A World Without Disease – AstraZeneca and the Health Works Initiative

Ahead of the inaugural World Without Disease Summit on Wednesday 21st June - conceived in partnership with Ben Wiegand, founding partner at CWWDA (the Connected World Without Disease Accelerator) – pharmaphorum spoke with the event’s two speakers from AstraZeneca, Stefan Woxström, SVP Europe and Canada, and Stefan Vlachos, Head of Health Works, an AstraZeneca initiative focused on collaboration between healthcare, patients, and industry to find relevant, viable, and sustainable solutions to complex healthcare challenges. Woxström and Vlachos will be giving the joint presentation, ‘Pharma’s role and experience in scaling a World Without Disease’.

Proactivity in prevention, reversal, and cure

AstraZeneca has set a bold ambition to transform patient outcomes, seeking new solutions to reduce the burden of care and ensure the sustainability of healthcare systems, and this is where Woxström’s role lies. It’s a much larger task than simply making sure medicines are being made available to patients: “If you look at what’s happening at the moment, in Europe today there is a growing chronic disease burden for healthcare systems, and we’re trying to address that,” he said.

Medicines still play a role in that process, of course, but there’s more to the story as the industry prepares for what’s to come.

"There's a need to be proactive and to try to stop, reverse, and cure patients with current medicines, but also to prepare healthcare systems to adopt the new innovations that will be coming in the near future,” Woxström explained, referring to cell and gene therapies. “What we're trying to do is to solve this issue right now, but also to future-proof the healthcare system, enhance resilience to manage ever increasing demands, as well as health crises, and make sure we're set up appropriately for these new treatments that are coming."

Resilience, sustainability, and an ageing population

For Woxström himself, this is not a new ambition, beginning his endeavours to improve and innovate healthcare over 25 years ago. In recent years, pressures have escalated, demanding accelerated and broader approaches to address the true nature of the challenges ahead. "Europe has an aging population who are living longer with more complex health needs. COVID was a wake-up call and showed us that healthcare systems across the world are very vulnerable," Woxström explained. "AstraZeneca recognised the urgent need to address health issues and strengthen health systems and alongside the World Economic Forum and London School of Economics launched PHSSR, which stands for Partnership for Health System Sustainability and Resilience." This global partnership is committed to collaborating across sectors and borders, bringing together stakeholders including governments, public and private providers, and healthcare payers. PHSSR has acted as the basis for policy recommendations and improvements in more than 30 countries worldwide, including 17 in Europe, and Woxström believes it's "much, much more important than a commercial win in market share".

The patient at centre

Meanwhile, Health Works has been running for about three and a half years, Stefan Vlachos explained, who himself joined the initiative two years ago. And their initiatives seek to improve future health outcomes and care entirely from "the viewpoint of the patient".

"We are looking at topics that are so complex that no single entity within the healthcare ecosystem will be able to successfully address them on their own," Vlachos said. "For example, there are topics relating to disease management, particularly predictive and preventive medicines, that require multiple parties to be involved - the healthcare provider, the payer, maybe MedTech or pharma suppliers - all focused on optimising preventive care, rather than responding reactively when diseases have progressed and it may be too late to treat them effectively." And this is where collaboration is key, in its need for “a mix of competencies in design thinking, in innovation, project management, and in business design,” Vlachos explained, “and not least in relationships and communication. All of those things are important in order to be the spark or oil in the machinery that helps all those entities collaborate.” And when this is functioning optimally, that's when the opportunities exist to scale up and drive greater impact globally.

Lifestyle changes, unmet needs, and the value of health

Tunnelling down into the specifics of Health Works’ key projects, Vlachos provided detail on the initiative’s two heart failure projects.

"Our longer-term programme is focused on patients newly diagnosed with heart failure," he said. "There's simply not enough support as it currently stands and too few healthcare professionals who can spend the one-to-one time and give the individualised care that's needed." Implementing patient self-management strategies can be as simple as certain lifestyle changes that can help to prevent disease or slow progression, but patients still have need - an unmet need - for ongoing guidance and support on how to go about enacting such changes. Yet, how is this relevant for a company like AstraZeneca?

Health Works’ other heart failure project concerns those who are much more progressed in the disease and are experiencing recurring “exacerbations”. Health Works designed a new technology that can identify disease exacerbations five to seven days in advance of an attack.

“We now know that you can predict exacerbations by measuring a number of vital disease signs, providing advance notice before an attack,” explained Vlachos. “What complicates things is in regard to who should be privy to this technology, receive the 'alert', and ultimately pay for the service. Driving patients to the ER unnecessarily is not what you want, primary caregivers are not equipped with enough knowledge to respond, and specialists are already overwhelmed with the patients they are already seeing in the hospital."

"Here's a bit of a catch-22,” Vlachos continued, “when the knowledge and skills of the specialists need to be disseminated through the capillaries of the healthcare system to the primary caregivers. We discovered that designing the technology is not actually the hard thing about changing disease outcomes: it's the business model of getting it into the hands of those who need it most that drives complexity."

