“The Best Way to Predict the Future is to Create it”. Third edition. Post-covid world. Chances and challenges for the healthcare sector

Introduction to the first discussion panel was given by prof. Marcin Czech (Warsaw University of Technology Business School, Institute of Mother and Child) and Marek Kowalski (President of the Federation of Polish Entrepreneurs).

Prof. Marcin Czech emphasized that coronaviruses are nothing new and have been accompanying people for a long time (most often their carriers are birds and mammals). According to the professor, they are also “the happiest viruses in the world” because due to their characteristics (it does not have its own metabolic systems, they use the benefits of infected cells), they can spread freely at an extremely fast pace.

Professor Czech professor admitted that the coronavirus pandemic has become a global problem and a challenge for all local health services in the world. Data at the end of May 2020 shows that over 5.5 million cases and over 350 thousand deaths have been registered worldwide. In view of these indicators, the professor admitted that the virus was relatively gentle with Poland.  Currently, Poland ranks 34-35 in the world in terms of the number of cases and deaths – the Polish health care system responded appropriately to infections and today we can talk about many free beds and respirators – comments prof. Marcin Czech. However, he chills excessive optimism by adding – we will only be able to say about the normalization of the situation when a drug or a vaccine is invented. Regardless, we should pay more attention to health.

The second introductory speech to the conference was delivered by Marek Kowalski – the Chairman of the Federation of Polish Entrepreneurs. He admitted that “The financing situation of the health service raises serious concerns – successive governments have not been able to sort out these matters. It is worth remembering that hospitals entered this year with PLN 4 bln in debt. Polish entrepreneurs shifted some of the responsibility for relieving the health service”.

President Kowalski also pointed out that the economic forecasts assume a GDP decline of around 4%. We can assume that hospital debts will increase by another PLN 12-13 billion. More effective factoring solutions for hospitals would be a valuable help in regaining the financial liquidity so much required today. Kowalski emphasized that if we cannot increase hospital budgets at the moment, we must increase the possibilities of helping suppliers.

The discussion in the first panel was focused on the analysis of possible scenarios for the development of the Polish health care system after COVID-19.  

In her speech, Olga Semeniuk emphasized the importance of the rapid response of the Ministry of Development to the first symptoms of the economic crisis. ‘When on 4 March we recorded the first COVID-19 case in Poland, together with Minister Jadwiga Emilewicz we started creatinh a list of the most threatened sectors of the economy; tourism, hotel industry and gastronomy were among them. At the same time, in cooperation with many public institutions, we were looking for domestic partners from the SME sector, who would be able to sew masks or produce visors. As a result, we have started cooperation with over a hundred sewing factories in Poland, which will be very important due to the second phase of the epidemic “.

The discussion was also attended by representatives of key government agencies: the Medical Research Agency, the National Health Fund, the Chief Sanitary Inspectorate, the National Medicines Institute and the Agency for Health Technology Assessment and Tariffs.

Chief Sanitary Inspector, prof. Jarosław Pinkas emphasized during the debate that “the Polish health care system has worked. Nobody in the Polish health care system had to choose which patient was to survive or who should have access to medical equipment “. He also added that the current “COVID law” offers a new catalog of tools to effectively fight the crisis: “The pandemic not only strengthened the Chief Sanitary Inspectorate, but also taught a lot to all of us. After this pandemic, we will be much smarter – summed up prof. Pinkas.

The President of the Medical Research Agency – Radosław Sierpiński also commented that “Today, coming out of the crisis, we can cautiously say that thanks to the joint actions of the government and the responsibility of Polish citizens, the crisis has been taken under control. However, the nearest future will be decisive – the next months and years in which the modern economy will shape itself”  – he added.

The conference guests unanimously admitted that the pandemic, despite many threats, has also become an opportunity for the health care sector. As a society, we have realized the importance of clinical research and the efforts of the international community to find a vaccine as soon as possible and to treat COVID-19 effectively. The role of the R&D sector in the fight against the effects of the coronavirus pandemic was discussed, among others, by the representatives of the pharmaceutical industry and medical experts.

