Summary

From the point of view of Biomedicine, the transplant to a man of a genetically modified pig kidney stands out, a medical milestone that could lead to dialysis being declared obsolete, which would be an extraordinary advance and an improvement in the quality of life for hundreds of thousands of patients, currently dependent on the machine several times a week for their survival. Also notable is the beginning of a clinical trial on a vaccine for tuberculosis. The current BCG vaccine offers protection to infants and young children, but does not protect adults and adolescents from pulmonary tuberculosis. If the results are good, this vaccine can be transformative.

As far as Global Health is concerned, a study warns of serious declines in birth rates globally, which will mean that by 2050 it will fall below population replacement, which will have important social and labor changes.

Regarding International Health Policy, a great paradox in the USA, although abortion is prohibited in 14 states and restricted in many others, in 2023 there were more abortions than ever, many of them non-instrumental and through the abortion pill, already responsible of 60% of abortions. China is facing a population decline, a phenomenon that has already begun. The one-child policy, in force for 36 years, is only one of the causes of this phenomenon. The European Union is advancing in the approval of pharmaceutical legislation, contemplated with reluctance by both the EFPIA and Medicines for Europe (the two large European pharmaceutical associations). The Lancet sees the upcoming European elections as an opportunity to put health policy higher on the EU agenda.

If we talk about National Health Policy (Spain), three important initiatives of the Ministry of Health: anti-smoking plan, modification of the medical guard regime and waiting lists. In all three cases there may be problems due to the powers and regulations of the autonomous communities. From the point of view of the regions, the OPE of Asturias stands out, which brings together 19,000 candidates. Although logically, temporality was and is a serious problem of public healthcare, which needed a solution, the way to do it through macro-OPE’s (consolidating the position in property, and with hegemony of the administrative and union logic, above the professional and autonomy of organizations) does not seem to be the best. This type of mass examination is more reminiscent of previous calls for the “military service”, when it was in force, than the professional selection for complex organizations, in which the professional qualification, the needs of the different organizations, the projects of the services, etc. should be taken into account.

As for Companies, on an international level, China is seen as the large market for anti-obesity drugs. Bayer wants to renew its portfolio, entering into cell and genetic therapies. As for Spain, the CNMV has released its report on Grifols, with several objections to its accounts. Faes Farma is preparing to grow in Latin America. For its part, DKV, the health insurer, wants to concentrate on group insurance.

Biomedicine

• The transplant of a pig kidney to a patient, a medical milestone. Genetically modified pig organs may one day make dialysis obsolete. Surgeons in Boston (Massachusetts General Hospital) have transplanted a pig kidney into a 62-year-old man. Three genes involved in the possible rejection of the organ had been removed from the kidney; and inserted seven genes to facilitate human compatibility. Xenotransplants are not without their detractors, some concerned about animal exploitation; and others, due to the introduction of new pathogens into human populations (https://www.nytimes.com/2024/03/21/health/pig-kidney-organ-transplant.html)
• A clinical trial on a vaccine for tuberculosis begins. The Bill & Melinda Gates Medical Research Institute announced that it was beginning phase 3 of its vaccine for tuberculosis. The BCG vaccine offers protection to infants and young children, but does not protect adults and adolescents from pulmonary tuberculosis. If the results are good, this vaccine can be transformative (https://www.thelancet.com/journals/lancet/article/PIIS0140-a6736(24)00579-8/abstract#:~:text=On%20March%2019%2C%202024%2C%20the,have%20high%20burdens%20of%20tuberculosis.)
• mRNA therapies beyond covid vaccines. The nature of these mRNA proteins, which do not need to enter the nucleus, makes them desirable for the treatment of a varied group of pathologies, from infectious diseases, to cancer and monogenic disorders. However, there are still challenges related to mRNA stability, duration of expression, efficiency and targeting, to increase the application of mRNA therapy, beyond covid vaccines (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02444-3/abstract)
• A rare genetic disease is treated with the most expensive drug: $4.25 million. This is metachromatic leukodystrophy (MLD), which affects about 40 American newborns a year (https://www.ft.com/content/6678c805-6a70-488c-a48e-97813c8778b5)
• An artificial human chromosome opens the door to creating cells immune to cancer. Researchers from the University of Pennsylvania have created an artificial human chromosome that is capable of fitting into human cells, adding to existing ones and passing from generation to generation (https://elpais.com/ciencia/2024-03-21/un-artificial-human-chromosome-opens-the-door-to-create-immune-cells-to-cancer.html#). Access to the original article: https://www.science.org/doi/10.1126/science.adj3566?adobe_mc=MCMID%3D25843968410940617573051215090892787148%7CMCORGID%3D242B6472541199F70A4C98A6%2540AdobeOrg%7CTS%3D1711024189
• They discover a possible origin of ALS. This devastating disease is a mystery to science. CNIO researchers formulate a first hypothesis: the accumulation of “junk proteins” in motor neurons. (https://www.alimente.elconfidencial.com/bienestar/2024-03-22/posible-origen-del-ela-y-causas-de-envejecimiento_3852877/). Access to the original article, published in the journal Molecular Cell: https://www.sciencedirect.com/science/article/abs/pii/S1097276524001734?via%3Dihub

