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The Rise of Respiratory Illnesses
May 2024
This article was contributed by the Sandpiper Health content team. Sandpiper Health is a specialist consultancy under Sandpiper Group, providing in-depth monitoring and analysis of the healthcare and life science sector, and helping pharmaceutical and medical technology companies, healthcare providers, patient and caregiver groups, as well as investors and professional organisations formulate effective stakeholder engagement strategies to achieve their business and communications objectives. To receive regular insights from Sandpiper Health on healthcare trends and policy updates in Asia Pacific, sign up to Asia Pacific Healthcare Outlook Monthly Newsletter.
Respiratory illnesses are on the rise around the world and pose a growing threat to healthcare systems across the Asia-Pacific region.
The post-COVID landscape has significantly reshaped our understanding of globalisation and its impact on transmissible diseases, particularly respiratory illnesses. The pandemic highlighted the risks involved in Asia Pacific’s critical role in global connectivity, as bustling international hubs like Hong Kong, Singapore, and Tokyo facilitated the rapid spread of the COVID-19 virus. This interconnectedness, while driving economic growth and cultural exchange, also amplifies the risk of disease transmission.
Even though respiratory illnesses are major global issues, they are particularly problematic in the Asia-Pacific region because of several factors, including rising smoking rates in some areas, recent viral outbreaks that have been spread worldwide, varying rates of tuberculosis (TB), bacterial antibiotic resistance, and socioeconomic conditions that have led to rising air pollution levels in certain areas.
Regional respiratory illness landscape
Health burden
In recent years, respiratory diseases, particularly respiratory tract infections, have continued to impose a growing worldwide health burden. Some of the most common respiratory diseases that cause hospital admissions are chronic obstructive pulmonary disease (COPD), reactive airway diseases, upper and lower respiratory tract infections, occupational lung diseases, and lung cancer. Despite tremendous progress in the development of antibiotics, respiratory infections remain one of the primary causes of mortality in impoverished nations.
The problem is acute in healthcare systems across the world. According to a study conducted in the UK, respiratory disease-related hospital admissions (RRHA) have surged by 133.4 percent in England and Wales from 1999 to 2019, with men being hospitalised at a higher rate. Approximately 25 percent of RRHA in England and Wales are classified as chronic lower respiratory disorders, which include asthma, bronchiectasis, and COPD.
A significant amount of money is spent on the UK health system and economy because of COPD, which is thought to cause 24 million lost working days annually. Therefore, reducing the requirement for hospital care among patients could potentially lessen the impact of COPD on the health system.
International organisations
International cooperation is vital globally and within Asia Pacific to prevent and control infectious respiratory viruses, as well as improve care and health management for chronic respiratory diseases. In 2006, the Global Alliance against Chronic Respiratory Diseases (GARD) under the World Health Organization (WHO) was established with the mission of elevating the priority of the prevention and management of chronic illnesses, with a focus on developing nations. With an emphasis on low- and middle-income nations, members of the GARD network are dedicated to lowering the worldwide burden of chronic respiratory diseases. Specifically, GARD aims to ensure that everyone with asthma and COPD has a prompt diagnosis, has access to quality care, and is less exposed to risk factors like air pollution and cigarette smoke through collaborative networking and campaigning.
To address the issue of emerging respiratory diseases in the Asia-Pacific region, the Asian Pacific Society of Respirology (APSR) was founded in 1982. In the past four decades since the organisation’s establishment, APSR’s work has significantly contributed to stimulating research, enhancing clinical practice via education, raising public awareness of lung health issues, and facilitating knowledge sharing among respirologists throughout the Asia-Pacific area and beyond.
Risks to healthcare personnel (HCPs)
A recent assessment found that up to 10 percent of infection cases were attributable to occupation. Workplace exposure to infections has been shown to significantly increase the incidence of community-acquired pneumonia. Among all occupations, healthcare personnel most often fall victim to occupational respiratory infections. Due to their constant exposure to infected patients, HCPs are thought to be at higher risk for contracting seasonal and pandemic influenza. Moreover, they may also spread the virus to patients and other healthcare personnel.
As a countermeasure to occupational infections, requirements of vaccination against various infectious pathogens for hospital staff are mandated by law in certain jurisdictions, and the practice is becoming more and more widespread in healthcare settings. However, questions have been raised concerning the vaccine’s inconsistent efficacy as well as the moral and legal implications of these regulations. Under the context of mandatory vaccination, healthcare professionals’ obligation to safeguard public and individual patients’ health may conflict with their right to personal autonomy. Furthermore, mandates may also raise legal concerns, such as the applicability of federal and state constitutional legislation and laws in some countries.
