Professor Dame Sally Davies was leading efforts to raise awareness of the world’s lack of preparedness for global health emergencies long before the COVID-19 pandemic struck. In her nine-year term as England’s chief medical officer and the United Kingdom’s chief medical adviser, and now as the master of Trinity College Cambridge, Dame Sally
has worked to highlight the increasing threat of antimicrobial resistance (AMR). Last year, she set up the Trinity Challenge, a coalition of leaders from business, academia, and the social sector dedicated to helping the world better prepare for future health emergencies.
She also serves as the United Kingdom’s special envoy on AMR and sits on the One Health Global Leaders Group on AMR.
In an interview with McKinsey’s Hemant Ahlawat and Mitch Cuddihy, Dame Sally discussed lessons learned from the COVID-19 pandemic, and the crucial role that better use of data and digital technology could play in preventing and managing health crises. The following is a condensed and edited version of the full interview.
McKinsey: It’s been more than a year since the COVID-19 pandemic broke. What are your thoughts on where we now stand, and what we have we learned?
Reflections on where we as a society stand today
Dame Sally Davies: It’s been tragic. The deaths. Long COVID-19. The implications of lockdown on economies and on mental health. The loss of jobs. And it’s not over yet. So one can only feel a great deal of sadness. But I’m also optimistic because we’ll come through it. And we have learned a great deal that is important.
We’ve learned about the interplay between behavior, the economy, and health in a way we haven’t had to before, or at least not since 1918 and the flu pandemic that killed so many millions. During the current crisis, some Asian countries have found ways to bring in mask wearing and social distancing in a way that has pushed down on outbreaks so that they haven’t ripped through their communities. But here in Europe, in Africa too, we haven’t been able to control the spread. As one of my colleagues in Asia said to me: “We used to look to Britain for the tool kit, for the rule book. Now it’s time you looked to us.”
Lessons learnt from the pandemic
We’re also learning scientifically. By the end of January 2020, we’d already sequenced the genome of COVID-19. And then, within a year, we’d trialed and agreed with regulators [on] some vaccines. That is amazing. And the [messenger] RNA vaccines are fantastic novel technologies. We need to learn the lessons from what we have achieved so we can do it again.
Importantly, too, we’re starting to use data differently. Of course, the impetus for such progress—COVID-19—has cost society dearly, which is why it’s so important to use this pivotal moment to move forward effectively.
McKinsey: What would moving forward effectively entail?
Dame Sally Davies: COVID-19 has made people understand the importance of data and that we haven’t been able to use it efficiently. We haven’t been able to get the right data to the right people at the right time. For example, decision makers need to understand who the virus has infected, where that person is, and how and at what speed the virus is moving between people. But such data often comes too late to be able to make effective decisions.
Neither have we been effective at combining data. It’s siloed in different places. For example, when trying to track disease transmission in a population, phone network operators’ data on mobility can be helpful. However, the data often sit with different companies, making it hard to extract and combine. And while it’s true to say we’ve made improvements, we’ve got to bake those improvements in. We mustn’t slip back. We’ve got to bring together the data generators, the analysts, and the users into a much closer loop so that decision makers can use all that data almost in real time.
Commercially held data could prove particularly useful. For example, in aviation, a commitment to safety led to the Skywise program: a privacy-preserving data platform developed by Airbus that integrates data from more than 100 airlines. Combining the information that was previously locked in silos yields valuable insights into equipment performance, efficiency, and safety. The analogy to public health is clear, and while this kind of integration is not going to be easy, it’s not impossible. The recent collaboration between the Spanish statistics office and the leading national telcos, whereby mobility data was used in strict accordance with data-privacy standards to help decision makers understand adherence to lockdown guidance, is a great example of what can be achieved when incentives and processes are aligned. Could others use this as a playbook?
It’s this sort of thinking that led us to set up the Trinity Challenge, which is a collaboration between those who hold data and those who understand that it might be possible to use it more effectively—and, of course, fairly. Fairness is at the forefront of what we do. Just as worldwide access to a COVID-19 vaccine is an equity issue and a moral issue—no one’s safe until everyone is safe—so too is digital an equity issue.
We’ve got to make sure digital tools address biases. We’ve got to make sure that everyone around the world has access to the health benefits of data and digital technology. We’ve got to find ways to scale that are efficient, effective, and affordable. And, of course, to move forward, we’ve got to take the public with us. We’ve got to be trusted. We’ve got to hold people’s data in a privacy-preserving fashion so that they feel safe.
McKinsey: Tell us more about the Trinity Challenge.
What the Trinity Challenge is
Dame Sally Davies: The Trinity Challenge is a collaboration founded by more than 20 leading public-, private-, and social-sector institutions that aims to surface the best thinking to help us identify, respond to, and recover from health emergencies using data-driven research and analytics. We want to make sure we are better prepared for next time. How can we screen better? Can we survey better so we detect risks? Can we hold data more safely and use it to spot developments? Can we respond better? That will mean thinking about vaccines and behavioral issues—from mask wearing and social distancing to vaccine hesitancy. And can we recover better?
