B20 POLICY PAPER HEALTH & LIFE SCIENCES

B20 ITALY

Health & Life Sciences

Policy Paper 2021

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TABLE
OF CONTENTS
Foreword by the Taskforce Chair

5Remarks from the Taskforce Co-Chairs

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Executive Summary

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Introduction

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Recommendation 1

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Recommendation 2

24

Recommendation 3

33

Annex I

40

Annex II

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Foreword by the Taskforce Chair
Health as a prerequisite for growth
The Covid-19 pandemic is an unprecedented health and social challenge but it
has also brought opportunities to improve the world we live in. This means that
we must prioritise health and place it at the very center of social and economicplanning for the future.
The life sciences community, academia and industry, reacted quickly to the crisis by producing vaccines, treatments, and diagnostic tools in a timeframe thatwould have been previously unthinkable.
The B20 Task Force on Health and Life Sciences has created a valuable spacefor discussion between the stakeholders and governments of G20 countries andI have had the privilege of working with four exceptional Co-Chairs; Werner
Baumann, CEO of Bayer; Sir Mark Caufield, Chief Executive Officer of Barts
Life Sciences; Geoff Martha, Chairman and CEO of Medtronic; and Leon Wang,
Executive VP International and China President of AstraZeneca. This policy paper is the result of overseeing six months work, with over 90 delegates from 20
different countries, and the results will hopefully go beyond the recommendations.
Our ambition is to initiate a change of mindset in how we all look at scientificresearch and healthcare. This goes far beyond the pandemic, which has shown
us how the results of ‘no action’ multiplies costs, when issues are not addressed
immediately. We have tried to clearly summarise and bring balance into our findings and make the paper accessible to anyone interested in the future of health.
We must see Covid, not simply as a problem to be solved, but as a game-changer. In less than a year, the fight against the virus has made it possible to makewidespread use of the mRNA technology that is currently used to produce effective vaccines. In the future, this can be used to combat the great killers of
our time, such as cardiovascular diseases, tumors, and autoimmune diseases.
This also applies to many other innovations that have experienced accelerated
development during the crisis.
The pandemic has also highlighted the need to develop and expand access anduse of health data to benefit patients. The technological and regulatory means
to monitor, share and analyze big health data in real-time is an infrastructurethat we must continue to develop - not only for diagnosis, but also to provide
effective, targeted and sustainable therapies, in line with the recommendationsin this document.
Today health must be seen as the primary smart investment for all countries,
whether with developed economies, economies in transition, or major developed economies. This is acknowledged by WHO, recognizing that health has asubstantial impact on economic, social, and global aspects of our society. The
ability to ensure optimal levels of health makes it possible to increase the wellbeing and therefore the productivity of a country and to create a real social elevator for communities, as well as for individuals. Investing in health generates
opportunities for growth, employment, sustainable development and equality.
A worldwide aging population where, for the first time in history, most people can expect to live to 60 and beyond, brings challenges that include increased incidences of chronic diseases and multi-chronic conditions. The adventof new pathogens, the emergence of new pandemics, and equality of access to5

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treatment, represent a global challenge for all countries. Governments need toreorganize current healthcare models and look at healthcare spending as anopportunity for growth and innovation. The global pandemic has shown howhealth policies impact immediately and profoundly on parallel and transversal
economic areas. We must learn from this and remember that health policies
made today and following interventions, will affect our medium and long-term
future. If health is an investment, global health policies must be developed logically, moving from tracking costs, to measuring value by innovative healthcare
solutions and procedures.
In this scenario, it is essential to incorporate the ability to respond effectively
to current, emerging, and future health needs, but above all, to respond to new
pandemic events in international macroeconomic assessments, and in individual countries. Responsiveness to emerging health needs must also be improved through the development of new therapeutic and interventional solutions,by activating new production and local chains. It is also essential to encourage
the development of a system of rules that motivates research and development
and, at the same time, provides access to innovative solutions for the patient.
Without forgetting the role of training and education policies, this will help produce an increasingly resilient workforce and also encourage cross-fertilizationand innovation between different training programs, in science, social sciences
and the humanities, bringing cultural and multidimensional change, that not
only involves medicine, but also the economic and social sciences.
This approach must guide G20 Government Strategy in Health & Life Sciences,directing investments in strategic areas, ranging from basic to applied research,through to the development and manufacturing of innovative solutions capableof generating value for global health. Health expenditure must be linked to an
investment strategy that fosters cooperation between public and private investment, as well as the health and the Life Sciences supply chain, enhancing theimpact of health policies and aimed at the industrial supply chain, in the socialand economic spheres.
Without a long-term vision and strong collaboration between healthcare systems and industry, it will become increasingly complex to respond effectively,
not only to extraordinary events, but also to the great challenges of our time. If
neglected, we risk not only severe recession, but also the loss of our health, socialand economic stability and opportunities for growth.
Sincerely,
Sergio Dompé
Chair of the B20-Taskforce on Health & Life Sciences
President of Dompé Farmaceutici S.p.A

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Remarks from the Taskforce Co-Chairs
Why Health & Life Sciences Matter

Werner Baumann
Chairman of Bayer AG

Sir Mark Caulfield
Chief Executive ofBarts Life Sciences

Geoff Martha

Chairman and Chief
Executive Officer
of Medtronic

Leon Wang

Executive Vice-President,Internationalof AstraZeneca“Reaching from a pandemic to climatechange or food insecurity, the progress in biotechnology has the potential
to tackle the global challenges of ourtime. We now need to ensure that thebenefits of science reach everybody– not just the developed world. The
B20 report offers a policy roadmap
to advance the bio-revolution over the
coming decade”.

“The major advances made globally tomeet the challenges of the pandemic show the dramatic pace of life sciences innovation that is possible fromstrong public - commercial - patient
partnerships. These recommendations
highlight the potential for new opportunities from data sharing and life science innovation to accelerate healthbenefits for patients. I hope the G20
will adopt these principles and foster a
global culture of life sciences withoutborders that recognize that every life
is precious”.
“We’re committed to creating moreaccountable, more equitable, andsustainable approaches for patients
everywhere. Unleashing the power oftechnology via policies that accelerate innovation and enable access andsharing of healthcare data will havea profound impact on outcomes andoverall costs of care. We look forward
to working with the G20 to improvehealthcare for all”.
“This report sets a clear pathway forG20 policymakers to build more resilient and sustainable healthcare
systems. Key to this is cementing thepartnership working between government and industry we have seen accelerated by the pandemic and which
we have long been a champion for at
AstraZeneca”.

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Executive Summary
Recommendation 1: Promote the strategic use of science, technology anddata
G20 Members should promote pro-innovation health ecosystems reflecting
the rapid pace of scientific discoveries and advances in biological sciences toboost public trust in science and new technologies through the developmentof appropriate regulatory frameworks that will unleash the full potential ofscience, technology and data.
Policy Action 1.1: Develop and monitor national plans to support the uptake of technologies
G20 Members should design policy frameworks that accelerate ecosystems
for digital health, Biopharma and MedTech, adopting an investment mindset
towards health, strengthening the use of technology, considering the overall
impact of health policies and monitoring these plans through a set of specific
Key Performance Indicators (KPI).
Policy Action 1.2: Develop coherent regulatory frameworks and establish
dialogues for areas of emerging technology to strengthen scientific research and the innovation environment
G20 Members should commit to accelerate pro-innovation regulation andgenerate Life Sciences and MedTech innovation ecosystems that reflect the
rapid pace of biotech and MedTech revolution, considering carefully designed incentives, securing proper Intellectual Property Rights (IPR), promoting partnerships and a convergence in regulatory requirements and technical standards, focusing on workforce lifelong education.
Policy Action 1.3: Design supportive legal frameworks for data sharing
and protection, customized to the healthcare sector; and promote digitization of Health Systems
G20 Members should focus on removing existing national legal framework
hurdles and set clear guidance on data sharing to improve diagnosis, treatment, care coordination, etc. between all actors in health ecosystems andbetween Health Systems, in compliance with privacy and security legislation.
Furthermore, the G20 Members should promote the harmonization andstandardization of health data to ensure systems interoperability.
Recommendation 2: Assess and measure Health as an investment and foster the transition to Value-Based Healthcare (VBH)
G20 Members should regard health as a strategic asset for national investment, measuring and optimizing its return, sustaining the shift from volume
to value-based healthcare, focusing on better access, overall, holistic outcomes and net value that benefits the patient, rather than the short term cost.
Policy Action 2.1: Establish governance models and policy structures toevaluate, identify and replicate successful VBH models
G20 Members should foster the transition to VBH by defining, implementing, monitoring and rewarding quality of care standards and patient carepathways, through metrics which consider a broader societal perspective,
adopting VBH contracts, promoting the digitization of health data and facilitating sharing.
Policy Action 2.2: Integrated care pathways to improve patient outcomes
G20 Members should promote the development of multidisciplinary approaches to care, guaranteeing better care integration and coordination in or-

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der to extend access to care, improve care pathways effectiveness and experience, increasing the efficiency of Health Systems.
Policy Action 2.3: Place greater emphasis on early diagnosis and prevention
G20 Members should focus on greater prevention, early screenings, timely
diagnosis, larger immunization campaigns and the promotion of wellness initiatives, etc. through new technologies that contribute to improving patient outcomes and the sustainability of Health Systems.
Recommendation 3: Build resilient and sustainable Health Systems
G20 Members should strengthen Healthcare Systems pandemic preparedness, promoting new partnerships, connecting health policies with industrial
activities and production for sustainability, supporting the development ofresilient health and life sciences supply chains and promoting a One Healthapproach.
Policy Action 3.1: Promote new partnerships to collectively learn fromCOVID-19 and jointly take actions that will improve system resilience andsustainability
G20 Members should promote new partnerships to foster collective learningand responses to health challenges, as COVID-19 reveals unmet needs andalso address chronic and acute diseases, ensuring academia and the public
and private sectors all contribute to their resolution to improve the resilienceand sustainability of Health Systems.
Policy Action 3.2: Strengthen crisis preparedness and response
G20 Members should support global collaboration on the creation of international benchmarks for crisis preparedness, definition of emergency protocols to reduce the development and go-to-market time for treatments,
adoption of early warning systems, surveillance mechanisms and dynamic
risk monitoring models.
Policy Action 3.3: Build resilient supply chains through diversification andregulatory cooperation
G20 Members should collaborate with industry and develop a multilateralpolicy framework to increase security of supply, inputs and end products tostrengthen the overall resilience of strategic supply chains.
Policy Action 3.4: Drive environmentally sustainable Health Systems
G20 Members should adopt a broader perspective while defining national
health-related policies considering the nexus of population health and wellbeing, sustainable development, environmental conservation, climate change, disaster risk reduction, gender equality and poverty alleviation, targeting
better worldwide socio-economic conditions.

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Introduction
Bio-Revolution and Tech-Innovation
Brings Breakthroughs in Prevention, Early Detection and Treatment
For almost two years the global community has been fighting an unprecedented pandemic. COVID-19 has shown the universal value of health in ensuring quality of life, socio-economic development and individual freedom. The
pandemic has made it clear that we must improve our pandemic preparedness and retain our newfound capabilities, focusing on bringing the energy ofLife Sciences innovation to developing sequencing capabilities, diagnostics
preventative measures and therapies.
Our minds are inevitably focused on escaping this crisis. However, this vitally
important task should not obscure the reality of broader public health challenges, such as the burden from missed oncological and cardiorespiratory
screenings in 2020-21 and the potential pandemic of widespread antimicrobial resistance (AMR).
Structural Reform to Meet Health System Challenges
The pandemic has strengthened the need to renew key elements of our Health Systems. Urgent structural changes (e.g. in demographics and chroniccare) have been made to respond to emergent epidemiological trends andto ensure the rapid flow of innovation in Life Sciences and Medical Technology reaches and benefits people worldwide. To respond to this global threat
to humanity, industry and Governments are working together to create newhealthcare capacity (intensive care), new non-invasive approaches with early
discharge and new diagnostic systems. Furthermore, they have streamlined
regulation of innovative adaptive trials that could provide new life-saving
therapies (e.g. dexamethasone) in months, which would previously have taken years. Public-private partnerships have been built on a thriving vaccine
innovation ecosystem and extensive research conducted over decades tocreate novel vaccines, which Health Systems are now deploying at a scale wehave never seen before.
The accelerated pace of innovations during COVID-19 demonstrates thetrue value of leading-edge healthcare and must be considered a global strategic asset that all countries should invest in.
“As countries move forward post-COVID-19, it will be vital to avoid cuts in public spending on health and other social sectors. Such cuts are likely to increase
hardship among already disadvantaged groups, weaken health system performance, increase health risks, add to fiscal pressure in the future and undermine
development gains” 1.
Health as a Strategic Asset and Investment
Investing in Life Sciences and Medical Technology means investing in health,wealth and the future of our nations. As ageing populations with multi-morbidity challenge our ability to provide care, we must shift from responding todisease towards prevention and more effective integrated care. This is valid
both for healthcare and for the innovative, structured and diversified Life
Sciences and Medical Technology sectors. Both are vital for health system
resiliency and will generate new industries as well as high quality jobs andtranslate into tremendous economic benefits and growth, in addition to theirpositive impact on health and food security. For instance, Biotech applica-

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10WHO, WHO urges countries to build a fairer, healthier world post-COVID-19 (2021)

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tions could create 2-4 $/tn in direct annual economic impact (2030-2040)2.
If it is to become the norm for children born today to become centenarians,
we must prioritize investment into prevention programs and appropriate
therapies that reduce pressure on healthcare and welfare systems.
The concept of value is even more true regarding vaccinations, as this publichealth intervention intrinsically provides broad value that goes beyond individual benefits. Research has shown that vaccinations can drive health-related and care-related productivity gains (due to avoided diseases and needfor care), community externalities, including the protection of the non-vaccinated, improvements in social responsibility and cohesion that can lead towider economic benefits by promoting workforce productivity. To prepare
for future pandemics, policies supporting a sustainable innovation ecosystem
are needed. In the case of AMR (often called the silent pandemic), urgent policy action is needed to revitalize the insufficient antibiotic pipeline, together
with reimbursement reforms to support access. Moreover, investment in healthcare leveraging digital tech facilitates the distribution of scarce competences and skills, enabling a broader access to high quality treatments. The
level of competencies employed and developed in the Life Sciences sector
drives the reskilling and up-skilling of the workforce with a positive global
impact. These innovations working together contribute towards creating healthier, more prosperous societies and the achievement of Sustainable Development Goals.
Revolutionary Innovation Brings Breakthroughs in Prevention, Early Detection and Treatment of Diseases
Technology is already transforming the way we manage health, but much
more can be done. As demonstrated by breakthroughs in vaccine technologies, R&D in the Life Sciences industry is a central factor in helping the world
recover from COVID-19. The speed of the scientific response is a “Bio Revolution '' in the Life Sciences, based on the converging worlds of genes, cells
and data. In healthcare, this Bio Revolution opens the way for new approaches and advanced therapies to diseases such as cancer, high blood pressure,diabetes, stroke and cardiovascular diseases, Alzheimer’s disease and Parkinson’s disease that compromise the lives of many people. This shift holds thepotential to help patients stay active and healthier longer, monitor general
well-being, improve physical health, support mental health and detect earlysigns of disease, as well as increase economic value, investment in jobs andthe growth that is generated by the Health and Life Sciences sectors.
Our aim is not just to treat symptoms, but to develop curative therapies. It
is estimated that 45% of the world's diseases could be addressed with newtreatments, vaccines, interventional therapies and diagnostics (especially, if
fueled by biotech innovations that are already conceivable today). Progressis within reach and in the last 20 years partnerships to advance public health have enabled immense improvements. For example, the Bill & Melinda
Gates Foundation has shown substantial progress can be made in fighting
infectious diseases and many other health challenges. Innovation needs not
only consistent funding (Gates has donated 7,8 $/bn, including more than 2$/bn for work combating HIV/AIDS, tuberculosis (TB) and malaria) but also
needs to apply new metrics and business techniques to ensure maximum impact from the funding.
From new treatments, to digital solutions, to medical devices and vaccines- technology has a critical role to play in addressing the cost of health. For
example, diagnostics and sensors enable us to better predict and prevent di-

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The Bio Revolution Innovations transforming economies, societies, and our lives – McKinsey (2020)11

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sease, helping to improve patient outcomes and reduce the cost of care. The
extraordinary advances in R&D and digitalization, allow us to measure andstore healthcare data digitally, enable personalized care, as well as streamline Health Systems management to help both patients and clinicians monitor
health and identify issues quickly. Appropriate use of data for medical carecan save lives. Technologies empower individuals to understand their own
health and can facilitate communication between healthcare professionals
and patients, offering new ways to seek and receive care in all environments.
This means that technological innovations can become central to reducing
costs of both chronic and acute diseases and contribute towards long-termsustainability and the resilience of Health Systems.

