The Middle East is putting force behind its mission to lead in the arena of healthcare – and we have never been closer to achieving it. However, there is one glaring obstacle in the way of realising the vision of world-leading care that we aspire to: the inequalities that exist throughout the region. 

The rural-urban divide

Bridging these inequalities requires expanding the progress made within pockets of innovation across the entire region. The rural-urban divide that exists means lack of access to quality healthcare for many patients, and we see this disparity play out in the ability (or lack thereof) of healthcare professionals (HCPs) to approach patient care equipped with the latest knowledge and technologies. Without the proper resources, HCPs in rural and developing areas are not able to provide the best level of care available, a reality that directly impacts patient outcomes.

Related: Connected telehealth - personalised patient care from anywhere

The rural-urban divide is an extremely complex issue and healthcare disparities are merely a symptom. In primarily urban areas, highly mature health systems have decided to concentrate on becoming a destination for high-end health services. The concept of health tourism is a fantastic economic endeavour, and one the rest of the region could benefit from.

Related: Digital technology and personalised medicine: Setting the tone for the healthcare of the future

Olfat Berro - Area Head, Middle East, Roche.

Roche’s recent report on the Middle East’s progress towards personalised healthcare systems demonstrates how the focus of highly mature systems on building health tourism – tailored to the wealthiest 10 per cent of the region – has inspired investment into providing high-quality basic care for the remaining 90 per cent of the population in medium-mature health systems. Some of the solutions for the broader population have included telehealth initiatives and overall emphasise a less centralised health system to meet the needs of rural patients.

Standardise data, standardise outcomes

Standardising healthcare outcomes across the region relies heavily on the standardisation of resources and knowledge available to HCPs.

We can achieve consistency by aligning our collective medical knowledge through data-driven, personalised healthcare. A data-based system gives HCPs an opportunity to have a robust patient profile to understand each patient, as well as compare their patient’s data against an entire region of other patients’ data. By identifying similarities, differences, and patterns, they can select the optimal treatment based on each patient’s needs.

Simply put, if every HCP has access to the same database of clinical information, then clinical decisions can be more streamlined and patient outcomes, as a result, will be more consistent. The most important part is that these patient-provider conversations in Dubai would be based on the same information available to HCPs in Al Qurayat.

Some countries have taken steps to ensure that data-based healthcare is the way of the future. Saudi Arabia, for example, is already mobilising for the future of health by establishing the Saudi Data and Artificial Intelligence Authority (SDAIA), which is incorporating AI into its healthcare systems. This adds a layer of possibility, with the ability to use AI to interpret data patterns more effectively and generate valuable recommendations for HCPs.

Digital health bridges the gap

The power of data is unquestioned. But it’s important to remember that data is a digital tool, and it requires an inherently digitalised healthcare system: one that can be expanded to every part of the Middle East.

Individual access to technology varies widely across the region, and so the effectiveness of systems that rely on individuals to have access to technology and digital infrastructure is inconsistent at best. A much more effective approach would be to integrate local HCPs into a regional digital infrastructure.  

Consider a local midwife with the ability to digitally correspond in real time with licensed professionals, or a primary care physician with the ability to share scanned patient images to diagnostic specialists in urban areas for interpretation. Connecting local care providers to the specialised resources available in the region maximises the impact of the expertise we already have.

The payoffs of a system like this are high, from the cost savings of avoiding unnecessary treatments or hospitalisations to the economic prosperity associated with improved regional health. One area where we need to invest to enable this system is in the training of local HCPs on the use of digital tools. This is an effort that could pay dividends: training existing local professionals in these digital tools addresses immediate patient needs and can also inspire and facilitate healthcare training for citizens of the region, helping to meet the growing regional demand for HCPs.

In every instance, investment in healthcare is truly an investment in the future of the region.

Investing in the future of the Middle East

The Middle East has an abundance of opportunities to improve the healthcare quality across the entire region. Making this healthcare oasis a reality starts with empowering all healthcare professionals to deliver care decisions based on the latest data and with the latest resources available to them. We can only be a destination for the world if our own people can benefit from our healthcare power. 

Olfat Berro is the Area Head — Middle East at Roche.

Ailing healthcare systems around the world are under the spotlight and the need for universal access to quality healthcare has never been greater as many factors continue to put pressure on the sector. These include ageing populations, clinical workforce challenges, rising utilisation stemming from a growing burden of chronic diseases like cancer, diabetes and cardiovascular disease (CVD), and reimbursement-related challenges.

Reassuringly, the pandemic has forced governments to reconsider every aspect of their healthcare systems. For example, workforce size and shape, digital infrastructure, models of care focusing on primary-care pathways and digitally enabled interventions and disease surveillance, research, supply chain speed and resilience, access to care, data use, regulation, and service integration.

Related: Report: The Future of Healthcare, Today

Ahmed Faiyaz, Strategy Partner and Head of Healthcare Advisory, KPMG Lower Gulf.

Related: Shedding light on emerging trends in public health

In the UAE, health spending grew from Dh45 billion in 2016 to Dh61.7 billion in 2020. Overall, healthcare spending is expected to account for 6 per cent of the country’s GDP by 2029. But changing demographics may be expected to put more pressures on the UAE healthcare industry.

