Over time, it becomes evident that the decisions made in boardrooms carry their greatest weight in those very moments. It would take years to understand it fully, but these moments were not isolated. They were the foundation for something I would later try to give voice to.

The Day the Ordinary Disappeared

In January 1975, I was traveling through Paris on my way to the United States. What should have been a routine journey became something else entirely. Terrorists fired two RPG shells at our plane. They missed us but struck a Yugoslav Airlines JAT aircraft on the tarmac nearby.

The randomness of it all was almost impossible to process. One moment, you are a traveler moving through the world, the next, you are told to hug the floor of the aircraft, confronted with how easily that world can be altered or taken away. I did not have the language for it then; however, I carried the feeling forward. Life is not guaranteed. It is a gift given to us to deploy.

In 1978, I was leading the first Think Tank Peace Mission to Egypt and Israel. There were no direct flights between the two countries. From Cairo, we flew to Cyprus, then to Tel Aviv.

An Air Cyprus flight had landed just before ours. It was overtaken by terrorists. An Egyptian Entebbe-like rescue was attempted. It failed. When we landed hours later, the aftermath was still there — the remains of the Egyptian military C-130 sat on the tarmac, destroyed and covered. It reinforces the adage, “that timing is everything.”

You do not process it fully in the moment. You carry it. An appreciation for what lies beyond our control. A respect for those who act with purpose, regardless of outcome. An understanding that we plan for the future, yet we live in the moment.

Years later, during my military service as a paratrooper and combat medic, that lesson was no longer abstract. It was immediate, urgent and often unfolding before me. I served six frontline combat tours in Lebanon, in places where the noise of conflict was constant and the margin between survival and loss was measured in inches.

I tended to friends and foes under fire. In those moments, there was no room for theory. Care was not a matter of courage or a concept; it was an instinctive action. Communication was not a strategy; it was survival. A word, a look, a clear instruction could steady someone, guide them and save them.

Where Care Is Action, Not Theory

War has a way of stripping away everything except what matters most. You see clearly how dependent we are on one another. You understand that courage is not the absence of fear; it is the determination to act despite it. You learn that presence, simply being there for another person in their most vulnerable moment, is one of the most powerful forms of care.

I thought I understood risk. I thought I had come to terms with uncertainty. Then life reminded me again.

On a flight to visit my parents in the United States, the Tower Air jet I was on caught fire over the Atlantic. Two engines on the left side were burning. We needed to find a place to land quickly or hit the ocean. There is a particular kind of silence that fills a plane in that moment. It is not panic. It is something deeper, more introspective. You feel time stretch. You think about the people you love. You consider what has mattered and what has not.

As we made our emergency landing in Gander, Canada, I remember not relief first, but reflection. Once again, life had placed me in a moment where its fragility was undeniable.

These experiences did not turn me away from the world. They pulled me closer to it. They shaped how I see people, how I listen and how I respond. They taught me that every interaction carries weight, that every conversation can matter more than we realize.

In recent years, I have traveled to Ukraine annually before and during COVID and now during the war, supporting friends and spending time in a small community facing circumstances most of us can only imagine from afar. There, I saw the same truths I had encountered earlier in life. Community becomes everything. Information becomes lifeblood. People look to one another not only for physical support, but for clarity, reassurance and meaning. Even in the darkest conditions, communication is not secondary to care. It is part of care.

Most in the business world know me through my work at FINN Partners as a health communicator, through my writing, speaking and advocacy as a champion of health innovation and a more human-centered health system. They see my professional journey. What they do not always see is the foundation beneath it. Decades of lived experience that have reinforced, time and again, that life is precious, that it can change in an instant and that how we show up for one another in those moments defines us.

At FINN Partners, I have found a community of colleagues who reflect these same values. There is an understanding that our work carries responsibility, and that we are capable of more when we challenge ourselves to rise to it. It is a culture that encourages each of us to think beyond the immediate and contribute to something more enduring.

That understanding became even more personal through my family. My wife and I have walked alongside our child as she navigates the complexities of a rare disease. There are highs and there are lows. There are moments of hope and moments of uncertainty. In those experiences, I have seen health care from another vantage point, not as a cohesive system, but as a series of human interactions that can either comfort or compound the challenge.

When you are a parent in those moments, you listen differently. You look for clarity in every word. You hold on to empathy when it is offered and you feel its absence when it is not. You come to appreciate that communication in health is not an accessory. It is essential. It shapes understanding, trust and the ability to move forward.

The Human Thread Through Every Moment

All of these experiences converge into a single, enduring belief. Communication is not separate from care. It is how care travels along its continuum. There are moments when that truth reveals itself outside the settings we expect.

On a transatlantic flight in 2001, turbulence turned severe. At one point, a call came over the intercom: “Are there any doctors aboard?” No one responded. Minutes later, the request broadened to “any health professionals.”

My wife looked at me and quietly suggested I press the call button.

I was escorted to a passenger, pale and wrapped in a blanket. He had lost and regained consciousness. I introduced myself warmly and began with simple questions to assess his awareness. His name. The President of the United States. The day we had taken off. He answered each one without hesitation. His vitals were stable.

I explained that I was not a physician, but a former military EMT. Given the turbulence and the length of the flight, dehydration and stress were likely contributors. I reassured him and suggested that he follow up with his physician upon landing and, if he needed me, not to hesitate to hit his call button.

As I returned to my seat, a man two rows behind called out, “I’m a neurologist. I would have handled that exactly as you did.”

It was meant as an affirmation. I received it that way. Yet it lingers differently. In that moment, the instinct to act had been replaced by the comfort of waiting. The systems we build, even when grounded in expertise, can condition us to hesitate when action is needed most.

In moments like these, care is not a title or a credential. It is the willingness to engage, communicate, and act.

Across the health ecosystem and in responsible business settings, success is often measured by growth, scale and financial performance. These are necessary markers of progress. They enable innovation, access and reach. However, there is a deeper measure that often goes unspoken. When we understand our role within the continuum of care and recognize the connection between balance-sheet decisions made in boardrooms and people’s experiences felt at the bedside, our work takes on greater meaning. It moves beyond what can be counted to what ultimately counts.

Over time, I came to understand that moments are not separate. They are connected. Each one revealing, in its own way, what happens when people are seen, heard and cared for, and what happens when they are not.

That understanding became Healing the Sick Care System: Why People Matter.

A life of observing, listening, engaging and caring was the kindling. The moments themselves were the spark. Together, they revealed a simple truth: when we lose sight of people, the system falters. When we honor them, it begins to heal.

That truth asks something of us.

It is not simply about words. It is about presence. It is about accountability. It is about the choice to act when action is needed. This is how humanity shows up in systems, and how those systems, in turn, earn the trust of the people they are meant to serve.

The post The Moments That Shape Us: Why Life and People Matter Most appeared first on Medika Life.

Perhaps we should not have been surprised. He was always on the go, ate healthy meals, never smoked, and enjoyed being with friends.

He always seemed calm and collected, so on his 101st birthday, I asked how he had managed his stresses — his ship, the Canberra, was torpedoed during WWII with the loss of many of his buddies, and he was nearly killed. He had lost his daughter to cancer when she was forty, and his wife to cancer when she was 67. Yes, he had grieved greatly, but somehow, he was resilient and came back strong each time. He had been very sad but lived through his grief and always appeared unperturbed. “Well,” he said, “I guess I just let stress roll off my back.”

Organs decline about 1% per year.

One of the most important things that happens with aging, sort of like a car, “old parts wear out.” Most organ functions decline by about one percent per year. Of course, there is great variation from person to person, year to year, organ to organ, but 1% is a pretty good average to consider. We usually think of a person being in their prime through at least age 60. In many ways, that is correct, but you may be surprised to learn that the 1% decline starts in early adulthood and continues throughout life, speeding up as we age. Fortunately, most of our organs have significant redundancy so that we can tolerate these declines without any appreciable impact. But eventually, the decline may get to the point where we have a functional impairment that can be serious or at least impair our day-to-day activities.

I recently turned 84. I don’t feel “old,” but I do know I can’t do everything I used to do, or at least not as quickly. My hearing is less; my vision is reduced. My muscle mass and strength are definitely much less than they were in the recent past. My balance is OK, but not as good as it used to be, and so on. It has been a set of changes that came slowly at first but are now progressing faster. I always enjoyed splitting wood for the fireplace. I kept a woodshed filled with wood split and logs drying for a year before splitting. As time went on, I realized that I couldn’t keep at it for as long before wanting to take a break. As one friend in his early 80s told me, “I was fine until about age 78, and then it seemed that the aging process was suddenly there and moving fast.” Those declines, developing “under the radar” for decades, had accelerated and become overt.