Bernard Waśko, Deputy President for Medical Affairs at the National Health Fund, referred to the forecasts presented in the discussion, stating that, in his opinion, they were too pessimistic. “Undoubtedly, the loss of several billion revenues from health insurance contributions will not remain unnoticed. However, it is difficult to predict how quickly the economy will accelerate, how the revenues and economic turnover will return to normal, and therefore what impact this will have on the level of employment and earnings of citizens”

Prof. Prof. Zbigniew Gaciong, the Rector-Elect of the Medical University of Warsaw, pointed out that in order to prepare for the next pandemics in the future, ‘we should ask ourselves a very important question: have more people died from COVID itself or as a result of coronavirus infection, Of course, we won”t get that answer today or tomorrow. It may require a period of months or even longer. Knowing the answer to this question, however, will enable us to prepare a strategy in the event of such situations or for a new threat in the near future – he commented.

Dr n. med. Grzegorz Czelej, Senator of the Republic of Poland, shared the information that in March a project was created to isolate antibodies based on the plasma of people, who had contact with the virus and prepare them in the form of a drug by Biomet Lubelski, which received funding from the Agency Medical Research.

Lieutenant Colonel Emil Lisiak of the Ministry of National Defense admitted that as the army they support the Chief Sanitary Inspectorate through activities such as, for example, evacuation of people from social welfare homes. He also added that “the military was one of the first to launch a support hotline. It is a joint venture of the Territorial Defense Forces and the Department of Military Health Service”. He indicated that the Ministry also helps veterans, medical families, and they cooperate with local governments.

During the debate, Irena Rej, President of the “FARMACJA POLSKA” Chamber of Commerce, said that a considerable concern is primarily caused by the fact that we are observing a significant decline in the pharmacy market. The decline is over 20% and the trend does not seem to be slowing down, but rather increasing. She also added that the amount of money in the system is reduicng and that there is an expectation to show in which direction the Ministry wants to solve it and what financial opportunities it sees.

According to experts, telemedicine and effective control over the quality services offered by the public sector turned out to be an extremely important factor increasing the effectiveness of combating the effects of the coronavirus.

In the second panel, the guests decided to focus on the topic of drug safety in Poland, as well as the access to modern technologies and R&D. The introduction to the panel was given by Maciej Miłkowski, Undersecretary of State at the Ministry of Health.

Undersecretary of State in the Ministry of Health, Maciej Miłkowski, in his speech touched upon, inter alia, the issue of supply chains and their efficient use. When the borders were closed, there was an idea was to create green routes. Together with the Border Service, we solved this problem. The production is carried out in many countries at the same time. However, no country is self-sufficient. The minister also referred to the issue of the publication date of the next reimbursement list: “The list will be published in September 2020; it is not possible to revert the July deadline, as we have already started issuing positive decisions with regard to the September deadline”.

Prof. Paweł Krawczyk, Head of the Laboratory of Immunology and Genetics at the Department and Clinic of Pneumonology, Oncology and Allergology of the Medical University of Lublin admitted that “many bad things happened during the COVID-19 pandemic – diagnostics were delayed, although in the case of a range of advanced cancers there is no medical grounds for delaying the examinations (even in the face of COVID). He also added that the Polish health care system still does not combine chemotherapy with immunotherapy.

Radosław Sierpiński from the Medical Research Agency pointed out that “in the first days of the pandemic, we launched a competition for PLN 50 million; this action allowed us to dynamise research on vaccine and drugs against COVID-19. It would not have been possible without the cooperation with Minister Szumowski “. He also added. that you should talk to pharmaceutical companies on an equal footing. The Medical Research Agency ensures such cooperation, thanks to which Poland becomes a valuable partner on the international arena.