Value-Based Healthcare
A Framework for Sustainable Adoption, Use of Innovation and managing
healthcare as an investment
The ongoing pandemic has underscored the importance of new organizational models and the imperative to shift to value-based healthcare (VBH).
Under great financial strain, the need to improve the efficiency and governance of Health Systems and support healthcare professionals and patientsis clearer than ever. But it is also clear that in order to fully understand thebeneficial impact of healthcare innovations, a holistic approach to value overmultiple time horizons needs to be applied. The pandemic has shown thatthe health of our populations is an investment. It should be measured thisway both for the assessment of technologies, and from a national accounting
point of view, including the impact on the Life Science and Medical Technology sectors’ competitiveness and value creation. As we move into a world
where the true personalized care paradigm becomes a reality and in a digital world, where the data patient outcomes can be more accurately tracked
and measured, this shift in thinking about value becomes more pressing. This
does not necessarily mean more money into the system, but better targeted
and more efficient spending to improve people and patient outcomes. As amodel in which clinicians are empowered to select appropriate people-centered care pathways and data is used strategically to measure the different
pathway outcomes, VBH offers a way forward. This shift holds the potential
to improve integrated people-centered health care to increase focus on prevention, as well as to increase economic value, investment in jobs and thegrowth that is generated by the Health and Life Sciences sectors.
Strengthening Strategic Sectors and Technology is Crucial to Building
Health System Resiliency
COVID-19 has rightly focused our minds on the urgent challenge of pandemic preparedness and response. As we recover from the crisis, policymakers
will inevitably wish to shift gears from crisis-mode thinking towards a longterm vision of resilient and sustainable Health Systems. Accelerated routes
to investigate and adopt Research and Technology has been a key asset in
the fight against COVID-19, so we must maintain momentum to build resilience and sustainability that will ensure we better prevent, predict and act
early on disease. This will enable us to manage costs, relieve pressure on healthcare professionals, and absorb peak demand in future crises. Furthermore,innovation in healthcare fuels economic dynamism across G20 Members as
the MedTech, Pharma, Biotech, Digital Tech, and healthcare industries areamong the largest sources of R&D and job growth in G20 Members, increasingly interconnected with deep supply chains drawing in thousands of large,

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medium and small suppliers across the G20. Moreover, the R&D expenditures are pivotal for an open innovation network of universities, medical research Centers and technology start-ups.
We are convinced, however, that no investment can be made or secured
without proper Intellectual Property Rights (IPR), sustainable incentive systems and industrial policies, are fundamental and must be maintained tofoster a Life Sciences eco-system to deliver innovation and improve patient
outcomes across the world. Furthermore, if it is true that the future of work
will be data-centric, technology-based and digital, the Science, Technology,
Engineering and Mathematics (STEM) workforce needs a fuller set of skills
following the Social Sciences, Humanities and the Arts for People and theEconomy (SHAPE) framework to truly thrive and address the broader impact
of technological innovation. Finally, the innovation coming from Life Sciences
can help us combat hunger, advance climate resiliency and decarbonize theplanet, namely by reducing the carbon footprint of Health Systems but also
by promoting a healthy population, a healthy economy and a healthy environment.
G20 Ongoing Collaborative Private and Public Stakeholders ForumCOVID-19 posed unprecedented challenges, empowering the G20 to erectpillars on which to base the evolution of the Health and Life Sciences systems,
through the promotion of structural changes to ensure valuable care for all
people. Health should therefore be a permanent item on the G20 Agenda,
and the G20 should establish a permanent Health and Life Sciences Meeting
to ensure continuity of work and track progress of past decisions on healthtaken by the B20/G20.
We Offer Three Recommendations
This paper distils the challenges and opportunities outlined above into threecore recommendations for G20 leaders, centered on:• promoting the strategic use of sciences, digital tools and technology;• fostering the transition to Value-Based Health Care (VBH);• building resilient and sustainable Health Systems.
Our recommendations are designed to shape a new model for a permanent
strategic dialogue between Institutions and Stakeholders aimed at a shift inmindset towards valuing health as a strategic asset. To unleash this value, weneed progressive policy frameworks, unlocking the benefits of technology
and innovation for humanity. To achieve this, a methodology of impact assessment of any healthcare policy on access to therapies and effects on jobs andinvestments in Life Sciences companies should be adopted. Bold new partnerships that cut across the public and private sectors, academia and civil society will be essential to achieving these shifts, and to maximizing the impact
of innovation to support healthy populations, economies and environments,
whilst maintaining public trust.
Our recommendations are weaved together in an overarching narrative aiming to show how reaction to the COVID-19 pandemic is presenting us aunique opportunity to permanently adopt the more efficient, agile and effective approach which has enabled us to counter an unprecedented healthand economic crisis. Therefore, to attain their full potential, the actions we
present should be considered as a solid and articulated line of work, rather
than a list from which to select individual points.

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Recommendation 1: Promote the strategic useof science, technology and data
G20 Members should promote pro-innovation health ecosystems reflecting
the rapid pace of scientific discoveries and advances in biological sciences toboost public trust in science and new technologies through the developmentof appropriate regulatory frameworks that will unleash the full potential ofscience, technology and data.
Policy Actions
1.1 Develop and monitor national plans to support the uptake of technologies – G20 Members should design policy frameworks that accelerate
ecosystems for digital health, Biopharma and MedTech, adopting an investment mindset towards health, strengthening the use of technology, considering the overall impact of health policies and monitoring these plans througha set of specific Key Performance Indicators (KPI).
• G20 Members should foster the development of digital health hubs, designed to support innovation through incentives and public-private partnerships, and involving start-ups, SMEs, and large companies;• G20 Members should activate national investment plans to support andincentivize access to Digital Health, Biopharma and MedTech innovation. Investment may be needed in training and upskilling of workforce, diagnostic
and treatment infrastructure, and foundational science and technology research;• G20 Members should activate key local context assessments, regulatory,
access and policy frameworks to bridge the gap between the developmentof new therapeutic and diagnostic solutions and the Health System's needs;• G20 Members should actively monitor emerging needs for scientific andtechnical competencies across the Healthcare and Life Sciences sector andthey should accordingly innovate, update and invest in education programsfor health and research professionals to drive competitiveness and change.
1.2 Develop coherent regulatory frameworks and establish dialogues
for areas of emerging technology to strengthen scientific research andthe innovation environment – G20 Members should commit to accelerate
pro-innovation regulation and generate Life Sciences and MedTech innovation ecosystems that reflect the rapid pace of biotech and MedTech revolution, considering carefully designed incentives, securing proper Intellectual
Property Rights (IPR), promoting partnerships and a convergence in regulatory requirements and technical standards, focusing on workforce lifelong education.
• During G20 cycles, the G20 Presidency should request a joint ministerial
meeting on Health inviting their industry organizations counterparts, to advance coordination on risks, regulations and policy implementation, together
with Economy, Industry and Foreign Affairs Ministers;• Members should consult with industry to explore more permanent structu-

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res for fostering dialogue on Health innovation. This may include the Global
Innovation Hub for Improving Value in Health; G20 Members should ask theOrganization for Economic Co-operation and Development (OECD) to produce a report on how to better and systematically structure as well as simplify international health regulation to ensure more regulatory consistency,
flexibility and support for innovation;• Members should commit to accelerate pro-innovation regulation thatreflects the rapid pace of the scientific discoveries and generates Life Sciences ecosystems to fully tap its potential. This may include ad hoc regulation
on specific public health priorities aimed at ensuring fast time to market toinnovative therapeutic solutions while preserving Health Systems’ affordability and sustainability (e.g. Italian Funds for Innovative Drugs); promotion ofdigital health applications and innovative solutions to monitor, manage anddeliver healthcare services to the population, in order to help boost healthcare and create the jobs of the future.
• G20 Members should support Health Systems related digital access to improve overall global R&D infrastructure and access to prior technology as
well as share a balanced international and local vision regarding an effective
protection of Intellectual Property Rights in Health and Life Sciences. These
measures should promote and incentivize innovation preserving and advancing social and economic welfare as well as maintaining patent pools, such as
the Medicines Patent Pool, to improve access to health innovations in developing Countries;• G20 Members should incentivize investments through tax benefits, facilitation of approval processes, market predictability, programs and political
initiatives/funding for innovation and production in the healthcare industry;• G20 Members should report on the progress against previous commitments related to innovation such as on the development and implementation ofpull incentives to tackle the increased threat posed by antimicrobial resistance (AMR) as well as solutions to support sustainable access as contained inprevious G20 statements.
1.3 Design supportive legal frameworks for data sharing and protection,customized to the healthcare sector; and promote digitization of Health
Systems – G20 Members should focus on removing existing national legal
framework hurdles and set clear guidance on data sharing to improve diagnosis, treatment, care coordination, etc. between all actors in health ecosystems and between Health Systems, in compliance with privacy and security
legislation. Furthermore, the G20 Members should promote the harmonization and standardization of health data to ensure systems interoperability.
• G20 Members should promote standards including a minimum, and meaningful, data set to be collected across different Countries, interoperabilityof health data systems, and good practices among its members for digitization of health records and connected care solutions;• G20 Members should develop legal, regulatory frameworks and standards
for cybersecurity, maintaining patient safety and privacy while protecting intellectual property, to make health-related data records interoperable, taking into account the diversity of sources in the Health Systems;• G20 Members should improve, address and regulate high privacy as well as15

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security standards for data flows, to ensure social acceptance and promotehealth applications as well as data pools;• G20 Members should enable pooling of relevant information and health records to respond to the need of high-quality health data, supporting national
and international research open to Public-Private Partnerships and to highquality research programs;• G20 Members should define national strategies to adopt the enabling infrastructure necessary for connected care solutions in healthcare (e.g. digital applications, high standards of fast internet and mobile coverage like 5G,etc.), raising awareness among health professionals partnering with scientificsocieties, education institutions, media and telecommunications industry todevelop national based projects;• G20 Members should strive to make connected care solutions a driver forpatient engagement and monitoring starting from national pilot projects
on prevention, primary and home care with involvement of socio-economic
sector, and targeting frail patient groups considering specific programs for
elderly and vulnerable people, as well as establishing follow up programs forchronic diseases and multi-factor cases;• G20 Members should develop national Key performance Indicators (KPIs)
to monitor Health Systems digitalization, data hubs and data interoperability
and readiness for connected care solutions.

Recommendation 1: Key Performance Indicators (KPIs)3

KPI

KPI

Availability of new drugs (NAS/NMEs/NTBs) and devices approved by
EMA/FDA/EU Competent Authorities
Number of new drugs (as New Active Substances (NAS), New Molecular Entities (NME) under New Drug Applications (NDA), or as New Therapeutic Biologics (NTB) under Biologics License Applications (BLA)) approved by EMA
and FDA; as well as number of new medical devices in the top two risk categories approved by FDA and European Notified Bodies
Health data sharing intensity
This indicator looks at the extent to which national health datasets may beshared with domestic and international stakeholders. The indicator value is100% when all national health datasets may be shared with all stakeholder
groups.

Context
Innovation in Healthcare and Life Sciences is gaining momentum, with synergies between R&D and new technologies feeding the pipeline, enabling
the development of new vaccines, therapies and diagnostic solutions to healthcare needs. This is thanks to cooperative, collaborative, multi-sectoral andmultinational approaches. Furthermore, the growth in Public-Private Partnerships in reaction to the pandemic has significantly accelerated the development and execution of clinical trials, both for drugs and vaccines, shortening the time between the development and availability of innovations.

Please refer to the section "Annex I | Key Performance Indicators (KPIs)" for more details regarding the explanation and calculation methodology of the Key Performance Indicators (KPIs).
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Therefore, it is strategically vital that the elements that enabled this acceleration in studies becomes the “new normal”. In parallel, there is a global andgrowing interest in Biosciences, to improve human health, food production
and guarantee environmental sustainability.
Leveraging technology across the Life Sciences and medical technology value
chain can revolutionize the way we deliver healthcare to patients, either bydeveloping new treatments, better using existing ones, or shifting the settingof care towards less intensive options. From basic research in Life Sciences tothe use of AI in R&D for more precisely targeted and effective treatments, tothe creation of new devices that help patients track, and clinicians treat, diseases; science and technology enable Health Systems to provide better andappropriate care, to manage their costs and outcomes. This is more pressing
given the trending demographic challenges and increased risk of developing,often concomitant, age-related diseases. The Bio revolution and new healthtechnologies are a great opportunity for people care and should not be regarded as a driver of costs to Health Systems, but as a way of reducing thecosts driven by disease and directing resources better through redesigned
care pathways. The impact on the broader economy is also clear; growing
high-tech industry to support growth and jobs.
COVID-19 has demonstrated vividly the economic and societal importanceof Health Systems. While chronic diseases have received less immediate attention, they too have a vast importance that can only be addressed throughthe strategic use of science and technology across Health Systems. To enable
the use of technology, there is an imminent need to speed up the creation ofinteroperable health digital infrastructures on a national and international
level to allow health data to flow within Health Systems. These infrastructures are a prerequisite for digitalization to ensure broader access to care withno regard to citizens’ social ranking, income or location4.
Policymakers have a key role to play here in designing regulatory and policy frameworks that support the strategic use of sciences and technologies
to achieve these objectives. It is thereby important to address data privacy
and data security while keeping data flow open to relevant public and private
stakeholders, as the safe use of health data is critical for the development of
new therapies and improving care. By strategic use, we mean delivering more
effective and sustainable care; with greater impact on societal goals; contributing to system resilience. In order to unleash the full potential of scienceand technology, it is crucial to accelerate pro-innovation ecosystems that
also reflect the rapid pace of scientific discoveries and boost public trust inscience and new technologies.

Longer life spans as well as better diagnostics are increasing the burden ofchronic diseases such as Parkinson’s and Alzheimer’s. More than 10 million
people worldwide are living with Parkinson’s (4% diagnosed before 50) while
Alzheimer’s accounts for up to 70% of the 50 million people suffering fromdementia and now considered a pandemic registering 10 million new cases
every year. Treatments so far have been symptomatic but Life Sciences anddigitally enabled collaborative approaches are opening the way to life changing treatments. As Parkinson’s is caused by the loss in the brain of dopamine producing cells, Bayer’s Cell and Gene Platform approach is targeting
its root cause with two approaches. AskBio’s adeno-associated virus (AAV)-based gene therapy introduces a functional copy of a defective gene into

4

This issue is addressed in the Digital Transformation Policy Paper, Recommendation 1, Policy Actions 1.1 and 1.2

Example 1 | Gene, cell therapies
open the way to life changing
treatments for Parkinson’s andAlzheimer’s as well as oncology
patients

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the patient’s cells harnessing the brain’s own cellular machinery to provide
continuous production of GDNF, a protein promoting dopamine production.
Bluerock´s cell therapy uses authentic dopaminergic neurons as therapy. Celltherapies also offer promises to disrupt cancer care, including the treatmentof mesothelin overexpressing tumors as ovarian, lung and pancreatic cancers
as well as mesothelioma (340,000 new cases a year with more than 2 million
patients in the United States alone). Bayer entered in a collaboration withAtara Biotherapeutics on the development of next generation, mesothelin-targeted CAR-T cell therapies for solid tumors. Mesothelin overexpression can be found in many tumors including ovarian, lung and pancreatic cancers as well as mesothelioma.
For the complete case studies please refer to the Annex: Bayer’s Cell andGene Platform; Atara Biotherapeutics.
Example 2 | E-health and AI improve
diagnostics, counselling and lessinvasive treatment expanding care
despite the COVID-19 pandemic

18

The COVID-19 pandemic has upset screening and check-up schedules fora great number of patients, including the elderly, those in need of regularmonitoring. E-health is proving effective in providing remote monitoring andcounselling, as well as in improving care and efficiency. Medtronic’s PillCam™
colon capsule offers a minimally invasive, digitally enabled solution to diagnosing colorectal cancer, the third most commonly occurring cancer in men
and the second most commonly occurring cancer in women with over 1,8 million new cases in 2018. In 2021, in partnership with the UK’s National HealthService, PillCam™ was deployed to meet the demand caused by thousandsof cancelled or delayed colonoscopies. In the US the FDA permitted homedelivery of the PillCam™ small bowel capsule for the duration of the publichealth emergency. In addition to COVID-19, one of the main challenges indiagnostics is linked to the growing ratio between the number of radiologicalexams required and the number of radiologists and imaging specialists. Thistranslates into increasing workloads for radiologists, shorter exams reading
time and higher probability of errors. New technologies are powerful tools to
help address this trend in diagnostics, such as Siemens Healthineers AI-Rad
Companion, an AI-powered and deep learning algorithms augmented workflow solution which helps to reduce the burden of basic repetitive tasks andincrease diagnostic precision when interpreting medical images. Remarkable
impacts in prevention and rehabilitation are being registered by Movendo
Technology’s Hunova, a robot revolutionizing the outcome of many orthopedic, neurological, geriatric and pediatric diseases. Hunova interacts withthe patient monitoring 130 biomechanical and neurological parameters andacquiring 19 thousand data. Machine learning and AI techniques highlight thepatient’s risk of accidental falls, health status and deficient functions and assign an intervention plan. Also transforming today’s healthcare are Huma’s
Remote Patient Monitoring Program and Brave Health’s mental and behavioral health platform. Boston Scientific is up to date with the use of apps
for care coordination simplification and inpatient process standardization(e.g. myTAVI and myPCI), or with platform (AskAngie) connecting physicianswith a catheter lab to setup clinical applications and remote assistance inreal time, which is COVID-19-proof. AstraZeneca developed a digital patient
platform, called Connect360, which brings together patient information,
patient data and monitoring and communication with Health Care Professionals (HCPs) into a single platform. Connect360 links diagnostic technology with a smartphone app to monitor patient's adherence to treatment,
demonstrate correct usage of the medicine and remind patients to take their
medication to prevent exacerbations.

B20 POLICY PAPER HEALTH & LIFE SCIENCES

For the complete case studies and more materials please refer to the Annex:
PillCam by Medtronic, AI-Rad Companion by Siemens Healthineers, Remote
Patient Monitoring by Hunova, Brave Health; myTAVI, myPCI and AskAngie
by Boston Scientific, Connect360 by AstraZeneca.
To promote the strategic use of sciences, technology and data, G20 should:
Policy Action 1.1: Develop and monitor national plans to support the uptake of technologies
G20 Members should design policy frameworks that accelerate ecosystems
for digital health, Biopharma and MedTech, adopting an investment mindset
towards health, strengthening the use of technology, considering the overall impact of health policies and monitoring these plans through a set of specific Key
Performance Indicators (KPI).
Building a consistent and coherent national plan means designing policy frameworks that accelerate supportive ecosystems for digital health, Biopharma and MedTech. This involves adopting an investment mindset towards
health and strengthening the use of technology to improve prevention, prediction, early detection and treatment of disease. This must be underpinnedby technology assessments that reflect the full humanistic, economic and social cost of disease (or non-adoption of technology).
In the People's Republic of China, Huawei launched an innovative AI-Assisted
screening system, allowing a rapid diagnosis of COVID-19 by analyzing thelesions in tomography scans of a patient's lungs. The system has proved effective both in terms of timeliness and accuracy. In a pandemic period, whichcaused a significant decrease in the number of in-person doctor visits, in the
UK, Roche and Moorfields Eye Hospital launched the Home Vision Monitor
App, a mobile application which allows patients suffering from eye diseases(e.g. neovascular age-related macular degeneration) to remotely monitor
their condition from their smart devices and test for changes in their visionfunction once or twice weekly. The potential of this solution is significant as
Roche is part of INSIGHT, the health data research hub for eye health in the
UK building one of the world’s largest data resources in ophthalmology, withthe aim to transform how eye diseases are diagnosed and managed through advanced analytics. Smartphone and mobile apps could also represent
powerful tools to improve health screening for diseases such as Alzheimer’s.
In this sense Biogen is working on a new virtual study to be launched in collaboration with Apple that plans to investigate the role Apple Watch and iPhone could play in monitoring cognitive performance. The collaboration will aim
to identify digital biomarkers to help monitor cognitive performance overtime and identify early signs of decline including Mild Cognitive Impairment(MCI). The fully virtual study will explore the subtle changes in behaviors of
those people that could be predictive of MCI, even before any symptoms arevisible to the person, family and/or circle of friends. Digital biomarkers derived from everyday use of consumer smartphones and smartwatches are
an example of emerging digital health technologies that may one day help
healthcare providers accelerate diagnosis of cognitive impairment, a processthat today currently can take up to 2 to 3 years.