The 1% Per Year Decline, Author’s image

Hearing decline begins at about age 25 but is not noticed until much later. Many of you will need reading glasses by age 40, even though you have had excellent vision for years; cataracts may occur later. Balance starts its inevitable decline early, although it, too, will not be noticed until much later. Meanwhile, internal organs, including the heart, lungs, and kidneys, are slowly declining, and so too is brain function, especially cognition.

This normal aging process of old parts wearing out is universal and is progressive, but you can slow it and sometimes reverse it, at least partially. Let’s use bone mineral density (BMD) as an example. BMD is easily measured to demonstrate the sturdiness of our bones — how strong they are. We start life with cartilage rather than bones. As we grow from toddlers to children to teenagers, calcium and other minerals, along with a protein-collagen matrix, are laid down in our bones, and they become increasingly strong, reaching a peak around the age of twenty. Once that age and that peak are reached, it can’t go up any further — that’s it. Then there is a plateau, and at about age thirty to forty it starts to decline at a rate of about 1% per year. At age twenty, men’s bone mineral density is, on average, higher than women’s.

Nevertheless, for women as for men, the decline is about one percent per year. Menopause changes this; the rate of loss increases to perhaps three percent per year for a few years and then returns to the one percent average decline until reaching osteopenia and then osteoporosis. There are three important points to consider. If you live long enough, your bone mineral density will decline to a level where, if you fall, a bone fracture becomes more likely. Since women start at a lower level and because they have this increased loss of BMD during menopause, they’ll reach that fracture threshold in life earlier than men. Since women tend to live longer than men, in total, more women than men will have a fracture at some point in their lives. We might just say this is one of the risks of living longer.

But why will you fall? Because your balance mechanism is likewise declining, and your muscle mass and strength are not as capable of “catching” your fall. The three combine together in a very negative manner!

Muscle mass and strength decline in a similar fashion, resulting in what doctors call sarcopenia. Most people lose perhaps 30% of their muscle mass between ages 50 and 70, and the loss continues at an even faster rate thereafter. Older individuals who exercise find it takes more effort to maintain their muscle mass and strength, but regular exercise and good nutrition have a significant beneficial impact and slow the process considerably.

Cognitive function is another example; your brain loses some of its abilities as you age. Cognitive abilities and brain volume do not decline in lockstep but do have a clear relationship. A fascinating study published in the journal Nature in April 2022, pulled together 123,984 MRI scans taken at over 100 institutions from 101,457 individuals ranging from 115 days post-conception to 100 years of age — from fetuses to centenarians. At the age of three years, the brain had reached 80% of its maximum size. The gray matter, which consists of the actual brain cells, reaches its maximum by about age 6, whereas the white matter, the inner connections between brain cells, does not reach its peak until the late 20s. The decline in brain volume thereafter is slow but accelerates after about age 50. These changes can be seen in the figure, which shows the growth trajectories of gray and white matter. The charts show volume (in mm3) across age, beginning before birth and ending at about 100 years.

If you are over 65, you have probably noted that you can’t memorize as well, recall names as quickly, etc. When I was in medical school, memorization was relatively easy; not so today! This is normal. This loss of cognitive function over time should not be confused with the disease Alzheimer’s. Nearly everyone who lives long enough will suffer from some cognitive decline, but only some will develop Alzheimer’s. As with BMD, you reach your peak cognitive function around age twenty; it plateaus for about 10 years, then starts that slow decline. Given the great redundancy in your brain, it is not noticeable for some time. Eventually, you reach a functional threshold where your cognitive function begins to impair your ability. This becomes more apparent when an older person is engaged in highly technical activities, very fast-paced activities, or stressful situations (emotional, physical, or health-related). Those cognitive challenges are less apparent in highly familiar situations.

This 1% annual loss is normal. No, it is not an exact number, nor is it the same for every person or every organ, nor is it exactly 1% in the same person at all times. But 1% is a good proxy for what is happening throughout your body throughout adulthood and into your elder years.

Slowing the aging losses

Here are some suggestions to slow that steady decline in functions. If you start at age twenty with very strong bones (i.e., a high BMD), then you have a longer way to go down before reaching that level of potential bone fracture from a fall. Perhaps too late for you if you are older, but encourage your children and grandchildren to eat a good diet, play/exercise daily, preferably outdoors, manage their stress, and get a good night’s sleep. And for their brains, do just the same (quality food, plenty of exercise, sound sleep, and managed stress) as for their other organs. Then, continually challenge their brains with new learning. Those with more years of schooling will start out with greater reserves, so the 1% decline will take much longer to cause difficulties. Muscle mass and strength are similar. Encourage them to build it up now as a teen. No need to be a muscled bodybuilder, but regular exercise and a good diet will mean more strength at the start of that long decline.

Most people seem to accept that, with age, comes a decline in function. “That is just what happens when we get older.” They may not like it, but they do not realize that they can substantially modify the downhill course. You can slow this continuing loss of body functions, including cognitive decline, and you can start at any age. It is never too late. It is not hard to do, and it does not cost money, but it does take time and persistence. It is all about how you move, what you eat, how you manage chronic stress, get adequate sleep, avoid tobacco, not too much alcohol, plus challenge your brain and keep socially engaged.

Stephen C Schimpff, MD, MACP, is a quasi-retired internist, professor of medicine, former CEO of the University of Maryland Medical Center, and author of Longevity Decoded — The 7 Keys to Healthy Aging, and is co-author with Dr. Harry Oken of BOOM — Boost Our Own Metabolism

The post Normal Aging — A Steady Decline in Organ Size and Functions appeared first on Medika Life.

Suicide remains one of the leading causes of death in the United States, with young people particularly affected. These are not abstract figures. Each life lost represents a story interrupted, a family altered, and a community left to navigate grief and unanswered questions. Public health requires that we confront this reality not only with data, but with a commitment to building systems that respond to human experience in real time.

From Fragmentation to Continuity Across the Lifespan

For many years, suicide prevention in the United States has been shaped by dedicated organizations working across research, advocacy, education, and crisis response. The American Foundation for Suicide Prevention has played a central role in advancing scientific understanding, funding critical research, and advocating for national policy changes that recognize suicide as a preventable public health issue. Its work has helped elevate awareness, influence legislation, and bring suicide prevention into mainstream health conversations.

The Jed Foundation has taken a complementary path, focusing on upstream prevention by strengthening emotional health among adolescents and young adults. Through partnerships with high schools, colleges, and universities, JED has worked to embed mental health support within the environments where young people live and learn. Its programs have helped institutions move beyond reactive approaches toward more proactive models that build resilience, identify risk earlier, and foster a sense of belonging.

Each organization has demonstrated meaningful impact over time. Each has contributed to saving lives and shaping how mental health is understood. Their efforts, however, have largely operated within distinct domains. One has advanced national research and advocacy. The other has transformed youth and campus mental health systems. Both have addressed critical points along the continuum of care, yet the broader system has remained fragmented.

The decision to merge as equals reflects a recognition that suicide prevention cannot be addressed in silos. Public health challenges of this magnitude require continuity across the lifespan. Early emotional support, community-based intervention, crisis response, and long-term recovery must function as part of an integrated system rather than a series of disconnected efforts.

Connection, Not Scale Alone, Defines Public Health Impact

Public health is often described through infrastructure and policy. Those elements are essential, yet they are insufficient on their own. Public health is ultimately about connection. It connects evidence to action, systems to individuals, and care to lived experience.

Suicide prevention sits at the intersection of these connections. Risk is influenced by social conditions, access to care, stigma, and the environments in which people interact. Protective factors such as trusted relationships, purpose, and community support can alter outcomes when they are present and accessible. The challenge has not been a lack of understanding. The challenge has been delivering that understanding in ways that are coordinated, equitable, and sustained.

A unified organization has the potential to bridge long-standing gaps. It can align research with real-world application, ensuring that scientific insights inform programs that reach people earlier. It can connect youth-focused interventions with broader public awareness efforts, creating continuity rather than gaps as individuals move through different life stages. It can also strengthen advocacy by bringing together complementary perspectives into a more cohesive national voice.

