Tune into this episode of PwC's Next in Health to hear PwC Health Research Institute's Trine Tsouderos, and Strategy& Principal, Igor Belokrinitsky, discuss whether the U.S. health industry is prepared to meet the challenges of a future pandemic. This episode highlights:
Topics: healthcare, health industry, pandemic, COVID-19, pharmaceuticals and life sciences, health equity, trust, providers, payors
Find episode transcript below.
Just a reminder. Later on in the episode, I'm going to make some remarks and the opinions that you hear on this podcast are my own and do not necessarily express the views and opinions of PwC.
00:00:17:00 Welcome to HRI’s Next in Health podcast, I'm Trine Tsouderos and I'm a management consultant with PwC, working with pharmaceutical companies on vaccines, mRNA, and other medical products. I've hosted this podcast since the early days of the pandemic, and it's been almost 80 episodes. It's hard to believe.
00:00:36:00 And I'm sad to say that this will be my last episode. After nine years with PwC, I'm leaving the firm and I'm going off to work on my Master's in the History of Medicine and spend time with my kids.
00:00:48:18 And so I just want to say, I'm so sad that this is the last episode. I can't believe what we've accomplished, but that I'm leaving it in great hands with Igor Belokrinitsky and the team that has backed us ever since the very beginning who've done a wonderful job.
00:01:04:00 I'm Igor Belokrinitsky. I'm Trine’s co-host and I am sad. I am a principal with PwC Strategy& where I help leading health organizations with their strategies and operating models.
00:01:17:00 And since Trine, you started out, with talking about the history of the podcast, let's turn briefly back to the beginning of the COVID pandemic when the flights were grounded and the quarantine started and we're all sort of trapped in our bedrooms and in our homes and in our apartments away from each other, and you brought us together.
00:01:42:00 You brought us together around the virtual watercooler, and we would tune in every day to hear from you the latest on what was happening with the pandemic because we personally wanted to know and because our clients expected us to know and expected us to help them navigate through the catastrophes, through the pandemic, through the crisis that we had all gone through.
00:02:07:00 And so this watercooler, this meeting place that you had organized become a place to come, to connect, to be informed, to hear from each other, to learn from each other, to support each other.
00:02:19:00 And it really played an outsized role as a source of community, as a source of information, as a source of insights. And obviously, you helped catalyze those conversations and learned a tremendous amount and shared a tremendous amount of information in the process.
00:02:35:17 And I'm curious to hear you reflect on what you've seen, what changes you've seen with your colleagues, with your clients, as you've seen every day the world evolving through these watercooler calls.
00:02:51:00 Gosh, Igor, thank you so much. That is so kind. Those calls became, like you said, a community and you were one of the earliest folks to the watercooler.
00:03:00:00 And actually, this podcast and the watercoolers are among the highlights of my whole career at PwC just to experience this whole pandemic with so many people and get that insight from so many of us that are working with clients, hospitals that were struggling with PPE early on and wondering how to handle COVID patients and wondering in some cases when they would be coming through the doors because if you remember early on, you know, we were having a huge flood of very sick people coming through the doors of New York City hospitals, but other hospitals were shutting down, but yet patients were coming through the door.
00:03:36:00 So we were hearing from them. We were hearing from pharmaceutical companies that were just gearing up to try to produce at the time vaccines, which we didn't know whether they would work or not.
00:03:44:24 And then insurance companies which were scrambling to figure out how this would impact their members and how to support their members. And so we heard from all of these different groups, all in this one call. And so it was really an amazing nerve center to be part of.
00:03:59:11 So, yeah, it's been an amazing ride. If I think back to March of 2020, when we started those calls and then we started this podcast out of them about six months later, at the time, I remember there was a model that came out of the Imperial College of London that was looking at estimating deaths in Great Britain and the U.S. under various scenarios.
00:04:20:00 And one of the estimates was that 2.2 million Americans would die during the pandemic under a scenario in which we had no masking, no social distancing, no vaccines, no nothing. So what would happen if we did nothing?
