2020 was a year of challenges and tragedies, but also provides a thought-provoking demonstration of the value of health research and science. With insights from laboratories and the relentless efforts and ingenuity of scientists and the biopharmaceutical industry, we are now seeing the light at the end of the COVID-19 tunnel. The pandemic has been a catalyst for change. Whether it is digitized clinical trials, improved healthcare delivery with remote and virtual engagements, new disruptive business models or radical and innovative collaborations, the world of healthcare will never be the same. Here are 10 key perspectives from our research in 2020 and thoughts about what to expect in the remainder of this new decade of health and science.

1. The biggest global pandemic since 1918

2020 brought the biggest global pandemic since the 1918-19 flu pandemic, with COVID-19 cases exceeding 80 million and deaths approaching 2 million globally. While not as deadly as the 1918-19 pandemic, which was estimated to have killed at least 50 million worldwide, including about 675,000 in the United States, the burden of the COVID-19 pandemic has been severe – whether you count the direct number of fatalities and diseases or the indirect number of deaths and diseases from the global lockdowns, delays in health screenings and treatments or the rise in mental health disorders, suicides and domestic violence. We still don’t know the full extent of the toll this pandemic will take, which is ongoing. Yet the pandemic has also been a catalyst for positive change, such as the renewed focus on public health institutions, epidemiology, the importance of understanding the natural history of disease, and the unanimous call for action to address the disparities and inequalities in health that were unmasked due to the disproportionate suffering of racial and ethnic minorities from the burden of COVID-19 infections and related co-morbidities. 

2. Breakthrough innovation at warp speed

The pandemic has prompted the extraordinary response from the healthcare industry, the research community, public health authorities, and governments to develop new therapeutics, repurpose existing drugs and develop new vaccines. It happened with a speed that broke all records, cutting the traditional timeline for the development of new vaccines from between 4 and 12 years on average to only 7 months – a remarkable victory for the ingenuity of science and research that inspired radically new forms of collaboration between private and public stakeholders and among competitors, both within the biopharma industry and among laboratories and hospital systems. Novel pathways for research, development, funding, and collaboration have been created, setting new standards and shorter timelines for discovery and innovation in the future for other life-threatening diseases. And all of this has implications for regulatory agencies and life sciences companies forced to maintain the new pace of innovation with agility, flexibility, and speed.

3. The digitization of the global healthcare industry

In 2020, the global healthcare industry was forced to fully embrace digital medicine, whether through virtual trials in clinical development, the use of telemedicine and telehealth in care delivery, new ways of engaging patients in their care, or using personal health technologies. The digital transformation reached an inflection point. We will see an escalation in advanced predictive analytics such as artificial intelligence, machine learning and natural language processing that will help catapult clinical research and generation of real world evidence. We can also expect to see the acceleration of person-centric models for patient care and delivery. And healthcare providers and life sciences companies will be forced to change to embrace the new world of digital, personalized health. 

4. Toward a new understanding of disease

The pandemic has further fueled the emerging understanding of health and disease as manifestations of complex clinical and non-clinical factors across biology, genetics, race, age, gender, personal behavior, and social, economic, environmental and cultural dimensions. It has helped unmask the realities of co-morbidities, multi-disease and interconnections between conditions. And it has added further evidence for the need to apply new models to natural history studies and the urgency of moving “upstream” to explore the impact of pre-disease and prodromal disease to enable early diagnosis and interception of disease. Ultimately, this emerging understanding of the complexities and intersectionality of diseases will challenge traditional demarcations of medical specialties and the siloed structures of healthcare provider systems.   

5. Overcoming inequalities in health

The year 2020 will be inscribed in history as the year where society and the healthcare industry finally decided to take action on an issue that for decades has been overlooked despite abundant evidence of its serious nature: racial and ethnic health disparities. Uncovered in its brutal reality during the pandemic and supercharged by the killing of George Floyd, efforts are now on track to address the disproportionate enrollment of racial minorities in clinical trials and the disparities in patient health outcomes. However, we must apply scientific rigor to ensure these efforts evolve beyond the declarations of goodwill and formal protocols for improved practice. We must validate desired game-changing efforts through evidence of tangible advances in inclusive clinical research, reduced racial bias, and deployment of diverse medical teams.