Scale introduces both opportunity and responsibility. A larger organization can mobilize resources, influence policy, and expand reach. Public trust, however, is built in local and personal interactions. The effectiveness of this merger will depend on its ability to maintain proximity to individuals and communities while expanding its national impact. Size alone does not create connection. Intentional design does.

The combined organization is expected to operate with substantial resources, which creates an opportunity to accelerate progress. Resources must translate into accessible programs, stronger partnerships with schools and health systems, and tools that enable families, educators, and clinicians to act with confidence. Public health systems succeed when they reduce friction for those seeking help and make support visible before a crisis emerges.

This moment also offers a broader lesson for the health sector. Fragmentation is not unique to suicide prevention. Across chronic disease, health equity, and digital health, organizations often operate with shared purpose but limited alignment. The willingness of these two organizations to merge reflects an understanding that structural change may be necessary to achieve meaningful outcomes.

The integration process will require thoughtful leadership and a clear sense of purpose. Combining cultures, programs, and strategies requires discipline and humility. Success will not be measured by organizational scale or visibility. It will be measured by whether fewer individuals reach a point of crisis without support and whether more people experience a system that feels connected, responsive, and human.

Suicide is often described as preventable, which places responsibility on the systems designed to address it. Prevention requires more than awareness. It requires intentional coordination, early recognition, and sustained engagement across the continuum of care.

This merger does not resolve the complexity of suicide prevention. No single organization can. It does represent a meaningful step toward greater alignment in how society responds to one of its most pressing public health challenges. Connection is not an abstract ideal in public health. It is the foundation upon which progress depends.

For more information about both organizations, visit these organizations’ websites at afsp.org and jedfoundation.org. 

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This story also ran on NBC News. See below.

West Virginia’s Public Employees Insurance Agency enrolls nearly 215,000 people — state workers, as well as their spouses and dependents. The new law, which will take effect June 10, will allow plan members who have been approved for a course of treatment to pursue an alternative, medically appropriate treatment of equal or lesser value without the need for another approval from the state-based health plan.

“This legislation is rooted in a simple principle: if a treatment has already been approved, patients should be able to pursue a medically appropriate alternative without being forced to start the process over again — especially when it does not cost more,” Gov. Patrick Morrisey said in a statement after signing the bill into law on March 31.

“This is about common sense, compassion, and trusting patients and their doctors to make the best decisions for their care,” he said.

Delegate Laura Kimble, the Republican from Harrison County who introduced the legislation, told KFF Health News the measure offers “a rational solution” for patients facing “the most irrational and chaotic time of their lives.”

From Arizona to Rhode Island, at least half of all state legislatures have taken up bills this year related to prior authorization, a process that requires patients or their medical team to seek approval from an insurer before proceeding with care. These state efforts come as patients across the country await relief from prior authorization hurdles, as promised by dozens of major health insurers in a pledge announced by the Trump administration last year.

The West Virginia law was inspired by Eric Tennant, a coal-mining safety instructor from Bridgeport who died on Sept. 17 at age 58. In early 2025, the Public Employees Insurance Agency repeatedly denied him coverage of a $50,000 noninvasive cancer treatment, called histotripsy, that would have used ultrasound waves to target, and potentially shrink, the largest tumor in his liver. His family didn’t expect the procedure to eradicate the cancer, but they hoped it would buy him more time and improve his quality of life. The insurer said the procedure wasn’t medically necessary and that it was considered “experimental and investigational.”

Related coverage

After Series of Denials, His Insurer Approved Doctor-Recommended Cancer Care. It Was Too Late.

Eric Tennant’s doctors recommended histotripsy, which would target, and potentially destroy, a cancerous tumor in his liver. But by the time his insurer approved the treatment, Tennant was no longer considered a good candidate. He died in September. Read More

Becky Tennant, Eric’s widow, told members of a West Virginia House committee in late February that she submitted medical records, expert opinions, and data as part of several attempts to appeal the denial. She also reached out to “almost every one of our state representatives,” asking for help.

Nothing worked, she told lawmakers, until KFF Health News and NBC News got involved and posed questions to the Public Employees Insurance Agency about Eric’s case. Only then did the insurer reverse its decision and approve histotripsy, Tennant said.

“But by then, the delay had already done its damage,” she said.

Within one week of the reversal in late May, Eric Tennant was hospitalized. His health continued to decline, and by midsummer he was no longer considered a suitable candidate for the procedure. “The insurance company’s decision did not simply delay care. It closed doors,” his wife said.

Had the new law been in effect, Kimble said, Tennant could have undergone histotripsy without preapproval, because it was a less expensive alternative to chemotherapy, which his insurer had already authorized. The bill was passed unanimously by the state legislature in March.

U.S. health insurers argue that most prior authorization requests are quickly, if not instantly, approved. AHIP, the health insurance industry trade group, says prior authorization acts as an important guardrail in preventing potential harm to patients and reducing unnecessary health care costs. But denials and delays tend to affect patients who need expensive, time-sensitive care, studies have shown.

The practice has come under intense scrutiny in recent years, particularly after the fatal shooting of a health insurance executive in New York City in late 2024. Americans rank prior authorization as their biggest burden when it comes to getting health care, according to a poll published in February by KFF, a health information nonprofit that includes KFF Health News.

Samantha Knapp, a spokesperson for the West Virginia Department of Administration, would not answer questions about the law’s financial impact on the state. “We prefer to avoid any speculation at this time regarding potential impact or actions,” Knapp said.

In a fiscal note attached to the bill, Jason Haught, the Public Employees Insurance Agency’s chief financial officer, said the law would cost the agency an estimated $13 million annually and “cause member disruption.”

West Virginia isn’t an outlier in targeting prior authorization. By late 2025, 48 other states, in addition to the District of Columbia and Puerto Rico, already had some form of a prior authorization law — or laws — on the books, according to a report published in December by the National Association of Insurance Commissioners.

Many states have set up “gold carding” programs, which allow physicians with a track record of approvals to bypass prior authorization requirements. Some states establish a maximum number of days insurance companies are allowed to respond to requests, while others prohibit insurance companies from issuing retrospective denials after a service has already been preauthorized. There are also a crop of new state laws seeking to regulate the use of artificial intelligence in prior authorization decision-making.

Meanwhile, prior authorization bills introduced this year across the country, including in Kentucky, Missouri, and New Jersey, have been supported by politicians from both parties.

“Republicans in conservative states see health care as a vulnerability for the midterm elections, and so, unsurprisingly, you’ll see some action on this,” said Robert Hartwig, a clinical associate professor of risk management, insurance, and finance at the University of South Carolina. “They realize that they’re not really going to get much action at the federal level given the degree of gridlock we’ve already seen.”

Last summer, the Trump administration announced a pledge signed by dozens of health insurers vowing to reform prior authorization. The insurers promised to reduce the scope of claims that require preapproval, decrease wait times, and communicate with patients in clear language when denying a request.

Consumers, patient advocates, and medical providers have expressed skepticism that companies will follow through on their promises.

Becky Tennant is skeptical, too. That’s why she advocated for the West Virginia bill.

“Families should not have to beg, appeal, or go public just to access time-sensitive care,” she told lawmakers. Tennant, who sees the bill’s passage as bittersweet, said she thought her husband would have been proud.

During Eric’s final hospital stay, Tennant recalled, right before he was discharged to home hospice care, she asked him whether he wanted her to keep fighting to change the state agency’s prior authorization process.

“‘Well, you need to at least try to change it,’” she recalled her husband saying. “‘Because it’s not fair.’”

“I told him I would keep trying,” she said, “at least for a while. And so I am keeping that promise to him.”

—–

NBC News health and medical unit producer Jason Kane and correspondent Erin McLaughlin contributed to this report. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

The post After Man’s Death Following Insurance Denials, West Virginia Tackles Prior Authorization appeared first on Medika Life.

I’m always surprised that the LSHTM gives me the privilege of returning to talk about the shifting landscape of funding and how to help assure that it is spent well and to benefit Africa’s future. As I met the Zoom room full of bright, engaged students (many of whom are living the challenges of adequate funding daily in countries such as Uganda, Nigeria, Kenya, and Cameroon) I was struck by how fast the familiar old world of advocacy died, and how urgent it is that we build a new one.