00:04:34:06 I remember that number was just unbelievable to me. It just stopped my heart. And here we are. We're in 2022 and about a million Americans have died, and that is still a heart stopping number. And that's with the vaccines and the masks.
00:04:50:12 And I think there's two ways to take it. It's a huge mountain of tragedy, and it's also a lot of tragedy averted, if you think about that 2.2-million-person number that came out early in the pandemic. And so there's two ways to look at it.
00:05:03:17 This is still an astonishing event. It's a historic kind of event to live through and for a lot of people, just incredibly life-changing.
00:05:11:00 Absolutely, absolutely. As I think back on that time there, a lot of unknowns in terms of the mechanism of spread and the speed of spread and the different variants of the resistance.
00:05:24:00 And we've learned an incredible amount in the past two years, but there also seem to be remaining gaps in our understanding of this disease, of the mechanisms of spread, of how it works in different environments and what the right set of safety rules and procedures ought to be even to dealing with this pandemic, let alone a different pandemic with a different mechanism or different chemistry.
00:05:49:00 I'm curious, as you now look to the future, where you see some of the priorities, some of the things that we need to understand better, some of the things we need to do better.
00:05:59:04 Well, top of my list would be just the continued disparities, the racial and ethnic disparities and how the pandemic played out. I think that's the most stark gap that we still have in the US health system, and that's nothing new.
00:06:15:24 I think if we had looked in 2019 and asked how do we think the pandemic is going to play out if we imagined sort of a potential pandemic, I think we could have predicted exactly how it played out, that people of color suffered far more.
00:06:29:17 They were more likely to be sick, to be hospitalized, to die from COVID-19 and that's exactly what happened. So I think that's the biggest ongoing persistent historic gap that we've known about for a very long time.
00:06:46:00 And I think there is a lot of effort and talk about trying to do real concrete things to change that and we hear that from hospital clients, we are hearing that from our insurer clients, we're hearing that from pharmaceutical companies.
00:07:00:00 So there are a lot of serious efforts to change that, to do something about that. And so I'm hopeful that the next time a pandemic comes around, hopefully in a hundred years that we won't see the same disparities play out the way they did this time around.
00:07:17:00 I don't know Igor what you think what would be on your list of vulnerabilities or weaknesses in the system that the pandemic laid bare.
00:07:24:00 For me, and I think we'll probably come back to it a couple of times during this conversation, the scarcest commodity in all of this and the scarcest resource has been trust and we've had amazing scientific breakthroughs.
00:07:38:00 We've had great funding mechanisms and reimbursement mechanisms. We've improved our ability to communicate. We've ramped up the infrastructure and the logistics, solved a lot of the supply chain problems.
00:07:48:16 But we are still losing when it comes to trust, when it comes to the ability to engage with populations and with individuals and with communities in a way that engenders trust, in a way that promotes the behaviors that contribute to good public health.
00:08:08:00 And these trust breakdowns, they exist with a variety of communities both inside and outside the health institutions. On the outside, it's the consumers, the communities, the families. On the inside, it's the employees and the workforces and the caregivers.
00:08:25:23 There's trust breakdowns everywhere. And as a consequence of those trust breakdowns, we see those reflected in behaviors. We see those reflected in how people access or don't access health services.
00:08:41:00 And at the end of the day, doesn't matter how good the science is, doesn't matter how good the treatments are, how good the diagnostics are, how good the clinicians are.
00:08:50:00 If there is a distrust, then we can't deliver great care. We can ensure great access, we can't produce high outcomes, and we can't reduce these disparities and inequities that you've already been talking about.
00:09:02:00 We also can't have good collaboration between the various players in the marketplace, public, private, commercial because they don't trust each other sufficiently.
00:09:13:00 We can't have collaboration across countries and global institutions, and so the lack of trust, the gaps in trust are hurting us in some very profound ways, and that's yet a battle to be fought.
00:09:28:00 So Igor, what do we do? I think that's a really profound thing that you're talking about that at the core of it is this lack of trust. We're not just talking about vaccinations and people who are skeptical and do not want to take a vaccination.
