SCIENCE – INNOVATION – POLICIESYEARBOOK2016
MIGRATION ANDREFUGEE HEALTH
From Care to Policy

INFECTIOUS
DISEASES
Lessons Learned from
Ebola to Zika

TECHNOLOGICALINNOVATION
Improving Healthcare
Delivery

TRANSLATIONALRESEARCH
Advancing Innovative
Treatment

EXCELLENCE
IN mEdICINE

EditorialT

his year’s World Health Summit found us face-toface with a challenge of unprecedented scale: For
the first time ever, more than 60 million people arefleeing war, terror and persecution. The effects have been
profound. Europe, seen for decades as a model of cooperation and friendship, is diverging from its blueprint.
Social norms and contracts are dissolving under theweight of mistrust and short-term interests. In many
countries, health systems are struggling hard with theduty of providing care for those in need.
Experience shows that there is only one way to confront
these paramount issues: We have to build up trust again
and intensify international cooperation. Last year’s G7
summit emphasized these issues and the German government ties its G20 Presidency at the end of 2016 to sharpening this focus and working on reforming the global
healthcare structure, as Chancellor Angela Merkel expresses in her Welcome Message. This strong political willis in alignment with the internationally endorsed Sustainable Development Goals (SDG) and highly promisingdevelopments in translational research that cross theboundaries between science and medicine, as well as theincreasing accessibility of data and powerful new tools.

The Charité - Universitätsmedizin Berlin is one of the largest university
hospitals in Europe. Indeed, with over 16,800 employees the Charité is
one of the largest employers in Berlin, generating more than one billion
euros each year. Day after day our highly-committed staff dedicate
themselves to the motto: ”Research, Teaching, Healing, Helping“. Within
this remit, the Charité achieves excellent results both in terms of preclinical research and in the clinical development of drugs and medicinal
products. In addition, the Charité is an innovative force within the healthcare system. It successfully brings together scientific rigour, compassionate
medical care and a creative, entrepreneurial approach to university
medicine and healthcare delivery.

This spirit of cooperation permeated the WHS Geneva
Meeting in April 2016, held on the occasion of the
Geneva Health Forum’s (GHF) sixth edition and 10 year
anniversary. It emphasized the continuous commitmentof the Swiss government and the GHF organizers to global health and peace, thus providing a sterling example ofpartnership and friendship while sounding a clear call forcollaboration across all health-related sectors.

To continue this call, the World Health Summit 2016
drew more international experts from academia, politics,
the private sector and civil society than ever before. Theirdeliberations focused on topics including:ȣ Migration and Refugee Health:
From Care to Policyȣ Technological Innovation for Health:
Improving Healthcare Delivery
ȣ Women, Empowerment and Health:Equality and Agency
ȣ Translational Research:
Advancing Innovative Treatment
ȣ Infectious Diseases:
Lessons Learned from Ebola to Zika
ȣ Sustainable Development Goals:
Transforming the Health Agenda
Supported by the M8 Alliance of Academic Health Centers, Universities, and National Academies, this meeting
demonstrates how trust and cooperation can improve
lives worldwide.
What better goal could we collectively target than the objective of longer, healthier lives that can be lived out inpeace? Please join us as we work toward this goal.

PROF. DR. ANTOINE FLAHAULTWHS President

PROF. DR. DETLEV GANTENWHS PresidentWORLD HEALTH SUMMIT

3

Contents
OPENING
Editorial
Antoine Flahault, Detlev Ganten

3WORLD HEALTH SUMMIT – BERLIN 2016

WHS GENEVA MEETING 2016

54 – 55 Need for Progress

82 – 83	Combined Conferences Break Records

56 – 62 WHS 2016 | Day1 – Day3

Welcome Messages
	Angela Merkel, François Hollande,
Jean-Claude Juncker
7–8

10 – 13World Health Summit – Mission and Goals

14 – 17

M8 Alliance: A Global Partnership

58

Faces and Voices in the Crowd

60 – 61WHS Startup Track: Tech Takes the Stage

65 – 66 The M8 Alliance Declaration

3

TECHNOLOGICAL INNOVATION

68 – 69 Introduction
70 – 71	
Improving Healthcare Delivery

Frans van Houten

72 – 73	
Innovations in Healthcare Delivery

Norbert Hauser

ANNUAL DISCUSSION
32 – 39 “There is a whole ­universe of ­fantastic,

1

unexpected new ­findings out there”
Matshidiso Rebecca Moeti, Pascale Ehrenfreund, 		Yukiya Amano, Manuel Delgado

MIGRATION AND REFUGEE HEALTH

74 – 75	Precision Health: Seizing the Moment

Lloyd B. Minor

76 – 77	Transforming Care: Consumer Applications

Steve Singh

78 – 79 “People indicate that they would like to change”

80 – 812
18 – 19

A. David Napier

22 – 23 Better Health Systems Strengthen our Common

Security
Wolfgang Ischinger

24 – 25	
Refugee Mental Health

Luciano Saso, Maurizio Marceca, Paolo Villari

26 – 27	Migration, Cultures and Health

Günther Stock, Reinhard Schäfers,
Jean-Yves K. Tano

28 – 29 “It’s a megatrend of the century”

Interview with William Lacy Swing

4

Interview with Jutta Allmendinger

84 – 85 Introduction

Health in Numbers

86 – 87	Translational Medicine:

Value for Patients
Erwin Paul Böttinger

Introduction

20 – 21	Migration and Refugee Health

30 – 31

INFECTIOUS DISEASES	
4
TRANSLATIONAL RESEARCH

Health in Numbers

YEARBOOK 2016

40 – 41 Introduction
42 – 43	L essons Learned from Ebola to Zika

Stefan H.E. Kaufmann

44 – 45	Flipping the Access Model to Innovation

Suresh Kumar

46 – 47	
Ebola to Zika: Areas of Action

Christian Bréchot

88 – 89	
Novel Targets for TherapyJoão Pedroso de Lima, Miguel Castelo Branco

90 – 91	
Asia-Pacific Beacon of Medical Research

K. Arnold Chan, Wei-Hsun Hsu

92 – 93	The Power of Translation

Tarik Möröy

94 – 95	“You make the biggest impact by doing basic

research”
Interview with Elizabeth Blackburn48 – 49	
L esson Learned: from Syria to Ebola

Yves Daccord

50 – 51	“We simply don’t know enough”

96 – 97 Health in Numbers

Interview with Rolf Zinkernagel

52 – 53 Health in Numbers

98

PREVIEW 2017 / IMPRINTWORLD HEALTH SUMMIT

5

Welcome MessagesT

he individual desire for health and well-being issomething we all share. With this in mind, one of
the aims of the 2030 Agenda for Sustainable Development is to encourage people across the globe to live
lives that are as healthy as possible at every stage of their
existence. We committed ourselves to this goal last year
within the framework of the United Nations. Now wehave to implement this ambitious objective. That involves
fighting epidemics and poverty-related diseases and also
extends to improving prevention and treatment of complaints of modern civilization such as diabetes and cardiovascular disorders.
Germany plays a very active role in global healthpolicy. To bring about further progress, we must strengthen healthcare systems worldwide and reform the global
healthcare structure. We sharpened the focus on boththese issues during Germany’s G7 Presidency. We intend
to build on this when our country assumes the G20 Presidency at the end of this year.
Whether we are talking about institutional factors
or other global health issues such as a joint approach to
tackling antimicrobial resistance, we can only be effective
in overcoming the challenges they present if scientists,
policymakers and society work together side by side. This
is why dialogue forums such as the World Health Summit
are particularly important. As the patron of the Summit,
I would like to welcome all participants to Berlin. Thismessage comes with my hope that you will enjoy a fruitfulexchange of new insights. I would like to thank you mostsincerely for your remarkable commitment to advancing
healthcare throughout the world.

DR. ANGELA MERKEL

Chancellor of the Federal Republic of GermanyT

he themes discussed during this eighth World
Health Summit are both ambitious and strategic.
They also reflect the deep changes we are seeing in
the world. The terms of globality and universality are
now, more than ever, associated with health: quality care
for all, accessible to all; international preventive measures; renewed support for health as a driver of development, growth and stability; and an ambitious researchpolicy, which is a source of progress. These are principles
to which France is committed, and which it supports ininternational bodies. France thus obtained, during thelast G7, that reflection will take place at the international
level on access to expensive medicines. This Summit is aforum for discussion and dialogue, bringing together
men and women of “good will.” That means it is a placeof peace.
I wish you all excellent meetings.

FRANÇOIS HOLLANDE

President of the French RepublicWORLD HEALTH SUMMIT

7

Welcome Messages

It is impossible to talk about health issues in the past
year in Europe without reflecting on the refugee crisis,
and the challenges and opportunities that it has presented for Europe. Over one million children, womenand men arrived at our shores and borders last year.
The European Union had a common responsibility
to ensure that these persons, many of them physically andmentally exhausted, were offered care and support,
including through the provision of healthcare whenrequired. Their journeys were punishing, and we cannot
imagine the impossible choice they had to make between
staying in their countries in extreme danger and theunenviable alternative of risking their lives at the hands ofpeople smugglers. Europe’s number one task was to offer
these people a humane reception in Europe, which theCommission helped to achieve by the setting up of
hotspots in Greece and Italy, and through financial andpractical assistance to our Member States under our
emergency asylum funding and through the EU’s Civil
Protection Mechanism.
Our next priority is to ensure the effective integration of those that are granted international protection.
For some, that will mean gaining access to our health services. At the same time, the people who arrive in Europe
must be given the opportunity to pay their way, throughaccess to the labor market. And there is an obvious counterbalance to the demands they make of our healthcare
system with the contributions that they can make to it. I
hear of many medical professionals coming to Europe
seeking to rebuild their lives; doctors and nurses, pharmacists and researchers, carers and therapists. In the next
year I hope to hear heartwarming stories of their integration into our national health services, care homes,
research institutes and universities, and the valuable
contribution they are making.
And one reason to welcome these new arrivals is
the reason I gave you in my message for last year’s World
Health Summit – Europe’s population is getting older,which makes it increasingly difficult to provide for ourhealthcare needs. I know that you will again address thehealthcare challenges of an aging population at this year’s
Summit. Setting strategic research priorities will be offundamental importance, and I am pleased that the European Commission continues to make an important contribution through our Horizon 2020 funding program.
Another area where we are making an important
contribution is eHealth. More and more people are taking
steps to monitor their own health and lifestyles throughwearable devices and smartphones. These form an excellent contribution to preventing and monitoring diseases.
Through the Connecting Europe Facility, we are contributing to building Europe’s digital health infrastructure. So
far, 20 of our Member States have applied for funding toconnect their systems and exchange health data andpatient information or to offer e-prescriptions and reduce
the administrative burden on our care systems.
Let me conclude by mentioning the healthcare
industry, which is one of the major drivers of jobs, growthand innovation in Europe. We need a successful economy
to sustain our European social model, and you are an
intrinsic part of this with the many thousands of jobs you
create and sustain. The world is getting older, and theworld is in need of health technology to sustain us as wego through a major demographic change. Europe must
lead the way in looking after its own citizens, and it must
generate a competitive advantage in the global market for
healthcare services and products.
I wish you a fruitful Summit, and another year of success.

The place to be for life sciences
and healthcare industries
You are innovative.
You are growing rapidly.
You are well connected.
Then you are located in theGerman capital region.
Not yet?
Learn what we have to offer!
www.healthcapital.de/en
Save the Date | Nov 6 – 8, 2017
Berlin – the place to be for BIO-Europe

JEAN-CLAUDE JUNCKER

President of the European Commission
EUROPEAN UNION8YEARBOOK 2016

World Health Summit – Mission and Goals

World HealthSummitAn International Forum for
Networking, Exchange andPolicy-Shaping Debate

T

he World Health Summit(WHS) is one of the world’s
most prominent strategic forums for global health. The interdisciplinary, international event takes
place within an atmosphere of academic freedom.
Every October, internationally renowned leaders and representatives
from the sciences, politics, business,and civil society travel to Berlin for
the WHS to discuss the latest challenges facing medical research andhealthcare. Under the high patronage of German Chancellor Angela
Merkel, French President François
Hollande and European Commission President Jean-Claude Juncker,
the World Health Summit is the premiere international platform for exploring strategic developments anddecisions in the area of healthcare.
The World Health Summit’s academic
think tank is provided by the “M8Alliance,” a unique collaborative net-

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YEARBOOK 2016

work made up of leading interna
tional medical universities, research
institutions and the InterAcademy
Partnership (IAP) for Health – representing science academies worldwide.
The M8 Alliance selects the World
Health Summit’s rotating annual
president and also organizes the associated Regional Meeting that takes
place each April.
Under the leadership of Charité –Universitätsmedizin Berlin, the medical alliance was set up in 2009 along
the lines of the G8 political forum.
Today, it is made up of 24 members
from 17 countries.

THE THREE PILLARS OF THE
WORLD HEALTH SUMMIT• Global challenges: At the WHS,
participants discuss and debate
topics such as chronic disease, theapplication of modern technologies in the healthcare sector, vaccination and immunization, thepromotion of innovation andinterdisciplinary cooperation in
healthcare research.
• Global responsibilities: Advancesin medicine have to reach people
faster and more effectively.
Sustainable approaches must playa central role in this process, andthe means for doing so are a major
focus at the Summit.
• Global networking: International
figures and bodies from the fields
of science, politics, business andcivil society come together topromote and strengthen cooperative efforts.

WORLD HEALTH SUMMIT

11

World Health Summit - Mission and Goals

World Health Summit – Mission and Goals

Past WHS
Presidents reflect
on a legacyof engagement

PROF. DR. JOSÉ OTÁVIOCOSTA AULER JÚNIOR

WHS President 2014 | Brazil

PROF. DR. SHUNICHI FUKUHARAWHS President 2015 | Japan“The recognition that
academic healthscience centers needed
to be engaged in the
global health debate
was a central lesson.
Good debates addressed the promise of
precision medicine
requiring even closer
collaboration between
academic institutions,healthcare providers
and social andcommunity care, as
well as the need to use
developments in digital
health and data
analytics to provide
real-time healthcare
choices at both thepersonal and publichealth levels.”“The WHS 2014 contributed to
improving health on a global scaleby providing approaches which
combined classic public healthrules with new strategies, somesetting explicit goals to integrate
public health with general welfare
policy. Health for all, healthpromotion, and population healthcontribute to this reorientation inthinking and strategy.”

PROF. DR. JOHN EU LI WONGWHS President 2013 | Singapore“The WHS 2013 showed that there
is a need for leading academics,
policymakers, and shapers of civilsociety to collectively develop
strategies to address important
health issues which affect oursociety. Following our Regional
Meeting in Singapore, we were able
to make significant progress in
helping the region with issues
ranging from uni­versal healthcoverage implemen­tation to
medical education and researchcollaboration.”

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YEARBOOK 2016

PROF. DR. MICHAEL J. KLAGWHS President 2012 | USA“We wanted to grow the number
and breadth of stakeholders
attending that meeting – which
definitely happened. At the sametime, we aimed at increasing thenumber of universities that are
members of the M8 Alliance,
which happened with great
success as well. It includes now
universities from around theworld and still more will bejoining in the future. Personally,
I made great connections withcolleagues and investigatorsfrom around the world throughthis network. Some even grew
into lasting friendships.”

PROF. DR. AXEL KAHN

WHS President 2009 | France“The highlight of the
WHS’s first edition was
the concept of evolutionary health and how it
linked global health andthe Darwinian principlesof evolution. One of mymost cherished memories
until today is the live
discussion we had withthe crew of the international space station.”

PROF. DR. STEVE WESSELINGHWHS President 2011 | Australia

PROF. DR. STEPHEN K. SMITH“It was a great honor to jointly
preside over the 2011 event, as it
demonstrated for the first time
the truly global reach of the
WHS, with significant involvement from the Asia-Pacificregion. There was clear evidenceof the potential of the Summit tofacilitate positive change on a
genuinely worldwide scale. It
highlighted new approaches in
research and innovation dealing
with a complex mix of escalating
rates of non-communicablediseases, climate change andworldwide political instability.”

WHS President 2010 | United Kingdom“The recognition that academic
health science centers needed
to be engaged in the global
health debate was a central
lesson. Good debates addressed
the promise of precision
medicine requiring even closer
collaboration between academic institutions, healthcare
providers and social andcommunity care, as well as theneed to use developments indigital health and data
analytics to provide real-time
healthcare choices at both thepersonal and public healthlevels.”WORLD HEALTH SUMMIT

13

M8xxxxxxxx
Alliance

M8xxxxxxxx
Alliance

M8 Alliance:
A Global Partnership
The M8 Alliance of Academic Health Centers, U­ niversities
and National Academies is a collaborative network of­academic institutions known for its educational and research
excellence. The network was founded in 2009 at the­inaugural World Health Summit, and has provided an­outstanding academic foundation to every WHS event since.

20

12

14

13

4
18

The M8 Alliance currently has 24
members based in 17 different
countries, each of which arecommitted to improving global
health and working with politicaland economic decision-makers todevelop science-based solutions tohealth challenges worldwide.

health science centers – thesestakeholders include individuals
and institutions active in government, industry and commerce,
inter-governmental agencies,
healthcare providers, academies of
medicine and science, professional
associations, and the media;

The M8 Alliance promotes thebench-to-bedside-to-population
health translation of research, aswell as the transformation ofcurrent medical care approaches totreating the ill by creating healthcare systems aimed at the effective
prevention of disease. The organization also works to adapt
health-related solutions to rapidlychanging living conditions throughresearch in priority areas, inparticular shifting demographics,
urbanization and climate change.

• setting an agenda for global healthimprovement by addressing issuesof interest to academic healthscience centers and conveying
findings and recommendations
based on scientific evidence
through the generation of key
statements;

The M8 Alliance is improving global
health through the pursuit of five
strategic goals:• developing a worldwide networkof academic health science centersand bringing together universities
and healthcare providers;• facilitating dialogue through theWorld Health Summit across a
global network of stakeholders
who are engaged with academic

14

YEARBOOK 2016

1

3

16
10

2

19

11

5

9

17
8

6

15

• positioning the M8 Alliance as an
authoritative influence when it
comes to decision-making in
global health;• creating a knowledge base amongst
M8 Alliance members, which
directly involves the promotion ofmutual learning, research collaboration, the enrichment of educational
capabilities and enhanced clinicaloutcomes.

7

Charité – Universitätsmedizin Berlin, Germany
Coimbra Health, Portugal
3 Imperial College London, United Kingdom
London School of Hygiene & Tropical Medicine, United Kingdom
4 Johns Hopkins Bloomberg School of Public Health, USA
5 Kyoto University Graduate School of Medicine, Japan
6 Makerere University, Uganda
7 Monash University, Australia
8 National University of Singapore
9 National Taiwan University, Taiwan
10 Sapienza University of Rome, Italy
11 Tehran University of Medical Sciences, Iran
1

2

University Sorbonne Paris Cité, France
University of Geneva, Switzerland
Geneva University Hospitals, Switzerland
Graduate Institute Geneva, Switzerland
14 University of Montreal, Canada
Montreal Clinical Research Institute, Canada
15 University of São Paulo, Brazil
16 InterAcademy Partnership (IAP) for Health
17 World Federation of Academic Institutions for Global Health (WFAIGH)
18 Association of Academic Health Centers International (AAHCI)
19 Chinese Academy of Medical Sciences
Peking Union Medical College, China
20 Russian Academy of Medical Sciences, Russian Federation
12

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WORLD HEALTH SUMMIT

15

M8 Alliance

Migration and Refugee
M8 Alliance
HealthCharité – Universitätsmedizin
Berlin, Germany

Makerere University,
UgandaUniversity Sorbonne
Paris Cité, France

Europe’s largest university clinic –and its oldest and most prominent
hospital – is located in the German
capital. Eleven Nobel Prize laureates
have worked at the Charité.

One of the oldest and mostpres­tigious centers of learningin Africa, Makerere University
is home to a staff of over 4,000
and more than 40,000 students.

The University Sorbonne Paris Cité
is a recently established consortiumof prestigious institutions that brings
together higher education andresearch institutions in the city ofParis.

Coimbra Health, Portugal

Monash University, Australia

Over 700 years old, the Universityof Coimbra is a keystone of European and global scientific culture, as
well as a UNESCO World Heritage
Site. Together with the Coimbra
Hospital and University Center,it forms Coimbra Health.

As Australia’s largest university –with approximately 60,000
students from over 170 countries –Monash has seven campuses:
five in Victoria, one in Malaysia
and another in South Africa.

University of Geneva,
Switzerland

Imperial College London, UK

National Universityof Singapore

Geneva University Hospitals,
Switzerland

Founded in 1905, the National Uni­versity of Singapore today consistsof 16 different faculties and schools.
Around 37,000 students can befound on its three campuses in
Singapore and seven overseas
locations.

The Geneva University Hospitals
are heirs to a centuries-long
tradition of excellence in medicine
and science. The HUG represents
a merger all public hospitals in
Geneva.

London School of Hygiene &Tropical Medicine, UK

National Taiwan University,
TaiwanGraduate Institute Geneva,
Switzerland

Founded in 1899, the London
School of Hygiene & Tropical
Medicine is one of the leading
research-focused graduate schools
in the world.

Known for its diverse and international curriculum, National Taiwan
University is made up of 11 colleges,
54 departments and 105 graduate
institutes. It has a student body ofaround 30,000.

A semi-private post-graduate
institution, the Graduate InstituteGeneva was the first university inthe world to be dedicated solely
to the study of international affairs.

Johns Hopkins Bloomberg
School of Public Health, USA

Sapienza Universityof Rome, Italy

University of Montreal, Canada

A fully accredited private institution,
the JHSPH was the first publichealth facility in the world, and it
remains the largest school in thefield.

Established in 1303 by Pope Boniface
VIII, Sapienza is one of the oldest
universities in the world. With about
115,000 students, it’s one of thelargest in Europe as well.

A public research university thatstarted with less than 100 students
in 1878, the University of Montreal
has more than 60,000 today.
Comprised of 13 faculties and morethan 60 departments, it has thehighest sponsored research income
in Quebec.

Kyoto University Graduate
School of Medicine, Japan

Tehran University of Medical
Sciences, IranMontreal Clinical ResearchInstitute, Canada

Russian Academy of Medical
Sciences, Russian Federation

The first institution of its kind inJapan, the Kyoto Imperial Uni­
versity College of Medicine wasfounded in 1899. Its successor, theKyoto University School of Public
Health, was established in 2000.

The university is the oldest, largest
and most highly ranked comprehensive higher education institute in
the field of medicine and public healthin Iran, offering a wide range ofcourses and receiving applications
from students from around the globe.

The IRCM was the first independent
academic research center in Quebec
to bring basic and clinical researchers
together under a single roof.

Set up in 1944, the USSR Academyof Medical Sciences was considered
the most prestigious scientific andmedical organization in the Soviet
Union. Its successor – the Russian
Academy of Medical Sciences –was founded in 1992.

The Imperial College of Scienceand Technology was created as aconstituent college of the Universityof London. Fully independent since2007, the Imperial College London
attracts students from more than
100 countries.

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YEARBOOK 2016

Founded in 1559 as a theologicaland humanist seminary, theUniversity of Geneva is renowned
for emphasizing the unity ofteaching and research. It’s the
only tertiary-level educational
institution of its kind in the region.

University of São Paulo, Brazil
Founded in 1934, the University ofSão Paulo arose from a combinationof institutions, including a medical
school. Today, the largest university
in Brazil is seen as the country’s
most prestigious edu­c ational
institution.

IAP for Health
The IAP for Health combines theexpertise and impact of the global
network of science academies toadvance sound policies, promote
excellence in science education andimprove public and global health.

World Federationof Academic Institutions for
Global Health (WFAIGH)
A global network of academic
health institutions, the WFAIGH was
set up to help provide evidence
to inform policies on global healthissues.

Association of Academic
Health Centers Intenational(AAHCI)The AAHCI is a global non-profit
organization that aligns efforts
among health professionals in edu­cation, research and patient care.

Chinese Academy of Medical
Sciences & Peking Union
Medical College, China
The college is among the mostselective medical institutionsin the People’s Republic of China
and one of its top two universities.

WORLD HEALTH SUMMIT

17

Migration andRefugee Health
According to the United Nations, there are an
estimated 65 million forcibly displaced people
worldwide, including 21 million refugees. The
statistics can be overwhelming – and numbing.
“The numbers hide one thing,” International
Committee of the Red Cross Director Yves
Daccord said in a speech at the WHS. “Behind
every number there is a person. When it
comes to migration and health, you need tounderstand the person.”
Caring for the many people displaced by war,
famine or natural disaster is a challenge that
requires medical professionals to think outside
the box. To be effective requires an understandingof different cultural backgrounds, the politicaland social roots of conflict, and the isolation anddespair that threaten refugees’ mental health.

Migration and Refugee Health

OVERVIEWMIGRATION ANDREFUGEE HEALTH
Caring for the health of migrants and refugees is not only
about available resources or even about cultural competency.
It is also about political wisdom and social trust.

I. FEARING THE FOREIGN

II. MIGRATION AND FORCED MIGRATION

Across the globe, migration and its impact on individual,family, and population health have emerged as a societal
challenge. Whether concerns around migration andrefugees are anchored in the perception of migrants
bringing with them communicable diseases or migrants
taking away limited resources from local populations,they share in common undifferentiated scapegoat
narratives that should have no place in the multiculturalsocieties of our time.

Migrants are people who move from their places of origin
and settle elsewhere. That in itself can be challenging andcomplex. Many of the world’s megacities are already madeup mostly of such people. But refugees are stateless people
whose civil liberties can remain unacknowledged or openly denied, leaving them both vulnerable to changing national sentiment and deeply dependent on humanitarian
goodwill.