My perspective is shaped by 35 years as a policy and communications consultant working across the continent. I have seen the era of the “Great Man” advocacy, where we simply tried to bend the ear of a US President or a billionaire philanthropist. We look back at those days with rose-tinted glasses: the billionaires and rich-country leaders were fickle and their focus was often on getting recognition or a seat at the top table, not on the real need. Even when they did try to assess the real needs, it was usually through the uninformed eyes of over-priced management consultants whose only knowledge of Africa came from airport VIP lounges. The billionaires were also shockingly bad at effective advocacy for something as obviously cost effective as health spending.

In any case, those days are over. If we want to secure the future of health in Africa, our work to influence policy must evolve to meet a much harsher, more complex fiscal reality.

The Shifting Foundation of Global Health Funding

We have seen a fundamental failure in advocacy around health funding. The data released by the OECD reveals a stark trend: the era of expanding bilateral aid is ending. Total Official Development Assistance (ODA) is contracting, and 96% of that decline is driven by just five donors: Germany, the UK, Japan, France, and most significantly, the USA.

The US alone is responsible for three-quarters of the global decline in health funding. While Germany has technically become the largest provider of ODA for the first time in history, even it is cutting budgets, albeit in an attempt to become more efficient. Meanwhile, traditional multilateral ODA, money flowing to the WHO or the World Food Programme for example, is shrinking less than bilateral grants, but the overall pie is getting smaller.

The good news is that the World Bank and regional development banks such as the African Development Bank (AfDB) are stepping in to fund some health projects. There are questions over “additionality”: are these institutions really funding things that private equity or other lenders to states would not? And there are frequent criticisms that the banks have failed to create funding buckets for innovative models such as low-cost private-sector primary care. However, there are real successes. The AfDB in particular has said loudly and clearly that economic growth depends in large measure on better health and has encouraged governments and funding agencies to invest accordingly.

The Rise of the America First Bilateral Accords

US funding has not disappeared: it has shrunk and mutated into the America First health policy. This administration is moving away from broad global initiatives toward strict bilateral health accords between the US and individual African countries. These are not just funding agreements; they are ideological and strategic contracts that come with significant strings attached.

Under these accords, the US makes a five-year commitment with a clear “exit strategy”: funding is front-loaded but tapers off to zero, forcing national governments to take on “ownership.” While national ownership sounds positive, the requirements are often demanding.

The focus is what you would expect from an administration with an ideological focus derived from Project 2030. It is on maternal and child health (and, yes. The State Department often says that it is the health of children “born and unborn”) and infectious disease.

These accords also require African countries to share pathogen data and specimens with the US within five days of an outbreak. This creates a parallel data mechanism to the WHO and, more importantly, seeks to capture what one of the post-graduate students called, “the new oil.” Africa holds 80% of humanity’s genetic diversity. In an era of genetic medicine, this data is a massive national asset. Several students at LSHTM rightly pointed out that countries like South Africa and Kenya see this as a key resource to be traded for R&D investment, not just given away for a few years of HIV funding. Africa is also developing national health databases that can be used to assess and model the impact of interventions and, as when the continent pioneered payments from mobile phones, it is less encumbered with antiquated existing systems and threatened vested interests.

Most alarmingly to me, these accords are sometimes tied to non-health issues. We’ve seen Zambia refuse to sign because the US tied HIV funding to access to critical minerals and mining data.

One Path Forward: the Accra Reset

The Accra Reset sets out to be a roadmap for this new era. It aims for 55% of health spending to be domestic by 2030, funded in part through “sin taxes” on sugar-sweetened beverages and tobacco. Other means of national funding include surcharges on profitable data transactions and health solidarity funds. Its organisers say that these taxes will raise £750 million in 2026 in six countries alone. I think that’s a high estimate, but there is real money there.

The Accra framework is, though, delusional in thinking that out-of-pocket health can be reduced over the next five years. The AfDB projection is that the private health market in Africa will explode. This is not necessarily bad news for health equity: much of the growth will come in highly efficient fixed-cost private primary care models targeted to working people (although, admittedly, rarely to the bottom of the pyramid or the working poor). These models can be valuable ways to give fast access to innovation and convenient, timely provision of sexual and reproductive health services.

Recommendations for the New Advocate

Given this backdrop, I suggested that these elite advocates do the following.

1. Make Health Explicitly Political

We often hear that health should be non-political. This is a mistake. Non-political subjects are boring and ignored. We need health to be the subject of election campaigns, impassioned debates and social media memes. When health becomes a political must-have, politicians make promises they can be held to. We want people shouting about health in the streets of Accra, Nairobi, and Lagos.

2. Frame Health as a Capital Asset, Not a Cost Centre

We must stop arguing for funding based solely on morality. We need to speak the language of Finance Ministers. According to the World Bank and the AfDB, health is a growth engine.

• ROI Data: For every $1 spent on malaria treatment, the economy gets $35 back. For paediatric immunisation, it’s $20. For SRHR, the returns are less often quantified rigorously but similarly massive because they enable women to enter the workforce and stay productive.
• Preventative Care as Infrastructure: Just as investing in robotics improves productivity, investing in the health of a citizen from birth to age 65 creates a stock of human capital that belongs on a national balance sheet, as the World Bank has now recognised.

3. Build Alliances with FBOs

Faith-Based Organisations (FBOs) provide roughly 30% of healthcare in Africa. The America First plan prioritises them, in part because it plays well to US domestic audiences and, in part, because they are efficient and embedded in communities. While we may disagree with some FBOs on abortion or family planning for unmarried youth, they have incredible national reach. As one student noted, a Pentecostal church in Nigeria aiming for a branch every 15 minutes of walking distance is a more powerful delivery network than any government programme. We must engage them to improve quality and advocate for rights within their frameworks.

4. Harness the Power of Media and Social Media

We can’t forget about media, especially in Africa where so many people are still dependent entirely on TV and local radio and where online and offline newspapers are declining less slowly.

Increasingly, though, we must go where the people are — which is social media. During the lecture, students raised concerns about medical influencers spreading misinformation or misogyny. My response: then we must flood the zone. We need to train responsible influencers. When Joe Fazer, a bodybuilding influencer with about 30 million followers produces content about health equity, he can mobilise a generation we will never reach through traditional policy papers.

Overall, we are in a time of great opportunity and serious danger. The transition from aid to co-investment is the only way to escape the whims of Washington or Berlin. We must be like the “trained revolutionaries” Lenin spoke of — professionals who know how to stir up movements and demand that our governments prioritise health not because a donor asked them to, but because their own citizens demand it.

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Health systems are not stepping into artificial intelligence from a place of calm or control. In the United States, spending now exceeds $4.5 trillion, with a significant share tied up in administrative work that adds complexity more than clarity. Clinicians are caring for more patients, navigating more data and making more decisions under pressure than ever before. The system is stretched. Artificial intelligence is entering at a moment when change is no longer a choice.

The discussion drew on the experience of three leaders who are not observing this shift. They are guiding it. Hal Wolf leads HIMSS, influencing digital health policy and implementation across more than 100 countries. Isaac Kohane, MD, PhD, Chair of Biomedical Informatics at Harvard Medical School, has spent four decades defining how data informs clinical care. Ran Balicer, MD, Chief Innovation Officer at Clalit Health Services, operates within one of the world’s most integrated health systems, where data and care are aligned across generations.

These are not just star panelists. They are system-wide architects.  What emerged from the hour-long conversation was not what artificial intelligence can do. It was a recognition that it is already doing more than most systems are prepared to guide and govern.

Dr. Kohane captured the tension immediately. “I think that we have to worry about the fact that we’re going both too slow and too fast.”

That statement reflects a reality many leaders feel but rarely express. Governance takes time because it must. Patient safety, validation and accountability require structure. Practice moves in real time. Clinicians do not have the luxury of waiting for perfect systems.

“They’re so desperate to do right by their patients to use other resources,” Dr. Kohane adds.

That instinct is not a weakness. It reflects a commitment to doing what is right for the patient. When clinicians turn to external AI tools, they are seeking clarity, speed, and confidence in their decisions. Artificial intelligence is already present at the point of care, shaping how physicians assess information, validate thinking, and move forward. The system is not adopting AI. The system is catching up.

This creates a condition that is difficult to measure and even harder to manage. Different clinicians use different ChatGPT platforms. Those tools produce different answers. Different assumptions shape those answers. Over time, consistency erodes. The system begins to operate with multiple definitions of truth (and the risk of varied outcomes).