00:09:42:00 We're not just talking about that. You're talking about sort of a pervasive, corroding lack of trust across the system that has resulted in a lot of deaths and a lot of suffering that perhaps could have been averted.
00:09:53:22 So what do we do about trust? I think that's a big, difficult question. What can we do to build up trust?
00:10:02:00 Well, our entire firm is in fact working on this issue. Our mission as PwC is to build trust in society and solve important problems. And there's efforts from the CEO and down to grow trust in society.
00:10:17:00 I see a couple of aspects to this. One, you know, everyone has a different definition of trust. For me, trust begins with acting in a predictable manner. When you tell people what you're going to do and then you do it, and if you don't do it, you tell them why you're not doing it or you could tell them in advance that you're not going to do it.
00:10:35:00 And then you become trustworthy in that people know what to expect from you and what to expect it. And so part of trust and improving trust in my head is communicating a lot better about your intentions and your reasons and your actions and then following up to show and to demonstrate how you've done the things that you've promised to do. And if the situation changes, if the environment changes, if the science changes, you communicate that directly.
00:11:05:20 And I think in particular, the need that I see and this might become a little bit more paradoxical, but I feel like our politicians need to learn a lot more science and become a little bit more scientists and our scientists need to become a little bit more politicians, and I’ll kind of explain what I mean by that.
00:11:28:05 I don't mean that our politicians need to become microbiologists or epidemiologists or virologists or medical ethicists or anything like that. But I do feel like they could benefit from learning some basic statistics and probabilities and starting to include that in how they communicate.
00:11:49:05 And so instead of saying this is definitely going to happen or this won't happen, and for sure, this will take place and this won't take place, making these proclamations and guarantees that are inevitably proven to be inconsistent and unreliable in the future and thus reducing trust, they should be able to speak in terms of likelihoods and say that it is more likely then X will happen or less likely then Y will happen and help folks be prepared for a variety of scenarios rather than just saying, oh, we were going to be fine or we're all going to die.
00:12:22:08 So more nuance and engaging with the public, being able to speak in terms of likelihoods and scenarios would be extremely helpful in improving trust.
00:12:34:00 It also allows you to say that we told you that X was unlikely, X happened. We didn't tell you that X would never happen. We didn't tell you that X is 0% likelihood. We just said it was unlikely, it happened. Sometimes unlikely things do happen. So you can have that conversation without losing the trust of your audience.
00:12:54:08 So more nuanced communication, more nuanced understanding of probabilities and statistics, and then an actual willingness to confront your prior promises and predictions and own up to mistakes I think would be helpful.
00:13:09:00 And then on the other hand, as I mentioned, scientists becoming a little bit more political again doesn't mean that we need scientists running for office, although that would be very much welcome. It'd be nice to have more of that thinking at the highest level in the policy arena.
00:13:23:00 But the ability that politicians have of building coalitions, of building support, of aligning interests and stakeholders and communicating effectively and telling stories and creating narratives that help people personalize and absorb the information that they're getting and be relevant to them, I think, would be highly useful because we all need to kind of understand the world around us a lot better. And if scientists had better tools and methodologies for communicating their insights, everyone could benefit from that.
00:13:58:22 So those are kind of a lengthy digression on some of the things to improve trust. Yeah, I think the messaging has been very challenging throughout the pandemic in terms of telling people what they should be doing and why and then what the outcome will be.
00:14:17:20 And sometimes the outcome is not very visible. So you wear masks and it's averting transmission. You cannot really physically touch that, right? It's not concrete.
00:14:28:00 I think that is one of the challenges with public health and pandemic preparedness in general is that if you do it well, things don't happen and it's hard to point to things that don't happen as a success.
00:14:40:00 And I think that one of the vulnerabilities that we have experienced as well is just that lack of investment in public health and then the preparedness for the next pandemic. It's no mystery that these kinds of pathogens will emerge and make their way around the world and that we will have pandemics.
