Summary

From the point of view of Biomedicine, in the United Kingdom an initiative aims to be able to produce medicines for individual patients in less than a year. According to the National Bureau for Economic Research (NBER) of the United States, artificial intelligence, even with use cases already developed, will produce savings in healthcare expenses between 5-10%. This will offset the rise in other expenses in the sector, such as new medicines and medical technologies.

As far as Global Health is concerned, there is a relationship between the pattern of economic income and obesity, which occurs more in low-income workers, in relation to those with higher incomes. The fight against climate change has already produced some results. The COP28 conference, which will take place starting next week in Dubai, is expected to produce a declaration on climate and health. Polio is about to be eradicated in a few months, but the great challenge is that it does not return, since eradication is not the same as extinction.

Regarding International Health Policy, in its latest issue The Economist dedicates a supplement to forecasts for 2024. Among the 10 general forecasts, there is one that says that in an older world, health expenditures will grow to reach one tenth of global GDP. Among the specific health forecasts, it is noted that the pandemic has led to a growth in public spending on health (up to 80%, starting from 75%). Growth in private activity and an increase in the global pharmaceutical market is expected, with research efforts concentrating on medications against obesity and mRNA patents. In the United States, there is evidence of the inadequacy of private health insurance to provide financial security to the elderly for long-term care. Important agreement in the United Kingdom between the NHS and pharmaceutical companies, with which an annual growth in spending on medicines of 4% is agreed until 2027. Surely, an example for many countries, including Spain. Also in the United Kingdom, an agreement between the NHS and community pharmacies for the provision of a series of services, which will mean a large reduction in consultations in Primary Care. The health insurance boom in the United Kingdom, due to the problems of the NHS, is revealing certain limitations of private health insurance to meet demand. Something similar to what happens in Spain. Important document from the WHO (European region) and the Observatory on health systems, in which several governments participate, including the Spanish one, talking about the convenience of the participation of the private sector in the public health service, establishing the requirements for this to be successful. European countries warn of the health problems of climate change, since Europe is the continent in which temperatures have risen the most.

If we talk about National Health Policy (Spain), new change in the Ministry of Health. Going to minister for a year or less does not seem like the best formula to address the long-term challenges of healthcare, without prejudice to the qualities of the new minister, which will have to be observed. Record in the waiting list, after the publication of the lists as of June 30 by the Ministry of Health. Important study on obesity in Spain published by the Carlos III Health Institute and AESAN, which demonstrates the relationship between the level of obesity and the postal district. A study by the Institute of Fiscal Studies shows that between the beginning of 2020 and the end of 2022, the number of doctors in the SNS has decreased by 17,000, despite the fact that the number of staff has increased globally. The Valencian Community launches a specific competition for positions that are difficult to fill. Aside from the approach of the tender, it is good that the specificities of this type of places are taken into account. There is no doubt that the standardizing approach to personnel policy does not allow us to solve certain problems, such as what are now called difficult-to-fill positions. Farmaindustria carries out, in collaboration with scientific societies, a study on clinical research in Primary Care. We are a powerhouse in clinical research in hospitals and there is no doubt that the bases of this success must be extended to other environments.

In the field of Companies, on an international level, problems in Bayer with a sharp drop in the stock, which the CEO of this company attributes to a limited pipeline, a consequence of a lack of effort in investment. At the national level, Vithas confirms its new hospital project in Valencia. For its part, Sanitas announces an investment to grow in nursing homes.

Biomedicine

• The world’s first pathway for individually designed medicines. The Medicines and Health-care products Regulatory Agency (MHRA) is working with Genomics England, the University of Oxford and Mila’s Miracle Foundation, to develop a pathway to enable a single way to develop and approve medicines for individual patients in less than a year (https://www.economist.com/britain/2023/11/22/the-worlds-first-pathway-for-individually-designed-drugs#)
• AI can reduce the cost of healthcare. According to the National Bureau of Economic Research (NBER) of the USA, greater adoption of AI, with the uses currently on the market, can lead to between 5-10% savings, which means between 200,000 and 360,000 million dollars annually. (https://www.unite.ai/how-can-ai-help-reduce-the-costs-of-healthcare/). Access to the original publication: https://www.nber.org/books-and-chapters/economics-artificial-intelligence-health-care-challenges/potential-impact-artificial-intelligence-healthcare-spending

