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By Risa Kerslake
Despite the vast amount of challenges COVID-19 created, it also brought about new technology in health care aiming to provide better patient care. The pandemic changed the way people access health care outside of a clinical setting, how research happens and even the future of vaccines — and many of these innovations, created out of necessity over the last two years, are here to stay.
Using mRNA technology for faster vaccine development
Many vaccines, like the flu vaccine, take a weakened version of viruses and use those to trigger an immune response. Once inside the body, these weakened pathogens are unable to reproduce well enough to infect a person — but the immune system will still mount a response, protecting against future infection. An advantage of these “live-attenuated” or “viral-vectored” vaccines is that they can provide long-term immunity — but development of new vaccines can take several years.
Vaccines that use messenger RNA (mRNA), like several deployed during the COVID-19 pandemic, can be made faster and have more flexibility than other vaccines.
Producing mRNA vaccines is more efficient, says Dr. Rudolf Jaenisch, a professor of biology at the Massachusetts Institute of Technology. Instead of using weakened pathogens, mRNA vaccines contain a synthetic mRNA — a genetic “code” that triggers an immune response. For COVID-19 vaccines, researchers created an mRNA vaccine targeting the virus’ unique spike protein. Put simply, immune cells receive an instruction to recreate the spike protein, and this allows the immune system to mount a faster and more effective response to future infections. The process of discovering a viral strain and creating an mRNA vaccine against it may take only a matter of weeks instead of half a year or more.
While research into mRNA vaccines “predates COVID-19 by decades,” explains Dr. Jan K. Carney, associate dean for public health and health policy and professor of medicine at the Larner College of Medicine at the University of Vermont, their implementation during COVID-19 proved successful — and now mRNA could be the future of vaccines.
Biotech companies like Moderna, which produced one of the mRNA vaccines against COVID-19, are now exploring the potential of this technology. For example, it may soon be possible to have one immunization containing two strains of mRNA against both COVID-19 viruses and influenza.
Cancer clinical trials are another area where mRNA technology is being developed for use, as well as in vaccines preventing HIV/AIDS, and dengue fever, says Carney.
“[It’s] revolutionizing how we treat these types of diseases,” explains Jaenisch, “not only infectious diseases but also others where you want to introduce a gene product into a cell.”
Using remote patient monitoring to increase access
When the pandemic made it harder for patients to get to appointments, remote patient monitoring (RPM) became necessary so that people could manage their health from home. The purpose of RPM is to digitally monitor your health metrics, such as blood pressure or blood sugar readings, and send that data to your provider. RPM has been around for monitoring chronic conditions, but during the pandemic, it’s expanded to include short-term health monitoring as well.
“[These] technologies, if successfully used, can engage patients as health care partners in their own environments, eliminate transportation barriers and complement the management of many chronic health conditions,” says Carney.
RPM can help increase health equity, but communities that are most likely to benefit can also have the most difficulty to accessing RPM. Making remote health care more equitable also involves making sure other essentials — such as stable housing and internet access — are widely available.
Expanding telehealth to connect with care more easily
Early in the COVID-19 pandemic, telehealth usage surged as consumers and providers sought ways to safely access and deliver healthcare. In April 2020, overall telehealth utilization for office visits and outpatient care was 78 times higher than in February 2020.
What drove this rapid adoption of a virtual platform in health care? Rules around accessing care virtually became temporarily relaxed during the public health emergency, says Faisal Khan, senior counsel and hospitals and health systems practice lead at Nixon Gwilt Law. Providers were then able to temporarily use platforms such as Zoom in order to care for their patients.
What drove this rapid adoption of a virtual platform in healthcare? Rules around accessing care virtually became temporarily relaxed during the public health emergency, says Faisal Khan, senior counsel and hospitals and health systems practice lead at Nixon Gwilt Law. Providers were then able to temporarily use platforms such as Zoom in order to care for their patients.
“It used to be the only way you get access is through a doctor’s office, and then a referral,” says Dr. Ronald Dixon, co-founder and CEO of CareHive Health, a telehealth provider. Dixon has seen how telehealth can improve patient care firsthand. Before founding CareHive, Dixon worked at the Virtual Practice Project at Massachusetts General Hospital, where he also helped create virtual monitoring tools for providers. He sees telehealth as a tool that empowers patients. “Now you can seek out an app [that] will provide you with strategies on how to manage your health.” All of a sudden, Dixon says, the traditional health care delivery model is out the window, because consumers can easily and digitally access approved therapies.
Telehealth is no longer only about seeing a provider about an urgent issue on a Saturday, but for consultations with specialists, surgical follow-ups, and mental health therapy appointments as well. In fact, from providers to insurance companies, many in the health care space are now considering telehealth services as a permanent fixture and adjusting how they serve patients. For example, Harvard Pilgrim Health Care members can access telehealth services that range from urgent care to behavioral health support and preventive care support through the health plan’s telehealth partner, Doctor on Demand. Similarly, Tufts Health Plan members can also access a variety of virtual health services through Teladoc.
It’s much more efficient to see a provider from your own home than to have to rearrange your schedule to go to a physical facility and wait to be seen, says Khan. And while it’s a big job to bring all the means of care delivery together, whether it’s through an app or your provider’s virtual platform, it needs to be done in order to improve the current quality of care and move forward.
Telehealth has the potential to increase health equity, allowing more people to easily access providers and services. Its future, however, depends on making sure there’s adequate access to broadband internet for telehealth services, particularly in rural areas or areas with underserved populations. In fact, there have been calls to consider broadband internet access and digital inclusion as a “social determinant of health, in the same way we think about affordable housing, transportation, and food security,” says Carney.
Clinical trials that put the patient first
Decentralized clinical trials use technology and processes to provide more convenient and efficient options for study participants. In other words, instead of having participants come on-site to answer questions or perform an activity for the study, they can do these things at home.
When COVID brought social distancing and stay-at-home orders, clinical trials needed to go virtual to keep everyone involved safe. This became an opportunity to open up trials to people that never would have participated prior due to barriers such as their distance from the trial site or accessibility issues.
For instance, biotech company Sanofi found that there was high interest for participation in clinical trials, but nearly 70% of the potential participants lived over two hours away from the trial site. But thanks to new technology, trial investigators can utilize wearables for their participants, make home visits, deliver study medications to homes, and gather data using web-based apps instead of scheduling participants to come to the trial location.
Despite the early challenges, researchers were quick to point out that these issues led to innovations and changed how we think about and conduct clinical research, Carney explains. This includes “participation opportunities for patients, reversing historical injustices, and improving the equity of trial participants,” she says. The critical question, she adds, is how do we take advantage of the lessons learned during the pandemic to improve access to life-saving research for people?
Looking toward the future
From moving patient care and research away from hospitals and into people’s homes to revolutions in how vaccines are made and distributed and putting a spotlight on the effects of inequalities, COVID-19 changed how care happens in many ways.
“What we have is ideas that can be conceptualized, created, and implemented right now,” says Khan. “How quickly [these are] going to get out to the market and change the way care is delivered permanently is going to be based on policymakers, new laws, and more incentives for both new and existing companies to want to invest the time.” Now, the task is to take those learnings from the pandemic into the future.
Harvard Pilgrim Health Care and Tufts Health Plan, as part of Point32Health’s family of companies, are committed to enhancing access to equitable care — physical and mental — for all their members, and for communities throughout New England. Learn more about Point32Health.
Sponsored by Point32Health
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