Although a “fear of the foreign” is, perhaps, as ancient as
the concept of “self and other,” today our moral and ethical obligation to assist those who come to us (both inexistential need as in the spirit of improving their lives) is
accompanied by an unprecedented experience of global
citizenship. If we are indeed one world, we need betterways of addressing how and why others become vulnerable. Otherwise, the flowing wave of human migration will
increasingly become a storm.
But while policymakers in receiving countries focus on
quotas and points-based systems, on procedures for
accepting or refusing migrant and refugee claims, and on
migration’s impact on economic growth, individual views
and community responses to migrant and refugee needs
are complex. In the end, the ability of any person to thrive
in a new home will also depend on the willingness ofcommunities in receiving states to accommodate others
whose lifestyles may diverge from local ways of living.
Crucially, this ability rests on understanding and successfully addressing the needs that stem from the unsettlingof individuals and communities in the first place. And it
rests in the longer term on how migrants and their families adjust and develop the social networks that are central to living lives fully realized. This last contingency is
why it is important to distinguish between migrant healthand the health of forced migrants, including refugees.

20

YEARBOOK 2016

To address refugee health requires, then, a careful assessment of their specific vulnerabilities and a sustained commitment to ameliorate what has made them vulnerable.
However, given the real tragedies that make people seek
refuge, that commitment must be honest and enduring.
This is why refugee health is so profoundly dependent onsocial trust and on the reliability and wisdom of politicalleaders. As important as is individual conviction, if
governments fail to act in openly humanitarian ways, citizens are asked to be generous without the assurance that
their generosity will be either acknowledged or supported.
This fact has been known for a long time. Indeed, John
Maynard Keynes long ago referred to that failure ofgovernments to express generosity in moments of social
stress as the “paradox of thrift.” The “paradox” for Keynes
rested in the destabilization created when leaders, citing
resource limitations, cut back on social welfare exactly at
the time when citizens needed to believe that theirgovernments will be there for them no matter what.
According to Keynes, the corrosive effects on public trust
under such conditions are immeasurable.
III. POLITICAL WISDOM

But wisdom is a precious commodity. And when it is absent, addressing migrant and refugee health and wellbeing can become problematic; for so many people areunsure whether to look right or left in an effort to build ahealthier and more vibrant society. We hear from the political right that the house is filling quickly and must be
ring-fenced from those who may exhaust its resources if
we are to care responsibly for citizen health and welfare.
From the left we hear that the house itself may need rebuilding, and that the only morally acceptable way of replenishing those cupboards is by opening the front door.
But the truth is that public sentiment is never so clearcut. Were the choice that simple, receiving countries
would with one voice either accept or reject outsiders;
and that is not at all what we now witness. Rather, astraightforward political divide is mediated by a deeper
and much broader public mistrust of government. Whenleaders retreat from the frontline of the policies that they
once supported and openly fought for, public trust collapses and with it the health of migrants and refugees isjeopardized.
When public anxiety is present, it is little wonder thatanti-migration sentiment becomes a primary way inwhich people both voice mistrust in political processes
and claim that society can hardly be expected to care forothers. Migrant and refugee needs, in other words, tell
us a great deal more about citizen trust than we often
acknowledge. So immigrant health has to be placed
against the background of wide-scale public anxiety, if
we are to understand the long-term impact of ourpolitical decisions.
This is why those who already feel disenfranchised anddisillusioned by political processes are often most vocallyagainst that nation being generous, even to the point of
supporting policies that may not be in the best interest of
citizens themselves. One merely has to follow the irresponsible chaos created across Europe by Brexit, or theradical political shifts on migration in the United States,
Australia and elsewhere to understand how migrant
health and migrant well-being are entangled with politics.

IV. THE NEW CONVERSATION

Migration has forced new conversations about humankind and its values, and the health outcomes of all of us
will be determined by how we adjust globally to the reality of a world in which actions in one country will havesignificant impacts in other places.
But it is here, also, where we have a real opportunity. Like
climate change, migration demands new forms of cooperation – at the individual level, in communities, within
nations, and across national borders. This truth meansthat migration is not a thing to be resolved by any one
country’s attempt to close itself off to the realities ofglobal disorder and the dire human needs of so manystateless peoples worldwide.
In other words, we all need to ask ourselves why someone
would migrate in the first place, and to commit collectively to addressing this much bigger question. That means
understanding the root causes of migration, for no walls
or fences will stop the flow of people around the globe
when migration is driven by an urgent desire to find thesocial security we all so much hope for.

AuthorPROF. DR. A. DAVID NAPIER

Director | Science, Medicine andSociety Network | University College
London | United Kingdom

WORLD HEALTH SUMMIT

21

Migration and Refugee Health

ESSAY

BETTER HEALTHSYSTEMSSTRENGTHENOUR COMMONSECURITY
Health, security and stability are inextricably linked.
As global instability and interconnectedness increase, so does
the risk of a catastrophic outbreak.

W

hat keeps you up at night?” is a popular question directed at security leaders anddecision-makers. Often, their responses refer
to weapons of mass destruction (WMD), the use of which
could kill people on a massive scale. Answers usually havean atomic component, ranging from the risk of nuclear
terrorism to a catastrophic escalation of conflict between
nuclear weapons powers. Bioterrorism, especially after
the 2001 anthrax scare in the United States, is also near
the top of the list – although it is not certain we are actually prepared for such an attack. But, many will admit, an
epidemic stemming from natural causes has long notreceived the attention it deserves. Yet an epidemic could
also bring about mass destruction – but there would be
no enemy to blame but ourselves for not being prepared.
“Freedom is indivisible, and when one man is enslaved,
all are not free,” US President John F. Kennedy famously
said in his “Ich bin ein Berliner” speech. Paraphrasing
him, one might also say: When one human is sick, all ofus may be threatened. Unfortunately, it did take a major
outbreak of a deadly disease, the Ebola crisis, to highlight that danger again: The health systems in place in
one country can have a great impact on global health as

22

YEARBOOK 2016

well as on international security and stability. Without adoubt, “the unprecedented extent of the Ebola outbreakin Africa constitute[d] a threat to international peaceand security,” as the UN Security Council found in September 2014.
One the one hand, none of this is new. Since the plague
killed almost 1 in 3 Europeans in the 14th century, states
have recognized that diseases can pose a disastrous danger and have tried to take necessary precautions. And in
the 20th century, in particular, there have been important
health success stories, including the advent of antibiotics
and the eradication of small pox.
KEY GLOBAL TRENDS INCREASE THE RISK OF
PANDEMICS

On the other hand, key global trends and characteristics
of today’s international system create a higher risk of acatastrophic global pandemic.
First, the progression of globalization, urbanization andpopulation growth keeps decreasing the time between theoutbreak of a disease and its spread. These trends are notentirely new, but they are accelerating – and make it moredifficult to get a pandemic under control again. In otherwords, the 2002-2003 severe acute respiratory syndrome(SARS) pandemic may only be a light blueprint of how amuch deadlier global spread might occur. For example,
Africa’s population is projected to more than double by
2050, and most of that growth will be in cities. Population
density in megacities can speed up the spread of diseases –and make widespread unrest and chaos more likely incase of an outbreak.
Second, the proliferation of state failure throughout
key parts of Africa and the Middle East is also accelerating, which exacerbates health security challenges in thosecountries. After all, preventing or responding to disease
outbreaks is extremely difficult in areas with limited governance or in areas of civil strife and war.
And consider this: We all know that if Ebola had been an
airborne pathogen of a similar lethality, the outbreak
could have caused millions of deaths. But, under different
circumstances, Ebola could have been just as catastrophic: What would have happened if, for instance,
populous Nigeria had been in complete turmoil in 2014
– or did not have relatively good health infrastructure inplace from the fight against polio? If Ebola had spread tothe megacity of Lagos under conditions of a civil war in
Nigeria, the world would be very, very different today.
Moreover, the proliferation of state failure and civil conflict in today’s world has also led to the biggest refugee
crisis in history, leaving many millions of migrants vulnerable and without adequate healthcare. And these state
failures, by the way, also increase the risk of terroristgroups having safe spaces to flourish and possibly evenplot attacks with weapons of mass destruction, including
biological weapons.
Conversely, of course, health security crises feed and foster instability as well; the Western African states most afflicted by Ebola will need years and years to fully recover.
In some countries, HIV/AIDS has decimated entire generations. Beyond the millions of personal tragedies, thesocietal, economic and political consequences of such a
massive health challenge can hardly be exaggerated.
Add to this challenge antimicrobial resistance, which experts say will skyrocket in the next decades and thus
make treatment of common infections and bioterrorism
more difficult, and you get a worrisome picture.
These are a few critical issues at the intersection of health,security and stability – and I have not even mentioned theprotection of healthcare workers in conflict zones or therole of militaries in fighting outbreaks yet.
These are also some of the key reasons why I have beencommitted to promoting discussions between health offi-

cials, NGOs, security strategists, the private sector anddecision-makers at Munich Security Conference eventsin order to deepen the conversation between professionals from different sectors.
To be sure, none of this is to suggest that security officials
should only care about health questions if and when they
have an impact on security policy in the traditional sense.
It is true that health policy and security policy are twodifferent policy areas, with sometimes competing priorities. Mixing them all together and “securitizing” health asa matter of principle is not sensible. But it would also be
negligent to downplay the critical intersection of the two.
A comprehensive understanding of security today must
include health security.
In addition, in terms of communication, it might be useful to frame global health emergency preparedness in security terms. This could help sharpen the awarenessamong publics around the world that this is not just a
problem of and for certain regions, and certainly not justfor less developed countries, but that this problem affects
everyone. It could help find the funds necessary for research and development, for disease surveillance, and for
health and response systems. The launch and first operation of the European Medical Corps in the Congo, forexample, has been a good step.
Moreover, it would be useful to routinely and prominently include health in security strategies, risk assessments and early warning mechanisms. Health systems
are, after all, a line of defense. They help prevent both
health and security crises, and thus strengthen ourcommon security.
Speaking at a panel discussion on the intersection ofhealth and security policy at this year’s Munich Security
Conference, Ghana’s Minister of Foreign Affairs and Regional Integration, Hanna Serwaah Tetteh, observed:“Even though the discussion [of health security] is now
more prevalent within our region and within our continent, […] I’m really wondering whether the lessons havebeen learned as well globally as they have within the place
where we suffered the crisis.”
Global health and global security may well depend on
learning those lessons without further delay.

AuthorWOLFGANG ISCHINGER

Chairman | Munich Security
Conference; Senior Professor for
Security Policy and Diplomatic
Practice | Hertie School of ­Governance; Former State
Secretary | German Foreign OfficeWORLD HEALTH SUMMIT

23

Migration and Refugee HealthESSAY

REFUGEE
MENTAL HEALTH
Welcoming refugees and organizing their integration into European
Union society depends on preserving their mental health by
reducing stressors before, during and after migration. It is a serious
challenge, but European values make it an ethical imperative.

are certainly positive steps towards saving human lives inextreme risk conditions, but much more needs to be done.
Post-migration stressors

Many studies indicate that long periods of detention for
asylum seekers, lengthy and complex asylum processes,
unemployment, perceived discrimination and changes insocioeconomic roles (including changes of gender roles)
have a dramatic impact on refugees’ mental health. Thus,
all possible efforts should be made to improve the qualityof the asylum seeker centers and accelerate asylum procedures.
HOW UNIVERSITIES CAN HELP IN REDUCING
POST-MIGRATION STRESSORS

Universities and other higher education institutions canplay an important role in improving the integration of
refugees, thus reducing the post-migration living difficulties and possible mental disorders, by providing:O

ur species, Homo sapiens, originated in Africa.
Between 60,000 and 70,000 years ago, we started
to migrate to other continents, probably due to amajor climate change which almost caused the species’
extinction. To date, we continue to migrate and mix. The
result is that, after centuries of racism and discrimination,scientists – and many others, though unfortunately not
everyone – realize that human “races” do not exist. In otherwords, there are no exclusive genetic characteristics corresponding to black people, white people, etc.
The phenomenon of migration is also part of the European Union’s DNA. In the aftermath of World War II, thefathers of the EU proposed the creation of the European
Coal and Steel Community (ECSC). One of its motivations was to make another “war not merely unthinkable,
but materially impossible.” The ECSC made possible themigration of workers – including around 140,000 Italians
who moved to Belgium between 1947 and 1957 – who
accepted very hard working conditions to try to improvetheir socioeconomic status.

MIGRATION STRESSORS AND MENTAL HEALTH
OF REFUGEES

24

the native population or family reunification immigrants.
That could be due to different type of stressors:
Pre-migration stressors

Many of the refugees reaching the EU from Middle Easternand sub-Saharan countries have fled due to wars, persecution and extreme violences, such as torture, loss or murderof family members and friends, and rape.
High-income countries should make a stronger commitment to prevent any type of conflict in the world andinduce non-democratic countries to respect human rights.
This may, at first, appear to be a naïve and idealistic statement but instead it is a very concrete one. Besides theobvious ethical reasons, prevention of wars, poverty, hunger, etc. would drastically reduce forced migrations andultimately be less expensive to deal with than the consequences of these tragedies. Higher investments in cooperation for development to stabilize areas at risk would savehundreds of thousands of lives and reduce the suffering of
millions of human beings. Just as in medical practice,
prevention is much cheaper and effective than therapy.
During migration stressors

According to the United Nations High Commissioner for
Refugees (UNHCR), there are currently about 65 million
forcibly displaced people worldwide, including about 21
million refugees (over half of whom are under the age of18) and 10 million stateless people. The vast majority ofthese forced migrations are towards low and middle-income countries and “only” about 1.2 million towards the
EU. But the impact has nonetheless been dramatic.

Refugees reaching the EU have often traveled for weeks,months or even years. Most of them crossed the Mediterranean Sea, sometimes losing family members andfriends along the way (3,771 people drowned or went
missing in 2015 alone). Many of them went throughcountries such as Libya, in which violence is usually
inflicted on the vulnerable. For women and minors (often
unaccompanied), these experiences are particularly traumatic. That is not ethically acceptable.

Several studies indicate that refugees have higher morbidity from several mental health disorders such as post-traumatic stress disorder, anxiety and depression compared to

The various initiatives taken at the national and international level (Mare Nostrum in Italy, Triton and, very
recently, the European Border and Coast Guard Agency)

YEARBOOK 2016

1. Training of experts to help refugee centers andhospitals offer high-quality ­­and culturally acceptable medical services. Fast tracks for the recognition of academic and professional titles should be
implemented, as Sweden has recently done.

OTHER POSSIBLE EU ACTIONS

Another European tool which could be strengthened is
the European Voluntary Service, a tool to organize training for young Europeans and provide short placements in
refugee facilities inside and outside the EU under the supervision of expert staff members. For instance, Sapienza
University of Rome, together with the Jesuit Refugee
Service/Italia, has recently started to promote volunteer
placements for medical students, which are getting very
positive feedback. This measure would be very useful inimproving the quality of the refugee centers and, in thismoment of crisis for the EU, could help to reinforce theEuropean values of peace, reconciliation, democracy andhuman rights for which the EU was deservedly awarded
the Nobel Peace Prize in 2012.
CONCLUSIONS

Facing the recent “refugee crisis” and enabling refugees’
integration into the EU in good mental condition is aserious challenge. It is also an opportunity to remember
our history and behave according to our values.

2. Education opportunities for young people, facilitating access through full recognition of previous
studies, skills and titles, creating preparatory andbridging courses, providing more scholarships,
etc.
3. Research opportunities for all qualified refugees
also in collaboration with the initiative Science4Refugees by the European Commission.
4. Cultural and sport programs, very useful to facilitate integration of young people.
5. Advice to political authorities.
Universities, in cooperation with other civil society organizations, can prepare projects which can be funded­under different European schemes:
� The Erasmus+ program is already funding
more than 70 projects addressing migration
issues� A call on “Migrants’ health: Best practices incare provision for vulnerable migrants andrefugees” was recently published within the
3rd EU Health Programme
� The Asylum, Migration and Integration
Fund (AMIF) (€3.137 billion for the period
2014-20) promotes the efficient management of migration flows and the implementation, strengthening and developmentof a common EU approach to asylum andimmigration

AuthorPROF. DR. LUCIANO SASO

Vice-Rector | European University
Networks | Sapienza University ofRome | Italy

AuthorPROF. MAURIZIO MARCECA

President | Italian Society of
Migration Medicine 2016-2020;
Department of Public Health andInfectious Diseases | Sapienza
University of Rome | Italy

AuthorPROF. PAOLO VILLARI

Head | Department of Public Healthand Infectious Diseases | Sapienza
University of Rome | Italy

WORLD HEALTH SUMMIT

25

Migration and Refugee HealthESSAY

MIGRATION,CULTURES AND
HEALTHThe arrival of migrants from different cultures is a challenge
our healthcare systems must acknowledge and overcome.
If they are to play their proper role, doctors and other healthcare
providers in receiving countries have to take into account thecomplexity different cultural practices bring to the system andadapt accordingly.

M

igration, mobility and globalization processes in
the 21st century have contributed to the rapprochement of populations, transfer of cultural
practices and values throughout the world. Questions of
belonging, similarities and differences of one’s own
cultural practices become increasingly relevant in a worldof comprehensive globalization. These phenomenarequire nations and individuals to understand each othernot only at an economic and political level but also to
grasp the complexities of each other’s histories, cultural
inheritances and narratives.
We witness processes of diversification and homogenization at the same time. As a result, some anthropologists
have even challenged the concept of culture, shifting theirfocus instead to “dynamic processes” being influenced byand influencing cultural practices. The current refugee
crisis in Syria, Iraq, Lebanon, Turkey and Europe has put
the spotlight on this new and complex dimension of cultural interaction.
Migrant populations include temporary migrants, refugees, asylum seekers and “illegal” or “undocumented”
migrants. According to the International Office of Migration, they assisted about 58 million migrants from 2011
to 2014 (IOM 2015) and 2015 saw the displacement of

26

YEARBOOK 2016

over 4 million people from Syria due to civil war. In addition, according to a release from the United Nations HighCommissioner for Refugees, 65.3 million worldwide are
currently forcibly displaced and 34,000 people are forcibly displaced daily due to conflict or persecution. Europe
and particularly Germany are the destination a large
share of migrants from the wider Middle East and Africa
aspire to reach. Most migrants and all refugees braveextremely perilous conditions to travel to countries with
cultures, values as well as healthcare systems very different from their countries of origin. For refugees, who are
fleeing war, political upheaval and desperation, the situation is particularly precarious. Most of them arrive inEurope with multiple traumatic experiences.
But in the end, practically all migrants have health issues
that need to be addressed. Many of them, for instance,
faced violence and physical threats (women are at higherrisk) during their journey. Furthermore, migrants frequently have to grapple with new health-related issues
following their settlement in their host country. Hostility
and lack of cultural awareness from the local inhabitants
can lead, for example, to a worsening of migrants’ mental
health following social isolation, poverty, loss of status
and insurmountable challenges. Under such circumstances, any traumatization tends to become a long-term

health issue. Such specific problems come in addition tocommunicable diseases like tuberculosis and hepatitisthat can be developed due to the perilous journey and thechange in environment.
Many migrants also suffer from non-communicable diseases like high-blood pressure or diabetes. Additionally,
migrants often live in poor conditions since they are more
likely to be offered employment in jobs that are “dirty, difficult and dangerous” (IPPR 2006) with minimal basic
occupational safeguards and workers’ rights (EC 2007).
This situation that is new in its sheer dimension for mostof the host countries raises important questions about therelevance of different cultural backgrounds in health prevention, delivery, care and health policies.
In order to continue to play their role properly in theinterest of public health in general healthcare systems,
receiving countries must take this complexity into accountand – in part – adapt accordingly. Healthcare providers
must be assisted by services that facilitate culturally sensitive healthcare as recently stated by the Regional Committee of the World Health Organization (WHO) European
Region. At the same time, in order to boost the culturalcompetency of healthcare providers, curricula will have tobe amended accordingly.
Our ambition should be to optimize existing healthcare
systems through new, culturally sensitive capacities ofcommunication. To achieve this important goal, aworkshop entitled “Migration, Cultures and Health”
was held on this topic at the World Health Summit
2016. The objective of this workshop was to attract attention to the need for cultural awareness and tolerance
in the provision of healthcare to refugees and migrants.
There is still a big gap between the understanding of
cultural diversity by healthcare providers, including
medical staff, politicians and NGOs, and the results
achieved in the field. Overcoming the existing shortcomings would not only mean an objective optimization of existing healthcare systems in the interest of all
but will also contribute to a reasonable policy ofintegration of those migrants who have a long-term
perspective to stay.

The call for better cultural competency at all levels in thehealthcare sector resounded throughout the workshop.
Clinics and health organizations need to examine theircultures, a process which has already started in various
places. For example, the German Commissioner for
Immigration, Refugees and Integration published a muchrequested brochure on dementia-related illnesses, andthe Charité – Universitätsmedizin Berlin initiated the“Woman to Woman” program, aiming at reducing cultural misunderstandings by holding seminars in thehomes of migrant patients. Such programs exist, but insmall numbers. They need to be increased and need toencompass the whole healthcare spectrum to achievesustainable improvements and mutual understanding.

AuthorPROF. DR. GÜNTER STOCK

President | Einstein Foundation |Germany

Author
REINHARD SCHÄFERS

(former) Ambassador | Germany

Author
DR. JEAN-YVES K. TANOWorld Health Summit |Scientific Advisor | Germany

WORLD HEALTH SUMMIT

27

Migration and Refugee Healthsooner these people get jobs, the sooner they are going to
pay taxes. In the end they pay back more in taxes thanthey’ll ever get from the public services. The healthier they
are, the better they contribute to the prosperity of theircountries of origin and destination. It is a win-win situation.

INTERVIEW“It’s a megatrend of
the century”

So the economic case is the most effective argument?
It is an argument amongst others. Migrants’ health bridges
rights, public health, and development, plus the contribution of diversity. Diversity does so much in terms of entrepreneurial skills, in terms of dynamism, languages, culture,
all sorts of impulses that enter a society. Diversity has madeso many countries very dynamic societies. I mean, my own
country continues to benefit from inflows every year of migrants. In fact, we would be in the same situation as Europe– with more people dying than being born – if it weren’t for
migration. The same thing goes for Canada.

Ambassador William Lacy Swing is the Director-General of the International
Organization for Migration, a post he has held since 2008. He came to the
IOM after serving as UN Special Representative of the Secretary-General for
the Democratic Republic of the Congo, where he oversaw the largest UN
peacekeeping operation in history. A­ mbassador Swing has been a diplomat
for over 40 years, and was the US ambassador to Nigeria, Liberia, South
Africa, the Democratic Republic of Congo, Haiti and the Republic of Congo.

In a lot of discussions, the words “migrant” and “refugee”
overlap. Part of the discussion about the recent arrival of
refugees to Germany concerns the economic benefits,
which obscures the right of people to be refugees, regardless of their economic utility. How do you make the casefor that pure right of movement in the current situation?
Swing — The International Organization for Migration
has its own view on this – and I think it’s a widely sharedview – which is that every refugee is a migrant, but not
every migrant is a refugee. In other words, refugees are acategory of migrants even though they are forced
migrants. So, of the 244 million people the UN says areinternational migrants, you have 23 million refugees,
which means that refugees are about 9% of all migrants.
Now, I’m sure some of our colleagues in the UN
system might not like that definition. Part of the tendency
here in Europe, given the large number of persons coming in from Africa and the Middle East, has been to saythat everybody who doesn’t qualify as a refugee under the1951 Refugee Convention is an economic migrant.
Well, that’s too simplistic. Migration is quite complex. You have in that group, for example, tens of thousandsof unaccompanied minors. Germany alone has apparently
about 55,000. You have victims of trafficking, you havepregnant women on the move, you have the sick and theelderly and you have, for example, Syrians who are simply
going north to Scandinavia to join their families. They are
not really refugees as such. But they still have rights.
The international community is planning to meet in New
York in 2018 to establish a global compact for safe, orderly and regular migration. That doesn’t leave a lot of timeto sway the public discourse in favor of migration’s benefits. What are some of the strategies you think people canuse to change the nature of discourse?

28

YEARBOOK 2016

First, all of us in positions of leadership, whether it be ingovernment, or in NGOs, or in an international organization such as IOM, we have an enormous responsibility to
begin to stand up and say what we all know: namely, that
migration is a natural, necessary and potentially enriching
phenomenon; that migrants are human beings deservingof respect, humane treatment and deserving of our thanks
for their skills, their innovation, and their social and cultural enrichment, whatever their status may be. Yet, many
migrants lack equitable access to health services, and manyare exposed to poor living and working conditions andoccupational health hazards that make them vulnerable toill health. Health professionals who know well that ensuring migrants access to health services is a sound publichealth policy have a role to play in that.
Secondly, persons in the media who are spreading
the word should offer people another approach, anotherangle, humanizing migration. We are engaging withsocial media and have, for example, an “I am a migrant”
social media campaign that’s designed to showcase
migrants who are doing interesting things. We are trying
to do more to talk about migrant contributions to society,both in the host country and the country of origin, toshow that historically migrants have always been overwhelmingly positive: They are the original agents ofdevelopment. To quote the economist John Kenneth Galbraith, “migration is the oldest action against poverty.”

Are the historical examples applicable? In the Germancase, there were 12 million migrants right after WWII, but
all of them spoke German. You have a different integration challenge today.

“It’s a myth to thinkthat migrants are coming
to take your jobs.”
WILLIAM LACY SWING

Director-General | International
Organization for Migration | Switzerland

It might be a poverty reduction strategy for the migrant
and their country of origin, but some politicians seem tofocus on the possibility that migration may be impoverishing the host country.
No, because migrants very often begin by taking jobs that
locals don’t want. I mean, how many Germans do you
have who are willing to work in the kitchen or to mop
floors or take care of the sick and the elderly? It’s a myth
to think that migrants are coming to take your jobs. They
will fill in the areas where you don’t have enough workers.

