🦠Covid-19 edition: emerging business opportunities with the vaccines
I am bullish on vaccine tourism, and digital health passports.
Hello and welcome to Careviser by Marie Loubiere, the weekly newsletter that cuts through the healthcare noise with a single focus: productization of the latest research and tech breakthroughs.
Initially I didn’t want to talk about covid-19. Covid fatigue is real. As new research articles about the effectiveness of public health policies kept getting published, I couldn’t help but address the topic.
We all know telemedicine start-ups have benefited tremendously from the covid-19 pandemic. I heard that some players have achieved their 2025 forecasts in 2020! But let’s talk about emerging opportunities related to the covid-19 vaccines. My bets are on:
🏝️💉 Covid-19 vaccine tourism will be a thing. A few Indian tour operators have already started pre-selling vaccine tours to the UK and the US for a few thousands US$. The leading medical tourism players have not advertised any covid-19 offers yet. It will happen over the next couple of weeks. New start-ups will emerge too. Wealthy people from emerging countries (and France?) will flock to the UAE, Russia, China and India in the upcoming months to get vaccinated. The super wealthy will even have access to vaccination in the UK and in the US. Who’s building it? Get in touch!
🚛💉 The distribution of the covid-19 vaccine, especially the mRNA ones, poses unseen logistics challenges. Eupry automates temperature monitoring with an IoT platform. It was spun out from a collaborative project between UNICEF and the Technical University of Denmark in 2014. They have raised over $1mn in seed. Their solution even works for ultra-low temperature freezers that store the Pfizer-BioNTech vaccine. They just unveiled a partnership with Atos to distribute a joint “Vaccine Logistics Monitoring as-a-Service” solution. Given the stakes that come with the logistics handling of the vaccines, it would probably be hard for a startup to secure deals with leading transportation companies so it makes sense that they need Atos to seize the opportunity.
Founded in 2016 in France, Koovea is another early-stage player in the field of IoT temperature monitoring. They had been working on the monitoring of an experimental ebola vaccine with an American NGO, and are now developing a new solution that would work for ultra-low temperatures.
🛂 Finally I am pretty bullish on digital vaccination passports. Travelling in covid times requires paperwork. Most countries ask for a negative PCR test result to cross borders. Some countries have developed their own covid-19 app which can collect test results directly from certified labs. But oftentimes, a border agent has a quick look at your test results and lets you in the country. This isn’t reliable. People photoshop positive test results or create fake ones when they don’t receive their results on time. This will most likely get worse with vaccine certificates. We are going to need a reliable source of data to prove vaccination. Building such a business from scratch at a global scale is close to impossible as it requires to partner with tens of airlines, border authorities and health authorities. It needs to be interoperable with tens of thousands of labs across the world. So there will probably be local players. LA started issuing vaccination receipts that can be stored on the Apple Wallet app. They are issued by startup Healthvana which claims to be the leading Patient Platform for COVID-19 in the US. They started out with test results and expanded with vaccines. Accredify is another seed-stage startup that developed a digital passport for Singaporeans. They raised US$300k in 2020.
All these local digital passports create a major interoperability and verification issue. That’s why we will also need startups to create universal verifiers applications that can access and verify certificates across apps and standards. Affinidi, which is a spin-off from Temasek, is building one. Who else is?
👩✈️ Ranking the effectiveness of worldwide COVID-19 government interventions by Nils Haug, Lukas Geyrhofer, Alessandro Londei, Elma Dervic, Amélie Desvars-Larrive, Vittorio Loreto, Beate Pinior, Stefan Thurner & Peter Klimek studied the impact of of 6,068 non-pharmaceutical interventions (ie, government interventions such as lockdown, mandatory remote work…) implemented in 79 territories on the effective reproduction number (the famous Rt) of COVID-19 at the heart of the first wave. They found that the largest impacts were achieved by small gathering cancellations, the closure of educational institutions and border restrictions. The least effective interventions included
government actions to provide or receive international help, measures to enhance testing capacity or improve case detection strategy (which can be expected to lead to a short-term rise in cases), tracing and tracking measures as well as land border and airport health checks and environmental cleaning.
They also found that the effectiveness of these measures depends on the sequence, with earlier implementation leading to higher impact, but also on the country. In a nutshell, lockdown measures work.
Limits of this study: it was done during March and April 2020 when 1/ test capabilities were extremely limited in Western countries so case numbers were greatly underestimated, and 2/ PPE were in short supply so they were not used by the public yet, and thus the impact of mandatory face covering in public spaces couldn’t be assessed.