Global Health

• A study warns of the dramatic declines in birth rates globally. The world will face a baby boom in a few countries (especially African) and a baby bust in others, the majority. In 2050 it will fall below population replacement (https://www.elmundo.es/ciencia-y-salud/salud/2024/03/21/65fb274efdddff19858b45b7.html#). Access to the original document: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00550-6/fulltext
• Healthcare in crisis in Haiti. The collapse of the government and the control of the country by violent gangs exacerbates the health crisis (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00577-4/abstract?rss=yes)
• First trial in Africa of a poliovirus vaccine. Although polio eradication owes much to the oral vaccine using attenuated Sabin viruses, it is not effective in the final phases of eradication. A new type of vaccine is being tested in Africa, with encouraging results (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00053-9/abstract)
• A new layer of streptococcus A behind the rebound in cases worldwide. This is M1UK, detected in the United Kingdom, but which is already circulating globally today (https://www.elmundo.es/ciencia-y-salud/salud/2024/03/22/65fc6bb0e4d4d83e0e8b45d9.html)

International health policy

• USA
  • Although there are fewer and fewer states in which abortion is legal, the overall number of abortions is growing in the United States. Although the procedure is prohibited in 14 states and with restrictions in some more, according to a study, one million abortions were performed in 2023, 10% more than in 2020 and the highest number in a decade. Many of these procedures were with pills (https://www.economist.com/united-states/2024/03/19/fewer-states-allow-abortions-yet-american-women-are-having-more#)
  • The Economist takes a position in an editorial against the US Supreme Court prohibiting or creating difficulties for abortion medications, which already account for 60% of abortions in the US (https://www.economist.com/leaders/2024/03/20/americas-supreme-court-should-reject-the-challenge-to-abortion-drugs)

• China
  • The low fertility trap in China. The population in China fell in 2023 for the second year in a row. The one-child policy, in force from 1980 to 2016, is only one of the causes (https://www.economist.com/china/2024/03/21/chinas-low-fertility-trap#)

• United Kingdom and the National Health Service
  • The Lancet talks about the urgent need to transform dental care in the NHS (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00352-0/abstract)

• France
  • Parliament reaches an agreement on the ban on disposable electronic cigarettes (puffs) (https://www.lemonde.fr/politique/article/2024/03/21/le-parlement-trouve-un-accord-sur-l-interdiction-des-cigarettes-electroniques-jetables-puffs_6223269_823448.html)
  • The French government transfers the project on the end of life to the Council of State (https://www.lemonde.fr/societe/article/2024/03/18/fin-de-vie-le-gouvernement-a-transmis-son-projet-de-loi-au-conseil-d-etat_6222769_3224.html)

• Japan
  • The rapid spread of a serious bacterial infection worries Japan. The country is facing severe forms of invasive streptococcus A infection, which are fatal in one in three cases (https://www.lemonde.fr/planete/article/2024/03/20/la-propagation-rapide-d-une-infection-bacterienne-grave-inquiete-le-japon_6223130_3244.html#:~:text=Le%20Japon%20s’inquiète%20de,avait%20dénamré%20941%20en%202023.)

• European Union
  • European pharmaceutical legislation, one step further with the agreement of ENVI (Committee on the Environment, Public Health and Food Safety of the European Parliament). EFPIA (innovative pharmaceutical industry association) and Medicines for Europe (generics and biosimilars association) recognize progress, although both entities describe the text as “imperfect” and demand new meetings (https://www.diariomedico.com/farmacia/profession/legislation-pharmaceutical-european-step-mas-ok-envi.html)
  • The European elections and healthcare. The Lancet sees these elections as an opportunity to place health with a higher priority in community policies, reinforcing the role of Health Agencies: the new Authority for Emergency Preparedness and Response; the ECDC (European Center for Disease Control), and the European Medicines Agency (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00576-2/fulltext?rss=yes )