Does that poverty reduction strategy work?

Have you found it an uphill battle to make the case that
granting access to health coverage to migrants as soon as
they arrive is a good idea?

It does. Global remittances amount to US $500 billion,
and last year the total foreign direct investment was
something like US $654 billion globally. So it’s almost as
much as all foreign direct investment – and twice as muchas foreign aid. For countries like El Salvador, for example,
probably 30% of its GDP comes from remittances.

It’s an ongoing challenge. Thailand is a good example. Thailand has 3 million migrants from Myanmar and othersfrom Laos and Cambodia. But they have given healthcare
access to all migrants and in many ways I think they havebenefited from it. They have a healthy workforce now, a productive workforce – they depend on these migrants. The

There is a psychological adjustment that countries like
European countries are having to undergo, and it’s notjust a question of getting over refugee amnesia.
European countries have peopled the world forthree centuries – colonies, investment, trade, academic
exchanges. And now we are becoming a continent of destination rather than just a continent of origin, whichmeans rather than you sending your people out, people
are coming to you. That’s always a little disconcerting.
This is where the media and governments have sucha big role to play. We try to explain why these people arecoming, who they are, and how one can prepare to receive
them. Both communities – the host communities and themigrants – have a responsibility to make integrationwork.
Do you have any particular examples in mind that arereally best-case scenarios or models?
I hesitate to use Canada, because when you say Canada
Europeans say, “look, they’ve only got one neighbor andthey’ve got two big oceans on either side.” But if you wantto take an example of who has done it and done it well,when the new Prime Minister, Justin Trudeau, was campaigning, he said, “If I am elected, we will bring in 25,000
Syrian refugees.” Then he went on to say, “We will bringthem in not as refugees, but as future Canadian citizens.”
That already sets a different tone for people. He sent his
minister John McCallum out to provincial governments
and talked to the mayors. That was, I think, done in awell-prepared way. It’s a bit different from the European
situation, but it has elements that could be adapted.
Sometimes people see this as a temporary crisis, but I’mhearing you say migration isn’t going away.
No. It’s a megatrend of the century.

WORLD HEALTH SUMMIT

29

xxxxxxxx

xxxxxxxx
HEALTH IN NUMBERS

Migration andRefugee Health:
From Care to Policy
The current inf lux of migration – the biggest since the end of World War II – isputting migrant health issues at the top of government agendas. Basic care is nolonger enough. We need new concepts for adapting health policy strategies thattake into account transformative processes, both in migrant countries of origin
and in the nations to which they emigrate.

STATEMENTON THE MOVE

What is goodfor migrants
would also be
good forpatients witha non-migration
background.

One out of every 122
people on Earth is
now either a refugee,internally displaced,or seeking asylum.

Prof. Dr. Jalid Sehouli (Director,
Clinic For Gynaecology,
Charité - Universitätsmedizin
Berlin) at WHS 2016

(UNHCR, 2015)

INFLUX OF REFUGEESSTRESS & TRAUMAWorldwide, the numberof people displaced
by war has reached astaggering new high.

10 x higher:
Refugees andasylum seekers
suffer posttraumatic stressdisorder (PTSD)
10 times more
often than
non-refugees.
(The German Association for Psychiatry,
Psychotherapy andPsychosomatics, 2016)of all refugees are hosted
by developing countries.
As a result, their healthproblems stress the entire health system in thesecountries.

0%

25%

50%

75%

Refugees

International migrants (including refugees)
under 1830

YEARBOOK 201618 to 59

60+

100%

2010

2011

2012

2013

2014

2015

(UNHCR, 2016)(The World Bank, 2016)

AVERAGE AGE

in millions

More than 50%of the refugee
population is under
18 years of age,making the world's
refugee populationmuch younger
than the overall
migrant population.

ORIGINSIn 2015, 54% ofrefugees worldwide
came from threedifferent countries:(UNHCR, 2016)(Unicef, 2016)

WORLD HEALTH SUMMIT

31

Annual Discussion

Annual Discussion“There is a whole­universe of ­fantastic,
unexpected new­findings out there”

DR. YUKIYA AMANO

Director-General | International Atomic
Energy Agency | Austria

32

YEARBOOK 2016

PROF. DR. PASCALE EHRENFREUND

Chair of the Board | German Aerospace Center |Germany

From smartphones to delivery drones, technology
is changing the way we think about public health.
But are its benefits – and risks – evenly distributed?
And what can be done to improve care for all thepeople of the world? At the World Health Summit,
four leading figures from different health-relatedareas gathered to discuss the way technology canbest be applied to pressing problems of public healthand other challenges facing today and the future.

DR. MANUEL DELGADO

Secretary of State of Health | Ministry of
Health | Portugal

DR. MATSHIDISO REBECCA MOETIRegional Director for Africa | World
Health Organization | BotswanaWORLD HEALTH SUMMIT

33

Annual Discussion

Let’s start by talking about the uneven distribution of technology, and what the needs are in developing and developed countries. Does the international community have its
priorities straight when it comes to funding, or is too muchbeing spent on solutions to first-world problems?
Moeti — In the African region it’s recognized that many
people are taking advantage of technology, IT in particular. They still have a long way to go for technology to be a
regular feature at the household or public health systemlevels.
Electronic health and mobile health, starting with information collection, surveillance and data gathering areimportant in our region. It’s critical to have data systems
that enable rapid awareness that a strange pattern of illness
and death is occurring somewhere, understand what thismeans, and trigger an investigation and response, for example. We see this as a huge opportunity waiting to be better exploited in the African region.
Amano — Yes, distribution of resources is uneven. But
we are doing a lot to change that. Just take, for example,
cancer. On the African continent, 28 countries do nothave any cancer diagnostic equipment or radiotherapy
equipment. Cancer patients come to the clinic too late, so
we cannot provide life-saving treatment. So this is unfair,
this is uneven, and this must be corrected.
What can we do as an international organization? I
think the different organizations need a different mandate and we need to cooperate. International organizations cannot do everything, so we need to cooperate withgovernment, NGOs and private companies. We can provide basic equipment, but not much. What we are betterat is providing training. We can receive trainees and what
we can do is use our network to place trainees into othercountries.
Are these devices cost-effective? Are they expensive? Yes, they are. The basic diagnostic machine cancost from US $1 million to US $2 million. More sophisticated machines can be around US $10 million. But if
you have one machine, you can diagnose 3,000 people ayear.
We were involved in the diagnosis of Ebola, andthat is much cheaper. One kit to detect the Ebola virus
was around €50,000, and that is a lot. With one kit,
though, we can detect the Ebola virus in 3,000 people. If
you consider the economic loss from Ebola, from cancer,
this is a very good investment, I think.

34

YEARBOOK 2016

Annual Discussion

Delgado — We have to put resources in perspective. I'm
coming from a country where frequently there are two
experiences. In Portugal, all the Portuguese have access totechnology. But we are linked to former colonies in Africa, and we see people coming to Portugal looking for help
to treat problems they can’t in their countries.
In a small country like Portugal, we have some problems with the distribution of these kind of treatments andtechnologies. The more treatments we make available, themore people will use them. So we are always trying to be
diplomatic around the doctors. If we politicians say “no,this equipment cannot be used in these circumstances,”they say, “But I am the doctor, not you.” That may be true,
but we need to promote the creation of criteria that are
independent of stakeholders to promote the correct use of
these kinds of treatments.

nosed. We need to address the contradiction: In developing countries, they don’t have this luxury. They often cannot afford any access. So we need to support them.
Help them establish expertise, or help them acquire thetechnology?
Moeti — I think you need to guide how they invest. Countries have asked WHO to advise them on how to navigate
the many different offers from private companies that areapproaching the ministries, the different decision-makers
within the system, offering deals. “I have got this for you, I
have got that for you.” I think they run the risk of purchasing and contracting for technology or equipment which is
not the most cost-effective for their needs.
Amano — This is exactly what we are doing together with
the WHO. Before these countries buy expensive equipment, they have to establish their first dedicated cancer
center, then they have to be able to train their own trainees.
Otherwise they cannot be sustainable.

Can you give an example?
Delgado — Take intestinal cancer. We decided in Portugal to promote colonoscopies for people over 50. What
happened was that the number of examinations increased
more than 600%, with marginal benefits in terms of decreased mortality. Of course, the government spent a lotof money on these examinations.
Now we are in a very difficult situation, because if
we introduce stricter criteria to promote the better use ofcolonoscopies, people will be unhappy.
Amano — I have personal experience on this: I became
the director of the International Atomic Energy Agency
in 2009 and attended the first conference as director in2010. I chose to address breast cancer. People thought thisnew director is a strange guy – he doesn’t talk about nuclear power generation, but will talk about breast cancer.
They were talking about which age women need to go toscreening, and there was a heated discussion. It’s a serious
issue.
But I said, “you are talking about which age women
have to start going to screenings, but in African countries,
which I have visited, people do not have any access tomammograms.” Some people cannot tell their husbands
that they have breast cancer – they leave the home andjust die.
So there are two realities. On one hand, you could say
people are suffering from an overdose of access to cancer
diagnosis. On the other hand, there are those who have noaccess and are just dying without being treated and diag-“The more­treatments wemake available,
the more people
will use them.”
DR. MANUEL DELGADO

Secretary of State of Health |Ministry of Health | Portugal

Ehrenfreund — I just have to talk a little bit from a different angle, since we are not really providing instrumentation. But we have a lot of cooperation with the United
Nations and other organizations. When there are majordisasters, like the recent Hurricane Matthew in Haiti, wedeliver data immediately for an immediate response –within hours, we actually deliver data that helps provide
humanitarian aid in those crisis regions. So from space
we can really help when there is a need.
In the long term, when you have detailed satellite
data on agriculture and climate you can also understandwhy people have to leave home in the first place. If we
could use those 30 years of data in order to look at trends,
perhaps we could stop the migration by improving thesituation locally.
Telecommunication satellites can also promotehealthcare solutions for remote locations. I think space
can really contribute a lot to solving global challenges, including healthcare. The United Nations Office for Outer
Space Affairs has, for instance, a network called the BasicSpace Technology Initiative. They are actually teachingdeveloping countries how to interpret satellite data, forinstance, and how to build small satellites. We and NASAand many other organizations help people in developing
countries look at their future and their health environment from space.

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Annual Discussion

Annual Discussion

Hurricane Matthew is a great example and I’m glad you
brought it up. Who do you deliver assistance to? Everybody here, whether you’re representing an internationalorganization or government, has to have partners you
work with. Is that collaboration good enough in thehealthcare arena?
Ehrenfreund — We are working with the United Nationsin that case. We have a satellite crisis management teamclose to Munich. And they deliver immediate data to theUN when it’s requested.

“Space can ­reallycontribute a
lot to solving­global ­challenges,­including­healthcare.”
PROF. DR. PASCALE EHRENFREUND

Chair of the Board | German Aerospace
Center | Germany

36

YEARBOOK 2016

Moeti — We could probably use the data better if we understood where within the UN this data could be available. For example, I’m interested in data that would help
predict disease outbreaks that might occur because ofclimate trends, weather pattern changes and the like. We
could use something like that in a forward-looking way,in order to help countries prepare for and plan for shifts
in the patterns of diseases.
I’m sure that more data on urban areas could also
help. Let me be frank – we were caught by surprise by theoutbreak of yellow fever that very soon spread to urban
areas in Angola and the Democratic Republic of Congo.
Everybody was petrified when we realized that the thinking about yellow fever and the strategy for prevention, atleast in the African region, was based on how people were
living 20 years ago.
We did not take into account the type of ecology thathas evolved over the years with the rapid urbanization in
African countries combined with the trends in the climate,which together have combined to really create a good environment for unusual patterns and unusually severe outbreaks of diseases like yellow fever and dengue. I think thathaving a better understanding of where such predictive
data might be available, which you might have and could
help with use in the UN and also, then, in the countries,
would be helpful.
So maybe I can ask a politician: How can technology bebetter applied to healthcare problems?
Delgado — It’s not an obvious thing but the health information system is technology, perhaps not applied totreatment but applied to knowledge. In Portugal, we arevery, very focused on this because we think that the moreaccess patients have to treatment and to their medical
records the better.

“Quite often,­people love tohave the mostadvanced device,
but we tell themit,s not always
a good idea.”
DR. YUKIYA AMANO

Director-General | International
Atomic Energy Agency | Austria

Our idea is to develop a national health service application. If you have a medical emergency you need to go toan emergency room, for instance: In Lisbon we have four.
You can use your phone to see which one has the shortest
waiting time. You can check waiting lists for surgery,waiting times for a patient consultation, all on your phoneor computer.
Another idea we implemented recently is the prescription of drugs without paper. The doctor inputs thedata directly into a computer and the patient receives anidentification number. With this identification number
he can go to any pharmacy and collect the drugs heneeds. So it’s more safe and eliminates corruption.
Dr. Ehrenfreund, are scientists listened to in the political
realm? How can researchers make more of a contribution
to the public debate?
Ehrenfreund — I think that scientists are always trying
to find new ways of defining new research avenues, butwhat they need is, of course, support for grants. You cantrigger research in a particular direction when you havespecial funding nationally but also from the ­EU or otherorganizations.
And where does that funding need to be? What are themain crises that need to be addressed right now by the
public health community?
Amano — I would say that there is too little attention tocancer. There is this perception that this is a disease thatjust affects people in developed countries. This must be
corrected. We want to promote more training and cooperation, perhaps using satellites and IT to get doctors in
African countries connected to their colleagues or Canada, or Sweden in the form of virtual universities or educational programs from the IAEA.
Ehrenfreund — At the DLR [German Aerospace Center],
we are not directly involved in healthcare as such, but I
want to make a real call for basic research. You need thiskind of research in order to have radical innovations. We
can only achieve real breakthroughs when we are not too
program-oriented.
I know this, from having previously led a researchfunding organization: In medicine, you need to fund thewhole innovation chain in order to be successful.

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Annual Discussion

Delgado — It’s true that in developing countries they haveno antibiotics, but in Portugal right now it’s the excessive
use of those that is a big problem. At the moment, some
hospitals present mortality rates from infections that are
higher than 10 years ago. The situation is so bad it’s becomea political issue. The challenge for industry is to develop
new antibiotics. But the companies say “well, it’s important,
but there’s not enough profit there – we need public investment to develop new antibiotics.”

system treats you, independent of the level of complexity
or gravity of this disease. But we cannot use all kinds of
new technologies before an agency assesses their effectiveness.

Moeti — I think antibiotic resistance is even more dangerous for low-income countries. As these antibiotics become ineffective in the wealthier countries, the market
reasons for continued production disappear, whichmeans that developing countries no longer will haveaccess to effective antibiotics. Some of the most common
antibiotics are simply not available.
Policymakers are starting to think about some sort ofglobal partnership, to create the incentives for pharmaceutical companies to invest in the research and developmentof new antibiotics.
Then there’s the issue of counterfeit or low-quality
drugs, which are frequently on sale in low-income countries all over the world. So again, there is demand forresearch and development to find solutions to thiscounterfeit drugs problem.

Delgado — Last year, a new drug for the hepatitis C virus
was approved. For each treatment, the initial proposal of
the industry was a significant amount per patient to curehepatitis C. Not to manage, but to cure. The government
negotiated directly with the company in order to bring
down the price.

And then investment in a time of austerity and pressure
on funding, you’re asking for basic science funding, you’reasking for a very applied use. Is that going to come from
taxpayers and governments?
Delgado — It’s very difficult to have a solution for this. The
question for the industry is very easy to understand: If weuse drugs and technologies without any kind of control, ata certain moment, the system goes broke. But if we use
these technologies with control, with health technology assessment, all sides benefit – the governments, the patients,
and the industry too. It’s much more sustainable to managecare. It's a compromise.
That kind of rationing can be politically unpopular. Patients want unlimited access to whatever care they mightwant or need.
Delgado — It is not a good idea to have free access tohealth providers. We prefer a national service, free for everybody, but with some limits. If you have a disease our38

Annual Discussion

YEARBOOK 2016

So restriction and control should be based on efficacy,
not cost? What if there were a fantastic new technology that was very expensive but better than the oldtechnology?

Moeti — So you have to go off the record.

“Developing
countries
no longer will
have accessto effective
antibiotics.”
DR. MATSHIDISO REBECCA MOETIRegional Director for Africa | World
Health Organization | Botswana

Delgado — I can tell you we decided to negotiate, for the
first time in Portugal, risk-sharing between the government and the company. We pay for the treatment, but
only if the patient is really cured. And we have a simultaneous control made by the government and the company
in order to define that with laboratory tests. If it works,
and we pay for 98% of the patients, the company stands toearn so much.
Moeti — That’s interesting.
Dr. Amano, when you’re proposing a country buy a very
expensive radiotherapy device, what are your cost-benefit
analyses?
Amano — We are not proposing very expensive equipment. Quite often people love to have the most advanced
device, but we tell them it’s not always a good idea. For
example, for linear accelerators, if their electricity is notstable it doesn’t make sense to buy very advanced ones.
But we do not recommend starting from zero.
Nowadays, medical treatment is very advanced andnuclear medicine is advanced, so why not start using theexperience of other countries? All people should beentitled to the best possible care. What is important issuitable, quality and effective care, including cost-effectiveness. So the technology must be reasonably
advanced, but there is no need to aim at the mostadvanced, most expensive thing. For example, in Japan,

heavy particle treatment is very effective for brain
tumors, but the equipment costs €300 million. There arevery few countries who can afford this. However, a €1.5
million machine can provide effective treatment for
thousands of patients over many years. But in the end,
it’s the country that decides.
Moeti — I was very interested in the question that Secretary Delgado raised about negotiating with pharmaceutical companies and the need to keep that information
confidential. There is a strong drive from our region fortransparency and information sharing about pharmaceutical prices. Joint negotiation with the pharmaceutical companies – so that you don’t find this one here paying a price very different from South Africa right nextdoor to each other – seems like a good idea. What could
be the role of inter-country joint approaches? The morecountries that can join in at affordable prices, the more
the market is growing. I think it’s a very interesting possibility.
Dr. Ehrenfreund, what about basic research? In light ofthe problems the world faces, is it worth spending moneyon discovery-based science?
Ehrenfreund — There is huge value in space and also basic research. When we conduct experiments on the international space station, we have some main questions
which we want to answer, and sometimes the results arevery new and unexpected. We have new findings on osteoporosis because of bone loss in microgravity and weightlessness. We have new insights into cardiovascular diseases and the orientation of the eye. And you have certainly
also heard that there are microbes which get very virulent
in space.
On the International Space Station, there are a lot ofradiation studies. And you can extrapolate from those results for cancer therapy on Earth. That also applies to technology, too – robots which we use in space can actuallythen be used for medicine here on Earth. But we also
looked at the spatial orientation of astronauts in zero gravity with a 3D eye-tracking device that is now used in laser
surgery for eyes.
What I’m saying is there are a lot of spinoffs and unexpected results from basic research. So you should notforget that there is a whole universe of fantastic, unexpected new findings out there which can be linked to research on Earth and help healthcare on our planet too.

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Infectious
Diseases
From age-old nemeses like malaria and tuberculosis to modern adversaries like Zika and ­Ebola,
communicable diseases are one of the greatest
challenges the public health sector has to ­face. The consequences of failure are tremendous:
2014’s Ebola outbreak cost an estimated US$1 billion to bring under control.
The solutions, experts say, are within our grasp:
Funding is needed for new vaccines, education
programs to emphasize the importance of
hygiene, and international coordination to deal
with disease outbreaks promptly.
A broader perspective is needed: “When we think
about infectious disease, we have to get outof the biomedical model and talk to economists,
geologists and sociologists,” said Peter J. Hotez,
President of the Sabin Vaccine Institute. “It’snot easy for us to do so because in the medical
world we’re quite siloed.”Infectious Diseases

OVERVIEWLESSONSLEARNED FROMEBOLA TO ZIKA
Infectious diseases remain a challenge. The Ebola crisis wasa wake-up call for better preparedness. Improved prevention
measures will be costly, but are a bargain compared withprojected annual losses on the order of US $30 – $50 billion.

T

he Ebola crisis was not only a humanitarian tragedy, but also the straw that broke the camel’s backand led politicians and economists to refocus not
only on humanitarian issues, but also on financial
impacts. Expert groups were gathered to develop new
ideas targeted at nullifying or at least reducing the risk ofpandemics. It was generally agreed upon that increasing
urbanization and globalization significantly enhanced
the risk that a local outbreak progresses into an endemic
with risk of a pandemic if countermeasures are not taken
immediately. In these calculations, not only were direct
costs for diagnostics, drugs, vaccines and medical careconsidered, but also indirect losses due to leave ofabsence, illness or disability and even losses in trade,transportation and tourism. A common theme was active
prevention, which was identified as the most cost-efficient option. Different reports calculated an average annual loss of US $30 to $50 billion due to new pandemics.
The rather short pandemic caused by the severe acute respiratory syndrome (SARS) virus in 2003 alone accounted for some US $54 billion in losses. Today, a pandemic of
the size of the Spanish flu of 1918, with some 50 million
deaths when the global population was less than 2 billion
people, would amount to an estimated US $3 trillion anda 5% decline in the worldwide gross domestic product(GDP). Over time, the idea of infectious diseases as beingof both human and animal origin has also gained increasing awareness. In the past, some 70% of all newly emerging pathogens have jumped from animals to humans.

42

YEARBOOK 2016

THE “NEW” CULPRITSThe Ebola endemic was virtually restricted to three West
African countries – Guinea, Sierra Leone and Liberia.
The few cases that had occurred up to the end of 2013
were more or less ignored. After all, small Ebola outbreaks had come and gone before. However, this timethings were different. Towards the end of 2014 more than
20,000 people had fallen ill and nearly 8,000 had died.
The incredible engagement of non-governmental organizations, notably Médecins Sans Frontières (MSF), together with local health workers, prevented the worst. As lateas August 2014, the World Health Organization (WHO)declared a global health emergency – too late for rapid
termination of the crisis. In January 2016, when almost
30,000 people had fallen ill and almost 12,000 people had
died, the WHO finally claimed the region Ebola-free.
Financial losses for the area amounted to more than
€1 billion and a 12% decline in GDP. Despite the inherent
fear that the endemic could turn into a pandemic, thisworst-case scenario was prevented. Of course a vaccine
would have been a game-changer, and indeed some candidates had been developed in the aftermath of 9/11
under the umbrella of the US biodefense program. Yet,these vaccine candidates could not be pushed through theclinical pipeline because of the absence of disease. Only
towards the end of the Ebola outbreak in 2015 did a clinical efficacy study which showed promising results
become possible.

Soon a new disaster emerged. The Zika virus had entered
Latin America. This virus is transmitted by Aedes mosquitos. In contrast to the Anopheles mosquitos responsible for transmission of malaria, the Aedes mosquitos haveadapted to urbanized areas. Because they are quite resistant to pollution and cold temperatures, they have spreadfrom tropical and sub-tropical areas to the Middle East,
India, the southern parts of the US and Europe. Although
the Zika virus was identified in Uganda in 1947 andappeared in sporadic outbreaks in subsequent decades, it
was more or less ignored because in most cases infection
produced only mild symptoms. During its 2015 and 2016spread throughout Brazil and some other 30 Latin American countries, it soon became clear that the Zika virus
can cause neonatal microcephaly when it infects a woman during pregnancy. This time, the WHO reacted
promptly, calling a global health emergency at the end ofJanuary 2016. By March 2016, around 1.5 million suspected or real cases of Zika disease and some 4,000 casesof microcephaly had been recorded in Latin America,
with the majority in Brazil.
In parallel and more or less unrecognized, another viralpathogen, which is also spread by the Aedes vector,
emerged. The dengue virus is responsible for at least 100
million cases of illness and 20,000 cases of deaths annually. A dengue vaccine has been licensed in Mexico, thePhilippines and Brazil very recently which, although not
perfect, provides some hope that this disease can bebrought under control. Although a Zika vaccine is not yeton the horizon, the Zika virus belongs to the group of
Flaviviruses. Together with dengue, these viruses also
cause yellow fever, FSME and Japanese encephalitis. For
all these diseases, vaccines have been developed. So a
blueprint for the development of a vaccine against the
Zika virus is already available. The fact that the availaility of a vaccine does not prevent outbreaks as long as it
is not widely used has been re-emphasized by the recent
outbreak of yellow fever in Luanda, Angola’s capital.
There, yellow fever has rampaged since December 2015
with some 500 confirmed cases and 200 deaths so far. By
now, some 6 million people have been vaccinated against
yellow fever in the Luanda area with the hope that further
spread can be prevented. However, the vaccine stockpiles
are almost empty, emphasizing the need for international
vaccine stockpiling.

occurrence of multidrug resistance. In 2014, the humanimmunodeficiency virus (HIV) infected some 2 million
individuals, causing 1.2 million deaths. In 2015, there
were roughly 214 million malaria cases, leading to nearly
450,000 deaths. It has been estimated that the increasing
incidences of drug-resistant TB, malaria and AIDS willcause financial losses in the order of US $100 trillion overthe next 35 years. An efficient vaccine is neither available
for AIDS nor TB, and the recently licensed vaccine
against malaria is far from satisfactory.
WHAT NEEDS TO BE DONE?

