Ricardo Baptista-Leite is the Member of Parliament for Lisbon in Portugal, while at the same time working as a medical doctor in a research and training capacity as the Head of Public Health at the Research Center of the Instituto de Ciências da Saúde at the Catholic University of Portugal. His medical career has focused intensely on infectious diseases, and in 2017 he established the UNITE Network as means of linking cross-disciplinary groups with parliamentarians with the goal of eliminating infectious diseases as a global health threat.
When I was elected to parliament for the first time in 2011, infectious diseases became an important part of my political agenda. We were entering the troika bailout programme following the 2008 financial crisis, so there was a lot of concern that issues like HIV, hepatitis and tuberculosis would drop off the priority list of the health agenda. There was a lot of work to be done, so we decided to bring together all of the different components of the system — not only politicians from different political parties, but also civil society, the scientific community and the media — to ensure that infectious diseases remained a priority throughout the financial crisis. In 2016 UNAIDS, the United Nations agency for HIV and AIDS, invited me to speak at the World Health Summit about what was lacking to end AIDS as a global health threat by 2030.
My argument was quite simple: we should not be taking a siloed approach to one disease or the other; we know today that there can be multiple synergies by dealing with diseases across the board. We also know that by taking that synergistic approach, we have the potential to end not only HIV AIDS as a global health threat, but also many other infectious diseases.
“The scientific community is very strong, and there are now technological tools that truly have the potential to decrease the burden of a wide variety of diseases while also increasing quality of life.”
But there has been a missing link in the fight to end infectious diseases as a global health threat: parliamentarians. Parliamentarians are the ones with the power to change policies and effect laws, and it’s parliamentarians that keep governments accountable; they are the interface between the people and governmental power.
So we, as parliamentarians, have the potential to reshape and redesign systems and to push government in the right direction, while ensuring we are in line with the concerns of those we represent. This sort of network, focusing exclusively on infectious diseases, did not exist, so the UNITE Network was founded in 2017 with the initial support of UNAIDS and then other philanthropic organisations that followed.
If you want to change anything, you need the five pillars — what I call the Pentagram For Change. There are the politicians, the media (whether that be conventional or social), the scientific community, civil society (including community-based organisations and patient advocates) and the private sector (certain sectors of the health industry and health providers). If you’re able to bring all of those elements together, then you are capable of promoting change from a public health perspective.
That’s how UNITE Network has positioned itself; in more than 65 countries across six different continents, we look at the scientific evidence of what policies work, and try to adapt them the best we can to each local setting for parliamentarians in their respective countries, trying to bridge consensus across the aisles by making sure that different political parties are supporting the changes that are needed. The parliamentarians become the champions on the field, while we at the UNITE provide them with the necessary technical support and peer-to-peer approach that is vital to ensuring that we’re all speaking a common language across the world.
Infectious diseases will always be a part of nature and human life; the question is how we deal with a range of different infections without allowing them to undermine our way of living, our safety, our security and our wellbeing.
COVID-19 has very explicitly shown how a lack of preparedness in response to pandemic threats can effectively undermine our whole economic model — which in turn leads to the undermining of our social conditions and the generation of even greater inequality.
This underlines the need to convince people that a prepared, synergistic response is the best reaction to any infectious disease — but this kind of policy does not always translate to the political field, which is where science can really help.
“The problem is that scientists’ findings are often not presented in a way that actually reaches those in a position to make decisions.”
Translating the basic science into something substantive that can be used to form concrete policies on the ground and develop a budget is really the primary challenge for politicians, and UNITE’s mission is to help facilitate that process.
“The role of digital health and the digital transition in this is no longer up for debate — it’s simply a question of whether policymakers want to realise its potential now or they want to be late to the game.”
Looking at everything that’s out there — from AI to quantum computing to telehealth — the truth is these technologies will only be fully effective if we have a vital resource that is currently lacking in most areas: data. Health data around the world — not only with regard to infectious diseases, but generally — is very limited, and very biomedical. For example, when we talk about HIV and AIDS there is data on viral load, CD4 counts and mortality. But if you want to talk about quality of life, you have zero indicators in terms of data. So how can we create models that actually help you push into the direction of better quality of life and well being if you don’t have the basic data to focus on those outcomes?
Furthermore, if you don’t have data on quality of life, how are you then going to develop new financial models that incentivise the focus on wellbeing instead of having financial models — as we do today — that focus exclusively on the disease aspect of healthcare. One of the major transformations that needs to happen is the understanding that we need a philosophical shift from having disease systems to health systems, with incentive models focusing on the wellbeing of the people.
We have technology that can help our decision-making process and our managerial skills, but we need data sets that are high quality and updated in real time.
If we were to then standardise the data sets to focus on health and quality of life indicators, that would be extremely valuable; we would be able to compare data between hospitals, healthcare systems and even countries — if there were cross-border cooperation in such an endeavour. A benefit of this, to provide one example, would be in the field of rare diseases, of which there are — by definition — very few cases in each country. That typically leads to those patients being forgotten in the system, because the industry is not willing to invest much in developing drugs for them. But if you were able to bring all of those patients from around the world together into one data set, then it becomes interesting from both a scientific and a market forces perspective — and creates the potential to establish European Centres of Excellence when you can determine which country is best at treating a certain condition. Extrapolate the idea of shared cross-border data even further, and you can make a clear case for the benefits in terms of pandemic preparedness and response — where coordination between countries can lead to simulations that help detect and contain risks early, leading to a faster and more effective response in terms of testing, tracing and treatment.
When you start to consider the impact of high-quality, global data sets coupled with innovative technologies like telehealth and remote surgical assistance, it becomes very clear that we are moving into an era of tremendous potential — particularly when it comes to helping those that are struggling in lower income countries.
The drive for universal health coverage creates the opportunity for poorer countries to leapfrog in terms of their health system development by learning from the past mistakes of richer countries, to develop health systems that are actually focused on health and wellbeing from the start while using innovative new medtech to support that transition process.
What’s crucial — in nations at any level of wealth — is that those who manage our health systems, those who define policies, and those who develop breakthrough technologies should all be sitting at the same table, looking at the big puzzle and seeing which pieces are missing; seeing how technology can help us fill those gaps to make sure that we are providing the best possible care for our people.
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