Studies show that the over-60 population in the country is expected to grow from 4 per cent in 2018 to 8 per cent in 2030 for nationals, and from 1 per cent to 3 percent for expats. To meet this demand, UAE healthcare spending is expected to grow at a CAGR of 6.9 per cent over 2016 – 2029 to reach Dh107 billion by 2029.

The KPMG whitepaper Champions of Change: How Governments can Lead Healthcare Transformation, published in cooperation with the World Government Summit 2022, examines the implications of the pandemic for the world’s health systems. It outlines the role of government action in the sector and the principles that should underpin it. This includes closer collaboration and cooperation with private-sector stakeholders including healthcare providers, health insurance companies, pharma and medtech companies, to help systems reimagine the role of patients, and deliver patient-centric, value-based services.

Here are five important trends that are set to drive major investments in healthcare in the future:

1. Accelerated digital adoption to improve patient outcome

Digital technology is allowing patients to become active partners in their care and to manage long-term conditions. Virtual consultations, telemedicine, digitally enabled and supported intensive care units (tele-ICUs), remote monitoring services, lab diagnostics at home and online ordering of medicines are being increasingly adopted by healthcare providers.

AI supported by biometric computing is increasing the precision in diagnosis and treatment, leading to reduced errors, better patient triage and redirecting of patient flows and improving patient outcomes. Regulators and healthcare professionals will now increasingly leverage AI, cognitive assistance, robotics and blockchain to augment productivity and the speed-to-delivery of care.

2. Growth of resilient, local supply chains

The pandemic exposed vulnerabilities in supply chains as difficulties in sourcing and supplying personal protection equipment (PPE), testing supplies, and some vaccines demonstrated local gaps and global interdependencies. This has led governments to recognise their role in boosting domestic production capacity, through onshoring and investment to avoid future shocks.

In the UAE, onshoring of pharma manufacturing for Sinopharm and other vaccines will likely drive future demand for locally produced pharmaceuticals in the GCC. Furthermore, the development of the Life Sciences cluster in Abu Dhabi should pave the way for a robust healthcare ecosystem.

3. Growth of traditional and complementary medicine

The GCC’s traditional and complementary market for anti-ageing and longevity account for 67 per cent of the total market, including traditional alternative medicines/botanicals, body healing, mind healing, external energy healing and sensory healing. This market segment is now expected to grow at a faster rate than the global market, at 24 per cent CAGR over the next five years, surpassing the global growth forecast of 22 per cent CAGR over the same period.

A fast-growing ageing population in the UAE is expected to further push up demand for specialised services and wellness centres in the future, especially as patient behaviour changes towards preventative care models and adoption of alternative healing therapies to manage healthcare risks and chronic conditions.

4. Wider adoption of cybersecurity measures safeguard patient data

As medical devices proliferate and connect with platforms, quality assurance and security controls have often failed to meet appropriate standards. With more and more connected devices, manufacturers, providers, users, and regulators will likely invest more resources to ensure that consumers are protected.

Increasingly, governments will play an important role in enforcing clear and commonly understood cyber-security standards, while maintaining the security of vital national infrastructure and intellectual property against malicious actors.

5. Integration of healthcare and smart cities

Smart cities aim to improve citizens’ lives through connected technology. In the UAE, the government’s Smart City strategy is enhancing mobility, healthcare, safety and social connectedness. Looking ahead, there is tremendous potential for smart cities and the Internet of Things (IoT) to bring healthcare and patient empowerment into the home, workplace, and leisure spaces.

There will be greater focus on integrating various touchpoints of daily life to optimise the way a city is designed and works, much like a new project that marries urban infrastructure with technology to improve people’s lives and how they interact with their environment.

Conclusion

In a post-pandemic world, wider digital adoption of AI will drive investments in R&D for vaccines and preventative medicines to tackle infectious diseases and viruses. Furthermore, we anticipate that better informed and engaged payers, including governments, healthcare providers, life sciences companies and patient groups – with real time diagnosis and access to health data – will demand a better health outcome and value, leading to healthier populations and more resilient economies.

 

Ahmed Faiyaz is the Strategy Partner and Head of Healthcare Advisory, KPMG Lower Gulf.

 

When the UAE announced it was shifting its healthcare strategy to focus on longevity and healthy ageing, the country’s leaders once again demonstrated progressive thinking in preparation for the health and well-being of our future society.

In 2016, only one per cent of the UAE population was age 60 and older. By 2050 this number is expected to reach 16 per cent of the country’s population or two million people. In fact, over the past 100 years, the average life expectancy has more than doubled with the median age of the UAE population increasing from 18 to 46.

This demographic shift is having major social and economic implications for the country that requires a re-thinking and re-orientation of the nation’s investment in health and social services. That is why the UAE is elevating the conversation around healthy ageing, developing national longevity policies, and encouraging innovators in the sector to establish longevity clinics and bring cutting-edge technologies to the market.

