COVID-19 and global healthcare: Implications for US-China collaborations

This global COVID-19 pandemic, unlike anything we've experienced in our lifetimes, is having a profound impact and transforming lifestyles and business models everywhere. Healthcare is no exception.

However, it is neither unprecedented nor a "black swan" event, but rather following the natural history of human global health and disease. It comes at a unique time in our history; a time of unprecedented global connectivity, technology and wealth. The risks to our lives, our communities and our economies are immense, but so are the opportunities for improving global healthcare and for ushering in a new era of international healthcare collaborations in areas of knowledge transfer, supply chain and research, as well as in digital connectivity and telehealth. 

Throughout history, the elimination of large-scale epidemic diseases has been inseparable from international cooperation. In the 1960s, the United States and the Soviet Union worked together to eventually eliminate smallpox. This was achieved during the height of the cold war. It highlights scientific cooperation between major global powers, despite conflict, to overcome common threats of epidemics and pandemics.¹ In the 21st century, with the world having undergone rapid globalization and integration, the U.S. and China stand as the two largest economies in the world. The need to collaborate has become increasingly important; the U.S. and China have extensive and in-depth resources and talent to deploy, not only to contain the novel coronavirus, but also to improve global healthcare and medical standards. 

No doubt, the medical and healthcare systems of the two countries are drastically different in terms of their historical and cultural backgrounds and context. In terms of healthcare expenditure, the U.S. accounts for over 17 percent of GDP, compared with 6 percent to 7 percent in China.² China has a centralized healthcare delivery system with resources consolidated in large public hospitals, which collectively provide nearly 90 percent of outpatient and inpatient services. In the U.S., private hospitals account for 85 percent of outpatient and inpatient services.³ In terms of the number of medical schools per million people, the share of the United States is 0.56, while that of China is 0.13.⁴ Despite these differences, it is in the sharing of different knowledge and experiences that we can truly gain insights into building a more safe, equitable and healthy future. 

Here are four areas for U.S.-China healthcare cooperation that, if achieved together in a structured and collaborative manner, will save lives and improve healthcare for billions of people around the world.

1. Recalibrate and optimize supply chain. During the onset of the outbreak, both countries experienced a shortage of personal protective equipment, including respirators. Urgent cross-border procurement plays a pivotal role in both China and the U.S. and across the world. For example, as of March 2, 2020, a total of 62 countries and seven international organizations have donated masks, protective clothing and other urgently needed emergency medical supplies to China. After the capacity to produce emergency medical supplies was restored in China, the Chinese government provided assistance in the form of medical supplies to at least 89 countries and four international organizations. As of April 20, 2020, China had provided the United States with more than 2.46 billion masks, about 5,000 ventilators and hundreds of millions of other PPE items.⁵ However, the global allocation of supplies is also limited by other factors beyond manufacturing, such as varying certification standards in different countries, transportation due to flight delays and cancellations and other disruption of routes. China and the U.S. must work together to create standards and bolster and protect the fragile global medical supply chain. 

2. Facilitate biomedical research collaboration. The novel coronavirus outbreak spread fast and furiously across the globe like nothing we’ve seen before. The rapid mobilization of top research programs and resources must, and arguably has, respond with equal vigor and tenacity. Up to now, more than 10,000 research articles related to COVID-19 have been published according to PubMed. The U.S. has led the world in advanced technologies and funding for drug development, medical equipment and clinical research. China is rapidly catching up in this area, growing by 16.9 percent in global research funding and development in recent years, and everyone stands to benefit from increased collaboration. According to the Nature Index database on scientific research cooperation and big science, China has become the second largest scientific research partner of the United States after the European Union from 2012 to 2018.⁶ Meanwhile, the research cooperation between the two countries has also received some unprecedented challenges. Under the influence of U.S.-China trade war, American scientific groups and organizations are affected by a large number of federal proposals and regulations aimed at restricting U.S.-China scientific cooperation. However, the outbreak also brought opportunities and solutions for U.S.-China research cooperation. For instance, Evergrande group provides Boston-based Harvard University and Guangzhou Institute of Respiratory Disease $115 million of scientific research funding to explore and develop new diagnosis and treatment programs to prevent the spread of the virus and treat infected patients.⁷ As the two biggest economies in the world, China and the U.S. need to lead international efforts in collaborative research into treatments and vaccines, and explore the sharing of pharmaceutical technologies among nations.

