In the recent years, there has been tremendous advancements in the healthcare industry. However, access to these innovations continues to be a challenge. It is noteworthy that disparities in access to healthcare are persistent and contribute to poor health outcomes for many populations around the world.
Recently, during a press conference by Johns Hopkins University, Financial Express.com got a chance to interact with Dr Judd Walson, Chair of the Department of International Health at the Johns Hopkins Bloomberg School of Public Health.
A 2020 study published in the Indian Journal of Community Medicine revealed that of the 195 countries for which data were available to compile the HAQ Index, India stands dismally at the 145th position, ahead of only Pakistan and Afghanistan among Asian countries.
“Even Bangladesh at the 133rd position and Sri Lanka, with all its political strife in recent decades, at the 71st position are way ahead,” the study found.
“India has made unbelievable and very remarkable progress in almost all areas of health. I mean, you know, just looking at reductions in maternal mortality, in child mortality over the last 50 years, it’s astounding. And so I think it’s important as we may be critical or we may suggest where we go from here to start from a place of acknowledging the incredible successes here. And the successes not only in the numbers, but at the scale, of achieving those numbers. There are very few places in the world that can talk about achieving impact at that enormous scale,” Dr Judd Walson told Financial Express.com.
Dr. Walson has conducted numerous trials investigating poor nutrition and infectious diseases to inform improvements in policy and programs globally. During the conversation, Dr. Walson highlighted that it is really important to understand that public health encompasses so much more than just the medical.
“There’s a lot of factors that go into that that are pre that child presenting to the health system. And then, after a child is discharged from hospital, what sorts of supports and structures are we putting in place to ensure the child is supported through their recovery, so that they don’t just go home and die from something else? And I think that is really a critical part of the next phase of thinking about public health in India and elsewhere. And so I think that’s, that’s really important. The other thing that we realized is, in that study, was that, we could identify quite well, actually, a group of children who were very high risk of death. There’s the same concept in maternal deaths,” he explained.
He also emphasised that creating a health system to serve the needs of a country as large, as diverse, as complex as India is no small feat.
“…when we think about the health system, and we think about the results we’re getting, we have to realize that the results we’re getting are directly a function of the system we’ve designed. And so if we want different outputs, we need to go back to the design of the system. So the ASHA worker program is a great example of a system that has had incredible impact…And now with emerging technologies and AI and machine learning and the use of huge data that we never had available to us before, we have the opportunity to really fundamentally reshape systems that will deliver better outcomes. And so that’s where I think there’s tremendous potential, is really rethinking health systems to be much more apt,” he told Financial Express.com.
He also revealed that Johns Hopkins is really excited to partner in India. “We one of the core pillars of our department is health systems. And I think we’ve been successful in UP and in other parts of India in partnering with Indian colleagues to try to help generate new knowledge around health systems, and and in partnership, I think we can come up with more innovative solutions. And that’s true just as we see the Indian community delivering far better outcomes in the US tech industry in partnership. I think we also can see better outcomes in India through these kinds of partnerships where we bring diversity of thought and lived experience together to problems,” he informed.
Dr. Walson also said that the pandemic, globally, was an incredible technical success. “So we saw the development of vaccines through the entire clinical trial platform and licensure. It’s never been done before. Like, it was amazing technical success, and we should all celebrate that. And we’ll talk in a moment about what other things we can do with that. But in many countries, I think India did a remarkable job. And again, at the scale of delivery, it was unbelievable,” he said.
He also shared that in many countries around the world, particularly in low and middle income countries, that technical success was coupled with tremendous diplomatic failure.
“So the US, you know, hoarded vaccines and didn’t distribute equitably around the world. There were huge problems in the international community supporting the distribution and access to all of this technical success. So I agree with you on the one front, huge success, but I also think there were a lot of failures that we should be learning from, and I’m not sure we have. And that’s, I think, concerning for the future. That being said, I think we’re now seeing an enormous, you know, outpouring of recognition of the need for development of technology manufacturing capacity in Africa, for example, around vaccine development. And that mRNA, for example, mRNA technology for vaccines is hugely exciting, and there’s a huge potential for new types of vaccines like mRNA-2s,” he highlighted.
While applauding India’s vaccination capacity and strength, Dr. Walson said that vaccine makers of India are not just manufacturing, they’re also innovating.
“I had, you know, I had the opportunity to go to Hyderabad recently and see some of this, and it’s remarkable. And so I do think we’re seeing that sort of, development. There’s also really exciting developments in the vaccine world for cancers,” he said.
He also emphasised that technical aspect must be coupled with health systems that can deliver the technology at scale to the people who need them, when they need them, where they need them.
“And they must be delivered with, you know, the diplomatic piece to be able to to ensure that they’re delivered in a timely way, and in an equitable way to make sure everyone has access. India’s remarkable also in the fact that it has an incredibly strong private health sector and a strong public sector,” he told Financial Express.com.
And there’s enormous opportunity in coupling those two things together, he pointed out.
“NCDs are, emerging as a major problem, particularly nutrition related NCDs. So cardiometabolic disease, you know, is a is a huge issue. And, and I think we are just at the beginning of understanding how to successfully intervene to prevent those diseases beyond simple behavioral messaging, diet, exercise, all the things that we need to do. I think we have to also continue to understand that delivering interventions, drugs, vaccines, other interventions, is not only about where the largest numbers of diseases are, but it’s also about equitably delivering. So you’re right in that noncommunicable diseases are expanding and becoming important and we should be focusing,” Dr. Walson told Financial Express.com.
However, he also warned that the burden of infectious diseases should not be forgotten.
“…It’s among the poor. It’s among the under resourced. It’s among the hardest to reach. And as long as those populations continue to suffer, we have to continue to address tuberculosis. Pneumonia, diarrhea, sepsis, you know, all of these things. So I think that there’s still an enormous need for that,” he said.
“And there’s some very interesting new, for example, enteric bacterial infection vaccines for shigella, for other pathogens emerging, which will be quite exciting to add to our arsenal. I think there will be many new, vaccines for lots of pathogens for which we currently don’t have. I think there will be many new vaccines for lots of pathogens for which we currently don’t have, solutions. And I think there will be increasingly new drugs available as we’ve seen to treat obesity, to modify diabetes risk, to do all of these things. So all of that’s super exciting.”
He also said that continued focus on improving the delivery of health interventions is crucial.
“…coverage is the key. We have to reach everyone to treat them. And even though the programs may achieve high coverage, 80 or 90%, that still means that 10 or 20% are not being treated. And so who are these 10-20%. We have to understand who are these populations…that’s where understanding the importance of high quality data to inform our programs is critical,” he said.
Other than some major bacterial and viral infections, he also revealed that AMR is becoming a major challenge in India and this is a huge priority. “Tuberculosis, you know, remains a major issue and a major cause of morbidity and mortality. And I think TB is something where there’s still an enormous room for innovation. Obviously, HIV is still an important issue, and we don’t yet have an effective vaccine for HIV. And that will remain, hugely important. So I think those are some of the areas that I would prioritize,” he said.