Example 3 | Smart screening andmobile apps boost patient health

For the complete case studies and more materials please refer to the Annex:
AI-Assisted Screening System by Huawei, Home Vision Monitor App by Roche & Moorfields Eye Hospital, the potential of digital biomarkers in Alzheimer’s disease by Biogen.

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Furthermore, national plans should also capture the impact of health policies on access to care, on Life Sciences economic sectors competitiveness, investments and jobs. These plans should be monitored through a collectively
adopted set of KPIs that track levels of technological adoption among G20
Members and their impact on improving outcomes for patients and Health
Systems.
SDGs impacted:
Good
healthGood
growthG20's 3Ps impacted:
Industry
innovation

Reduced Partners forinequality
goals

PeopleProsperity

Policy Action 1.2: Develop coherent regulatory frameworks and establish
dialogues for areas of emerging technology to strengthen scientific research and the innovation environment
G20 Members should commit to accelerate pro-innovation regulation and generate Life Sciences and MedTech innovation ecosystems that reflect the rapid
pace of biotech and MedTech revolution, considering carefully designed incentives, securing proper Intellectual Property Rights (IPR), promoting partnerships
and a convergence in regulatory requirements and technical standards, focusing on workforce lifelong education
To take advantage of the advances in science and its potential supportin tackling global challenges, G20 Members should commit to accelerate
pro-innovation regulation and generate Life Sciences and MedTech innovation ecosystems that reflect the rapid pace of the biotech and MedTech
revolution.
Strengthening scientific research means considering carefully designed incentives that are vital to encouraging investments and the uptake of newtechnologies. Partnerships are key to the discovery, development and mosteffective use of health technology. Bold new partnerships which span private
and public sectors, academia and geographies are needed. Some of the most
exciting developments are happening at the nexus where multiple academic
disciplines meet. More can be done to facilitate this through investment in
multidisciplinary centers. Promising partnerships have emerged (see Example 3) and should be scaled up to other geographies and areas of healthcare.
New areas, like the development of biologics (i.e., cell and gene therapies)
and the application of AI technology to diagnosis and treatment, need bothrobust social dialogue around their risks and opportunities, and regulatory
frameworks that support their unique development pathways and defend
the intellectual property that underpins them. To leverage the potential of
global R&D and integrated supply chains, global alignment and convergencein regulatory requirements and technical standards are needed. Plurilateral
institutions such as the International Conference on Harmonized Standards(ICH) and national regulators must maintain their speed of working towards
coherent acceleration of innovation. Emergency protocols and proceduresshould be put in place to further accelerate development and regulatory timelines for medicines and vaccines in case of a future public health emergency and/or pandemic5.

This issue is addressed in the Action Council on Sustainability & Global Emergencies Policy Paper, Recommendation 2, Policy Action 2.3.
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Moreover, it is important for G20 Members to focus on skills policy and investment in Science, Technology, Engineering and Mathematics (STEM) andencourage lifelong education among industry professionals, physicians, patients and caregivers.
Finally, no investment can be made or secured without proper IPRs, that are
fundamental and must be maintained to foster a Life Sciences ecosystemthat can deliver innovation and improve patient outcomes across the world.
In other cases, still fundamental scientific and economic challenges exist thatare preventing progress. For example, the world agrees on the significanceof the challenge posed by Antimicrobial resistance (AMR), responsible for700.000 deaths annually, but action plans tailored to individual countries
and progress on creating effective pull incentives for antibiotic R&D andestablishing antimicrobial surveillance and stewardship programs are still
deficient.
From China to Europe, network innovation and cooperative research areaccelerating research and improving patient care and underscore the importance of public-private partnerships able to engage and protect patients. In China, AstraZeneca, together with the government and in partnershipwith over 200 technology companies, runs its Innovation Center in charge ofre-assessing patient pathways and designing new solutions to facilitate patients’ access to information, screening, early diagnosis, treatment and follow
up. Launched at the onset of the COVID-19 pandemic, Exscalate4CoV (E4C),
a public-private consortium composed of 18 partners backed by the EU, has
combined the most powerful European computing centers (CINECA, BSC,JÜLICH) together with laboratory and clinical skills in order to identify potentially effective treatments against the SARS-CoV-2 virus. On the dementia front, the Davos Alzheimer’s Collaborative (DAC), convened by the World
Economic Forum in 2020 launched a six-year, 700 $/mln plan to diversify
innovation leveraging global collaboration to accelerate drug development;
create global clinical trials slashing the cost and time to bring new treatments
to patients as well as better preparedness of Health Systems and faster diagnosis.

Example 4 | Public-Private-Patient
partnerships step-up search for
new drugs, disease management,
remote tech-support and personalized medicine

For the complete case studies please refer to the Annex: Innovation Centers
by AstraZeneca; Exscalate4CoV; DAC.
G20's 3Ps impacted:

SDGs impacted:
ZerohungerGood
healthQuality Work Industry Reduced Cons. &education growth innovation inequality Prod.

Partners
for goals

PeoplePlanetProsperity

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Policy Action 1.3: Design supportive legal frameworks for data sharing
and protection, customized to the healthcare sector; and promote digitization of Health Systems6
G20 Members should focus on removing existing national legal framework hurdles and set clear guidance on data sharing to improve diagnosis, treatment,
care coordination, etc. between all actors in health ecosystems and between Health Systems, in compliance with privacy and security legislation. Furthermore,
the G20 Members should promote the harmonization and standardization ofhealth data to ensure systems interoperability
National authorities should focus on the hurdles and parameters for clinicaldata and set clear guidance on data sharing, for both public and private research, as well as for improved diagnosis, treatments and care coordination,
built around a healthcare-specific stakeholder dialogue. It is critical that data
can be shared effectively across actors in a national healthcare ecosystemand between Health Systems, in compliance with privacy legislation. Therefore, the development of Codes of Conduct (e.g. like the European one),determining which actor and under what terms, access and use health data,is necessary. Furthermore, a genuine commitment to raising the level of harmonization and standardization of data to promote interoperability of Health Systems is also crucial7. This collaboration is required to enable standards
for interoperability across data sources, from research to clinical trials andbeyond, taking into account the diversity of sources in the Health Systems:
hospital records, payer records, public databases (such as cancer registries)
and others. As in every other domain in which personal data is collected andshared, there are important privacy and security concerns in the generationof digitalized health data. Also, the frameworks for data sharing need to distinguish healthcare data from technical data and ensure quality, safety andsafeguarding of intellectual property, legal frameworks for sharing of dataon human pathogens and associated information. Appropriate solutions are
required in this area, customized to the specifics of healthcare data.
Example 5 | Safe sharing ofpatient data improves diagnostics
and treatments

Safely sharing clinical data and the results of clinical research has proven effective in cutting costs and time of treatments, with the potential to optimize
public health development in the future. Project Data Sphere, an independentand non-profit initiative of the CEO Roundtable on Cancer’s Life Sciences
Consortium enables researchers to download, share, integrate and analysepatient-level data from Phase III cancer clinical trials conducted by academic researchers or pharmaceutical companies. Through the collaboration of
24 countries and backed by the EU, the 1+ Million Genomes project aims tohave at least 1 million sequenced genomes available by 2022. Once pooledwith Europeans’ health data, genomics will boost the development of moretargeted personalized medicines, therapies and interventions, also enabling
better diagnostics. From cancer, to rare diseases, neuro diseases and prevention, genomics could soon greatly improve health conditions of EU citizens.
In the UK, Huma developed several applications to monitor and keep track of
COVID-19 spread and other diseases like Pulmonary Arterial Hypertension(PAH). Foundation Medicine Inc., (part of Roche Group.), is pioneering progress in personalized oncology, through its Comprehensive genomic profiling(CGP) supporting physicians in their clinical decision-making process. Securedata from CGP tests are stored in a database (FoundationCORE). More than
450,000 profiles in a structured format can be leveraged to develop next
generation treatments, creating a valuable resource for biopharmaceuticalcompanies and academic researchers across the globe.

6

22

7

This issue is addressed in the Digital Transformation Policy Paper, Recommendation 2
This issue is addressed in the Digital Transformation Policy Paper, Recommendation 2, Policy Action 2.3.

B20 POLICY PAPER HEALTH & LIFE SCIENCES

For the complete case studies and more projects please refer to the Annex:
Project Data Sphere; 1+ Million Genomes; Remote monitoring for COVID-19
patients, BreeConnect by Huma, Digital Data collection for monitoring COVID-19 spread by Huma and Comprehensive genomic profiling by Foundation Medicine Inc and Roche

SDGs impacted:
Good
healthIndustry Partners forinnovation
goals

G20's 3Ps impacted:
PeopleProsperity

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Recommendation 2: Assess and measure Health as an investment and foster the transition to
Value-Based Healthcare (VBH)
G20 Members should regard health as a strategic asset for national investment, measuring and optimizing its return, sustaining the shift from volume
to value-based healthcare, focusing on better access, overall, holistic outcomes and net value that benefits the patient, rather than the short term cost.

Policy Actions
2.1 Establish governance models and policy structures to evaluate, identify and replicate successful VBH models – G20 Members should foster thetransition to VBH by defining, implementing, monitoring and rewarding quality of care standards and patient care pathways, through metrics which consider a broader societal perspective, adopting VBH contracts, promoting thedigitization of health data and facilitating sharing.
• G20 Members should put in place policy mechanisms and governancestructures to identify, share, and replicate successful VBH), Value Based Funding (VBF) and Value -Based Procurement (VBP) national programs. The goal
should be to identify the core elements in the successful models, including
the best care pathway, the data and analytics used to evaluate implementation of the model and the results achieved, and the payment or incentivemodel to reward good results. Policy mechanisms should aim to create theconditions for spreading the models across the system. These policy measures should include increasing accountability for delivering VBH, with appropriately resourced agencies who can monitor and act on quality standards
and have the data and power to act on wasteful spending;• G20 Members should commit to a work plan to establish globally accepted standards of data in order to leverage outcomes based on Real World
Evidence (RWE) for a uniform quality assessment and as a metric for setting
reimbursement criteria;• G20 Members should drive the adoption of a broader VBH approach inreimbursement systems for healthcare providers, sharing a common groundacross Health Systems of clear and measurable KPIs;• G20 Members should mandate that the Health System enhances equity. For
example, a great proportion of caring for the elderly and sick falls on women,thus perpetuating and widening the inequality gap as the populations growolder.
2.2 Integrated care pathways to improve patient outcomes – G20 Members should promote the development of multidisciplinary approaches tocare, guaranteeing better care integration and coordination in order to extend access to care, improve care pathways effectiveness and experience,increasing the efficiency of Health Systems.
• G20 Members should share best practices and experiences in the development of integrated primary care networks, frameworks for boosting the ac-24

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cessibility and clinical value of patient-clinician interaction, especially through the greater use of telehealth and health monitoring systems;• G20 Members should commit to working with industry and academia to
explore novel and flexible ways to assess and pay for healthcare goods andtechnologies to support more patient-centered models of care;• G20 Members should enable more extensive patient-clinician interaction.
Digital technologies can also help improve a patient’s access and quality ofcare through telehealth systems. Easy access to discussion with a clinician
from home can lower the barrier for patient access for large segments of the
population, including in under-served areas and among the elderly, or mobility-impaired populations;• G20 Members should foster digital technology being used to monitor
outcomes of patient care, to identify and address variations in quality andresults in different settings and systems, and to determine which treatments
and care pathways are more effective for care of patients. Data collection is
key to measure outcomes achieved and the cost incurred relative to a baseline case.
2.3 Place greater emphasis on early diagnosis and prevention – G20
Members should focus on greater prevention, early screenings, timely diagnosis, larger immunization campaigns and the promotion of wellness initiatives, etc. through new technologies that contribute to improving patient
outcomes and the sustainability of Health Systems.
• G20 Members should identify new strategies and solutions to create an integrated network of primary care (particularly focused on greater prevention, early screening, and timely diagnosis), hospital care and home care providers to improve patient management and healthcare services;• G20 Members should promote the definition of protocols that leverage thenew digital solutions (e.g. wearables, app integrated with small scanning device) that encourage the delivery of care directly at home to foster prevention through more sustainable solutions;• G20 Members should promote the use of incentives (e.g. training programs,
certifications, and tax reliefs) for those companies that launch prevention
campaigns to promote healthy habits and lifestyles or Patient Support Programs, including digital solutions, to improve disease management;• G20 Members should invest more to include immunization across the life
course and prevention on top of their policies to improve resilience, employment, social outcomes and economic growth;• G20 Members should promote and incentivize Wellness driven initiatives
to provide individuals with preventive services for their physical and mental
wellbeing.

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Recommendation TWO Key Performance Indicators (KPIs)8

KPI

Expenditure on preventive care as % of total healthcare expenditure
Share of total health expenditure on preventive care related to total healthexpenditure (considering all financing schemes: Government/compulsory,
voluntary healthcare payment, household out-of-pocket)

Context
Health should be regarded as a strategic asset for Nations to invest in and,as with any investment, it is critical to be able to measure and optimize return9. To do so effectively requires taking account of the following: being sickis much more expensive than appropriately treating diseases, healthy people are more productive to contribute to economic prosperity, a vibrant Life
Sciences economic sector is essential to fuel economic growth, create jobs
and attract investments. For example, in 2016 there were 18 billion hours of
unpaid care by 15 million caregivers, valued at 230 billion. COVID-19 has highlighted once more the colossal cost of disease, confirming that investments in health can yield highly positive welfare benefits. For example, data reveals that on average 1$ invested in health will yield 2-4$ in return . In the Italian
context, a recent study shows that for every 1€ invested in pharmaceuticalclinical studies, this benefits our NHS by 2,77€, constituted by the fees thatare paid to hospitals by companies and by the averted costs for the NHS totreat patients that are shouldered by companies. Moreover, chronic diseases,
such as diabetes and obesity, account for 60% of deaths worldwide and areleading contributors to the growing healthcare crisis. This should compel us
to move from measuring inputs and designing incentives for Health Systems
around the volume of care to determining the value of care.
A focus on overall, holistic outcomes and net value, rather than short term
cost, is what a truly value-based healthcare (VBH) model should do moving
forward.
Example 6 | Measuring theperformance of the Health
Economy in Germany

The Healthcare Economy (HE) has a profound impact on both the Gross Domestic Product (GDP) and employment in Germany. In terms of contribution to the GDP, every 8th euro of Gross Value Added (GVA) created in theGerman economy in 2019 was generated by the Health Economy. In terms of
employment, every 6th job in 2019 was created in the Health Economy. Overall, accounting for spillover effects, every 5th euro and 4th job in Germany
were associated with the HE. Alternatively viewing these results, for every 1
euro in the HE, there is an additional 0,82 euros spillover effect for the whole
economy, and for every 2 jobs in the HE, there is an additional job created forthe whole economy. In the table below, the impacts of the HE in Germany arepresented at the country level, as compared to the impacts at the EU and
Global levels. A 2019 study from EFPIA shows that for one person employedin the pharmaceutical industry in Europe, there are three more jobs createddirectly and indirectly.

Please refer to the section "Annex I | Key Performance Indicators (KPIs)" for more details regarding the explanation and calculation methodology of the Key Performance Indicators (KPIs).
9
McKinsey (2020) Invest 1$ in known health improvements, get up to 4$ back in GDP
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Why Measure Health Investments - ROI in Germany, EU, Global
Indicate results of impacts of the HE on GDP in the German, Global and EU Economies in 2020

Germany

Gross value
added

Employment

EU

GlobalEvery 8th euro

9,6%

9,3%

In the total economy is linked to the
Health Economy*

Share of Health Economy in the overall
EU** economy

Share of Health Economy in the overall
global economy***Every 6th euro

12,5%

200m

In the overall economy is linked the Health
Economy*Share of the Health Economy labor force
in the overall EU** economy

Jobs in the global economy**** Germany: Every 8th euro og GVA and every 6th ob is crreated in Health Economy (every 5th euro and 4th
job was linked to the HE).
** EU: The HE made up to 0,6% of the EU's GDP and up to 12,5% of the EU labor market in 2020.
*** Global: The GVA share of the global HE in total economy was 9,3% and contributed to 200 million employees.
Source: G20HDP, WifOR Institute, Prof. Rifat A. Atun, Harvard University; The economic and societal footprint of thepharmaceutical industry in Europe, EFPIA 2019.

To achieve the goal of improving the value of care, we urge G20 leaders to
pursue the following recommendations:
Policy Action 2.1: Establish governance models and policy structures toevaluate, identify and replicate successful VBH models
G20 Members should foster the transition to VBH by defining, implementing,monitoring and rewarding quality of care standards and patient care pathways,
through metrics which consider a broader societal perspective, adopting VBH
contracts, promoting the digitization of health data and facilitating sharing.
To foster the transition to VBH, it is essential to define, implement, monitor
and reward quality of care standards and patient care pathways, which are
known to deliver effective care. Specifically, economic assessments need tobe reformed and assessed across the healthcare delivery system based oncontribution to defined care standards.
To ensure effectiveness of investments and cost drivers in the health system,
metrics should be developed considering a broader societal perspective.
This means, assessment of the full humanistic, economic and social costs of
disease (value of health), with emphasis on improving economic assessments
to properly identify GDP impacts. This should include measuring productivity gain for patients and caregivers including paid work (productivity), unpaid
productivity and consumption effects.
Modern national accounting models are crucial for tracking costs and benefits with a multi-annual and holistic approach. Value-based contracting,
impact investments, and other models will also be key to accelerating thetransition to VBH.
A key enabler for the successful delivery of VBH is the ability to identify andmeasure the outcomes that matter most to patients and Institutions. Coreto this is the collection and use of high-quality Real-World Evidence (RWE)
including patient reported indicators and clinical medical records to support
better understanding of the patient journey.
Another key enabler is the digitization of clinical medical records and frameworks. Appropriately sharing access to the records is also essential to designing VBH models and measuring their success, in other words to ensure
the accountability of stakeholders to a value-based proposition.