6. Fighting the opioid epidemic

There was other good news in 2020, which marked another year of double-digit decline in prescription opioid use. Expected to reduce usage in the United States to levels not seen since the early 2000s, prescription opioid use completes a 20-year cycle that peaked in 2011 and has declined steadily since. Use in the U.S. has now declined by 60% from its 2011 peak.¹  Decreases in prescription opioid use over the past nine years were driven by changes in clinical use, regulatory and reimbursement policies, and in progressively more restrictive legislation enacted since 2012. These significant decreases are remarkable evidence of the positive impact of the collective efforts to reduce the use of prescription opioids by the medical community, public health authorities, and legislators at the state and federal levels. Yet the decade ahead requires sustained focus on illicit opioid use and its underlying social causes, as well as a focus on efforts to develop non-opioid options for effective pain management.

7. The value of healthcare

The past year has also provided an important recalibration of the value of healthcare systems. Challenging the conventional wisdom that healthcare is overly expensive – the U.S. healthcare system, in particular – health science and innovation have struck back with a vengeance. Additionally, we have seen a reassessment of the value of ICU capacity and testing capabilities, not to mention front-line healthcare workers. When lives are on the line, there is greater acceptance of the value of R&D and innovation to deliver life-saving or life-prolonging therapies. The breakneck speed of the development of novel vaccines to inoculate against COVID-19 and the parallel and extraordinary funding of manufacturing of vaccines prior to approval have provided a powerful case in point. Concerns about the price of drugs will remain a focus of payers in the U.S., despite the moderation in average list price increases and net price increases trending lower than inflation.² But assessments of “value” may be modified in light of the experience of the pandemic. Moreover, the decade ahead should see accelerated movement toward removing the siloed approach to setting drug budgets that is still commonplace in many countries, and recognition of the integrated role that social care plays in healthcare – and related budget implications. While there are inefficiencies, redundancies and overuse of resources in some parts of the healthcare system, on balance, a robust, science-based healthcare system is a critical foundation for human health and economic prosperity. 

8. The advent of new modalities

Efforts to find new vaccines against COVID-19 have led to a novel method for inoculation in the development of the genetically encoded mRNA-based vaccine technology, which is the basis for the vaccines developed by Pfizer/BioNTech and Moderna. Not only is the so-called messenger RNA vaccine an exciting technology for prevention of COVID-19 infections, efforts to apply mRNA- technologies in the fight against infectious diseases, cancer and other diseases will now be catapulted by new investments and projects across R&D initiatives.³

9. The Promise of Human Data Science

We have seen a tsunami of studies demonstrating the capacity of the worldwide research and medical community to pursue new insights when confronted with the threats of a new, unknown disease such as COVID-19. New insights have been generated using a plethora of methodologies – genomics studies, randomized clinical trials, real world evidence, infection case surveillance, disease modeling predictions and personal behavior tracking – and benefitting from the combination of traditional clinical research and advanced analytics powered by sophisticated digital technologies. This is the era of Human Data Science. We will see clinical science bond with data science to generate new insights based on breakthroughs in data science and technology to advance our understanding of human health. This will help drive better health outcomes, address challenges in understanding interconnections of social and healthcare dimensions, overcome health inequalities, and control the rise in healthcare costs in the decade ahead. 

10. A Year of Celebrations and a Word of Caution

As evidenced above, there are many great achievements to celebrate in healthcare in the middle of a dark pandemic. Thanks to these achievements, we can see the light at the end of the tunnel. Yet a major word of caution. Before we know it, when the massive vaccine campaigns have inoculated millions of people against COVID-19, things will quickly swing back to normal, and we will soon begin to forget. It is human nature. But it is also a reflection of a tendency to disregard history and neglect science. When SARS CoV-2 struck, public health officials and governments were scrambling to look for ways to combat the disease outbreak. Nobody learned from the 1917-1918 flu pandemic and the excellent published studies that demonstrated the value of non-pharmaceutical interventions when vaccines and therapeutics were not available.⁴ Once again, history has shown us the importance of listening to science and research. Perhaps the greatest value in the decade ahead will come from cementing the lessons of 2020 throughout all aspects of our health and social systems more effectively than we have done in the past. 

 

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¹IQVIA Institute for Human Data Science. Prescription Opioid Trends in the United States.crisis
https://www.iqvia.com/insights/the-iqvia-institute/reports/prescription-opioid-trends-in-the-united-states

²IQVIA Institute for Human Data Science, Medicine Spending and Affordability in the United States, August 2020

³Kwon D. The Promise of mRNA Vaccines. The Scientist. November 25, 2020.
https://www.the-scientist.com/news-opinion/the-promise-of-mrna-vaccines-68202

⁴Markel H et al. Nonpharmaceutical Interventions Implemented by US Cities During the 1918-1919 Influenza Pandemic. 
https://jamanetwork.com/journals/jama/fullarticle/208354