National health policy

• Initiatives of the Ministry of Health
  • The minister will take the Anti-Tobacco Plan to the Interterritorial on April 5. Feedback from the autonomous communities is expected until March 27 (https://www.consalud.es/politica/monica-garcia-llevara-interterritorial-5-abril-nuevo-plan-antitabaco_141809_102.html)
  • The ministry proposes to reduce medical shifts from 24 hours to 17. Apparently, the minister is aware that this is a complex measure that will require a restructuring of the SNS, for which it is necessary to modify the Framework Statute, which it intends to do before the end of 2024. In no case are reductions in the salaries of professionals proposed (https://www.eldiario.es/sociedad/sanidad-propone-reducer-guardias-medicas-24-horas-17_1_11229274.html)
  • Waiting lists: the new regulations will be based on two laws. The problem is not to collide with the regulations and regional powers (https://www.redaccionmedica.com/secciones/ministerio-sanidad/sanidad-ultima-un-nuevo-marco-legal-de-listas-de-espera-basado-en-2-laws-3712)

• Initiatives of the autonomous communities
  • The largest opposition in Asturian healthcare begins, with 19,000 applicants. With this, SESPA plans to give a permanent position before the end of the year to 5,534 interim workers of all categories (https://www.eldiario.es/sociedad/arranca-opuesta-sanidad-publica-asturiana-congrega-19-000-aspirantes_1_11238433.html)

• Private healthcare
  • College of Physicians of Madrid: doctors group together to defend their interests against insurers (https://www.epe.es/es/sanidad/20240319/medicos-privados-agrupan-defender-intereses-aseguradoras-conflicto-99640431)
  • Spaniards with a private health policy increase by 40% in a decade (https://www.elindependiente.com/economia/2024/03/17/espanoles-poliza-privada-de-salud-aumenta-40-en-a-decade/#:~:text=In%20general%20terms%2C%20in%20the,starting%20from%20the%20pandemic.)

• Measles
  • Measles is back in Spain (https://elpais.com/sociedad/2024-03-21/el-sarampion-esta-de-vuelta-en-espana-estos-son-los-riesgos-y-la -way-to-prevent them.html)

Companies

• International News
  • China will be the big market for weight loss drugs. Novo Nordisk’s Wegovy is expected to be approved for sale in China this year. But there are local pharmaceutical companies prepared to compete in this field (https://www.ft.com/content/7eaea2be-11fa-48b1-b6cb-873f9e40fbc2)
  • AstraZeneca acquires biotech radiation therapy oncology company Fusion Pharmaceuticals for $2.4 billion (https://www.ft.com/content/cf6b8ab8-03ef-43fa-9523-9c7d026830c5)
  • Roche sells its biologicals plant to Lonza for 1.2 billion dollars (https://www.plantadoce.com/empresa/roche-vende-su-planta-de-biologicos-a-lonza-en-eeuu-por-1200-millions-of-dollars#:~:text=biological%20in%20USA-,USA,during%20a%20period%20of%20transition.)
  • Bayer takes a big leap: presents its new cellular and genetic therapies (https://www.redaccionmedica.com/secciones/industria/bayer-da-el-gran-salto-para-crear-nuevas-terapias-cellulares-y-geneticas-6356#:~:text=Following%20with%20the%20line%20of,from%202020%20to%20the%20date.)

• National
  • Grifols: the four critical points that the CNMV has detected in Grifols accounts (https://www.elconfidencial.com/empresas/2024-03-22/cuatro-puntos-criticos-cnmv-grifols_3853251/)
  • IMQ and Grupo Scanner join forces to open a radiology center in Bilbao (https://www.plantadoce.com/empresa/imq-y-grupo-scanner-se-alian-para-abrir-un-nuevo-centro-diagnosis-of-radiology-in-bilbao#:~:text=Faes%20Farma-,IMQ%20and%20Grupo%20Scanner%20partner%20to%20open%20un,diagnosis%20of%20radiology%20in%20Bilbao&tex)
  • Faes Farma expands its factories to eight and plans to grow by double digits in Latin America (https://www.plantadoce.com/empresa/faes-farma-amplia-a-ocho-sus-fabricas-y-preve-crecer-a-double-digit-in-latinoamerica#:~:text=La%20pharmacéutica%20española%20explain%20en,su%20I%2BD%2Bi.)
  • Werfen sells its medical material distribution business to Palex (https://cincodias.elpais.com/companias/2024-03-20/werfen-vende-a-palex-su-negocio-de-distribucion-de-material-medico.html)
  • DKV will focus on collective health insurance (https://www.eleconomista.es/salud/noticias/12727131/03/24/dkv-se-focalizara-en-los-seguros-de-salud-colectivos-en -the-next-years.html)