Dr. Kohane’s warning is not about misuse. It is about misguided permanence. “The worst outcome will be if the worst parts of medicine get concrete poured over it, by AI.”

Artificial intelligence does not fix a system; without leadership, it accelerates the integration of incorrect assumptions. If workflows are inefficient, they become more efficiently inefficient. If bias exists in data, it becomes more precise. If fragmentation defines care, it scales.

This is not a failure of technology. It is a mirror held up to system-wide leadership.

Hal Wolf, among the health sector’s leading policy and operational voices, grounded this moment in proven experience. Health care has seen this pattern before. When internet connectivity entered hospitals, clinicians moved faster than governance. They created access where it was needed. Systems responded later. Risks were discovered after adoption.

Artificial intelligence now follows that same trajectory, though at far greater speed and with far greater consequences. Web connectivity gave quick access to information. Artificial intelligence influences how that information is interpreted and acted upon.

“We have to go faster,” Mr. Wolf said. “But there needs to be structure around it.”

That is the leadership challenge of this moment. Speed without structure creates exposure. Structure without speed creates irrelevance. The tension between the two is not something to resolve. It is something to manage continuously.

The industry has predictably responded to artificial intelligence. It has started where risk is lowest and return is clearest. Documentation, scheduling and revenue cycle optimization have become the entry points. These applications reduce burden and improve efficiency. They are necessary. However, they are not transformational.

The shift occurs when artificial intelligence moves into clinical decision-making. At that point, the question is no longer whether the system works. The question becomes whether it should be trusted.

Who owns a decision informed by an algorithm? How is accuracy validated? What happens when a clinician disagrees with a recommendation? These are not technical questions. They are questions of accountability. Artificial intelligence does not assume responsibility. It does not carry consequence. That remains with leadership.

Dr. Balicer reframed the conversation, shifting how the room thought about artificial intelligence. “There’s no such thing as AI neutrality. Algorithms are just opinions embedded in code.”

That insight is easy to acknowledge and difficult to operationalize. Every model reflects choices. What data is included? What outcomes are prioritized? What trade-offs are accepted? Those decisions are embedded in the system, shaping how it interprets information.

When a health system adopts an AI tool, it is not simply implementing technology. It is adopting a perspective.

At Clalit Health Services, alignment across payer and provider creates a system where priorities are consistent. Even there, external AI models introduce new assumptions. Those assumptions may not align with the system’s goals. If leadership does not define its own values, it inherits someone else’s.

This becomes real in proactive care. Artificial intelligence enables systems to identify patients at risk before they present. It allows for earlier intervention, often improving outcomes.

It also creates a new kind of pressure. “The toughest choice is what not to do,” Dr. Balicer said.

That statement deserves more attention than it receives. Health care has been built around responding to need. Artificial intelligence introduces the ability to anticipate it. When every patient can be flagged, every risk predicted and every intervention suggested, the system is no longer constrained by insight. It is constrained by capacity.

Artificial intelligence expands what can be done. It does not expand who can do it. Leadership becomes the act of choosing who does what based on validated data.

There is a moment that captures this shift. Imagine a primary care physician starting the day not with a schedule of patients who have called for appointments, but with a list generated by AI identifying individuals who are likely to experience clinical complications in the next six months. Some will develop chronic conditions. Some will require hospitalization. Some can be helped now – preventively.

The physician cannot see them all. Artificial intelligence expands what is possible. Leadership decides what is essential and permissible.

The industry often responds to complexity with activity. Organizations pilot, test and explore. They engage broadly without committing deeply. This creates motion. It rarely creates progress. Pilots are nothing more than experiments. At some point, leadership must decide what to scale, what to stop and what defines value.

Hal Wolf grounded the conversation in discipline. Without a defined, shared objective, effort becomes noise. Pilots create learning, though they often avoid decision-making. Leadership requires clarity. What problem are we solving? What outcome defines success? What are we willing to prioritize? Without those answers, artificial intelligence adds another layer of complexity to an already complex system.

Dr. Kohane brought the conversation back to the discipline of leadership. It cannot remain abstract. It must be informed by experience.

“Go and pay a few bucks and use three or four of the models… get a feel for what this does,” Dr. Kohane advised.

That is not a call for technical fluency. It is a call for leadership proximity. Leaders cannot guide what they do not understand. Artificial intelligence does not behave consistently across models. It produces different answers, shaped by different assumptions. Without direct engagement, those differences remain hidden, and leadership becomes removed from the very decisions it is responsible for guiding.

This is where many organizations hesitate. Artificial intelligence feels complex and complexity invites delegation. At this moment, delegation creates distance. Leadership is required to move closer, not further away.

Artificial intelligence is not reducing the role of leadership. It is redefining it.

This is not a gradual transition. It is already underway. Artificial intelligence is embedded in workflows, shaping decisions and influencing behavior in real time. The system is adapting whether leadership is ready or not.

The question is no longer whether artificial intelligence will shape the future of health. It will. The question is whether leadership will shape how it is applied.

Artificial intelligence will not fix health. It will scale whatever we allow it to touch. The question is whether it will scale what is best in health or what we have yet to fix.

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History, however, offers a useful caution. Breakthrough technologies in medicine rarely achieve their full potential simply because they exist. Their real impact depends on whether the institutions responsible for health-care delivery know how to adopt them wisely, integrate them responsibly and align them with their mission to improve patient health.

Artificial intelligence now stands at that same threshold. The industry has moved beyond fascination with what algorithms can do and entered a more demanding phase: determining how these tools should be evaluated, governed, and integrated into the environments where care is delivered. At the same time, some health professionals are turning to AI – not to augment their knowledge – but assuming the information is patient-care ready.

Across the health ecosystem, leaders are discovering that the most important questions about artificial intelligence are not technological. They are organizational, ethical and operational. Which AI systems genuinely improve clinical decision-making? Which tools strengthen the efficiency of hospitals and health systems? Which innovations introduce complexity without delivering measurable benefit?

Answering those questions requires a perspective that bridges policy leadership, real-world care delivery, and the scientific foundations of biomedical informatics. That convergence of experience sits at the center of a “Views From the Top” mainstage discussion at the HIMSS Global Health Conference & Exhibition, where some 35,000 leaders whose work spans the global health ecosystem will examine how organizations can recognize the true value proposition of artificial intelligence applications before embedding them into health-care systems.

The perspectives shaping this discussion reflect three essential dimensions of responsible artificial intelligence in health: governance frameworks that guide innovation, operational insights from large-scale health care delivery, and scientific rigor grounded in biomedical informatics. Together, these vantage points illuminate the path from technological promise to practical value.

Governing Innovation in a Rapidly Changing Health Ecosystem

Digital transformation in health rarely succeeds simply because technology exists. It succeeds when organizations develop leadership frameworks capable of evaluating innovation, managing risk and aligning new tools with patient-centered goals.

Few leaders have observed the evolution of digital health across as many national systems and institutional environments as Hal Wolf, president and chief executive officer of HIMSS, Ran Balicer, MD, PhD, chief innovation officer of Clalit Health Services and Isaac Kohane, MD, PhD, chair of biomedical informatics at Harvard Medical School. The three will step onto the mainstage at HIMSS to share their “View from the Top” in a session titled: “Recognizing the ‘Value Proposition’ Criteria While Selecting AI Applications.”

Through his work with global government health ministries, hospital networks, and technology innovators worldwide, Wolf has consistently emphasized that technological progress must be anchored in governance and trust.

“Digital health transformation is not about technology alone. It is about leadership, governance, and the trust that allows innovation to improve care,” Wolf has said in discussions about global digital health transformation.

Artificial intelligence intensifies this leadership challenge because its influence extends far beyond traditional clinical tools. AI systems increasingly operate across multiple layers of healthcare delivery. Some applications assist clinicians by analyzing medical data or suggesting treatment options. Others function within hospitals’ and health systems’ operational infrastructure, helping manage patient flow, prioritize diagnostic reviews, and allocate scarce resources.

These operational algorithms rarely capture headlines; however,  they shape the environment in which health care is delivered. Decisions about which cases are reviewed first, how clinicians allocate their attention, and how health systems manage capacity can profoundly influence patient outcomes.