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VBH depends on data. Sharing of data can be achieved by federated pipeline connections between datasets in different jurisdictions and will accelerate translation and transformation into patient benefit worldwide. The data
enables shifting from an up-front promise to achieve better results in relation to cost, to real-time verification of whether those promises are met.
There is also scope within this approach to harness the potential of the cooperative business model, which is a reliable organizational tool that protects
healthcare workers, strengthens Health Systems, and contributes to achieving Universal Health Coverage, especially in mid and low-income countries.

Example 7 | How VBH solutions
improve care and clinicaleffectiveness as well as costs
ratio of procurement

28

Bits and sensors have opened the way to a new generation of indicators andmetrics to gauge the effectiveness of a treatment or the quality of care. Thisadvancement enables more accurate Value-Based Healthcare (VBH) Models
and approaches, with benefits both for the patient and for the sustainabilityof the system. Diabeter, a Dutch-certified clinic network owned by Medtronic has pioneered a new value-based diabetes care model for pediatric type1 diabetes patients in the Netherlands. An IT platform makes real-time patient data available to a multidisciplinary team of diabetes care specialists
and patients via e-dashboards, personalized emails and physician alerts. This
coordinated data sharing allows for timely adjustments to therapy that – inturn – optimize results that matter to the patient. Following the positive results, Zilveren Kruis, Netherlands’ largest health insurance provider, recently
implemented a value-based payment model that shares the benefits frombetter health outcomes and lower healthcare costs for its patients. Similarly, Roche has launched in Denmark a partnership between the Herlev Gentofte Hospital and its genomic division Foundation Medicine to compare
treatment outcomes and costs for non-clear cell renal cancer patients. By
investigating the clinical impact of targeted immunotherapy through genetic
profiling and personalized medicine, also combined with AI, allowed medical
teams to compare the holistic value of different treatment options paving
the way for future procurement negotiations on precision medicine. A VBH
approach has been recently adopted by Boston Scientific related to chronic
pain, which in addition to being one of the most impacting diseases in termsof both disability and healthcare resources consumption, includes some effective treatments, such as spinal cord stimulation (SCS,) which are under-adopted due to cultural limits, lack of knowledge and economic constraints.
Through VBH implementation in Hospital Pain Therapy departments in Italy,
it has been possible to guarantee the best innovative care strategy based on
spinal cord stimulation for chronic pain patients and ensure the sustainability of the National Healthcare Services without compromising the qualityof care delivery. A value-based approach has also been adopted in Italy by
ESTAR, Tuscany’s central purchasing agency that sees Medtronic assume therisk of any ineffectiveness of its Cryoballoon ablation therapy used to treat
atrial fibrillation, an irregular rhythm of the heart. By engaging in value-based
procurement, payers, providers, and governments can realize cost savings forthemselves, while also delivering improved outcomes for the patients they
serve. For the complete case studies and more projects please refer to theAnnex: Diabeter by Medtronic, VBH for non-clear cell renal cancer patientsby Roche, VBH for chronic pain by Boston Scientific, Cryoballoon by Medtronic.

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SDGs impacted:
Good
healthWork
growthIndustry Partners forinnovation
goals

G20's 3Ps impacted:
PeopleProsperity

Policy Action 2.2: Integrated care pathways to improve patient outcomes
G20 Members should promote the development of multidisciplinary approaches to care, guaranteeing better care integration and coordination in order toextend access to care, improve care pathways effectiveness and experience, increasing the efficiency of Health Systems.
A multidisciplinary approach to care can help patients move progressively
through a clinical experience to positive outcomes, ensuring active and independent ageing of the population. Better integration and coordination
will not only improve the patient experience but can help to reduce the costof healthcare and improve overall efficiency. Improved coordination between primary and specialized care is essential to improve the effectiveness ofmanaging diseases, as is the ability to provide specialized care in community
settings. Overcoming silos in care pathways has the potential to extend access to care, improve population health, and increase the efficiency of Health
Systems.
The imperative to rethink the paradigms underlying healthcare management
and a value-based vision focusing on care needs, is accelerating the integration of care pathways and a smarter use of data. In Humanitas, a highly specialized teaching and research hospital located in Milan, Italy, a review of thebariatric surgery clinical path led to the definition of relevant new outcomessuch as reduction of comorbidities as diabetes. The result is better outcomesin post-surgery where 77,5% of patients had no pain, death dropped to 0 andreadmission to 0,4%. In the UK, a value-based healthcare approach in secondary case setting has been implemented by Johnson & Johnson and Barts Health NHS Trust, focusing specifically on a patient pathway for elective
orthopedic surgery. The patient pathway optimization, through clinical bestpractices standardization, process variation reduction and staff engagement
increases, led to improved clinical outcomes, savings in bed days, increased
surgical utilization and generated extra operating theatre time and the opportunity to schedule additional procedures and improve productivity andincome. HeartLogic, a Boston Scientific validated diagnostic tool for heart
failure, has been proven to preventively detect 70% of heart failure events,
with an average advance of 34 days, thus bringing to less than 2 alarms for
episodes of destabilization of heart failure that could occur within a year. Solutions such as HeartLogic represent innovations capable of positively contributing to good health, both through the prevention of critical issues andthe reduction of hospitalizations, and with the overall care of the patient who
is ensured effective care, continuous monitoring and assistance towards a
good quality of life. Similarly, Medtronic developed Solitaire, a device which
has revolutionized stroke care, the second leading cause of death worldwide
killing about 5,5 million people annually. The revascularization device can benavigated endovascularly through blood vessels in the body into the brain
to capture and remove the clot, thus restoring full blood flow immediately,
providing physicians improved delivery performance. About 61% of the trea-

Example 8 | Data and patients'
needs guide an efficiency revolution

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B20 POLICY PAPER HEALTH & LIFE SCIENCES

ted patients showed an almost complete return to functional independence.
With innovation outcomes are improved, cost savings are achieved and theeconomic burden avoided.
For the complete case studies and more projects please refer to the Annex:
VBHC bariatric surgery by Humanitas Research Hospital, Delivering patient
pathway optimization by Johnson & Johnson and Barts Health NHS Trust,HeartLogic by Boston Scientific, Solitaire by Medtronic.

SDGs impacted:
Good
healthIndustry
innovation

G20's 3Ps impacted:
PeopleProsperity

Policy Action 2.3: Place greater emphasis on early diagnosis and prevention
G20 Members should focus on greater prevention, early screenings, timely diagnosis, larger immunization campaigns and the promotion of wellness initiatives, etc. through new technologies that contribute to improving patient outcomes and the sustainability of Health Systems.
While there is a general understanding that preventing disease is better thantreating it, concrete actions need to be taken to shift mindsets and modesof operating within Health Systems. Central to the shift to Value-Based Health Care (VBHC) will be a focus on greater prevention, early screening andtimely diagnosis, facilitated by the strategic use of new technologies. This has
a material impact on improving people and patient outcomes, allowing diseases to be prevented or detected and treated early, and contributes to theoverall sustainability of Health Systems. The Decade of Vaccine Economics(DoVE) Project calculated that if we take into consideration the averted costsof illness by vaccination there is a return on investment of 21$ for every dollar
invested, and if we also capture the benefits beyond costs averted, together
with economic productivity, a 54$ return on every dollar invested in vaccine programs can be estimated. Prevention is key to allow the sustainabilityof Health Systems and investments have to increase to guarantee that the
population receive vaccination for all vaccine preventable diseases, have access to oncology screenings and chronic diseases are controlled. The need toprevent all preventable diseases and disabilities should lead to a consideration of health spending in prevention as an investment to be increased by all
countries to maintain a healthy and productive population and reduce healthcare and welfare costs. Life-course immunization and health promotion
must be extended empowering young and older people to maintain a healthy
life and improving confidence in vaccines and regular screenings. Governments should include immunization across the life course and prevention on
top of their policies to improve resilience, employment, social outcomes andeconomic growth. By empowering the patient to better know and manage
their own health, these technologies help slow the advancement of diseases,in particular chronic conditions such as diabetes, cardiovascular conditions
and Alzheimer’s Disease, that otherwise become more severe over time leading to more expensive interventions and health consequences for the patient. Another key element connected to prevention and a healthier lifestyle is wellness. This rapidly expanding approach is enabling governments toenhance economic development, providing individuals with additional me-30

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ans to improve their overall mental, physical and aesthetical health. Wellness
is becoming an extremely important driver for foreigners to visit other countries and is providing individuals with a successful alternative and preventive
solution to better manage, control and cure health conditions.
Preventive screenings, physical and mental health monitoring based on digital technologies and platforms and encouraging the move to a balanced
diet are the building blocks of future Healthcare. Closely connected withprevention is the area of well-being, as a complex combination of a person's
physical, mental, emotional, and social health factors, with the potential tolimit the impact on healthcare expenditure. BioBeats, has developed and validated a holistic wellness tool for mental health which combines measures ofactivity, sleep, heart rate and self-reported wellbeing using phone and wearable data, to continuously measure user wellness. The tool can be used topromote healthy lifestyles and improve wellbeing by employers, health systems, insurance companies, or directly by customers. Lyfebulb is a patientengagement platform bridging the gap between patients and the healthcare
industry, empowering patients to get their voices heard and allowing Health
Systems to better assist them in their journey. Onegevity Health has a “precision wellness” approach based on a multi-omic artificial intelligence (AI)platform providing user-friendly, at-home tests, products, and digital health services such as Gutbio, a microbiome test for gut health, Agebio, which reveals the body’s biological age and Onegevity which focuses on “precision wellness”. COVID-19 Severity Risk Score is a personalized and highly
accurate assessment, developed by Huma in partnership with Johns Hopkins
University, of an individual’s risk of developing severe complications for COVID-19. Combining 31 criteria and risk factors associated with COVID-19 it
empowers people to make informed decisions based on their risk profile creating a more resilient population and it can be used to screen participants forclinical trial enrolment. Based in Argentina, Mantra Beauty, provides regularand trustable information on good habits and the importance of self-carefor healthy skin and general well-being. Its 2020 “Sun Damage AwarenessCampaign” against skin cancer reached more than 100.000 followers (80%between 25 and 44) drawing in 60% to use sun protection and 29% to booktheir first online meeting with a dermatologist.

Example 9 | AI and digital platforms
engage patients in a “win-win” loopof healthy lifestyles, better
prevention and reduced costs forall

To learn more about successful case studies, please refer to the following cases in the Annex: BioBeats by Huma, Lyfebulb, Onegevity, COVID-19 Severity
Risk Score by Huma, Mantra Beauty.
Many private organizations, such as insurance companies, are pioneering"win-win" solutions to lower both customer health risks and costs. The Health Check-up Discount offered by Dai-ichi Life a Japan-based life insurancecompany, offers customers with favourable health check-up results a further
discount on their premiums. What makes this unique is that Dai-ichi Life gives discounts to all of the customers who provide the health check-up results regardless if the result is good or bad. Similarly, Neo First Life offers anindustry-first product using “Health Age” to calculate the premiums insteadof actual age, as a customer's health status does not always have a relationship with a customer’s actual age. The product re-calculates the premium
every 3 years based on the customer's health check-up result and offers a
reduced premium for a younger health age. Following an analysis of healthand medical big data on over 10 million insurance policies using the latest
technology Dai-ichi Life and Neo First Life derived that people who undergo

Example 10 | How healthierlifestyles are promoted by data
driven incentives and businessinitiatives

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B20 POLICY PAPER HEALTH & LIFE SCIENCES

health check-ups are 10 less likely to require payments for major diseases and
30 less likely to require payments due to death, compared to those who do
not undergo health checks. These findings enabled them to develop a mechanism that predicts customer's chances of getting diseases from healthcheck-up results. In 2002 Technogym launched the Wellness Valley project
to create the first Wellness Community in the world in Emilia Romagna, Italy- an entire territory that has made wellness development a strategy by creating a model of social innovation that focuses on people and their health andpromotes constant improvement in quality of life. Thanks to more than 70
best practices (e.g. educational programs for childhood obesity, free physicalactivity in public parks for active aging, prescription of physical exercise forchronic diseases prevention, etc.) the initiative has positively impacted on thehealth of the local population. The sedentary population of Wellness Valley isless than half of the national average; risk of disability due to chronic diseases
and number of people hospitalized are both lower than the national average.
For the complete case studies and more projects please refer to the Annex:
Health Check-up Discount by Dai-chi Life Insurance Company and HealthAge Insurance by Neo First Life, Wellness Valley by Technogym.

SDGs impacted:
No
poveryIndustry
innovation

32

G20's 3Ps impacted:

Zero hunger Good health Clean water

Reducedinequality

Cons. and
Prod.

Partners for
goals

People Prosperity

B20 POLICY PAPER HEALTH & LIFE SCIENCES

Recommendation 3: Build resilient and sustainable Health Systems
G20 Members should strengthen Healthcare Systems pandemic preparedness, promoting new partnerships, connecting health policies with industrial
activities and production for sustainability, supporting the development ofresilient health and life sciences supply chains and promoting a One Healthapproach.

Policy Actions
3.1 Promote new partnerships to collectively learn from COVID-19 andjointly take actions that will improve system resilience and sustainability– G20 Members should promote new partnerships to foster collective learning and responses to health challenges, as COVID-19 reveals unmet needs and also address chronic and acute diseases, ensuring academia and the
public and private sectors all contribute to their resolution to improve theresilience and sustainability of Health Systems.
• G20 Members should foster cooperation among Ministries connecting health, agriculture, education, infrastructure, and finance policymaking to address common Planetary Health challenges through regulation, investments
and Public Private Partnerships (PPPs).
3.2 Strengthen crisis preparedness and response – G20 Members should
support global collaboration on the creation of international benchmarks forcrisis preparedness, definition of emergency protocols to reduce the development and go-to-market time for treatments, adoption of early warning
systems, surveillance mechanisms and dynamic risk monitoring models.
• G20 Members should devise positive incentives for countries to build more
preparedness and resilience, as well as surveillance mechanisms, for example,
access to development funding, foreign aid, or favorable interest rates from
capital markets or regional banks (e.g. European Central Bank);• G20 Members should promote the incorporation of economic and social
impact of pandemics in national macroeconomic risk assessments, to drive
policymaking and investments in preparedness;• G20 Members should define national preparedness plans, incorporating
flexible manufacturing capacities and setting up public programs to incentivize strategic productions to readily supply medical countermeasures to ensure supply chain, research activities and healthcare services continuity, andvaccination pathways simplification;• G20 Members should invest in digitalization to improve early warning systems e.g. for rise in demand of medical products monitoring (for example
through using the 2D-matrix codes & serialization) and in streamlining regulations for sharing of data e.g. faster sharing of information on human andanimal pathogens to accelerate R&D of medical countermeasures.
3.3 Build resilient supply chains through diversification and regulatory
cooperation – G20 Members should collaborate with industry and develop

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a multilateral policy framework to increase security of supply, inputs and end
products to strengthen the overall resilience of strategic supply chains.
• G20 Members should ensure resilient supply chains, through the alignment of international standards and should strengthen coherence throughmultilateral or plurilateral organizations such as for example World Trade
Organization (WTO) for trade rules, World Health Organization (WHO),
Pharmaceutical Inspection Co-operation Scheme (PIC/S) and International
Council on Harmonisation (ICH) for technical standards in clinical trials andmanufacturing, digital health, and biotech innovation/ Cell & Gene Therapy(C&GT). To facilitate exchange on this point B20 should encourage a joint
meeting of G20 health and trade ministers with B20 presence during the Italian G20 presidency to discuss resilient supply chains and the simplificationof trade regulation around health care;• The Organization for Economic Co-operation and Development (OECD)should also be assigned to host regular roundtables on supply chain resiliency for essential products and business critical functions, including need for askilled and trained workforce in a government-industry-partnership format
to educate, discuss best practices and develop joint recommendations andtoolboxes for OECD Members, affiliated organizations and G20;
• G20 Members should collaborate with industry to build mechanisms foravoiding trade restrictions on goods and personnel or bottlenecks among
member states, and to establish consultation and rapid-response mechanisms for detecting and addressing supply chain concerns among G20 Members;• G20 Members should promote collaborative approaches to strengthen theparticipation of low and middle-income Countries in global value chains.
3.4 Drive environmentally sustainable Health Systems. – G20 Members
should adopt a broader perspective while defining national health-related
policies considering the nexus of population health and wellbeing, sustainable development, environmental conservation, climate change, disasterrisk reduction, gender equality and poverty alleviation, targeting better worldwide socio-economic conditions.
• G20 Members should promote partnerships for change, bringing together
academia and the private and public sectors to act in the main areas of opportunity as identified in local or international assessments of health system
resilience and sustainability through One Health’s three axis approach: people, animals and environment;• G20 Members should promote Science Technology Engineering Mathematics (STEM) careers and encourage lifelong education in Social Sciences, Humanities and Arts for the People and the Economy (SHAPE) sciences among
students as well as industry professionals, physicians, patients and caregivers
through policies and incentives for education and training through a systemopen to public-private partnerships;• G20 Members should commit to net zero CO2 emission targets and createclear and publicly accessible roadmaps to achieve targets together with thehealthcare industry;• G20 Members should work on identifying and addressing key trends in the34

B20 POLICY PAPER HEALTH & LIFE SCIENCES

demographic change, as stressed in previous G7/G20 Presidencies, to prepare Health Systems and Social Security Plans for future challenges related tosustainability and population health status;• G20 Members should set the Worldwide Research priorities considering theincrease of incidence and prevalence of chronic, infectious, and debilitating
age-related diseases.

Recommendation 3: Key Performance Indicators (KPIs)10
Average of 13 International Health Regulations (IHR) core capacity scores,
SPAR version
Percentage of attributes of 13 core capacities that have been attained at a
specific point in time. The 13 core capacities are: (1) National legislation, policy and financing; (2) Coordination and National Focal Point communications;(3) Surveillance; (4) Response; (5) Preparedness; (6) Risk communication; (7)Human resources; (8) Laboratory; (9) Points of entry; (10) Zoonotic events;(11) Food safety; (12) Chemical events; (13) Radio nuclear emergencies.