Today, it is about helping people live better and longer while maximising society’s longevity opportunity. The longevity opportunity is where society recognises that our older population carry vast experience, knowledge and wisdom that make invaluable contributions to the continued social and economic development of the country.

With growing investments in the healthy ageing sector, we now can take control over the ageing process and reverse some of the physical and cognitive declines that typically occur around the age of 50. Aviv Clinics, for instance, created the first of its kind treatment that triggers the body’s natural process of generating new stem cells, which are the building blocks of tissue rejuvenation. By using a unique protocol of hyperbaric oxygen (HBOT), the body proliferates new stem cells in an environment full of oxygen to supply the energy for the process. Enabling the body to go over those processes again and again throughout the treatment period ends in enhanced and optimised brain and body performance.

Similar programmes have proven an ability to treat age-related cognitive and physical decline and change the way people experience the ageing process. Improvements in memory, attention span, speed of thinking, focus and other brain-related executive functions are only part of the benefits one can get from the treatment. In addition to improving cognition, other treatments can reduce bio-markers associated with the development of Alzheimer’s disease. The protocol is also relevant to treating deterioration in brain functionality caused by physical trauma or other medical conditions such as stroke, fibromyalgia, and other indications that result in damaged brain tissues.

For the UAE, being a pioneer in the healthy ageing sector also brings with it economic development opportunities. In 2020, the UAE reported that its longevity sector – which includes everything from BioTech and pharmaceuticals to FinTech and InsurTech – surpassed $19 billion and is expected to reach $32 billion by 2026. It will also contribute greatly to the UAE’s growing and dynamic medical tourism industry, which globally is expected to grow from just under $14 billion in 2021 to $53.5 billion in 2028. Both are tangible economic outcomes from investing in the UAE longevity opportunity.

The societal view on ageing historically has been that once people reach retirement age, it is time for them to relax and enjoy their “golden years” with their children and grandchildren caring for them. Breakthroughs in longevity science and ageing have totally changed that paradigm.

By investing in this emerging sector, the UAE is making a powerful statement that we can do so much more than just care for our ageing population and enable people to live longer.  We can eliminate the phrase “you are in good health for someone your age” from the medical community lexicon. And we can help ensure the UAE and its people get the full benefit and impact of today’s new longevity opportunity.

Mike Frayne is the CEO of Aviv Clinics Dubai.

Jason Kang — CEO and Co-Founder, Katherine Jin — Chief Technology Officer and Co-Founder, and Kevin Tyan — Senior Advisor and Co-Founder, founded Kinnos based on the need to make a difference during the 2014 Ebola outbreak. Their flagship product Highlight® was created to address the urgency of improving disinfection applications for both epidemic response and everyday use.  

Their mission to empower people to disinfect surfaces confidently and provide society with peace of mind through visible disinfection has led to Highlight® becoming an award-winning, patented colour additive platform that helps with disinfection and compliance. Independent studies and whitepapers have shown that its real-time colour visualisation consistently increases cleaning thoroughness. Highlight® is now used internationally by hospitals, first responders and transit agencies, and has been recognised by Harvard Innovations Lab, Forbes, Newsweek, USAID, the USPTO Humanity Award, and others. 

Related: Sterilisation and disinfection vital in hospital infection control

“We wanted to develop a simple, effective solution that would make it easy to confirm that surfaces have been disinfected correctly; this is how our Highlight® technology was born. For the first founding years, we focused on global health and worked with NGOs in countries like Liberia, Guinea, Uganda, Haiti, DR Congo, and others.  

Over time we realised our technology also had applications in hospitals, where patients suffer from healthcare-associated infections or infections they get from the hospital itself. Over the last couple of years, we have been making a concerted effort to expand our technology platform into hospitals,” says Kang. 

Triumphing at Innov8 

Related: COVID-19 pandemic drives improved disinfection of hospital areas

Since then, Kinnos has been named as one of the top 100 healthcare technology companies of 2021 by The Healthcare Technology Report and recognised by the World Health Organisation as Innovative Health Technology. It also won this years’ Arab Health Innov8 competition, following an intensive week-long judging process that saw a total of 24 different companies pitch over the opening three days of Arab Health. 

“Participating in Innov8 was a great experience and winning has helped us explore opportunities in the MENA region for the first time. The announcement of our win has encouraged the local healthcare community and its ambassadors to connect with us. We are looking forward to exploring how Kinnos can partner with both local healthcare systems and government authorities to implement our technology in the UAE. Unfortunately, a high infection rate still exists with roughly 28 per cent of MENA patients interacting with variations of communicable infection. As hospitals in the MENA region are rapidly advancing, we can become a key part of their journey towards progressively innovating.” 

Colourising disinfectants  

Highlight® works by colouring the liquid bleach and disinfecting wipes used in hospitals to clean surfaces, allowing users to instantly see disinfection coverage. The colour improves visibility, fades in colour automatically to train on disinfectant contact times and provides peace of mind to the public through visible disinfection. It has prevented the use of incorrectly mixed or expired bleach products in various critical healthcare situations because its colour fades only when healthcare-strength bleach is used. It is the only product on the market designed to provide real-time visual feedback during manual disinfection so that quality is maintained every single time a disinfectant is used.  

