World Forum for Ethics in Business Future of Healthcare Post COVID: Moving Towards an Integrative Approach

EUROCAM's Secretary-General Dr Ton Nicolai gave a presentation about the 'Future of Healthcare Post COVID-19, moving towards an Integrative Approach at the Conference 'Changing Paradigms in a Pandemic World'. The virtual event was organised by the World Forum for Ethics in Business on World Health Day 2021.

Lessons learned from COVID-19

COVID-19 took us by surprise

  • We were not prepared in spite of earlier epidemics by coronaviruses, such as SARS and MERS
  • It was termed “a deadly virus” which aroused an immense fear among the population
  • According to the WHO Dashboard 6 April 2021, we have more than 130 million confirmed cases
  • More than 2.8 million deaths
  • It brought prosperous nations and well-run healthcare systems to their knees.

Was it a threat to everyone? 

  • Hospitalizations are 6 times higher and deaths 12 times higher among those with other serious health problems — such as heart or lung conditions, weakened immune systems, obesity, or diabetes compared with those with none reported.
  • A large majority of people remain unaffected, suffer no symptoms or just mild ones. In other words, germs are a necessary but certainly not a sufficient cause for communicable disease. When strong, the immune system keeps people healthy in spite of their constant exposure to germs.

Annihilating the germs vs immunity

  • Infection is always the result of two factors:

            exposure to the germ and a person's susceptibility.

  • Western biomedicine focuses on annihilating the germs.
    Result: Antibiotics have dramatically reduced illness and death from serious infectious diseases.
  • The importance of the host and the host’s ability to repel invaders, a good working immune system, has been neglected.
  • Comparing it with the military metaphor:

            Search and destroy the invader/enemy


            Strengthen the home forces

Annihilating the germ, combating the disease

  • The main treatment strategy for COVID-19 is ventilators, intravenous fluids, suppressing fever and cough, supplemented by the combination of broad-spectrum antibiotics, antivirals (remdesivir), corticosteroids (dexamethasone), monoclonal antibody treatments, anticoagulation drugs.
  • Western biomedicine is primarily focused on defeating disease by forceful intervention, destroying infectious agents or blocking specific pathophysiological pathways.
  • It, therefore, is a highly effective model for the treatment of acute emergencies and life-threatening conditions.
  • Perceived as the ultimate solution: developing antivirals and vaccines

Strengthen resilience

  • On the other hand, Traditional and Complementary Medicine (T&CM) is not directed at combating a specific disease or killing germs, but at mobilising and stimulating the self-regulating capacity of humans and animals, thus increasing their resilience and self-efficacy/self-empowerment
  • Greater resilience means
    • swift and sustained recovery from infections
    • reduced susceptibility to future infections
  • Traditional & Complementary Medicine can be used for prophylactic care, for treatment of mild infections or as an add-on intervention to biomedical treatment.

Healthy lifestyles

Healthy lifestyles have always been an essential part of Traditional & Complementary Medicine. For many centuries we have advocating healthy lifestyles.

Ample evidence for the effectiveness of a variety of lifestyle factors such as:

  • exercise,
  • stress reduction,
  • healthy nutrition,
  • sufficient sleep,
  • spending time in nature,
  • positive inner attitudes.

Challenges & Opportunities

What are the current challenges in managing infectious diseases? How to deal with them to regain trust?

Disruption of the microbiome

  • Growing awareness of the importance to the health of the microbiome – the collective genomes of the microbes (composed of bacteria, bacteriophages, fungi, protozoa and viruses) that live inside and on the human body. Billions of microbes, more than there are humans on Earth.
  • Bacteria perform the most important roles in maintaining life on this planet. Bacteria protect us and feed us, all life on Earth depends on their activities. Bacteria are the planet's recyclers, plant nurturers, and undertakers.
  • The microbiome plays an essential part in the immune system protecting us against infection, breaking down food in the digestive system to release energy and producing vitamins and helping in the elimination of waste.
  • Antibiotics can have a disrupting effect on the microbiome, leading to an increased susceptibility to infections and may be causatively involved in a number of chronic medical conditions.

Antimicrobial resistance – AMR

Antibiotics are both a blessing and a problem. Antibiotics are leading to antimicrobial resistance because bacteria adapt easily and become resistant to antibiotics. AMR is one of the major global public health threats facing humanity.

  • WHO: global deaths from drug-resistant infections could rise from the currently estimated 700,000 every year to 10 million people every year by 2050.
  • Bacteria adapt easily and become resistant to antibiotics.
  • New antibiotics are no longer in the pipeline and cannot solve the problem, it is a dead-end street.
  • Viruses, including the SARS-CoV-2-virus, constantly change through mutation, and new variants of a virus are expected to occur over time.

Vaccines as the ultimate solution?

  • Many believe that vaccines are the most ideal option to prevent or deal with outbreaks of a virus – but vaccines can take years, and sometimes even decades, to be developed.
  • Funded by governments, manufacturers and leading scientists have been working at record speed to develop a successful vaccine for the novel SARS-CoV-2-virus within a year; but will we need another year of lockdown and vaccine development when the next pandemic emerges?
  • Viruses will continue to mutate to such a degree that first-generation vaccines will probably be less effective at preventing infection.
  • Do we want constant tests and vaccine passports for every new virus?
  • Vaccines are a wonderful invention but it seems to be a temporary solution.

Zoonotic diseases

  • 75% of new or emerging infectious diseases that infect humans originate in animals.
  • The risk of zoonotic diseases is predicted to continue to increase.
  • Clearing forests for agriculture leads to farms being built near forests, livestock having an increased opportunity to mix with wildlife, which increases the chances pathogens will jump from one animal to the other.
  • Intensive livestock farming with its overuse of antibiotics, high animal numbers and low genetic diversity have created ideal conditions for such diseases to thrive with devastating outcomes on animal and human health.

Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES) is working on the problems of Zoonotic diseases. They say the following:

  • ‘Future pandemics will emerge more often, spread more rapidly, do more damage to the world economy and kill more people than COVID-19 unless there is a transformative change in the global approach to dealing with infectious diseases.
  • ‘631,000 - 827,000 unknown viruses in nature could still infect people’.
  • ‘Current economic impacts are 100 times the estimated cost of prevention'.
  • ‘The same human activities that drive climate change and biodiversity loss also drive pandemic risk through their impacts on our environment. Governments worldwide should take the necessary steps to change humanity’s ‘promiscuous treatment of nature’ or there will be more pandemics.

How to deal with these challenges so as to regain trust?

Positive developments

  • Increasing awareness that it is time to act:
  • Science-Policy Platform on Biodiversity and Ecosystem Services - IPBES is supported by 137 governments
  • Worldwide support of the One Health approach — achieving optimal health outcomes recognizing the interconnection between people, animals, plants, and their shared environment.
  • Recently adopted EU4Health Programme in the European Union supports health promotion and disease prevention, by fostering healthy lifestyles both in communicable and non-communicable diseases.
  • Governments worldwide are steadily implementing the World Health Assembly resolutions that call on to integrate T&CM into national health systems.
    [and Europe is still lagging behind]

Necessary actions

  • The sector of Traditional, Complementary and Integrative Medicine to continue raising awareness of the substantial contribution it can make to current healthcare challenges in infectious diseases, e.g.
    • non-antibiotic treatment of infections, thus helping reduce AMR
    • strengthening patients’ resilience through lifestyle changes and T&CM treatment.
  • Citizens and health professionals to continue advocating for the availability, accessibility and affordability of Traditional, Complementary and Integrative Medicine in national health systems.