Healthcare Innovations, HTA and Policy: COVID-19 and Beyond Dr. Kanchan Mukherjee Professor Centre for Health Policy, Planning and Management, School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India 1
‘Reflections’ on COVID-19 What do we see? What do we know? What do we learn? What do we do? 2
What do we see? Uncertainty Decisions Crisis Systemic Voids Opportunity-Potential Efficiency Equity Sustainability Syndemic Innovations 3
Healthcare Innovations What do we know? Innovations are transdisciplinary and meant for value addition The goal of healthcare innovation is to improve efficiency, effectiveness, quality, sustainability, safety, and affordability of healthcare (WHO) Value for money AND Value for many across innovation lifecycle Emergence, Adoption and Diffusion Valued highly by policy makers, but remain a challenge Challenge of Uncertainty 4
Healthcare Innovation Ecosystem What do we know? Dynamic and Evolving Institutions POLICY Activities Actors HTA Artifacts PIE Context Context EIP Competition Collaboration Health Systems HCI 5
Healthcare Innovations (India) Driver of healthcare sector growth (private) Favoured by a strong policy push - Startup Policy (2016), STIP Happening broadly through two paths: 1. By existing established companies 2. Healthcare startups 6
Lifecycle Distribution of Healthcare Startups (India) 12% 21% Ideation Validation 33% Early traction Scaling 34% Mukherjee K. (2021). Healthcare startups and ecosystems: Insights from an emerging market economy. Cambridge Open Engage. Doi. 10.33774/coe-2021-08ql0 7
Healthcare Startup Categories and their Lifecycle Stages (%) (India) 70 53 35 18 0 Pharmaceutical Healthcare IT Biotechnology Medical devices Emergent (%) Diffused (%) Adopted (%) Mukherjee K. (2021). Healthcare startups and ecosystems: Insights from an emerging 8 market economy. Cambridge Open Engage. Doi. 10.33774/coe-2021-08ql0
COVID-19-related Healthcare Innovations Rapid diagnostics Assisted ventilation Cold chain sample transport Peripheral medical devices Personal protective equipments Air/Surface sterilizers and disinfectants Digital technology, etc. 9
HTA of COVID-19 Healthcare Innovation (FELUDA) FNCAS9 Editor-Limited Uniform Detection Assay (FELUDA) diagnostic test. CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats) technology Azhar M et. al. (2020) Rapid, field-deployable nucleobase detection and identification using FnCas9. MedRxiv 2020. https://doi.org/10.1101/2020.09.13.20193581 10
FELUDA Case Study Original Testing Policy: Only RT-PCR [From Feb 2020 to June 23, 2020] Revised Testing Policy: RAT + RT-PCR [June 23, 2020 onwards] RAT had moderate sensitivity, and risk of false negatives high Mukherjee K. ( 2021). Integrating technology, innovation and Policy: COVID-19 and HTA. https://doi.org/10.1016/j.hlpt.2021.01.003 11
Policy Implementation and Health Technology Adoption Policy decision is just the beginning of another cycle: Implementation cycle The nature and extent of implementation of a policy decision affects adoption and diffusion of a health technology as well as the evidence generated for the next cycle of analysis Role of ‘street level bureaucrats’ 12
Impact of Revised Testing Policy SARS-CoV-2 testing speed in equal blocks of time (90 days) Mukherjee K. (2021). SARS-CoV-2 testing in India: Please mind 13 the gaps. Int. Journal Prev. Medicine (Article in press)
Policy Decision: Wear the MASK (What do we know?) The Evidence: Supports the use of face mask in community settings Coclite D et al. (2021). Face Mask Use in the Community for Reducing the Spread of COVID-19: A Systematic Review. Front. Med. 7:594269. doi: 10.3389/fmed.2020.594269. 14
The MASK (What do we see?) Mask Hesitancy? 15
Policy Decision: Vaccinate What do we see? 16
Evidence from social experiments and qualitative studies (What do we learn?) What boosts adoption of social distancing? ‘Messenger matters’ 17
What boosts adoption of vaccine? Message matters Milkman K.L. et al. (2021). A mega-study of text-based nudges encouraging patients to get vaccinated at an upcoming doctor’s appointment. PNAS. https://doi.org/10.1073/pnas.210116511188
Qualitative Insights help in Decision Making and Implementation (HTA using mixed methods design) Quantitative Findings Qualitative Findings Barriers and Facilitators to adoption of HMIS Familiarity with TPBS, ability to review, rewrite/overwrite (Barriers) System transparency, ease of maintenance, hospital prestige (Facilitators) Mukherjee K and Babu A. (2014). Economic evaluation of hospital management Information systems in Tamil Nadu, India. IJMEDPH https://ijmedph.org/article/234 19
Decisions: What do we learn? Key drivers of pandemic containment Decisions guided by: The values of equity in health and its determinants Scientific evidence Partnership driven solidarity response Citizens’ trust in government institutions and political leaders Technical solutions to adaptive challenges is the primary cause of low implementation rates of good ideas and potential solutions. COVID-19 is not a technical challenge requiring existing technical solutions. It is an adaptive challenge requiring transformative changes with the opportunity to develop new capacities. Mukherjee K.(2021). Leadership, Crisis and COVID-19: Vuja de OR Déjà vu. SSRN 20 http://dx.doi.org/10.2139/ssrn.3934791
HTA: What do we do? It depends on (Determinants): The current status of HTA maturity The support of ‘policy champions’ Our will to learn and act 21
HTA Maturity Status Mukherjee K. (2020). A SMART framework for HTA capability development: Lessons 22 from India. Health Policy and Technology. https://doi.org/10.1016/j.hlpt.2019.12.001
HTA needs Powerful Allies: ‘Policy Champions’ Technology can be a potential seismic force for social cohesion or division, but this need not be left to chance, it is a choice. Policies should be much broader than merely identifying and contextualizing new technologies. They should be more democratic, inclusive and discuss the kind of society we want for the future. Hence, policies should provide scope for democratizing the future in the making. 23
HTA Lifecycle (Model A and B countries) INNOVATE EVOLVE Policy ADAPT (Model C and D countries) Champions INVOLVE 24
Thinking Aloud Could the future of HTA be this practice of innovative- adaptive work, creating new capacity involving people to meet the challenges they face? Can HTA be a transdisciplinary tool for co-creation of health technologies for sustainable societies? 25
Domo Arigato (Thank you very much) Email: [email protected] Webpage: https://www.tiss.edu/view/9/employee/kanchan-mukherjee/ 26
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