“Today our technology is primarily compatible with bleach-based disinfectants, and the reason we started with bleach is that there is a need to be able to fully cover surfaces and target hard-to-kill pathogens. The use of Highlight® has resulted in 30 to 70 per cent improvements in disinfection scores, which according to studies have shown a strong correlation to reductions in infections. We have not only supported improvements in disinfection techniques, but hospitals have relayed that Highlight® has been instrumental in training new staff and existing staff. We have also spent extensive time working collaboratively with top hospital partners in the US to quantify improvements in disinfection quality as a result of using Highlight®.  

Jason Kang (centre), Katherine Jin (right), and Kevin Tyan (left)

“Presently, there are labour shortages due to COVID. Therefore, the ability to have built-in visual training is a big value-add and saves hospitals time. We are also aware that patients throughout the pandemic want to see enhanced cleaning in facilities. Highlight® is a very tangible, visible way for businesses and for hospitals to demonstrate that commitment to patient safety and delivering a better patient experience,” he explains.  

Future of Kinnos 

A part of the winning prize of Innov8 includes participation as an exhibitor in the next edition of Arab Health. “We went up against some tough competitors and I was blown away by some of the other solutions. It feels like we are starting to enter the future of tech and the future of healthcare. We are honoured to be selected as an overall winner, and as far as Arab Health goes, I was very impressed with the quality of professionals and the quality of companies. Exhibiting next year at Arab Health is going to be a great opportunity for us to continue to showcase our existing product line and what we have in store.  

“Many hospitals tend to use alcohol- quaternary ammonium or hydrogen peroxide-based disinfectants, and by the end of 2022, we plan to have full product compatibility with all commonly used disinfectants. Having that full suite will be a very powerful tool for any hospital’s arsenal. We are hoping to showcase this at Arab Health 2023 as well,” he concludes. 

Findings from a new phase 1 trial led by global health system Cleveland Clinic show that an experimental “gene silencing” therapy reduced blood levels of lipoprotein(a), a key driver of heart disease risk, by up to 98 per cent.

Findings from the “APOLLO Trial: Magnitude and Duration of Effects of a Short-interfering RNA Targeting Lipoprotein(a): A Placebo-controlled Double-blind Dose-ranging Trial” were presented  this week during a late-breaking science session at the American College of Cardiology’s 71st Annual Scientific Session and simultaneously published online in the Journal of the American Medical Association.

In the trial, participants who received higher doses of SLN360 – a small interfering RNA (siRNA) therapeutic that “silences” the gene responsible for lipoprotein(a) production – saw their lipoprotein(a) levels drop by as much as 96 per cent to 98 per cent. Five months later, these participants’ lipoprotein(a) – also known as Lp(a) – levels remained 71 per cent to 81 per cent lower than baseline.

The findings suggest this siRNA therapy could be a promising treatment to help prevent premature heart disease in people with high levels of Lp(a), which is estimated to affect 64 million people in the United States and 1.4 billion people worldwide. It is estimated that nearly 20 per cent to 25 per cent of the world's population has elevated Lp(a). “These results showed the safety and strong efficacy of this experimental treatment at reducing levels of Lp(a), a common, but previously untreatable, genetically determined risk factor that leads to premature heart attack, stroke and aortic stenosis,” said the study’s lead author Steven E. Nissen, M.D., Chief Academic Officer of the Heart, Vascular and Thoracic Institute at Cleveland Clinic. “We hope that further development of this therapy also will be shown to reduce the consequences of Lp(a) in the clinical setting through future studies.”

Lp(a) has similarities to LDL, also known as bad cholesterol. Lp(a) is made in the liver, where an extra protein called apolipoprotein(a) is attached to an LDL-like particle. Unlike other types of cholesterol particles, Lp(a) levels are 80 per cent to 90 per cent genetically determined. The structure of the Lp(a) particle causes the accumulation of plaques in arteries, which play a significant role in heart disease. Elevated Lp(a) greatly increases the risk of heart attacks and strokes.

Although effective therapies to reduce the risk of heart disease by lowering LDL cholesterol and other lipids exist, currently there are no approved treatments to lower Lp(a). Since Lp(a) levels are determined by a person's genes, lifestyle changes such as diet or exercise have no effect. In the current study, the siRNA therapy reduces Lp(a) levels by “silencing” the gene responsible for Lp(a) production and blocking creation of apolipoprotein(a) in the liver.

In the APOLLO trial, researchers enrolled 32 people at five medical centers in three countries. All participants had Lp(a) levels above 150 nmol/L, with a median level of 224 nmol/L (75 nmol/L or less is considered normal). Eight participants received a placebo and the remaining received one of four doses of SLN360 via a single subcutaneous injection. The doses were 30 mg, 100 mg, 300 mg and 600 mg. Participants were closely observed for the first 24 hours after their injection and then assessed periodically for five months.

