Etisalat is a regional telecommunications powerhouse that perhaps needs little introduction. Founded 43 years ago, the UAE company has grown to become the 14^th biggest mobile network operator worldwide, with operations in 15 markets.

What might not be known is that Etisalat is also an emerging force in eHealth.

Related: Dr Osama AbouElkhir, the physician fixing healthcare with AI

Overseeing the telco’s charge into new territory is digital transformation specialist and healthcare industry veteran Khalid Ghalou Adine.

Adine, who earlier this year had contributed to the Innovation Committee at Innov8 Talks, Arab Health 2020’s sessions on the latest ideas, explained to Omnia Health Insights that Etisalat was at the beginning of an important journey.

Related: Marwan Abdulaziz, the catalyst putting Dubai on the healthcare innovation map

He pointed to the transformation of the healthcare industry, one that was shifting from provider centric approaches to patient centric – as a trend that was especially apparent in the Middle East and in the UAE in particular.

Seizing the opportunity to empower this transformation – and positively impact society - healthcare was established four years ago as a strategic industry vertical within Etisalat Digital, the company’s business unit dedicated to digital technologies.

Its mission was to provide a new care delivery model, leveraging the Etisalat’s assets (big data, cloud security, IoT, AI and so forth) to improve patient outcomes and efficiencies for customers.

Change is change, of course, and rather than appoint specialists from a telecommunications background, Etisalat looked to the healthcare industry itself, building a multi-disciplinary team that included clinicians, doctors from A&E, system integrators, and experienced hires from NHS Digital in the UK.

Smart solutions

Etisalat Digital Healthcare has identified three key areas of opportunity.

The first is “smart hospitals”. Through smart solutions and capabilities that help caregivers enhance their processes, patients can enjoy safer service and managers to reduce inefficiencies. Examples of such solutions include Smart Room,  smart parking, BMS, EMRs and medical imaging.

Second, Etisalat Digital is offering a “health information exchange” or framework - leveraging the ‘pipe’ and Etisalat assets like cloud compute, connectivity, cyber security or information backbone to enhance healthcare processes. Etisalat is contributing to the government of UAE with a use case for health information exchange initiatives.

Etisalat is working with Abu Dhabi, for instance, to deliver an integrated electronic health record across the emirate through providing a light EMR as a cloud service, which has already been integrated with Malaffi to increase adoption of the health information exchange in Abu Dhabi.

Etisalat with the Department of Health – Abu Dhabi (DoH) announced the launch of the Digital Health Centre, an initiative aiming to drive innovation in areas that include chronic disease management and the healthcare marketplace, in addition to the use of blockchain, AI and big data to enhance healthcare outputs and quality of services.

Medical imaging is another health information framework use case, with Etisalat providing medical imaging software in the cloud as a Pay As You Go (PAYG) model so that no initial investment is required by the customer.

At Arab Health 2020, Paxera Health and Etisalat launched their cloud-based medical imaging platform powered by the former’s AI-based PACS and the latter’s 5G broadband, meaning that healthcare institutions can access and manage high volumes of medical images at lightning fast speeds.

Third, Etisalat Digital is focusing on telemedicine, a solution it describes as “population health management” – allowing patients to enjoy a better quality of life from home by enabling caregivers to monitor and control their condition through telehealth solutions.

Again at Arab Health 2020, American Hospital – with whom Etisalat enjoys a “remarkable synergy” - announced that it had launched a first of its kind telehealth service in the private sector using Etisalat Digital’s specialised telemedicine software platform offering advanced voice, video conferencing and collaboration technologies. Adine stressed that popular video calling solutions used by many hospitals, such as Zoom and Microsoft Teams, are not strictly telehealth solutions.

Securing trust

While Etisalat Digital is well equipped with the technologies, vision and talent necessary to lead the digital healthcare revolution, it faces challenges, as can be expected with any attempt to disrupt or digitally transform.

