The EU needs an ambitious and coherent agenda for the 2019-2024 legislative term to boost the resilience, equitability and sustainability of Europe’s healthcare systems. This report, based on a Science|Business expert roundtable, sets out recommendations for such an agenda.
When it comes to healthcare, Europe has strong foundations on which to build. It already has among the best systems in the world, with the most equitable access. The EU has demonstrated a long-term commitment to European research and innovation policies for health research, building on leading university hospitals and great science. Europe edges out the rest of the world in life expectancy and is on track to reduce early deaths from cardiovascular disease, cancer, diabetes and chronic respiratory diseases by 1.5 per cent a year by 2020. Companies based in the EU produce almost 80 per cent of the world’s vaccines. The continent is moving into a new era of innovation, where advances from cell and gene therapy, to genomics and precision medicine hold great promise for extending the healthspan of EU citizens.
The engine is there; now, how can the EU help it fire? How can the European institutions help healthcare systems innovate, maintain quality and deliver the economic benefits of a healthy population and a strong life sciences sector?
Because, despite strong foundations, it’s not all good news. The rising incidence of chronic disease is hurting Europe’s healthcare systems. Europe leads the world in both alcohol and tobacco consumption. Nearly every country in the region is seeing growing levels of obesity. And an ageing population is putting unprecedented pressure on healthcare services.
There is increased urgency to act. While health accounted for 8.5 per cent of public expenditure in the EU in 2015, by 2060, it could reach 12.5 per cent, according to the European Commission. And there’s the looming threat of antimicrobial resistance, as well as the recent alarming recurrence of measles on the continent in the wake of anti-vaccination campaigns.
In the face of this, many see a role for ‘more Europe’ to help ensure the sustainability of healthcare. At its best, EU policy can level the playing field, by providing coordinated and strategic planning for health research, increasing collaborative efforts across member states, both avoiding duplication of effort and helping to close the gaps between the region’s healthiest and unhealthiest locations.
There is an important new tool at hand to help with all this, in the digitisation of healthcare. This can help across the board, from better self-care, better monitoring of chronic disease, improvements in diagnostics through AI, streamlining of R&D, and the collection of data showing how medicines perform in the real world, to modernising the way healthcare systems are run.
EU research funding, for example, can help drive new healthcare technologies for doctors and patients, and also bring combined and coordinated resources to bear on the threat of cybercriminals and thieves from hacking and stealing personal health information. The EU can help bring medical records closer to patients. Investment in data infrastructure means medical records could be disaggregated into individual or family units, rather than stored in centralised databases. Public health campaigns managed out of Brussels can save lives and money, while some judicious policymaking could modernise financial markets and improve investment in life sciences for the whole continent.
There are some powerful examples of how long-term coordination and funding from the EU has promoted better healthcare across Europe. One notable example is the focus it has brought to rare diseases by backing research, the creation of the orphan diseases regulation that incentivises companies to develop therapies for rare diseases, and the formation of the European Reference Networks that allows clinicians across Europe to get access to clinical experts in any country.
Another example is in the support the EU has given to the creation of a common approach to health technology assessment (HTA) of the cost-effectiveness of new medicines coming to market, and to ensuring that clinical trials not only gather the data needed for the European Medicines Agency to judge the safety and efficacy of new drugs, but also the inputs needed by HTA bodies. The EU has also created a framework within which HTA bodies can provide early advice to manufacturers on clinical trial design and evidence requirements.
The EU has also energised and supported patient groups, for example through training non-expert patient advocates to give evidence to HTA bodies and to make sure the patient voice is heard. But the EU is always hampered in active health policy because national healthcare systems are the sole responsibility of member states, and governments do not generally carry out projects in this field with other countries.
The recent EU elections were an occasion to strengthen the EU’s commitment to health. There was never such interest in an EU election and health, unusually, was high on the agenda. Look at the discussion around cancer. One leading candidate, Manfred Weber, said he wants Europe to work together on “an ambitious approach on medicine research,” because “nobody thinks that one single country can win the fight” against the disease.
Citizens’ expectations, and policymakers’ ambitions, are higher than they were five years ago. The giant strides made in recent years point the way toward the possibility of more progress. The EU and member states need to make the most of this opportunity.