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The importance of collaboration to advance digital health

By luis.lacerda, on 27 March 2024

Earlier this month the Government announced a £3billion+ package to update fragmented and outdated IT systems across the NHS and transform the use of data to ease administrative burdens. That same week, the Policy Impact Unit (PIU) hosted a roundtable on digital health in the UK, bringing together colleagues from across UCL (see co-authors) as well as visiting researchers from the FioCruz Oswaldo Cruz Foundation in Brazil.

FioCruz is a federal public research foundation working with academic autonomy under the Ministry of Health of Brazil which was responsible for coordinating the COVID-19 vaccination campaign. The Brazilian delegation were keen to hear about UK experiences on health digitisation, challenges and opportunities, as well as developing a deeper understanding of the context and evaluation of several commitments agreed under the Brazil-UK High-Level Strategic Dialogues from 2020, some of which focussed on health cooperation and were funded by the Official Development Assistance (ODA) [1].

The main challenges discussed in the meeting, in relation to the digitalisation of the NHS, were systems’ interoperability, training and workforce capacity. Although there has been a push towards the adoption of federated data platforms (FDP), which will sit across NHS trusts and integrated care systems allowing them to connect data they already hold in a secure and safe environment, these are still disjointed and connecting them relies on platform providers talking to each other, which often does not happen.

Common challenges: interoperability, training and workforce capacity

The adoption of new digital health approaches is also reliant on having trained healthcare professionals to understand the power of data and new technologies. Particularly in primary care and GPs it is essential to have digitally literate colleagues that can engage communities, be clear and transparent about how health data is used and input it correctly to build FDPs that can be further used for research and to invest on the health of the nation[2]. Programmes like the NHS “Developing healthcare workers’ confidence in artificial intelligence” and inclusive digital healthcare are important, because there is a risk that ambitions to digitise the NHS, which are well intended, could exacerbate existing health inequalities and exclude some groups.

Incidentally, there is still a lack of progress to de-identify General Practice data and address low levels of confidence in new technologies among diverse communities – such as highlighted in the Health and Social Care Committee’s recent evaluation. Trust can be undermined as is the societal buy-in needed to deliver on ambitions for a more digital NHS.

Opportunities and way forward: innovation in regulatory mechanisms

On the flipside, there is an opportunity to bring people in early on to discussions on how AI tools are being used in medical devices, and how to properly manage the balance of risk and benefits such technologies may bring. The recent launch of the UK Regulatory Science and Innovation Networks was discussed, as well as the launch of a MHRA roadmap to create a framework for medical devices in the UK. Patients, researchers and industry representatives being included in this process, and being clear about how data can be used for the purposes of research, poses a great opportunity to bring real impact to clinical practice in terms of diagnosis, treatment, and monitoring of diseases.

Including other global partners in this conversation is essential given the importance of sharing learnings in different contexts, but also given the increasingly important role of international recognition in the medical domain as a factor to evidence impact. Specifically for global issues such as AI and post-market surveillance, where it is very difficult for regulators to know how new tools will perform before they are deployed, there is now a chance to have new standards emerge to shape digital health strategies across countries. We hope that visits like this inspire colleagues to work collaboratively and look forward to hearing from FioCruz how their visit is supporting Brazilian policy decisions on the development of digital health strategies.

Authors Note

Written by Dr. Luís Lacerda, Policy Impact Unit and co-authored by Professor Amitava Banerjee, UCL Institute of Health Informatics, Professor Derek Hill, UCL Dept of Medical Physics & Biomedical Engineering and Professor Patty Kostkova, UCL Institute for Risk & Disaster Reduction.

References

[1] For a list of projects funded under the scheme, please visit https://devtracker.fcdo.gov.uk/

[2] A particular good example was the COVID-19 registry where data such as vaccination rates, long-covid reports were put together in the same place and from different countries.

What can we do to decrease the cost of advanced cancer therapies and make them available for all?

By luis.lacerda, on 9 February 2024

There are 3 million people living with cancer in the UK, predicted to rise to 4 million by 2030[1]. Different societal groups are affected differently, in particular ethnic minorities who experience poorer outcomes[2]. Health inequalities are complex and their root causes diverse, including the fact that some cancers are more prevalent in specific communities[3]. Advanced research on targeted and personalised treatments can therefore bring hope to improve outcomes in the future and to “close the gap” in the access to cancer care. But how can these be made more affordable and included in holistic government strategies to manage cancer care?

Illustration of two people, two pill bottles and two DNA strandsAt UCL, the Future Targeted Healthcare Manufacturing Hub (FTHM Hub), which brings together academics, manufacturers, and policymakers, has been addressing manufacturing, business, and regulatory challenges to ensure that new targeted biological medicines can be developed quickly and manufactured at a cost affordable to society. This includes innovative research on the manufacture of promising cancer therapies ranging from Chimeric antigen receptor T-cell (CAR-T) therapies through to targeted drug therapies such as antibody-drug conjugates and cancer vaccines. The Hub engages with and supports several clinical groups at UCL that develop advanced therapy medicinal products (ATMPs), some of which have been commercialised or are being translated into the clinic.

The FTHM Hub’s work also includes more fundamental research into optimising manufacturing by innovating processes and finding new ways of reducing production costs of these therapies. Examples of this activity include manufacturing autologous CAR-T therapy at the patient’s bedside or in an automated “GMP-in-a box” system[4], which can bring about benefits in terms of cost reductions, accelerating bench-to-bedside innovation, and mitigate risks that are generated by market shortages[5].

