Summary

From the point of view of Biomedicine, certain advances stand out in the search for a treatment for multiple sclerosis, a disease that affects 1.8 million globally and for which at this time there is no effective therapy. As announced by the president of the Spanish Society of Nephrology, the new drugs will allow many cases of dialysis and transplant to be avoided.

As far as Global Health is concerned, the most worrying thing is the poor perspectives observed regarding the pandemic treaty, the objective that the WHO had proposed for 2024. The obstacles are the accumulation of vaccines and the sharing of knowledge about them, problems of rich countries and companies, respectively. The Lancet warns about the need to strengthen cervical cancer screening, which continues to cause hundreds of thousands of deaths a year, especially in low- and middle-income countries. Warning about ultra-processed foods (cereals, protein bars, soft drinks, and fast food) linked to 32 harmful health effects, including increased risk of vascular disease, cancer, type 2 diabetes, mental illness and premature death.

In terms of International Health Policy, a very serious problem with fentanyl in the United States, which in the last twelve months until September 23 had caused 105,000 deaths in that country. Until now, the policy was aimed primarily at preventing the entry of drugs; some extremist politicians had even proposed invading Mexico to put an end to the gangs. With the current Administration, efforts are directed more towards discouraging its use and treating addicts. Big problem for Republicans in the USA with the decision of the Alabama Supreme Court to declare frozen embryos as “extra-uterine children”, with all the obstacle that this has for the popular procedure of in vitro fertilization, so widespread in the United States as in other developed countries. This Alabama decision seems like a gift to Democrats: “First it was abortion, now it is in vitro fertilization and then it will be birth control,” warned Hillary Clinton. Even Trump was forced to distance himself from this decision. In France, the National Assembly is putting pressure on the pharmaceutical industry regarding the shortage of medicines, forcing laboratories to have a four-month reserve of “medicines of high therapeutic interest.” In order to strengthen drug R&D, the European Union is considering “giving away” a year’s patent to those drugs whose research has been carried out in Europe.

If we talk about National Health Policy (Spain), the current Ministry of Health, unlike previous Ministries, wants to get involved in the problems of the SNS, while the previous ones wanted to get involved as little as possible, with the argument that “everything was transferred” . This attitude seems, in principle, positive for the SNS. Another thing is priorities. It seems that among these are the suppression of 24-hour medical guards; addressing waiting lists; and, the State Public Health Agency. Regarding the first issue, the challenge is formidable, since medical guards, regardless of whether they are necessary or not, have become an important salary supplement. It is impossible to address this issue without considering the complements of medical personnel, which is no small issue. Regarding waiting lists, aware that their management corresponds to the communities, it seems that they want to establish a kind of “best practices”, with economic incentives for the communities that apply them. Not an easy matter either. And as for the State Public Health Agency, the ministry seems to have reached an agreement with the PNV and Junts, for the withdrawal of their amendments to the law. Let us hope that this agreement does not go against the strength and operation of the new Agency. For its part, SESPAS, the Spanish Society of Public Health, has published an interesting document on the characteristics that this body should have, with 11 very interesting recommendations. The Economic and Social Council of Spain (CES) publishes a report on the health system. Although the report is well prepared, it is difficult to find anything new in it that has not already been said or any innovative proposal. Taking advantage of the day of rare diseases (although it is now preferred to call them minority) the Spanish Association of Orphan and Ultra-orphan Drug Laboratories releases a report on the situation of these drugs in Spain. Much has been improved, although there is still room to advance. Both the La Paz hospital in Madrid and the Sant Joan de Deu in Barcelona launch special units to treat this type of illness.

As for Companies, on an international level, the Danish Zealand Pharma, a new relevant player in the field of obesity. On the national level, Viamed will launch a comprehensive unit for women in its hospital in Tarragona. New punishment in the Grifols Stock Market.

Biomedicine

• Scientists searching for a treatment for multiple sclerosis. This disease affects around 1.8 million people globally and has no effective treatment. It occurs when the immune system attacks myelin. Epstein Barr virus vaccines may be effective in multiple sclerosis (https://www.economist.com/science-and-technology/2024/02/28/scientists-want-to-tackle-multiple-sclerosis-by-treating-the-kissing-virus?utm_medium=cpc.adword.pd&utm_source=google&ppccampaignID=18151738051&ppcadID=&utm_campaign=a.22brand_pmax&utm_content=co)
• Discovered a new protein that intervenes in the sense of touch. A group of researchers has discovered the protein called Elkini, which seems essential in the sense of touch (https://elpais.com/ciencia/2024-02-29/descorta-una-nueva-proteina-que-interviene-en-the-sense-of-touch.html#). Access to the original article in Science: https://www.science.org/doi/10.1126/science.adl0495
• Consequence of long covid, which can cause measurable cognitive decline, especially in memory (https://www.nytimes.com/2024/02/28/health/long-covid-cognitive-effects.html#:~:text=Long%20Covid%20may%20lead%20to%20measurable%20cognitive%20decline%2C%20especially%20in,the%20equivalent%20of%206%20I.Q.) Access to the original NEJM article: https://www.nejm.org/doi/10.1056/NEJMoa2311330#:~:text=Conclusions,small%20cognitive%20deficits%20after%20recovery.
• The new drugs will allow dialysis and transplants to be avoided in many cases, according to the president of the Spanish Society of Nephrology, Emilio Sánchez. In Spain there are 7 million people with chronic kidney disease (https://www.lne.es/cuencas/2024/03/02/nuevos-farmacos-permitaran-evitar-dialisis-98895162.html)