Participants receiving 300 mg and 600 mg of SLN360 had a maximum of 96 per cent and 98 per cent reduction in Lp(a) levels, and a reduction of 71 per cent and 81 per cent at five months compared to baseline. Those receiving a placebo saw no change in Lp(a) levels. The highest doses also reduced LDL cholesterol by about 20 per cent to 25 per cent. There were no major safety consequences reported and the most common side effect was temporary soreness at the injection site. The study was extended, and researchers will continue to follow participants for a total of one ye

The phenomenon of how immune cells recall an infection or vaccination, so they can leap to defence decades later has been a perplexing question in immunology. Research led by UC Berkely scientists in collaboration with Emory University investigators discovered that a small pool of immune cells that responded to the original invasion survive for years and developed specific characteristics that keep them prepared and ready for the same microbe to infect the body again.

While the spinal cord and brain have their own army of unique immune cells, the peripheral immune system defends against invaders with a greater drive of proteins, cells, and entire organs, such as the spleen. Researchers have made significant progress in understanding how the peripheral immune system influences cerebral activity in the last decade, including how immunological signals originating outside the central nervous system might influence cognitive functions, social behaviour, neurodegeneration, and more. In fact, they discovered that immune cells from the periphery regularly patrol support the central nervous system's operation. Researchers discovered for the first time that, just as the brain remembers people, locations, smells, and other things, it also stores "memory traces" of the body's prior illnesses in a new study. The peripheral immune system can be quickly summoned to defend at-risk tissues by reactivating the same brain cells that encode this knowledge.

Related: Improving brain health through exercise

So, how does Neuroplasticity fit in?

Neuroplasticity is the ability of the nervous system to reorganise its structure, function, and connections in response to intrinsic and extrinsic stimuli. It can be described at many levels, from molecular to cellular to systems to behaviour, and can occur during development in response to the environment, in support of learning, in response to disease, or in relation to therapy.

Related: Long COVID or mental burnout? Life beyond the pandemic

When trainer and athlete Ben Ahrens was diagnosed with Chronic Neurological Lyme Disease at the age of 25, he was bedridden for over three years. As an advocate for a healthy and active lifestyle, he sought solutions but found that conventional medical treatments were unable to help him recover fully. This prompted Ahrens to learn about neuroplasticity and establish Re-origin, a platform that provides effective, science-based, self-directed neuroplasticity programs and technologies.

In an interview with Ahrens as its Co-Founder and CEO, we learn more about neuroplasticity’s place in clinical application and the journey of Re-origin. Excerpts:

 

How is neuroplasticity being harnessed for clinical applications?

Neuroplasticity is the brain's ability to change its structure and its function. Today, 75 to 90 per cent of hospital visits in the US and in other parts of the world is due to stress-related conditions. Inflammation is known to be the root of several chronic conditions, where the body is subject to a stressor, such as a physical injury or viral infection, but it responds by healing. The problem lies in many patients experiencing a sustained stress response that leads to ongoing inflammation persisting long after the initial trigger has gone.

Evidence and research suggest that through the continuation of stress responses, the brain, specifically the limbic system, can learn through neuroplasticity to protect the body. This has been used successfully for decades in clinical practices for neurocognitive rehabilitation.

Re-origin now applies those same principles and approaches through PRT therapy, CBT training, and interoceptive training, for example, to help people overcome anxiety, depression, and chronic inflammatory conditions. Self-directed neuroplasticity can teach people how to retrain the stress response in their brain, so they have control over the inflammation produced by the body.

The frequency of these exercise is lowering that inflammatory response, helping patients improve conditions such as chronic fatigue, fibromyalgia and COVID. In addition, neuroplasticity training has been used in overcoming chronic pain, or even regaining function to limbs that had previously been disconnected due to stroke or injury.

Tell us about the direction Re-origin is taking when it comes to becoming a vital part of the healthcare landscape, are there recent success stories of collaborations and partnerships with healthcare entities?

In the past, certain conditions that were a result of complex chronic illnesses fell into the category of mystery ailments. Many patients saw the Re-origin program as a last resort when conventional medicine could not provide a permanent solution. More physicians are collaborating with us and offering the program to their patients as a first response and, in some instances, in conjunction with their treatment.

The program supports by identifying and interrupting the inflammatory processes and patterns that take place in the body. It replaces those inflammatory responses with our parasympathetic responses, which is our body's natural healing state.

We are working with a handful of PhD neuroscientists and clinical psychologists to gather more clinical data with the goal of having Re-origin's approach become the first response, as opposed to being the last resort for conditions like long COVID, chronic fatigue, pain syndrome, as well as treatment-resistant anxiety and depression.

How does the rewiring phenomenon work? Does it help address the cause of long COVID?

The brain can make a neurological association between stress and inflammatory activity. Even after a long period since the body has cleared the virus, it can learn that those symptoms or similar resembling symptoms of COVID can be dangerous and perpetuate an inflammatory response.

Some patients tend to have persisting flu symptoms after COVID recovery and those inflammatory processes are often triggered by actions such as running up a flight of steps, mimicking the same type of symptomology they experienced when they were ill.

The brain creates these associations to learn from the past to protect us in the future. The issue is that it may not receive the right messages. With neuroplasticity programmes, the goal is to start to retrain the brain to ultimately reclassify those symptoms and experiences from threatening to non-threatening. Our bodies can then experience everyday activities and register experiences like fatigue, headache, even brain fog to some extent, shortness of breath, but without necessarily triggering that overactive immune response.