Global Health

• The income pattern on obesity is worse than previously thought. Obese workers (with a body mass index above 30) have been found to earn significantly less than their thinner colleagues (https://www.economist.com/finance-and-economics/2023/11/23/the-obesity-pay-gap-is-worse-than-previously-thought?utm_medium=cpc.adword.pd&utm_source=google&ppccampaignID=18151738051&ppcadID=&utm_campaign=a.22brand_pmax&utm_content=conversion.direct-respons)
• The Economist editorial: progress in the fight against climate change has not been fast enough, but it has been real. Although the 2015 Paris COP was considered a failure, the truth is that certain forecasts for 2100 have improved. Much of this progress comes from the use of renewable energy (https://www.economist.com/leaders/2023/11/23/progress-on-climate-change-has-not-been-fast-enough-but-it-has-been-real)
• Nature article: How we can ensure that polio does not return after eradication. Although the polio eradication campaign may be successful in a few months, the real challenge and work ahead is to ensure that it does not return, since eradication does not mean extinction (https://www.nature.com/articles/d41586-023-03602-5)
• Measuring the health impacts of environmental pollution. A study in Science makes some calculations about deaths from this cause (https://www.science.org/doi/10.1126/science.adl2935)
• Health at COP28, this meeting that will take place in Dubai between November 30 and December 12, 2023, will dedicate an entire day to health and a declaration on climate and health is expected (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02614-4/fulltext)
• Large-scale malaria vaccination in Africa will begin soon (https://www.lemonde.fr/afrique/article/2023/11/22/paludisme-la-vaccination-a-grande-echelle-en-afrique-va-bientot-commencer-affirm-gavi_6201738_3212.html)

International health policy

• The Economist health predictions for 2024
  • Predictions about the health industry. Among the 10 general trends, one of them is that a world with higher levels of aging will spend more on health. With one in 10 people aged 65 or over, health expenditures will reach one tenth of global GDP. Almost 80% of health expenditures will be incurred by governments or compulsory insurance systems, up from 75% before the pandemic. Egypt to extend universal coverage; India will increase health spending; USA will focus on cost savings. Private activity will experience rapid growth. The global pharmaceutical market will exceed $1.6 trillion, with many drugs going off patent and the entry of generics. The research will focus on mRNA patents and anti-obesity drug trials (https://www.economist.com/the-world-ahead/2023/11/13/ten-business-trends-for-2024-and-forecasts-for-15-industriesutm_medium=cpc.adword.pd&utm_source=google&ppccampaignID=18151738051&ppcadID=&utm_campaign=a.22brand_pmax&utm_content=conversion.direct-respo)
  • New medical treatments will use genetic scissors. CRISPR technology will be used in sickle cell anemia and beta-thalassemia and will advance in other fields (https://www.economist.com/the-world-ahead/2023/11/13/new-medical-treatments-will-use-genetic-scissors-and-other-clever-tricks)
  • A great year is expected for weight loss drugs. Novonordisk and Lilly will turn their drugs into blockbusters. In this case, demand exceeds supply (https://www.economist.com/the-world-ahead/2023/11/13/expect-a-bumper-year-for-weight-loss-drugs?utm_medium=cpc.adword.pd&utm_source=google&ppccampaignID=18151738051&ppcadID=&utm_campaign=a.22brand_pmax&utm_content=conversion.direct-response.anonymous&gad_)
  • The British NHS will remain a serious political problem in 2024. If the Labor party, as it seems, wins the next election, it will have to make difficult decisions about where to put the money (https://www.economist.com/the-world-ahead/2023/11/13/britains-nhs-will-continue-to-be-a-political-hot-potato-in-2024?utm_medium=cpc.adword.pd&utm_source=google&ppccampaignID=18151738051&ppcadID=&utm_campaign=a.22brand_pmax&utm_content=conversion.direct-re)
  • The next pandemic could hit global crop supplies (https://www.economist.com/the-world-ahead/2023/11/13/the-next-pandemic-could-hit-global-crop-supplies)

• USA
  • Long-term care insurance does not cover most. Private health insurance has proven woefully inadequate to provide financial security for millions of older Americans (https://www.nytimes.com/2023/11/22/health/long-term-care-insurance.html)

