View from Brussels: How the Pandemic Changed the EU’s Public Health Role Forever
There was already some optimism that the EU might begin to punch its weight as a public health player even before Coronavirus swept through Europe. For the first time this century a Commission President was appointed with a passion for health policy in 2019. As a medical doctor and with experience of a close family member with rare cancer, Ursula von der Leyen had already pledged to take on public health as a priority.
The EU Treaty firmly establishes Member States as responsible for the delivery of healthcare to EU citizens, with the EU responsible for delivering a single market for health products. Nevertheless, President von der Leyen hoped to persuade the capitals that working together on some challenges, for example cancer, can be greater than the sum of our parts.
The arrival of the pandemic, and with it the necessity to take decisive action with little concern for previous political and economic taboos, drove three decisive changes for our sector.
Mindset
The mindset on common European public health action has changed fundamentally. There was a false start; the EU institutions and Member States did not respond to Italy’s call for help in the first European outbreak in February 2020. But the lesson was learned fast; solidarity and action must extend to public health just as it does for the economy.
Bad memories of the botched joint procurement of medicines for the H1N1 influenza pandemic in 2009 were banished with the EU’s mechanism for Coronavirus vaccines. The approval (EU responsibility) and roll out (Member States responsibility) may have been slightly slower than in the UK, but Europe had an equitable and good value programme. The European Medicines Agency came to be seen as a credible voice on all issues vaccines by observers around the globe. The fact that one of the leading lights was developed by a European company, BioNTech, underpinned by mRNA technology invested in with EU research funds since the 1970s, further bolstered confidence. Member States were also supported with joint procurement of medical equipment and PPE.
Another success story in the eyes of policy makers was the EU’s interoperable vaccine, test and travel app which supported continued commerce and travel. The plan now is to build on this new public engagement with digital health through an Electronic Health Record and the Health Data Space.
Money
A clear sign of this change in mindset came with the agreement of the budget framework for 2021-2027. The Public Health Program (now called EU4Health) budget, which the Commission uses and disburses to carry out its priority health policies, increased by a factor of 12 compared to the previous period.
Billions of Euros have been made available to Member States under the pandemic Recovery and Resilience funds to spend on improving healthcare infrastructure. For example, France has successfully applied for €6 billion and Italy for €18 billion under the healthcare budget line. Sums that were previously unthinkable. There is additional health related funding to come under the EU’s digital programme which demonstrates the Commission’s new ‘Health in all Policies’ approach.
Political buy-in and resources are both clearly in place for a new era of EU health policy. MEPs, stakeholders, and national governments will try and ensure that it is spent wisely.
HealthTech: where once we were out, now we are in…
The challenges of implementing the MDR and IVDR, and the new public engagement with HealthTech during the pandemic, have shifted focus from the previous prioritisation of pharmaceuticals. HealthTech is now fully in scope of many new health, research, and industry initiatives:
- The EU’s new health emergency body, HERA
- The European Medicines Agencies (EMA) expanded powers to deal with health emergencies
- The change in management of MDR and IVDR Expert Panels from the Commission to the EMA
- The Health Technology Assessment Regulation
- The EU’s Beating Cancer Plan
- The Public Private Partnership, IHI, which now includes MedTech Europe and COCIR
- Digital health including the proposed AI Regulation and the European Health Data Space
- Efforts to ensure European Strategic Autonomy in critical products and raw materials
- Increased funding under the Horizon Europe research programme.
The demands are high on HealthTech stakeholders to try and shape so many crucial initiatives that are happening at the same time. The new attention from policy makers is welcome but we are keen to see that HealthTech specific approaches are developed rather than ‘hand-me-down’ pharmaceutical approaches.
It remains to be seen if the EU’s new approach on public health will be hampered by the war in Ukraine, or if it will empower the bloc to take a leading role on trying to reduce health impacts on injured and displaced people. There are already encouraging efforts to offer care to Ukrainian cancer patients at expert centres in the EU. It is fair to say that policy makers can feel far more confident about the value of the EU as a global public health player in 2022 than it did in 2019 which should encourage their proactivity.
Steve Bridges is a Brussels-based independent public affairs professional: www.bridges.be