THE history of our world is deeply intertwined with the trajectory of infectious diseases. For centuries, infectious diseases have been among the leading causes of death, aggressively threatening societal health and progress. And in more recent instances, exacerbating already serious healthcare concerns – overburdened infrastructure, limited funds, stretched resources and an ever-growing patient population.
The threat from infectious diseases is further compounded by the rise of new, often unrecognized pathogens and the re-emergence of old infectious diseases due to globalization, urban density and weather volatility.
Ironically, the advent of innovations such as antibiotics, immunisation and improved public health measures, have moved attention away from the need for ongoing infectious diseases control, and created a greater shift towards tackling non-communicable diseases (NCDs). Tuberculosis (TB), for instance, has been responsible for the death of more people than any other infectious disease; over a billion deaths in the last 200 years – that’s the combined population of the United States, Indonesia, Pakistan and Bangladesh.
The current pandemic has shown us the devastating repercussions of a short-sighted healthcare ecosystem and calls for a new approach – one that places predictive and preventative care at the center of the patient journey. Healthcare in the post-COVID era requires the following:
A recalibrated approach to health financing
Infectious diseases have changed the course of healthcare and the practice of medicine. SARS is an example that shows the damage possible in a globalised world, and has helped to instil heightened awareness around early detection and isolation of suspected infectious diseases cases.
While diagnostics have been central to control and prevention strategies during COVID-19, the same cannot be said for diagnostics tests in general – with diagnostics accounting for only 2% of healthcare spend globally, despite it influencing over 70% of all clinical decisions.
As COVID-19 has demonstrated, testing has been a first line of defence for all countries battling the virus. Rethinking health financing in “value” terms rather than cost alone will provide much-needed impetus to develop a sustainable healthcare model that embeds diagnostics at the core of care delivery. This also requires overhauling reimbursement strategies to incentivise the adoption of a value-based model.
Such an approach to healthcare investments will empower countries to safeguard the health of their citizens during a disease outbreak – but more importantly, it will leverage such a comprehensive care model in the management of other diseases, including NCDs.
Strengthening national-level preparedness with diagnostics at the centre
To complement predictive and preventative care, there is a need to reframe national health policies to allow fast decision-making and decisive action. The speed with which countries were able to deploy mass testing or change testing strategies to suit the rapidly evolving situation has been a real test of their ability to control widespread transmission. Without the appropriate laboratory infrastructure and resources to support timely and accurate results, this would not have been possible.
The time has come to ensure healthcare systems are prepared for the next pandemic. Policy reviews conducted in the aftermath of disease outbreaks such as SARS have consistently emphasised the importance of strengthening regulatory frameworks to ensure an agile, fit-for-purpose ecosystem that enables rapid approval for diagnostics tests. This includes activating or creating expedited exemption or approval pathways for diagnostics tests and leveraging regulatory reliance models or authorisations from overseas reference authorities to minimise duplication of approval efforts, recommendations that have been made in a recent Asia Pacific Medical Technology Association (APACMed) position paper.
At its core, digital health represents a much-needed linkage between data science and healthcare. It connects the dots for better, more informed health decisions by providing early warning for infectious disease outbreaks, and timely information to inform disease control and elimination programmes that can improve diagnosis and patient management.
COVID-19 has provided real-world evidence of digital health technology’s role in facilitating pandemic strategy and response in ways that are difficult to achieve manually. But we need to go beyond ad hoc initiatives to drive tangible outcomes. Here are two approaches:
Establishing surveillance systems. Diagnostics has a role to play across the continuum of care. Obtaining timely, patient-level data on emerging threats to global health, including infectious diseases, can be invaluable for improving triage, management and patient isolation. The capture and sharing of patient healthcare data from testing can inform disease control strategies that will ultimately save costs, resources and lives by addressing infectious diseases before they become severe outbreaks.
Investing in digital health infrastructure: COVID-19 has accelerated the adoption of digital health technology. Countries that invested in developing such capabilities pre-COVID including the aggregation and mining of health data, interoperability and data security were able to move swiftly to ensure continuity of care even when quarantine and social distancing measures were in place. The upswing in the use of digital decision support tools, such as virtual tumour boards for cancer management during the pandemic, is a great example of this.
Infectious diseases are here to stay
Every country needs a plan to scale-up diagnostics deployment as part of their strategy to drive healthcare access and funding sustainability, using early lessons from the pandemic. Imagine to what degree we could reduce the burden of all diseases if countries exhibited the same agility as some of the best examples seen during COVID-19.
Governments and healthcare stakeholders need to work together to understand, contain and minimise the threat of outbreaks. Poor management in one country can easily have a ripple effect, highlighting the need for a collaborative approach.
Now more than ever, the value of diagnostics needs to be better recognised so that it can serve as a driving force for sustainable change in healthcare. A greater reliance on diagnostics, now and in the future, can help effectively manage, if not eradicate infectious diseases, and ensure that next time, we are far better prepared.
History is filled with instances where infectious diseases have been successfully eradicated. Can we do the same in the case of other existing and emerging infectious diseases? Only time will tell, and it will depend on our actions today.