The answers to all this lie in the spaces where data on public health, behavior, and the economy collide. We have members collaborating on all these issues. And lessons learned are already being used. Take Internews, a nonprofit that seeks to promote the dissemination of trustworthy news and information in low- to middle-income countries. It had previously conducted work on how to identify the right kind of trusted, authoritative people to convey health messages, and how to use social media to amplify their voices and influence behavior. That work was used at the start of the pandemic to promote mask wearing and other interventions. And it is proving relevant again now as many countries seek to counter opposition to vaccine uptake.
The Trinity Challenge has issued a public challenge too, inviting people from around the world to submit their own ideas on how we might safeguard our health and economic systems from the threat of future global health emergencies. We’ve had lots of really exciting entries. And while we are still open to more, some of the early entrants are already working with Trinity Challenge members to see whether their ideas will deliver and can be shared and used globally.
McKinsey: You were leading the fight against AMR well before the COVID-19 crisis broke. What progress do you see on that front?
Dame Sally Davies: There hasn’t been enough. Back in 2013, when I first started getting interested in AMR, people didn’t understand the gravity of the situation. And to a certain extent they still don’t. Some 700,000 people a year are dying of [drug-] resistant infections. That shouldn’t happen.
Tackling antimicrobial resistance
We need to acknowledge the risk. The COVID-19 pandemic has been like dropping a lobster into boiling water. The lobster makes a noise as it dies, and the world takes notice. AMR, on the other hand, is like putting the lobster into cold water and heating it up ever so gently. No noise at all, so no one takes much notice. But the lobster is still going to die. So we need to respond. We need to look after the drugs we’ve got. We need better diagnostics, more vaccines, and much better infection prevention and control.
But we also need new drugs. I want to commend the work the International Federation of Pharmaceutical Manufacturers and Associations is doing for the AMR Action Fund, an initiative that also involves the World Health Organization [WHO], the European Investment Bank, and the Wellcome Trust to invest $1 billion and bring up to four new antibiotics to market. And here in the United Kingdom, the NHS [National Health Service] is piloting a really exciting payment model for new antibiotics whereby the pharmaceutical companies are paid an annual subscription based on the health benefits to patients and the value to the NHS, rather than the amount of drugs they sell, helping them to reliably forecast their return on investment.
But we’ve got a broken market, in that it is hard to encourage companies to develop drugs that, under normal circumstances, might not get used. And we’ve got a behavioral problem—the overuse and misuse of the drugs we have. These are really difficult problems to crack. I’m hopeful that with the new, tripartite One Health Global Leaders Group for AMR, on which I’m honored to sit, we can move this forward. But it’s going to take a lot of effort. The good news is that AMR is now firmly on the G-7 agenda. Ministers on the finance track are scheduled to discuss it, and those on the health track have already started doing so. Let’s hope we can make progress.
McKinsey: You have one foot in the world of healthcare and, as the master of Trinity College, one in education. What strikes you about what lies ahead from these two perspectives?
Dame Sally Davies: In healthcare, you have to be struck by the power of digital technology—the Fourth Industrial Revolution—to totally change how we deliver healthcare.
We are already seeing glimpses: speedier, smoother movement of patient data around the health system, virtual consultations, and artificial intelligence to support a raft of tests. Then there’s precision medicine and genomic risks scores—the ability to use multiple loci in the genome to tell us our risks of cardiovascular disease, of different cancers, or of diabetes. Once we have that information, we could perhaps devise ways to modify our lifestyles or undergo more intensive screening if we face high risks.
Then there’s the power of digital technology to help manage future health crises. Take the Fleming Fund. I persuaded the UK government to establish the fund to support low- and middle-income countries to generate, share, and use data on AMR. The aim is to help governments make informed policy decisions that will help reduce the growing global threat of AMR and guard against the emergence of an additional health crisis. We’ve seen all sorts of simple digital projects emerge as a result. A novel app developed in Bangladesh, for example, helps local vets work out the most appropriate treatments based on national and global WHO guidelines—the right types of drugs, the right dosage, et cetera—with a view to promoting the responsible use of antimicrobials. Digital technology and mobile telephony are going to help some countries leapfrog ahead in ways that will really make a difference to global health.
Solutions lie with empowered young people
In my role as master of Trinity College, a wonderful thing that has struck me is that young people seem to care more and more about each other and about society. We must build on that and release their innovative capacity. We don’t need a society run by old men and old women. To take us forward, we need to empower the young to use digital, to find different ways of doing things.
There’s a great book called New Power
that shows how you can shift behaviors using social media to peer-drive and channel energy. But it goes way beyond that. Think how veganism is taking off through this “new power.” Think how low-alcohol beer has taken off through it. If we empower young people, they will surely innovate and support the society we live in.