🇦🇺 Impact of Victoria’s Stage 3 lockdown on COVID‐19 case numbers by Allan Saul, Nick Scott, Brendan S Crabb, Suman S Majumdar, Benjamin Coghlan and Margaret E Hellard confirms the previous findings. They study the implementation of Stage 3 lockdown measures in the Victoria suburbs in Australia. These included the closure of restaurants, bars, entertainment venues, places of worship, and limiting public gatherings to two people. They found that the effective reproduction number went from 1.75 to 1.16. It didn’t fully flatter the curve (which requires the Rt to be <1). However the impact was significant, and the number of cases continued to plummet when mandatory face covering in public was introduced.
🤡 The Impact of Public Health Organization and Political Figure Message Sources on Reactions to Coronavirus Prevention Messages by Marcella H. Boynton, Ross E. O'Hara, Howard Tennen, Joseph G.L. Lee. studies how the source of a covid-19 prevention messages (e.g., “cover your face in public”) impacts their effectiveness.
One early effort, “President Trump's Coronavirus Guidelines for America,” included a postcard mailed to every U.S. household. Each card was branded in large text with President Trump's name and with small White House and CDC logos.
The study presents different prevention messages to 934 adults, from different sources (President Trump, CDC, local health authorities). It found that participants responded more negatively to messages that came from President Trump as opposed to the ones from the CDC and local health authorities, even when controlling for lack of trust in President Trump. In general, this shows that using political figures to promote public health safety measures isn’t the most efficient way. Using credible independent sources such as the CDC works better.
The Spanish Flu vs. Covid-19: what happened
We have been hearing a lot about the 1918 pandemic since Covid-19 started as the two pandemics share similarities. Starting in the last months of WWI, the Spanish flu is sometimes called the “forgotten pandemic” as most of the attention of the public was focused on the devastation caused by the war. However it actually killed more US soldiers than the war did!
💭 Origin: caused by the H1N1 influenza A virus (which also led to the 2009 swine flu), the origin is still debated among researchers, but it is likely to have originated either in the US, or in Europe either from birds or from a non human mammalian.
💀 Casualties: about ⅓ of the total health population was contaminated and up to 50-100 millions died (2-5% of the world population). The basic Rt was between 2 and 3, and the death rate could have been increased by fact that soldiers and populations were malnourished at the end of a world war, and that they were hospitalized in crowded field hospitals that were not equipped to deal with a highly contagious virus. Contrary to covid-19, the Spanish influenza proved lethal to both young adults and older generations.
🌊 Waves: The various waves show how Allied troops and former prisoners were moving across borders during and after WWI.
The first wave started in early 1918 in the US and it then spread in Western Europe when the US entered WWI. It started spreading all across Europe as the war ended with the release of Russian prisoners from Germany after the signing of the Treaty of Brest-Litovsk. By summer 1918, North Africa, most Asia countries and Australia were reporting cases but overall the number of reported cases were plummeting.
The second wave started at the end of the summer 1918 as US troops were heading back home from France. As troops moved across the country, the virus started to spread in the entire North American, and then in Latin America. US troops were also travelling to Sierra Leone where they started to spread the virus across Africa. In Europe, the second wave swept through Russia and then Asia following the Russian Civil War and the Trans-Siberian railway. It was the most lethal wave.
The third wave started in Australia at the beginning of 1919 after the end of a maritime quarantine, and then spread through Europe and the US. It lasted until summer.
The fourth (and last!) wave was reported in the spring of 1920 with isolated clusters in the US, some European countries (Switzerland, Spain, Scandinavia..), Peru and Japan.
It then ended most likely due to herd immunity and to the fact that the most dangerous strains of the virus died out. At the time, there was no vaccine, and no effective medication-based treatments were found.
🧐 Public health strategies: The public authorities waited to implement measures as they were busy with the end of WWI. A great deal of censorship was applied in most countries, newspapers were banned from reporting the death toll. A few maritime quarantines were implemented in places like Australia. Social distancing measures were introduced.
😷 Masks: they were already a topic of controversy back then. They were widely used in Japan, but faced criticism in countries such as the US where the Anti-Mask League of San Francisco was born when the city passed an ordinance to mandate wearing a mask at all times in public.
😂 Fun facts: Similarly to covid-19, some leaders blamed other countries for its inception: it was called the “Spanish flu” because when the first cases of the pandemic appeared in late 1917, they were covered up by the French, German and British authorities that did not want to appear weak. Only Spain which was neutral in WWI allowed newspapers to report on the disease giving the impression that the country was overly affected by the influenza virus.
It is said that the Spanish flu may have influenced the outcome of the war as Germany and Austria were hit harder and sooner by the pandemic.
That’s a wrap for today! I wish you all a happy & healthy 2021. Don’t hesitate to reply to this email with comments, I read and answer all emails :)