Conditions like Long COVID and post-viral fatigue have a certain "learned component" which through self-directed neuroplasticity can be unlearned, and ultimately, undone. 

Policymakers need to drive strategic partnerships and set clear national objectives to improve the lives of patients suffering from haemophilia, a rare but life-threatening condition in which a person has excess bleeding due to a genetic mutation or from the development of an inhibitor antibody that prevents a normal amount of clotting proteins from being present in the circulation. 

According to the latest Annual Global Survey published by non-profit organisation World Federation of Hemophilia, the mortality rate for people with haemophilia is higher than the mortality rate in the general population due to inadequate care over a patient’s lifetime. To put numbers into perspective, there are 393,658 people living with haemophilia in 120 countries as of year 2020. The most prevalent type of the disorder in this population is haemophilia A, haemophilia B and type unknown (209,614 people), and the von Willebrand disease (84,197 people). Statistics of patients in other countries, including the Middle East region, are still unknown. 

Related: Hemophilia gene therapy: Where do we stand?

As the globe marks World Haemophilia Day on April 17, the goal for 2022 is to create ‘Access for All’ with a focus on partnership, policy, and progress. The theme seeks to engage governments across the world and integrate inherited bleeding disorders into their national policy.  

Initiatives to improve haemophilia care 

UAE-based Haematologist Dr Mustaqeem A. Siddiqui says that the first step is to address issues around the need for frequent infusions in a hospital or clinic, and the importance of shifting that to a home setting. 

Related: The role of the Transfusion Practitioner in Haemovigilance

Dr Siddiqui, who is also a haematology and oncology consultant at Sheikh Shakhbout Medical City in partnership with Mayo Clinic, added: “Since many of the treatments are expensive, we need to find ways to ensure that people still receive their treatment in some way if it becomes unaffordable.” 

For those who have severe haemophilia and spontaneous bleeding, the biggest challenges are getting factor replacement therapy on a consistent schedule three times a week and rehabilitation of muscles and joints after bleeding has occurred in them. “In regard to factor replacement, a person with haemophilia may need to travel to an infusion centre in a hospital or clinic multiple times a week and receive an IV treatment. This can be very disruptive to normal work or home life,” he said. 

Dr Mustaqeem A. Siddiqui, Haematology and Oncology Consultant, Sheikh Shakhbout Medical City in partnership with Mayo Clinic

Current treatment landscape and emerging therapies 

While this treatment can sometimes be given at home, it requires coordination and planning to have the medication and medical professional to travel to a person’s home to administer the factor replacement therapy. 

“This can also be quite costly, and not all insurance companies will cover this treatment. However, government-driven partnerships with the makers of factor replacement therapies can have these treatments delivered and given to a person in the comfort of their own home,” he added. 

The second challenge is the management of pain, discomfort, and loss of function of a joint after bleeding. Dr Siddiqui explained that the most common joints in which bleeding occurs are the knees, hips, elbows, and shoulders. This causes significant pain and damage to the bones in the joint. Over time, it can lead to difficulties walking or using the arms, which is why pain management and physical rehabilitation are the cornerstones of managing this issue. 

According to the haematologist, the current treatment landscape revolves around replacing the factor that is not made by the body. Factor can be from normal donors or synthetically made by a pharmaceutical company, but gene therapy — a treatment in which genes can be reintroduced in a person who is lacking the gene — holds great promise. Studies have shown that people who receive this therapy can begin to make their own factor and no longer need to rely on infusions.
 
Gene therapy, despite being one of the most important biotech solutions to date, has yet to be approved by government regulators. But when it does become available, Dr Siddiqui said that policymakers across the globe will have to set guidelines for regulatory approval, ensure the treatment is covered by insurance, designate centres of excellence responsible for administering gene therapy, and ensure they continue to benefit from it over time. 

Understanding haemophilia and risk groups 

Haemophilia is a rare disorder that affects the body’s ability to clot. Due to a genetic mutation, they can either be passed on from parent to child, or a person can develop haemophilia on his or her own with a new genetic while developing in the womb. People who have the highest risk of being born with haemophilia are those that have a family history, while people who develop an antibody inhibitor, those above the age of 60, have autoimmune conditions, or even pregnancy are at higher risk. 
 

Resources for professionals  credits: World Federation of Hemophilia (WFH)   Achieving Global Impact: Strategic Plan 2021-2025 Haemophilia Annual Global Survey (October 2021)  Haemophilia education and e-learning

Forescout’s Vedere Labs, in partnership with CyberMDX, have discovered a set of seven new vulnerabilities affecting PTC’s Axeda agent, which we are collectively calling Access:7. Three of the vulnerabilities were rated critical by CISA, as they could enable hackers to remotely execute malicious code and take full control of devices, access sensitive data or alter configurations in impacted devices.

The Axeda solution enables device manufacturers to remotely access and manage connected devices. The affected agent is most popular in healthcare but is also present in other industries, such as financial services and manufacturing. A detailed list of 150+ potentially affected devices from 100+ vendors highlights the significance of the vulnerabilities. The list contains several medical imaging and laboratory devices.