00:15:05:00 For as long as there's been written history, we know that there have been epidemics and they make their way around the populations, and here we are again. So when I look forward at what is the U.S. doing to prepare for the next pandemic, what's the world doing to prepare for the next pandemic, knowing that we're not out of this one yet, I don't know that we'll see the kind of mobilization that you might expect from an event that has had such a huge impact on everybody across the world.
00:15:37:00 And so that, I think, is one of the things that we'll be watching to see if there's a real mobilization to prevent the catastrophe that happened this time. And I don't know if that's going to happen.
00:15:50:00 I remember reading a quote from a doctor in Toronto during the first SARS. It never turned out to be a pandemic, but the SARS outbreaks. And that was kind of this warning shot, right, from coronaviruses that these viruses could produce really serious illness way beyond the common cold.
00:16:08:00 And this doctor in Toronto said that this is the warning shot and we should do something to prevent something much bigger from happening. And sure enough, here we are, you know, with SARS-2 and we didn't make those preparations.
00:16:21:00 And I think what we can expect from the next pandemic is something along the lines of what we have this time around where we will have the technology to rapidly turn around vaccines thanks to the mRNA and other platforms.
00:16:34:14 And I think that we will have in the United States a patchwork response similar to what we had this time where you have states, just because that's the way our public health is set up where state and local officials make the decisions about public health, not the national government, not the federal government.
00:16:51:05 So I think we'll have that again. We will have a real patchwork of responses, and they will vary in terms of how aggressive the use of the non-pharmaceutical interventions, the masking, the social distancing. They'll vary according to that. And they'll also probably vary in terms of the embrace of the vaccines when they come out.
00:17:11:19 And I think we'll just see in a lot of ways a replay of what happened this time around. And hopefully, like I said, just a few minutes ago, hopefully some of the gaps in terms of racial and ethnic and economic disparities are closed so that that part of this pandemic doesn't replay.
00:17:29:06 But I think that structurally the way things work, I think we will see something very similar and that sounds very grim. But just looking back at history and looking at what happened this time, there will be some changes.
00:17:40:21 But generally speaking, I think we can expect something very similar. But there have been some changes, so I shouldn't say everything will change. I think telehealth is also a distinctive part of this pandemic that will carry forward along with the mRNA vaccines and things like that.
00:17:56:20 I don't know what you think Igor. What do you think about the pieces that will change that maybe could help us next time around?
00:18:03:00 Well, since we're looking on the positive side of this, I do feel that some great seeds have been planted and some of it I know you mentioned at the global or country level we haven't made a ton of progress in cooperation and coordination and planning, but I think at the grassroots level, we've seen quite a bit of progress and we've tried and experimented with a lot of things and now we know how well they work and where they fall apart.
00:18:31:11 We've seen factories be able to retool quickly to manufacture PPE. We've seen citizen scientists working with enormous datasets and producing insights that some of the larger institutions couldn't replicate or can be as nimble.
00:18:48:00 We've seen funding mechanisms pop up to give money to do innovation, while the rest of the institutions were still slow to redeploy.
00:18:56:18 We've seen some regulatory innovation suspending certain rules and to ease the progress. So, I think we've seen some great experimentation.
00:19:06:00 We've also seen some great relationships built as health organizations and non-health organizations have had to cooperate with each other and just individuals meeting and building relationships so that next time there is some sort of a crisis, they know who to call and what to say. And it's much easier to kind of warm up those relationships again and be able to cooperate because a lot of this does happen at the human level.
00:19:32:00 All of that is encouraging and then in our work as consultants, we often help organizations do their strategic planning. We help them come up with future scenarios. And we know that going forward, there's going to be much greater sensitivity about how uncertain the world around us is and how it's not deterministic, how there's not one future, but a variety of scenarios, and everybody needs to have plans for the worst case, and the worst case is usually much worse than you can imagine.
00:20:01:00 And so it is important to not be depressed and dejected by it, but instead to have those contingency plans and to have that defense in depth and to have that enterprise resilience to withstand the bad scenarios while also planning for the scenarios we want for the good scenarios.