The world needs to be better prepared for infectious diseases. Newly emerging diseases need to be recognized
and countered immediately and existing infectious
threats need to be combatted more rigorously. One study
proposed investing some US $4.5 billion per year, split
into US $2–$3 billion for early surveillance and counteraction; US $1 billion for research and development andUS $150 million for establishing and sustaining these activities. Compared with estimated losses of US $30–$50
billion annually due to infectious disease outbreaks andpandemics, that sum looks like a bargain. The major
activities to be put immediately into effect include:ȣȣ Functional clinics and basic medical care, including better vaccination and hygiene programsȣȣ Global organization and stockpiling of intervention measures
ȣȣ Global surveillance to rapidly identify emerging
hotspots, ideally before the epidemic starts
ȣȣ International centers for global health security
measuresȣȣ Strengthening of research and development for
novel medicines and interventions
Only if we learn our lesson from the Ebola crisis will webe better prepared for the next outbreak.

THE “OLD” CULPRITSThe dengue pandemic reminds us that in parallel to newly emerging diseases, existing pandemics are equally
threatening and cannot be ignored just because they havebeen around a long time. Notably, the three major killers– tuberculosis (TB), Acquired Immunodeficiency Syndrome (AIDS) and malaria – are responsible for millions
of infections and deaths. With a morbidity rate of 9.5 million and a mortality of 1.5 million in 2014, TB remains a
global threat which is further exacerbated by increasing

AuthorPROF. DR. STEFAN H.E.
KAUFMANN

Director | Max Planck Institute for
Infection ­Biology | Germany

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Infectious Diseases

ESSAY

FLIPPING THE
ACCESS MODEL TO
INNOVATION
Recent epidemics have shown that infectious diseases know nobarriers and cross international borders with impunity.
Immunization programs are critical to improve our response
system to these outbreaks, but the vaccine access model toinnovation needs to be flipped to reach those in greatest need.
We must work together to develop more equitable accessmodels to innovation.

T

he 2014 Ebola epidemic in West Africa and therecent Zika epidemic are painful reminders of thedreadful toll infectious diseases can take on populations and economies. They have shown that countries
are not well prepared to respond to global epidemics
caused by emerging pathogens. Though a global collaborative effort has allowed us to move from having novaccines against Ebola to several candidate vaccines, theEbola crisis should serve as a wake-up call that we need tochange the access model to innovation.

launched first in developed markets in small volumes andat a competitive price, and made available in low- andmiddle-income countries (LMICs) significantly later (i.e.,
8 to 10 years) at a lower price once the innovation cost has
been recouped. Access in poorer countries thus tends tobe delayed, and diseases which affect these countries only
– such as Ebola, Chikungunya, dengue or Zika – are often
neglected.

Immunization programs are not only critical to improve
our response system, but are also one of the “best buys”
when it comes to public health and socioeconomic development. Vaccination is the most cost-effective healthcare intervention after the provision of safe drinking
water and sanitation. In order to secure the highest publichealth and economic impact, vaccination programs
should reach those in greatest need through broad
programs implemented in the shortest time possible. Thisrequires challenging the conventional vaccine introduction model.

Dengue fever – for which half the world is at risk, mainly
in LMICs – propelled Sanofi to adopt a new access model
to innovation. Dengue is a serious and complex disease
which mainly affects sub-tropical and tropical regions,and which is associated with a substantial socioeconomic
burden at both individual and societal levels. The incidence of dengue has surged 30-fold over the last 50 years,
amplified by globalization, urbanization and climatechange, but the true scale of the disease burden is likely
underestimated. According to some estimates, the dengue
burden can be twice as high when considering the broader
impact of dengue on productivity loss, decrease in foreign
investment and losses in revenues from tourism.

In this model, innovation is steered by the medical needsof wealthier countries which can afford the launch prices
necessary to finance and incentivize both innovation andproduction scale-up. As a consequence, new vaccines are

44

YEARBOOK 2016

DENGUEThe Sanofi dengue vaccine – a live, attenuated, tetravalentvaccine – is the only vaccine that has demonstrated

evidence of clinical efficacy against dengue in clinicalstudies (40,000 individuals enrolled in 15 countries). It
has been licensed in five countries as of July 2016 (Mexico, the Philippines, Brazil, El Salvador and Costa Rica)and has been recommended for use by the Strategic Advisory Group of Experts (SAGE) on Immunization of theWorld Health Organization (WHO).

laborations. In endemic countries where the clinical trials
were conducted, Sanofi has developed strong cross-sector
collaborations, empowered local healthcare providers
with disease and vaccine knowledge, trained communities at risk on dengue prevention and upgraded healthcare facilities. This should facilitate future vaccine introductions.

POPULATIONS AT GREATEST RISK FIRST

Today, Sanofi is building on its successful history in developing vaccines against dengue and other similar flaviviruses (yellow fever, Japanese encephalitis), to answer
the global call to action to fight Zika. Sanofi’s expertiseand established R&D and industrial infrastructure for the
dengue vaccine is being leveraged to better understandthe spread of the Zika virus and to expedite the identification of a vaccine candidate. It is, however, critical to underline that Sanofi cannot solve this alone; we need governments, international organizations, academia andindustry partners to collaboratively work on a Zika vaccine development project.

The dengue vaccine, already launched in the Philippines,
is having its initial introduction in LMICs where the needis the greatest and where it can have the greatest impact
on global dengue burden. Sanofi is introducing the vaccine in both the public and the private sectors so as toensure broad access and highest impact from registration
on. To achieve this, the company is valuing the vaccine ina way that balances the cost of innovation against affordability in these LMICs.
A BOLD AND EARLY ENGAGEMENT

Twenty years ago, long before the results of phase III clinical trials and the vaccine launch, Sanofi committed to thefight against dengue through an unprecedented investment of resources in scientific, technical and industrial
capabilities. The company acknowledged the magnitudeof the dengue challenge at its early stages and made a bold
and uncommon decision: It took the risk to develop thevaccine, invest in industrial capacity and prepare market
launch all at the same time, rather than as a sequence as is
usually the case.
Sanofi committed substantial financial resources to dengue, including a €350 million investment in a dedicatedstate-of-the-art production plan in Neuville, France. This
major investment allows the company to produce around
100 million doses per year, and to supply one billion
doses over 10 years. Thanks to this early – and risky –engagement, Sanofi already has doses available at thetime of licenses, thus avoiding a time lag between licensing and implementation.
PAVING THE WAY FOR THE INTRODUCTION OF
FUTURE VACCINES

A successful introduction of the dengue vaccine would
demonstrate to other private sector companies that thedengue business model is attractive, and encourage sustained investment in healthcare innovations for LMICs,
while improving the response system to dengue outbreaks. Dengue could serve as a model for the introduction of new vaccines which will be implemented throughbroad vaccination programs.
The dengue access approach has also created social value
at local level through the strengthening of in-country
skills and capacity and the building of public-health col-MOVING FORWARD TOGETHER

Because infectious diseases such as Zika know no barriers, common protocols and approaches are needed topromote investment and to prevent and cure diseases.
When there is an immediate and guaranteed market,
companies have an incentive to invest fast, but when theopportunity is longer-term and more uncertain, society
flounders when struggling to come up with solutions.
Populations, however, cannot wait 20 years for an essential cure. Diseases do not pause for us to get the accessmodel to innovation right: not addressing this fundamental challenge fast enough is putting entire populations at risk. We thus need to develop more equitable
access models to innovation that do not forgo long-termsocietal value for short-term returns. Let’s think of it aslife insurance: Paying a premium today will allow protect
ing populations who need it most in the long term.
More innovative access models such as the one introducedby Sanofi for dengue are needed to allow LMICs timely andsustainable access to innovative vaccines and to improve
the response system to outbreaks. Close international andcross-sector cooperation is vital to support an integrated
approach to infectious diseases and to fight the global
threat they represent. To go far, we must go together.

AuthorSURESH KUMAR

Head of Government Relations US
ad interim | Sanofi | USA

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Infectious Diseases

ESSAY

EBOLA TO ZIKA:
AREAS OF ACTION
Recent outbreaks of Ebola, Zika and yellow fever have highlighted vulnerabilities and weaknesses in the way the global healthcommunity responds to these threats. The Institut Pasteur International Network is working, with other international partners,
toward improving preparedness and response to infectious disease
outbreaks and proposes the following actions to address theseissues.

Here, I outline three major areas of action that will
help prepare for infectious disease outbreaks andwhat the Institut Pasteur International Network(IPIN), composed of 33 research institutes in 26 countries
and five continents, is doing to address these issues.
ACTION NEEDED – BETTER PREPAREDNESSAND COORDINATION DURING PUBLIC HEALTH
EMERGENCIES

Changes in ecosystems, due to changes in human behavior and encroachment on the natural habitat of animals,changes in land use and food and agriculture systems,
and the impact of climate change on animal and vector
environments have given rise to an apparent increase in
the number of outbreaks of emerging and re-emerging
infectious diseases, often in somewhat new and unexpected geographic locations – H1N1pdm09 influenza
virus in North America, Ebola in West Africa, and the
Zika virus in Latin America and the Caribbean.
The reality is that infectious disease outbreaks will continue to occur and we are currently unable to accurately
predict when and where they will occur. The challenge
therefore lies in improving preparedness and responses
to infectious disease outbreaks in order to minimize
their impact. That is, improving surveillance and monitoring of not only human populations, but also animal
populations and the surrounding ecosystem, in order tobe able to quickly detect, monitor and characterize
emerging threats. This needs to be accompanied by rapid
evaluations of the potential impact of an outbreak and of

46

YEARBOOK 2016

the effectiveness of possible control strategies. It is alsourgent to further develop, improve and/or render accessible relevant and diagnostic tools, including rapid tests,
point-of-care tests and tests enabling us to discriminate
easily among different pathogens often giving rise tosimilar syndromes.
The IPIN institutes have proven their technical capacities
in preparing for and responding to infectious disease
outbreaks with a One Health approach. As I write this,scientists of IPIN in Dakar, French Guiana, Brazil, Guadeloupe and Paris are actively working in the affected
countries with WHO and others on Zika to develop
accurate and rapid molecular and serologic diagnostic
tests and vaccines, evaluate vector competence andcontrol options, develop and implement standardized
epidemiologic studies to better understand the diseases
Zika causes in adults and fetuses of infected mothers aswell as the transmission dynamics. Similarly, colleagues
from Cambodia, Cameroon and Paris are actively investigating outbreaks of H5N1 in poultry, while others from
Dakar and Paris are on the front lines of the yellow fever
outbreaks in Africa.
On the preparedness side, IPIN is active in 30 Africancountries to improve laboratory detection and effective
surveillance, with training of African scientists and public health workers as a major component. International
collaborative projects have provided support to train
African scientists for the detection of hemorrhagic fever
viruses in eight countries, as well as to set up surveillancesystems for respiratory viruses.

Building on the expertise of IPIN and on the Laboratory
for Urgent Response to Biological Threats, as well as on
dozens of reference centers (national-, regional-,
WHO-collaborating-, OIE-reference-, hosted in IPIN
Institutes), the Center for Global Health has establishedthe Institut Pasteur Outbreak Investigation Task Force(OITF). Upon request from a Ministry of Health orWHO, the OITF calls upon experienced interdisciplinary
teams of IPIN scientists to be rapidly deployed to support
investigations of outbreaks. Our aim is to better understand emergence and transmission patterns, to limit further spread in human populations, to improve emergency
response management, to enhance preparedness, to contribute to the development or improvement of efficient
diagnostics and to advance global understanding of
emerging and re-emerging infectious diseases.

tion, it has also highlighted the need for enhanced big
data capacity and analysis.

ACTION NEEDED – BUILDING AND
MAINTAINING CAREERS OF SCIENTISTS,
MEDICAL PRACTIONERS AND
PUBLIC HEALTH PROFESSIONALS

MOVING FORWARD AND WORKING TOGETHERThe Ebola outbreak in West Africa highlighted not only thedramatic consequences of poor preparedness and weak
health systems, but also the shortage of trained personnel
and laboratory-based capacity in areas such as surveillance, diagnostics and medical care. We strongly believethat education and training are critical to strengthening
capacity in a way that improves local responses todetecting, monitoring and managing public health threats.
The IPIN has long-running experience in educating andtraining scientists, medical practioners and public healthprofessionals throughout the world through undergraduate, Master’s and doctoral programs that are strongly
anchored in national educational systems. This is complemented by specific fellowship, post doc and early career
placements within the IPIN institutes designed to further
professional scientific development in the countries
which need this most.
The Institut Pasteur is launching a new educational initiative: the Pan-African Coalition for Training (PACT) in
Research and Public Health. This multi-country,
multi-partner initiative builds on the existing educational
and training activities of the IPIN. The long-term establishment of IPIN institutes in Africa will provide stability
and opportunities for lifetime careers for local scientists
and practitioners, but we have also developed strategic
partnerships with key African players.

The Institut Pasteur Global Health Genomics Center(GHGC) is currently developing a specialized, cloudbased platform dedicated to data storage, sharing andanalysis, while samples are collected, referenced and kept
in local biobanks under well-standardized procedures.
Local resource hubs throughout the IPIN will enableremote access to data and the translation of datantensive biomedical research to clinical practice acrossthe IPIN, enhancing capacities to respond to infectious
disease threats. The GHGC also offers a training andeducation framework with a particular focus on bioinformatics, biostatistics, computational and modeling skills(also part of the PACT initiative).

We have learned that we have to invest in the younger
generation of scientists by providing not only robust education but opportunities for post-graduate research andemployment. We have also learned that it is essential toorganize surveillance systems with ministries of healthand veterinary services, as well as to help laboratory networks to communicate more efficiently on i) actions in
the field, ii) training actions, and iii) establishing an easy,
fair and transparent way of sharing samples and data
during outbreaks.
We know that infectious disease outbreaks are inevitable
and recognize there are many obstacles to effective management and response when they occur. We believe that
improving actions across these four areas is essential tobeing better prepared for and able to respond more effectively, and that it takes a global community to do so. The
IPIN is committed to working in partnership with multisectorial partners, including the WHO, OIE, the Foodand Agricultural Organization, academic, research, public health and industry partners to achieve these major
challenges of our era.

ACTION NEEDED – ENTERING THE DIGITALSCIENCE AND MEDICINE ERA

The genomics revolution has allowed enormous progressin gene sequencing and molecular detection capacity, as
well as possibilities for personalizing medicine. While
this puts scientists at the forefront of the “omics” revolu-

AuthorPROF. DR. CHRISTIAN BRÉCHOT

President | Institut Pasteur | FranceWORLD HEALTH SUMMIT

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Infectious Diseases

ESSAY

LESSON LEARNED:FROM SYRIA TO
EBOLA
Improving access to healthcare in fragile environments ofconflict, displacement and disaster is an urgent global challengethat goes far beyond the simple humanitarian imperativeand demands concerted action on numerous levels.

Health care – in all its many aspects – is a major
casualty of war and other situations of violence inmany parts of the world today. Constrained accessto emergency and basic healthcare services just when
they are needed the most is one of the main problems facing many millions of conflict-affected people, and one of
the main concerns of humanitarian organizations such as
the International Committee of the Red Cross (ICRC).
Direct attacks on healthcare facilities and ambulances,which kill or wound staff and patients, are one part of the
problem. The airstrike on the ICRC and MSF-supported
Al Quds hospital in Aleppo, Syria, in April 2016 is justone example. It killed at least 49 civilians and six staff
members, including one of the last paediatricians in thecity, and destroyed vital equipment and drugs – animmeasurable loss to the many people for whom thehospital was a lifeline. In Syria alone, 63 MSF-supported
hospitals and clinics were bombed or shelled on 94 separate occasions in 2015, destroying 12 facilities. And Syria
is by no means singular: the ICRC documented almost
2,400 attacks against healthcare (personnel, facilities,
transport and patients), by a range of perpetrators, in 11
countries over three years up to December 2014.
Beyond the impact of specific incidents, the general insecurity and disruption created by armed conflict orviolence, while hard to measure, undoubtedly has a massive impact on the provision of, and access to, impar­tial
healthcare. Even where healthcare facilities are functioning, albeit barely, reaching them may be fraught withdangers – and fear. Obstacles and threats directed by

48

YEARBOOK 2016

states and by non-state armed groups at health workers
and humanitarian organizations that are seen to help “theother side” impede access for entire communities in needof vital medical care. Furthermore, the crippling loss ofhealth professionals has compounded the humanitariancrises in countries like Syria, Iraq, Yemen and many others. More than half of Syria’s doctors are reported to havefled or been killed (in opposition-held parts of Aleppo
the toll is as high as 95%).
Moreover, the generally protracted nature of armed
conflict and armed violence, which is increasingly
concentrated in urban areas, is in many cases causing thecollapse of healthcare systems, together with other vital
infrastructure and public services, reversing development
gains previously made. The inability of such weakened
systems to absorb new shocks – even years after conflicts
have ended – was made painfully clear during the Ebola
pandemic, chiefly in Liberia, Sierra Leone and Guinea.
With healthcare systems largely incapacitated and coping
mechanisms overstretched, millions of already vulnerable people were at potential risk.
In armed conflicts, as in pandemics such as Ebola, vast
numbers of people suffer and die not only from the direct
effects but also because they are unable to access medicalcare for diseases or illnesses that could otherwise be treated or prevented altogether.
Women and children are impacted the most. More thanhalf of preventable maternal deaths and deaths amongchildren under five occur in fragile settings of conflict,displacement and natural disasters. Worldwide, womenand children are up to 14 times more likely than men todie in a disaster. And in an alarming number of cases,
women and girls are deliberately targeted as a tactic of
warfare, subjected to horrific sexual violence and otherinjury, with grave consequences for their psychologicaland physical health.
In Syria, as in many other countries suffering armed conflict, women lack access to appropriate healthcare services during pregnancy and childbirth, either because
they are unavailable or because it is too dangerous or difficult to reach them. As a result, many women are giving
birth without any medical assistance – presenting huge
health risks to mothers and babies.
Infants who survive the early days after birth are inmany cases exposed to further health risks because of
the disruption of routine immunization programs. In
Syria, polio has made a comeback after being eradicatedin the 1990s, as well as deadly diseases like measles andmeningitis.
Women and children were also disproportionately
impacted by the Ebola crisis. Barriers to access and weakness of health systems – exacerbated by years of armed
conflict and insecurity in the three worst affected countries – meant that maternal and reproductive healthservices were fragile even before the outbreak, making
maternal mortality rates among the highest in the world.
Pregnancy was shown to make women even more vulnerable to the disease, yet in many cases health workers
afraid of becoming infected refused to deliver post-nataland delivery care. Furthermore, as healthcare resources
became ever scarcer, diseases such as malaria, HIV/AIDS
and tuberculosis were in many cases left untreated,claiming yet more lives.
Meeting the massive and complex challenge of
constrained access to healthcare in armed conflicts orother emergencies requires action on multiple levels by arange of stakeholders. One of the main problems inarmed conflicts is a widespread lack of respect for therules of international humanitarian law (IHL) by states
and non-state armed groups, specifically the rules
related to the protected status of the medical mission,and those governing humanitarian access to populations
in need. Violence against healthcare facilities andpersonnel is clearly illegal under international law, while
the wounded and sick – combatants and civilians alike –must be spared further suffering during armed conflictand receive timely assistance. In situations of violence
other than armed conflict, international human rights
law stipulates that states must refrain from deliberately
withholding or delaying healthcare to the wounded andsick in life-threatening circumstances, and that everyone
has the right to access essential healthcare facilities andservices on a non-discriminatory basis.

The real challenge is preventing violations from happening in the first place. While primary responsibility for thisissue lies with states and with combatants, national
legislators and courts must also fulfil their responsibilities
of ensuring that domestic legislation recognizes the criminal responsibility of those who violate IHL, and of actually enforcing such legislation. Perpetrators of violations
must be held accountable. The performance and behaviorof humanitarian organizations and healthcare workers
themselves is also critical. Securing acceptance for theirwork from all communities and political and militarygroups is essential to being able to work in sensitive andvolatile contexts. This requires a clear demonstration of
impartiality: the provision of healthcare based exclusively
on humanitarian needs.
In countries where health systems are already fragile andaccess to healthcare is constrained under normal circumstances, sudden crises – such as the Ebola pandemic – canbe devastating. The need for long-term investment at
national and international levels to reinforce basic publichealth systems before disaster strikes is imperative. The
most vulnerable should be prioritized, with maternal andinfant health at the top of the list.
The Ebola outbreak also put into sharp relief the need tobetter boost the resilience of communities affected bymultiple crises, as well as the need for humanitarian organizations – including the ICRC – to better anticipate andprepare for such crises.
Universal access to healthcare is a fundamental prerequisite to ensuring health and well-being for all, as aspired toby the Sustainable Development Goals. Achieving thiswill require innovative thinking, bold new approaches,
and a major concerted effort across sectors. For the ICRC,
this means better collaborating and co-creating innovative solutions with increasingly diverse stakeholders –including certain states, the private sector, civil society
organizations, academic and policy centers and many
more. Partnerships, as well as principles and preparedness, are absolutely vital.

AuthorDR. YVES DACCORD

Director General | International
Committee of the Red Cross (ICRC) |Switzerland

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Infectious Diseases

INTERVIEW“We simply don,tknow enough”
Rolf Zinkernagel is Professor Emeritus of Immunology at the Universityof Zurich. In 1996, he was awarded the Nobel Prize in Medicine forhis research into the way the body’s immune system recognizes cells
infected with viruses. The discovery advanced clinical efforts tostrengthen the immune response against invading microbes andcertain cancers. It also aided in research on autoimmune reactions thatcause diseases like multiple sclerosis and diabetes.
What has the international community learned about infection from Zika, and what are the differences in termsof detection and the potential for a vaccine compared toEbola?
Zinkernagel — The difference is very simple – Ebola kills
you in five to seven days. One is the acute, lethal type.
Lots of classical infections belong to that category – measles, polio, smallpox, bacterial tetanus, diphtheria, and soon. If you don’t survive these infections you are out of theevolutionary circuit: All these diseases hit you before
puberty. If you don’t have a good immune response
against these acutely lethal types, you’re dead.
There are many more infections that do not harmthe cells in which they grow. If a cell is infected with avirus that doesn’t destroy the cell, there is no clinical sign.
In effect, it isn’t there as far as the immune system is concerned. Examples of that type are hepatitis B, hepatitis C
and HIV.
Many of these viruses are transferred from themother to the newborn at a time when the immune system doesn't work. There’s no immune response, and theoffspring doesn’t die: It survives at least 30 or 40 years.
The infected person will eventually develop liver cancer
because of the infection, but that doesn’t interfere withreproduction. And in biology, that’s all that counts.
We don’t quite know whether the Zika belongs tothat second category. After all, it hangs around for a longtime, it doesn’t kill the mother, it doesn’t kill the offspring,and it seems to jump from mother to the offspring.
What about before birth? Because the changes from Zika
affect fetal development in the womb.
We just don’t know enough at the moment. There arevery, very few viruses that interfere with developmental
processes. It’s actually a field that is almost unexplored.

50

YEARBOOK 2016

even if you make a neutralizing antibody response, three
weeks later or three months later this is not worth anything because the virus or parasite has shifted its shape.
We don’t know these things about Zika. So far, from theviruses to which that virus seems to compare, it would bea surprise if the virus were so variable. It’s a reasonableguess a vaccine is possible, but the evidence isn’t there.
Turn the clock back two or three years to the virus of the
moment. Back then it was Ebola. What’s the status of thescience there?
Very easy. You know, if it’s not a serious health problem thennobody cares. This was certainly the case with Ebola. Ebola
had been known for quite some time, but never recognized
as a big problem. And once an infection like this starts, there
are always two types of measurements to deal with it. One is
the purely hygiene prevention-type of measurements,
which was the big problem with Ebola. Then come all therest like looking for protective drugs and vaccines.
What’s the evolutionary strategy of a virus like Ebola thatkills everybody in five days?
A virus that did that would be too successful. It would killitself. But that never happens. Both sides have to find abalance, which we call co-evolution.

“Viruses depend on our
unreasonable behavior to
spread, and we are only
too happy to provide thatto them.”
PROF. DR. ROLF ZINKERNAGEL

Emeritus | Institute of Experimental
Immunology | University of Zurich |Switzerland

Does that happen in the case of Ebola, for example? That’s
something that springs from another species, potentially,and hasn’t had time to co-evolve.

Do we know enough for you to be able to say something
about the vaccine potential for Zika?
No. We simply don’t know enough. What is important is if
it is neutralizing antibodies. There are some indications
that this might be the case, and then it should be reasonably possible. What we don’t know yet is how variable Zika
virus is. Take influenza – the influenza virus changes the
key protective surface deterrents every year or two. Other
viruses – and all parasites, not just HIV or malaria –change these key protective deterrents every few weeks. So

In the 14th century, smallpox came from the east to continental Europe. Smallpox is about as lethal as Ebola. In
some cities, 90% of the population was killed in the firstround. The reason for that is the virus is very cytopathic:
It kills many cells of the host and the host dies. But evensmallpox never killed all Europeans, and the reason isvery simple – the infection needs a certain population
density to spread. Therefore it’s no wonder that smallpox,
and also Ebola, really got off the ground in urban areas.
Even in the 14th century, smallpox hit areas where
the population density was very low and very few people
actually got infected. So there are many aspects that regulate the aggressiveness of the infection, like the population density and culture.