KPI

Context
While health is almost always ultimately the responsibility of national governments, its challenges are often international in nature. As we have seen
pandemics spread across borders, supply chains for critical medical technologies are global, and scientific research is among the most international of
disciplines.
COVID-19 has emphasized the ways in which policymakers can be drawn into
thinking nationally in a crisis, but also shown the limitations of this approach.
Building resilient and sustainable Health Systems is not just about preparing
for future pandemics or environmental risks. It is about redesigning our health policies to overcome structural and governance challenges. Innovative
treatments for chronic, deadly and high prevalence diseases, will require infrastructural investments and a new paradigm focused on prevention andearly detection supported by digital solutions.
To build more resilient and sustainable Health Systems, the G20 should:
Policy Action 3.1: Promote new partnerships to collectively learn fromCOVID-19 and jointly take actions that will improve system resilience andsustainability11
G20 Members should promote new partnerships to foster collective learningand responses to health challenges, as COVID-19 reveals unmet needs; and also
address chronic and acute diseases, ensuring academia and the public and private sectors all contribute to their resolution to improve the resilience and sustainability of Health Systems.
COVID-19 has revealed that many Health Systems face similar challenges
with regards to their ability to withstand shocks, but also with regards to theirability to answer unmet needs and to address chronic and acute diseases12.

Please refer to the section "Annex I | Key Performance Indicators (KPIs)" for more details regarding the explanation and calculation methodology of the Key Performance Indicators (KPIs).
11
This issue is addressed in the Action Council on Sustainability & Global Emergencies Policy Paper, Recommendation 2, Policy Action 2.2.
12OECD (https://www.oecd.org/health/healthcarecostsunsustainableinadvancedeconomieswithoutreform.htm)
10

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New partnerships are needed to promote collective learning and action witha focus to address these challenges, and to ensure academia, public and private sectors all contribute to their resolution.
Such collaborations are required both at national and international levels. At
a local level, rapid assessments of country and region-specific opportunities(or gaps) to improve resilience to shocks and to more effectively address diseases will be important to foster and enable support with relevant tools andframeworks.
Example11 | How partnershipsbuild resilience against global
health shocks

Cooperative and collaborative partnerships, including multi-sectoral ones,
from public-private to public-patient-private, are emerging as key to ensuring resilience against pandemics and global health shocks in general. The
Partnership for Health System Sustainability and Resilience (PHSSR), launched by the London School of Economics (LSE), the World Economic Forum(WEF) and AstraZeneca, has eight Organisation for Economic Co-operation
and Development (OECD) countries as protagonists and has produced a pilot study aimed at mapping the factors that ensure resilience and sustainability to Health Systems, with particular reference to the SARS-Cov2 pandemic. A series of recommendations and a preliminary assessment have been
identified. Since 2000 Gavi, a global public-private partnership of key UN
agencies, governments, vaccine industry, private sector and civil society has
vaccinated +822 million children through routine programs; +1,1 billion vaccinations through vaccination campaigns, +14 million future deaths prevented,
255 million future disability adjusted life years (DALYs) averted as a result ofvaccination with Gavi supported vaccines from 2016-2019, 495 vaccine introductions and campaigns. COVID-19 is also being countered with the firstmultilateral and multisectoral end-to-end global vaccine collaboration mechanism (COVAX) launched in April 2020 to bring together governments,
global health organizations, manufacturers, scientists, private sector, civilsociety and philanthropy, with the aim of providing innovative and equitable
access to COVID-19 diagnostics, treatments and vaccines. COVAX has so far
shipped over 48 million COVID-19 vaccines to 120 participants.
To learn more about successful case studies, please refer to the following cases in the Annex: “Partnership for Health System Sustainability and Resilience” (PHSSR) by the World Economic Forum, London School of Economics andAstraZeneca, COVAX by CEPI, Gavi, WHO and UNICEF.
On an international level, quantitative metrics should be devised allowing forinternational benchmarking of Countries’ health system resilience and sustainability. Such a global index would be instrumental to direct global andlocal resources towards where the largest opportunities (gaps) exist. International mechanisms could incentivize collective action supporting the strengthening of Health Systems.

SDGs impacted:
Good
health36

WorkgrowthIndustry
Reducedinnovation inequality

G20's 3Ps impacted:
Cons. & Partners for
Prod.
goals

PeoplePlanet Prosperity

B20 POLICY PAPER HEALTH & LIFE SCIENCES

Policy Action 3.2: Strengthen crisis preparedness and response13.
G20 Members should support global collaboration on the creation of international benchmarks for crisis preparedness, definition of emergency protocols
to reduce the development and go-to-market time for treatments, adoption ofearly warning systems, surveillance mechanisms and dynamic risk monitoringmodels.
Global collaboration on the creation of international benchmarks for crisis
preparedness is essential in order to avoid different standards being adopted in different countries and to harness global capabilities and data sources.
Emergency protocols also need to be devised to reduce the time taken todevelop, evaluate and approve vaccines and therapies for emergency use14.
At the same time, it is fundamental to establish early warning systems (EWS)or surveillance mechanisms for early detection of disease emergence/re-emergence (e.g. abnormal mortality and morbidity in livestock and/or wildlife
populations, unusual cases of an illness in human populations, increased purchase of antibiotics or flu medicines, increased internet searches on certain
clinical signs and therapeutics, etc.). Dynamic risk monitoring is also a priority to be addressed through cross sectoral data integration and analysis(e.g. for demand-rise in medicinal products to enable a quicker reaction andthe prevention of shortages in pandemic, or crisis settings) and the sharingof data on both human and animal pathogens to accelerate R&D of medical
countermeasures.
A new generation of AI driven alert system use known geographical hotspots for early detection of viral transfer in human and livestock populations
to prevent further virus transmission at the local level. Chinese tech giant
Huawei launched an artificial intelligence pig farming project, that will help
farmers, in China, to better track the health of their livestock. A facial recognition system can identify individual pigs and other technologies monitor
the pigs’ weight, diet and level of exercise, allowing farmers to constantly
monitor animals and detect threatening diseases in time. In Norway, Stingray
developed a unique system targeting and kills lice on salmons and trout witha laser while also monitoring their health and growth 24/7. Stingray’s solution combines stereo machine vision, advanced software and high-precisionlaser to target and kill parasites that infect farmed fish, as well as monitoring
growth via biometrics application. Viso.ai Vision Suite platform combines AI
and live camera streams for real object-detection to automatically detect
livestock, track animal movements or behaviors across multiple locations andmonitor their health and wellbeing.

Example 12 | From pigs tosalmons, AI monitors livestock
and prevents pandemics

For the complete case studies and more projects please refer to the Annex:
Huawei, Stingray, Visio.AI.

SDGs impacted:
No
povertyGood
healthWork
growthG20's 3Ps impacted:
Industry Reduced
innovation inequality

Climate Partners forchangegoals

PeoplePlanet Prosperity

This issue is addressed in the Action Council on Sustainability & Global Emergencies Policy Paper, Recommendation 2, Policy Actions 2.1 and 2.2.
14This issue is addressed in the Action Council on Sustainability & Global Emergencies Policy Paper, Recommendation 2, Policy Action 2.3
13

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Policy Action 3.3: Build resilient supply chains through diversification andregulatory cooperation15.
G20 Members should collaborate with industry and develop a multilateral policy framework to increase security of supply, inputs and end products to strengthen the overall resilience of strategic supply chains.
This should be addressed through diversification, incentives, alignment of international standards, trade facilitation at borders for goods and personnel,
dataflow across borders, non-proliferation of export restrictions, eliminationof customs duties on medical goods and the access to components and raw
materials. Risk-reaction and product specific mitigation plans in industries
are key and need to be better recognized and understood by policy makers.
Governments and the Life Sciences industry should also partner up to ensure
a better understanding of global supply chains.
Example 13 | Preventing
supply chain disruption toprotect global health

Since 2020, COVID-19 has revealed the way unilateral government reactions
and export restrictions hinder increasingly globalized healthcare and Life
Sciences supply chains. New solutions preventing disruptions that could affect patients and communities combine smart solutions with new organization models. Resolution, developed by Johnson & Johnson, is an end-to-end
touchless supply chain solution driven by Radio-frequency identification(Rfid), automatically managing the procurement of medical devices in theoperating room, tracking consumption for individual patients or surgicalprocedures and controlling warehouse movements. As demand for respiratory ventilators skyrocketed during the first wave of COVID-19, the world’s
largest medical device company, Medtronic, faced new trade restrictions
among G20 countries that impeded the scale-up of production and disrupted supply chains for more than 1500 components of its ventilators provided
by 100 suppliers in 14 different countries. The solution involved persuading
governments to remove those restrictions and tapping into the engineeringand manufacturing capacity of suppliers across the globe.
To learn more about successful case studies, please refer to the following cases in the Annex: Resolution by Johnson & Johnson, Ventilator Global Supply
Chain by Medtronic.

SDGs impacted:
Good
healthWork
growthIndustry
Reduced Partners forinnovation inequality
goals

G20's 3Ps impacted:
PeopleProsperity

Policy Action 3.4: Drive environmentally sustainable Health Systems.
G20 Members should adopt a broader perspective while defining national health-related policies considering the nexus of population health and wellbeing,sustainable development, environmental conservation, climate change, disasterrisk reduction, gender equality and poverty alleviation, targeting better worldwide socio-economic conditions.
A more collaborative and transdisciplinary approach is urgently needed tosuccessfully address the health challenges of today and tomorrow. A “OneThis issue is addressed in the Trade and Investment Task Force Policy Paper, Recommendation 1 and 2, Policy
Actions 1.1 and 2.3 and in the Finance and Infrastructure Task Force Policy Paper, Recommendation 3 Policy
Action 3.4
15

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Health” approach, including human health as well as animal and environmental metrics needs to be incorporated in defining national policies. It willbe crucial to consider the nexus of population aging, health and wellbeing,sustainable development, environmental conservation, climate change, disaster risk reduction, gender equality and poverty alleviation, targeting betterworldwide socio-economic conditions. Furthermore, G20 Members should
work in identifying opportunities to integrate sustainability considerations
more actively into Health and Life Sciences policies (e.g. tax benefits, facilitation of approval processes, support programs and political initiatives, etc.)
including the use of clear reference frameworks and incentives. Training andeducation programs should also be aligned to a Social Sciences, Humanities
and Arts for the People and the Economy (SHAPE) approach to include theseareas as enablers for the progress of society and economic development.
A One Health approach and a focus on sustainability issues are current concerns for all organizations that are keen to prove they can deliver greater
benefits to society with fewer costs for the environment - in line with net
zero targets and Environmental, Social and Governance (ESG) standards of
the Life Sciences industry, Governments and Health Systems. Embracing a B
Corporation business model, Italy’s Chiesi Farmaceutici has adopted a dual
purpose, pursuing financial objectives as well as the progress of society - including shareholders, people, communities and the environment. As a certified B Corp, the company has taken tangible actions to measure, reduceand offset CO2 emissions, increase the use of renewable energy, adopt asustainable chemistry approach and map the waste produced by industrial
processes to define best management. They have committed to achieving
Carbon Neutrality by 2035, well before the second half of this century - a target set out in the Paris agreement. With a similar goal Boehringer Ingelheim(BI) is fully committed to fighting Foot & Mouth disease (FMD) and limiting
achieving the negative economic impact, significant cost to farmers and theirlocal communities, as well as the threat to food security. BI has created 17
national and regional FMD vaccine banks, protecting countries from outbreaks and their consequences. They have also invested in the construction of abiosafety level-3 site for the manufacture of FMD vaccines in France. Their
One Health approach is not limited to FMD, but also focuses on the controlof rabies, through preventive vaccination of stray dogs, offering potential forsavings in human health expenditure. Recently BI supported a rabies projectin Pakistan, which vaccinated stray dogs. Following vaccination, dogs were given an identification collar showing that they had been vaccinated and were
safe. For the complete case study, please refer to the Annex: B Corporation
certification by Chiesi Farmaceutici, Foot & Mouth Disease (FMD) and Rabies
Management by Boehringer Ingelheim

SDGs impacted:
Good
health

Clean
water

Cons. and
Prod.

Example 14 | Adopting a One Health approach to pursue progressin favor of people, communities
and the environment

G20's 3Ps impacted:
ClimatechangeLife onland

Partners for
goals

PeoplePlanetProsperity

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Annex I | Key Performance Indicators (KPIs)
In the Policy Paper some Key Performance Indicators (KPIs) have been identified, subdivided by the recommendations to which they refer. The goal of
the KPIs is to monitor the progress of the G20 countries in line with the suggestions formulated by the Task Force and outlined in the Policy Paper.
The KPIs are calculated using data currently collected by international organizations (e.g. WHO, OECD, etc.) and it’s proposed to use specific targets for2024 as outlined below.
It should be noted that regarding to Recommendation #2 ("Assess and measure Health as an Investment and Foster the transition to Value Based Healthcare"), no relevant information has yet been collected related to VBH.
Some initiatives have been recently launched by leading international institutions, - e.g. Patient-Reported Indicator Surveys (PaRIS) by OECD, Global
Coalition for Value in Healthcare by World Economic Forum (WEF) - but they
are still underway and/or no numerical evidences are available, so it is suggested that future developments be monitored.
The individual KPIs identified are detailed below:

1. Recommendation 1: Promote the strategic use of science, technology and data
KPI Title

Availability of new drugs (NAS/NMEs/NTBs) approved by EMA/FDA

KPI Description

Number of new drugs (as New Active Substances (NAS), New Molecular Entities(NME) under New Drug Applications (NDA), or as New Therapeutic Biologics(NTB) under Biologics License Applications (BLA)) approved by EMA and FDA.

KPI Data source

European Medicines Agency / Food & Drug Administration

KPI Baseline

2020 Data

KPI Target(2024)+10% increase over 2020 Baseline

KPI Title

Health data sharing intensity (Link)

KPI Description

This indicator looks at the extent to which national health datasets may be sharedwith domestic and international stakeholders. The indicator value is 100% when
all national health datasets may be shared with all stakeholder groups. National health datasets surveyed by the OECD contain personal data on hospital andmental hospital in-patients; emergency health care, primary care, and formal logterm care data; prescription medicines data; cancer, diabetes, and cardiovasculardisease registry data; and mortality data. Not all countries have national health

Example | Availability of new
drugs (or other therapies)
approved by EMA/FDA or otherinstitutional bodies)40

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datasets covering each of these areas. Domestic stakeholders include healthcare
providers; the government; universities and non-profit research centres; andfor-profit businesses. International stakeholders include foreign governments,
universities and non-profit research centres. Maximum (100%) sharing potential isachieved when all of the national health datasets present in a country are sharedwith all stakeholders. A % of sharing potential of less than 100% indicates that one
or more of the health datasets present in the country does not allow sharing withstakeholders. A % of sharing potential of 0 indicates that no sharing of the healthdatasets present is permitted. Sharing does not necessarily imply fully open accessto a dataset; sharing is usually subject to privacy protections such as de-identification and stakeholders must apply and be approved to access a dataset.
KPI Data source

OECD

KPI Baseline

2020 data

KPI Target(2024)Breakdown of countries into quartiles- Target for 1st Quartile (Low performers) is the highest
performer using the latest data
- Target for 2nd Quartile is the average of the 3rd Quartile
using the latest data
- Target for 3rd Quartiles is the average of the 4th Quartile using the latest data as of June 2021.
- Target for 4th Quartile (High performers) is the highest
performer using the latest data

Example | Health data sharing
intensity (2020)

2. Recommendation 2: Assess and measure Health as an Investment and Foster the transition to Value Based Healthcare
KPI Title

Expenditure on preventive care as % of total healthcare expenditure

KPI Description

Share of total health expenditure on preventive care related to total health expenditure (considering all financing schemes: Government/compulsory, voluntary
healthcare payment, household out-of-pocket)

KPI Data source

OECD

KPI Baseline

Latest data (2018 or nearest year)

KPI Target(2024)Breakdown of countries into quartiles- Target for 1st Quartile (Low performers) is the highest performer using thelatest data
- Target for 2nd Quartile is the average of the 3rd Quartile using the latest data
- Target for 3rd Quartiles is the average of the 4th Quartile using the latest data
as of June 2021.
- Target for 4th Quartile (High performers) is the highest performer using thelatest data

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Example | Expediture on preventive case as % of total healthcare
expediture 2018 or latest data)

3. Recommendation 1: Build resilient and sustainable Health Systems

Example | Avarage of 13
International Health Regulations(IHR) core capacity scores, SPAR
version 2019)42

KPI Description

Percentage of attributes of 13 core capacities that have been attained at a specificpoint in time. The 13 core capacities are: (1) National legislation, policy and financing; (2) Coordination and National Focal Point communications; (3) Surveillance;(4) Response; (5) Preparedness; (6) Risk communication; (7) Human resources; (8)Laboratory; (9) Points of entry; (10) Zoonotic events; (11) Food safety; (12) Chemical
events; (13) Radionuclear emergencies.
The Expected frequency of data dissemination is Biannual (Six months)

KPI Data source

WHO

KPI Baseline

Latest data (2019)KPI Target(2024)Breakdown of countries into quartiles- Target for 1st Quartile (Low performers) is the highest performer using thelatest data
- Target for 2nd Quartile is the average of the 3rd Quartile using the latest data
- Target for 3rd Quartiles is the average of the 4th Quartile using the latest data
as of June 2021.
- Target for 4th Quartile (High performers) is the highest performer using thelatest data

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Annex II | Case studies
Rec.