00:20:20:00 So, I think we'll see big changes in how research is done and how funding is done, how strategic planning is done in a lot of organizations and ultimately how they collaborate in their communities, with their business partners, with their public sector counterparts.
00:20:34:22 So this is an important experience that we've all gone through. And there will, of course, also be deleterious effects, there will, of course, be scars left in the literature on pandemic and epidemic scarring, behavioral scarring that occurs, belief scarring that occurs.
00:20:51:13 We know, for example, that when we study prior epidemics and pandemics and even the prior flus like the Spanish flu and the Russian flu, we see, for example, that the trusts in institutions does tend to erode in particular among the 18 to 25 year olds, their trust in public institutions tends to erode.
00:21:13:00 If they've grown up during a pandemic, we see a spike in mental health challenges. There have been studies of what happened to, for example, mental health admissions after the Spanish flu spiking by a very large number after that event. So we have some major challenges to overcome in the coming years if prior pandemics and epidemics are any indication.
00:21:38:12 But we also are faster, smarter, and hopefully also more compassionate and will be that way going forward.
00:21:47:00 Yeah, yeah. I think if you look at even just the vaccines as one side of the coin, other side of the coin I think we're going to look at a future of sort of a renaissance of vaccines where you have a huge amount of money and interest going into vaccines right now. I think we're going to see combination vaccines, new combination vaccines, maybe influenza, COVID, RSV all in one shot, things like that, more effective flu vaccines we all hope in the future.
00:22:15:02 So, you've got this sort of flowering of vaccines coming. But on the flip side, coming out of the pandemic, you've got also a flowering of hesitancy and skepticism and misinformation about vaccines and worries about vaccines and people not taking vaccines that can prevent a fatal COVID infection.
00:22:34:16 And now we see some evidence of this hesitancy and the skepticism, bleeding into flu vaccine uptake and things like that and children's vaccine uptake.
00:22:44:00 And so as we see this sort of flowering of new vaccines, which are among the health interventions that have had the biggest effect on life expectancy around the world, will we see at the same time in the United States this concurrent turning away from vaccines?
00:22:58:00 And so I think that's in a way the story of the pandemic, where we have some innovations and we also have a corrosion in some areas like Igor you were saying about the trust aspect of things and then the erosion of trust in young people who have grown up through the pandemic and will be looking at institutions with greater skepticism.
00:23:20:00 And then, you know, the greater vaccine skepticism we have coming out of this a huge amount of change I think that our society will be grappling with for many years to come.
00:23:30:00 And that's just the nature of these events. They affect all of us individually, they affect our communities, they affect our institutions and all the ties that bind us all together and we’ll figure out what the fallout of all that is I think over time and eventually someone maybe will look back at it—well, many someones, many historians will look back and have a better long lens on it like we have now with the 1918-1919 influenza pandemic. So from our vantage point, it's hard to know exactly how this will all fall out.
00:24:03:22 But I feel like, Igor, we had a good seat being part of all this and hearing from all these different parts of the health care system. We had a good seat at least to see what was happening as it was happening with all the different pieces of US health care.
00:24:17:17 That's right, and I think everybody wants to help. Everybody wants to be part of the solution and we’ll be busy in the years to come, continuing to inform and communicate and improve trust and come together around this topic.
00:24:32:00 I agree. Well, it's hard to wrap up a discussion like this, and it's hard to wrap up a podcast hosting role. But I just want to thank you, Igor, for being such a great podcast co-host.
00:24:47:00 It's been a really fantastic bunch of episodes that we've recorded together, and I'm really also very thankful to the whole team that puts together these episodes week after week.
00:25:00:00 We've really looked out with such an exceptional team of marketers and sound engineers and producers and research assistants. And that's why these episodes sound so beautiful and they come out so well. So thank you to everybody.
00:25:13:05 It's really been great and wonderful.
00:25:16:00 Thank you, Trine, and thanks everyone.
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00:25:31:00 Until next time, this has been Next in Health.
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