3. Strengthen knowledge transfer. Knowledge transfer among medical experts around the world plays a crucial role in improving international standards of medical and health services, as well as supporting innovation and rapid development of the healthcare field. For over two decades, leading U.S. hospitals and academic medical centers have been actively engaged in knowledge transfer activities with institutions overseas — mainly in the form of in-person faculty exchanges, education and training, and consultancies — with the goal of building capabilities and capacities locally, in terms of healthcare resources and higher quality clinical service offerings.⁸ Especially during this period, the demand for expertise in chronic disease management, primary and middle-level care provider training, service line improvement, and value-based care models are increasing. We see this as not only a one-way transfer of knowledge, but a bidirectional exchange — one where both parties can learn. 

4. Develop telehealth as a solution. Within the U.S., prior to the COVID-19 pandemic, telehealth had been limited by a variety of regulatory and policy hurdles, which has restricted the growth of telehealth. Almost overnight, the virus has upturned health systems and telehealth has been a critical enabler for patients to access care. Reports from individual hospitals indicate anywhere from 1,000 percent to 6,000 percent increases on telehealth platform usage over the last few months. Reports on physician and patient perceptions on use of telehealth all indicate positive satisfaction and that it is here to stay. A recent U.S. public opinion survey shows that 84 percent of patients prefer to choose institutions providing telehealth services. China has also seen a similar uptick on use of telehealth. In just two months, the flow of internet diagnosis and treatment has increased significantly. According to a report from the leading internet diagnosis and treatment platform in China, PingAn Good Doctor, the number of new registered users has increased nearly 10 times during the pandemic. Telehealth has been historically used as a way to expand access, reduce costs, and fill in gaps in care. In a post-COVID-19 world, those benefits are needed more than ever, as health systems struggle to manage growing demands from patients, contain costs, deal with an aging population and the rapidly growing prevalence of chronic disease, and as seen recently, tackle public health emergencies. Additionally, as patients increasingly look to limit travel and gain world-class healthcare near their own homes, we see tremendous opportunity in U.S.-China institutional collaborations that leverage telehealth to enable physician-to-physician communications and allow care teams to more fully participate in direct-to-patient virtual services in the midst of regulatory uncertainties and barriers. 

Healthcare is an industry that has no geographic boundaries and only benefits from the cross-border sharing of best practices and knowledge. There are huge opportunities from international cooperation — and huge costs if we fail to work cooperatively on risks.

Author affiliations

• Yumi Gu, senior representative of the international services team at Los Angeles-based Cedars-Sinai Medical Center
• Heitham Hassoun, MD, vice president and medical director for international services at Cedars-Sinai Medical Center
• Benjamin Seo, manager of global business development at Cedars-Sinai Medical Center
• Yawei Kong, PhD, director of Asia global services at Cedars-Sinai Medical Center

References

1. Global coronavirus challenge calls for U.S. China cooperation by Christine Clark available from https://ucsdnews.ucsd.edu/feature/global-coronavirus-challenge-calls-for-u.s-china-cooperation
2. Global Health Observatory （GHO）data available from https://www.who.int/gho/health_financing/health_expenditure/
3. Fraze T, Elixhauser A, Holmquist L, & Johann J. (2008). Public hospitals in the united states, 2008: statistical brief #95. [J]. 2006.
4. Muhammad Rizwan, Nicole J Rosson, Sean Tackett & Heitham T Hassoun. Globalization of Medical Education: Current Trends and Opportunities for Medical Students[J]. Journal of Medical Education and Training, 2018, 2(1).
5. Foreign Ministry Spokesperson Geng Shuang's Regular Press Conference on April 20, 2020 available from http://www.china-embassy.org/eng/fyrth/t1771576.htm
6. The top 10 countries for scientific research in 2018 available from https://www.natureindex.com/news-blog/top-ten-countries-research-science-twenty-nineteen
7. Scientists from Harvard, China to unite against coronavirus available from https://news.harvard.edu/gazette/story/2020/02/harvard-and-china-collaborate-on-coronavirus-therapies/
8. Rosson N J, Hassoun H T. Global collaborative healthcare: assessing the resource requirements at a leading Academic Medical Center[J]. Globalization and health, 2017, 13(1): 1-8.