So there’s sort of a perfect match between them?
Eventually. The same Ebola in a rural, spread out area
wouldn’t have impacted people as heavily as it did in theurban areas. However – and now comes the but –hygiene, education or social structure can play a role too.
That was the case or is the case in these parts of the world
where family members and friends hug the dying person,
which is an ideal occasion for Ebola to transfer.
So what would you say we can learn from these two cases?
I think that ultimately there is nothing new. Acute lethal
infections, which we by experience called childhood infections, need to be controlled, and the most efficient way to dothat is by vaccines and hygienic measures. It’s very simple.
Then there are all the infections that don’t kill you
in seven days but kill you in 20 years. Those basically arevery difficult to control because the immune system cannot normally deal with them. Once you’re infected andyou’re a carrier of the virus, you cannot make a postinfection vaccine to get rid of the virus. Zika is a little
different: So far we haven’t had to deal with an infectious
agent that has a direct impact on fetus or embryo development, so that is new.
Is Zika comparable to herpes? In other words, you could
be infected and get over it, but still be a carrier and always compromised in terms of whether you might pass it
on to your offspring.
With all the herpes viruses, you usually get infected when
you’re young. You control the infection but you never getcompletely rid of the virus. There’s a very low-grade
infection somewhere. Herpes viruses are always persistentin nerve cells and don’t seem to interfere with functioningof the cells, which we just don’t know yet with Zika.
Are we paying enough attention to Zika? Is it too much?
How big of a problem is this really, and are we responding
appropriately?
I think that’s too difficult a question for me. We need simple epidemiology of the classical type: When does it happen? Where does it happen? How is it transmitted? Whenis transmitted? Where does the virus hide? When does aninfected mother transfer to the offspring? Is it during acertain phase of the mother’s infection or can it happen
once and then she’s infected all the time? These are all
simple questions, but so far we don’t know the answers.
So what do we do until then?
Whenever they have the opportunity, humans like to behave stupidly. Viruses depend on our unreasonable behavior to spread, and we are only too happy to providethat to them. Most infectious diseases basically depend
on unreasonable behavior of humans, including Ebola.
Zika would not be a problem if, you know, people practiced safe sex and mosquito control – things that we havenow been advocating for years.

WORLD HEALTH SUMMIT

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Infectious Diseases
HEALTH IN NUMBERS

DENGUE FEVER

Infectious Diseases:
Lessons Learned ­from Ebola to Zika
In the wake of the Ebola epidemic in Africa, the WHO has declared a global publichealth emergency based on clustered conditions thought to be caused by the Zika
virus. The headline-grabbing viruses highlight a global threat from infectious
diseases that are estimated to cost US $30 – $50 billion each year. Research on
infectious diseases from AIDS and tuberculosis to Ebola must be combined with
culturally sensitive treatments to be most effective.

ZIKA VIRUS
countries and territories have reported
evidence of mosquito-borne
Zika virus transmission since 2015.

MAIN DISEASES“The big three,” namely
AIDS, malaria andtuberculosis, cause
nearly 33% of all infectious disease deaths.
(Max Planck Institute, 2016)

STATEMENTIn 2015, there were major outbreaksof dengue fever worldwide, with
the Philippines reporting more than
169,000 cases and Malaysia an
excess of 111,000 suspected ­c ases,­a 59.5% and 16% increase in casenumbers over the previous year,
respectively.
(WHO, 2016)

A lot of forces I ascribe
to the Anthropocene
are creating a whole
new set of issues related
to the expanding
portfolio of infectious
diseases.
Prof. Dr. Peter J. Hotez (President of the
Sabin ­Vaccine Institute) at WHS 2016

MORTALITY RATE

(WHO, 2016)

EBOLA OUTBREAK

The world’s deadliest animal? The mosquito passes on diseases
that kill approximately 725,000 people each year.
Ebola:

24,655Since 1976, 6,023 people have diedfrom the Ebola virus in Africa, ­75% of which were in West Africa
in 2014 alone.
(Centers for Disease Control and Prevention, 2015)52

YEARBOOK 2016

healthcare workers
have been trained ­in infection prevention
and control in West­A frica since the outbreak in 2014.
(Centers for Disease Control andPrevention, 2015)(WHO, 2014)

TUBERCULOSIS
infected 10.4 million people in 2015 and killed 1.8 million. Over 95% of TB deaths occur inlow- and middle-income countries. Asia, for example, accounts for 61% of new cases,
followed by Africa with 26%.
(WHO, 2016)

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xxxxxxxx

World Health Summit - Berlin 2016

Need for ProgressTechnological innovation and women’s empowerment werein focus at the World Health Summit 2016 as hundreds ­of the world’s top public health thinkers gathered in Berlin.

T

he World Health Summit’s
international character was
striking. The three-day event
brought over 1,600 participants from
more than 80 countries to historichalls of the German Foreign Ministry. The Summit was also available via
live-stream, and about 3,000 people
tuned in and joined the active debate
on social media. The global interest
was a hopeful sign that a top goal of
everyone there – namely, breaking
down the silos that prevent theinsights of one discipline from being
applied to others – was within reach.
The Summit featured addresses byleading experts in global health, fundamental research, public andprivate policy. At the opening ceremony on Sunday afternoon, German
Federal Minister of Health Hermann
Gröhe called for cooperation: “Dueto war and instability, we are facing
an unprecedented influx of migration. Securing healthcare for refugees is becoming an increasingly
difficult challenge,” Gröhe said. “Success can only be attained by joint andcoordinated efforts.”
His speech was followed by remarksof Alain Berset, Federal Councillor
and Head of the Federal Departmentof Home Affairs in Switzerland, and
Ren Minghui, WHO Assistant
Director-General for HIV/AIDS,
Tuberculosis, Malaria and Neglected
Tropical Diseases. Emmanuelle
Charpentier, Director of the Max
Planck Institute for Infection Biology
in Berlin, then spoke strongly in fa-

54

YEARBOOK 2016

vor of fundamental research. The
French microbiologist reminded theaudience that regulations can put science – and national science programs– at a disadvantage. “CRISPR/Cas9 is
a good example of how some countries can react faster than others,”
Charpentier said. “In some countries, the train has already left thestation, while in others, they’re still
discussing the design of the train.”
The sessions that followed touchedon issues including antimicrobial
resistance, polio eradication, addiction and cardiovascular health.
University College London researcher David Napier explained theimportance of culture in health andinfant mortality, stem cell research
and access to medicine in Africa.
Dario Campana of Singapore’s
National University Cancer Instituteurged patience when it comes to seeing benefits from basic research.
And Paul Hudson, CEO of Novartis
Pharmaceuticals, emphasized industry’s role in transforming how
healthcare is delivered. “All of theconditions are here for us to do theright thing,” he said, “and forpharma to play its part.”

and age. Nobel Prize laureates and aclass of curious high schoolers fromthe US passed each other in the halls,
students from international publichealth programs pressed seniorscientists on their findings andpolicy recommendations, high-ranking representatives of civil society
and the private sector shared tables
during sessions and breaks alike.
One of the Summit’s key topics thisyear was the role of women, a theme
that was reinforced by a panel
discussion on “Women, Empowerment and Health” that closed theSummit. Fittingly, the Summit’s final
day coincided with the International
Day of the Girl.
The need for progress made by women in the public health sector was​underlined by panelist Heidemarie
Wieczorek-Zeul. Indeed, “There isno path to this goal if we do notempower women and girls,”
Wieczo​rek-Zeul said.

The role of entrepreneurs was
highlighted by the World HealthSummit Startup Track, a competition
that brought ten finalists to present
their ideas in front of a jury and theSummit’s expert audience.

WHS Presidents Antoine Flahaultand Detlev Ganten joined incoming
WHS President Hélène Boisjoly onstage to read the M8 Alliance Declaration – a call to action on points
like guaranteeing refugees healthcare and urging governments tocontinue investing in research,development and innovation. “It’snot the closing ceremony, it’s the beginning of a new era,” Ganten said.

Audiences at the Summit were
diverse, both in terms of geography

The entire M8 Alliance Declaration
can be found beginning on page 65.WORLD HEALTH SUMMIT

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World Health Summit — Berlin

WHS
2016 –
Day 1

World Health Summit — Berlin

12“The 2030 Agenda
provides us with anincredible opportunity
to accelerate the progress of public health.
That comes with anincreased commitment
to fund research.”

Sunday, October 9, 2016

43

Novartis Foundation head ­Ann Aerts (1)addressed theimpact of noncommunicablediseases.
At the opening
ceremony,
microbiologist
Emmanuelle
Charpentier (3)made a case forbasic researchand WHS­P resident Detlev
Ganten (2)welcomed
high-ranking
officials (6) and
top researchers.
Participants
discussed key
issues (4, 5).

DR. REN MINGHUI
1
WHO’s Ren
Minghui (1) called
for cooperation
across disciplines. German
Minister of Health
Hermann Gröhe,
Alain Berset of
the Swiss Federal
Council and
Erwin Böttinger,
CEO of the Berlin
Institute of
Health, met atthe Summit (3).
WHS President
Antoine Flahaut(2) welcomed
participants.

Hélène Boisjoly,
Dean ofthe Universityof Montreal
and WHS
President 2017(5) participatedin several
workshops ­with fellow
speakers (4).
Manfred Dietel,
Director of theInstituteof Pathology
at the Charité(6, left), speaks
as a WHS
Ambassador.

Assistant Director-General for HIV/AIDS, TB,
Malaria and Neglected Tropical Diseases (WHO)

2

3

4

5

56

6

10:30 AM
WorkshopEnding the AIDS Epidemic
Room Adenauer

1:30 PM
Panel Discussion
Infectious Diseases
Europasaal

5 PM
Opening Ceremony
Weltsaal“The modern paradox is the fact thatwhat is haunting our society morethan the epidemic is the stigma
associated with being gay or an
intravenous drug user,” said Luiz
Loures, Deputy Executive Director of
The Joint United Nations Programme
on HIV/AIDS (UNAIDS).

“Ebola is a peace and wartime ­d isease.
Now is the peace time – and we need
to be preparing for war,” said Stefan
Kaufmann, Director of the Max Planck
Institute for Infection Biology. “It’s
more expensive to deal with thedisease than implement protective
measures.”“The involvement of non-governmentalorganizations is indispensable for solving
global health problems,” said German
Minister of Health Hermann Gröhe.
“An unwavering commitment to solutions
and perspective is important whenisolationist voices are threatening todivide us,” emphasizes Erwin Böttinger,
CEO of the Berlin Institute of Health.

YEARBOOK 2016

5

6WORLD HEALTH SUMMIT

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World Health Summit — Berlin

World Health Summit — Berlin

Faces and
Voices in
the Crowd

Here I have learned how
health is approached from a
global perspective, with afocus on containing
outbreaks and managing
migration. It is very
different from Cambodia,
where we worry most about
weak governance.
SEAN TSI

National University of Singapore,
Singapore

WHS
2016 –
Day 2

1“If you are a refugee,
you are more
likely to face physicaland mental
health risks that
could destroy
your future.”
Here you can feel solidarity
amongst different stakeholders in public health andthe desire to shareknowledge. We are all here
to make something happen.

Monday, October 10, 2016

HELLE THORNING-SCHMIDTCEO of Save the Children
International

OCHE ITODO

I went to a session on
government for health. I had
not thought of corruption
as a transparency issue
before. It is a sensitive topic;
it was nice to hear people
speak so openly about it.

EHESP School of Public Health,France5Helle ThorningSchmidt of Save
the Children
International (1)pushed forrefugees’ rights
to healthcare.
The Weltsaal was
packed (2)during major

panels on topics
like technologicalinnovation (3),After a longday of talks
participants
gathered at the
WHS Night to
network andrelax (4, 5).

2

LEILA YOUSIFManagement Center Innsbruck(MCI), Austria

What brought me here were
the topics and meeting thecommunity. I was familiar
with the concept of “valueand health” but at thesession they developed it somuch further.
ANNIKA CALOVKfW Development Bank, Germany

If you want to learn about
what is really going on in
healthcare you come to the
WHS. This year they have
hit the nail on the head:planet health, antibiotic
resistance, migration andhealth, SDGs – I think these
topics are going to be therewith us for the next 10 years.
DR. BOGOSI MOGALE

Embassy of the Republic of South
Africa, Belgium

58

YEARBOOK 2016

As a student I feel like you
can absorb so much here. It
is a great chance to find
new ideas and actually
pursue them, to understandwhat you want to do in ­the field of public health.
LIANA PETROSOVA

Maastricht University,
Netherlands

4

9 AM
Workshop
Coalition for Epidemic Preparedness
Innovations (CEPI)
Room Adenauer“We don’t know which country will be
hit by the next epidemic. The only
way to make sure we have the rightresources to meet those challenges is
to co-invest,” said John-Arne Rottingen,Director of the Division of Infectious
Disease Control at the NorwegianInstitute of Public Health.

3

11 AM
Panel Discussion
Planetary HealthEuropasaal

4 PM
KeynoteTechnological Innovation for Health
Weltsaal“There are two types of tuberculosis:
active and latent,” said Sanofi Aventis
Vice-President for Access to Medicines Robert Sebbag. “In case ofclimate change, or decreasing humidity,
you can change from latent to active
TB. Migrants in particular are affectedby this fact.”“By 2020, it is estimated that 80% of theadults on the planet will have access toa smartphone,” said Stanford University
School of Medicine Dean Lloyd B. Minor.
”That is going to change the way people
get information about their health, andgive us data so we can better understand how to treat and prevent diseases.”WORLD HEALTH SUMMIT

59

xxxxxxxx

WHS Startup Track

German Minister of Health Hermann
Gröhe (1) announced the Startup Trackwinner iFeel Healthy, an asthma-treatment app, at the WHS Night. Urszula
Wójtowicz (2) represented Pelvifly, oneof 10 startups competing.

patron of the event,” explained
Minister Gröhe in his speech. Shortly after, Elad Fein, CEO of iFeel
Healthy, emphasized just how
important this opportunity is: “Wewant to help the hundreds of millions of people that have respiratory
problems in a fun way.” Key toreaching those people is reaching a
global audience, which is one of thereasons why iFeel Healthy applied
to the WHS Startup Track 2016.

1

WHS Startup Track

Tech Takes the Stage
The World Health Summit Startup Track draws attention to the roles businessand entrepreneurship have in improving the global healthcare system.

At the World Health Summit
2016, technology was a hot
topic. To help small companies and startups compete against
well-established players, the WHS
Startup Track – now in its second
year – invited young entrepreneurs
to present concepts for healthcareof the future in a competitive pitch
session in front of a jury andaudience.

60

YEARBOOK 2016

This year, 10 ambitious innovators
took the stage in the Europasaal. The
general focus was on new smart devices, software and applications. In asense, they were already winners: The
startups represented some of the mostoutstanding healthcare business ideas
garnered from a pool of 80 proposals
from 22 countries. Each participant
made a three-minute pitch andaddressed questions from the jury.

Later that day, German Federal Minister of Health Hermann Gröhe,
patron of the WHS Startup Track,announced the WHS Startup Track
Winner: iFeel Healthy from Israel.
“The Startup Track offers young
companies from all over the world aunique opportunity to network witheach other and make important
contacts, That’s why I took over as

Other startups echoed the sentiment.
“The World Health Summit is thecollection of all the pieces of the puzzle in global health,” said Joshua
Okello, the CEO and co-founder of
Uganda-based startup WinSenga.
“That is why we came here.” WinSenga is a portable ultrasound device. It
connects to a smartphone and allows
midwives in resource-poor regions
to monitor fetuses. Okello described it as a modern update on the
Pinard horn, a low-tech 19th century
listening device, for those who cannot afford another alternative.
Symptoma, an Austrian startup, also
proposes a high-tech solution to an
age-old problem. Healthcare professionals can enter different symptoms
and lab results into the platform,
then the software weighs the differ-

3
The WHS Startup Track put 10 businesses from Austria, Greece, Germany, Israel, Poland and Uganda in frontof an expert jury and audience topresent their ideas (3).

2Breathe Easy

A winning idea

ent possibilities to produce a diagnostic report. “Experts once deemedsomething like this impossible,” said
Symptoma CEO Dr. Jama Nateqi.
Today, the technology has caught up.
“Now we are showing that it is possible and that medical misdiagnoses
are a problem worth trying to solve.”
An all-in-one blood sampling device
that integrates blood collection withtesting and analytics was pitched bymidge medical UG from Germany.
Using a smartphone as a bar code
scanner, it can also connect to a
database that helps healthcare workers manage patients. Michael Diebold, the firm’s CTO, said the device– which is simple, easy to use anddoes not need power – was particularly practical in rural environments
and emergency situations where
electricity was hard to come by orintermittently available. Each midge
testing pod even comes with its own
disinfectant wipe.
Other startups included Care Across,a network connecting cancer patients and their caregivers with medical experts within hours; evivecare,a speech therapy app for stroke patients; Glasschair, a Google Glass appthat drives a wheelchair with head
movement; OneWorldDoctors, aplatform that connects doctors andspecialists to improve medical infrastructure in underserved regions;
Pelvifly, which attempts to help millions of women who have issues withincontinence due to age or pregnancy complications. Finally, Germany’s
Cold Plasmatech is seeking ways toharness the power of cold plasma
for dermatological and antibacterial
applications.

Elad Fein pitched his iFeel Healthy
app to a jury of experts.

“How can a mobile game that you
love help you with asthma?” EladFein asked the jury and audienceat the WHS Startup Track thisyear. Fein, who is the CEO of iFeel
Labs, won the WHS Startup Track
2016 competition with the iFeel
Healthy app.
iFeel Healthy monitors and analyzes respiratory function using
popular mobile games with a small
wearable device. It also helps manage maladaptation to stress. Users
are trained to breathe properly andstrengthen their lungs. If the datafrom the pulse oximeter in thewearable senses that the heart rate
and breath are not in sync, thegame is locked. The user has tobreathe properly in order to unlock
the game and continue playing.
Over 300 million people sufferfrom asthma worldwide. Whenpresenting the award at the WHS
Night, German Federal Ministerof Health Hermann Gröhe said thestartup was a “revolutionary approach to one of the biggest global
health problems today.”iFeel Healthy is an example ofmedical insights paired with technological innovations. But thetransition is difficult. Reaching
the right audience, such as thegovernments and institutions
present at the World Health Summit, is important: “Winning the
WHS Startup Track 2016 could
push us forward and help makedigital health available to a large
audience,” said Elad Fein.

WORLD HEALTH SUMMIT

61

World Health Summit — Berlin

WHS
2016 –
Day 3

2

Tuesday, October 11, 2016

1

“Women constitute anarmy of unpaid
care providers andthe highest proportion of paid healthcare ­professionals.
Healthy womenare so important.”

3
WHO official
Matshidiso
Rebecca Moeti
und Sanofi’s
Karen Linehan (1,left and right),
Nobel laureate
Elizabeth Blackburn (3) andAfghan Ambassador Suraya
Dalil (4) strongly
advocated for
women inresearch. Christina

MATSHIDISO REBECCA MOETIRegional Director for Africa of the World
Health Organization (WHO)Akerman,Eric Hans Eddes,
Norbert Hauser,
Stefan Larsson,
Jan Kimpen
and Paul Hudson(5, from left)
discussed therole of pharma in
making healthcare affordable.
Interactive
workshops
brought new
insights (2).

At home in Berlin.
Mercedes-Benz Berlin – official mobility partner of the WHS 2016.

5

4

9 AM
Workshop
Cardiovascular Diseases
Room Rathenau

9 AM
Panel Discussion
Value in Healthcare
Europasaal

2 PM
Workshop
Implementing the Health-Related SDGs
Room Rathenau“To prevent cardiovascaluar disease, thefirst step is to make sure that everyone
knows their own blood pressure, evenchildren. The material is cheap, it is easy
to handle – people just have to haveaccess and know how to use it. We haveto bridge this knowledge gap,” said
Daniel Lackland, President of the World
Hypertension League.

“A lot of healthcare is delivered bycommunities. That’s an opportunity –fewer or no sunk costs, no existing
infrastructure and less divided
public opinion puts us in a position
to leapfrog old technology,” said
Norbert Hauser, Chair of the Boardof The Global Fund to Fight AIDS,
Tuberculosis and Malaria.

“Academic institutions and think tanks
should take their models to theground. They should not wait for
countries to shop around. They should
work in countries directly to implement them,” said Joy Phumaphi,
Executive Secretary of the African
Leaders Malaria Alliance.

Anbieter: Daimler AG, Mercedesstr. 137, 70327 Stuttgart

Daimler AG, vertreten durch Mercedes-Benz Vertrieb PKW GmbH62

YEARBOOK 2016

Mercedes-Benz Berlin,

14x in und um Berlin
Telefon +49 30 39 01-00, www.mercedes-benz-berlin.deThe M8 Alliance Declaration
World Health Summit 2016
Fresh Ideas for your HealthWhat’s new in medical treatment, alternative medicine,wellness and fitness — as well as nutrition and beauty? In
Good Shape is the weekly health show on DW, covering all
aspects of healthcare. We present current topics, in-depth
interviews with specialists, and offer you opportunities to
ask your own questions.

T

his year’s World Health Summit (WHS) took place in a political context of great hopeand serious alarm. Immense strides
were made to strengthen commitments to the Sustainable Development Goals and to global health action at the UN General Assembly, theWorld Health Assembly of the WHO,as well as at G7 and G20 meetings.
The right of all people to universal
health coverage (UHC) has been emphatically endorsed. But at the sametime, the plight of millions of people
on the move, the predicament of refugees and the unacceptable destruction of health facilities clearly showed
the limits of humanitarian and global
health action when there is a lack ofpolitical will to ensure human rights,
peace and security.
The past year has reinforced that wemust face global health challenges
collectively: the challenge of antimicrobial resistance has been likened toclimate change; the Ebola crisis has
been followed by severe Zika andyellow fever outbreaks; and there isincreasing concern that the target ofpolio eradication might not bereached on time.
Crises are a key determinant ofhealth – be they war, insecurity, ecological or financial upheaval. Aroundthe world, 130 million people needhumanitarian aid, more than 60 million people have been forcibly displaced from their homes, the global
migration and refugee movementshows no sign of abating and many
countries are still burdened with thehealth consequences of austerity. A
new mix of health inequity, humanitarian, ecological and security challenges has emerged which confronts
us with the limits of existing systems.

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Donor countries are stretched tokeep their global commitments aspressure increases at home to set newpriorities and cut development aid.
Terrorist attacks all around the world
have increased a general feeling ofinsecurity and have led to protectionist responses. This raises basic
questions about global solidarity in aworld of great wealth.
We, the members of the M8 Alliance,
call on heads of state and government to invest in people and to ensure that no one is left behind. Following the discussion at this year’sWorld Health Summit, action in five
key central areas of global health ismandatory:
1. Empowerment of Women andGirls
2. Right to Health of Refugees andMigrants
3. Resilience and Global Health
Security
4. Antimicrobial Resistance
5. Investment in Research, Development and Health Innovation
I. EMPOWERMENT OF WOMENAND GIRLS

Achieving progress in global healthrequires addressing the health, education and empowerment of womenand girls. Indeed, advancing genderequality creates measurably healthierand more productive communities
and could add US $12 trillion to
global GDP by 2025. Supporting all
women, especially the most marginalized, in reaching their full potential
at every stage of life is a priority. This
includes equal access to healthcare,sexual health and rights, enhancing

reproductive health, improving infectious and chronic disease protection and treatment, and addressing
aging issues. It also requires applying
a gender lens to all health issues.
Call for Action:
The M8 Alliance calls for supporting
policies which increase women’scontrol of their life choices and ensure their bodily integrity. This includes the right of women to modern
family planning and safe abortion.
We recognize that progress has beenachieved for women over the past
decades, but in many countries thereality on the ground continues tofall short. The main determinants ofwomen’s health are not being addressed appropriately by governments. We are particularly concerned about the ongoing epidemicof gender-based violence. We also
call for a greater recognition of thecontribution of women as paid andunpaid health workers and see a clear
need to address the global care chain
in the context of health worker migration.
II. RIGHT TO HEALTH OFREFUGEES AND MIGRANTS

Global health still fails the most vulnerable: populations in fragile states,
victims of war, refugees, asylum
seekers, trafficked populations, people in forced labor, slaves and global
migrant workers. Refugees and migrants have the same universal human rights and fundamental freedoms, including the right to health.
Our approaches to global healthmust integrate people’s movements
as a key determinant of health and
we must develop strategies that can
respond to the diversity of people on
the move, as well as their needs.