Related: IoT-enabled devices: Transforming healthcare and supporting claims prevention

IoT devices use a wide variety of operating systems, hardware and software. Typically, IoT manufacturers do not allow customers to install software, including security agents, on their devices. In the case of Access:7, PTC depends on IoT manufacturers to install the Axeda agent before their IoT devices are sold to customers in what is typically called an original equipment manufacturer (OEM) approach.

The table below shows the newly discovered vulnerabilities. Rows are colored according to the CVSS score: yellow for medium or high and red for critical.

CVE ID	Description	Potential Impact	CVSSv3.1 Score
CVE-2022-25249	The Axeda xGate.exe agent allows for unrestricted file system read access via a directory traversal on its web server.	Information disclosure	7.5
CVE-2022-25250	The Axeda xGate.exe agent can be shut down remotely by an unauthenticated attacker via an undocumented command.	DoS	7.5
CVE-2022-25251	The Axeda xGate.exe agent supports a set of unauthenticated commands to retrieve information about a device and modify the agent’s configuration.	RCE	9.4
CVE-2022-25246	The AxedaDesktopServer.exe service uses hard-coded credentials to enable full remote control of a device.	RCE	9.8
CVE-2022-25248	The ERemoteServer.exe service exposes a live event text log to unauthenticated attackers.	Information disclosure	5.3
CVE-2022-25247	The ERemoteServer.exe service allows for full file-system access and remote code execution.	RCE	9.8
CVE-2022-25252	All Axeda services using xBase39.dll can be crashed due to a buffer overflow when processing requests.	DoS	7.5

Related: IoT is the future of healthcare

All versions of the Axeda Agent below 6.9.3 are affected, and Axeda has released patches for all the vulnerabilities. More details about the vulnerabilities and their exploitation are available in this technical report.

Impact of Access:7 supply chain vulnerabilities on IoT devices

Forescout has populated a list of more than 100 vendors and 150 devices that use the Axeda solution. Using anonymised customer data in the Vedere Labs Global Cyber Intelligence Dashboard, more than 2,000 unique devices running Axeda on their networks were seen. By examining these sources, the potential impact of the vulnerabilities could be learned.

The figure below illustrates the distribution of vendors in the Forescout device lake that use Axeda. More than one-half of those (55 per cent) belong to the healthcare industry, followed by almost one-quarter (24 per cent ) developing IoT solutions.

From a device deployment perspective, again there is more than one-half (54 per cent) of the customers with devices running Axeda are in the healthcare sector.

The figure below illustrates the distribution of medical device types running Axeda. The agent was found to be more popular in imaging (36 per cent) and lab (31 per cent) machines than in any other type.

Axeda was developed as a cloud platform for IoT devices; therefore, it is found in a variety of applications beyond healthcare. Vulnerable devices used in other industries include ATMs, vending machines, cash management systems, label printers, barcode scanning systems, SCADA systems, asset monitoring and tracking solutions, IoT gateways and machines such as industrial cutters.

Access:7 mitigation recommendations for network operators

Complete protection against Access:7 requires patching devices running the vulnerable versions of the Axeda components. PTC has released its official patches, and device manufacturers using this software should provide their own updates to customers.

In the technical report, mitigation strategies for device manufacturers is discussed. For network operators, the following is recommended:

1. Discover and inventory devices running Axeda. A constantly update list of affected device models can be found here.
2. Enforce segmentation controls and proper network hygiene to mitigate the risk from vulnerable devices. Restrict external communication paths and isolate or contain vulnerable devices in zones if they cannot be patched or until they can be patched. In particular, consider blocking one or more of the vulnerable ports listed below for use on any of the affected devices in your organisation. The port numbers are listed with their default values; however, they may be configured differently by manufacturers.

CVE	Port Numbers	Description
CVE-2022-25249	56120, 56130	Web server of main agent service
CVE-2022-25250	3011	Main agent service shutdown signal
CVE-2022-25251	3031	Main agent service configuration
CVE-2022-25246	5920, 5820	VNC agent
CVE-2022-25248	3077	Event log used in deployment configuration
CVE-2022-25247	3076	Code execution and filesystem access used in deployment configuration

3. Monitor progressive patches released by affected device manufacturers and devise a remediation plan for your vulnerable asset inventory, balancing business risk and business continuity requirements.
4. Monitor all network traffic for malicious packets that try to exploit these vulnerabilities. Block known malicious traffic or at least alert network operators of its presence.

How Forescout can help

With the recent acquisition of CyberMDX, Forescout healthcare customers can use CyberMDX’s solution to identify vulnerable medical and IoT devices. The solution automatically detects the medical assets within your network and organises them in an accessible inventory listing. Assets affected by Access:7 will appear in the Vulnerabilities Cyber Risks screen. Using the CyberMDX Control Center, customers can also track the number of affected devices and follow the progress of remediation.