Vaccines
The landscape of respiratory illness vaccines is rapidly evolving, with significant advancements in vaccine technology and distribution. Recent developments include new vaccines for influenza, COVID-19 variants, and RSV (respiratory syncytial virus). The Asia-Pacific region is seeing increased production capabilities and improved vaccine accessibility, driven by both public and private sector efforts. In 2022, Asia Pacific accounted for 55 percent of the global market for respiratory illness vaccines, making it a truly significant region for this domain.
Opportunities abound for enhancing vaccine coverage and efficacy. Collaborative efforts between governments, healthcare providers, and pharmaceutical companies can enhance vaccine deployment, particularly in underserved areas. Investment in vaccine education and outreach programs can also improve public acceptance and coverage rates. Still, misinformation remains a significant barrier to vaccine uptake. Myths and misconceptions about vaccine safety and efficacy spread rapidly through social media and other channels, undermining public health efforts. Combating this problem requires a concerted effort to provide accurate, science-based information. Health authorities and professionals must continue to engage in proactive communication strategies to dispel myths and build public trust in vaccines.
Case Study: Hong Kong
Hong Kong stands out as a compelling case study for combatting respiratory illnesses in Asia Pacific, having encountered one of the highest rates of Severe Acute Respiratory Syndrome (SARS) worldwide in 2003. This case underscored the remarkable efficacy of the region’s health organisations in responding swiftly to respiratory illnesses. Following the first few SARS cases in the city, the Department of Health of the Hong Kong Special Administrative Region Government promptly enacted legislation to classify SARS as a notifiable infectious disease. Concurrently, they implemented a comprehensive five-pronged prevention program.
This program encompassed preventive education and extensive public awareness campaigns, rigorous training on identifying infection sources, and the implementation of comprehensive control regulations. The government also enhanced collaboration and communication channels with Mainland China and WHO, as well as the development of a rapid diagnostic test.
After the peak of the epidemic, the government implemented additional measures to strengthen epidemic control and support the post-epidemic recovery of the region. Notably, they appointed an international expert committee to facilitate global collaboration in disease prevention. This initiative underscores the importance of continuous and collaborative medical efforts internationally to mitigate respiratory illnesses and prepare for future potential diseases.
Respiratory illness and climate change
There is now ample evidence to suggest that human-caused climate change, due to its role in rapid temperature changes and extreme weather events, may lead to a rise in respiratory illnesses through direct and indirect means. Sudden changes in precipitation and temperature affect the survival, reproduction, and distribution of pathogens that are sensitive to climate change, with one study claiming that 58 percent of pathogenic diseases are aggravated by climate change. In addition to climate change’s impact on pathogens, rapid fluctuations in temperature also impair the immune system’s ability to fight off respiratory infections. For instance, a sudden temperature drop in autumn might be followed by a more severe winter flu outbreak, mortality from respiratory illnesses was found to be higher during heatwaves, and higher temperature changes between neighbouring days (TCN) and temperature variation within the same day (DTR) have respectively been associated with increased childhood pneumonia and bronchitis. However, according to the 2022 Access to Medicine Index, not enough pharmaceutical companies are investing in the R&D of emerging infectious diseases (EIDs), which lowers the world’s chances of being prepared for the next pandemic. The United Nations Development Programme (UNDP) appraises that Asia Pacific stands to be particularly hard hit by the worst effects of climate change, bringing even greater risks to development and public health.
Zoonotic viruses
In recent years, the Asia-Pacific region’s alarming rise in respiratory illnesses has been significantly driven by zoonotic viruses such as avian and swine flu. These animal viruses pose substantial threats due to their potential to jump from animals to humans, often with severe health consequences. Avian influenza, commonly known as bird flu, is caused by influenza viruses that naturally occur in wild birds. Strains like H5N1 and H7N9 have been particularly concerning, leading to severe respiratory diseases in humans with high mortality rates. The densely populated poultry farms and live bird markets in parts of Asia facilitate the rapid transmission and mutation of these viruses, raising the risk of widespread outbreaks.
Similarly, swine flu, caused by influenza viruses circulating in pigs, can result in significant human infections. The H1N1 pandemic of 2009 highlighted the rapid global spread potential of swine-origin influenza viruses, underscoring the need for vigilant monitoring and response systems. The convergence of high population densities, frequent human-animal interactions, and robust viral adaptability makes the Asia-Pacific region a hotspot for these emerging respiratory threats.
Looking ahead
For MNCs with respiratory illness medicines and therapies, opportunities abound in the Asia-Pacific region as it continues to tackle this growing public health problem. Such firms are well advised to monitor the latest policy initiatives in the respiratory health domain and consider how their expertise can contribute to discussing and resolving this challenge.
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