For leaders responsible for health systems, artificial intelligence cannot be treated as simply another technological upgrade. It must be evaluated through governance structures capable of understanding how algorithms function, what assumptions shape their recommendations, and how their use aligns with institutional priorities.

Without that oversight, innovation risks amplifying complexity rather than improving care. Instead of informing, it can spread misinformation.

Aligning Artificial Intelligence With the Values of Medicine

Governance provides the policy foundation for responsible adoption of artificial intelligence, but real-world implementation reveals a second challenge: ensuring that AI systems operate effectively within healthcare delivery itself.

Large population health systems increasingly use advanced analytics to anticipate risk, manage chronic disease, and allocate clinical resources across diverse communities. Within these environments, artificial intelligence is no longer a theoretical innovation. It is already influencing how health organizations prioritize patients, coordinate care and deploy limited resources.

That operational perspective is central to Ran Balicer, MD, PhD, of Clalit Health Services, one of the world’s most advanced data-driven health systems. The Clalit integrated infrastructure connects hospitals, clinics, and community health programs through longitudinal datasets that support predictive analytics at the national scale.

Experience within such systems reinforces an important insight: artificial intelligence models do not function independently of human judgment. They reflect priorities embedded in their design and the assumptions guiding their deployment.

“Algorithms are opinions embedded in code,” Balicer has observed in discussions about the role of artificial intelligence in population health.

In practice, this means that AI systems interpret clinical data through frameworks shaped by human choices. The way a model defines risk, prioritizes cases, or recommends interventions reflects decisions about what matters most within a healthcare environment.

Those decisions carry ethical implications. When artificial intelligence helps determine which patients receive immediate attention or which cases are escalated for further review, transparency about how algorithms function becomes essential to maintaining trust among clinicians and patients alike. The scientific frontier of health-care AI reinforces that concern.

Isaac Kohane, MD, PhD, who has also served as a co-author of the Institute of Medicine Report on Precision Medicine, which has served as the template for national efforts, has spent decades exploring how machine learning can advance medicine while preserving the judgment that defines clinical practice. His research emphasizes that artificial intelligence in healthcare must align with the ethical traditions and professional responsibilities of medicine.

“AI systems in medicine must ultimately reflect the values of the profession they serve,” Kohane has written in discussions about AI alignment in biomedical informatics.

This perspective highlights a crucial distinction between technological capability and clinical responsibility. Many AI models entering healthcare environments were originally designed for broader computational tasks rather than the nuanced realities of patient care. Medicine operates within a landscape shaped by uncertainty, empathy, and accountability, and technologies introduced into that environment must reflect those values.

Ensuring that artificial intelligence aligns with the principles guiding health-care delivery, therefore, represents one of the most important scientific and ethical challenges facing the future of health.

The Discipline Required to Make Innovation Matter

The health sector has experienced waves of technological enthusiasm before. Electronic health records promised seamless information exchange, but then introduced administrative burdens on health professionals when implemented without thoughtful workflow design. Data analytics promised unprecedented insight, but sometimes led to fragmentation when systems failed to communicate across institutions.

Artificial intelligence now stands at a similar moment in the evolution of health technology.

Its capabilities in supporting decision-making flow are extraordinary, yet realizing them will require disciplined leadership to evaluate, integrate and govern AI tools within health-care delivery systems. Health leaders must learn to ask deeper questions before embracing the next algorithmic breakthrough. What problem does this system truly solve? How does it strengthen clinical practice? What assumptions guide its recommendations? How does its use advance the mission of improving patient health?

These questions move the conversation beyond technological novelty toward operational practicality. It’s among the many reasons these three global leaders step to the HIMSS stage together.

Artificial intelligence will undoubtedly reshape the health ecosystem in the years ahead. Its long-term impact, however, will not be determined solely by the sophistication of algorithms or the speed of technological progress. Along with how to leverage AI, ChatGPT and LLMs, users require heightened cognitive awareness.

It will be determined by whether the health community develops the discipline and ability required to translate innovation into systems that strengthen care, support clinicians and improve the health of the populations they serve.

The real story of artificial intelligence in health is no longer about what machines can do. It is about how wisely the health sector chooses to use them.

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I believe in making it very difficult for people to refuse vaccines. There’s enough of the libertarian about me that I wouldn’t actually strap them down and inject them, but I’m fine with school districts making parents write out their conscientious objections to children being immunised or with sports clubs requiring adult proof of immunisation before people can join. What I or you think is, though, beside the point. Much of the US is walking away from cajoling and compulsion and there’s great pressure in Europe for similar change. We can either go on moaning about how we wish the world hadn’t changed or we can respond effectively.

Before the current US Administration began rewriting vaccine recommendations, one in six US parents wasn’t following them. We used to joke that vaccine-preventable diseases in the West had become diseases of children of the over-educated middle classes who shopped at Whole Foods and did naked yoga classes; vaccine refusers now are still more likely to be white, but they skew to being conservative, very religious, and young. Recommendations actually reduced uptake in this group because most have a deep distrust of the Federal Government and its agencies.

Formal vaccine refusals in Poland more than doubled from 2017 to 2022 and reached over 87,000 in 2023, a 1685% increase since 2003; measles cases surged 10x in early 2024 due to falling rates. Ireland, where I live, has the third-lowest childhood vaccine coverage rate in the OECD.

There are bright spots too, Italy for example, and the battle is far from lost. But the mistrust now endemic to the United States is coming to Europe.

High-handed US and European experts

You can understand confusion, if not mistrust. About half of parents in the USA did not vaccinate their children for flu in the past year, compared with 41 percent who said they had done so, a Washington Post / Kaiser Family Fund poll found. Coverage started declining after 2019. In 2016, the US CDC said that the nasal flu vaccine used in children provided “no measurable benefit” (injectable vaccines for adults were, as usual, highly effective). In the same year, Public Health England said that the same vaccine (produced by a British company in a British factory) was 58 percent effective. Canada followed the UK, saying that its population was very different to the USA! It’s very unlikely that both the Americans and the Canadians were right — despite those obvious population differences…. Few journalists covered the story — I suspect because no-one wanted to be accused of promoting vaccine scepticism. The vaccine is now recommended again in the USA.

Few American paediatricians and even fewer nurses would have been able to explain this to parents because no-one ever bothered to give the professionals an explanation. What do we think doctors told parents who asked why a vaccination was recommended then was not and then was again? British parents who did a web search (this was pre-Chat GPT, remember) might have asked why their children were getting an apparently ineffective vaccine and would have met equally bemused stares from their health providers. Did anyone brief social media influencers or health journalists? Of course not, who do they think they are? What impudence…

I know some of those involved and I’m sure that there was no subterfuge and nothing sinister going on; the answer is likely to be dull and involve methodology and surveillance systems.

This is the way we all used to approach treatment discussions 40 years ago — the doctor told you what to do, you thanked him (it was nearly always a him) and you did it. Questions were a sign of disrespect, of even psychological illness. I was recently treated by a Russian dentist, now practising in Ireland, who was shocked and outraged when I questioned his recommendation to use antibiotics prophylactically; if he had been Irish, he would have been completely used to it.

Nonsensical recommendations in developing countries

Vaccine hesitancy looks a bit different in France. Those least likely to have their children vaccinated tend to be more educated, high users of the internet for information and to have lower trust in health authorities. Those who refuse vaccines for themselves tend to be at the lower end of the social hierarchy with less education and fewer financial resources. Many are ​immigrants and descendants of immigrants, and residents of French overseas departments. Both are probably likely to know about the vaccines which Western experts recommend for children in the developing world, including in Francophone countries.

I remember doing a policy interview with the health minister of a large Indian state. I was trying to find out what he might pay for an effective TB vaccine. “But”, he said, “we already have a TB vaccine. Why do I need a new one?” His top civil servant was sitting behind him and frantically gesticulating to me to try to stop me explaining that the BCG vaccine, given to almost every Indian newborn, may do nothing to prevent TB infections and, at best, may make the disease less severe in some of the children who contract it. It is, though, very good at causing severe side effects. No developed economy uses it; almost every poor one does.

I’m ashamed to say that I did not explain BCG as clearly as I should have to the minister. He was the norm, not the exception, in that series of policymaker interviews: few of those making decisions about TB vaccine policy had ever been given a thorough, honest briefing about the limitations of the vaccines their expert advisers recommended. None of the parents, of course, were ever told about any of these reservations.