The Forescout platform also protects against Access:7 vulnerabilities as follows:

eyeSight uses the Security Policy Templates (SPTs) module to identify and group vulnerable and potentially vulnerable devices. A new version of the SPT package, which can identify devices vulnerable to Access:7, can be downloaded here.

eyeInspect uses a new Access:7 Monitor script to identify vulnerable devices and detect exploitation attempts against them. The figure below shows the alert raised by eyeInspect when it detects an exploitation attempt against CVE-2022-25247.

Access:7 security advisories

Find up-to-date information about impacted vendors and devices on the following links:

• PTC advisory
• CyberMDX page
• ICS-CERT advisory 

When we think of pioneering solutions with the potential to save lives, resource optimisation and capacity building may not be the first areas of healthcare that come to mind. But the past three years have drawn much attention to the role of organisational efficiencies in keeping patients alive. In fact, with the right tools and technology in place, admin saves lives.

The pandemic stretched the healthcare sector across the Middle and Africa (MEA) beyond its limited capacity. As things stood before 2020, it was estimated that 400 million people in Africa had little or no access to healthcare. Similarly, more than 57 million people in the Middle East and North Africa (MENA) needed humanitarian assistance before COVID-19 even began.

Related: Why data should fuel healthcare for all

There is a great disparity in terms of how different countries in MEA have been able to cope during the crisis, with many nations challenged by a lack of hospital beds. In some instances, hospitals were unable to provide patients with the necessary care due to shortages in resources such as oxygen, resulting in devastating consequences.

But this is where data has a powerful role to play in transforming healthcare delivery.

Related: How post-COVID radiology will be shaped by data-driven insights powered by AI

Forward-looking companies can use data to enhance and optimise clinical, operational, and administrative efficiencies. By introducing AI and machine learning algorithms, they can predict patient flow for the coming month or week. This not only helps them foresee and prepare their capacity for peak periods, but also allows them to predict times when they are able to relieve their resources.

Planning around the unpredictable

Data-driven solutions are a game-changer, not just for hospitals, but for companies across the sector, including healthcare providers, payors, pharmaceutical companies and especially the supply chain.

Laboratories, for example, must enable complex materials handling, tracking and pricing for thousands of items. As patients’ lives may depend on their ability to test and deliver results quickly and efficiently, their support systems need to deliver the ability to order at the right price from the right organisation, receive stock into warehouses, and they must enable batch tracking and expiry date tracking in real time.

Mohammed Saleh, Health and Life Sciences Regional Lead at Microsoft Middle East & Africa

 

To cope with this level of complexity in supply chain management, Lancet Laboratories in South Africa migrated to Dynamics 365. Even amidst the unplanned increase in demand for the company’s services during the early months of the pandemic, the supply chain flexed and functioned as intended, accommodating sudden shifts in procurement, new demands on timelines, and the need for increased stock levels.  

And the good news is that healthcare companies already have the huge amounts of data needed to drive such solutions. Combined with the right tools and platforms, the wealth of data they possess can help the healthcare sector solve many of the other trials brought to the fore by the pandemic – and not only challenges in operational efficiency, but in clinical efficiency as well.

Improving access and outcomes

If a patient needs to undergo an X-ray or CT scan, for example, they will have it done at the nearest hospital. Thereafter, the assisting technician will wait on a radiologist to come to the hospital and read the image to make a diagnosis.

Through the practice of teleradiology, however, a radiologist from any location can examine the image and create their diagnosis in a digital format without physically having to travel. This creates a significant timesaving for the specialist who would otherwise need to commute between one or many hospitals. And they can use the time saved to make a greater number of diagnoses.  

Thanks to telemedicine, a much broader pool of patients in the region can access a higher quality of healthcare more easily.   

In South Africa for example, healthcare companies are increasingly using HoloLens 2 to facilitate remote consultations between experts and the healthcare sector. By enabling the physical and digital worlds to co-exist and interact in real time, the mixed reality solution is unlocking significant opportunity for companies to augment the jobs of first-line employees.

Solutions such as health bots are also enabling patients to access expertise in everything from diagnosis, to triage and symptom-checking, as well as general medical information and recommendations. In the midst of the pandemic, UAE-based health insurance company, Daman, collaborated with Microsoft to deploy the Daman Health Bot. The AI-powered tool is a great example of a solution that assists patients to conduct self-assessment on symptoms and guide them to the appropriate level of care.

During COVID-19, the ability to merge different tools and platforms helped many healthcare companies like Daman reimagine their operations overnight. And the technology required to respond with this level of adaptability is becoming increasingly sophisticated. In fact, it was just recently that Microsoft Cloud for Healthcare was launched, bringing together all Microsoft’s tools, technology and platforms, from templates to accelerators, machine learning, AI, and beyond, into one industry-tailored solution.

The last three years have dramatically accelerated the urgency of existing healthcare challenges in MEA, whether it be the ability to provide distributive delivery of care, real-time-from-anywhere access, or healthcare across any device. But the pandemic also catalysed a lasting change in the way healthcare companies respond to these challenges by drawing on data.  

The data available to healthcare companies is infinite. And the question is no longer “why” data – but how to gather, store and make sense of data in a way that creates value quickly, drives innovation and, ultimately, saves lives.