Changing mindsets is one – a challenge that many disruptors can relate to - including any internal misconceptions that Etisalat Digital is providing telco services.

In a similar vein, Adine cited fear as holding the local healthcare industry back from any innovation that might impact patients.

With cloud computing a key component in the transformation of the industry, he acknowledged that in the last five to 10 years there were security breaches in healthcare in advanced countries.

He nonetheless stressed that they were learning from mistakes made, adding that Etisalat is a trusted cloud service provider (Etisalat OneCloud and Microsoft Azure). Not only is its cloud services within the UAE and therefore compliant – it is a key security player through worldwide partnerships in cybersecurity and having gone through “long and painful” certification programs.

Adine identified local regulations as a second challenge, using the example of telemedicine - a service cutting across SMS, calling and connectivity - and called for a stronger regulatory framework in support of digital healthcare.

He however reserved praise for the UAE Government who, as he put it, is working hard to support companies such as Etisalat in enabling services that are compliant with international medical service standards.

Healthy prospects

While conceding that healthcare was not an industry that readily embraced transformation – unlike for example banking (fintech) – Adine remained highly optimistic.

The biggest disruption is happening right now with the COVID-19 pandemic, with Adine even speaking of a “before” and “after”.

The ongoing crisis is forcing the rapid adoption of new technologies: demand is surging not only for telehealth but wearables too, as individuals look to measure their blood pressure, temperature and oxygen saturation among other metrics.

Demand has also grown for big data solutions – in tracking COVID-19 patients and the epidemic spread for example.  

Indeed, Adine believes that a combination of IoT and big data, more than any other technology or innovation, will have the biggest impact on the healthcare industry in the years to come.

With the increased support of governments, who Adine considers will prioritise healthcare like never before after the global pandemic, Etisalat Digital and other disruptors from outside healthcare will be firmly positioned to transform the industry - and correspondingly people’s lives.

A number of countries have now started to report that the rate of COVID-19 cases has started to decline. However, the progress that is being watched even more closely is the development of a Coronavirus vaccine.

It normally takes years to develop, approve and produce an effective vaccine. But due to the need of the hour, there are currently over 70 COVID-19 vaccines in development worldwide, according to the World Health Organization (WHO).

Related: Coronavirus test kits: Effective way to monitor and manage the pandemic

Creating a safe vaccine would provide some protection by training people's immune systems to fight the virus so they don’t get infected. It would, therefore, allow lockdowns to be lifted and social distancing rules to be relaxed. Below we take a look at the progress of a few developments:

Oxford COVID-19 vaccine begins human trial stage

University of Oxford researchers have begun testing a COVID-19 vaccine in human volunteers. Around 1,110 people will take part in the trial, half receiving the vaccine and the other half (the control group) receiving a widely available meningitis vaccine. They will reportedly have a million doses ready for use by September.

Related: Ventilators – the difference between life and death in Coronavirus

The researchers started screening healthy volunteers (aged 18-55) in March for their upcoming ChAdOx1 nCoV-19 vaccine trial. The vaccine is based on an adenovirus vaccine vector and the SARS-CoV-2 spike protein and has been produced in Oxford, UK.

It aims to assess whether healthy people can be protected from COVID-19 with this new vaccine called ChAdOx1 nCoV-19. It will also provide information on the safety aspects of the vaccine and its ability to generate good immune responses against the virus.

ChAdOx1 nCoV-19 is made from a virus (ChAdOx1), which is a weakened version of a common cold virus (adenovirus) that causes infections in chimpanzees, that has been genetically changed so that it is impossible for it to grow in humans.

Genetic material has been added to the ChAdOx1 construct, that is used to make proteins from the COVID-19 virus (SARS-CoV-2) called Spike glycoprotein (S). This protein is usually found on the surface of SARS-CoV-2 and plays an essential role in the infection pathway of the SARS-CoV-2 virus. The SARS-CoV-2 coronavirus uses its spike protein to bind to ACE2 receptors on human cells to gain entry to the cells and cause an infection.