There might also be a case for the current practice of giving many children in Africa and Asia a vaccine that sometimes causes polio, instead of preventing it, although I doubt it. The risks of a child contracting polio from the live-attenuated oral vaccine are probably underestimated when they’re presented to politicians and policy influencers. Hardly any parents who bring their children forward for these vaccines are told about the risk or the rationale for continuing to use them, rather than the perfectly safe inactivated vaccine used throughout the rich world.

Is it any wonder that those with insight into the developing world are sceptical? The real wonder is that vaccine confidence is still so high in Africa and Asia. That probably comes from everyday encounters with the tragic consequences of infection by vaccine-preventable illnesses, an experience blessedly denied to most Americans and Europeans.

What we need to do now

The road ahead has been cleared for us. Thirty years ago, I went out with a trainee doctor at the Royal College of Surgeons in Ireland. He was upset one evening because he had been berated by his tutor for telling an older patient that she had cancer — it had been agreed with the family that she would be told that she had a “growth” to avoid upsetting her. At least she found out: King George VI of the United Kingdom sent his daughter, Princess Elizabeth, on a world tour in 1952 because neither he nor she had been told that he had lung cancer and that it was terminal. He never saw her again. These stories shock us now because honesty, realism and communication are taken for granted in what we tell patients who are ill. These principles need to be the new basis for what we tell people who are healthy and want to stay that way.

First we need a change in attitude. Whether to be immunised or not is a decision that people will take — actually, a series of decisions. We don’t need to think about whether we like the concept or not, it is the way things increasingly are. We have to get ordinary people used to making good decisions, just as they do about other life issues such as house buying or insurance or continuing education. Ordinary people are not property experts or risk analysts or trained evaluators of course offerings, but they mostly make reasonable choices. They can do the same thing with vaccines.

Then, we need to communicate much more. Vaccine producers are free to talk to the public about recommended vaccines in many countries; where they are not, they need to be allowed to. Then they need to accept their responsibility to speak often, clearly and loudly. They are the experts on the vaccines they produce and they must tell potential recipients or the parents of recipients about the benefits and disadvantages. Of course, they need to do it in an honest and balanced way. They will be more successful if they communicate in partnership with professional organisations, charities and respected consumer groups. They can be transparent: they have a commercial interest in getting people to accept vaccines but a legal responsibility to set out all the factors in deciding whether to or not. It’s like banks selling mortgages and car dealerships selling warranties.

Researchers and healthcare providers need training in communication and answering questions. They need to be much better at helping policy makers to make decisions about vaccines. Today, too few vaccines are reimbursed and many are offered only to some of those who would benefit from them. In many countries, it is still too hard to get vaccinated and even where rules have changed, practices have not — look at Poland, for example. Politicians and public officials can unleash vaccines so that they can do even more to boost productivity, growth and wealth in society.

Those same scientific and medical experts need to be much better at talking to people who are making decisions about immunisation. Research tells us clearly what helps the right decision, but too few professionals follow the evidence. The most powerful prompt to action is a trusted health professional saying, “I would like you to do this”. Setting a good example works wonders too, but too few health professionals have had all of the vaccines recommended for them.Communication can change all of this.

The vast majority of social media influencers want to give good advice and powerful motivation but no-one talks to them — after all, we want people to follow the guidelines, not think, don’t we? For example, have you seen Dr Mike Varshavski take on 20 vaccine sceptics at once? Thirty million people probably have over various platforms and he’s brilliant. Industry and professionals need to work with influencers who specialise in women’s issues, childhood, workplace effectiveness and, of course, health. Look at this from Dr Ahmed Ezzat — his videos on RSV reduced calls to the emergency services by 25% — and just think what he can do for vaccines.

Journalists are discouraged from writing pieces about vaccine decisions — “just tell people to follow expert recommendations”. Many, consequently, avoid writing about vaccines. We need to treat these journalists as powerful allies in helping lay people to make important decisions with lifelong implications for their risk of developing chronic illnesses. It’s the way that property developers treat journalists who write about houses,

Honestly, I still think it would be simpler and still ethically correct to just nudge almost everyone into getting immunised but that is not an option in many places now and, given the global market in ideas, won’t be one anywhere soon.

Parents get things right

Asia should encourage us. Many parents save and spend to get their children the best vaccines. The state often provides old tech or nothing, so middle-class parents take their children to private clinics for the best protection and pay full price for it. Of course, it’s not fair to poorer children and it is crazy public policy given that population sizes will plunge across Asia over the next 30 years so every child, whether middle class or not, is a precious national resource. Still, it shows that individual families can and do make better decisions than health policy makers when the routes of communication are open and used well.

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Primary care continuity allows physicians to develop a longitudinal awareness that no episodic encounter or health tech tool can replicate. Over time, physicians learn what is normal for each patient and what represents meaningful clinical change. Subtle physiological shifts, early symptoms or emerging risk factors appear not as isolated data points from a blood exam, but as part of a social narrative unfolding across time. Early recognition allows earlier intervention, often before disease takes its profound toll.

Clinical evidence confirms the protective effect of continuity. It’s not a matter of opinion. A systematic review published in BMJ Open found that patients with sustained continuity of care had significantly lower mortality than those with fragmented care. Continuity did not just improve satisfaction; it altered survival. The physician who knows the patient can detect disease earlier and guide care more effectively.

Listening allows physicians to detect patterns that laboratory values alone cannot explain. Patients share information differently when they believe that their physician understands them and remembers their history. This sustained awareness allows physicians to identify emerging illnesses without relying solely on reactive diagnostics. Continuity transforms listening into clinical intelligence and a deeper care partnership.

In Healing the Sick Care System: Why People Matter, which has become a surprise Amazon bestseller, one insight repeatedly emerges: patients do not seek care only for treatment; they seek reassurance that someone who knows them is guiding their journey. Physicians who listen across time accumulate knowledge that cannot be captured in a chart alone. That memory allows earlier recognition, more accurate interpretation, and wiser intervention. Healing begins in that continuity of understanding.

Transactional Care Solves Symptoms but Sacrifices Understanding

Health has, for some time, been undergoing a structural shift toward transactional encounters. Walk-in clinics, urgent care centers, and virtual platforms provide speed and accessibility that patients value. These models address immediate symptoms efficiently and fill important gaps in care delivery. Accessibility has improved, yet continuity has weakened.

Transactional medicine treats episodes rather than trajectories. Each encounter begins without the benefit of longitudinal understanding. Clinical decisions are made with time-stamp specific knowledge of how symptoms emerged or how physiology has changed over time. Care becomes reactive rather than interpretive.

Research demonstrates the consequences of this fragmentation. Studies published in the Annals of Family Medicine show that sustained primary care continuity reduces hospitalizations and lowers healthcare expenditures. Early recognition prevents complications that require more invasive, costly interventions. Fragmentation delays recognition and increases clinical risk.

In fact, physicians in the vanguard of building relationships encourage their patients to ask questions.  In their co-authored book Let Patients Help! A “Patient Engagement” handbook – how doctors, nurses, patients and caregivers can partner for better care by “e-Patient Dave” deBronkart with Daniel Z. Sands, MD, MPH, the founder of the Society for Participatory Medicine, offer 10 suggestions that clinicians say to encourage patient engagement.

This shift also alters how patients engage with care. Connections that develop over time can be lost quickly when continuity disappears. Patients become consumers navigating isolated services rather than partners guided across time. The clinical relationship weakens, and with it the interpretive depth that makes prevention possible.

Health systems globally recognize the value of continuity. The Organization for Economic Co-operation and Development (OECD), a Paris-based international organization that promotes policies to improve economic and social well-being globally, reports that hospital admissions for chronic diseases, often preventable through effective primary care, account for a substantial share of healthcare utilization. Systems that preserve physician-led primary care continuity achieve better outcomes and greater efficiency. Relationship stabilizes care.

Innovation Requires Connection to Fulfill Its Potential

This shift toward transactional care carries life-threatening implications that extend far beyond the patient experience. It also directly affects whether health innovation fulfills its promise or becomes a compensatory tool addressing fragmentation. Innovation depends on context to generate meaningful insight. Context emerges through continuity. That context can devalue life-saving innovations.

Artificial intelligence, predictive analytics, and remote monitoring technologies are designed to detect patterns across time. These tools require longitudinal clinical awareness to distinguish meaningful change from statistical variation. Physicians who know their patients can interpret innovation correctly and act earlier. Innovation becomes transformative when anchored in relationship.