PolicyActionCompany

Case study

Description

1

Bayer
(Cell and Gene
Platform)

New treatments
for neurodegenerative diseases

Bayer is advancing two product candidates to treat
Parkinson's disease (PD), in a cell and a gene therapy
approach. These employ intervention mechanisms
fundamentally different to the current standard ofcare that address the symptoms and become lesseffective with disease progression. Since the current
standard of care discovery in 1955, innovation in thearea has been limited. The cell and gene candidates
now target the disease at its root cause, they aim to
go beyond symptomatic treatments. As PD is caused
by a loss of nerve cells in the brain responsible for
producing dopamine resulting in a loss of control
over body-movements, the gene and cell therapies
aim to regenerate the midbrain neurons or re-innervate the affected regions so as to restore damaged
motoring functions. Concretely, AskBio´s adeno-associated virus (AAV)-based gene therapy approach
introduces a functional copy of the defective gene
into cells. It delivers a glial-derived neurotrophic
factor (GDNF) that harnesses the brain’s own cellular machinery to provide continuous productionof GDNF. Bluerock´s cell therapy uses authentic
dopaminergic neurons as therapy. The company has demonstrated that they can manufacture
these authentic midbrains dopaminergic neurons
and reverse the motor-control deficit in animalmodels after implanting them. Both companies arerecent Bayer acquisitions to Bayer´s Cell and Gene
Platform. For Parkinson patients and their families,
a successful treatment would be life changing. Affecting more than 10 million individuals worldwide,
Parkinson’s disease is the most common neurodegenerative movement disorder in the world. In the
U.S., there are approximately 60,000 new Parkinson’s disease diagnoses per year. The vast majority ofpatients are diagnosed between the ages 60 and 70,
and incidence increases with age. The cardinal features of the disease include resting tremor, rigidity,
slowness of movement and postural instability. The
product candidates for Parkinson’s disease are also
a great example for the benefits of cross-industry
collaboration and how biotech, pharma and MedTech innovation enable truly new paths and curative
treatments. The GDNF gene therapy investigational agent will be delivered via a novel, image-guided
neurosurgical delivery technology in an effort to
optimize the precision, safety and efficiency of genetransfer within the brain. The protocol uses intraoperative magnetic resonance imaging (iMRI) technologies to precisely target the therapy to a collectionof specific nerve cells in a brain region.

1

Atara
Biotherapeuthics

Bayer entered in a collaboration with Atara Biotherapeutics on the development of next generation,
mesothelin-targeted CAR-T cell therapies for solid
tumors. Mesothelin overexpression can be found inmany tumors including ovarian, lung and pancreaticcancers as well as mesothelioma. Atara´s R&D thus
offers potential for transformative benefit in an areaof high unmet medical need: The number of mesothelin overexpressing tumors has been estimated to
be about 340,000 new cases a year with more than
2 million patients in the United States alone. As mesothelin overexpression plays an active role in bothmalignant transformation of tumors and tumor
aggressiveness, these cancers have short survival
times and the need for transformative therapies isparticularly high. CAR-T therapies have the potential to provide a meaningful clinical benefit and disrupt cancer care. These therapies are human T-cells
engineered by introduction of a chimeric antigen
receptor (CAR) that has the ability to recognize thecancer cells. The engineered CAR-T cells targeted tomesothelin can recognize and eliminate the abnor-

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mal mesothelin expressing cancerous cells from thepatient. The licensed technology leverages a novel,
proprietary Epstein-Barr Virus (EBV) T-cell platform combined with next generation CAR-T technologies targeting mesothelin to improve efficacy,
persistence, safety, and durability of response. The
collaboration includes two development candidates:
One next generation allogeneic CAR- T-cell immunotherapy (BAY3491688 / ATA 3271), and the otheran autologous version (BAY3491689 / ATA2271), forthe treatment of mesothelin-expressing tumors
such as malignant pleural mesothelioma and nonsmall-cell lung cancer. Atara is a pioneer in T-cell immunotherapy with an industry-leading manufacturing facility. In March 2021, the autologous program
BAY3491689 / ATA2271 reached the milestone offirst patient dosed in a Phase 1 clinical study.

44

1

Medtronic

Non-Invasive
Screening for
Colon Cancer(PillCam™)

PillCam™, created by Medtronic, is an easy-to-swallow pill — the size of a vitamin – that can help physicians diagnose gastrointestinal diseases, includingcolorectal cancer. It’s the second deadliest cancer
worldwide, with 935,000 deaths reported in 2020.
Yet, it remains preventable — 90% of patients canbeat it when caught early. PillCam™ capsule endoscopy has the potential to improve the patient experience and lessen the burden on Health Systems as
an alternative to more invasive, often more expensive, traditional procedures. The pandemic resulted
in a significant drop in elective GI procedures — suchas upper and lower endoscopies — so Medtronic partnered with regulators, Health Systems, andother industry leaders like Amazon to ensure that
diagnostic testing — with the potential to save lives— was no longer delayed. In the UK, the PillCam™
colon capsule helped meet the demand caused bythousands of cancelled or delayed colonoscopies,
with a minimally-invasive test that visualizes the colon; and in the U.S., the PillCam™ small bowel capsule
was permitted by the FDA to be delivered directly topatients’ homes using Amazon’s broad delivery network for the duration of the national public healthemergency. Digital transformation will further revolutionize this device. In the future, advanced AI
algorithms trained on hundreds of thousands ofanonymized images will create PillCam™ Genius —an intelligent capsule endoscopy device — allowing
for pattern identification to detect GI disease, suchas colorectal lesions. These algorithms, currently indevelopment, will enhance physicians’ ability to diagnose and direct their treatment — faster — in order to improve patient outcomes. With more data,
AI will only get more accurate — highlighting why
access to data is paramount to creating disruptive
solutions for healthcare.

1

Siemens
Healthineers

AI-RadCompanion

The AI-Rad Companion* is a family of products
which offer diagnostic aid for radiologists providing augmented workflows that support radiologists
in their diagnostic task interpreting medical images
using artificial intelligence and deep learning algorithms. It is intended to be used by a radiologist
concurrently with original images from modalities
such as Computer Tomographs (CT), Magnetic Resonance Imaging (MRI) scanners and digital X-ray
devices before a final decision is made on a case. Automatic post-processing by the AI-Rad Companion
can help to manage the workload of the radiologists
and improve the workflow efficiency. For example,
the AI-Rad Companion Chest CT, automatically
performs measurements and prepares results forreports – helping radiologists manage their workload. It automatically highlights abnormalities,
characterizes anatomies, and measures both whenthey’re relevant. The quantitative outcomes delivered by the AI-Rad Companion Chest CT do havean impact on clinical outcomes, as the inter-reader
variability reduces. In some countries, the numberof radiology examinations is skyrocketing, while thenumber of radiologists and imaging specialists isB20 POLICY PAPER HEALTH & LIFE SCIENCES

not keeping up with the trend. The result is a dramatically increased workload for radiologists. With
shorter reading time, the error rate may rise. The
retrospective error rate among radiological exams
is 30%. Cutting in half the interpretation time ofradiologists increases the interpretation error rate
percentage by 16,6%. Cancer cases are expected tosurge between now and 2030. That means radiotherapy departments will see a huge rise in the number of patients requiring their support. To manage
these challenges, the healthcare workforce needs tobe able to treat more patients, more efficiently. For
innovations such as the AI-Rad Companion to work
properly around the world, radiologists and hospitals require access to high-quality, standardized imaging data that can be exchanged between interoperable modalities from different vendors and accessto high speed internet. Policy makers should workwith the healthcare industry to enable interoperable
data access in and between countries. In addition,
the use of AI requires, among other things, up-todate cybersecurity infrastructures in hospitals andother healthcare institutions to ensure data privacy
and security.
1

Brave
HealthMental andbehavioral healthplatform

Brave Health has been able to give concrete answers to mental and behavioral health problems
and help afflicted patients to conduct a stable anddisorder-free life through a telehealth platform,
able to make treatments available to more people,
when and where they need it. Brave Health in fact isa virtual clinic, currently serving some US areas, thatprovides telehealth-enabled counselling, rehabilitation, psychology, and drug management, as well as
medication-assisted care. It treats a wide variety ofmental health and substance abuse disorders andallows patients to receive unique evidence-based
and highly personalized care plans, supported byqualified personnel (licensed physicians, nurse practitioners, therapists, counsellors, etc.).

1

MovendoTechnology

HunovaHunova is a robot for sport and health, created byMovendo Technology, which thanks to AI and big
data, is changing the way of rehabilitation and prevention. In fact, the robot isn’t limited to facilitating
the patient rehabilitation process, but also allows
to measure, predict and prevent many orthopedic, neurological, geriatric and pediatric diseases
with important benefits also in the sports. The visit
with Hunova lasts 20 minutes, during which the robot interacts with the patient also through gaming,monitoring 130 biomechanical and neurological parameters and acquiring 19 thousand data. Information is then processed with machine learning and AI
techniques at the end of which the robot will tell thepatient if and why it is at risk of accidental falls, highlight health status and deficient functions, assign anintervention plan, choosing from 200 exercises and
30 rehabilitation protocols ("Silver Index"). To date,
the robot also works to treat physical damage left by
COVID-19.

1

Huma

Remote Patient
Monitoring
platform

Huma, a global health tech company based in London (United Kingdom), and Discover-NOW, a healthdata research hub led by Imperial College HealthPartners, are powering remote care for people livingwith Type 2 Diabetes. Huma has developed a Remote
Patient Monitoring (RPM) platform that enables thecontinuation of patient monitoring while patientsare at home, and the education to help those livingwith chronic/long-term conditions to better understand and manage their health. Through remotemonitoring and group video consultations, patientsare seen more regularly, and their data is reviewed
more frequently, without increasing costs. Data
collected through the Huma platform is utilized tofurther understand, optimize and improve patient
pathways.

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46

1

BostonScientific

myTAVI, myPCI,AskAngie

Ask Angie is a merged reality technology, developed by Boston Scientific, that virtually connects
physicians with a catheter lab to expert support. In
addition to live support, Ask Angie provides clinicalapplications, setup, and troubleshooting for many
devices and procedures. The greatest advantage
and tool that Ask Angie enables is the fact that it
creates safe, timely and accurate support to HCPs
from manufacturers without risk of infection in a
COVID-19 period in which reps have difficulties toreach their clients under COVID-19 restrictions.
Also, it increases operational efficiencies by optimizing procedure times and minimizing errors.

1

AstraZeneca

Connect360

In order to improve severe asthma patient adherence to a medication and ultimately secure better
patient outcomes, AstraZeneca developed a digitalpatient platform called Connect360. Connect360
brings together patient information, patient data
and monitoring and communication with HCPs intoa single platform. Connect360 links with diagnostic
technology and a smartphone app to monitor patient's adherence to treatment, demonstrate correct usage of the medicine and remind patients totake their medication to prevent exacerbations.

1

1.1

Huawei

AI-Assisted
Screening
SystemThe Patient Screening system for COVID-19, developed by Huawei, is an AI program specifically designed to recognize COVID-19 in CT scans of lungs.
To create a database of images, doctors mark andlabel the tell-tale lesions caused by COVID-19-induced pneumonia in CT scans, providing the information that allows the algorithm to learn to identify
and recognize similar patterns in other CT scans.
The system has proven very effective in diagnosing
the disease quickly – up to three days faster thanmanual methods – and far more accurately – with
a 98% accuracy rate. Designed to adapt to the typeof data it receives, the AI program can be fed new
information on changing or evolving symptoms, allowing it to diagnose future mutations of the SARSCoV-2 virus. Huawei CLOUD has already deployed
the AI-Assisted Patient Screening system in 60 hospitals across the globe, including Malaysia, Thailand,
Italy, and Ecuador. Beyond the current COVID-19
crisis, the system could prove immensely useful infighting other infectious diseases.

1

1.1

Roche &
Moorfields Eye
Hospital

Home Vision
Monitor App

Home Vision Monitor App is a mobile application,
launched by Roche together with Moorfields Eye
Hospital for a pre-commercial trial, that allows patients, suffering from eye diseases such as neovascular age-related macular degeneration, to remotely
monitor their condition from their smart devices,to test for changes in their vision function once or
twice weekly. The care team can remotely monitor
each patient’s disease progression and detect those
who need clinic visits. Roche is a founding memberof INSIGHT—the health data research hub for eyehealth in the United Kingdom, which aims to build
one of the world’s largest data resources in ophthalmology. When this data is combined with advanced
analytics, the result can transform how eye diseases
are diagnosed and managed. Data from INSIGHT
are already being used to understand the impact of
COVID-19 on patients with these conditions. In addition to helping ensure patients with life-threatening or chronic diseases receive uninterrupted care,a team of Roche data scientists and epidemiologists
created a novel data and analytics tool to develop anunderstanding of the relationship among mobility,
infection and morbidity of SARS-CoV-2. This tool isbeing made available to local hospitals and testing
facilities to enable them to allocate resources more
effectively.

1

1.1

BiogenThe potential of
digital biomarkers in Alzheimer’s disease

Alzheimer’s disease is a progressive neurodegenerative disease that leads to cognitive impairment,functional disability and eventually death. It is the
3rd leading cause of death in developed coun-B20 POLICY PAPER HEALTH & LIFE SCIENCES

tries (according to the WHO), and the only top 10
causes of death without a preventative or curative
treatment, or one that slows its progression. As a
Pioneer in Neuroscience pushing science towards
novel approaches for previously intractable neurodegenerative conditions, Biogen remains committed
to furthering Alzheimer’s disease research and development, aiming to help address the unmet needsin this devastating condition, with an emphasis on
early-stage disease. Although Alzheimer’s disease isusually diagnosed in people aged 65 and older, andalthough the main risk factor for developing Alzheimer’s is ageing, Alzheimer’s disease is not a normalpart of ageing. As the proportion of people aged 65
and older is forecasted to increase, the number ofpeople living with Alzheimer’s disease and dementia – currently 10 million in Europe - is projected to
double by 2030. The costs of dementia in Europe
are estimated to increase to more than 250 €/mln
by 2030, 2 $/tn worldwide. Alzheimer’s disease operates out of sight – slowly developing over years
to cause injury to the brain. It can be present for
decades before it is even suspected. The build-up
of toxic plaques in the brain can begin 10-20 years
before the first symptoms appear. Even then, it often goes undetected for far too long. As such, andin addition to clinical development, Biogen is working to improve screening and develop advanced
technologies and digital tools to improve the timely detection of the earliest signs of Mild Cognitive
Impairment (MCI) of those developing Alzheimer’s
disease. One example of Biogen’s digital research
efforts includes a new virtual study to be launchedin collaboration with Apple that plans to investigate
the role Apple Watch and iPhone could play in monitoring cognitive performance. The collaboration will
aim to identify digital biomarkers to help monitor
cognitive performance over time and identify earlysigns of decline including MCI. The fully virtual study
will explore the subtle changes in behaviors of thosepeople that could be predictive of MCI, even before
any symptoms are visible to the person, family and/or circle of friends. Digital biomarkers derived fromeveryday use of consumer smartphones and smartwatches are an example of emerging digital healthtechnologies that may one day help healthcare providers accelerate diagnosis of cognitive impairment,a process that today currently can take up to 2 to 3
years.

1

1.2

AstraZeneca

Innovation
Centers, China

One promising model for integrating digital technology in order to improve healthcare delivery is
the Wuxi Internet of Things Innovation Centre in
China. Run by AstraZeneca together with local government and in partnership with over 200 local andinternational technology companies, since 2017 theInnovation Center has coordinated stakeholders inorder to re-evaluate the patient pathway and design solutions that integrate the latest technology
innovation in order to make it easier for patients toaccess information, screening, diagnosis, treatment
and follow up. The result is 14 disease management
solutions that are now being implemented in hospitals across China and have already helped over 10
million patients access ameliorated care, whether itbe through remote diagnosis using AI-empowered
screening, improved asthma case at hospitals byenabling technology to help patients self-manage
their treatment, or digitally equipped ambulances
to connect with patients sooner and transmit theirdata to hospitals in order to reduce waiting times.
This Wuxi collaboration model offers a glimpse ofwhat is possible when all stakeholders in the healthcare space collaborate together, beginning with afocus on truly understanding what care looks like toa typical patient and how that can be improved atevery juncture of the process. The center that was
initially launched in Wuxi is now being replicated inother parts of China, and has attracted the interestof stakeholders in other parts of the world to replicate the partnership model and explore how thesolutions themselves can be applied in other settings.
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48

1

1.2

A multidisciplinary
Europeanresearch-based
consortium
composed by 18
institutions

Exscalate4CoV(E4C)

The EXSCALATE4CoV (E4C) project is a public-private consortium composed of 18 partners and supported by the Horizon 2020 program of the European Union, which aims to combine IT, laboratory andclinical skills to identify potentially effective treatments against the SARS-CoV-2 virus. Using the IT resources currently available in the three most powerful European computing centers (CINECA, BSC andJÜLICH), the project aims to select, from over 500
billion molecules, the most promising treatments
against coronavirus both to enhance the design of
new drugs, both to identify, among the drugs alreadyavailable or in development for other pathologies,
those that show promising potential in the fightagainst the coronavirus. Recently, the consortium's
activity has achieved a first result, identifying raloxifene, a generic drug widely used for the treatmentof osteoporosis, a drug potentially capable of having
effects against SARS-CoV-2. However, the Consortium's work did not end here and last November in
Italy the most complex supercomputing experiment
ever carried out in the world was carried out to study
the interaction of over 70 billion antiviral moleculeswith the proteins of the SARS virus. Cov-2.

1

1.2

World Economic
Forum

The Davos
Alzheimer’s
Collaborative(DAC)

The Davos Alzheimer’s Collaborative, convened by
the World Economic Forum, was created as a global
effort to build a global response to the growing Alzheimer’s disease pandemic. Its practical approach inthe context of dementia will allow the accelerationof progress in three areas: 1) global cohort development to increase discovery of targets for drug development with associated biomarkers; 2) global clinical
trials to reduce the cost and time to bring new treatments to market; and 3) Health System preparedness
to advance Health System readiness in the fields ofdetection, diagnosis, infrastructure, and access. Thisapproach will help governments reduce the burdenof such diseases in both developed and developing
nations. Since its conception at Davos 2020, DAC
has gained support for a six-year, 700 $/mln plan toaccelerate and diversify innovation in Alzheimer’s
disease.

1

1.4

EuropeanCommission

1+ Million
Genomes

The European Union has launched the “1+ Million Genomes” initiative, which is a cooperation mechanism
involving 24 countries aiming to create a frameworkthat will enable linking, access, and analysis of genomic and health data in Europe, both inside and acrossnational boundaries. Genomics in fact has the potential to revolutionize healthcare in many ways. It could
lead to the development of more targeted personalized medicines, therapies and interventions. It could
also enable better diagnostics, boost prevention andmake more efficient use of scarce resources. From
cancer, to rare diseases, neuro diseases and prevention, genomics can greatly improve health conditionsof EU citizens. Equally important, genomics has thepotential to improve the effectiveness, accessibility,
sustainability and resilience of Health Systems in theEuropean Union. To create this framework with its
focus on more than one million genomes, new waysof collaborating are needed and various areas of activity are at the core of the initiative’s work: work organization, implementing personalized healthcare in
Health Systems in cost-effective and efficient ways,
ethical, legal, and social issues, health and phenotypicdata, good genomic practice and standards, and infrastructure and interoperability.

