#Health - Commissioner hearings: Stella clears first European Parliament hurdle

European Health Commissioner-designate Stella Kyriakides (pictured) went before the European Parliament yesterday (Tuesday 1 October) for a three-hour Q&A session with MEPs on the Committees on the Environment, Public Health and Food Safety(ENVI) and Agriculture (AGRI), writes European Alliance for Personalised Medicine (EAPM) Executive Director Denis Horgan.

Today, she received the backing of ENVI, although her overall performance lacked convincing answers on pesticides.

ENVI chairman Pascal Canfin tweeted last Wednesday (25 September) that Kyriakides got the “green light” from the committee which was, nevertheless, insisting on the need for “additional concrete measures notably on pesticides”.

The hearings for all commissioners-designate continue until 8 October, with Parliament holding its vote on the full team in the week beginning 21 October.

In an opening statement on Monday (1 October), Kyriakides outlined her health background and explained her horizontal ‘One Health’approach to the portfolio.

The Commissioner-designate emphasized that health issues are of the utmost importance for all European citizens and that this fact would be her compass during her mandate.

She added that, at the end of that mandate in five years' time, she wants to be able to say that the Commission delivered on the cancer plan, on healthier and greener food, and improved public health and access to medicines.

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At the top of the hearing, Kyriakides also expressed her commitment to implementing the EU’s incoming medical device regulations, a topic that was - perhaps surprisingly - not followed up by any MEPs.

Artificial intelligence and digital tools need to be leveraged because they can help patients and healthcare professionals, she also said, adding that Europe has a special place to play on the global stage and it cannot look inwards. Its scope should be global and multilateral.

On cancer

Kyriakides told the committees that Europe's Beating Cancer Plan is a flagship project for the Commission and close to her heart. 

She said that 40% of people will face cancer in their lives, and that most families have been touched by the disease. This, she said,is already reason enough for cancer to be a top priority in health. 

She talked about food, lifestyle, medicines, care, technology, and access to treatment - all in respect of cancer. The plan needs to address prevention, diagnosis, treatment, research, survivorship and palliative care, while involving sectors beyond health, including education and environment, she stressed.

MEP Dolors Montserrat asked what the Commissioner-designate planned to do in terms of fairness on access to treatment? Kyriakides replied that for the plan to be effective, it cannot leave anyone behind. 

In terms of diagnosis, she noted that countries have implemented screening programmes, but these need to be accredited and follow European guidelines. Access to medicines is also a crucial part of the plan, she said, also noting that a number of cancer patients lose their lives because of antimicrobial resistance (AMR).

AMR

On the topic of AMR, the Commissioner-designate talked of the need to encourage industry to move forward with innovation and new antimicrobials, leading by example.

Antimicrobial resistance is a danger in Europe and in the world, andEurope should lead the global effort. Kyriakides said she will advocate for a global agreement on antimicrobials and prioritize the implementation of the One Health Action Plan.

Digital health 

Meanwhile, Cristian-Silviu Buşoi asked what measures Kyriakides would take as Commissioner to support the digitalization of the health sector in the EU.

She replied that the formation of a European Health Data Space was part of her mission letter and that digitalization is significant for citizens. 

The effects of this have already been seen, she said, highlighting e-prescriptions and patient summaries being exchanged between Member States. 

The Commission, she said,is committed to digitalization because it will promote research and innovation and can radically change patient care and treatment. 

Data protection of patients is an issue, she said, and has to be as equally important as treatment. 

The Commissioner-designate did note that not all member states are currently in the same place in terms of digitalization, and there is a need to encourage countries to move forward with eHealth. 

There is also a need to increase information to patients - it being the obligation of member states to keep them informed, she said.

Stella firm on HTA 

With some health attachés currently talking about the increasing pressure being put on the Commission to rethink the EU-wide mandatory aspects of HTA, as far as Kyriakides is concerned, the (now 20-month-old) proposal on health technology assessment is something for which she will seek consensus, but doesn’t intend to climb down on.

It’s “obvious that the voluntary way is not working”, she said during her hearing.