By vaccinating with ChAdOx1 nCoV-19, the hope is to make the body recognise and develop an immune response to the Spike protein that will help stop the SARS-CoV-2 virus from entering human cells and therefore prevent infection.

Vaccines made from the ChAdOx1 virus have been given to more than 320 people to date and have been shown to be safe and well-tolerated, although they can cause temporary side effects, such as a temperature, headache or sore arm.

The University of Oxford recently also announced an agreement with the UK-based global biopharmaceutical company AstraZeneca for the further development, large-scale manufacture and potential distribution of the COVID-19 vaccine being trialled.

 

Pfizer and BioNTech to co-develop vaccine

Pfizer Inc. and BioNTech SE announced that the companies have agreed to a letter of intent regarding the co-development and distribution (excluding China) of a potential mRNA-based coronavirus vaccine aimed at preventing COVID-19 infection.

The collaboration aims to accelerate the development of BioNTech’s potential first-in-class COVID-19 mRNA vaccine programme, BNT162, which was expected to enter clinical testing by the end of April. The rapid advancement of this collaboration builds on the research and development collaboration into which Pfizer and BioNTech entered in 2018 to develop mRNA-based vaccines for prevention of influenza. 

 

Sanofi and GSK collaborate

Sanofi and GSK recently announced that they have signed a letter of intent to enter into a collaboration to develop an adjuvanted vaccine for COVID-19, using innovative technology from both companies, to help address the ongoing pandemic.

Sanofi will contribute its S-protein COVID-19 antigen, which is based on recombinant DNA technology. This technology has produced an exact genetic match to proteins found on the surface of the virus, and the DNA sequence encoding this antigen has been combined into the DNA of the baculovirus expression platform, the basis of Sanofi’s licensed recombinant influenza product in the U.S.

GSK will contribute its proven pandemic adjuvant technology to the collaboration. The use of an adjuvant can be of particular importance in a pandemic situation since it may reduce the amount of vaccine protein required per dose, allowing more vaccine doses to be produced and therefore contributing to protecting more people.

The combination of a protein-based antigen together with an adjuvant is well-established and used in a number of vaccines available today. An adjuvant is added to some vaccines to enhance the immune response and has been shown to create a stronger and longer-lasting immunity against infections than the vaccine alone. It can also improve the likelihood of delivering an effective vaccine that can be manufactured at scale.

The companies plan to initiate phase I clinical trials in the second half of 2020 and, if successful and subject to regulatory considerations, aim to complete the development required for availability by the second half of 2021.

 

Moderna announces Phase 2 Study of mRNA Vaccine

Moderna, Inc., a clinical-stage biotechnology company, recently announced that it has submitted an Investigational New Drug (IND) application to the U.S. Food and Drug Administration (FDA) for the company’s mRNA vaccine candidate (mRNA-1273) against the novel coronavirus (SARS-CoV-2) to evaluate mRNA-1273 in Phase 2 and late-stage studies if supported by safety data from the Phase 1 study led by the National Institute of Allergy and Infectious Diseases (NIAID), part of the U.S. National Institutes of Health.

Moderna has received initial feedback from the FDA on the design of the planned Phase 2 study, which is expected to begin in the second quarter of 2020. This study will evaluate the safety, reactogenicity and immunogenicity of two vaccinations of mRNA-1273 given 28 days apart. Each subject will be assigned to receive placebo, a 50 μg or a 250 μg dose at both vaccinations. The company intends to enrol 600 healthy participants across two cohorts of adults ages 18-55 years (n=300) and older adults ages 55 years and above (n=300). Participants will be followed through 12 months after the second vaccination.

Subject to data from Phase 1 and Phase 2 studies and discussions with regulators, a Phase 3 study could begin in the fall.

