COVID-19 generated scientific momentum; will it transfer to other chronic conditions?

By Margaret Anderson, managing director, Deloitte Consulting LLP

COVID-19 highlighted long-standing inequities in health care. It also demonstrated that science is capable of moving quickly when necessary. As we emerge from the pandemic, health care stakeholders should take advantage of this momentum. We should apply the knowledge gained during the development of COVID-19 vaccines and therapies and apply it to other infectious illnesses, cancers, and rare diseases. We can’t go back to business as usual.

Prior to joining Deloitte, I helped to shape FasterCures, which is the Milken Institute’s non-profit biomedical-research-focused center. FasterCures is typically seen as an aggregator, a convener, a connector, and an accelerator that has pushed medical research to the next level by bringing multiple stakeholders together and putting patients at the center of it all. Last month, I participated in a panel discussion at the Milken Institute’s Future of Health Summit where I was joined by current and past leaders of FasterCures and related organizations. We reflected on some of the challenges we have overcome in the past and discussed opportunities the pandemic might have created for the future.

RWD and health equity

In recent years, real-world data (RWD) has revealed that health outcomes for most chronic conditions—from diabetes to cancer to mental health issues—can be profoundly influenced by geography, income, race, and ethnicity. Greg Simon, who previously headed the White House Cancer Moonshot Task Force, said the pandemic brought health equity into full view because so many essential workers were under-represented minorities and women. As my colleagues Asif Dhar and Kulleni Gebreyes noted in a blog last summer, Black Americans are more than twice as likely to die from COVID-19 than white Americans.

On his first day in office, President Biden signed an executive order to advance racial equity and support for underserved communities.¹ The next day, he issued another executive order directing the federal government to address health equity in responding to, and recovering from, the pandemic.² Since then, Federal agencies have been taking a close look at the role they can play in addressing issues around equity.

FasterCures has worked to address racial, economic, and gender disparities in health care for years. In the organization’s early days, Greg noted that researchers typically didn’t seek information directly from patients. Today, that type of RWD is critical for understanding patients, diseases, and therapies. Esther Krofah, the current executive director of FasterCures, said the pandemic experience, combined with RWD, could help ensure that medical innovation becomes more inclusive for patients with all types of conditions and from all types of communities. She suggested we have entered “a golden era of science,” but cautioned that not everyone benefits from that science, which is an issue that should be fixed.

Since the beginning of the pandemic, data scientists and researchers have been engaged in efforts to capture and analyze RWD to understand the nature of the disease and the efficacy of drugs to treat it. The Reagan-Udall Foundation’s COVID-19 Evidence Accelerator, for example, brought together major data organizations, regulators, and academic researchers to look for ways to convert RWD into actionable insights, according Deloitte’s recent report on Measuring the return from pharmaceutical innovation 2020.

Diversity in clinical trials

The need to improve diversity in clinical trials is not new. We’ve been talking about the importance of recruiting women and ethnically diverse populations for decades. Now this critically important issue is becoming a priority for many stakeholders. Moreover, regulators, biopharmaceutical companies, patient advocacy groups, and philanthropy organizations recognize that structural racism can have an enormous impact on health outcomes. Last fall, the National Institutes of Health (NIH) announced a program to provide outreach and engagement efforts in ethnic and racial minority communities that have been disproportionately affected by the pandemic. The NIH Community Engagement Alliance (CEAL) Against COVID-19 disparities, works closely with communities hit hardest by the pandemic.³

In September, the Deloitte Center for Health Solutions and the Pharmaceutical Research and Manufacturers of America (PhRMA) will publish a detailed report about clinical-trial diversity. The report is based on a two-day workshop of 500 stakeholders from 150 organizations representing industry, health systems, academic institutions, government entities, the faith community, and others interested in clinical trials. Enhancing clinical-trials by including participants from diverse populations can help sponsors ensure that their products and services are accessible to all populations, while simultaneously examining potential bias in tools and algorithms that may be perpetuating inequalities. Diverse representation of patient populations in clinical trials can also help to build public confidence in tested therapies once they become available.⁴

