Perry Cohen, PharmD, FAMCP

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Two important risk factors for COVID-19 severity are age and obesity. Both Sweden and Japan have populations significantly older than that of the U.S. Japan has the greatest proportion (28%) of people older than 65 in the world. Sweden ranks 12th with 20%, and the U.S. is 36th with 16%. Based on the age of its population, Japan would be expected to be hardest hit by COVID-19.

But obesity is a major contributing factor to diabetes, hypertension and other morbidities associated with poorer prognosis for those who have received a diagnosis of COVID-19. Just over 36% of the U.S. population is obese — the largest proportion in the world, and greater than in Sweden (20.6%) and Japan (4.3%).

The exact course of the pandemic is difficult to predict, but as of Dec. 14, 2020, COVID-19’s impact on the Japanese, Swedish and American populations was dramatically different. Japan had significantly fewer cases and deaths on a population basis than the U.S., whereas Sweden had one-third fewer cases and one-fifth fewer deaths per million people. On a population basis, the U.S. has among the highest number of cases and deaths of any country in the world.

How did your country initially respond to COVID-19?

 Unlike the U.S., Sweden took what many considered a controversial and dangerous hands-off approach that did not include lockdowns or mandatory use of masks. The country also kept its schools open. The initial spike in cases and deaths was largely in nursing homes and among the elderly. The attitude among the country’s health officials was to treat the COVID-19 response as a marathon, not a sprint. Doing too much too quickly would cause people to get tired of the requirements and actually make things worse in the long run.

Swedish officials encouraged working from home and banning large gatherings but did not impose lockdowns or face masks. These steps were based on our goals of not overwhelming the healthcare system, minimizing the negative impact on the economy and not exhausting society’s resilience before the pandemic is over. The Swedish people have a high level of trust in the government. Anders Tegnell, M.D., the very controversial Swedish equivalent of Anthony Fauci, M.D., had an extremely high approval rating – people were even getting tattoos of him. Combined with Sweden’s relatively healthy population and the normal social distancing in our culture, the approach of moderation seemed the most effective way to go. (Note: This approach has not been as effective as once thought. Sweden currently has one of the highest rates of COVID-19 death in the world on a deaths per million population basis.)

 Japan immediately put five strategies in place. The first involved offering easy access to care through the government’s national healthcare system; the second, assuring high-quality care even in the rural and more remote areas; the third, reinforcing the Japanese citizens’ high standard of personal hygiene; the fourth, focusing on early detection of COVID-19; and, the fifth, prospective tracing and follow-up with close contacts of anyone diagnosed.

Culturally, Japanese people are very open to, and experienced with, wearing masks and practicing social distancing, even prior to the pandemic. Building on this, the government’s focus has been to promote avoidance of the three C’s: closed spaces, crowded places and close-contact settings.

What is the plan for vaccinating people in your country?

 We will start the vaccination process in either late winter or early spring 2021. Our expectation is that the Swedish people will walk and not run to be vaccinated because many remember a swine flu vaccine (2009) that left some children with narcolepsy.


 Because there is much emphasis on holding the Summer Olympics in Japan in 2021, there is a strategy to move quickly with vaccinations. The government has contracts with AstraZeneca, Pfizer and Moderna. People have a high trust in the vaccines if they have been approved by the FDA .

Is the vaccination going to be enough to get through this pandemic?

 My personal opinion is that because we’ve never used mRNA vaccines before and we have developed these vaccines much more rapidly than any previous one for a new disease, no one really knows how this will go. The best case is that we will still be dealing with COVID-19 until the summer and that we won’t see a fourth wave in the fall of 2021.

 While the vaccine is important, we won’t be relying on it alone. The public health measures and the need to continue the three C’s will still be important. We expect to be through it and safely host the Olympics in the summer.

What changes in the healthcare system, including telemedicine, and in the economy do you expect to continue after the pandemic is over?

 Sweden is already a leader in telemedicine, and the use of remote technologies for healthcare will continue to grow. I expect to see online retail to increase and moremployeoffices going virtual.

 Japan does not depend on telemedicine because so much healthcare is delivered in the home. But the interest level has been very high, and we will be moving toward increasing telemedicinie.

 is CEO of The Pharmacy Group and the TPG family of companies and a member of the 

Articles

Opinion piece by MHE's Editorial Advisory Board Member and CEO of The Pharmacy Group, Perry Cohen. Perry discusses the response differences and vague similarities between the countries and addresses the continuous question, "What is the new normal?"

COVID-19 Response in Japan, Sweden and the United States

Some of the most amazing things are happening in the delivery of medical care these days. Surgical techniques, new devices, drugs, and diagnostics can treat and cure many medical conditions. Now the only challenge is who pays for these advances and how. More than ever, managed care pharmacy is at the center of healthcare and needs to help design, develop, and implement new solutions to address this challenge.

, discusses the changing nature of managed care pharmacy and the role it needs to take in curbing healthcare costs. Here are some of my thoughts.

With the growth of specialty pharmaceuticals, the roles of the physician, pharmacist, and patient need to be redefined and the total cost of care must be evaluated to see what really adds value in medical care. We need to develop new models of care to address the new world of healthcare.  

The administrative costs of medical and pharmacy benefits must decrease and there must be more price transparency as patients begin to act as consumers.

Currently, purchasers measure the effectiveness of PBMs by whether they reduce the unit cost of prescription drugs. Utilization management is also widely used to make sure the right drugs are used by the right patients. Systems and processes for this work are driving physicians and pharmacists crazy.

We need to merge pharmacy claims data with medical claims data and patient reported outcomes to measure drug performance and have value-based contracting.

Managed care pharmacy needs to reinvent itself to make value-based contracting happen on the healthcare financing side.

It’s encouraging to see that most industry leaders agree that value-based contracting is a top priority. When asked, “What is the biggest opportunity to reduce specialty pharmaceutical costs?” The most popular response among healthcare executives who took our Managed Care Pharmacy Survey 2018 was value-based contracting (see page X). Further, 60% of respondents said value-based contracting with manufacturers is the best coverage strategy for new, innovative therapeutics and biologics. 

It’s also good to see that new players and new technology to deliver healthcare, such as telemedicine, are continuing to grow. The kitchen countertop in the patient’s home is where the action will happen. New technology from Google, Amazon, and others will drive this change.

As younger patients view time and space differently from senior citizens, the roles of physicians and pharmacists will change and the movement of information will be digital. Pharmacist house calls will be used to provide patient supportive care and lead to more collaboration between physician, pharmacist, and patient.

The use of companion diagnostics to drive personalized medicine will become the standard of care for certain diseases.

Lastly the use of data, analytics, and reporting will drive decision making for physicians, pharmacists, and patients in the delivery and financing of healthcare to ensure the best use of resources.

Exciting times are ahead, and managed care pharmacy is well positioned to drive the necessary changes.

 editorial advisor and chief executive officer of The Pharmacy Group and the TPG family of companies, which provides services to associations, healthcare and information technology organizations, payers and pharmaceutical companies.

Perry Cohen, PharmD, FAMCP

Articles

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