Johnson & Johnson to initiate human clinical studies by September

Johnson & Johnson recently announced the selection of a lead COVID-19 vaccine candidate from constructs it has been working on since January 2020. The company has been working with Biomedical Advanced Research and Development Authority (BARDA) and has rapidly scaled manufacturing capacity with the goal of providing a global supply of more than one billion doses of a vaccine. The company expects to initiate human clinical studies of its lead vaccine candidate at the latest by September and anticipates the first batches of a COVID-19 vaccine could be available for emergency use authorisation in early 2021.

BARDA, which is part of the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services, and Johnson & Johnson together have committed more than US$1 billion of investment to co-fund vaccine research, development, and clinical testing.

Cleveland Clinic is establishing the Center for Global and Emerging Pathogens Research to broaden understanding of emerging pathogens – ranging from Zika virus to SARS-CoV-2 (which causes COVID-19) – and to expedite critically needed treatments and vaccines.

The new center has been in the planning stages for 18 months and will span Cleveland Clinic’s Lerner Research Institute and the soon-to-open Cleveland Clinic Florida Research and Innovation Center (FRIC) in Port St. Lucie, Florida, U.S. A team of renowned experts will lead the center to advance research toward diseases such as COVID-19, highly pathogenic influenza, Dengue fever, AIDS and Zika virus-related conditions.

“Novel pathogens to which we have little or no immunity are a tremendous risk to global health,” said Serpil Erzurum, M.D., chair of the Lerner Research Institute. “We have some of the world’s top research experts in virology, immunology, genomics, population health and drug discovery coming together to form a team approach on infectious disease research.”

Leveraging Cleveland Clinic’s research infrastructure, the center’s researchers will uncover the scientific mechanisms of how SARS-Cov-2 and other pathogens cause disease. In addition, the researchers will collaborate with the newly established Cleveland Clinic BioRepository to have access to patient tissues and electronic medical record data through a large-scale secure database. The new center will be supported in large part by philanthropy.

The research team will collaborate with the drug developers at Lerner Research Institute’s Center for Therapeutics Discovery to rapidly translate research findings into life-saving therapies and experts in the Populations Health Research Center to understand socioeconomic factors that affect risk of infection and poor outcomes.

In light of the global pandemic and in anticipation of the new center’s opening, Cleveland Clinic is ramping up research related to COVID-19. A research registry of nearly 10,000 patients is collecting data from patients tested for COVID-19 at Cleveland Clinic and there are plans to integrate the data with the electronic medical record. The researchers will mine the data to inform other studies, such as the development of tools to predict risk and outcomes in patients.

Cleveland Clinic researchers published findings in March on a network-based prediction model using artificial intelligence to identify targets for drug repurposing in coronaviruses and COVID-19 specifically. Based on their findings, they prioritised 16 drugs and three drug combinations as potential treatments.

Other projects are uncovering how SARS-Cov-2 enters human cells, replicates and causes disease. A clinical trials committee has been formed to identify and prioritize the most promising therapies for mild to severe disease.

In partnership with Cleveland Clinic Florida, the new center will also conduct research at the Florida Research and Innovation Center building, a state-of-the-art research facility, complete with a biosafety level 3 laboratory anticipated to open in summer 2020. The facility features 107,000-square feet of high-tech laboratory and office space situated on eight acres of land.

“The new Florida Research and Innovation Center will complement and expand clinical research underway throughout Cleveland Clinic,” said Joseph Iannotti, M.D., Ph.D., Cleveland Clinic Florida’s Chief of Staff and Chief Academic and Innovation Officer. “Our vision is to create a research institute dedicated to taking bench discoveries and creating leading-edge diagnostics, preventatives and treatments for infectious disease, oncology and other pressing healthcare problems.”

“This new center will span our global healthcare system,” said James Young, M.D., Chief Academic Officer at Cleveland Clinic. “It will provide critical technologies and resources, empowering our clinicians and scientists to understand biological pathways and develop new treatments against the novel coronavirus and other dangerous pathogens.”