Piotr Najbuk from AstraZeneca admitted that “Although AZ is a global pharmaceutical concern, the Polish innovation system is extremely important to us. We manage clinical trials from over 40 countries from Poland – so we are an extremely Polish-centric company” . He also raised the issue of drug availability and various opinions emerging on the issue of ensuring drug independence. Added that in the long term, one of the most important mechanisms is, inter alia, RTR (reimbursement drug regimen).

Dr. Roman Topór-Mądry, President of the Agency for Health Technology Assessment and Tariffication, said that in the context of combating the effects of COVID-19, AOTMiT is constantly working on guidelines for medical devices. ‘We will publish the first part of them soon. We are currently working together with a team of over 70 experts”.

In turn, Dr. Małgorzata Gałązka-Sobotka from the National Health Fund Council referred to the topic of domestic drug production: “The COVID-19 pandemic made us realize that more drugs should be produced in our region. However, there is no country in the EU that would be able to cover all drug needs through its own production”.

Prof. Leszek Czupryniak, Head of the Diabetology and Internal Diseases Clinic at the Medical University of Warsaw, admitted that – a breakthrough has finally been made when it comes to treating patients (diabetology). We have basically all the latest reimbursement drugs. The authorities of the Ministry of Health are extremely proactive in this area. He also emphasized that the introduction of e-prescriptions and online doctor consultations helped many patients immediately.

MEP Barbara Dziuk, Chairwoman of the Parliamentary Team for Rare Diseases, admitted that in the time of a pandemic, we can observe a much more generous approach “at solving problems that have not been solved so far.” She also emphasized the important role that the activities of the Medical Research Agency play in the current situation.

The introduction to the third panel was given by Agnieszka Kister, Director of Healthcare Information Systems Center. In her speech, she raised the health care development topic, especially in the context of the facilities offered by modern technology. “All of us – both patients and doctors” have learned to use and appreciate the benefits of telemedicine. This also applies to small-size practitioners and primary health care institutions, who can help their patients effectively in this way. It turned out that patients are also able to operate in the new reality.

Undersecretary of State at the Ministry of Funds and Regional Policy, Anna Gembicka, recalls that “the coronavirus pandemic will definitely accelerate the healthcare sector digitalization. Some e-services should certainly stay with us also after the end of the COVID-19. At the same time, she admitted that” there are still white spots on the map of Poland – places where access to the Internet, telemedicine or digital services is not as common as we would like it to be. As part of the Digital Poland program, we are working on 177 e-services with an extremely high degree of e-maturity”.

Dr. Anna Kowalczuk from the National Medicines Institute admitted that “the pandemic has shown us how important it is to be active in the area of R&D, both in the scientific and commercial areas. She also pointed out the increased activity of the Medical Research Agency and the National Center for Research and Development. She added that “various types of programs have been launched to intensify efforts to fight the coronavirus. The outlays and the perception of R&D have also changed” comments Kowalczuk.

Dr. Paweł Grzesiowski from the Department of Healthcare Organization and Certification at the Postgraduate Medical Education Center admitted that when talking about effective telemedicine, everything starts and ends with a good internet connection, which we must ensure so that telemedicine is possible at all. Prof. Grzesiowski indicated data analysis and building trust between the doctor and the patient, as other areas, which require attention.

Wojciech Szefke, President of the Management Board of Technomed stated that COVID has disenchanted the medical technology market and that of medical devices. He pointed out that the pandemic has shifted the center of gravity in terms of technology use and the public has realized that medical technology and telemedicine are not that scary. The President also emphasized that both the Polish and foreign industry present in Poland currently offer many interesting solutions in the field of technology, such as registration of the patient’s health condition or monitoring of blood glucose levels.

Prof. Artur Mamcarz, Head of the 3rd Clinic of Internal Diseases and Cardiology at the Medical University of Warsaw admitted in the context of telemedicine, which is also used during educational classes with medical students, that although “some of the visits could have taken place over the phone, there is no way to carry out certain physical examination in the digital version and thus the personal contact of the patient with the doctor will have to take place sooner or later.” He also emphasized the role of mobile applications in the healthcare, as well as the challenges they can be associated with.

