Comment in 2022

Gender-affirming care for transgender and gender diverse people should be inclusive, community led and evidence informed to support mental health and wellbeing.

Clinical research often excludes people with disabilities who have impaired decisional capacity, but they can be included through supported decision-making, where their decisions can be assisted by designated supporters of their choosing. This will promote equitable access to research.

Most health systems struggled to obtain and analyze real-time data during the COVID-19 pandemic, but places that succeeded can be studied to provide a model for data-enabled responses to future epidemics and pandemics.

The ethical impact of AI algorithms in healthcare should be assessed at each phase, from data creation to model deployment, so that their use narrows rather than widens inequalities.

Results from clinical trials can be deemed trustworthy only if they are properly conducted and their methods are fully reported. The SPIRIT and CONSORT checklists, which have improved clinical trial design, conduct and reporting, are being updated to reflect recent advances and improve the assessment of healthcare interventions.

Paying individual people for their health data will widen inequalities and reduce altruism, luring people to sell their privacy. Health data should instead be treated as collective property, and commercial profits should be shared with the public.

Machine learning algorithms are a powerful tool in healthcare, but sometimes perform no better than traditional statistical techniques. Steps should be taken to ensure that algorithms are not overused or misused, in order to provide genuine benefit for patients.

Wastewater monitoring has been used to identify SARS-CoV-2 outbreaks and track new variants. This sentinel system should be expanded to monitor other pathogens and boost public health preparedness.

Hematopoietic stem-cell gene therapy has proven to be an effective treatment for several primary immunodeficiencies, and yet companies in this space are withdrawing from the EU market. Technological and regulatory innovations and a change to cost–benefit models are needed so that rare disease patients can receive these life-saving medicines.

Greater emphasis on reproducibility and reusability will advance computational pathology quickly and sustainably, ultimately optimizing clinical workflows and benefiting patient health.

Pigs offer a potentially plentiful supply of organs for humans, but widespread xenotransplantation will require a collaborative and iterative approach to research, as well as involvement of transplant patients and the public.

Cholera is endemic in 47 countries, but deaths from this disease can be eliminated with a package of low-cost measures implemented by community healthcare workers.

Deep brain stimulation is an effective treatment for obsessive–compulsive disorder but is rarely used. Action is needed by psychologists, psychiatrists and insurers so that patients with otherwise intractable cases can receive this therapy to improve their mental health.

The H3D Centre is a South African-based academic translational research unit that has had many successes and could provide a much-needed model for drug discovery and development in Africa.

A new approach to pandemic and epidemic intelligence is needed that includes modern approaches to surveillance and risk assessment, as well as improved trust and cooperation between stakeholders and society.

Improved screening, novel therapies and a focus on health equity can reduce cancer mortality by 50% in the next 25 years, but these must be underpinned by an investment in basic, translational and clinical research, along with open data.

The elimination of malaria from China relied on local decision-makers who tested and implemented interventions, combined with a centralized drug discovery program. This holds lessons for other malaria-endemic countries.

Ethnicity information is often missing from health data, impeding action on inequalities. Recording and using ethnicity data will require training, efforts at standardization, and policy changes, while engaging with patients and the public.

Global sequencing and surveillance capacity for SARS-CoV-2 must be strengthened and combined with multidisciplinary studies of infectivity, virulence and immune escape, in order to track the unpredictable evolution of the ongoing COVID-19 pandemic.

Publicly funded research leads to the development of many new drugs, but the profits are largely reaped by big pharmaceutical companies through exclusive licensing deals, mergers and acquisitions, which can reduce competition and patients’ access to medicines.