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. 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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: https://www.scidev.net/afrique-sub-saharienne/technologie/actualites/l-intelligence-artificielle-dans-le-secteur-de-la-sante-en-afrique-28092020.html http://french.peopledaily.com.cn/Afrique/n3/2020/0914/c96852-9760056.html https://www.broadbandcommission.org/Documents/working-groups/AIinHealth_Report.pdf https://www.agenceecofin.com/homepage/0909-80001-l-adoption-des-technologies-dans-la-sante-pourrait-aider-les-pays-pauvres-a-depasser-les-riches-dans-lacces-aux-soins https://www.chinadaily.com.cn/a/202009/10/WS5f5a1ebba310f55b25a81cdd.html https://www.rfi.fr/fr/podcasts/20200915-l-intelligence-artificielle-service-la-m%C3%A9decine-en-afrique https://www.agenceecofin.com/entreprendre/1609-80257-guinee-mountaga-keita-a-concu-une-tablette-capable-de-detecter-les-symptomes-de-la-covid-19 https://camerounactuel.com/sante-a-base-de-lintelligence-artificielle-une-chance-pour-les-pays-a-faible-revenu/ https://cio-mag.com/e-sante-guinee-tulip-industry-des-ordinateurs-debout-adaptes-a-lafrique/ https://capecameroun.org/la-tech-africaine-se-mobilise-contre-le-covid-19/ https://auctoday.com/2020/03/31/roll-out-the-radiologists/ https://www.lepoint.fr/afrique/covid-19-l-afrique-sur-la-carte-mondiale-de-l-innovation-23-04-2020-2372639_3826.php https://www.mei.edu/publications/rethinking-egypts-economy https://www.alliance4ai.org/companies/https://clevva.com/press-release/6-artificial-intelligence-startups-africa-look/ https://medium.com/alliance4ai/ai-generation-learnings-from-alliance4ais-first-100-startups-in-africa-acfba0f753d1 https://www.distrelec.de/current/en/engineering/companies-robotics-ai-make-lives-better-africa/ https://www.leconomiste.com/article/1063657-technologies-de-la-sante-le-maroc-leader-et-futur-hub-en-afrique https://www.nydc.gov.zm/tafadzwa-kalisto-munzwa-dawa-clinic-co-founder/
Exploring the COVID-19 testing strategies in Italy reveals Lombardy and Veneto, the first two regions hit by the virus, embarked on divergent paths in managing 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 https://www.fnopi.it/wp-content/uploads/2020/03/Circolare_9_marzo_2020.pdf http://www.trovanorme.salute.gov.it/norme/renderNormsanPdf?anno=2020&codLeg=73799&parte=1%20&serie=null https://www.ilpost.it/2020/05/04/pandemia-coronavirus-lombardia/ https://www.ilpost.it/2020/04/23/tamponi-andrea-crisanti/ http://www.salute.gov.it/portale/nuovocoronavirus/dettaglioContenutiNuovoCoronavirus.jsp?area=nuovoCoronavirus&id=5351&lingua=italiano&menu=vuoto https://www.startmag.it/mondo/covid-19-lombardia-veneto/
As the retail sector of the UAE continues to expand, marking its place as 5th among developing countries for future growth, the Health & Beauty segment emerges as a pivotal contributor to this dynamic market. 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: http://www.ardentadvisory.com/files/GCC-Retail-Sector-Report.pdf Press: https://www.khaleejtimes.com/business/local/uae-retail-evolves-from-bricks-to-clicks Press: https://www.khaleejtimes.com/business/retail/uae-retail-sector-continues-to-grow- Antonio Pilogallo – Research Manager at INFOMINEO
In response to the global financial crisis of 2007-2008, the importance of robust economic strategies has become paramount. Within this context, Saudi Arabia's Healthcare Vision 2030 emerges as a groundbreaking initiative aiming to transform the Kingdom into a vibrant society with a thriving economy 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 c.palme@55east.com Tel: +971503968598