Progress and challenges in addressing disease

Across the US and around the world, COVID-19 demonstrated that we are all harnessed together in a way we couldn’t have imagined before the pandemic. Here’s a look at some of the issues we discussed during our session that relate both to the pandemic and our progress against all diseases: 

• Real-world applications of patient data: The NIH’s All of Us research program will be the most racially and ethnically diverse cohort in existence. The goal of the program is to build a cohort made up of 1 million people or more and make their data available to the scientific community. Data generated by the program is expected to give researchers deeper insight into the biological, environmental, and behavioral factors that influence health. Case in point: In June, researchers announced that stored blood samples contributed by the program revealed that COVID-19 was spreading in multiple states (outside of major urban hotspots) in January 2020—well before the first cases had been reported in those areas.⁵
• Access: Issues related to care access have been obvious since the pandemic began, and these challenges continue—in the US and throughout the world. About 85% of COVID-19 shots have been delivered to people living in wealthy countries.⁶ While the US has the ability to share vaccines and best practices with the rest of the world, we have only scratched the surface.
• Culture: Getting people to make healthy decisions can be a challenge, Greg Simon noted. We have to socialize what it means to be healthy and provide tools for how to effectively respond to a cancer diagnosis or a pandemic. But we need to be mindful of how inequity started in the first place to create health disparities. Even the best strategies might not be enough to overcome cultural barriers during a public health crisis. “Culture eats strategy for lunch. During the pandemic, it was lunchtime,” he said. The virus overwhelmed our culture’s ability to respond to this threat politically, scientifically, and socially.
• Patient activism and empowerment: The power of patient activism was demonstrated during the HIV/AIDS crisis of the 1980s and ‘90s. A playbook emerged about how to hold the system accountable. From there, many not-for-profit organizations adopted that playbook and began working more closely with the government and for-profit community and expressing their needs. They also began looking more closely at the value of patient input. Including patients in the conversation with regulatory bodies and industry is an idea that FasterCures helped to pioneer but it is now table stakes across the system. Over the next 20 years—as outlined in Deloitte’s landmark report on the Future of Health^TM—patients and consumers will move to the center of the health care system. They will be armed with data about their health and will be empowered to make important decisions about their care and well-being.
• Data sharing: Greg noted that too much time is wasted because it is still difficult for researchers to share data. “You can’t make a 3-minute egg in one minute, but you also don’t need six weeks to set up the process,” he quipped. We were wasting so much time by not sharing data or by making medical records ubiquitous and available. The recently enacted rules around data interoperability could make it easier for health care organizations, researchers, and patients to share information.

In conclusion

I don’t believe scientific advancement can go back to where it was before the pandemic, and I expect other disease communities will try to take advantage of the momentum the pandemic generated. We have witnessed what is possible in terms of science, drug discovery, collaboration, regulatory approval. Esther said we have reached a perfect moment to remove health inequities in health care and biomedical research. “We can build a path toward a better future where biomedical innovation is inclusive of all patient types,” she said. “We need to make sure that everyone benefits from science. That hasn’t always been the case.”  

Endnotes:

1. Executive order on advancing racial equity and support for underserved communities through the federal government, The White House, January 20, 2021

2. Executive order on ensuring an equitable pandemic response and recovery, The White House, January 21, 2021

3. NIH to invest $29 million to address COVID-19 disparities, NIH press release, April 29, 2021; NIH Community Engagement Alliance (CEAL) Against COVID-19 Disparities

4. Racial diversity within COVID-19 vaccine clinical trials, Kaiser Family Foundation, January 26, 2021 

5. Antibodies to SARS-CoV-2 in All of Us research program participants, January 2-March 18, 2020, Infectious Diseases Society of America, June 15, 2021

6. Rich countries cornered COVID-19 vaccine doses, Science, May 26, 2021