WORLD HEALTH SUMMIT

65

M8 Alliance Declaration

Call for Action:
The M8 Alliance calls for a welcomingof the outcome of the first UN Summit on large movements of refugees
and migrants in 2016, which guaranteed the safety, dignity, human rights
and fundamental freedoms of all migrants and reinforced the legal frameworks for refugees. The response
framework that has been developed
will guide further action, also inhealth. It reinforced that everyone has
the right under international law to
the highest standards of physical andmental health. It has also highlighted
the need for equity and access. We underline the need to monitor the follow-up to these commitments and toensure the full accountability of UN
organizations, humanitarian actors
and nation states.
III. RESILIENCE AND GLOBALHEALTH SECURITY

Significant activity to improve prevention, detection and response time
to outbreaks has been underway
around the world following the Ebola crisis. We welcome the many actions and initiatives to build healthresilience, including the new WHO
Health Emergencies Programme, theGlobal Health Security Agenda, thelaunching of the Pandemic Emergency Financing Facility, and the
support for the Ebola-affected countries in building their health systems.
The continuing concern of the G7,
the G20 and the UN will be critical toestablish a global system of preparedness and response and securesustainable financing for work on
health crisis and to invest in UHC.
This includes ongoing attention toother public health emergencies ofinternational concern (PHEIC) suchas polio and Zika.
Call for Action:
The M8 Alliance calls on all countries and development partners toensure the full implementation of theInternational Health Regulations(IHR) capacities. We encourage allcountries to engage in tabletop andsimulation exercises to test gaps incapacity and to do this in full cooperation with many sectors. Healthsystems must be strengthened, professionals trained and communities

66

YEARBOOK 2016

fully involved. Mechanisms foraccountability to the global community – through reliable, independentand external evaluations – must be
established. This includes the commitment to ensure the last phase ofpolio eradication and the transitionof its assets into national health systems.
IV. ANTIMICROBIAL­RESISTANCEAt the UN General Assembly thisyear, the heads of state and government acknowledged that the resistance of bacterial, viral, parasitic andfungal microorganisms to antimicrobial medicines is the greatest andmost urgent global risk, requiring
increased attention and coherence at
the international, national regional
levels. Following the recommendations of the WHO, they have called
for a global development and stewardship framework which brings together the many stakeholders – fromhealth and agriculture to food, animal health, development banks, andUN agencies – to address the enormous challenge to humankind. The
M8 Alliance will work hard to implement a multi-stakeholder approachin the development of national,
regional and global alliances andstrategies to address antimicrobial
resistance (AMR).
Call for Action:
The M8 Alliance calls for an endorsement of the political declaration on
AMR and the WHO action plan on
AMR. In particular, we support research and development of new antimicrobial medicines, vaccines anddiagnostics. We further call for determined action on implementing
the One Health approach to fightAMR and we reinforce the need toensure access and affordability. All
healthcare institutions and professions must do their utmost to fightAMR.
V. INVESTMENT IN RESEARCH,
DEVELOPMENT AND HEALTHINNOVATION

We must harness the enormous potential of science to better meet urgent global health needs. A stronger

focus on translational research canhelp turn early-stage innovations
into new health products, advancing
innovation to the point where it becomes attractive for further development by the medical industry or
healthcare agencies. Many new discoveries have the potential to improve health, but turning those ideas
into deliverable products can proveextremely difficult. We require astronger focus on the cooperation
between public and private sector
and between basic scientists, clinicalresearchers, clinicians and patients
to drive novel observations about thenature and progression of disease
that often stimulate basic investigations. This requires new incentives,
innovative funding streams and new
solutions to challenges in relation to
intellectual property, as has beenoutlined in the report of the UNSGHigh Level Panel on Access to Medicines issued this September 2016.
Call for Action:
The M8 Alliance calls for cross-sectoral contribution to developing strategies in translational research, securing the translation of results fromclinical studies into everyday clinicalpractice and health decision-making,while ensuring that new treatments
and research knowledge actually reachthe patients or populations for whomthey are intended. We also commit toensuring patients’ participation insuch developments. The M8 Alliancewill promote the effective translationof new knowledge, mechanisms andtechniques generated by advances inbasic science research into new approaches for prevention, diagnosis
and treatment of disease, so that theessential goal of improving healthfrom bench to bedside can be reached.
We understand that this will require
new forms of cooperation between the
public and the private sector.
The M8 Alliance emphasizes that thechallenges facing global health havebecome too numerous and too complex for a business-as-usual approach. We will continue to do ourutmost to engage actors at all levels
and from all sectors to move thisagenda forward.
http://bit.ly/M8-Declaration_2016

Before it became
a medicine,
It was 5,OOO researched compounds.

87 different protein structures.
5OO,OOO lab tests.
1,6OO scientists.
8O-hour workweeks.
14 years of breakthroughs and setbacks.
36 clinical trials.
8,5OO patient volunteers.
And more problems to solve than we could count.
Before it became a medicine,
It was an idea in the mind of a Pfizer scientist.
Now it’s a medicine
That saves lives every day.

www.pfizer.com

TechnologicalInnovation
By 2020, 4.6 billion people will own a mobile
phone. The opportunities for improving healthcare
are tremendous: Technology makes it possible tocommunicate better with patients and collect datathat deepen our knowledge of disease.
But there are threats, too. Deep-seated distrust oftechnology is widespread, along with fears thatbig data will lead to “Big Brother”-like abuses of
personal information.
As technological advancement races ahead, canpublic health keep up? And equally importantly, isit possible to distribute technology’s benefits
evenly? “Global health needs to push for affordable, sustainable innovation,” said Antoine
Flahault, Director of the Institute of Global Healthat the University of Geneva, at the WHS Opening
Ceremony. “It needs to work in a frameworkof human rights and dignity.”68

YEARBOOK 2016

WORLD HEALTH SUMMIT

69

Technological Innovation

OVERVIEWIMPROVING
HEALTHCARE
DELIVERY
Digitization, data and connectivity are changing the way the world
works. Today, virtually every industry – from publishing toagriculture, from aerospace to travel – is being profoundly disrupted.

Yet, compared to progress in other industries,
healthcare is still just in the infancy of a datadriven revolution. Digitization offers a golden
opportunity to tackle our biggest health challenges in amove towards outcome-based care delivery. Further still,
it could enable unprecedented improvements to careaccess, particularly to those in resource-limited settings.

increases in digital health technologies will, of course,
bring even greater data proliferation and more connected
measurable insights. In emerging markets, this challenge
becomes an opportunity. In places where legacy infrastructures are not so embedded, we can achieve a“leapfrog” moment in health transformation in astraight-to-digital approach.

To put the challenge we face in context: Populations are
aging and chronic conditions continue their relentlessrise. Health systems are creaking under the pressure.
Meanwhile, the industry tends to work in silos optimized
around medical specialties rather than the patient. This,in turn, results in high levels of waste and misdirectedresources. Misdiagnosis is just one stark example. For
cancer care, the figure stands at 20-30%, depending on
which survey you read.

In both scenarios, long-term thinking and a solutions-orientated approach are required to manage digital transformation and unlock the potential of connected health.

It is little wonder that most resources go to episodic acutecare or that cross-workflow collaboration is scarce, as opposed to efforts being directed towards addressing societal trends, root causes or striving for integrated solutions.
While healthcare remains a somewhat conservative andregulated industry, we are seeing digitization and connectivity, through big data, unlock insights for deep andfar-reaching industry transformation.
One immediate challenge is how we manage this transition to digital health effectively and efficiently. In mature
health systems, vast amounts of data input fields remain“analog” and have yet to be digitized. Incremental

70

YEARBOOK 2016

For large-scale transformation, one clear trend is the“industrialization” of care. The principle is simple: break
down any complex process into its constituent parts and,once you’ve digitized, you can stitch together each component seamlessly online. That’s how great online retailers or
logistics providers make a complex service feel joined-up
and efficient. For healthcare, the concept is a gem!
Industrialization is also driving systematic improvements
in care delivery – supporting the move from reactive
acute care to proactive chronic disease management andstimulating greater patient and clinical investment in lifestyles and prevention. Further still, precision medicine,the delivery of precise and first-time-right diagnosis, is
now an emerging reality thanks to new smart diagnostic
technologies and better connectivity across the healthcontinuum.
The cloud plays a huge role here, which leads to the next
trend: the “personalization” of care.

The proliferation of smartphones and other connected
devices means that consumer and professional healthcare
is converging. Increased patient, and consumer, empowerment is one immediate outcome – allowing patients toremain informed, proactive and have more choice in theirown health and medical well-being. Further still, whenharnessed well, individualized treatment plans can be informed by connecting multiple data points.
There is tremendous value in how we build, scale andanalyze patient profiles. By harnessing and processing adiverse range of individual patient data across the full
spectrum of care, we can apply a deeper understanding ofwider population trends. As such, big data and analytics
are forging impactful population health management
solutions that offer real opportunities to reduce the costof care and ease pressures on overburdened healthsystems.
When coupled with “tele-health” or remote monitoring
solutions that connect population patterns with real-timepatient-data, the potential is tremendous, especially whenit comes to reaching less engaged patients in resource-limited or deprived areas. This is where population healthdelivers highest impact by increasing patient health literacy and engagement, and in addition, providing criticalaccess that is all too often absent – all without placing aheavy burden on primary care.
This is not a substitute for face-to-face care. But, by maintaining a continuously-connected relationship with highrisk patients remotely, care providers can identify individual and population health issues and formulate
combined prevention and treatment strategies.
One compelling example is in Liverpool, UK. Philips
partnered with the NHS to deliver a large-scale self-supported care pilot targeting chronic disease management
for patients in the city’s most impoverished areas. Over
three years, 2,234 patients with one or multiple chronic
diseases including COPD, heart failure and diabetes wereenrolled. The program combined tele-monitoring equipment in the home with the support of a clinical hub and astructured program for case management, monitoring,education and coaching.

structural constraints that contribute to poor healthalongside primary care needs building a holistic view ofuniversal healthcare in a dual approach to improved caredelivery and access.
The value in this approach is immediately clear in emerging markets. For example, Philips Community Life Centers are transforming primary and community-basedcare in rural Africa. The self-sufficient centers housestate-of-the-art primary care health and IT facilities fordiagnosis, testing, treatment and training.
While simultaneously acting as mother and child centersto address urgent infant mortality rates, additional value
is achieved through the provision of 24/7 sustainable
light, power and clean water. This allows the centers tofunction far beyond the core primary care focus and act
as safe and secure sites for community engagement withadded communal energy and sanitation resources. Inclusive innovation in this way has embedded the long-termbuilding blocks of improved universal health within thecommunities they serve, while also dramatically expanding primary care capacity.
Ultimately, if we are to fully capitalize on the potential of
digitization and connected care, we require a different
end-to-end approach in how we define and manage
healthcare systems, with better outcomes, lower waste
and variance. We are only scratching the surface of thepotential. Technological innovation for robust and highquality data insights is necessary. But, most important isgetting the processes right so that what we’re connecting
is transparent and logical – changing consumer, patientand clinical behaviors to adapt to new ways of working.
Deep collaboration and co-creation with partners will
also enable us to further develop high impact consultative
solutions. This means sharing joint responsibility for outcome-based metrics like improved efficiency, higher
quality, reduced costs and, ultimately, better patient
health outcomes with customers and partners.
This is progressive work, and it is very promising. But
we have much to do to make integrated digital health a
reality.

By engaging patients using a full array of connected
technologies, the program achieved reductions in emergency admissions and secondary care costs ranging
from 22 to 32%. Ninety percent of patients felt more incontrol, have gained confidence and / or felt better able
to cope with their condition. Again, this is another​­example of connected care improving lives and saving
essential resources.
Finally, the need for inclusive innovation and design isalso key to how we manage healthcare transformation.
This means breaking out of silos in order to tackle

AuthorFRANS VAN HOUTEN

CEO | Royal Philips | Netherlands

WORLD HEALTH SUMMIT

71

Technological Innovation

ESSAY

INNOVATIONSIN HEALTHCARE
DELIVERYTechnology – whether mobile, online or device-based – hasrevolutionized our daily lives. Its role in global health is that of astrategic enabler and sustainable change-maker, dependent
on its complex relationships with individuals and health systems.
The benefits of integrating? Priceless.

T

he five horsemen of technology are nanotechnology, biotechnology, information communicationand technologies (ICT), robotics and applied cognitive science. Together, they have changed daily life forbillions around the world. Over 3.6 billion people in theworld own a mobile phone, a number the global mobile
phone association, GSMA, estimates will reach 4.6 billion
by 2020. In the world of international development andglobal health, that amounts to simple mathematics: 4.6
billion unique mobile phone subscribers equals 4.6 billion opportunities for global health to create agame-changing and sustainable change.
Mobile money, another game-changer, has revolutionized
the way businesses operate and individuals make and receive payments. More than 400 million registered mobile
money connections are present in the world today.
TECHNOLOGICAL INNOVATION MUST RELY ON
COMPLEX RELATIONSHIPS

Integrating technological changes and innovative
platforms with healthcare delivery is not without its own
challenges – and yet, it is necessary. Take a generic healthcare patient pathway in India, and we see at least seven
relationships to work through: the individual seeking
treatment, community healthcare workers, health clinics,
laboratories, pharmacies, rural hospitals, and larger, referral hospitals. Add in partners like donors, ministries ofhealth, drug manufacturers and regulators, and one is
faced with myriad public and private healthcare systems
that are disparate and at times, collaborating together.

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YEARBOOK 2016

Once we add in technological innovations, the core questions become what elements should be prioritized, andwhat solutions need to be integrated? How has technological innovation led to a more efficient, effective and impactful system that provides the most benefit to the patient?
Technology can also protect patients from counterfeit or“fake” drugs, whether it be by scanning products at eachstage of the supply chain to confirm authenticity or by apatient using their mobile to scan or send codes to an authentication service. Technology can also powerfully
connect different approaches so that end-to-end securityof a supply chain is achieved, ensuring that a medicine
goes from factory to patient without issue.
Technological innovation cannot be seen as a standalone
solution – it is an enabler in complex connections,
whether it is facilitating a relationship between a community health worker and a patient through WhatsApp toprovide educational awareness on malaria; creating a
relationship between a health clinic and a “rider” providing ARV medicines through riding his bicycle; or building a relationship of trust as a patient agrees to use
biometric technology for improving tuberculosis treatment as is done by Operation Asha in India.
DONORS FUNDING TECHNOLOGICALINNOVATION FOR GLOBAL HEALTH

Technological innovation is becoming a core part ofhealth ecosystems across countries and at a global level,with donors and funders supporting innovations. We witness a growth of innovation labs and testing platforms.
The US Agency for International Development’s (USAID) Global Development Lab, Unicef ’s Innovation Labs
and the Gates Foundation’s investments in technology area few such examples.
The Global Fund to Fight AIDS, TB and Malaria, theworld’s largest funding agency to fight the three diseases,
remains on track to save over 22 million lives by the endof 2016. It realizes the immense impact technology canleverage by nature of its funding to more than a 100 countries. The Global Fund established the Innovation Hub in2014 as a partnership engagement platform focused on
solutions in three key areas: procurement and supply
chain management, financial and risk management, andprogram quality. As of 2016, the Innovation Hub leads
over 30 key relationships, each of which has been identified and tested for maximum impact.
THE GLOBAL FUND’S ROLE IN ACCELERATINGTECHNOLOGICAL PLATFORMS TO STRENGTHENHEALTH SYSTEMS

Through the Innovation Hub, the Global Fund worked
with PharmAccess Foundation and Vodafone in Kenya todevelop a mobile health wallet, called M-Tiba, using
M-Pesa as the backbone. This allows someone visiting aclinic for a malaria test to pay for it from their mobile
phone and allows the clinic software to collect age, genderand test results – in turn providing powerful potential foruse of data. M-Tiba stands out as an innovative platform
to tackle numerous health challenges through one solution: addressing quality of care and turning real-time data
into targeted health services. In Kenya, the Global Fund’s
principal recipient, AMREF, now uses M-Pesa to pay salaries and related payments through the health chain. This
simple solution has helped incentivize health workers bypaying on time, reducing the risk of carrying cash andtracking payments. Beyond M-Pesa, the Global Fund isalso partnering with Vodafone Group to deploy inventory platforms in selected countries. Relaying data on
mobile, the platforms are aimed at preventing medicine
shortages at the regional stores and health center level.
In addition to supporting last-mile delivery and strengthening health system supply chain management, technological solutions and devices have a critical role in the
future of eliminating AIDS, tuberculosis and malaria inthe coming decades by ensuring that early detection of
diseases such as malaria and HIV/AIDS can help save aneven greater number of lives. The GeneXpert test,
endorsed by the WHO just over five years ago, is a newmolecular test that detects the DNA in TB bacteria andgives results in less than two hours. In Nigeria, the biotech innovation of using a urine test for malaria results indiagnoses in less than 25 minutes. And the Boston-based
Disease Diagnostic Group’s Rapid Assessment of Malaria(RAM) – is a mechanical device that promises to detectmalaria in only five seconds using a drop of blood. Similarly, self-testing kits for HIV are currently being piloted
in Zimbabwe, Malawi, Zambia and South Africa.
WAMBO.ORG: THE GLOBAL FUND’S ONLINE
MARKETPLACE TO POOL PROCUREMENTThe Global Fund has developed a new online marketplacethat gives countries the tools to access pooled procurement which helps reduce the price of products. Wambo.
org is a simplified procurement platform, requiring only
an Internet connection, and it provides implementing
partners the power to search, compare, purchase andtrack the delivery of transparently priced, quality-assured
medicines and products.
The Global Fund is also a founding member of the Global
Steering Committee for Quality Assurance of Health
Products and Services (GSC) to advance coordinated​action against counterfeit health products that endanger
public health. Members include Gavi, United Nations
Development Programme (UNDP), UNITAID, US
Agency for International Development (USAID), US
Food and Drug Administration (FDA) and the World
Bank. They work closely with the private sector to coordinate and amplify activities to strengthen regulatory
systems, increase awareness and build and connect
reliable data.
In addition, the Global Fund supports the Global Health
Assurance Partnership (GHAP) which conducts market
assurance reviews and, if necessary, helps the country
solve any issues.
PARTNERSHIPS ARE KEY TO HEALTHCARE
DELIVERYTechnology is rapidly advancing and here to stay. Whether
it is mhealth platforms in Asia, mobile money in Africa,
robotic ATM-like pharmacies in South Africa, or unmanned aerial drug delivery in Rwanda, the future ofhealthcare delivery is fast evolving and changing. The key
to long-term sustainable strengthening of healthcaredelivery can only lie in partnerships ensuring that
donors, countries, private sector partners, and communities that we serve work together to find the most effective
systems for their needs.

AuthorNORBERT HAUSER

Chair of the Board | The Global
Fund | Switzerland

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Technological Innovation

ESSAY

PRECISIONHEALTH: SEIZINGTHE MOMENTHarnessing the power of big data offers a way forward for healthcare on a massive scale, while holding out the promise of solutions
that are effective because they are tailored to individual patients.
But to get there, researchers and practitioners will have to break
down silos and win the trust of patients and doctors.

Precision Health, the global approach to healthcarethat we are championing at Stanford, has its roots inthe teachings of Hippocrates. The fundamentals of
this approach – individualized care that’s predictive, preventive, and specific – were trumpeted by the ancient
Greek physician when he said: “It is more important toknow what sort of person has a disease than to know whatsort of disease a person has.”
Jump forward a few millennia, and, for the first time inhistory, we find ourselves in possession of the transformative technology and other tools needed to bring thevision for truly personal healthcare to life. Precision
Health involves the precise application of science acrossthe spectrum to predict and prevent disease before it
strikes, and cure it decisively if it does. It uses all possible
data points – genetics, environment, behavior, and socioeconomics – to provide care that’s not one size fits all, but
one size fits one.
While most medical research is currently focused on genetics and medical treatment, evidence shows that paying
close attention to all four of these data points is key toachieving optimal health. In the 1990s, for instance, Los
Angeles was one of the most polluted cities in the world.
Now, two decades later, the air is significantly cleaner. A
study of this 20-year period by the University of Southern

74

YEARBOOK 2016

California demonstrated that lung function had
improved in local children: In 1998, 8% of 15 year-olds
had significant lung defects; by 2011, that number had
fallen to 3.5%.
From a global health perspective, consider the case ofclean drinking water. The World Health Organization(WHO) estimates that 2.3 billion people gained access toimproved drinking water between 1990 and 2012. During
this same time, the number of children dying of diarrheal
diseases, strongly correlated with a lack of access to cleanwater, steadily fell.
And in a behavior-related example, Stanford Medicine
epidemiologist Sanjay Basu analyzed a recent change inthe payment schedule of Peru’s cash assistance program:
The government moved from twice-monthly to
once-monthly payments, without changing the overall
payment amount. Under the new schedule, he observed astriking increase in the purchase of “temptation goods” –alcohol, sweets and tobacco – that have a negative impact
on health. The Peruvian government once again makes its
payments every two weeks as a result.
At Stanford Medicine, we’re putting Precision Health into
action across every area that influences health. Just one
among many real-world uses is our MyHeart Counts app,developed in partnership with Apple, that taps theiPhone’s built-in motion sensors to both monitor an individual’s own cardiovascular health and share that heart
and activity data with researchers at Stanford. Data from
the MyHeart Counts study are used to help ordinary people manage their risk of heart disease.
Now is the moment for individuals and practitioners
alike to embrace the extraordinary potential of Precision
Health – and to surmount the four top hazards that could
prevent us from fully realizing what is the most important
healthcare goal in generations.
Silos are among the hazards, dominating much of thecurrent medical and scientific research in Precision
Health areas. Without question, researchers in these areas
need to work together to thoroughly grasp the uniquehealth status of each individual – and they need to engage
in extended collaborations across institutions and industries. We’re already seeing glimmers of this in things likethe Stanford Woods Institute for the Environment, whichis partnering with over 25 groups to explore our effect on
the environment and its effect on us, as well as the new
US $250 million Parker Institute for Cancer Immunotherapy, comprised of six of our country’s leading cancer-fighting institutions that are tackling the disease
through a team approach. Success requires more of thiscross-pollination.
Speed of progress is another obstacle – counterintuitive,
yet real. Medical knowledge has advanced so far and fastthat a majority of practicing physicians actually went tomedical school before the human genome was sequenced.
The repercussions of this were captured in a recent
Genetics in Medicine survey, showing that many doctors
worry about misunderstanding genetic test results orconveying them incorrectly. We need to ensure that all
doctors, old and new, are proficient in understanding
genetic tests of diagnosis (and predisposition) to disease,and to develop efficient and effective ways to make sure
medical knowledge is readily accessible.

which insurance companies may now be reluctant to pay.
Developing targeted drugs with their associated diagnostic tests isn’t cheap, either. But costs will decrease as
technology progresses. We’ve seen it before – take MRIs.
We can help history along by maintaining our focus on
reducing costs whenever and wherever possible. Moreover, prescribing drugs and other treatments based upon
information on which patients will benefit, rather thanusing the same approach for everyone, will decrease thecost to the healthcare system overall.

“Experimental audacity that was unimaginable in thepast” – this was Stanford Medicine professor Paul Berg’s
phrase for the dawn of recombinant DNA in the 1970s,
which led us to the brink of today’s biomedical revolutionin Precision Health.
Berg laid the groundwork for this revolution with his
Stanford peer, Stanley Cohen, when they mixed DNA
from different species to engineer new genes and usheredin the molecular biology boom. Cohen and University ofCalifornia San Francisco Professor Herb Boyer then usedthat technology to produce the first therapeutic proteinsfor humans. They patented gene cloning in 1974. This led
to, among other things, the founding of Genentech.
Years later, Genentech developed the first real example ofprecision medicine, tailoring medical treatment to the individual characteristics of the patient – Herceptin for
HER2+ breast cancer. We’re now going beyond the spectacular promise of precision medicine to true Precision
Health – with its focus not just on effective treatment, but
on prediction and prevention.

Privacy concerns also continue to loom large in the mindsof patients. We can hardly blame them: One cybersecurity think tank this year estimated that 47% of
Americans had had their medical records hacked in thepast twelve months. We must solve the issue thoroughly
and systemically, while encouraging individuals to share
their information with programs and institutions that arecommitted to data security. Precision Health won’t keep
individuals healthy without data, and we must develop
the secure technologies and rigorous procedures toassuage patient fears.
While currently a roadblock, cost will not always be. Detractors of the more precise approach say individual
genetic sequencing tests (a pipe dream a decade ago) are
too pricey. True, these tests can cost thousands of dollars,

AuthorPROF. DR. LLOYD B. MINOR

Dean | Stanford University Schoolof Medicine | USA

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Technological Innovation

ESSAY

TRANSFORMING
CARE: CONSUMER­APPLICATIONS
Lack of real-time access to data and meaningful insights is slowing
innovation in healthcare. Being patient-centric, providing
transparency, and leveraging the power of ecosystems will leadto fundamental change.

data. They must give patients control over how and withwhom information is shared and for how long. And, theyneed to work on the user’s behalf. Knowing the person
and the context of their request, applications should deliver the desired result, with minimal input from the patient or healthcare provider.
Second, we need to provide transparency into the massive
amounts of available health and healthcare data, connecting silos and giving access to the right stakeholders. We
can bring together structured and unstructured clinicaldata, claims data, genomic data, and data from wearables,
as well as operational and financial data from healthcareorganizations. Then, we can make the data accessible andmeaningful to different stakeholders across the ecosystem, with the patient’s permission.
For research communities, we can increase the sample
size significantly to use the power of large numbers togarner better, more useful, more accurate insights. We
can enable powerful, new correlations and predictions – amajor benefit that a more limited view can’t offer. We canalso use data insights to improve the value-to-cost ratio in
healthcare, research and life sciences organizations.
Finally, we need to leverage the power of others. Today’s
most pervasive technologies are those that have effectively built ecosystems around a platform. The innovation ofindividual companies can often be inspiring, but it’s nothing compared to the innovation of communities. Think,for example, about the iPhone. It is a beautiful product,
but it is the community of partners that surrounds it thatmakes the phone indispensable.

T

Technology has clearly transformed much of what
we do in our daily lives: how we manage our finances, how we consume news and entertainment, how
we shop. But when it comes to a central part of our lives– our health – digital transformation has lagged behind.

pursuit of value. Citizens, governments and businesses
are more aware and more concerned about increasing
costs. Individuals and families are more focused onhealthcare quality. Patients have more choices anddemand a better experience.

While we’ve seen encouraging movement toward the digitization of records and significant advancements in thearea of data analytics, much of the data remains disconnected, siloed and opaque. Digitizing health information,
while necessary, is not sufficient. Real transformation will
only happen when information is connected, integrated
and delivered in real-time.

To transform the healthcare industry, we need to takelessons from other consumer services that start with theuser at the center and deliver amazing experiences bycreating open systems or “platforms” that connect andleverage the power of others.

The lack of progress toward the digital age in healthcare isdriven by a number of factors, including a regulatoryenvironment that does not fully understand or embrace
the benefits of technology, competing interests acrosshealthcare stakeholders, and initiatives that are not centered around the patient. However, today’s healthcare
industry is at a tipping point. The same pressures thathave propelled change in other industries are driving theneed for new solutions in healthcare: rising costs and the76

YEARBOOK 2016

I propose three core lessons that are most relevant to ourwork in healthcare innovation:
ȣȣ Start with the consumer – the patientȣȣ Offer transparency and insight by connecting
the enormous amounts of data we haveȣȣ Leverage the power of an ecosystem; i.e., thepower of others
First, we must start with the consumer. Solutions need tobe personalized and have complete, real-time medical

To enable this community, we need to build open platforms, breaking down barriers and working together tofoster openness and partnerships. When we collaborate,
we can radically improve the experience and value forthose we serve.