In July, Finland’s EU presidency submitted a discussion paper tackling some of the most controversial elements of the original proposal, including the scope of therapies subject to EU-level HTA; ways to ensure the quality of the joint reports; the use of joint assessments; and whether that report is ultimately included on a list of assessed joint technologies.

Meanwhile, Belgium has also got its teeth into the use of joint assessments, suggesting that member states “shall consider” or “shall take into account” such aspects.

France and Germany are keen on the provisos, but only if it’s clear in the text of the regulation that individual governments get to decide which aspects of the joint report are relevant to their national process.

The two EU heavyweights only want 10 joint clinical assessments per year to start with.

Also, Paris and Berlin have suggested leaving conclusions out of any joint clinical reports, calling for scientific report descriptions only, with no value judgment.

It’s fair to say that those member states who want a stronger system of cooperation are unlikely to be impressed.

Medicines shortages, prices and transparency 

On shortages of medicines, Kyriakides told MEPs that this is a “huge issue”. But as far as she is concerned there is “not only one reason” for this and no “quick fix”.

“Shortages and affordability are equally important,” she said, adding that the “pharma industry has a legal obligation to allow access to medicines”.

Green MEP Margrete Auken asked Kyriakides how she would approach medicine-pricing transparency, and referred to Italy’s resolution in the World Health Organization(WHO) earlier this year.

The Commissioner-designate replied that patients do not have access to medicines due to prices and shortages, adding that she would “work closely” with all stakeholders, industry and member states to examine the pricing mechanisms and look at how medicines are reimbursed.

Under pressure from Auken, who accused her of complicating a question that was “very simple”, Kyriakides admitted that she needs more information in respect of the WHO resolution.

Mental health 

UK MEP Caroline Voaden spoke about mental health issues, underlining that these affect individuals, families, and job prospects. Europe isfacing record levels of youth mental health issues, and Voaden wanted to know how the Commissioner-designate will put mental health on the EU agenda and ensure that member states do likewise and implement measures.

Kyriakides said that mental health has not been on the agenda for a number of years. In many member states, she said, there is still a stigma. 

She added that if we look at the problems today in adolescents in terms of behavioural issues and self-harm, there is a need to work on prevention.

Three more candidates face MEPs today 

Meanwhile, as you read today’s update (our second already of this busy week), it’s the turn of Didier Reynders, commissioner for justice, Helena Dalli, (Equality), and Sylvie Goulard, (Industrial Policy and the Digital Single Market) to face the deputies.

SANTE on investment 

Earlier this week we mentioned the EU Health programme conference that has just taken place. So here’s a bit more from DG SANTE chief Anne Bucher, who spoke at the event in Brussels.

It’s not only more investment in health that Europe needs, but new forms of it, which involves moving away from the traditional hospital-centred approach towards investment in new medicines and hospital equipment for community-based care, new patient pathways and integrated care services, she said.

Boucher added: “We have to support the adaptation and training of the health workforce and the digital equipment and ICT services for data sharing and health technology assessment,” as such investments are more relevant today for facing future challenges.

Meanwhile, the Structural Reform Support Service, which was created in 2015 to help member states with expertise in major reforms, is set to become a Commission directorate-general. So said Géraldine Mahieu, who is head of unit in charge of the health and social services, the labour market, and education. She pointed out that the service has this far supported 57 health-care projects in 21 EU countries. 

Mahieu added that Spain, Portugal and Greece are currently being offered technical support to improve affordable innovative medicines.

Smoke signals 

Speaking of Greece, the government in Athens is looking to ramp-up its smoking ban. The health ministry is drafting a law to broaden the ban’s scope and hire more police officers to enforce it. 

The plan is to extend the ban to open-air public venues and clubs, with a €200 fine for those naughty enough to defy it.

And in Germany, outdoor tobacco advertising restrictions, plus new rules on e-cigarettes, are currently under consideration.

E-health records

Croatiahas now begun receiving patient summaries from travellers coming from the Czech Republic. The Czechs have been sending electronic health records to Luxembourg since June, with Finland already sending e-prescriptions to Estonia.

As we’ve reported previously, the Commission expects 22 member states to be actively exchanging e-health records by 2021.

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