This week: Health-care unhappiness and free med school

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Here’s what we’re following in the world of health security this week, from rising fears about worker shortages to worrying declines in measles vaccination rates:

Losing faith

A new survey from the Canadian Health Coalition and Environics shows that 74 percent of respondents believe the health-care system in their province is in crisis, and 64 percent think their provincial government isn’t doing enough to address health-care workforce shortages. In fact, the shortage of health-care workers was the most pressing “major concern” for 80 percent of respondents, with wait times listed as a major concern for 76 percent of those polled.??

Canadians are also adjusting their behaviour because of perceptions about the state of health care. A full 40 percent said they didn’t go to an emergency department because of the stories they’d heard about long wait times, while 12 percent have avoided calling an ambulance because of delays in response times. Overall, the survey shows Canadians are heavily in favour of more investment in health care. Nearly 80 percent of respondents said premiers should implement an immediate emergency increase in health-care spending targeted at recruiting and retaining public health-care workers.??

Notably, 80 percent of the survey’s respondents said they’d support their premier working with the federal government to implement pharmacare in their province or territory. However, at the same time? – despite their expressed concerns about the health-care system and the cost of drugs – the survey’s respondents were largely unaware of the federal government’s pharmacare program. Thirty-eight percent said they’d heard nothing about it, while nearly half (49 percent) said they’d heard “a little” about it. Only 13 percent said they’d heard a lot about it.?

READ MORE FROM PPF:?Primary Care for Everyone: An Urgent To-Do List for Reform

Global glitch?

Not long after the U.S. reached an agreement with Microsoft to help protect health systems from cyber threats, a massive outage of Microsoft systems last Friday caused by a software update from the cybersecurity firm CrowdStrike led to disruptions of health-care systems around the world.???

In the U.K., for instance, thousands of doctors’?offices and some hospitals struggled to complete patient bookings and appointments and deliver care, including in at least one instance, radiotherapy. Hospitals in Germany cancelled elective surgery appointments, while some in the U.S., including in Michigan, Boston, New York City and Cincinnati, reported downed systems and cancellations.??

At one hospital in Michigan the breakdown was classified as a “catastrophic major incident.” “We do some fairly sophisticated automatic monitoring of our core systems, and when those suddenly went offline, that triggered alerts,” Andrew Rosenberg, the chief information officer at Michigan Medicine told Wired. “In a couple of our units, the majority of their computers all had the blue screen of death.”?

In Ontario, the Children’s Hospital of Eastern Ontario, the University Hospital Network in Toronto, North York General, Queensway Carleton Hospital and Sunnybrook Health Services all reported problems; in Newfoundland, the province’s health authority made a public service announcement, warning that its main information system had been affected; and in B.C., Health Minister Adrian Dix said more than 50,000 devices across the provincial health ministry were affected, adding that hospital staff turned to pen and paper to complete lab work, scheduling and dietary orders.??

“Our team worked through the night to protect patient care, whether it's ensuring what people get for breakfast in the morning...to diagnostic tests, to lab work, to the work done scheduling surgeries, all of that briefly went to paper and back,” he said.?

By Saturday, systems appeared to be slowly returning to normal. ?

Dropped coverage

Nearly three million more children worldwide were left either un- or under-vaccinated in 2023 compared to 2019, according to new data from the WHO and UNICEF. One big reason for that is a rise in conflicts around the world. Key vaccine distribution has stalled, according to the report. For example, the number of children who received three doses of the vaccine against diphtheria, tetanus and pertussis (DTP) in 2023 stalled at 108 million, or 84 percent. Worse is that the number of children who didn’t receive even one dose of the DTP vaccine – what UNICEF calls a “key marker for global immunization coverage” – increased, from 13.9 million in 2022 to 14.5 million in 2023.?

Among the vaccines being under-distributed is the measles vaccine. In 2023, 83 percent of children worldwide received their first dose of the measles vaccine through routine health services. In 2019 it was 86 percent. And while the number of children who received their second dose did increase – to 74 percent – both figures are a far cry from the 95 percent coverage needed to prevent spread and outbreaks.?In Canada, 92 percent of children aged 2 have been vaccinated against measles. But the percentage of children who are fully vaccinated for measles has been falling, 85.7 percent in 2013 to 79.2 percent in 2021.??

UNICEF notes that not one of the 91 countries with what it calls “strong measles vaccine coverage” experienced an outbreak last year. The number of measles cases in Canada has dropped since the winter, but just this week, Montreal health authorities confirmed the region’s second measles case in the past month.??

Free med school?

In recent months, two U.S. universities have received significant philanthropic donations designed to make medical school free. In February, Ruth Gottesman, a former professor at the Albert Einstein College of Medicine,?announced a $1-billion donation to the Bronx-based school. The money means that four-year students will immediately be freed of their tuition fees, and there will be no tuition fees for those students beginning this fall. Last week, Bloomberg Philanthropies also committed to providing free tuition for med students at Johns Hopkins University – provided their family’s annual income is under $300,000. The idea is that without the high entry barrier, the schools can attract more students from a larger breadth of society.?

It may not be as easy as it sounds. In 2018, NYU’s medical school also eliminated tuition fees thanks to a grant of $100 million from the co-founder of Home Depot – ?after which applications surged, especially from underrepresented groups (which rose 102 percent), according to STAT. But the percentage of students who actually enrolled at NYU who identified as Black/African American fell below 11 percent between 2019 and 2022, down from 14 percent in 2017, the year before the free tuition scheme was introduced.??

The NYU program also didn’t mean any more graduates went into family medicine, where doctors are sorely needed in the U.S. No students from the inaugural tuition-free year at NYU matched into family medicine when they graduated in 2022, according to STAT.??

As experts told STAT this past week, a key barrier that remains – even with free tuition – is the number of spots at each school. That number hasn’t expanded, meaning the actual pool of doctors isn’t necessarily expanding. “Without increasing the number of physicians, you aren’t going to have any impact on the labour market downstream. It’s not going to be more affordable to find a doctor, it’s not going to be easier to find a doctor,” said one.?

British breakdown?

A new report into the U.K.’s preparedness for, and reaction to, the COVID-19 pandemic has determined that planning was beset by “fatal strategic flaws” and “serious errors on the part of the state.” The chair of the U.K.’s statutory inquiry into the pandemic, Heather Hallett, found in her report that the government made a “fundamental error” in having focused too much on the threat of a flu outbreak, despite the fact that a coronavirus outbreak at a pandemic scale was foreseeable. “It was not a black swan event,” Hallett, a former judge, said of the pandemic.??

The report noted that in the years leading to the pandemic, there had been a lack of “adequate leadership, coordination and oversight” and that ministers “were not presented with a broad enough range of scientific opinion and policy options and failed to challenge sufficiently the advice they did receive from officials and advisers.” Making matters worse, the report also found?“a number of workstreams for pandemic preparedness were also paused due to reallocations of resources to Operation Yellowhammer,” the internal codename for the U.K.’s contingency plan in the event of a no-deal Brexit. The report is the first in a series that will be issued (the next is due in 2025). The COVID pandemic killed 230,000 Britons.??

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