CancerLinQ amasses structured and unstructured datafrom disparate electronic health record systems, unlocking data silos by de-identifying and aggregating patient
data from across the United States, revealing patterns andinsights that will lead to improved, more individualized
patient care from personalized insights. CancerLinQ willoffer anonymized data to researchers and pharmaceuticalcompanies for targeted cancer treatment advancements.
CancerLinQ runs on SAP Connected Health built on
SAP HANA, an in-memory data management and application platform. CancerLinQ’s data lake currently has
more than one million patient records, and more than
1,500 physicians from 70 practices have signed up to
participate. CancerLinQ allows physicians to view andcompare patients’ treatment plans to see how peers aretreating similar patients, and identifies opportunities intheir own patient population to deliver timely, recommended care following appropriate guidelines.
In closing, I ask three things of all of us. First, let’s work to
update regulations to support – not constrain – data
sharing. Let’s look at what policies need to shift, what barriers can be lifted, and what progress we can maketoward a more open and collaborative ecosystem.
Second, let’s be willing to share our data and our innovations. Consider whether we have data that would be
useful to share, how we can foster a culture of openness
and sharing in our organizations, and whether there’s an
app or solution we’re building that would benefit from acollaborative community.
And finally, let’s embrace new types of partnerships, seeking out ways to partner with other organizations acrossthe ecosystem to help spark new ideas and new ways toaddress important issues in health. The advancements weseek will only come from collaboration and working
together as a community.

I believe we can do these three things within healthcare.
We can leverage the power of networks to create solutions
that are built around the user and turn data into transparency and insights and, in so doing, fundamentally change
healthcare as we know it.
This year in the United States alone, about 1.7 million
people will be diagnosed with some form of cancer, but
only about 5% of these patients will participate in clinical
trials. Data on the other 95% of patients is secured indisjointed electronic health records across physician
practices and hospitals. In 2015, SAP partnered with
CancerLinQ, a non-profit subsidiary of the American
Society of Clinical Oncology. CancerLinQ is a healthinformation technology platform that aggregates andanalyzes the rapidly-growing store of patient data to
uncover insights and trends and to benchmark physicians’ care against current recommended guidelines.

AuthorSTEVE SINGH

Executive Board | SAP SE | USA

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Technological Innovation

INTERVIEW“People indicate that theywould like to change”
Jutta Allmendinger is president of the WZB Berlin Social Science Center andformer director of the Institute of Employment Research in Nuremberg. A
sociologist, her specialty is the impact of institutions on the life course. She
has served on national advisory committees for research and innovation­and anti-discrimination. In cooperation with the research institute infas and theGerman weekly DIE ZEIT, she recently conducted a large, nationally representative survey of popular attitudes towards key aspects of life, including work,
family, nutrition and technology. Among the topics addressed in particular
was healthcare technology.

You’ve just completed a huge study asking three thousandcitizens between the ages of 14 and 80 about their understanding and acceptance of healthcare technology. What
were the most important lessons you learned? Is the basic
idea that people who trust technology now think they willin the future as well?
Allmendinger: — The basic question is to what extent
people accept improvements in healthcare technology.
We can say that about half are adamantly opposed to genetic diagnostics and individual health monitoring.
Those are impressively low numbers.
Low compared to other countries?
No, low in absolute terms. Many technological innovations have the potential to keep people healthy longer, but
first people have to use them. For that to happen, we needto have basic acceptance. That’s at the core of preventive
medicine.
To measure basic acceptance, the use of newtechnologies is one indicator. The potential use of newtechnologies is another. Therefore, we have not only
asked “What kinds of healthcare technology do youuse?” but also whether people would recommend using
these technologies to future generations. Moreover, theboundaries of acceptance are important to identify. So,
we asked: “What extent of use do people recommend,
and what is over the top?”
What we found is that people who actually use
healthcare technology today are quite in favor of its use
in the future, and would recommend it to others. Of the78

YEARBOOK 2016

27% saying: “yes, I use healthcare technology for monitoring my health,” 95% would like to pass this on to
future generations.
So they’re open to it?
Absolutely. In addition, we can identify those people who
do not use it themselves but are still open to change.
Taken together, we see little evidence that people reject
the idea of using technology in the future.
However, there is serious concern that the developments will be in such a direction that people cannot anddo not want to adopt. These are the boundaries of acceptance that I mentioned before. People recommend
advancement to a certain extent but they expect developments to go beyond. This is viewed as a future role ofhealthcare technology that they do not want to accept orwould recommend accepting.
Were you surprised about the initial openness?
Most people recommend to future generations exactly
what they themselves are doing. This willingness to gowith technological change surprised me.
The second surprise was that people who are disadvantaged are the ones who are actually in favor of thisimproved health technology. We usually assume it’ssociety’s more privileged people who use all the newest
technologies. This is in fact not what we found. That isgood news. People with a poor education and low income

are much more likely to fall ill because of wrong lifestylechoices. It turns out they’re the ones who are most open
to change. I hope that they will really do this and get the
support they are going to need.
The third surprising fact is that people are moving
forward somehow but are afraid of going all the way. They
are really afraid of the future they expect.
Could it be that poor people are more impressed bydoctors? That they are more willing to trust the experts?
I don’t think so. They are poor, they don’t think of themselves as having good job opportunities. Maybe many ofthem feel that heathcare is the last system that will provide the same opportunities for everyone – regardless of
their income and social position, which do limit theirchances in the educational system.
Can these findings be applied to other countries?
This is a Germany-specific survey, and although we havenow been asked by Italy to replicate the study there, I
don’t know the results yet. But we know that other countries are further along when it comes to thinking about
healthcare technology. They are also more open to communication technology and the Internet in general thanare Germans. For historical reasons, Germans have serious problems with privacy rights connected to big data,
which is one of the venues in which healthcare delivery ismaking enormous advancements. And they’re right, I
guess.
So what are the lessons for policymakers and doctors?

“A lot of these technological innovations
have the potential tokeep people healthy
longer, but first they
have to use them.”
PROF. DR. JUTTA ALLMENDINGER

President | WZB Berlin Social Science
Center | Germany

The message is: We have to educate people and makethem familiar with new technologies and how those
new technologies can bring them better health overtheir entire life course. Simply put, there needs to bemuch more education on health than what we have at
the moment.
The other lesson points in the opposite direction.
Given the fact that some groups show initial acceptance,
you have to reassure them that they can keep the right to
opt out of or reject the use of those technologies. There’s aschool of thought that believes if they give away personalor private data, corporations like health insurance companies will be able to do whatever they wish to do withthe data without asking. It’s suddenly turning into a question of privacy rights. This can also be shown with ourdata: Over half of the respondents firmly reject the idea ofgiving data to insurance companies.
If you want to develop a national digital health system or
improve things on a large scale, can some people opt out?
Yes, I think that you need to give them that opportunity.
Or else they won’t be willing to opt in in the first place.

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HEALTH IN NUMBERSPEAK

3D PRINTING

Technological Innovation:
Improving
Healthcare Delivery

3D printing was born. Charles
Hull invented the stereolithography, a printing processthat enables a tangible
3D object to be created fromdigital data. The technology
is used to create a 3D modelfrom a picture.
(International Journal of Multidisciplinary
Research and Development, 2015)

Successful healthcare quality and delivery depends on the tools and devices used
for prevention, diagnosis, treatment and rehabilitation. Technologicalinnovations in the field are helping reduce inefficiencies in healthcare delivery
while, at the same time, streamlining access, reducing costs, improving quality
and making medicine more personalized and precise.

A team from Doctors without
Borders created 3D models ­and a virtual reality reproductionof a recently designed facility
in the Philippines that was later
built to help people after a2013 typhoon.

BIG DATA(Doctors without Borders, 2016)

Due to rapidly increasing data
volume and new technologies
for data analytics, big data is ahuge topic in medical circles. In
Germany alone, revenue frombig data analysis is expected toreach € 3.6 billion in 2016.
(Bitkom, 2014)(MarketsandMarkets, 2015)

MOBILE APPS
Healthcare
Providers/Insurance
Other

2012

2013

2014

2015

2016

Medication
Reminders & Info
Fitness

Women's Health& Pregnancy

BOOMING BUSINESSThe market for
medical robots
is expected toreach US $11.4
billion by 2020,
up from US $4.2
billion in 2015 –a compound
annual growthrate (CAGR) of
22.2%.
(MarketsandMarkets, 2015)

STATEMENTDigital transformation is lacking
in healthcare. ­The data is analog,
siloed and opaque.
Transformation isdriven by connection,and data needs
to be integrated
and real-time.
Steve Singh (SAP SE President for BusinessNetworks and Applications) at WHS 201680

YEARBOOK 2016

With US $104 billion­­
invested in the health
IT market, 2016 was
one of the biggest
years for healthcaretechnology ever. The
worldwide health IT
market is expected toreach US $228 billion
by 2020.

DiseaseSpecific

Diet &
Nutrition

Lifestyle& Stress

Less than 1/4 of all
mHealth apps ­­are about specificdiseases, medication reminders
and healthcare
providers.
(IMS Institute for Healthcare
Informatics, 2015)

NANOROBOTICS
In 2016, researchers from the
University of Montreal and McGill
University developed new nano­robotic agents capable of navigating
through the bloodstream to deliveranti-cancer drugs directly to tumors.

(University of Montreal, 2016)

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xxxxxxxx

WHS Geneva Meetingfor further adaption in and beyond
the healthcare sector.
TOMORROW’S AFFORDABLEHOSPITALThe theme “Global Health: Sustainable and Affordable Innovation in
Healthcare” palpably permeated the
GHF 2016’s three days’ program. A
special highlight for participants aswell as media representatives was the“Tomorrow’s Affordable Hospital”
exhibit. A small hospital was reconstructed, allowing visitors to ­discover
several innovations at the individual
stands. The inventions on display
were selected according to two criteria: their accessibility (i.e., afford­
ability for all) and their low environmental impact (i.e., sustainability).
1
2

WHS Geneva Meeting 2016

Combined Conferences
Break Records
The 300 square meter temporary
hospital was organized into six
departments:On the occasion of the Geneva Health Forum’s sixth
edition and 10 year anniversary, the World Health Summit
Regional Meeting 2016 was organized in Geneva and called the
WHS Geneva Meeting. This partnership emphasized the deepfriendship of these global networks,
expressing the desire to mutually
support each other on an international level and across all sectors.
Both the organizers and the morethan 1,200 attendants in Geneva
agreed that collaborations like thisare pivotal to improve health on a
global scale as agreed.

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YEARBOOK 2016

WORKSHOPS ESCAPE THE
USUAL ROUTINE

After more than a year of preparations, the WHS Geneva Meeting presented eight specially marked sessions organized by members of the
M8 Alliance. The workshops discussed major global health issues likeresearch funding, medical education,
sustainability and affordability.
Simultaneously, the Geneva HealthForum (GHF) organizers convened
11 groups of experts from six continents to answer major questions on
health issues. The goal was to address

topics in depth in specially designed
workshops, breaking away from theusual routine of many international
conferences. The sessions tackled awide range of topics, including access to cancer treatment for children
in the poorest countries, mental
health in remote regions and telemedicine. These experts repeatedly
met via teleconferences and in person in a closed session on April 19 torefine their data and presentation.
The findings and recommendations
were presented in open parallel sessions on April 20 and highlighted in
the last plenary session on April 21.
The results were published later on

1. Internal medicine: addressing public health issues.
2. Gynaecology, obstetrics andneonatology: dealing withcomplications following
childbirth.
3. Laboratories and medical
imaging: presenting innovations inspired by the TV
series CSI.
4. Pharmaceuticals: focusing
on counterfeit medicinesand presenting a machine
designed for rural hospitals
to find out the compositionof a drug and determine if it
is genuine or a fake.

5. Logistics: tackling issues ofwater purification and protection against infections.
6. Training and research: unveiling various telemedicine
systems that allow doctors
in rural hospitals to contact
urban experts.
Highlights included a pharmacy
equipped to detect counterfeit drugs,
a digital radiology unit customized
for tropical climate conditions for afraction of the market price, guidance on how to wash your hands
while only consuming 10 cubic centimeters (or 10 milliliters) of water,and even a shower that used only asingle liter of water.
THE FEDERAL CAFÉ –A PLACE TO MEET

The Federal Café sessions offered an
ideal spot for Swiss organizations
and especially non-governmentalorganizations (NGOs) to introduce
topics of special interest. Presentations included “Globalization ofClinical Trials,” “Mastering HealthData” and “Health Promotion.” Many
participants eagerly used these sessions to discuss new global healthperspectives in an open debate while
enjoying beverages and snacks. They
established new communities andnetworks of shared interest withpeople from all around the world.

3

As World Health Summit 2016 President Professor Antoine Flahault putit, “the 6th edition of the GHF hosting the World Health Summit defined how we want to act on global
health at Geneva. It demonstrated
our deep commitment to ethics andvalues, from advocating against violence against women to debating the
IT revolution’s impact on the healthsector. The world we want must provide health innovations to all.”
The next Geneva Health Forum will
be held in 2018. The next WHS
Regional Meeting will be organizedin May 2017 in Montreal, Canada.
www.worldhealthsummit.org
www.ghf2016.g2hp.net

1,200 PARTICIPANTS FROM
80 COUNTRIESThe GHF 2016 hosting the WHS
Geneva Meeting proved to be aunique opportunity for collaboration
between the academic and hospitalworld, policymakers, experts frommajor global health NGOs, public-private partnerships, and representatives of the private sector. On its
tenth anniversary, the Geneva HealthForum attracted a record 1,200 participants from 80 countries, showingthat two internationally leading conferences working together for theshared goal of improving healthworldwide could be a tremendous
success.

4

The WHS Regional Meeting 2016 washeld in Geneva, Switzerland (1), where
researchers gathered to debate important issues (2). Antoine Geissbuhler
gave an Innovation Award to Audrey
Garcia (3). Didier Pittet, Mauro Poggia
and Bertrand Levrat (4, from left) discussed healthcare policy.

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Translational
Research
In a society that prizes results and deliverables,
the importance of basic research is sometimes
overlooked. Yet from infectious disease treatments
to cancer cures, the mechanisms of our biology
must be understood before doctors can devise
treatments.
While major breakthroughs in science sometimes
take years of translational research to make theleap from bench to bedside, only continued
investment in our understanding of basic biology
can continue pushing medicine forward.
That’s a challenge public health professionals must
be willing to tackle. “The system we have in mostcountries is one where science and care are largely
disconnected,” Erwin Paul Böttinger, CEO of
the Berlin Institute of Health, said at the WHS.
“We need to bring science, research and clinicalcare together.”84

YEARBOOK 2016

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Translational Research

OVERVIEW

TRANSLATIONALMEDICINE: VALUEFOR PATIENTSWhile considerable progress has been made in advancing the­understanding of health and disease mechanisms, scientific­advances have not always resulted in direct benefits to patients.
­Translation of biomedical ideas into societal and economic ­­benefits that improve people’s quality of life is necessary.

science and engineering technology to the clinic is one of
the most pressing research and development issues
worldwide. The path leading from knowledge about basic
human biology and disease mechanisms to clinicallyapplicable diagnostics, therapeutics and prevention measures presents a variety of hurdles and bottlenecks. These
include communication and collaboration gaps, separate
infrastructures, insufficient research time for clinicians,
and lack of access to a wide range of data from bothpre-clinical and clinical practices. More work is needed tosupport innovation and the creation of value. New education and training programs will be essential to ensure thatscientists and clinicians become the driving force behindtranslating today’s discoveries into health benefit.
In short, in a shifting healthcare landscape, translational
medicine has become a global priority. In order to overcome these challenges, foster the transformation towards
a value-based, innovative and even more personalized
medicine, and increase success rates, key issues have to beaddressed.
SOLUTIONS TO FOSTER INNOVATION IN
TRANSLATIONAL MEDICINET

he scale of the demographic challenges ahead, rising healthcare costs, the burden of progressive diseases and their impact on our societies, on healthcare, and on research have all become familiar but arenonetheless significant. These developments will lead to
far-reaching changes in patient care, biomedical researchand the whole healthcare sector in this century. Future
healthcare will be marked by a range of influential trends.
FACING POWERFUL CHALLENGES

Due to the rising average age of citizens in the industrialized societies, there are an increasing number of people
with chronic diseases. Thus, there will be more people athigher risk of needing care. Progressive diseases in particular lead to a reduced quality of life for sufferers andhigh treatment costs for healthcare providers. In responseto these developments, within modern healthcare systems the reimbursement of healthcare services is increasingly dependent on improved quality and quantifiable
results. These value-based programs – for example, theQuality and Outcomes Framework in the United Kingdom – have, in the initial analysis, achieved better results
at lower cost. On top of that, they have reduced socioeconomic disparities in healthcare provision.
Another evolving challenge which will affect the healthcare system is a new paradigm of biomedical research. A
better understanding of the underlying mechanisms andcauses of diseases as well as technological advancements
are transforming medicine from a reactive to a proactive

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and personalized discipline. Systems medicine approaches to biology and medicine provide patients andclinicians with personalized information about eachindividual’s unique health experience at the molecular,
cellular and organ levels. This information will make disease care radically more cost-effective by personalizingcare to each person’s unique biology and by treating thecauses rather than the symptoms of disease. Systems
medicine is a holistic approach to the challenge of biological complexity. In order to yield a comprehensive understanding of human biology, it uses high throughput
technologies – such as DNA and RNA sequencing – toproduce global data sets tracking multiple dimensions ofdynamic network interactions. With this information,scientists and clinicians can begin to understand how anindividual’s genetic make-up and environment mutually
influence health and disease.
Above that, the digital revolution introduces radicallyenhanced capabilities for collecting, integrating, storing,
analyzing and communicating data and information,
including conventional medical histories, clinical tests
and the results of the tools of systems medicine (e. g., bioinformatics, data science). Also important is patients’
access to information and rising interest in “managing”
their own health.

More than ever before, technology plays a significant role
not just in supporting research, but also in driving key
advancements in science and discovery.
Digitization: Digitization is transforming research andhealthcare. The introduction of universal electronic
health records and digital clinical information systems
has helped revolutionize the quality of healthcare in somecountries including, for example, the United States. Linking clinical data with information from insurers, data on
people’s fitness and even genome-level data allows clinicians to make informed decisions in real time andenhances the development of personalized medicine.
Patient involvement: Fostered by digitization developments, patients are increasingly taking on a more activerole in the treatment of their own diseases and are thus
contributing to research and healthcare. In the future,patients will become even more involved in helping
researchers formulate important research questions, andwill often benefit directly from the contribution of theirpersonal data. This will lead to significant advances inclinical research approaches and methods.

MOVING MEDICINE FORWARD FASTER

Systems medicine research: New technologies in systems
medicine research involving genetic, systems biological,
clinical, environmental and behavioral data must be used
to develop markers and models that characterize interindividual differences better to improve diagnoses andrisk predictions, particularly for distinct subgroups.

However, these are not the only trends and challenges tobe considered. The efficient translation of biomedical

Advanced therapies: Stem cell technologies and geneediting techniques are two of the most promising recent

developments in biomedical science. The ability to reprogram common cells, such as those in blood, and turnthem into the multipurpose cells the body uses to regenerate tissue has already become a powerful treatment
tool. And the use of enzymes to alter gene sequences, forexample, by repairing disease-causing mutations, could
soon be widespread. Both are valuable in developing
personalized therapies.
Innovation: The physical process of bringing new ideas
and promising therapies to fruition is one of the toughest
challenges in biomedical research, and one of the mostimportant for a translational medicine center to do right.
Researchers must know what to do with promising
results, have a clear pathway to follow, and have expertiseto support them in bringing a therapy to market.
TRANSLATIONAL RESEARCH IN GERMANY

Coupled with advances in digital medicine and information sciences, these innovative fields have created huge
opportunities to develop new ways of tackling disease
and advancing translational medicine. In Germany, sixCenters for Health Research, launched by the German
federal government in 2010, are addressing the challengeof translational research in common diseases. As inter-institutional centers with a decentralized structure, thesecenters pool knowledge and expertise from universities
and their teaching hospitals plus extra-university institutions. Berlin Institute of Health (BIH) is yet anothertranslational research organization bundling strengths in
one location and focusing on personalized medicine. The
institute with its member entities (Charité – Universitätsmedizin Berlin and Max Delbrück Center for Molecular
Medicine in the Helmholtz Association) addresses the
key solutions outlined above as part of the “BIH Strategy
2026.” BIH aims to achieve scientific breakthroughs andultimately develop tools that predict disease as well as
therapies that save lives and prolong quality of life. And,
BIH wants to achieve significant medical achievementswith a truly integrative and interdisciplinary systems
medicine approach, new alliances and research initiatives
as well as an entrepreneurial culture of innovation. The
ultimate objective: long-term, sustainable impact forhumankind.

AuthorPROF. DR. ERWIN PAULBÖTTINGER

CEO | Berlin Institute of Health |GermanyWORLD HEALTH SUMMIT

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NOVEL TARGETS
FOR THERAPYThe Brain Imaging Network core infrastructure of Portugal hosted
at the University of Coimbra’s Institute of Nuclear Sciences
Applied to Health (ICNAS) is a translational biomedical research
effort that ranges from new molecular probes to human imaging
of brain structure, chemistry and function.

We feature a fully translational biomedical­research effort, from the design of new molecular probes to human imaging of brain structure, chemistry and function with a focus on the humanbrain (Medical Imaging Branch of Euro-BioImaging).
­ICNAS started in 2008 and operates a mature imaging­infrastructure facility. We have leading expertise, instrumentation and cutting-edge imaging facilities.
Together with five universities, we have eight collaborating research nodes. Several European networks are alsocollaborating with us. Our mission includes developing
and exploiting new imaging technologies driving development and access to state-of-the-art imaging instrumentation. Together with CHUC (the University Hospital of Coimbra) and its Nuclear Medicine Department,
we also cover advanced research and clinical areas in theareas of cardiology and oncology.
We have defined training programs, including short- andmedium-term courses in advanced neuroimaging methodologies. Initiatives such as the Brain Imaging Network
are instrumental to help solve the societal challenge ofobtaining a sustainable healthcare system. We hope to­accomplish this by helping establish the use of the most
updated imaging technologies to provide advanced diagnostics in combination with better and more costefficient treatment.

Our participation in the National Roadmap, approved
after international evaluation, is justified by the importance of our National Medical Imaging Infrastructure. In
fact, the range of our activities covers all the medical
imaging work packages of Euro-BioImaging, from translational research using molecular and functional imaging
techniques to basic and clinical research in neuroscience,
including clinical trials.

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The level of complementarity is also very high because of
our specialized radiochemistry unit, which can synthesize new compounds for molecular imaging in humans
and animals, using several tracers, including C11. Moreover, we also have the possibility of developing new magnetic resonance imaging (MRI) approaches, taking
advantage of the research collaboration with Siemens andinteractions with centers such as John Hopkins Hospitaland the Martinos Center at Harvard Medical School. Our
infrastructure has proven its ability to study large cohortsof healthy volunteers (more than 600 on a recent study of
aging of different visual functions) and patients(hundreds of patients studied in several national andinternational neuroimaging/phenotyping projects onneurodegenerative diseases). This helps us design new
molecular probes for imaging of structure, chemistry andfunction with a focus on the human brain. We publishedmultimodal studies in top basic and clinical neurosciencejournals, by adding possibilities to unravel molecularmechanisms of disease to the development of novel diagnostic imaging biomarkers to better define and detect
early ­disease processes and test new therapies.
We have implemented MR- and PET-based imaging
probes based on dopamine , GABA and glutamate, which
are neurotransmitters that have been related to developmental, aging, neurological and psychiatric diseases
affecting cortical- basal ganglia interactions such as
Parkinson’s Disease and related syndromes including
Huntington’s disease, schizophrenia and autism. The
potential was demonstrated by recent publications inprestigious journals such as Brain and Neurology that
confirmed in humans the hypothesis raised in animalmodels of impaired inhibitory neurotransmission. We
prioritize understanding diseases associated with vision
and aging and neuropsychiatric disorders associated withstriatal-frontal lobe dysfunction.

This strategy is anchored in our success, as shown by international evaluations of the main affiliated research units, inproviding leading publications linking vision, neuroscience, healthy aging and neurodegeneration, cognitive
sciences and neuroengineering in health and disease.

brain imaging network infrastructure, we began distribution of our own FDG formulation in 2012 and quickly became the market leader, supplying 80% of the country’s
active PET scanners in 2012. This provides tight coupling­between research and services to the community.

From a methodological point of view, we have consolidated the ability to combine different modalities (asshown in our success performing simultaneous EEG/
fMRI studies to study cognition and mechanisms of disease such as in epilepsy). Finally, we have a research
agreement with Siemens, which allowed for the firsttime to implement GABA measuring sequences in theirscanners (and together with a collaboration with John
Hopkins University a clinical neuroscience study). We
have also implemented a novel data-mining biomedical
facility with significant impact in the development ofnovel diagnostic tools and therapeutic targets.

In sum, we cover a broad range of disciplines, which iswell documented by the interdisciplinary nature of ourstaff. These include MDs, pharmacists, biomedical engineers, psychologists, biologists and biochemists, eachwith a broad interest in complex biomedical data, clinical
trial design and biomarker research.

