A healthier, wealthier Scotland
Ahead of the next Scottish Parliament elections, ABPI Scotland have set out their manifesto, with lessons learned from the pandemic and the better use of healthcare data at its heart
“There’s nothing like a common enemy to bring everybody together and to make you go at pace,” says Alison Culpan, director of ABPI Scotland. “COVID-19 has demonstrated what we can achieve when we collaborate and engage industry, academia and the public sector for the same goal. If we can keep that up, then I think we are sending out a great signal that we are absolutely open for business and that the business we’re in delivers for the healthcare sector many times over.”
Culpan is reflecting on the last year as the world has grappled with COVID-19. It has been an unusual time for the pharmaceutical sector, which has never been so keenly watched as the public waited for positive news.
An early win came in June 2020 when trials proved dexamethasone, a cheap and widely available steroid treatment, dramatically reduced the risk of deaths among the most ill patients. Now over a year into the pandemic, the NHS is busy rolling out a variety of vaccine options and further candidates continue to be researched. It has been an impressively efficient process.
Culpan says: “There is a real spotlight on our sector which wasn’t there previously, and as a result the man on the street understands our sector in a way he never has before. Isn’t it fascinating that you could go down to Tesco and meet someone in the aisle and start talking to them about clinical trials? For someone that’s been in this industry for so long, that to me is just astonishing. It has actually taken the whole medicines and vaccines debate, I think, to another level, a far more knowledgeable level, which is great. One of the other things that’s happened is it’s alerted lots of young people to the job opportunities that are available in the life sciences sector and that they are actually quite exciting jobs. They’re jobs where you can really make a huge difference to mankind and what can be more satisfying than that? There have been silver linings to this very dark cloud.”
As Scotland moved to respond to the public health crisis, healthcare enjoyed the radical adoption of digital technology. This ranged from GPS being able to offer video consultations, to the nationwide Protect Scotland app as part of the track and trace strategy. But one of the real benefits for the life sciences sector was the opening up of data which allowed, for the first time, easier access to pan-scotland information.
“When you’ve only got 5.3 million population, you want to be able to access the whole population datasets because then your evidence will be much richer… The researchers want to continue with that level of access, and from an industry perspective, we’re very keen they get that because it will add enormously to their research,” Culpan explains.
But as the tide has started turning against coronavirus, there are signs that that access is slowly being eroded. She says researchers are already being told to go back to the narrower, more localised datasets and there seems to be a retreat to the more siloed approach of the past.
In a bid to combat this, the Scottish Council for Development and Industry (SCDI) released a report earlier this year calling for the Scottish Government to invest in data. Chief executive Sara Thiam said: “Scotland has a narrow window of opportunity to establish itself as a leader in data and innovation in health and social care. There are big social and economic gains for all of us if we can work together to close Scotland’s data gap.”
That data gap, the report explains, is between “the health and social care data we collect, utilise or share today and the health and social care data we need and could collect, utilise or share in the future”.
And it’s a problem that was identified long before the pandemic started. Holyrood’s health committee launched an inquiry into the supply and demand of medicines in 2019 and in its report published last year, MSPS highlighted a failure by the NHS to collect and share data.
Convener Lewis Macdonald MSP said: “We found the lack of care taken to understand people’s experience of taking medicines impacted the system at every stage. The almost complete absence of data collection, or data sharing across the health service before the current COVID-19 crisis, or analysis of a medicine’s impact on patients, is staggering. Quite simply, patients deserve a better system than this.”
The pandemic has proven barriers to better data are not insurmountable. Indeed, the government has reflected on this and committed to the creation of Scotland’s first-ever dedicated data strategy for health and social care. That is expected later in 2021.
What does industry need from this? Culpan says: “You want to be able to collect the data in a meaningful way – and I’m going to stress meaningful – that is of benefit to clinicians who can then have a much faster idea of what’s going on with patients, and can also help recruit patients more effectively for clinical trials.”
She adds: “We must evaluate systems that have been used during COVID and keep those that have been successful. Speedy clinical trial set-up, affording researchers access to large inter-connected datasets in order to produce the insights they need. We need that to happen.”
And Culpan is enthusiastic about the benefits this could bring, “not just to the health but genuinely to the wealth of Scotland”.
Economically speaking, the pharmaceutical industry brings in £1.8bn to Scotland’s economy. It has grown by six per cent since 2018 and ABPI believes there is no reason for this not to continue.
“If we can get this right, we will absolutely change the fortunes of Scotland because we’re such an important part of our economy,” says Culpan. “It will create jobs in research and in the manufacturing space.
“About a fifth of the world’s penicillin is made in North Ayrshire, for example, that’s a huge amount. For one in five people taking a penicillin tablet today, it will have started its life in Irvine. You’ve got huge amounts of respiratory medicine made in Montrose. We’re going to have the Valneva factory churning out lots of COVID vaccines in the future, if approved.
“We’re very lucky. For such a small country, we’re already punching more than our weight. I just think we cannot rest on our laurels, and the next Scottish Government needs to deliver joined up data in order to attract further investment.
“We’ve got to put energy behind this, and we need ambitious policy to drive it. We need the policy, the strategy, and the implementation to keep this all going in the right direction and make the most of what we’ve got. Doing so can make Scotland fit for purpose for life sciences, and this is what we are calling on the next Scottish Government to do.”
Clinical trials are an integral part of this. The average patient in a trial is worth about £9,000 in investment, while at the same time the patient receives a new, innovative drug for free. But to attract companies to Scotland, they need to know patients are suitable and willing to take part.
This partially comes down to data being easily accessible so researchers can find participants. Patient willingness has been helped by COVID, with a huge number of volunteers supporting the global hunt for a vaccine. Over 200,000 people in Scotland have signed up to SHARE, the Scottish Health Research Register.
But despite the large number of people willing to participate in clinical research, recruitment to NON-COVID work has been very slow to resume during the pandemic. Culpan says that reversing this picture needs to be a priority: “Whilst COVID-19 is taking up so much attention, research into other disease areas has stalled and this needs to change if we are to deliver the next generation of treatments to patients in Scotland. The next Scottish Government will need to work with industry and others to implement the clinical research vision.”
And of course, the closer Scotland is to the creation of cutting-edge medicine, the more we as individuals will benefit from better healthcare, not just in terms of trials but also as we move to more personalised care.
The latest in DNA modelling and genetic technology is going to be truly transformative. Culpan explains: “It’s not just the big blockbuster for COPD and a new inhaler. We’re now stratifying the disease area by your genetic make-up, so the medicine for my Parkinson’s might be different from the medicine for your Parkinson’s. We need the data on you – to know what your DNA type is – to get you the right medicine.”
A key part of this is not just enabling NHS boards to open up their datasets, but ensuring patients are confident that their information is being used safely and securely. Culpan insists a balance between confidentiality and the release of data is possible. “We have to take it forward in a way that understands patient concerns. Usually, if you can communicate why information is being used, and that it’s for reasons to improve care, then you’ll take the public with you. But that’s a conversation we need to have with both patients and the NHS.”
Assuming these barriers can all be overcome, there is no reason Scotland cannot continue to be at the forefront of life sciences. Culpan adds: “We’ve never seen Scotland working so well together. I feel there’s a sense of urgency and that we’re on the crest of a wave where people have now seen the importance of our industry and they realise its success is vital to our health and wealth.”
“For such a small country, we’re already punching more than our weight. I just think we cannot rest on our laurels, and the next Scottish Government needs to deliver joined up data in order to attract further investment” Alison Culpan, director of ABPI Scotland