Global Health

• Problems with the new pandemic treaty. The political impetus for this treaty has disappeared. It should be approved at the WHO assembly on May 24. The latest draft from October-23 is very disappointing. The intention was to avoid the accumulation of vaccines by rich countries, and to share knowledge that could save lives by companies. The Lancet Editorial: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00410-0/fulltext. Call to attention from several scientists published in Nature: https://www.nature.com/articles/d41586-024-00545-3#:~:text=The%20proposed%20Pandemic%20Agreement%20must,290%20scientists%20call%20for%20action.&text=Colin%20Carlson%20is%20assistant%20research,University%2C%20Washington%20DC%2C%20USA.
• Cervical cancer screening. Call to promote this screening, especially in low- and middle-income countries. An estimated 348,185 women died from cervical cancer in 2022 and 90% were from low- or middle-income countries. (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00408-2/abstract)
• Ultra-processed foods (cereals, protein bars, soft drinks, and fast food) linked to 32 harmful health effects, including increased risk of vascular disease, cancer, type 2 diabetes, mental illness and premature death. (https://www.theguardian.com/society/2024/feb/28/ultra-processed-food-32-harmful-effects-health-review#:~:text=Health-,Ultra%2Dprocessed%20food%20linked%20to%2032,effects%20to%20health%2C%20review%20finds&text=Ultra%2Dprocessed%20food%20(UPF),largest%20rev) Original article in the BMJ: https://www.bmj.com/content/384/bmj-2023-077310
• Obesity is already the most common form of malnutrition in most countries. It already reaches 1 billion globally, cases in children have quadrupled in three decades and in adults they have almost tripled (https://elpais.com/salud-y-bienestar/2024-02-29/la-obesidad-It is already the most common form of malnutrition in most countries.html#:~:text=A%20study%20published%20this%20Thursday, adults%2C%20almost%20se %20have%20tripled.)

International health policy

• USA
  • The Economist Editorial: Fentanyl cannot be defeated without new tactics. In the last 12 months through September 23, 105,000 Americans died of overdoses, almost twice as many Americans killed in combat in Vietnam, Afghanistan and Iraq. Fentanyl is a synthetic opioid 50 times more powerful than heroin and is linked to 70% of drug deaths in the USA. Many politicians lean toward extreme solutions, such as invading Mexico, to put an end to the gangs. For the first time, the American Administration spends more on discouraging its use and treating addicts than on preventing the arrival of the drug, but there is much more to do (https://www.economist.com/leaders/2024/02/29/fentanyl-cannot-be-defeated-without-new-tactics)
  • In the USA, Republicans in trouble after the Alabama Supreme Court’s decision to consider frozen embryos as “extra-uterine children.” This prevents in vitro fertilization, a very popular method in the USA and in many other countries (https://www.lemonde.fr/international/article/2024/02/29/aux-etats-unis-les-republicains-embarrasses-par-la-decision-de-l-alabama-de-considerer-les-embryons-congeles-comme-des-enfants_6219345_3210.html#:~:text=États%2DUnis-,Aux%20Etats%2DUnis%2C%20les %20ré)
  • Deaths from alcohol resurface, almost 500 a day, according to the CDC. Alcohol consumption rose sharply during the pandemic and has not stopped. Political remedies can be: more taxes on alcohol, limits on sales and campaigns among the population (https://www.nytimes.com/2024/02/29/health/alcohol-deaths-cdc.html)
  • CVS and Wallgreens, the two largest pharmacy chains in the USA, will begin selling abortion pills (mifepristone) this month, after receiving guidelines from the FDA. They will not serve medication by mail (https://www.nytimes.com/2024/03/01/health/abortion-pills-cvs-walgreens.html)