Internationalization is well grounded, with partnerships
including Euro-BioImaging, the International European
Consortium on Imaging Infrastructures, the Joint
Program of Neurodegenerative Diseases (EU), European
Networks, E-Rare European Initiatives (two consortia),
as well as European projects with a focus on neuroimaging and neuropsychiatric diseases (BrainTrain andAutism Consortia).
Our strong radiopharmaceutical expertise is well substantiated by our track record in molecular probe production
and molecular imaging. We have unique expertise and theequipment for developing imaging markers in brain, heart
and cancer imaging. ICNAS can run Phase 0 microdosing studies, and clinical imaging trials in humans. It
also develops new imaging techniques in partnership withindustry, and labels candidate drugs for scientific andindustry studies. Aside from hosting the national core

AuthorPROF. DR. JOÃO PEDROSO
DE LIMA

Director | Department of Diagnosis |The Coimbra Hospital andUniversitary Centre | Portugal

AuthorPROF. DR. MIGUEL CASTELOBRANCO

Director | Institute for Nuclear
Sciences Applied to Health | Universityof Coimbra | Portugal

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ESSAY

ASIA-PACIFIC
BEACON OF
MEDICALRESEARCH
National Taiwan University Hospital (NTUH) is known
for pioneering research on diseases endemic to Taiwan
and providing a basis for treatment guidelines inmany clinical disciplines. NTUH plays a leading role inclinical trials and research in the Asia-Pacific region.

N

TUH was founded in 1895. It was initially locatedat Dadaocheng, Taipei, and then was relocated tothe present site in 1898. The building was initiallyconstructed out of timber and then it underwent renovation in 1912 to become a tropical renaissance-style building. When completed in 1921, it was the largest and mostmodern hospital in Southeast Asia. Currently, the hospital employs just over 6,000 staff, has approximately 2,400
beds and serves over 8,000 outpatients daily. Each year,
approximately 2,075 clinical interns and medical students, 1,010 residents, and 790 other healthcare workers
receive clinical training at NTUH. NTUH is also committed to promoting international collaboration, thereby
gaining experience and knowledge from the medical
development of advanced countries, and thus enhancing
the delivery of high-quality medical care in Taiwan.
PROVIDING HIGH-QUALITY AND PATIENTCENTERED CARE

For more than a hundred years, NTUH has been providing the people of Taiwan with high-quality and compassionate medical services. The success of NTUH medicalcare services lies in the prompt and effective introductionof the latest medical knowledge to and prevent disease
and improve the care of patients. NTUH continues touphold its philosophy of “patient-centered” medical

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YEARBOOK 2016services to provide medical care at the highest level. The
objective is not only that these efforts will enable NTUH
to set an example of medical care in Taiwan, but also inSoutheast Asia and other developing countries.
NTUH is committed to the promotion of international
cooperation. NTUH runs myriad exchange programswith top international academic medical centers to facilitate access to the latest knowledge and information on
medical treatments in order to improve medical researchand continuing medical education, and advance the quality of medical care in Taiwan. In accordance with theprinciples of equality and mutual benefit, there are anumber of ongoing international cooperative training
programs, including programs for medical students,
attending physicians, and other medical professionals.
There are active collaborative programs with institutions
in France, Japan, Korea and Estonia.
MEDICAL RESEARCH AS ONE OF NTUH’S
CORE VALUESAs a university hospital and medical center, NTUH has
identified medical research as one of its core missions
because it not only affects competitiveness, but also has a
far-reaching impact on the nation's healthcare technology, teaching and research. NTUH firmly believes that theessence of medical research is innovation and the fruit ofresearch and development is the direct result of the unrelenting dedication of each staff to meet “patients’ medical
needs.” NTUH’s focus on “medical research” has enabled
it to carry out clinical breakthroughs in the world andAsia. NTUH has enjoyed a reputation for world-classpioneering achievements in hepatitis research, organtransplantation, cancer diagnosis and treatment, biophotonics, tissue materials, emergency and critical care, immunology, cardiology, infertility, dermatology, ophthalmology, orthopedics and minimally invasive surgeries.
In order to pursue high-quality research and conform tointernational research ethics standards, NTUH proactively participates in the Association for the Accreditation of Human Research Protection Program. The pharmacogenomics laboratory received accreditations fromthe Taiwan Accreditation Foundation and the College ofAmerican Pathologists. More than 200 clinical trials are
initiated at NTUH each year, many of them part of global
multinational trials. There are more than 40 ongoing new
drug Phase I trials at NTUH.

3. The pneumothorax research team conducted arandomized clinical trial to verify that the addition of minocycline pleurodesis after the standard
treatment of aspiration and drainage for primary
spontaneous pneumothorax can effectively reduce the rate of recurrence and the probability ofa follow-up operation. The study was publishedin The Lancet in 2013.
4. Through a collaborative team effort, researchers
from National Taiwan University Hospital(Department of Internal Medicine and Department of Medical Genetics), National Taiwan
University College of Medicine and Academia
Sinica discovered the genes that cause antithyroid
drug-induced agranulocytosis. Results of this research were published in Nature Communicationsin 2015.

INNOVATIVE RESEARCH ACHIEVEMENTS
IN THE PAST 5 YEARS

1. Investigators at the Department of Medical
Research of NTUH and the Department ofChemical Engineering of National Tsing Hua
University collaborated to work on the latest
Enterovirus (EV) vaccines. Using molecularbiology techniques, the joint team researched anddeveloped a virus-like particle (VLP) vaccine.
Animal trials of this VLP vaccine on macaquemonkeys were successfully completed. The
results showed the animals developed substantial
concentration of antibodies, as well as the ability
to neutralize EV-71. This research finding was
published in the journal Vaccine. This researchteam is the international frontrunner in the research and development of EV vaccines.
2. A multi-center randomized trial led by theinvestigators from the Department of Internal
Medicine of NTUH confirmed the efficacy of anovel sequential treatment as the first-line
treatment for Helicobacter pylori infection –a common pathogen for gastric diseases. In thisresearch, the research team extensively analyzed
antibiotic resistance, designed a decisionmodel that could predict the efficacy of anti-H.
pylori treatment in different regions around theworld, and disseminated an important message
that the optimal regimen should be tailoredto the local prevalence rate of the antibiotic
resistant strains. Results of the study were published in one of the top medical journals,
The Lancet, in 2013.

AuthorPROF. DR. K. ARNOLD CHAN

Director | Department of Medical
Research | National Taiwan University
Hospital | Taiwan

Author
DR. WEI-HSUN HSU

Attending Physician | Clinical Trial
Center | National Taiwan University
Hospital | Taiwan

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ESSAY

THE POWER OF
TRANSLATION
Translational research promises to use the discoveries of fundamental
biomedical research to develop new clinical applications. Whether
this promise has been kept is a matter of intense debate. Here wedemonstrate how both fundamental and applied research play roles inthe development of new and innovative treatments.

T

his summer, the US Food and Drug Administration (FDA) has approved two drugs called Alirocumab and Evolocumab. Both are inhibitors of the
proprotein convertase subtilisin kexin 9 (PCSK9) andhave the potential to replace the well-established statinsas the standard treatment for lowering blood cholesterollevels. The approval of PCSK9 inhibitors by the FDA is aparadigmatic example that fundamental researchoriented toward a general understanding of biologicalprinciples can create the knowledge base for the development of new drugs. The PSCK9 gene was found during
research to better understand how proproteins and theirconvertases function. It was quickly recognized that it
encodes a new proprotein convertase, but its function in
regulating cholesterol levels was only uncovered when
PCSK9-deficient mice and humans with crippling PCSK9
mutations were analyzed and found to have strongly
reduced cholesterol levels in the blood. It took over 10
years from the original discovery of PCSK9 to the first
FDA approval of PCSK9 inhibitors as new drugs. Somehave even argued that it is questionable whether PCSK9
would have been found by research directly targeted at
finding new cholesterol regulating enzymes.
DISEASES IN THE CROSSHAIRS OF APPLIEDRESEARCH: THE EXAMPLE OF THE ARTIFICIALPANCREAS

One of the most fascinating developments in the field of
applied medical research is the artificial pancreas to treat
diabetes type 1. The development of the artificial pancreas is based on extra-corporal insulin pumps that are used

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today by people with type 1 diabetes. These patients haveto carefully manage their blood glucose levels to avoid
hypo- or hyperglycemia. This is particularly difficult atnight, where periods of hypoglycemia remain the mostcommon adverse effect of insulin therapy. The newest
generation of the artificial pancreas, which should beavailable to patients within the next 2-3 years, use computer algorithms that allow a precise dosing of insulin
and glucagon in response to varying blood glucose concentrations, which are measured using a sensor. The
monitoring of blood glucose and the activation of theinsulin or glucagon injections are continuous and will
ideally be reviewed by the patient via smartphone applications and should increase the quality of life of diabetes
type 1 patients significantly.
NEW BIOMARKERS AS “COMPANIONDIAGNOSTICS” FOR PRECISION MEDICINE

Biomarkers are now used increasingly in clinical practice to follow the course of a disease more precisely andto select suitable treatments more adequately, forinstance, according to an individual patient’s genetic
make-up or to identify therapy responders within entire
patient cohorts. Biomarkers can be genetic variants,
metabolites or substances which, once introduced into
an organism, allow a physician to monitor a specificphysiological parameter or even the function of wholeorgans. Rubidium chloride, used to evaluate heart muscle perfusion, is one such example. Other biomarkers
may indicate changes in expression of proteins or
metabolites that correlate with the course of a disease,with individual risk or with a specific prognosis. Even
brain images can be used as biomarkers as recent examples from psychiatric research shows. Recognizing anddiagnosing mental illness has always been a particularchallenge for psychiatrists and researchers alike. However, recently, functional magnetic resonance imaging
or functional MRI (fMRI), which is a neuroimaging
procedure, has been used to measure blood flow andthereby neuronal activity. A recent report showed thatfMRI markers could identify autistic patients with good
accuracy. This is most certainly a major advance in the
diagnosis of mental illnesses.
USING IMMUNE CELLS TO TREAT CANCER

Harnessing the body’s own immune system against cancer cells has long been on the mind of oncologists andcancer researchers. This idea stems from old but largely
anecdotal observations that cancer patients sufferingfrom viral infections sometimes had a more favorable
outcome than their non-infected counterparts. The concept is plausible, since cytotoxic T-cells that can recognize
and kill virus-infected cells are part of our immune
defense and their “killer” capacity could be directedagainst tumor cells. Recently, we have witnessed a comeback of this idea in the form of a new therapy that uses socalled chimeric antigen receptor carrying (“CAR”)
T-cells. Here, T-cells are collected from a cancer patient
by apheresis and are treated to express a CAR, which is
nothing else than a modified T-cell receptor able to recognize a specific tumor antigen expressed on the surface
of a cancer cell. The CAR-carrying T-cells are then
expanded in vitro and re-injected into patients, where
they eliminate the cancer cells that carry the cognate
antigen. Examples are T-cells with CARs directed against
the disialoganglioside GD2, which can recognize and kill
neuroblastoma cells expressing GD2 or T-cells with CARs
for CD19, which have already shown high potential to kill
B-cell type leukemia cells.

clease and the right guide RNA molecules are delivered
into a cell, the genome of this cell can be cut at a precise
location, exactly where the guide RNA finds acomplementary sequence. This enables the removal ordestruction of genes, corrections of mutations or the
introduction of new mutations in any given genome. This
opens infinite possibilities to design new therapies in particular for monogenetic diseases, but also for infectious
diseases or to revert therapy resistance. CRISPR/Cas
genomic editing has been tested and already proven capable of correcting gene defects in mouse models for sickle
cell anemia, muscular dystrophy and cystic fibrosis; hence
for diseases where single gene mutations are at the root of
the problem. Other applications include the targeting ofviruses (e.g., herpes, hepatitis B or even HIV) where a
DNA intermediate is required for their life cycle andwhich can be targeted by Cas9 and suitable guide RNAs
to be eliminated or incapacitated.
In 2014, researchers from MIT and their colleagues who
co-discovered the CRISPR/Cas9 system described a way
to use this editing tool to “drive almost any genome alteration through sexually reproducing populations.”
They declare that “gene drive could benefit humanhealth for instance by altering insect populations transmitting diseases such as malaria.” However, the spreading of genome alterations through entire populations
could have unpredictable consequences and it remains
to be seen whether the elimination of entire species bygene drive – even if it concerns flies transmitting deadly
diseases – is controllable. Therefore, some of theresearchers that were involved in the discovery the
CRISPR/Cas9 system and had demonstrated its potential to manipulate entire genomes have called for a
moratorium on using CRISPR/Cas9 on the human germline. This ongoing debate reminds us again that many
new scientific discoveries and breakthroughs, as exciting as they are, still bear risks that we have to weigh withcaution against all potential benefits.

NEW GENOME EDITING TOOLS FOR GENE
THERAPIES AND THE RISK OF “GENE DRIVE”

A new genome editing tool called CRISPR/Cas9 isanother example of how discoveries from fundamental,
non-targeted research can provided powerful tools forclinical applications. By investigating how bacteria deal
with foreign DNA, for example coming from bacteriophages, researchers have discovered the CRISPR/Cas
system. The immense significance of this discovery andits potential for biomedical research and gene therapy
was immediately recognized and experiments with these
new tools are now present in laboratories the world over.
CRISPR associated, or “Cas”, proteins are RNA-guided
DNA endonucleases. CRISPR stands for Clustered Regularly Interspaced Short Palindromic Repeats and together
with the protein Cas9, for instance, enable bacteria todegrade foreign DNA at specific sites. When the Cas9 nu-

AuthorPROF. DR. TARIK MÖRÖYPresident and Scientific Director |Montreal Clinical Research Institute(IRCM) | CanadaWORLD HEALTH SUMMIT

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lives influence their telomeres. So many conditions inpeople’s lives actually impact on disease risks, but it wasvery hard to accept that your neighborhood is actually arisk factor for cardiovascular disease and diabetes. It
turns out stress makes your telomeres wear down faster.

INTERVIEW“You makethe biggest
impact by
doing ­basic
research”

How do you bottle that knowledge?

Elizabeth Blackburn is president of the Salk Institute for Biological Studies,
one of the world’s preeminent research centers. In 2009, Blackburn won
the Nobel Prize in Medicine for discovering telomeres, which serve as protective
caps on chromosomes and are essential for preserving genetic information.
Telomeres seem to play a key role in aging and diseases such as cancer, andBlackburn’s work helped jumpstart new research in these areas.

Congratulations on your recent appointment to head the
Salk Institute. Are you here to advocate on behalf of thetranslational potential for basic research?
Blackburn — I think I’m more here to cheer for health. To
me that is the overarching consideration. Jonas Salk invented a vaccine for polio in the 1950s. And he didn’t getrich from it, but he had this vision: You make the biggest
impact by doing basic research.
Despite all our knowledge, there is still such a lot that
we don’t understand about how diseases unfold, especiallythe non-infectious ones. Those diseases are not really wellunderstood. Alzheimer’s is a really dramatic example.
Please tell us about your experience researching the telomere – did you think it would have clinical applications?
It began as very basic research – what’s at the end of chromosomes? Nobody knew. I was using whatever moleculartechniques were available to get an answer.
It turned out that telomeres had inherent properties
that could mean chromosomes would become unprotected over time. What has been exciting over the years
has been finding out how that actually plays out in human
lives. Of course, we have life expectancies in developed

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countries of 80 years or more, so in humans you have to
ask questions in ways that you can’t ask in rapid, short life
model organisms.
Non-communicable diseases are basically when thecomplex machine of the human body starts breaking
down. They are truly huge killers – diabetes, cancers, cardiovascular diseases, strokes, even lung disease. And thenneurodegenerative disease is having such an impact, notso much by killing people but by having a real impact on
quality of life. When telomeres shorten too much over decades of life, that starts to accelerate these diseases andmake them worse.
How did you make that transition from looking at
telomeres in the model organisms to humans?
I went to a medical school and somebody says to me, oh,would you like to join our cancer investigation. By thenpeople knew the enzyme we’d discovered played a role inmost human cancers.
Then a young colleague, Elissa Epel (Department of
Psychiatry, University of California) came in one day andsaid, “When human beings are stressed, then they look
more and more aged, what happens to their telomeres?”That grew a whole field looking at what things in people’s

It’s very interesting because it turns out that everything
your mother told you to do is right, in terms of the effects
on maintaining telomeres. Every good parent says, “sleep
well, eat healthily, get some exercise, have a good attitude.” All these things help preserve the ends of our chromosomes, it turns out. You’re not asking for an untested
drug. It doesn’t cost you anything to walk.
If we emphasize treatments but we don’t emphasize
prevention, then we’re never going to get anywhere. The biology of prevention is more complex and less urgentseeming, but in terms of public health overall, it’s simple:
that’s where we also need to be putting the money. Nobody
likes this because it’s too distant-seeming and does not havethe same commercial attractions as disease treatments.
Thus, prevention is a much more challenging question, because the incentive is always to treat a disease thatis there right now. Of course, by that time it’s way too late
and the disease has already done a lot of damage. With
telomeres we have a really good molecular biomarker.
That, to me, is very practical. No one could love
Western medicine more than me, but at some point you
realize that part of the picture is preventing and intercepting disease.

“It turns out thateverything your mothertold you to do is right,
in terms of the effects on
maintaining telomeres.”
PROF. DR. ELIZABETH BLACKBURN

President | Salk Institute for Biological Studies |La Jolla | USA

In your presentation you gave a great example: People
who have bladder cancer and simultaneously have both
shorter telomeres and depression at the time of diagnosisof their cancer are far more likely to die than people withjust one of those conditions – also that people with depression have shorter telomeres. What’s the link?
Depression has big physiological readouts and clear
increases in risks for co-morbid diseases like cardiovascular and diabetes. It clearly causes a big physiological change.
If someone who is depressed has cancer, the host – thebody – in which the cancer is growing is not the same as a
non-depressed host.
And there is a clear dose dependency between telomere shortness and depression history and severity.

When you look at telomeres in a number of cohorts, themore days of lifetime accumulated untreated depression aperson has in their past the shorter their telomeres. If you
could measure telomere length in long-term depressedindividuals, you might be able to assess their risk of
co-morbidities.
Is there a way to systematize the dialogue between clinicians and basic scientists?
That can be done at a sort of policy or strategic level fromthe national funding agency. In my experience, the National Institutes of Health in the US showed a real willingness to see the value in why this kind of research should
be funded. That’s been one thing I’ve observed that hasreally changed in the last decade, in a good way.
You mean encouraging as many different disciplinary approaches as possible in a grant?
If you’re going to write a good proposal to do good
research on complex problems – and human biology iscomplex! – you’re going to need to talk to people whohave very different training, a very different mindset, anddifferent languages that they use.
I think it works more when there are really material
incentives. In my case it was grants. I did it within, by andlarge, a big research university. But then I felt it was reallyvery easy to do between research universities as well. You
need the right sort of openness, which is to say to one’s
basic scientists that your clinical colleagues are actually
really smart, but in ways that are different from yoursmartness. I found you need to talk one-on-one because
you really need to make sure you’re talking about thesame things.
So it’s a matter of changing the funding and the culture?
I have been a basic scientist for decades, and it wasn’t that
hard to start conversations. But you have to think that
there was some value to it.
If you could come up with a pill to preserve telomerase,would I want to take it?
You’d be stupid because significant research in humans
indicates that you’d increase your risks of some cancers.
Because my cells would never die?
Increases in telomere maintenance is associated withincreased risks for some cancers. When you’re looking atthings over decades and decades of life, small effects cancumulatively add up to big overall cumulative risks fromcancer – imagine the risk goes up a few percent each year,
but that plays out for three decades. That’s going to have a
big overall risk effect.
We already have ways that we know are better atmaintaining telomeres – exercise, rest and reducing
stress, for instance. They are free, so those are the smart
things to go with.

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HEALTH IN NUMBERS

MARKET SUCCESS

Translational Research:
Advancing Innovative
Treatment
Translational research is advancing innovation, making it even more attractive
for further investment and development. A central aspect of this process isthe effective translation of knowledge, mechanisms and techniques generated byadvances in fundamental scientific research, turning them into novel
approaches for prevention, diagnosis and treatment.

GLOBAL FUNDING

FIGHTING AIDS(UNAIDS, 2016)

2 MIO

2005
2015

It’s very importantfor decision-makers
to incentivize this ­kind of work. This
is where we will see
the next step up to
unlocking thepotential of valuebased healthcare.
1 IN 10,000 scientificdiscoveries makes it tomarket.

BIG INVESTMENT
On average, it costs
US$ 2.6 billion
to develop and gain
marketing approval
for a new drug.
(Tufts Center for the Study ofDrug Development, 2014)

1.1 MIO

CHILD MORTALITY(Lancet, 2013/WHO, 2016)

Worldwide, the rate fell by more thanhalf from 1990 to 2015, and deathsof children under 5 fell from 12.7 million
to 6 million, having dropped from90 to 43 deaths per 1,000 live births.

LIFE EXPECTANCY RISING
71.4 Years in 2015.
69.8 Years in 2010.
68.0 Years in 2005.
66.4 Years in 2000.
(WHO, 2016)96

YEARBOOK 2016

Christina Akerman (PresidentInternational Consortium for
Health Outcomes measurement)
at WHS 2016

(National Center for Advancing
Translational Sciences, 2013)

Since the disease's peak in
2005, AIDS-related deaths
have dropped: In 2015, 1.1
million people around theworld died from AIDS-relatedcauses, a 45% drop from the2 million people killed in 2005.
Diseases mostly found in low-income andmiddle-income countries like malaria
and tuberculosis receive just 1% of all global
funding for health research, despite
WHO estimates that these diseases accountfor more than 12.5% of the global disease
burden.

STATEMENT(United Nations Development Programme, 2016)

1990

2015
WORLD HEALTH SUMMIT

97

PREVIEWWHS REGIONAL MEETING –NORTH AMERICA, MONTREAL 2017

WORLD HEALTH SUMMITBERLIN 2017

TOPICSTOPICS

New Frontiers in Medical Treatment
Development of precision medicine, rare andgenetic diseases, viral infections, diabetes andantibiotic resistance.

Health Policy in the G7/G20:
The Future of Global Health Governance
The Sustainable Development Goals underline
the need for financial and political commitments to solve global health challenges.

Environmental, Social and Cultural Determinants of HealthTransformation of the urban environment andits impact on the health of city dwellers, thepromotion of healthy lifestyle habits and its
influence on healthcare costs.
Medical Education for Optimal Healthcare
Medical education and the evolution of physicians’ role in society, the global health curriculum and the accreditation of medical schools.

SAVE THE DATEREGIONALMEETINGNORTH AMERICAMONTREAL
MAY 8-9, 2017SAVE
THE DATE
WORLD HEALTHSUMMITGERMANYBERLINOCT 15-17, 2017

Global Health Security:
Policy Responses to Planetary Challenges
Communication and cooperation are key toprotecting the world from health threats.
Healthy and Resilient Cities:
Rethinking Urban Transformation
Health must be integrated into urban planningand policy decisions.
Vaccination and Disease Eradication:
The Role of Research & Development
Vaccine research is a must when it comes tocontrolling dangerous pathogens.
New Frontiers in Health Sciences:
Remodeling Healthcare
Improving the health of patients must be at thecenter of efforts to restructure healthcare.
Big Data for Health Governance:
Benefits, Frameworks & Ethics
Data can improve health outcomes, but collecting personal information poses ethical,
regulatory and technical challenges.

INNOVATION FOR LIFEIMPRINT98

HEAD OF THE PROJECTILLUSTRATIONS & INFOGRAPHICS

PUBLISHER WHS Foundation GmbH,Dr. Joachim Schüring

Kristina Heldmann

c/o Charité – Universitätsmedizin Berlin,

PROJECT MANAGER

REPRODUCTION Twentyfour Seven

Charitéplatz 1, 10117 Berlin, Germany,

Kathleen ZiemannCreative Media Services GmbHwww.worldhealthsummit.org

AUTHORS Andrew Curry, Oluwakemi

PRINTING LASERLINE Digitales

EDITOR-IN-CHIEF Tobias Gerber,

Aladesuyi Arogundade

Druckzentrum Bucec & Co. Berlin KG

Tel: +49 (0) 30 450 572 114,

COPY EDITOR Barbara Serfozo

RIGHTS Reprints in part or as a whole arecommunications@worldhealthsummit.org

PHOTO EDITOR Beatrice Jansen

only permitted with explicit approval of

EDITORIAL BOARD Prof. Dr. Detlev Ganten,

ART DIRECTOR Mirko Merkel

WHS Foundation GmbH. The editors are

Dr. Jörg Heldmann, Dr. Alexander Hewer,

LAYOUT Jessica Sturm-Stammberger

not responsible for unsolicited manuscripts

Julian Kickbusch, Daniela Levy

PHOTOGRAPHY Bundesregierung/Steffen

and pictures.

PUBLISHING HOUSE

Kugler (p. 7) | European Commission (p. 7,

EDITORIAL DEADLINE November 1, 2016

TEMPUS CORPORATE GmbH –8) | Steffen Kugler (p. 29, 32, 33, 35, 36, 37,

ein Unternehmen des ZEIT Verlags, Büro

38, 50, 54, 56, 57, 58, 59, 60, 61, 62, 78, 94) |Berlin: Askanischer Platz 3, 10963 Berlin,

Patrick Lopreno (p. 82, 83) | Julien Gregorio

Germany,(p. 83) | vege – Fotolia (p. 10) | World Healthwww.tempuscorporate.zeitverlag.de

Summit (p. 3, 12, 13, 21, 23, 25, 27, 43, 45, 47,

MANAGING DIRECTOR Jan Hawerkamp

49, 71, 73, 75, 77, 87, 89, 91, 93)

YEARBOOK 2016

HOPE IS WHAT ENERGIZES OUR RESEARCHERS TO PUSH
THE FRONTIERS OF MEDICAL INNOVATION EVERY DAY.
To fight against dengue fever, hypercholesterolemia,
diabetes and atopic dermatitis, our researchers help
turn discoveries into solutions -- even faster. With major
treatment launches planned by 2018, Sanofi shares thehopes of millions of patients and public health partners.
www.sanofi.com© Gabo Morales/Capa Pictures -Health and Healthcare Delivery for SpecificGroupsFirst Nations health, health and immigration,
health in the workplace, healthcare quality andpatient safety.

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