offering diverse opportunities for tourism development and therefore large capacity of absorbing hospitality investments. West Africa is also a key target for several investors, with Nigeria on top of priority, followed by Cote d’Ivoire and Ghana. Both countries are very attractive due to the rise of their business travelers, as their economies keep prospering. Historic segment investors like international hotel groups are actively taking advantage of the market opportunities. They all plan several openings and hotel extensions, with some looking to increase their footprint on the continent through hotel acquisitions in main countries and local development offices to support their strategies: AccorHotels has set up partnerships with strong investors to conquer the African hospitality market and aims to increase its sub-Saharan Africa network to 15,000 rooms in 100 hotels over the next five years. Carlson Rezidor, with 30 hotels comprised of 6,300 rooms under development across the continent, has set up a hospitality fund, Afrinord Hotel Investments, with Nordic institutions to support its growth on the continent. Marriott International announced in 2014 its plan to expand its African presence to 150 properties in 17 national markets by 2020. Its acquisition of Protea, a 116-hotel group spanning seven African nations, for USD 200 million, marks a key step in its strategy. The American group Hilton, with 39 hotels in 17 African countries, intend to double its presence to 80 hotels by 2020 with new openings and extensions in Ghana, Kenya and Nigeria. Even if international hotel chains seem to be the leading active players on the field, the local groups are not in marge. Mangalis Hotel Group, the new African hotel chain is investing USD 340 million to build 15 hotels in west and central Africa through 3 brands (Noom, Yaas and Seen) with a total of 2,200 rooms and suites. Azalaï Hotels who has footprints in several west African countries, with a capacity of 1,000 rooms, intends to grow above 1,600 rooms in terms of capacity after this fundraising. At the beginning of this year, AfricInvest announced an injection of EUR 17.3 million in Azalaï Hotels capital, to support the hotel group development across Africa through capacity extension and service improvement. Beside the hotel groups, institutional investors are also showing interest to the hospitality and tourism sector. Gradually increasing their exposure on the segment, investment funds see the African hospitality sector as a golden egg, and show their enthusiasm for the segment by mainly investing through equity vehicles. Their investments target both greenfield and brownfield projects in all geographies. These funds targeting African hospitality markets are largely funded by development institutions around the world, helping local tourism sectors take off and raise the economy. As other institutional investors, African sovereign wealth funds are looking to hospitality, as the segment is considered as a relatively safe investment sector. The Libyan Investment Authority (LIA), the Libyan sovereign wealth fund, has been actively investing in hotels in Africa through its subsidiary LAICO, Libyan African Investment Company. The fund owns hotel chain Laico Hotels & Resorts, which also owns the Ensemble Hotel Holdings group, proprietor of the high-prestige Michelangelo Hotel in Johannesburg. Laico Hotels & Resorts has 10 properties of 4-star and 5-star hotels with over 2,200 rooms through 2 brands: Laico and Ledger. Most of its acquisitions were targeting three-star to five-star hotels and are managed by international operators. In 2008, LAICO established a joint venture, called LAICO Hotels Management Company, with Tunisia Travel Service (TTS), a Tunisian company involved in the hospitality sector through hotel management, airlines and ground transportation. LIA is similarly followed by Angola’s Fundo Soberano de Angola (FSDEA), which is starting investments in hotel and commercial infrastructure in sub-Saharan Africa. The fund is expected to invest in 50 sub-Saharan African hotels over three years, including in Angola. This is thanks to allocation of USD 500 million in equity capital to a hotel development fund for Africa, as it has earmarked the tourism space as a particularly potent area. FSDEA’s hotel fund will focus on three-star to five-star hotels in sub-Saharan African capitals and other commercial centers, targeting business travelers rather than tourists for their currently returns. The fund will target existing hotels changing ownership or those still under development. Funds from Mozambique, Nigeria and Ghana are all intending to follow their peers and to exploit the recent rises in tourism to Africa. The new dynamism on the African hospitality sector proves that investment opportunities on the continent are diverse for all types of investors. All it takes is to be more alert to rising opportunities and growing sectors. Gaicha Saddy, Senior Associate at Infomineo. Sources: Agence Ecofin, AfricInvest investira 17,3 millions d’euros pour soutenir le développement du groupe Azalaï Hotels (January 2017) Jeune Afrique, Hôtellerie : Hilton entend doubler sa présence africaine (October 2016) W Hospitality Group, Hotel Chain Development Pipelines in Africa 2016 (May 2016) EY’s attractiveness survey, Africa 2015, Making choices (2015)$FILE/EY-africa-attractiveness-survey-2015-making-choices.pdf JLL, Hotel Investment Outlook 2015, Hotels & Hospitality Group (January 2015) African Union, Invest In Africa 2015 (2015) Bloomberg, Angola Sovereign Wealth Fund Starts Hotel, Infrastructure Pools (April 2014) African Development Bank, Africa’s Quest for Development: Can Sovereign Wealth Funds help? (December 2011) Companies websites  

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