• United Kingdom and the National Health Service
  • The United Kingdom, behind other countries on waiting lists for cancer treatments. The research compares access to radiotherapy and chemotherapy in Australia, Canada, Norway and the United Kingdom, published in The Lancet Oncology (https://www.theguardian.com/society/2024/feb/27/uk-bottom-list-waiting-times-radiotherapy-chemotherapy-study#:~:text=UK%20patients%20experienced%20the%20longest,was%2039%20days%20in%20Norway.&text=In%20radiotherapy%2C%20the%20UK%20fared%20even% 20worse.)
  • NHS Scotland faces an uncertain future as demand outstrips resources (https://www.bmj.com/content/384/bmj.q476#:~:text=“As%20BMA%20Scotland%20has%20warned,%2D26%2C”%20he%20said.)
  • Resident doctors in England on strike for the 10th time (https://www.bmj.com/content/384/bmj.q500#:~:text=The%20dispute%20over%20pay%20between,in%20mid%2DMarch%20last%20year.)

• France
  • Medicine shortage. The National Assembly intervenes and the deputies put pressure on the pharmaceutical industry, forcing it to have reserves of up to four months for “medicines of high therapeutic interest” (https://www.lemonde.fr/societe/article/2024/03/01/penuries-de-medicaments-l-assemblee-nationale-en-faveur-d-une-inscription-dans-la-loi-de-stocks-planchers_6219350_3224.html#:~:text=Santé-,Pénuries%20de%20medications%20%3A%20les%20députés%20mettent%20la%2)
  • Public hospitals pressure the government to increase rates, due to increased expenses. Current rates do not correspond to the reality of costs and do not allow the real activity of hospitals to be financed, says the Federation of French Hospitals (FHF) (https://www.lemonde.fr/sante/article/2024/03/01/les-hopitaux-publics-pressent-l-executif-d-augmenter-significantment-leurs-tarifs-devenus-obsoletes_6219501_1651302.html)

• South Korea
  • Striking junior doctors, who oppose government plans to increase the number of doctors in the country, threatened with arrest and suspension (https://www.bmj.com/content/384/bmj.q495)

• Slovenia
  • The longest doctors strike in Slovenia (https://eurohealthobservatory.who.int/monitors/health-systems-monitor/updates/hspm/slovenia-2022/longest-doctors-strike-in-slovenia-s-history-still-ongoing#:~:text=Longest%20doctors%27%20strike%20in%20Slovenia%27s%20history%20still%20ongoing&text=Doctors%)

• European Union
  • The new priorities of the ECDC, an organization located in Sweden and created in 2005. The Lancet greets the new director, the Austrian Pamela Rendi-Wagner, a doctor with academic, management and political experience. Its key priorities are seen as implementing the lessons of the pandemic within and beyond the EU (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00406-9/abstract?rss=yes#:~:text=Experts%20say%20new%20head%20Pamela,preparedness%20and%20other%20infectious%20diseases.)
  • Europe proposes “giving away” a year of patent to medicines researched in the EU, extendable to 12 more months if production is in the EU (https://www.eleconomista.es/salud/noticias/12693632/02/24/europa-proposes-giving-a-year-of-patent-to-medicines-being-investigated-in-the-eu.html#:~:text=The%20commission%20also%20proposes%20one,have%20to%20depend%20on%20exterior.)

National health policy

• 24 hour guards
  • The Ministry of Health wants to end 24-hour medical guards this term. The Ministry will study the legislative framework that the autonomous communities can apply. The aim is to organize it by hospitals and without losing salary, since the guards can represent up to a quarter of the professionals’ salary. The challenge is formidable, since it must be implemented by the autonomous communities, it involves a reorganization of hundreds of services, an increase in staff and addressing the complements of medical personnel (https://www.eldiario.es/sociedad/sanidad-quiere-finish-medical-guards-24-hours-we-will-give-you-answer-legislature_1_10957897.html)

• Financing fund for waiting lists
  • The Ministry of Health will create a financing fund for the CCAA that join its plan for waiting lists. The book aims to publish “books of good practices” on waiting list management, with an economic incentive for the communities that follow them (https://www.elespanol.com/invertia/observatorios/sanidad/20240301/sanidad-willcreate-fund-financing-ccaa-sumen-plan-waiting-lists/836416778_0.html)

• Economic and Social Council (CES) report on the health system
  • Report from the CES on the health system. Among the recommendations it supports public health and prevention; specify and update the SNS service portfolio; make Primary Care the true axis of the system; confront waiting lists; strengthen the comprehensive mental health model; enhance the quality of pharmaceutical provision; promote the planning and reinforcement of human resources of the SNS; reinforce patient participation; contribution of the private for-profit and non-profit sector; improvement of system management and evaluation (https://www.ces.es/documents/10180/5299170/INF_012024.pdf)