1

1.4

CEO Roundtable on Cancer’sLife Sciences
Consortium

Project Data
SphereThe Project Data Sphere, an independent andnon-profit project of the CEO Roundtable on Cancer’s Life Sciences Consortium, created to develop
and implement initiatives for the reduction of cancer
risk, diagnosis access to the best available treatments
and support for the discovery of new and more effective anticancer therapies. The project revolves
around a web-based platform for accessing open-

B20 POLICY PAPER HEALTH & LIFE SCIENCES

source data. Through this site, researchers can download, share, integrate and analyse patient-level datafrom Phase III cancer clinical trials conducted by academic researchers or pharmaceutical companies. It isa model that could increase the knowledge of a large
community of scientists from different fields andpromote crowd-sourced solutions to important clinical problems. To date, Project Data Sphere has successfully housed more than 150 datasets from over
100,000 cancer patients and provides community
access to these data. Data has been accessed nearly
20,000 times and has supported 81 publications todate. The data have also supported the developmentof multiple new tools that will aid product development in different cancers.
1

1.4

Huma

Remotemonitoring
for COVID-19
patients

In 2020 the UK’s NHS teamed up with Huma to provide remote monitoring for COVID-19 patients. The
solution comprises a smartphone app (Medopad)
for patients, a web-based portal for HCPs, companion medical devices like digital thermometers andpulse-oximeters. The app allows patients to record
the symptoms and physiological parameters such asheart rate, blood pressure, oxygen saturation, bodytemperature, etc. simply by remaining at home under
the remote supervision of their care team. This not
only avoids unnecessary travel and exposure, but also
helps Health Systems manage capacity. Care teams
are able to configure thresholds for alerts. They can
use the flagging system to identify COVID-19 patients' health deterioration or improvement and adjust their care plan accordingly. The solution was tested as a pilot in 5 healthcare facilities and allowed toachieve: an average of 32 minutes saved per patientin one healthcare facility, an average of three minutes
saved per 'hot hub' patient per day, a 5% 28-day readmission rate for Medopad patients vs 8% for non-Medopad patients, 100% Medopad patient recovery ratein primary care vs 87% for non-Medopad patients.

1

1.4

Huma

BreeConnect

BreeConnect is a smartphone application, developed by Huma and Bayer, with the goal to constantly
support people affected by Pulmonary Arterial Hypertension (PAH) to monitor and keep track of their
medication doses and to maintain a healthy qualityof life. BreeConnect connects to a patient's Breelib®
nebulizer and can track the patient’s medication dose
against their prescribed medication regimen. Moreover, this application allows people to monitor theiroverall physical activity and health related quality oflife for a complete understanding of their current
health state. The information stored by the application is automatically shared with the care team thatcan further analyze the health status of the individual.

1

1.4

Huma

Digital Data
collection
for monitoring
COVID-19
spreadCambridge MRC Epidemiological unit is partneringwith Huma to collect an array of digital data acrossthe cohort to monitor the spread and impact of
COVID-19 across a well-studied and deeply phenotyped group of individuals. By combining existing richFenland data such as WGS, multi-omics, blood-based
biomarkers, functional assessments, imaging, lifestyleand many other clinical parameters, from the Fenland
study that investigates the interaction between environmental and genetic factors, with prospectively
collected digital data alongside 2-monthly COVID-19
serological testing. The ultimate objective is to create
an integrated data framework to enable machinelearning driven analytics to identify novel digital biomarkers.

1

1.4Foundation
Medicine Inc &Roche

Comprehensive
genomic
profiling

Comprehensive genomic profiling (CGP) tests, developed by Foundation Medicine Inc and Roche, broadly
analyze the tumor genome to identify clinically relevant genomic alterations and genomic signatures tohelp physicians in deciding on the most appropriate
treatment choices for each individual patient. Where
permissible, the de-identified / pseudonymized data49

B20 POLICY PAPER HEALTH & LIFE SCIENCES

from Foundation Medicine’s clinical CGP testing isstored in Foundation Medicine’s FoundationCORE®.
One of the largest databases of real-world comprehensive genomic profiling results in oncology, FoundationCORE® currently includes more than 450,000
genomic profiles in a structured format. This data canbe leveraged to inform the next generation of treatments, creating a valuable resource for biopharmaceutical companies and academic researchers acrossthe globe.

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2

2.1

Medtronic

A VBHC Modelfor Diabetes
Management(Diabeter)

Diabeter, a Dutch-certified clinic network owned by
Medtronic has pioneered a new value-based diabetes care model for pediatric type 1 diabetes patientsin the Netherlands. Each clinic in the network is organized as an Integrated Practice Unit (IPU), where amultidisciplinary team of diabetes care specialists is
responsible for the full cycle of care for an individual
patient. An IT platform developed by Diabeter makes
real-time patient data available to the care team andpatient via e-dashboards, personalized emails andphysician alerts. This coordinated data sharing allows
for timely adjustments to therapy that – in turn – optimize results that matter to the patient. The Diabeter
network has grown to include 2,000 patients acrossfive locations and is a top performer when comparedto other clinics of at least 100 patients. Diabeter’s
success in helping patients reach their target HbA1c
number (the key outcome measure for patients withdiabetes) has led to a lower hospitalization rate thanother Dutch pediatric diabetes clinics and less direct annual costs for individuals. As a result of thesesavings, the Netherlands’ largest health insurance
provider, Zilveren Kruis, implemented a value-based
payment model that shares the benefits from better
health outcomes and lower healthcare costs for its
patients. The World Economic Forum recently selected Diabeter as a Global Innovation Hub.

2

2.1

Roche

VBHC for nonclear cell renal
cancer patients

In 2018 Roche launched in Denmark a partnership
between the Herlev Gentofte Hospital and its genomic division Foundation Medicine Inc to compare
treatment outcomes and costs for non-clear cell renal cancer patients. Clinicians and researchers investigate the clinical impact of targeted immunotherapy
through genetic profiling and personalized medicine
Roche and FMI use gene-profiling technologies combined with artificial intelligence to support treatment
decision-making. For each patient measures include
quality of life as well as costs relative to the episodeof care. All treatment options including those notprovided by Roche
are evaluated with the same
methodology. Through this VBHC approach medical
teams are learning how to compare the holistic valueof different treatment options paving the way for future procurement negotiations on precision medicine

2

2.1

Boston Scientific

VBHC forchronic pain

Chronic pain is one of the most impacting diseases
in terms of both disability and healthcare resources
consumption. In addition, some effective treatments
such as spinal cord stimulation (SCS) are under-adopted due to cultural limits, lack of knowledge andeconomic constraints. Boston Scientific supported
Hospital Pain Therapy departments in Italy throughthe implementation of a Value Based approaches
to optimize processes of care i.e. eliminating redundancy or un-useful treatments and to implement SCS
treatment in the best possible way taking into consideration both clinical and organizational appropriateness. VBHC implementation has a positive impact onseveral areas such as clinical outcomes maximization,
patient quality of life restoration thanks to pain reduction and discontinuation of drug consumption,
hospital and NHS important reduction in the expenditure related to chronic patient management.
Through VBHC implementation it has been possible
to guarantee the best and innovative care strategy
based on SCS for chronic pain patients as proper andensure the sustainability of the NHS without compromising the quality of delivered care.

B20 POLICY PAPER HEALTH & LIFE SCIENCES

2

2.1

Medtronic

Value Based
Healthcare
Procurement(Cryoballoon)

Medtronic recently signed the first value-based procurement agreement in Italy with the central purchasing agency in the Tuscany region (Estar). Under
the agreement, Medtronic assumes the risk of any
ineffectiveness of its Cryoballoon ablation therapy
used to treat atrial fibrillation, an irregular rhythmof the heart. For each repeat ablation procedure,
Medtronic will provide a free Cryoballon kit, up to a
maximum of 15% of the number of patients treated in
12 months. By engaging in value-based procurement,
payers, providers, and governments can realize costsavings for themselves, while also delivering improved
outcomes for the patients they serve.

2

2.2

Humanitas
Research
Hospital

VBHC bariatricsurgery

In Humanitas, a highly specialized teaching and research hospital located in Milan (Italy), in 2015 a
multi-disciplinary team reviewed for the first time
the bariatric surgery clinical path, involving directly the patients and their caregivers. This led to thedefinition of relevant new outcomes like for example
pain after surgery and the reduction of comorbidities,
such as diabetes, that weren’t considered and measured before. This review resulted in better outcomesin post-surgery where 77,5% of patients had no pain,
the death rate was down to 0 and the readmission
decreased to 0,4%. It also resulted, in the medium
run, with no diabetic patients in 81% of the sample
and no night apnea in 76% of the cases.

2

2.2

Johnson &JohnsonDelivering
patient pathway
optimization
at Barts Health
NHS Trust

A VBHC approach to address Triple Aim (increase
efficiency, reduce costs and increase patient satisfaction) in secondary case setting has been implemented by Johnson & Johnson and Barts Health NHS Trust,focusing specifically on a patient pathway for elective
orthopedic surgery. The patient pathway optimization, through clinical best practices standardization,
process variation reduction and staff engagement
increase, allowed to improve clinical outcomes (e.g.
Oxford Hip scores and Oxford Knee scores), save bed
days, increase surgical utilization and generate extra
minutes operating theatre time to schedule additional procedures and realize associated productivity andincome gains.

2

2.2

Boston ScientificHeartLogic

HeartLogic, a Boston Scientific validated diagnostic
tool for heart failure, together with the adoption ofdiagnostic algorithms and sensors capable of recording physiological variables is able to detect early
warning signs of a potential worsening of heart failure. The HeartLogic index aggregates measurementsfrom multiple sensors placed on the device (heart
tones, chest impedance, respiration, night rate andactivity) and reflects changes over time in the datacompared to the corresponding baseline values.
Heart Logic has been shown to preventively detect
70% of heart failure events, with an average advanceof 34 days, thus bringing to less than 2 alarms for episodes of destabilization of heart failure that could
occur within a year. Solutions such as HeartLogic represent innovations capable of concretely contributing
to good health, both through the prevention of critical issues and the reduction of hospitalizations, andwith the overall care of the patient who is ensured
effective care, continuous monitoring and assistanceand a good quality of life.

2

2.2

Medtronic

The
Solitaire ™
deviceStroke is the second leading cause of death worldwide killing about 5,5 million people annually. The
Solitaire™ device, a Medtronic Med Tech innovation,
has revolutionized stroke care. The revascularization
device provides physicians improved delivery performance. The. Solitaire™ device can be navigated endovascularly, through blood vessels in the body, into thebrain to capture and remove the clot, thus restoringfull blood flow immediately. The prime study of thedevice, that led to the FDA approval, showed that in
68,7% of patients the large vessel is completely open
and that in 89% of the patients the large vessel is atleast 50% open. Furthermore, 60,8% of the treated51

B20 POLICY PAPER HEALTH & LIFE SCIENCES

patients showed an almost complete return to functional independence. With innovation, outcomes are
improved, cost savings are realized and economic
burden avoided.

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2

2.3

Huma

BioBeats

BioBeats, a Huma company, has developed and validated a holistic wellness tool for mental health which
combines measures of activity, sleep, heart rate andself-reported wellbeing using phone and wearable
data, to continuously measure user wellness. These
measures are crucial in identifying mental deterioration early and support patients to maintain qualityof life and sustain lifestyle change. The product also
provides tailored wellness activities and educational
resources. In addition, the product offers customized
wellness activities and educational resources. The
tool can be used to promote healthy lifestyles andimprove wellbeing by employers, healthy systems,
insurance companies, or directly by customers. Thissolution provides a constant monitoring of an individual's mental health state and is able to identify possible issues that might arise in order to prevent further
mental deterioration.

2

2.3

Lyfebulb

Evolution andeffectiveness ofpatients' journey

Lyfebulb is a patient engagement platform thatbridges the gap between patient communities andthe healthcare industry, bringing insights and solutions from patients to industry and empowering patients to get their voices heard by those who can bring
revolutionary products to market. This care management approach would allow Health Systems to better assist patients throughout their journey. It would
create a more tailored and successful experience thatwould constantly improve due to the insights andsolutions received by patients.

2

2.3

Onegevity

AI platform forpatients’empowerment

Onegevity Health is a consumer health intelligencecompany that combines a unique multi-omic artificial intelligence (AI) platform and machine learning with user-friendly, at-home tests, products, anddigital health services. The mission of Onegevity is
to use an all-in-one platform to empower individuals seeking better health with the best science frompersonalized health research, a platform that targets underserved, wide-spread chronic health issues
across patient populations. Onegevity provides patients with advanced at-home tests, such as Gutbio,
a microbiome test that uses cutting-edge sequencing
and AI to provide an in-depth look at your gut health,Agebio, which reveals the body’s biological age vschronological age, and provides personalized recommendations (e.g. lifestyle, sport, food, supplementation) from a scientifically validated blood panel, tokeep the body healthy for longer. The Health Intelligence Platform translates a wealth of complex healthinformation obtained from the tests into actionableinsights on how to optimize health and wellness. The
platform also leverages the billions and trillions ofdata points collected on other individuals similar tothe person who’s using the service, so that she/he can
optimize their health using the collective intelligenceof the Onegevity community. Onegevity focuses on“precision wellness”. Through the at-home tests thesystem identifies patterns of variation associatedwith diminishing wellbeing and uses machine learning
to address the results with actionable solutions for
diet, nutrition, and lifestyle measures. The solutions
are individual lifestyle recommendations intended
to restore altered patterns to an increased state ofthriving.

2

2.3

Huma

COVID-19
Severity Risk
Score

COVID-19 Severity Risk Score is a personalized andhighly accurate assessment, developed by Huma inpartnership with Johns Hopkins University, of an individual’s risk of developing severe complications for
COVID-19. This tool combines 31 criteria and risk factors associated with COVID-19 and empowers people to make informed decisions based on their risk

B20 POLICY PAPER HEALTH & LIFE SCIENCES

profile creating a more resilient population and canbe used to screen participants for clinical trial enrolment. This tool enables individuals to better acknowledge their singular situation and better prevent themfrom increasing the chances of developing severe
complications.
2

2.3

Mantra Beauty

Improving healthhabits to prevent
skin diseases by
providing trustable information

Mantra Beauty, a small/medium enterprise basedin Latin America with headquarters in Argentina iscommitted to the prevention of skin diseases andto improving the health’s habits of clients. The company provides regular and trustable information
on good habits and the importance of self-care forhealthy skin and general well-being. With this innovative approach, Mantra seeks to build a long-term
relationship of trust with the Mantra’s community,“Mantra Lovers”, while contributing to the SDG 3 bypromoting healthy lives and well-being for everyone.
In 2020, Mantra launched their “Sun Damage Awareness Campaign” in social media, which included recommendations provided by Board Certified Dermatologists specialized in skin cancer with the objectiveof incentivizing the regular use of sun protection
regularly, as the principal factor to prevent skin pathologies. The campaign reached more than 100.000
followers around different countries of Latin America and according to a survey conducted by Mantra
among its clients’ base, 60% begun using sun protection on a daily basis after the campaign. Moreover,
39% started a skin care routine and 29% booked theirfirst online meeting with a dermatologist. Around
80% of responders are between 25 and 44 years old,
meaning that they are in a crucial stage of their lives
to improve health habits and prevent skin diseases in
the future.

2

2.3

Dai-chi Life
Insurance
Company

Health Checkup
Discount

Health Checkup Discount is a life insurance industry-first system, created by Dai-chi Life Insurance
Company in Japan, that offers a discount simply forsubmitting the results of a health checkup when buying a life insurance policy, and approximately 80% ofpolicies so far have had the “Health Checkup Discount” applied. The discount does not reward only
healthy people, but all policyholders who get a healthcheckup, creating the opportunity for customers to
become aware of their health, including the importance of early detection and early treatment of diseases and improvement of lifestyle habits. Throughthis system, about 40,000 Total Life Plan Designers
reach out to customers and encourage them to havea health checkup, which translates into a greaternumber of customers promoting their health. Behindthe Health Checkup Discount is an idea that undergoing a health checkup is the first step toward good
health. In fact, data shows that relative to people who
do not undergo health checkups, those who do are
10% less likely to require payments due to the threemajor diseases (cancer, acute myocardial infarctions,and strokes) and 30% less likely to require payments
due to death. This data was derived following an analysis of big data on over 10 million insurance policies of
Dai-ichi Life using the latest technology.

2

2.3

Neo First Life

Health Age
Insurance

Neo First Life is a Japan-based life insurance company that offers an industry-first product using “HealthAge” to calculate the premiums instead of “Actual
Age.” "Actual Age" has been traditionally used to
calculate insurance premiums in the Life and Medical insurance industry. However, a customer's healthstatus does not always have a relationship with theiractual age, as it is affected by their daily lifestyles. The
developed product re-calculates the premium every
3 years based on the customer's health checkup resultand offers less premium for less health age. Neo FirstLife developed a unique mechanism that predicts a
customer's chance of getting diseases from healthcheckup results through 10 million health and medical
big data analyses.

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54

2

2.3

Technogym

Wellness Valley

The Wellness Valley is the first international Districtfor knowledge in Wellness and the Quality of Lifeand the first example of a Wellness Community inthe world. The project involves the whole region of
Romagna and was launched publicly in 2002 Technogym. The Wellness Valley is a social innovation
model which focuses on people and their health andpromotes well-being for everyone at all ages by creating an environment that supports and encourages
healthy lifestyle choices. The Wellness Valley project
leverages the human, economic and social capital of
Romagna and networks the excellences to produce
innovative projects and initiatives that bring wellness into the lives of thousands of people, with benefits at both an individual and a collective level. The
initiative involves over 250 public and private stakeholders, including institutions, municipal administrations, schools, companies, medical doctors, research
centres, health authorities, the university, sports andcultural associations, gyms, spas and hotels. Over theyears more than 70 best practices have been developed in the Wellness Valley which make this territory
a true living lab and demonstrate how it is possible tocreate a “Wellness Ecosystem”: from the educational
programs against childhood obesity to free physicalactivity in public parks for active aging, from the prescription of physical exercise for the prevention ofchronic diseases to the promotion of lifestyle events
up to active holiday packages that combine movement, food and wine, nature, art and culture. Today
the Wellness Valley is regarded as an international
benchmark for the realization of effective, inclusive
and sustainable integrated Health Systems.

