Interview: Raising the Access Bar
January 20, 2022
Fast, agile and shock-proof: Carlene Todd believes Canada’s healthcare system can get there
An overarching vision inspires Carlene Todd, Vice President of Access at Roche Canada: helping patients access the right medicines in the right place at the right time. She and her colleagues at Roche work toward this objective by engaging multiple stakeholders to improve the reimbursement and funding process. A native of New Zealand and also an Australian citizen, Carlene led the Market Access & Public Policy team at Roche Australia from 2012 to 2019. She is also a member of the recently created Resilient Healthcare Coalition. In this chat, Carlene shares some details about the Coalition’s vision and her own.
What prompted the creation of the Resilient Healthcare Coalition?
Like most countries, we discovered that our healthcare system has fault lines that can crack in an emergency like Covid-19. It’s this insight that led to the formation of the Coalition, which seeks to achieve a faster, nimbler, and more shock-absorbent health system.
What do you see as the goal of the Coalition’s mandate letter?
The RHC drafted the mandate letter as inspiration for Prime Minister Justin Trudeau to use as he develops the mandates for his cabinet ministers. We addressed the letter to both the Ministers of Health and of Innovation, Science, and Industry to capture the kind of bold, compelling, and essential policy recommendations that can only be established through the collaborative efforts of both Ministers.
Can you tell us a bit about the content of the letter?
We’ve been bold, as we strongly believe Canada can become a leader in sustainable and resilient healthcare systems. The letter starts by outlining two objectives: optimizing the use of health data to inform coordinated and integrated healthcare decisions, and enhancing access to innovative health technologies, which include vaccines, diagnostics, therapeutics, medical devices, and digital health technologies. The letter then goes on to describe five key priorities that we believe the federal government must address to protect both our health and our economy.
Do you think the Government of Canada will be receptive to this message?
I’m very hopeful, yes. As it happens, the letter aligns quite closely with the mandate letter that Prime Minister Trudeau sent to his new minister of Health, Duclos, in December 2021.36 Just like the RHC mandate letter, this mandate letter encourages Minister Duclos to increase investment in research, to expand virtual care in the service of equitable access, to harness the full potential of data and digital systems, and to work toward an integrated and human-centered health strategy across the country. It's encouraging that multiple stakeholders are speaking the same language.
Can you expand a little on the goal of reducing the time between innovation and access?
It’s about removing unnecessary duplication and creating a coordinated, synchronized regulatory framework that ensures patients are not left waiting. There's an opportunity for improvement: as of 2020-2021, the average time between submission to the Canadian Agency for Drugs and Technologies in Health (CADTH) and provincial funding is 598 days for oncology drugs and 822 days for non-oncology drugs.37 The delay is almost twice as long as the median for OECD countries and about three times longer than in Germany and the UK.38 We can learn from other countries that have shorter durations and explore how their models could translate to the Canadian environment.
And it’s not just about lowering the average time to access in Canada: we also need to make it more equitable, regardless of where you live in the country. Currently, the average time to listing varies by hundreds of days across the provinces—and in some provinces, certain medicines aren’t funded at all. This has to change.
What actions would you like to see the Canadian government take to build our national health data capacity?
The country has an opportunity to create pathways for the standardization, integration, and use of healthcare data to optimize patient care and create more efficient and resilient health systems. As a first step, the federal government needs to work with the provinces to streamline siloed data systems. In order to move forward with an enduring health data strategy, we will need to build trust by creating a sense of shared purpose supported by transparency across the public and private sectors.
How can we ensure the lessons from Covid-19 are not temporary?
Stakeholders across the country must make a shared commitment to health as an investment toward a thriving community and economy, rather than viewing health as a cost. This investment happens through increased funding in appropriate technologies and health system capacity, better access to health data to support clinical decisions, and greater support for commercialization of innovations. We have devoted a lot of effort to Covid research over the past couple of years, and for good reason. At the same time, we must invest in a number of different medical conditions to avoid pandemics in other therapeutic areas, such as cancer.
What does effective collaboration look like to you?
The pandemic has shown us the importance of working beyond borders to avoid duplication and bring the best minds, capabilities, and skills together. In fact, countries such as Australia, New Zealand, the UK, and Canada are working together to solve complex healthcare problems. Addressing health system-level challenges requires this level of collaboration to effect real change.
Collaboration also means including the patient community and caregiver voice. The principle of “nothing about me without me” captures the centrality of the patient voice. Having different voices at the table enables us to create shared and meaningful goals, with everyone bringing different skill sets to the effort. I describe this as converging on outcomes while diverging on activities.
“The principle of ‘nothing about me without me’ captures the centrality of the patient voice.”
If you could transport yourself a year into the future, what system-level improvements would you hope to see?
I would hope to see the federal government taking the lead in disseminating the Coalition’s five key priorities to the provinces and territories. I would hope to discover that Canada’s recently created Biomanufacturing and Life Sciences strategy is being implemented, with clarity on commitments and accountabilities. I would also like to see expansion of the pan-Canadian Health Data Strategy, with federal and provincial governments working closely with other stakeholders. I would like to see industry, patients, government, and researchers sitting at the table in an ongoing dialogue and decisions about shared priorities. On a more granular level, I would hope to see various programs that reveal what works and what doesn’t, so we can iterate and adapt. In terms of metrics, I would like to see evidence that the timeline to access has decreased. Perhaps most importantly, seeing ‘health in all policies’—an acknowledgement of the socioeconomic determinants of health—would tell me we’re headed toward long-term success. Like most things in life, health doesn’t happen in isolation, but connects with the other threads of our social fabric.
RESILIENT HEALTHCARE COALITION’S JOINT MANDATE LETTER: KEY PRIORITIES16
1. Ensuring equitable access to a broad spectrum of vaccines and related treatments: Canada must develop a world-class vaccine evaluation body and the infrastructure for the efficient delivery of routine and emergency vaccinations.
2. Closing the health research gap: Canada’s excellent scientists must be better resourced to fill the research voids that have widened over the past two years.
3. Expand the pan-Canadian health data strategy: health data must be gathered more effectively and efficiently to better connect treatments with outcomes.
4. Reduce the time to bring innovation to patients: models that shorten the time between regulatory submission and clinical use of new technologies must be identified and implemented.
5. Ensure Canadians have full access to revolutionary healthcare tools such as comprehensive genomic profiling: provinces and territories must be funded to broaden access to innovative technologies and their companion diagnostics.
References
16 - Joint mandate letter drafted by the Resilient Healthcare Coalition. Oct. 28, 2021. https://static1.squarespace.com/static/600f391a99309024c056ab8a/t/617a09a50819a566b3bc2247/16353878133
36 - Prime Minister of Canada. Minister of Health mandate letter. Dec. 16, 2021. https://pm.gc.ca/en/mandate-letters/2021/12/16/minister-health-mandate-letter
37 - MORSE Consulting, Canadian Reimbursement & Forecasting Timelines Report, 2021 Edition.
38 - Hoskin SL. Explaining public reimbursement delays for new medicines for Canadian patients. Innovative Medicines Canada. http://innovativemedicines.ca/wp-content/uploads/2020/07/CADTH-TTL-8.5x11-EN-Final.pdf