In turn, Jakub Berezowski, Deputy President for research funding at the Medical Research Agency, admitted that “telemedicine is a considerable challenge and work on it will have to be significantly accelerated.” As for the modernization of clinical research processes, President Berezowski informed that ABM announced a competition for modern clinical research centers, which will be established in the selected hospitals and where modern solutions, such as a modern oncological research search engine, will be used.

The fourth panel began with the second, English-speaking block of the conference. International experts, including from the USA, Portugal and Sweden focused on the impact of the coronavirus on the global health care system.

Dr. Grzegorz Juszczyk, General Director of the National Institute of Public Health – National Institute of Hygiene admitted that “during the last 4 months we have fought both with COVID-19 and with overwhelming fear”. He also stressed that we see many effects of the freezing of the economy during the pandemic today  we must be prepared for a repetition of such situations in the future. Dr. Juszczyk also suggested that it might be advisable to create a special fund for such circumstances as COVID-19, in order to be able to pay salaries from it in the future for people staying at home, e.g. in quarantine.

Krzysztof Wojciechowski from the Polish-American Business Council referred to the words of Dr. Juszczyk: “I am a representative of an industry that is facing enormous demands in the current situation, especially regarding the invention of a vaccine or COVID-19 treatment. It is only a matter of time at this point. From January to the present day, over 200 institutions interested in creating such a method of treatment applied.”

Jakub Berezowski, Deputy President for research funding at the Medical Research Agency, admitted during the debate that “The COVID-19 pandemic has shown how important the Medical Research Agency turned out to be in the process of fighting the coronavirus. In the first days, we set up a hotline to which hundreds of companies contacted.” He also informed that ABM has decided to spend savings on clinical trials and fighting the coronavirus.

Dr. Michał Gryz, Director of the Department of Inspection of Medicinal Products and Medical Devices at the Office for Registration of Medicinal Products, Medical Devices and Biocidal Products stated during the debate that “The first step is to create an effective vaccine against or COVID-19 treatment. Afterwards, the regulatory process is very important as thousands of patients are waiting for the vaccine.” He also stressed that in this process a relevant role could play the European Medical Research Agency: “The Agency will be responsible for the COVID-19 vaccine effect. It will have an enormous responsibility to approve such a vaccine.”

Professor Waldemar Priebe, Professor of Medicinal Chemistry; Department of Experimental Therapeutics; Division of Cancer Medicine; The University of Texas MD Anderson Cancer Center admitted that “We were not prepared for the pandemic despite warnings from China and the fact that the disease is spreading from person to person.” He also added that a trip to Wuhan was proposed several times in the US “to investigate the causes and effects of the epidemic”.

Radu Rasinar, President of the Management Board of AstraZeneca in the CEE area, admitted during the panel discussion that his company is currently carrying out “a lot of investments in the field of R&D in Poland and it is our commitment to introduce changes in the future’. He also stated that AstraZeneca is a strong candidate for a vaccine.”

Dr. Lindsay Davies, Chief Scientific Officer at NextCell Pharma admitted, that “If we find a COVID-19 vaccine and find the right treatment, we”ll have more recoveries. It will have a good impact on many different aspects of the post-COVID reality.’ She also stressed that we need a lot of cooperation between the pharmaceutical companies sector and the academic world.”

The introduction of the fifth and last panel of the conference was given by Cpt. Jacek Siewiera, MD, PhD – head of the clinical department of hyperbaric medicine at the Military Institute of Medicine.

