The pandemic’s convulsions are still reverberating across societies but, with the virus held at bay with vaccines, the focus reverts to the more insidious and growing threat posed by a rapidly ageing population with co-morbidities.

Healthcare systems, weakened by the corrosion of COVID-19, must now wrestle with alarming rises in chronic disease afflicting a demographic of over-65-year-olds that will reach more than a quarter by 2050, a rise of 70% in 20 years.1
Worryingly, a report by the European Federation of Pharmaceutical Industry Associations (EFPIA) revealed that 25% of the working age population is already living with a chronic disease while 36% of EU adults over 65 have two chronic diseases2 with devastating impacts on family life, society, economies and healthcare systems.

It is a lethal challenge without a silver bullet solution. But the ability of industry, academia, innovators and governments to collaborate to create, manufacture and distribute effective vaccines is the template to meet and neutralise these alarming demographics.

Collaborations and partnerships are flourishing and providing hope across Europe and Ed Piper, Medical & Scientific Affairs Director at AstraZeneca UK, is at the spear tip of the organisation’s growing array of projects deployed at the coal face of UK healthcare.

“The trajectory of the epidemiology for patients with long-term conditions is only going in one direction,” he says. “There are some startling statistics about patient numbers expected in ten years’ time, which is why we have to get more efficient at getting medicines to patients to enable better outcomes.

“Health services are always challenged but they are now under severe capacity constraints and we believe that there are partnerships where AstraZeneca, and organisations like us, can play a really valuable part in helping services get better outcomes for their patients.”

Piper, a former clinician with 20 years’ industry experience across the entire value chain, leads a 120-strong team at AstraZeneca that is dedicated to identifying partnerships and initiatives that are scalable across geographies. The unit features new teams specialising in real-world evidence, population health and clinical pathways.

“We’ve been on a journey over the last two or three years to set up the organisation to be in great shape to meet these challenges, with tools and services that are of use to our NHS partners and expertise to study the outputs of those partnerships, and we even have a team that works on complete clinical care pathways, helping systems remodel them when problems have been identified,” he adds.

‘An EFPIA report revealed that 25% of the working age population is already living with a chronic disease, while 36% of EU adults over 65 have two chronic diseases’

“There is a fundamental belief in the organisation that to achieve better outcomes for patients with multiple conditions, you have to be able to intervene early. You do that best by understanding the biology of the disease and the medicine that would best fit the disease. And you’ve got to get the best medicines into the right patients as early as possible in order to change the trajectory of their disease to enable better outcomes.”
Devoting time, energy and resources to partnerships that deliver high quality clinical care is an important endeavour for the company, he emphasises.

“We spend an awful lot of money on R&D and bringing a medicine to market,” observes Dr Piper. “All that resource only starts to mean something when the medicine actually gets to patients so they get its benefits. We have learnt that our company has a major role to play in partnerships that can enable our medicines to reach eligible patients.”

Many organisations have partnerships with the NHS and other European healthcare systems that drive mutual benefit. The Association of the British Pharmaceutical Industry (ABPI) states that partnerships and collaborations ‘can support delivery of NHS priorities and enable the ‘triple win’ – improved patient outcomes, more efficient use of NHS resources and evidence of impact for industry – as well as replication and scaling across the NHS.’

The approach underpins a growing structure of collaborations designed to de-stress healthcare systems and identify new, leaner ways of working. Health Innovation Manchester, a body spanning academia, industry and the health service, has created three pillars of digitise, integrate and innovate to boost the health of the population of 2.8 million it serves. Its mission statement is clear: ‘We work with innovators to discover, develop and deploy new solutions, harnessing the transformative power of health and care, industry and academia working together to address major challenges and tackle inequalities.’

AstraZeneca is collaborating with Manchester Cancer Network and Qure AI on a project across seven hospitals that has examined 250,000 chest x-rays to speed up lung cancer diagnoses. It has scored early success and could be scaled up across other regions. In Hull, Piper’s team is a core partner with Hull University Teaching Hospitals NHS Trust and Hull York Medical School, in a programme targeting the area’s extreme issues with poor asthma outcomes and overuse of reliever inhalers, and high hospital admissions from exacerbations.

“The asthma population was not being optimally managed and the use of reliever inhalers was very high by national standards. But the collaboration was able to introduce a quality improvement programme to, where appropriate, transfer patients to a better treatment strategy recommended by the local guideline,” Piper says. “The data is truly remarkable, with a 30% reduction in asthma exacerbations, a major reduction in blue reliever inhaler use and a consequent reduction in carbon footprint.  What started as a project across six Primary Care Networks (PCNs) is now being scaled across 300 PCNs in England and Wales.”

Respiratory care is, of course, a strong area for AstraZeneca and Piper comments: “It is fair to say that we seek partnerships in therapy areas where we have existing expertise or where we are developing future innovative medicines. Underpinning all these partnerships is the expertise we can bring to bear. By definition, partnerships tend to flourish when there is a win-win for all parties. This model of setting up partnerships to change clinical practices is embedded in our organisation right across Europe.”

In Spain, the company has designed a programme to optimise clinical care pathways for patients with long-term conditions such as asthma, COPD and chronic kidney disease, which has been endorsed by ten scientific societies and is being replicated across Spanish healthcare.

As all organisations know, synchronising industry expertise with health system function is a challenging construct that varies from region to region and condition to condition, requiring reservoirs of agility and flexibility.

“We are set up to deal with that complexity,” adds Piper. “We choose our partnerships carefully and spend a lot of time looking at health service data to figure out where the need is greatest and therefore where the collective efforts of the partners make the most sense and are likely to have the most benefits for patient outcomes.

“We have to deal with an archipelago of NHS organisations, but we are becoming increasingly skilled at looking at the right places to partner and then having conversations openly with health system teams to see whether there is room for meaningful partnerships to form and flourish.”

He believes that the AstraZeneca’s partnership with Oxford University and the UK government to produce a vaccine at pace and scale during the pandemic has clearly established the efficacy of collaborations.

“Our philosophy is that we were successful combatting COVID-19, so why can’t we be just as successful with the same model with COPD, with heart failure and lung disease where there is a pressing unmet need? The art of the possible is what drives us as an organisation because we know we can make significant progress when we join forces with other stakeholders in the health ecosystem,” he adds.

“My passion is making sure those medicines get to the right patient at the right time so that the most patients possible enjoy the benefits, and we certainly need those benefits at the moment on so many levels.

“As we look ahead, AstraZeneca is on public record of aiming to launch 20 new medicines by 2030, so the work that we’re pioneering at the moment is a real opportunity for us to take all the learnings that we have and make sure that those 20 new medicines get to patients as swiftly as possible.

“There is a lot of hard work ahead, but there is also an exciting future despite the challenges we all face.”

Danny Buckland is a journalist specialising in the healthcare industry