• China
  • WHO asks China about numerous cases of undiagnosed pneumonia, indicating increased concern since the pandemic (https://www.ft.com/content/c1ef57d8-1e80-47e2-ad49-a56170b3e1c9)

• United Kingdom and the National Health Service
  • The NHS reaches an agreement for the sale of medicines with large pharmaceutical groups. The so-called Voluntary Scheme for Pricing, Access and Growth (VPAG) means an agreement between the NHS and big global pharmaceutical companies to cap the annual growth of spending on medicines at 4% until 2027 (https://www.ft.com/content/287a07f8-b725-4383-9ada-2bc3556b4646). Summary of the key agreements: https://www.gov.uk/government/publications/2024-voluntary-scheme-for-branded-medicines-pricing-access-and-growth-summary-of-the-heads-of-agreement/2024-voluntary-scheme-for-branded-medicines-pricing-access-and-growth-summary-of-the-heads-of-agreement
  • The NHS remains concerned about productivity. The government had set 2% annual growth in productivity, which is measured by the Office for National Statistics (ONS) (https://www.bmj.com/content/383/bmj.p2731)
  • Check-ups and contraception services in pharmacies can save more than 10 million GP appointments, following a deal between the government and community pharmacists in England (https://www.bmj.com/content/383/bmj.p2722#:~:text=Pharmacy%20health%20checks%20and%20contraceptive%20service%20could%20save%2010%20million%20GP%20appointments,-BMJ%202023%3B%20383&text=More%20patients%20in%20England%20could,checks%2C%20and%20some%20minor%)
  • How the boom in private health insurance is exposing its problems. The growth in demand, due to the problems of the NHS, is exposing the limitations of insurance, ill-prepared to respond adequately. It is considered a great opportunity for the sector, but also a very dangerous moment (https://www.ft.com/content/6b6e0952-d340-45c2-a425-91a706994922)

• France
  • France cools the debate on assisted death and euthanasia. Although the announcements were that a bill would be prepared in December, President Macron himself is slowing down these forecasts (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02615-6/fulltext#:~:text=A%20citizens%27%20assembly%2C%20convened%20by,both%20euthanasia%20and%20assisted%20suicide.)
  • Home births: a drama relaunches the debate. The death of a 37-year-old woman who had decided to have a home birth activates the opposition of doctors, gynecologists and anesthetists to this practice (https://www.lemonde.fr/societe/article/2023/11/25/accouchement-a-domicile-un-drame-relance-le-debat-entre-soignants_6202330_3224.html)
  • Childhood lung diseases are experiencing a sharp increase in France. Difficult to evaluate the pathogen responsible (https://www.lemonde.fr/planete/article/2023/11/25/les-pneumopathies-infantiles-connaissent-une-forte-recrudescence-en-france_6202291_3244.html#:~:text=Santé-,Les%20pneumopathies%20infantiles%20connaissent%20une%20forte%20recrudescence%20en%20France,la%20p)

• WHO (European region) and European Observatory on healthcare systems
  • Important report on the involvement of the private sector in health. Most important messages: Private sector expertise can improve health service delivery, this requires good governance practices, making private sector collaboration with the public explicit, good alignment and transparency. The WHO creates an advisory group to promote the successful involvement of the private sector in health care delivery (https://eurohealthobservatory.who.int/publications/i/engaging-the-private-sector-in-delivering-health-care-and-goods-governance-lessons-from-the-covid-19-pandemic)

• European Union
  • European countries warn of the health problem of climate change. It is estimated that last summer there were 62,000 deaths in Europe due to heat, since this is the continent with the highest temperature rises. 18 member states ask the European Commission and ECDC for action (https://www.ft.com/content/52e71922-d9fc-49b6-98b5-3a4d37c21dbc)

National health policy

• New Minister of Health: Mónica García
  • The new minister puts listening and dialogue at the center of policies and announces an Interterritorial Council (https://diariofarma.com/2023/11/24/garcia-defiende-el-poder-de-cohesion-social-of-health-and-announces-a-swans-shortly)

