Geneva Health Forum Covers Wide Range Of Policy Issues

Non-communicable diseases, access and affordability, global health governance and information and communications technology innovation are some of the important issues discussed and debated at the recent Geneva Health Forum (GHF).

The theme of this year’s forum, which took place from 15-17 April, was “Global Health: Interconnected Challenges, Integrated Solutions.” The forum was opened by President of GHF, Louis Loutan, chief executive officer of the University Hospitals of Geneva, with messages from professors and officers from Geneva’s universities, and Swiss state councillors.

“We are all faced today with the same challenges,” Federal Councillor Alain Berset, head of the Federal Department of Home Affairs of the Swiss Confederation, said referring to the global problem of non-communicable diseases (NCDs) in both developed and developing countries.

Berset emphasised the need for collaboration and a multi-sectorial approach, stating, “Healthcare is not just something that concerns specialists. It also concerns politicians.” Geneva is an important place to reinforce collaborative interaction as it is the “world capital of health,” he said.

Mauro Poggia, state councillor of the Department of Employment, Social Affairs and Health of the Republic and State of Geneva, discussed trends in innovation.

There is no longer a monopoly over innovation by the European Union or North America, he said, and pointed to innovative initiatives coming from all “four corners of the world.” Local innovation is important, he said, and the GHF provides the opportunity to compare experiences from the field with global healthcare policies. This requires a global approach and a “will to share,” to inspire each other mutually to improve the entire world, Poggia added.

Jean-Dominique Vassalli, rector of the University of Geneva, highlighted the power of universities to bring multi-sectorial activities together – be it from health, law or economics – to solve some of today’s major challenges.

The keynote speaker was geneticist Denis Duboule, professor at the University of Geneva. Duboule talked about the growing trend for personalised medicine based on genetics. Two important issues he discussed were the growing power of individuals and patients who provide genetic data, and the debate over genome ownership. The quantity of data available for medical research and treatment from patient’s genomes is unprecedented. Quantities are so high that they can substitute quality, he said. Patients will take control over who can access their genomic data, and “physicians will become customers of these networks,” he predicted.

Exploring the idea ownership of genetic material will necessarily evoke questions over consent and responsibilities, he said. Rejecting the idea that the genome can be “owned”, Duboule recalled that the genome is inherited and maternal and paternal contributions are mixed. “If anyone should own our genome, it should be our parents,” he said. He also argued that we all share most of our genome, so we are all stakeholders in the human genome. When we share genomic data, we inevitably share personal data about our families too.

Access and Affordability

A recurring issue at this year’s forum was the global lack of accessible, affordable and quality assured medicines and health technologies for non-communicable diseases. Both speakers and participants expressed relief that people are finally coming around the table to discuss NCDs, a much-neglected issue during this “era of infectious diseases.”

A panel moderated by the World Health Organization on this issue shared country experiences and recommendations such as Moldova’s policy of mandatory prescribing of generic medicines that comply with regulations regarding quality, the public distrust for efficacy and quality of generic drugs in Peru, and local production in Vietnam.

On the one hand, speakers argued that “medicines alone will not save lives,” healthcare systems must have the capacity to deliver treatments and a regulatory system that does not introduce barriers to access. Johanna Ralston, CEO of the World Heart Federation said cardiovascular disease drugs are off patent for example, they are known to work and are available, adding that it is “unconscionable that they are not more widely available.”

Others argued that pricing remains a serious issue. Dr. Nils Billo from the International Union Against TB and Lung Disease said it is necessary to make sure that those who procure drugs in developing countries become more efficient in trying to get better prices from pharmaceutical countries. He added that pricing issues are not just a developing world issue, but is also a growing problem for the US and Europe.

Manica Balasegaram, executive director of the Access Campaign at Médecins Sans Frontières (MSF, Doctors without Borders) called for more transparency in pricing so that purchasers are aware of medicine and price options available in the different regions when choosing the best affordable procurement projects.

“For certain products, particularly talking about certain cancer medicines, we need to look at all the flexibilities that are available, including the flexibilities around IP that will be useful to make products available,” said MSF. They also called for innovative companies to “look at their own access strategies” to make their products available.

Mario Ottiglio, director at the industry lobby group International Federation of Pharmaceutical Manufacturers & Associations (IFPMA), said that there are generic alternatives for most non-cancer diseases as well as some cancers, adding that there are some 4,000 medicines in the pipeline for cancer. He said that part of the problem of access is lack of capacity building and training, and pointed to new initiatives to make medicines available such as public-private partnerships and tiered pricing.

ICT Innovation for Health

The use of ICT for public health is seen as a revolution, according to Dr. Allison Goldberg, Director of Global Corporate Affairs at Anheuser-Busch InBev, panellist during the GHF.

In a panel entitled “Information and Communication Technologies to Promote and Facilitate Health”, panellists presented several examples on how ICT can improve health.

Dr. Clothilde Rambaud-Althaus, PhD candidate at the Swiss Tropical and Public Health Institute, presented a tool developed to assist clinicians in their diagnostic of malaria and prescription on children under 5 years old. The main goal is to decrease the prescription of antibiotics in order to fight against antimicrobial resistance. In another panel, the correlation between antimicrobial resistance and overuse of antibiotics was asserted.

ICT is also a tool to train clinicians. Sabina Beatrice-Matter, project manager at the Novartis foundation for sustainable development, presented a software providing e-learning for the World Health Organisation’s Integrated Management of Childhood Illness guidelines. Those distance-learning courses help to reduce costs of trainings.

Other panellists emphasised the opportunities and challenges of mHealth technologies, which consist of the practice of medicine through mobile devices.

Prof. Don de Savigny of the Swiss Tropical and Public Health Institute, raised the importance of the Systems thinking approach to design those devices. The main challenges in these issues are stand-alone pilots, weak constituencies of support, limited stakeholder engagement, and the lack of national eHealth standards.
ICT can also be used to promote health, mainly through social media. Dr. Anthony Adoghe, research PhD student in public health at the University of Essex and founder of Adoghes’ Online Public Health Clinic, stated that ICT tools such as Facebook are “simple but powerful,” given that the “key is interaction”.

But ICT can also have adverse effects on health, as stated Goldberg, Director of Global Corporate Affairs at Anheuser-Busch InBev. She took the example of ICT use possibilities for road safety. But at the same time, texting or using its smartphone while driving can cause accidents. She stressed a need to reconcile those trends, by elaborating norms to promote a safe use of technology.