The Hub has worked closely with healthcare specialists and regulatory authorities to analyse how CAR-Ts and other high-cost therapies affect NHS England’s ability to resource other health services. It has conducted detailed supply chain economics analysis to identify key cost of goods drivers for CAR-T therapies, supply chain optimisation, and to assess the risk-reward trade-offs between centralised and distributed manufacture.

The recent agreement reached between the Department of Health and Social Care (DHSC), NHS England and the Association of the British Pharmaceutical Industry (ABPI) on a voluntary scheme for branded medicines pricing, access and growth is a welcomed programme to explore how industry and government can better work to support the delivery of new advanced treatments for cancer, but this is not enough.

Furthermore, and for this important work to continue, investment and support on advanced manufacturing is required to understand possible implementation challenges of novel options such GMP-in-a-box in clinical settings. The new UK’s life sciences manufacturing funding to build resilience for future health emergencies is a good opportunity to do this to expand on the FTHM Hub’s work and ensure every patient living with cancer will have accessibility of treatment irrespective of geographical location.

In addition, time and cost of travel to specialised centres can pose an economic burden to patients and carers due to disparities in cancer care. New centres will also need dedicated staff to help deliver advanced therapies and the FTHM Hub is also training a new generation of professionals to enable rollout of those to patients.

In the week that marks World Cancer Day, the FTHM Hub continues to develop important work to treat patients with cancer and it is our hope at the Policy Impact Unit that we can work towards imagining new futures together, close the care gap, and bring better outcomes for all of those living with cancer.

 

References

[1] https://www.macmillan.org.uk/dfsmedia/1a6f23537f7f4519bb0cf14c45b2a629/11424-10061/Macmillan%20statistics%20fact%20sheet%20February%202023

[2] Martins, T., Abel, G., Ukoumunne, O.C. et al. Ethnic inequalities in routes to diagnosis of cancer: a population-based UK cohort study. Br J Cancer 127, 863–871 (2022). https://doi.org/10.1038/s41416-022-01847-x

[3] Delon, C., Brown, K.F., Payne, N.W.S. et al. Differences in cancer incidence by broad ethnic group in England, 2013–2017. Br J Cancer 126, 1765–1773 (2022). https://doi.org/10.1038/s41416-022-01718-5

[4] Pereira Chilima, T. & S. Farid. 2019. ‘A roadmap to successful commercialization of autologous CAR T-cell products with centralized and bedside manufacture.’ Cell Gene Therapies VI 73. Comisel, R. 2022. Decisional Tools for Supply Chain Economics of Cell and Gene Therapy Products. Diss. UCL (University College London).

[5] Bicudo, E. & I. Brass. 2023, ‘Advanced therapies, hospital exemptions & marketing authorizations: the UK’s emerging regulatory framework for point-of-care manufacture’ Cell and Gene Therapy Insights 9(1), 101-120.

Three shifts for improving the governance of emerging technologies

By Basil Mahfouz, on 11 June 2022

Without a coordinated global response, emerging technologies could quickly transform our world into a dystopia. By 2050, the lack of climate action may push mankind towards experimenting with planetary systems via geoengineering, lethal autonomous weapon systems could be deciding who lives and who doesn’t, while neuro-technologies will challenge the definition of what it means to be human.

To understand how to manage the societal impact of these technologies, on 16 May 2022, I joined 29 other specialists representing 21 countries at the Science Diplomacy Week Immersion Programme, a forum co-organised by the Geneva Science and Diplomacy Anticipator (GESDA) and the United Nations Institute for Training and Research.

The discussions highlighted that effectively governing frontier technologies requires three fundamental shifts across international science diplomacy: (1) adopting a proactive approach towards solving challenges, (2) leveraging cutting-edge computational tools, and (3) systemically scaling access to scientific knowledge.

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Moving on from Haldane: what are the challenges to steering STI for social and economic goals?

By joanna.chataway, on 10 February 2022

If anyone wants an overview of current S&T policy in the UK at the moment, you could do a lot worse than listening in to a recent discussion hosted by the Foundation of Science and Technology. Panellists were Sir Patrick Vallance, Chief Government Scientific Advisor and National Technology Adviser, Dame Ottoline Leyser, Chief Executive of UKRI, Naomi Weir, Programme Director, Innovation at the Confederation of British Industry and Professor James Wlisdon, Director of Research on Research, University of Sheffield. A fantastic lineup and a conversation that touched on many complexities of science, technology and innovation policy.  The importance of engineering policy was mentioned as part of the overall picture but much less was said about this, which is a pity[1].

Female lab researcher

Photo by Julia Koblitz on Unsplash

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Proposal for a ‘Net Zero What Works Centre’

By Siobhan Pipa, on 29 October 2021

From Professor Jeremy Watson CBE FREng

The legal requirement for the UK to achieve Net Zero greenhouse gas emissions by 2050 presents society with a wide-ranging and demanding set of challenges whose solutions require holistic and cohesive systems thinking across all sectors of activity. Social, technical, political and policy considerations must be taken together and solutions evolved that are driven by need, and which are applicable and acceptable for the whole of UK society. The November 2021 COP 26 meeting to be hosted by the UK, throws all this into sharp focus and suggests that government will wish to clearly demonstrate methods and pathways by which the 2050 objectives can be achieved. A Net Zero What Works Centre (NZWWC) may be an innovative and effective approach to accelerating and focusing coherent action.

Photo by Thomas Richter on Unsplash

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