At this point, our discussions turned to the World Without Disease Summit itself, exploring how pharma - with its experience and knowledge - could be used to scale up innovation, helping to improve patient-centricity, and support novel payment models.

Building on Vlachos' comments, Woxström expanded, "If we're talking about creating a world without disease then we really have to start thinking about disease prevention, identifying disease signals much earlier than we are doing today. This requires an investment in health, shifting financial flows to focus on prevention, and different types of health economic calculations to demonstrate value."

That’s not to say that health calculations should be done away with entirely, though.

“They are necessary, but we also need to actually find the rivers of money that we can tap into to move them,” Vlachos continued. “[It] then also makes financial sense to move something earlier, because then we will spend much less later. In order to do that, again, you have to understand what the individuals are facing here. That taps into the role of health innovation such as medicine becoming more focused on precision - your physiology, your genomics, your biology, but also into who you are as a person, and what types of interventions you are prepared to undergo."

So, it comes down to lifestyle changes and individual patient attitudes to their own care.

“That will not be the same for all people,” Vlachos accepted. “When I worked at the Karolinska University Hospital, we asked our colleagues how many people they thought would be willing to be active in their disease management, they predicted about 95%. The reality was actually only 50-60% - that's a big discrepancy."

Future-proofing healthcare systems

Addressing such a discrepancy is where future-proofing healthcare systems comes in, and where Vlachos deferred to Woxström:

“We have great therapies today, but there are also great therapies coming,” he explained. “We're on the doorstep for the new generation of new medicines, which is advanced therapies, cell and gene therapies. But if you look on the other side, we have a fast-ageing population.”

“Fifty million people in Europe live with multiple chronic diseases,” Woxström continued. “If you just zoom in on one disease, take Chronic Kidney Disease (CKD): we've got 100 million people in Europe living with that disease and that costs European healthcare systems around €140 billion..”

That’s according to a recent Economist report, and it’s an enormous number, both in cost and suffering. 

“We need to detect these patients early,” he continued. “We need to find new ways to identify patients, give them the right treatment at the right time, and keep them out of hospitals. We’ve been talking here about stopping, reversing, and ultimately curing. We can stop and reverse today, but for many of these diseases, with the next type of medicines, we actually will have the opportunity to cure. That's what we believe at this time.”

Collaboration for meaningful change – climate accountability

Nonetheless, it is not something that can be undertaken alone. As the saying goes, ‘No man is an island’ – and the same is true for pharma.

“We also need to make sure we can collaborate and have partnerships between private and public to help drive the changes necessary in healthcare,” Woxström said. “This is where the PHSSR project comes in. Following COVID-19, we're now facing a new crisis, rising rates of chronic disease as a consequence of climate change which are driving demands on our healthcare services and systems globally."

Indeed, the impact of the climate crisis on human health is seemingly already here. "The climate crisis is now considered the greatest health threat of the 21st century, driving hospitalisations and deaths from respiratory and cardiovascular conditions. Managing these types of chronic diseases also causes issues for the environment and actually adds to the climate crisis. For example, if you take dialysis, this intervention consumes 160 billion litres of water annually and produces 900,000 tonnes of plastic waste. That's an enormous amount, just mind-blowing numbers."

“If you look at the CO2 emissions in the world,” he continued, “the healthcare sector is responsible for 5% of global greenhouse gas emissions. Most of that is coming from hospitalisation. If we can detect patients earlier, maybe stopping them from developing the disease in the first place or from symptoms worsening, then we can avoid costly hospitalisation. You understand how much that will mean in terms of alleviating patient suffering, but it will also offer improvements for society and the environment as a whole. It's all very interlinked so we need to put the right sense of urgency behind chronic diseases."

As yet, however, very little is being done in this respect. 

"If you look at how much of the total healthcare budget is spent on preventive care, it's less than 3%. The WHO frequently talks about our focus on 'sick care' and the need to go from 'sick care' to 'health care'. It speaks for itself - we're on the back foot when it comes to chronic disease."

Ameliorating population health, together  

From bedside to global climate considerations, in summation, for AstraZeneca transforming patient outcomes means addressing population health.

"The industry has a responsibility to come together to find solutions that will address patient and healthcare system needs, and that should be our priority above and beyond sales," Woxström posited. "The shift that we're trying to do is to future-proof healthcare systems: that's of absolute importance. The burden of chronic diseases is sucking up all our resources in the healthcare system. Costs and patient suffering will continue to escalate unless we start focusing on preventive care, and this means we won't be able to embrace the new types of treatments that are coming forth."

"At AstraZeneca, we promote collaboration between different entities and functions," Vlachos continued. "We have a network of innovation entities and hubs that are driving science forward, and we have very good external collaborations with patient advocacy groups, NGOs, healthcare professionals, and professional organisations. These are all essential to realising the changes that my colleague Stefan has discussed. Innovation from the deepest molecular and technical level to innovation on health system design and delivery simply cannot come about without effective collaboration."