• Waiting lists
  • Historical record of waiting lists. 820,000 people are waiting for surgery (https://www.eldiario.es/sociedad/record-historico-listas-espera-operacion-820-000-personas-10-ano_1_10701930.html#:~:text=El%20num%20de%20personas%20que,para%20somerse%20a%20una%20operación.) The government releases the information as of June 30, 2023: https://www.sanidad.gob.es/estadEstudios/estadisticas/inforRecopilaciones/docs/LISTAS_PUBLICACION_jun2023.pdf

• Obesity in Spain
  • X-ray of obesity in Spain. Study by the Carlos III Health Institute and AESAN (Spanish Agency for Food Safety and Nutrition). A low educational level and having relatives with obesity, risk factors (https://elpais.com/salud-y-bienestar/2023-11-23/radiografia-de-la-obesidad-en-espana-mas-de-half-of-adults-and-a-third-of-children-are-excess-weight.html). To access the original document: https://www.isciii.es/Noticias/Noticias/Documents/ENE-COVID%20INFANTIL%20FINAL.pdf

• Multi-resistant bacteria
  • Multi-resistant bacteria kill 20 times more than traffic accidents in Spain (https://elpais.com/salud-y-bienestar/2023-11-20/las-bacterias-multirresistentes-matan-20-veces-mas-that-the-traffic-accidents-in-spain.html#:~:text=“The%20figure%20is%20twenty%20times,carried out%20in%202018%20and%202019.&text=In%20total%2C%20se%20produce)

• The employment of health doctors falls significantly
  • Public health lost 17,000 doctors during the pandemic (https://www.elconfidencial.com/economia/2023-11-24/sanidad-publica-perdio-medicos-pandemia_3778723/). To access the original document from the Institute of Fiscal Studies: https://www.ief.es/docs/destacados/publicaciones/papeles_trabajo/2022_06.pdf

• Delays in payments to healthcare providers
  • Record in three years of delays in payments to health providers (https://www.consalud.es/autonomias/pago-proveedores-sanitarios-septiembre-2023_137197_102.html)

• Places that are difficult to cover
  • Competition for places that are difficult to fill in the Valencian Community (https://www.redaccionmedica.com/secciones/gestion/-haremos-un-rd-con-concurso-de-meritos-para-plazas-de-dificil-cobertura–8294)

• Research in Primary Care
  • An important report on clinical research in Primary Care appears. 8 key points are defined (https://www.farmaindustria.es/web/wp-content/uploads/sites/2/2023/11/Guia-Investigacion-Clinica-en-AP.pdf)

• Increase in salaries in private healthcare in Madrid
  • Private healthcare in Madrid will raise salaries by 10% over the next 4 years (https://www.redaccionmedica.com/autonomias/madrid/la-sanidad-privada-de-madrid-pacta-subir-un-10-salaries-in-4-years-9274)

• Increase in salaries in public healthcare in Catalonia
  • Salut increases the remuneration of Catalan healthcare workers (https://www.lavanguardia.com/vida/20231122/9399080/salut-aumenta-retribuciones-sanitarios-piensen-irse.html)

Companies

• International News
  • Bayer shares sink after news of the halt of its clinical trial on an anticoagulant medication (https://www.ft.com/content/86e6009a-a252-4a52-a4e4-930a50ef2d5a)
  • Bayer’s CEO blames the problems on the scarce pipeline, a consequence of years of underinvestment (https://www.ft.com/content/ffce99b0-7fd6-4b47-94f4-45d03cd68882)
  • AstraZeneca receives accusations that its covid vaccine was defective (https://www.ft.com/content/e605325b-00c0-4c94-aa45-551076d52785)
  • Merck MSD acquires Careway Therapeutics (https://www.plantadoce.com/empresa/merck-msd-se-va-de-compras-y-adquiere-caraway-therapeutics.html#:~:text=De%20agreement%20with%20%20terms,such as%20%20contingentpayments%20for%20milestones”.)

• National
  • Vithas confirms its new Valencia Turia hospital project for early 2025 (https://www.plantadoce.com/empresa/vithas-confirma-su-nuevo-proyecto-hospitalario-valencia-turia-para-principio-de-2025.html)
  • Sanitas will invest 50 million to open 5 new residences (https://www.expansion.com/empresas/seguros/2023/11/21/655c7949468aeb0b7d8b45fe.html)