• State Public Health Agency
  • SESPAS Proposal on the State Public Health Agency. The report gives 11 recommendations: 1. Agency model; 2. Within the framework of the National Long-Term Strategy (Spain 2050); 3. Strengthen collective intelligence in public health in Spain; 4. Network structure; 5. Prestige, through good governance and independence; 6. Definition of functions; 7. Comply with article 4 General Public Health Law; 8. Participation in the healthcare data-lake; 9. Prepare the healthcare data lake; 10. Innovation; 11. Collaborative research (https://www.researchgate.net/publication/356717947_INFORME_SOBRE_LA_AGENCIA_ESTATAL_DE_SALUD_PUBLICA_PROPUESTAS_DE_LA_SOCIEDAD_ESPANOLA_DE_SALUD_PUBLICA_Y_ADMINISTRACION_SANITARIA_SESPAS_PARA_SU_DISENO_Y_OPERACIÓN_SESPAS_y _Public_Health_School)
  • The government agrees with PNV and Junts to save the Public Health Agency before being approved in Congress. Both PNV and Junts withdrew their amendments, after an agreement with the government (https://www.epe.es/es/politica/20240229/gobierno-pacta-pnv-junts-salvar-98820203)

• Rare diseases
  • Report on access to medicines for rare diseases. By the Spanish Association of Orphan and Ultra-orphan Drug Laboratories. It is estimated that there are between 6,000 and 8,000 rare diseases in the world, of which only 5% have some type of treatment. Spain has 78 financed medicines for rare diseases (45 in 2019). It is recommended for Spain to improve and streamline the approval processes for orphan drugs (https://aelmhu.es/wp-content/uploads/2024/01/resumen_ejecutivo_informe_de_acceso_aelmhu_2023_def.pdf)
  • La Paz will create a special unit for rare diseases (https://www.elespanol.com/madrid/comunidad/20240229/paz-esperanza-ninos-enfermedades-raras-unidad-especial-menores/836166799_0.html)
  • Sant Joan de Deu begins work on a building dedicated to minority diseases (https://www.plantadoce.com/empresa/sant-joan-de-deu-inicia-las-obras-de-un-centro-dedicado-a-minority-diseases)
  • Research on rare diseases, with great challenges (https://www.consalud.es/profesionales/dia-mundia-investigacion-enfermedades-raras_140831_102.html)

Companies

• International News
  • Medicharme, the French group for seniors and people with disabilities, bankrupt (https://www.lemonde.fr/societe/article/2024/02/26/le-groupe-d-ehpad-prives-medicharme-va-etre-place-en-liquidation-judiciaire_6218624_3224.html)
  • The breakup of Bayer seems inevitable (https://www.ft.com/content/d75f44c6-35be-49af-88ae-fc93b53d2443)
  • The Danish Zealand Pharma flies on the stock market due to the success of a drug to combat obesity (https://cincodias.elpais.com/mercados-financieros/2024-02-26/la-danesa-zealand-pharma-vuela-en-bag-for-the-success-of-a-medicine-to-fight-obesity.html)

• National
  • Viamed presents a comprehensive unit for women in its Tarragona hospital (https://www.plantadoce.com/empresa/viamed-presentan-una-nueva-unidad-de-salud-integral-de-la-mujer-para-your-hospital-in-tarragona)
  • Sanitas stands as the most valuable Spanish brand in the health sector (https://www.plantadoce.com/empresa/sanitas-se-erige-como-la-marca-espanola-mas-valiosa-del-sector-salud#:~:text=Farma%20Oryzon%20Genomics-,Sanitas%20se%20erise%20como%20la%20marca%20española%20más%20valiosa%20del,consultant%20Interbrand%2C%20Mejores%20Mar)
  • Roche and HM hospitals join forces in precision medicine (https://www.plantadoce.com/empresa/roche-y-hm-hospitales-se-alian-para-investigar-formarse-y-avanzar-en-medicina-de-precision)
  • Asisa increases its premium volume by 4.3% in 2023 and exceeds 1,487 million (https://www.elespanol.com/invertia/observatorios/sanidad/20240219/asisa-eleva-volumen-primas-supera-millones/833916696_0.html)
  • Rovi will double the production of its plant to manufacture more for third parties (https://www.eleconomista.es/salud/noticias/12690120/02/24/rovi-duplicara-la-produccion-de-su-planta-para-manufacture-more-at-thirds.html#:~:text=Rovi%20prepares%202024%20for%20adapt,%20production%20of%20the%20plant.)
  • More punishment for Grifols, which sinks 35% after publishing its unaudited accounts and reducing profits by 71% (https://cincodias.elpais.com/companias/2024-02-29/grifols-reduce-beneficios-un -71-and-admits-that-the-accounts-are-not-audited-in-full-threat-of-gotham.html)