Fragmented care weakens this interpretive capacity. Data collected across disconnected encounters lacks coherence. Predictive tools lose precision when longitudinal context is absent. Innovation becomes reactive, identifying disease after symptoms emerge rather than predicting disease before it develops.

Technology achieves its highest value when it extends the physician’s ability to listen and observe. Remote monitoring allows earlier recognition of physiological change. Predictive analytics strengthens preventive intervention. Innovation amplifies continuity when guided by sustained physician leadership.

Team-based primary care models reflect this principle. Nurse practitioners and physician assistants expand access while physician leadership preserves interpretive continuity. Research published in Medical Care Research and Review confirms that coordinated team-based care maintains strong clinical outcomes. Physician oversight ensures that innovation remains integrated within longitudinal care. It also improves health professional job satisfaction and reduces burn-out.

Innovation cannot replace the relationship at the center of medicine. Algorithms detect patterns but do not understand meaning, and they do not strengthen physician/patient ties. Devices collect data, but do not know the patient behind the data. Physicians translate information into guidance by integrating technology with human understanding.

The future of health innovation depends on preserving continuity between patient and physician. Technology deployed within sustained relationships strengthens prevention and improves outcomes. Technology deployed within fragmented systems often compensates for structural weakness rather than transforming care. Continuity determines whether innovation fulfills its promise.

Health systems now face a defining moment. Transactional care offers speed and convenience. Relational care offers understanding and prevention. Innovation will achieve its full potential only when it strengthens the continuity that allows physicians to listen, learn, and guide patients across time.

Healing begins with being heard. Health technology succeeds when it helps physicians listen more deeply and act more wisely in the service of the people who entrust them with their care.

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The country’s trajectory has been building for years. A fast-growing middle-income population, rising chronic disease burden, and expanding health infrastructure have created both demand and urgency. What is changing now is the environment in which innovation can move, driving faster approvals, a culture of collaboration, digital infrastructure and a government signaling policy readiness to engage global partners in shaping the next era of medicine.

The economic momentum is significant. The Indian health ecosystem has expanded from roughly $372 billion in 2023 to $638 billion in 2025, making it one of the fastest-growing major health markets in the world. The broader industry is expected to exceed $610 billion by 2026, fueled by rising insurance coverage, expanding hospital infrastructure, and growing demand for chronic disease management. Health growth in India continues at approximately 10–12 percent annually, well above the growth rates typical of mature markets, reflecting both rising access and structural transformation.

BIOAsia 2026 reflects this inflection point. The global gathering in Hyderabad, themed “TechBio Unleashed: AI, Automation & the Biology Revolution,” highlights the (bio)convergence of biology, data, and intelligent systems reshaping health worldwide. Organizers emphasize that the meeting aims to drive health transformation and reinforce India’s position as a leading global life sciences force. For multinational innovators, the message is increasingly clear: India is not only where innovation is deployed; it is also where it is developed. It is where innovation is increasingly defined. India has become a go-to market for multinational enterprises.

Policy Signals and Market Scale: From Opportunity to Strategic Partnership

India’s regulatory and policy environment is evolving in ways that matter deeply to multinational innovators. One pivotal shift came with the country’s decision to allow certain medicines approved in specified developed markets to launch without local clinical trials, a move designed to accelerate patient access while aligning more closely with global regulatory science. This policy shift reflected confidence in international data, a commitment to innovation, and recognition that faster access must remain central to national health strategy.

The scale of India’s pharmaceutical and life sciences market reinforces this transformation. The pharmaceutical sector reached approximately $68 billion in 2025 and is projected to grow to more than $170 billion during the next decade, driven by expanding middle-income demand and strong domestic manufacturing. India already supplies roughly one-fifth of the world’s generic medicines. It produces the majority of global vaccines by volume, positioning the country as a central player in global health supply chains.

As Aman Gupta of SPAG/FINN wrote in Medika Life, “India’s health sector is undergoing a profound transformation, bolstered by government-led reforms and a favorable FDI regime. The allowance of 100% foreign direct investment through automatic routes in health and related sectors has already attracted global giants.” His observation reinforces a central reality for multinational innovators: India’s policy environment is increasingly designed not only to welcome global participation, but to encourage long-term strategic partnership in building the future of healthcare.

Investment trends tell the same story. Health and pharmaceutical private equity and venture investments have reached multi-billion-dollar levels annually. At the same time, India’s contract drug development and manufacturing sector is projected to exceed $22 billion within the next decade. These dynamics position India as a growth market and as a strategic partner across the innovation lifecycle from discovery and clinical development to manufacturing and global distribution.

Shakthi Nagappan, CEO of Telangana Life Sciences Foundation, captured this moment clearly, noting that BIOAsia arrives at a time when technology and biology are redefining healthcare and creating “unprecedented opportunities for innovation, investment, and impact.” The language reflects partnership rather than transaction, a signal that India is moving from market opportunity to strategic collaboration.

Digital Infrastructure, BIOAsia and the Multinational Innovation Imperative

India’s digital transformation may be its most potent catalyst for long-term health innovation. Unlike many mature systems, the country is building a national-scale digital health infrastructure designed to connect patients, providers, and health systems across a population of more than 1.4 billion people, with a rising middle class of 400 million.

The Global Digital Health Market is projected to grow from USD 288.55 billion in 2024 to USD 2,688 billion by 2035, expanding at a CAGR of 22.55% during 2025–2035. This surge is driven by the rapid adoption of AI-powered diagnostics, telemedicine, wearable devices, and data analytics solutions that are revolutionizing patient care and operational efficiency worldwide.

Hundreds of millions of citizens are already using digital health services, including telemedicine, electronic prescriptions, and remote care. The Ayushman Bharat Digital Mission is creating an interoperable national health ecosystem, enabling secure health records, improved care coordination, and population-scale data infrastructure that supports research, real-world evidence, and precision health.

For multinational companies, this digital backbone creates a uniquely strategic environment, enabling large-scale clinical research, faster pharmacovigilance, AI-supported health insights, and rapid deployment of innovation across diverse populations. India’s digital infrastructure is not simply modernizing health delivery. It is enabling national-scale transformation.

BIOAsia sits at the center of this conversation and convergence. The gathering reflects India’s ambition to lead at the intersection of biology, artificial intelligence, and scalable innovation. Leaders from industry, government, and science convene not only to discuss growth but to shape the next phase of global life sciences, where biology, data, and digital systems converge to influence global health.

One conference panel, among the many high-powered sessions, brings together global leaders in advanced therapeutics to explore how next-generation modalities are moving from discovery to scalable care. Panelists across biopharma, translational science, and hospital systems are examining progress in cell and gene therapies, mRNA, and radiopharmaceuticals, underscoring that innovation now depends as much on manufacturable scale and delivery as on scientific breakthrough. India’s expanding capabilities in clinical research and bioprocessing strengthen its role as a key partner in advancing next-generation therapies.

For multinational innovators, the implications are clear. Engagement in India now extends beyond commercialization. It calls for collaboration in research, investment in digital and scientific ecosystems, alignment with national health priorities and partnership in strengthening health delivery.

India’s Strategic Role in Global Health Innovation

India’s rise in global health innovation reflects the alignment of policy, market growth, digital infrastructure, and scientific capability forces that together are reshaping where and how healthcare innovation occurs.

For multinational companies, India now represents a full-spectrum innovation environment. It is a place to conduct clinical research across diverse populations, scale manufacturing and supply chains, deploy digital health at a national scale, and co-develop solutions addressing both local and global health challenges. Increasingly, India is not simply a recipient of innovation developed elsewhere. It is becoming a co-creator of next-generation health.

This shift changes the strategic equation. Market entry alone is no longer sufficient. Meaningful engagement requires partnership with policymakers, regulators, scientists, health providers, and digital health ecosystems. Organizations that invest in collaboration, align with national health priorities, and contribute to strengthening healthcare systems are most likely to succeed in India’s evolving landscape.

BIOAsia sets the stage for this transformation. It is more than a conference. It is a convergence of global health ambition, scientific capability, and policy momentum. The conversations taking place in Hyderabad mirror a broader reality: the geography of health innovation is expanding, and India is now central to its future.

For global health innovators, the question is no longer whether India matters. The question is how deeply they choose to engage in shaping what comes next.

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