COVID 19 health care is tightly linked to the economy. The magnitude of the event – the COVID 19 pandemic – in the recent history of humankind is becoming obvious to everyone everywhere. Even for those who to deny it, and who have slowed the understanding of the wider consequences. The Brazilian and American governments, and specifically presidents Trump and Bolsonaro, continue to downplay the effects of the pandemic, now that they cannot deny the event in itself. The opposition in the USA is slowly catching on the idea that the major reason for the president’s actions are his inability to comprehend the natural and  biological event in itself, and thus he rejects something he cannot control. As if he threw away a Lamborghini because he was afraid of crashing it on the first drive around the block of Trump Tower in Manhattan.

But American think-tanks are not idle. There are many worries in the horizon, as the anti-vaccine movement makes clear. As much as elected officials have been in the denial mode for the most critical period, their supporters are widespread and their attitude has a major impact on how the situation will evolve. The MIT Center for Collective Intelligence and U.S. Pharmacopeia released a report in June 2020, the result of work by Trust CoLab. Over a four-week period they searched for ideas from leading experts in the most active health related organizations. The Bill and Melinda Gates Foundation, the American Association of Pharmacy and Harvard Medical School were some of the contributors. Called “Trust or Consequences 2040: will innovations in health and medicine deliver?” the report contains analysis of what these experts thought might define people’s health in the next 20 years, and how these developments might modify trust in medicine and health care. It seems clear the popular attitude and reaction to government and institutional action will shape the future. As a result, gauging them is critical.

The The MIT Center for Collective Intelligence and U.S. Pharmacopeia report draws four possible scenarios for the next 2 decades.

  1. The pink scenario: naming and making clear the tried and true: the response to serial health tragedies by key players in health care is wide-reaching cooperation.  All sectors come together to establish global mechanisms in international institutions, with the common objective of delivering established, basic, proven cures to everybody.
  2. The red scenario: problems with big data, information technology and gene modification lead to widespread frustration with medical failures. Disparities in access to medical technology continue. The consequence is a division of society in 3 tiers. The wealthy depend on the latest, science and evidence-based medicine. The middle class relies on trusted local caregivers. The less-privileged escape towards folk medicines, plant and food-based cures.
  3. The purple scenario: genetics, big data management and artificial intelligence lead to great leaps forward, but inequality and disparities, financial, cultural and political, lead to a situation of conflict between those who have access to the advances, and those who have not. The latter doubt the health system is credible.
  4. The blue scenario: the solution of future problems. Intelligent innovation is widely distributed. People understand that science turns into predictable even completely new diseases, like HIV, HPV, H1N1 and COVID. The focus of health care goes from diagnosis and treatment to prevention.  Innovation leads to remarkable new discoveries which turn complex problems around with simple solutions, bringing down the cost of health care, and thus, of human well-being.

Presently, the red scenario appears to be leading internationally, partly due to the populist political environment in influential segments of the world population. But the unpredictability and violence of COVID 19 is certainly responsible for part of the confusing situation. It may be that the political world was not prepared for something like what is going on. It is likely that the problem has been made worse by information technology, as sad as that statement may be. Modern components of human life, specially the widespread availability of instant knowkledge through mobile gadgets, has taken away the possibility of established institutions to lead the way, to shape atitudes. Perhaps Carl G Jung is now smiling. He would never feel good about a situation like ours, presently. But COVID 19 health care, as well as COVID 19 and the economy, appear to be linked through a collective unconscious, the mechanisms of which are ethereal, cybernetic, dependent of weird nerds, not even God knows where.

Dr Paulo Bittencourt

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