4.1
4.1 Key trends
Mental health and wellbeing has always been important, but the pandemic has given new impetus to action by companies, governments and individuals. More research is needed to evaluate the claims made around wellbeing and mental health by companies. In part obscured by our focus on the pandemic, important healthcare innovations are coming through that promise to save many lives.
- Health and wellbeing are on all our minds
- People want access to better mental health services and new wellbeing products are taking off
- There is rapid innovation in mRNA technology, liquid biopsy and artificial intelligence
- These promise to save many lives in future and expand affordable access
The pandemic has been a public-health disaster. According to the best estimates the pandemic has led to 10m extra deaths so far. Many more will follow.
These costs were not shared equally. Take the example of California, on which there is high-quality research. The average working-age Californian saw their risk of death rise by 22% during the pandemic. Line cooks saw their risk of death rise by 60%, while bakers saw their risk rise by 50%.
Among California residents 18–65 years of age, by occupational sector and race/ethnicity, March to October 2020.
Many countries have longstanding health inequalities, whereby people of different races/ethnicities, and different income groups, have different life expectancies.
A growing share of Americans, even before the pandemic, reported that they were putting off medical treatment for economic reasons. In part because of demographic reasons, health-care spending globally continues to rise.
Percentage of people who have put off treatment for serious condition
Increases in rich-world life expectancy have slowed or even reversed in recent years.
Following the pandemic, telehealth is at a tipping point. It will see permanent changes, with higher usage and adoption. This will in turn help improve access to healthcare for underserved populations.
Live virus-neutralising antibody activity is strong for both main UK vaccines in relation to different variants, though single doses appear less effective against the Delta variant.
As the virus rages in poor countries, ensuring vulnerable groups in poorer countries get access to vaccines is a global priority.
In addition to the devastating human cost from COVID-19, failure to mount a major international vaccine response could cast a long shadow over climate negotiations later this year.
4.2
4.2 Wellbeing and mental health in the wake of COVID-19
Mental health was an underappreciated but crucial issue long before the pandemic. COVID-19, however, had led to a tipping point in societal recognition of its importance. The mental health effects of the pandemic are likely to last for some time, with unpredictable consequences.
Many millions of children have missed out on vast amounts of education in the past year. Access to online learning was stratified by income group. The burdens of child care, and subsequent mental-health challenges, fell disproportionately on women/mothers, which may have reversed some of their economic gains.
Not all countries saw a decline in suicides in 2020, but many did. The data below covers Queensland, Australia, which has especially reliable data.
Experts are however concerned that this may be a temporary effect and many risk factors remain. In some countries, such as Japan, there has been a rise in suicides in later phases of the pandemic.
Many countries have strategies that point to the need to invest a greater share of healthcare spending on mental health, as opposed to physical health.
The evidence suggests that spending across many types of mental health interventions is a cost-effective way to improve patient outcomes. Preventative interventions, including school-based learning programmes, appear to be particularly beneficial.
Mental health accounts for 28% of morbidity but only gets 13% of expenditure
Few countries spend very much on provision of mental-health services. The median spend on mental health is about 2% of total healthcare spending. Even in wealthier countries, the share is typically below 10%.
There is minimal provision of mental-health services in most poor countries.
In the United States, about 15% of people consider mental health to be the top health issue facing the country, a figure which has doubled in the past five years.
Deal volumes have continued to increase in the mental-health space and total funding has risen sharply.
It is important to verify the effectiveness of these solutions as they continue to scale.
Corporates were offering new wellness programmes in the lead-up to the pandemic. Digital and mental-health offerings are the next frontier for 2021 and beyond. The question is whether these programmes are making a meaningful difference to employees' wellbeing, or whether they are merely PR.
4.3
4.3 New breakthroughs with huge potential to save lives
There are nearly 300 COVID-19 vaccines in pre-clinical or clinical development. The scale-up of manufacturing capacity and roll-out of vaccinations has not been as fast as we would have liked, but was nonetheless an impressive achievement.
COVID-19 is of course the focus at the moment, but the technology is being applied to many other health challenges too.
The total number of mRNA trials is near an all-time high
This index tracking global medical innovations has risen strongly in recent months.
In 2020 wild polio was eradicated in Africa, though pockets of concern do still remain.
Researchers from the University of Oxford reported findings from a Phase IIb trial of a candidate malaria vaccine, R21/Matrix-M, which demonstrated high-level efficacy of 77% over 12-months of follow-up.
Breakthroughs were made elsewhere. Unfolded or misfolded proteins contribute to the pathology of many diseases. But accuracy of protein-folding massively improved last year.
The main metric used by CASP to measure the accuracy of predictions is the Global Distance Test (GDT) which ranges from 0-100. In simple terms, GDT can be approximately thought of as the percentage of amino acid residues (beads in the protein chain) within a threshold distance from the correct position.
Liquid biopsy refers to the sampling and molecular analysis of the biofluids of circulating tumor cells, extracellular vesicles, nucleic acids, and so forth. The ability to detect and characterise tumours in a minimally invasive and repeatable way could have huge clinical implications, in particular in terms of early cancer diagnosis.
Personalised medicines continue to grow rapidly, allowing treatments to be more targeted to individuals.
There have been calls from international organisations and some governments to address trade-related obstacles to vaccine production and access, to save lives and accelerate the economic recovery.
Director-General Okonjo-Iweala has called on WTO members, other international organisations and vaccine manufacturers to address trade-related barriers in the scale up of vaccine production and distribution.
Image: WTO
This is a global health crisis, and the extraordinary circumstances of the COVID-19 pandemic call for extraordinary measures
US Trade Representative, Katherine Tai