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Before COVID-19 100+ experts identified top threats & opportunities for global health

May 21, 2020

ROCKVILLE, Md., May 21, 2020--Just a few weeks before the first cases of COVID-19 were made public, a group of more than 100 leaders in health and medicine was imagining the future of health innovation and factors that could determine its success or failure. A recurring theme was the increasing frequency of global crises that could lead to widescale disturbances and force healthcare leaders to collaborate and deliver truly global health solutions. This hypothetical series of events, now beginning to play out in real time, is described--alongside other future-oriented scenarios--in a new report released today by the U.S. Pharmacopeia (USP) and the MIT Center for Collective Intelligence (MIT CCI).

The report--Trust or Consequences 2040: Will Innovations in Health and Medicine Deliver?--describes the changing environment for medical breakthroughs leading up to 2040 and the importance of trust in encouraging adoption. It addresses major questions such as "What developments will shape people's health between now and 2040?" and "How will trust be critical in ensuring these developments help people everywhere live longer and healthier?" The report also identifies risks to health systems and medicine supply chains worldwide, opportunities to improve global health and consequences that threaten to undermine public trust in medicine.

"New health threats will emerge with significant impact on the delivery of healthcare throughout the world," forecasted Roy Guharoy, system vice president of pharmacy, Baptist Health System and professor of medicine, University of Massachusetts Medical School. "The current global supply chain is fragile and infested with many problems, as evidenced by frequent drug shortages. A solid infrastructure for the global supply chain is critical to ensure availability of medications to meet the needs of patients around the world."

In April, as the pandemic was spreading, USP and MIT CCI asked the experts a follow-up question: "The COVID-19 pandemic has surfaced vulnerabilities in the global healthcare supply chain. Given this, what is the single biggest issue that should be addressed to ensure the availability of safe, quality medical products?" Participants identified drug supply chain resiliency and shortages across the medical device and supplies sectors as crucial issues to tackle. They also offered a variety of solutions, which will be released in a future report.

"Many of the challenging issues we face in healthcare are recurring and persistent. Trust or Consequences 2040 points out that we must plan for the healthcare future we want, or we risk an erosion of trust and failure to fully benefit from promising innovations in health and medicine," said Ronald T. Piervincenzi, chief executive officer of USP. "During the COVID-19 pandemic and beyond, trust is needed to ensure the integrity of our medicines and the global medicines supply chain. The decisions we make now, and in the months following this crisis, will have a lasting impact on the future of healthcare, trust in medicine and in building resilient supply chains."

The consequences of erosion or collapse of trust are dire. Patients may not seek out medicines already proved to be safe and effective, leaving them vulnerable to bad actors. They may avoid needed healthcare or neglect to adhere to prescribed medical treatments. They may turn to unproven or risky alternatives rather than qualified health professionals and quality-assured medical products--all to devastating effect.

The report presents four potential future worlds that could emerge by the year 2040, and which are greatly influenced by new advances in technology--notably big data and artificial intelligence (AI)--as well as access to healthcare.
  • Scaling the tried and true. A series of rolling crises spur effective global collaboration to address health concerns broadly. Meanwhile, medical advances based on big data and AI occur gradually and are implemented incrementally. As a result, the focus is on baseline care provided to all.

  • Dangerous uncertainty. Problems with big data and AI lead to devastating healthcare failures. Unequal distribution of access means only the rich receive the most advanced treatments while people of modest means turn to therapies informed by traditional folkways. The efficacy and safety of science-based medicine are called into question.

  • A world of difference. The successful application of big data and AI leads to rapid advances in personalized medicine and prevention, diagnosis and treatment informed by genetic information. Not everyone has access to the fruits of these innovations. Disparities between and within nations perpetuate a "haves" versus "have nots" dynamic.

  • Solving tomorrow's problems. Smart and deliberate innovation is broadly distributed. Advances in big data and AI help create effective, inexpensive genetic diagnostic tools that are applied globally. Diseases become more predictable and, informed by new insights about why illness occurs, the focus of healthcare evolves to emphasize prevention. New treatments also emerge. Technological advances not only lead to remarkable new therapies but also contribute to curbing increases in healthcare costs.

Trust or Consequences 2040 also suggests how public quality standards for medical products could help promote trust in health and medicine in the future--as they have for 200 years. In the most positive future outcome, diverse entities--standards-setting organizations like USP, caregivers, government entities and commercial providers active in the healthcare sector--work together to develop the new standards and oversight practices required to guarantee the safety and effectiveness of future medicines and products. Standards could also help address inequities in patient care by enabling the faster dissemination of best medical practices.

"This report inspires recognition of the importance of the public's trust and guards against the dangers that rapid change sometimes presents," said Kathleen Kennedy, executive director of MIT CCI. "We are grateful to the many prominent expert participants from around the world who shared their insights, which will help global, national and local leaders as they make important choices now during the COVID-19 outbreak and well into the future."
For more information, visit

About USP

USP is an independent, nonprofit, scientific organization that collaborates with the world's top experts in health and science to develop quality standards for medicines, dietary supplements, and food ingredients. Through our standards, advocacy and education, USP helps increase the availability of quality medicines, supplements and food for billions of people worldwide. For more information about USP, visit

About the Trust CoLab

Insights for the report Trust or Consequences 2040: Will Innovations in Health and Medicine Deliver? were gathered from 105 global experts in healthcare and medicine by the MIT Center for Collective Intelligence and Scenario Insight with USP through an online platform and exercise called the Trust CoLab. The pilot took place September 18 through October 4, 2019 and the full exercise ran from October 28 through November 24, 2019. For more information, visit

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