3

3.1

World Economic Forum,
AstraZeneca
and London
School of
Economics

Partnership for
Health System
Sustainability
and Resilience(PHSSR)The Partnership for Health System Sustainability and
Resilience (PHSSR), an initiative launched by the London School of Economics (LSE), the World Economic Forum (WEF) and AstraZeneca, whose goal is tocontribute to the preservation and improvement of
global health in the long term, by improving understanding and enabling actions to be taken towards
sustainability and resilience of the health system ona global basis. The initiative, which sees eight OECD
countries as protagonists, produced a pilot study,
aimed at understanding the factors that ensure resilience and sustainability to Health Systems, withparticular reference to the SARS-Cov2 pandemic.
Thanks to the use of a framework to measure the resilience and sustainability of Health Systems with reference to 5 domains (governance, financing, personnel, drugs and technologies and provision of healthservices), a series of recommendations and a preliminary assessment have been identified. application of
the framework, identifying the areas in which this canbe strengthened.

3

3.1

CEPI, Gavi,
WHO and
UNICEF

COVAX

Gavi, a global public-private partnership was definedin 2000, to bring together the best of what key UN
agencies, governments, the vaccine industry, private sector and civil society had to offer in order toimprove childhood immunization coverage in poor
countries and to accelerate access to new vaccines.
Gavi represents the sum of its partners' individual strengths, from WHO's scientific expertise and
UNICEF's procurement system to the financial knowhow of the World Bank and the market knowledge ofthe vaccine industry. By pooling demand for vaccinesfrom the world’s poorest countries, securing longterm funding and shaping vaccine markets, GAVI
accelerates access to life-saving vaccines in the countries that need them the most. Since its foundation,
GAVI has defined five-year strategic plans, identified
a set of mission indicators and a set of specific strategic indicators to measure the effectiveness of its
actions. Overall, since 2000 GAVI has achieved thefollowing objectives: +822 million children vaccinated through routine programs: +1,1 billion vaccinations
through vaccination campaigns, +14 million future
deaths prevented, 255 million future disability adjusted life years (DALYs) averted as a result of vaccination

B20 POLICY PAPER HEALTH & LIFE SCIENCES

with Gavi supported vaccines from 2016-2019, 495
vaccine introductions and campaigns. The importance of partnerships is also crucial at a time when
the COVID-19 pandemic is spreading and there is arace to find a cure. In fact, to prevent economicallyricher countries from hoarding most of the available
vaccine doses at the expense of poorer nations, an
ad hoc program (Covax), co-led by CEPI, Gavi, WHO
and UNICEF, was launched in April 2020. Bringing
together governments, global health organizations,manufacturers, scientists, private sector, civil society
and philanthropy, with the aim of providing innovative and equitable access to COVID-19 diagnostics,
treatments and vaccines. COVAX has so far shippedover 30 million COVID-19 vaccines to 54 participants.
3

3.2

HuaweiAnimal healthmonitoringfor pandemic
prevention

Huawei, the Chinese tech giant, launched an artificial
intelligence pig farming project that will help farmers
in China, to better track the health of their livestock.
The technological innovation consists in facial recognition that can identify individual pigs and othertechnologies that can monitor the pigs’ weight, dietand level of exercise. These technologies will allow
pig farmers to constantly monitor their animals anddetect threatening diseases in time. These innovative
solutions revolutionized the concept of livestock andanimal monitoring and the early detection of possible threatening conditions. These intelligent technologies for agriculture and aquaculture will allow amore controlled environment for animals where they
can healthily grow. It will also reduce global costs of
prevention. These innovations will definitely help withprevention of future pandemic scenarios.

3

3.2

Stingray

Animal healthmonitoringfor pandemic
prevention

Stingray, a Norwegian company, developed a uniqueand innovative system that targets and kills lice on
salmon and trout with a laser while also monitoring
their health and growth 24/7. This innovative patented solution, using an image-based louse counting,provides a better overview of the parasite infection.
Stingray’s technology combines stereo machine vision, advanced software and high-precision laser totarget and kill parasites that infect farmed fish, aswell as monitoring growth via biometrics application.

3

3.2

visio.ai

Animal healthmonitoringfor pandemic
prevention

Viso.ai is a tech company that developed a computer vision platform called Vision Suite. This platform,
through the adoption of AI technology, uses camera
streams for real object-detection in many fields, aswell as in agriculture and farming. With visual Deep
Learning it is possible to automatically detect livestock, track animal movements or behaviors acrossmultiple locations. This will allow us to constantly
monitor animals’ health and wellbeing.

3

3.3

Johnson &JohnsonResolution

Resolution is an innovative end-to-end touchless supply chain solution driven by Radio Frequency Identification technology for seamless order and inventory
management. It reduces the risk associated with processing error from the check and replenish process
by delivering an automated solution. It automaticallymanages the procurement of medical devices in theoperating room, tracks consumption for individual
patients or surgical procedures and controls warehouse movements. It fits perfectly in support of thecurrent need to increase remote control, reduce contacts between staff and free up resources to devote
to patient care. Resolution enables efficiency and costsaving through the entire healthcare value chain.

3

3.3

Medtronic

Ventilator Global
Supply Chain

Medtronic, the world’s largest medical device company, has more than 48,000 suppliers across 135
countries. The most complex Medtronic ventilator
contains more than 1,500 components. More than
100 suppliers in 14 different countries build the parts.
As the global pandemic brought unprecedented ventilator demand, two constraints hindered the rapid55

B20 POLICY PAPER HEALTH & LIFE SCIENCES

quintupling of production. First, government-imposed export restrictions blocked key components.
Second, some key suppliers in G20 countries lacked
capacity to rapidly scale production. Medtronic andits suppliers organized intensive advocacy to easegovernment export restrictions and keep facilities
operating as essential businesses. Medtronic scoured
the globe for additional suppliers with the engineering skill, quality systems, and manufacturing capacity
for components for life-saving equipment. The additional suppliers came from diverse places, from the
U.S. to Vietnam. Going forward, the keys to greater
supply chain resiliency are:Measures by companies to ensure less dependence
on a few suppliers, new approaches to inventory
management, re-evaluation of contractual structures, consideration of logistics service providers as
partners, rethinking sourcing and make or buy decisions, and supply chain digitalization
Measures by governments, especially the global leaders of the G20, to avoid trade restrictions and competitive national supply chain retrenchment, whichrisks weakening the supply chain for all; andDialogue between industry and governments on theactual supply chain situation and measures to help
reduce potential choke points or exposures.

56

3

3.4

Chiesi
Farmaceutici

B Corporation
Certification

In today's environment adopting sustainable models,more respectful of the environment, is an imperative
for all organizations, a prerequisite for continuing tooperate on the market. In such a context act B Corporations, i.e., companies that together form a global
movement whose aim is to spread a more evolved
business paradigm. Worldwide, certified B Corporations stand out because they go beyond the profit
goal and continuously innovate to maximize their positive impact on employees, the communities in which
they operate, the environment and all stakeholders.
In fact, the B Corporations company voluntarily andformally chooses to simultaneously produce socialand environmental benefits while achieving its profit results. In the Life Sciences sector, one of the maingroups that has chosen to embrace this cause is Chiesi, adopting a business model with a dual purpose,
which pursues financial objectives and the progressof society in favor of all shareholders, people, communities and of the environment. Furthermore, as acertified B Corp, Chiesi is called upon to measure theimpact of its actions every year in order to pursue andachieve the dual purpose. With specific reference toissues, for example, Chiesi has taken tangible actions
to measure, reduce and offset CO2 emissions (-11%2019 vs 2018), increased the use of renewable energy(4,5x 2019 vs 2018), adopted a sustainable chemistry
approach and mapped the waste produced by industrial processes to define the best management (-21%2019 vs 2018), committed to achieving Carbon Neutrality by 2035, well before the 2050 target set out in
the Paris agreement.

3

3.4

Boehringer
Ingelheim

Foot & Mouth
Disease (FMD)
and Rabies
Management

Beyond the economic impact of an FMD outbreak,there is a significant cost to farmers and their local
communities as well as to local food security. During
the last FMD outbreak in the UK for example, themental and emotional effects of culling some 6,5
million animals were far-reaching and constituted
significant social trauma, in addition to the important
corresponding environmental footprint. BI manages
17 national and regional FMD vaccine banks insuring
countries against such outbreaks and their consequences. Boehringer Ingelheim works with the respective national disease control authorities to modeland plan optimal vaccination programs in the eventof an outbreak. Boehringer Ingelheim is investing
230m euro in a biosafety level-3 production site inFrance for the manufacturing of FMD vaccine. Since
the sixties of the last century, Boehringer Ingelheim
has been a partner to institutions, health authorities
and veterinarians for the control of rabies. Globally,B20 POLICY PAPER HEALTH & LIFE SCIENCES

Boehringer Ingelheim has the largest footprint within the industry for rabies control both in pets and inwildlife with nearly 100 million vaccine doses administered annually. Rabies is a classic One Health example in the sense that preventive vaccination of straydogs offers significant potential for savings in humanhealth expenditure. The cumulative cost of post-exposure prophylaxis required for human victims ofdog bites in an endemic geography tends to be muchhigher than the cost of preventive rabies vaccination
programs for dogs. An example in action here is a
project in Pakistan where stray dogs are first vaccinated against rabies, and then marked with a collar
that identifies them as safe.

Schedule of Taskforce Exchanges#

Date

LocationTheme1

21/22 01.2021

RemoteInception Meeting2

23/02/2021

RemoteConference Call I3

23/03/2021

RemoteConference Call II

4

27/04/2021

RemoteConference Call III

5

01/06/2021

RemoteConference Call IV

Distribution of Members
Country#Country#Country

#

Italy

30

United Kingdom

4

Mexico2Germany

7

Russia3

Australia

1

USA

6

Argentina

3

Uruguay

1

France6

Brazil3South Africa

1

Switzerland

5

Japan

3

Portugal

1

Turkey5

Saudi Arabia

2

Canada

1

China

4

Spain

2

Belgium

1

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B20 POLICY PAPER HEALTH & LIFE SCIENCES

Taskforce Members
NameCompany/Organization

DeputyCountryDompé Farmaceutici

Guido Romeo

Italy

Werner Baumann

Bayer

Claus Runge

Germany

Sir Mark Caulfield

Barts Life Sciences

Geoff Martha

Medtronic

James Southwick

USA

Leon Wang

AstraZeneca

Sjoerd Hubben

China

Chair
Sergio Dompé
Co-Chairs

United Kingdom

Members

58

Maha Alateeki

Second Direction Co.

Saudi Arabia

Nidal Alattas

Sidanah International company

Saudi Arabia

Alberto Chiesi

Chiesi Farmaceutici S.p.A.

Italy

Erica AlessandriTechnogym

Italy

Alberto Alvarez Saavedra

Gador S.A.

Uruguay

Celestino Alves

Vanderturion

Portugal

Diego Andreis

Fluid-o-TechItaly

Pierluigi Antonelli

Angelini Pharma

ItalyJohn Bakker

Pharmidex Pharmaceutical Services Ltd

United Kingdom

Alper BobekTofaş - FCA Bursa Plant

TurkeyMassimiliano Boggetti

Confindustria Dispositivi Medici

Italy

Olivier Bogillot

SanofiFranceRiccardo Braglia

Helsinn

Switzerland

Juan Martin Buccafusca Jurado

Coordinadora de las Industrias de Productos Alimenticios

Argentina

Mustafa Oguzcan Bulbul

Abdi Ibrahim Pharmaceuticals

TurkeyAlan Butler

Molson Coors

CanadaDomenico Maria CaprioliYoursciencebc Ltd

Italy

Massimo Caputi

Terme di Saturnia

Italy

Francesco Cecchini Manara

Gondola Medical Technologies SA

Switzerland

B20 POLICY PAPER HEALTH & LIFE SCIENCES

Fabrizio Chines

SIFI

Italy

Alfredo Citrigno

Group Citrigno

Italy

Gennaro Claps

Comunica.Live srl

Italy

Viktoria De Bourbon De Parme

World Benchmarking Alliance

Switzerland

Daniela Delledonne

Becton Dickinson & Company

Italy

Stefan Dittmer

Dentons, International Chamber of Commerce

Germany

Victor Dmitriev

ARPM

RussiaJohn Dombrosky

Oerth Bio

USA

Victor Dosoretz

Mantra Beauty

Argentina

Adolph Dubose

Athena Health

USA

Facundo Etchebehere

DanoneFranceSergio Fontana

Farmalabor SRL

Italy

Johanna Friedl-Naderer

BiogenSwitzerland

Massimo Gaiotto

A. Menarini Srl Industrie Farmaceutiche Riunite

Italy

Ugo Gay

DiaSorin SpA

Italy

Laura Gillio Meina

Boston Scientific

Italy

Ferron Gray

Grae Matta Foundation

United Kingdom

Berit Hamer

Ottobock SE & Co. KgaA

Germany

Shanna Hiemstra

Medtronic

South Africa

Nina Kandelaki

Russian Direct Investment Fund

RussiaTaku Kitayama

Keidanren Japan Business Federation

Japan

Maria Laura Lefevre

Unión Industrial Argentina

Argentina

Mark Lloyd Davies

Johnson & Johnson

United Kingdom

Martina Lorusso

Bawer S.p.A.

Italy

Jeffrey Minfang Lu

China Mengniu Dairy Company Limited

China

Alexsandra Machado

DiageoBrazilSavas Malkoc

Pharmaceutical Manufacturers Association of Turkey (IEIS)

TurkeyEnrico Manaresi

Technogym

Italy

Roberto Marti

Isopharma Cosmetics Srl

Italy

59

B20 POLICY PAPER HEALTH & LIFE SCIENCES

60

Henrique Mattos

Novartis Biociências

Brazil

Ben Mayer

Siemens Healthineers GmbHGermany

Rafael Mazzeo Ferri

Sandoz (Novartis Group)

BrazilStefano Mazzuccato

Casa di Cura Madonna della Salute

Italy

Fabrice Meillier

LEEM - Les Entreprises Du Médicament

FranceNathalie Moll

European Federation of Pharmaceutical Industries & Associations

Belgium

Ryan Morhard

Ginkgo Bioworks

USA

Alexandra Ogneva

Roscongress Foundation

RussiaCemal Seref Oguzhan Ozturk

Arçelik

TurkeyGaia Simonetta Panina

Novartis Farma S.p.A.

Italy

Mark Pearson

OECD

FranceOliviero Pelosini

B. Braun Milano Spa

Italy

Mario Pennisi

Biostate Pty Ltd

Australia

Stefano Piancastelli

Tema Sinergie Spa

Italy

Dorothée Pineau

Medef

FranceAlessandra Polin

General Filter Italia SpA

Italy

Monika Puri

Hoffmann-La Roche

Switzerland

Luciano Ravera

Humanitas

Italy

Fulvio Renoldi Bracco

Bracco Imaging Spa

Italy

Luis RossanoBlue Quark Group

MexicoPremarajani Sabanantham

GHA - German Health Alliance

Germany

Adriana Silvia Sartor

Elettrotec Srl

Italy

Michael Schmitz

Crowell & Moring International

USA

Paul Sekhri

eGenesis, Inc.

USA

Neal Seth

Wiley Rein LLP

USAChristoph Seydel

Mededis GmbHGermany

Peilan Shen

CCPIT

China

Simona Sinesi

Never Give Up (Social Impact Organisation)

Italy

Hiroko Sugiyama

Astellas Pharma Inc.

Japan

B20 POLICY PAPER HEALTH & LIFE SCIENCES

Ahmet Tamer

Güven Future

TurkeyHiroki Tamura

Business at OECD (BIAC)

FranceFabio Torriglia

ViatrisItaly

Toshitsugu Tsuji

The Global Federation of Insurance Associations

Japan

Filippo Uberti

Eni S.p.A.

Italy

Dan Vahdat

Huma

United Kingdom

Emmanuelle Valentin

General Medicine GBU Sanofi

Italy

Miguel Angel Vargas Cruz

Grupo Alianza Empresarial

MexicoSara Vinciguerra

Boehringer Ingelheim

Germany

Hao Yu Xu

Yangtze River Pharmaceutical GroupChina

Hao YuBGI Group

China

Carlos Zarco

Fundacion Espriu, International Health Cooperative

Spain

Organisation

Coordination Group

Luca Del Vecchio

Task Force Manager

Confindustria

Francesco Iervolino

B20 Secretariat

Confindustria

Matteo Corsini

B20 Secretariat

Confindustria

Vincenzo Grassi

Knowledge Partner

PwC

Andrea Fortuna

Knowledge Partner

PwC

Davide Orlandi

Knowledge Partner

PwC

Christian Ferraris

Advisor to the TF Manager

Assolombarda

Felice Lopane

Advisor to the TF Manager

Assolombarda

Carlo Riccini

Advisor to the TF Manager

Farmindustria

Valeria Ingrosso

Advisor to the TF Manager

Humanitas Research Hospital

Daniela Bianco

Network Partner

Ambrosetti

Corrado Panzeri

Network Partner

Ambrosetti

Ali Karami-Ruiz

Network Partner

BIAC

Hiroki Tamura

Network Partner

BIAC

61

B20 POLICY PAPER HEALTH & LIFE SCIENCES

62

Rachel Bellegy Chazelas

Network Partner

GBC

Susanne Andreae

Network Partner

WEF

Francesco Grigioni

Scientific Partner

Campus Biomedico

Andrea Palermo

Scientific Partner

Campus Biomedico

Cristina Masella

Scientific Partner

Politecnico di Milano

Antonio Gasbarrini

Scientific Partner

Università Cattolica del Sacro Cuore

Giuseppe Castaldo

Scientific Partner

Università di Napoli Federico II

B20 POLICY PAPER HEALTH & LIFE SCIENCES

An initiative byKnowledge partners

Network partners

Scientific partners

64

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