At the beginning of his speech, Cpt. Siewiera raised the issue of COVID-19 pandemic development , recalling “The moment we felt the real importance of the COVID-19 threat was the epidemiological situation in Italy. It was the first European country to announce the threat and its real power of influence. Captain Siewiera also comments on the differences in the American and European approach to the Coronavirus. “In Europe, one of the first decisions aimed at combating COVID-19 was to reintroduce controls at the borders of internal EU countries (and in practice to close them), preventing free movement. In the US, however, you can still buy a plane ticket and go anywhere in the country”, he adds. “We observe that in Europe, countries with a similar economic and pandemic situation are opening their borders in such a way that they can open up international trade, but at the same time isolate themselves from the rest. An example of this phenomenon is, for example, the transport sector in Europe or trade between South Korea and China.”

During the fifth, i.e. the last panel of the conference, the invited guests exchanged the best international practices in the area of combating the effects of COVID-19.

Eric Stewart, President of the American – Central European Business Association emphasized the role of active discussion between representatives of the medical ecosystem and public administration. “In the fight against COVID, apart from the daily operational work of representatives of public administration related to the purchase and storage of the necessary protection measures, medical care for infected patients, etc. it is important not to forget about the dialogue with those sectors of the economy that can have a key impact on the effective recovery from the coronavirus crisis – agriculture and food production, transport, logistics, tourism, etc. It is worth thinking a step further than just the economy during a pandemic” what factors will foreign investors pay attention to employee health (and methods of its assessment), the efficiency of the supply chain, the amount of taxes, public policy, etc. the end of the crisis, but we have to think about it today.

In her speech, Réka Szemerkényi, President of the Center for European Policy Analysis, paid particular attention to the restoration of transatlantic cooperation. I believe that identifying the missing and weaker links in transatlantic cooperation and their restoration on the COVID-19 crisis is now a clear priority. We saw this as the key to the transatlantic community, and in this context, I believe there is probably no more important lesson from the crisis. This is an extremely important starting point for the discussion about the future of our transatlantic community” comments Szemerkényi.

In his speech Jakub Baran, President of Polski Bank Komórek Macierzystych, emphasizes the need to unify and standardize the approach to combating COVID-19. “I would like to call on governments to establish one method of collecting data on the current situation, because only then will we be able to draw objective conclusions for the future. Lack of people’s knowledge and access to reliable information is one of the key reasons for the development of unnecessary conspiracy theories. Citizens should therefore be informed about the crisis in a transparent way – similar to the model of “briefings” that authorities receive about the coronavirus. Bearing in mind that the nascent conspiracy theories are constantly gaining in publicity and popularity, the state authorities will sooner or later have to deal with their negative consequences.

Advocate Mączyński, who works with Katarzyna Bondaryk Chancellary, emphasized the important role of telemedicine in the fight against COVID-19 and a number of advantages resulting from this method of medical consultations. “The weapon in the fight against COVID-19 is medicine and technology, especially telemedicine and screening also carried out at the international level, because thanks to telemedicine we can fight the fear of the possibility of transmission of the virus due to some kind of social distancing. Let us not give the chance and the threat of encountering the virus. We can also fight the patient’s fear of limited access to medical services, thanks to which they will be well protected, and I think that thanks to telemedicine we can monitor patients with certain health problems at a distance”- he comments.

Jakub Berezowski, ABM Deputy President for financial affairs, emphasized the problem that appeared before the research conducted by the Agency. Our scientists are cut off from information about research carried out globally, we still do not know what is happening around the world. It is possible that we are conducting overlapping studies with other countries because there is no complete exchange of information on their course. I think that this strengthening of cooperation is not enough. I believe that we need to create some kind of such data exchange platform at the beginning, perhaps the institutional backbone of ABM.

Paul Hatch, Dentons US Office, when asked if Europe should copy the American patterns of combating COVID-19, replies: “I am disappointed with the American approach and I am not convinced if I would recommend a similar course of action to Europe. In the United States, politics appears to be more important to some people than public health.

Joana Branco, BioCant park in her speech emphasized the establishing international cooperation and partnership with pharmaceutical companies. Strengthening ties between and within individual countries is important. The key to success in this pandemic is the creation of a system of cooperation between state health care and pharmaceutical companies and their work for the benefit of the community. I believe that this joint action is needed and we need to bring it all together.