Juncker’s ‘rolled-up sleeves’ must ensure EU health security

Opinion by European Alliance for Personalised Medicine Executive Director Denis Horgan

When it comes to issues of ‘security’ in the European Union, there are many facets. Military, economic and energy security are often mentioned - but the health security of 500 million citizens across 28 member states cannot be overlooked or, indeed, over-valued.

The Alliance for Personalised Medicine (EAPM) strongly believes that investing further in the exciting arena of personalised medicine, or PM, will help to bring about this security and tangible improvements in the lives of the EU’s citizens now and long into the future.

PM will help to bring about more effective preventative, as well as individually targeted, treatments and medicines which will keep more people away from expensive hospital beds. As well as bringing about better well-being, the long-term cost benefits of investment in PM will be huge.

At the beginning of this month, the new European Commission led by President Jean-Claude Juncker officially began a term of office that will run until 31 October 2019 – five years.

On 1 November Juncker said: "Now it's time to roll up the sleeves and get down to work. Europe's challenges cannot wait," and EAPM will happily work with the president’s team of relevant new commissioners to ensure that one area that cannot wait is that of health, with full inclusion of PM at the heart of the agenda.

The new Commission inherits a situation in which healthcare issues are officially Member State competencies under the EU treaties although, over the last two decades, the European Union has had a growing impact on the management of national healthcare systems.

In 1992, the Maastricht Treaty gave the EU its first legal public health mandate, which was updated in the Amsterdam Treaty in 1997. Article 35 of the EU Charter of Fundamental Rights states: "A high level of human health protection shall be ensured in the definition and implementation of all Union policies and activities."

Since then, theoretically, everyone has had the right of access to preventative health care and the right to benefit from medical treatment under the conditions established by national laws and practices.

So, the EU mainly plays a complementary and supporting role by shaping the conditions for, among other things, health workforce mobility, the purchase of goods and supplies, the financing of health systems and the delivery of services. Its implementation of the Single Market and many of the laws involving that have also had a large impact in the health arena.

Generally speaking, the EU’s growing influence in the health sector has been indirect, rather than through health-related policy. although this has changed of late with regulations in terms of pharmaceuticals, clinical trials and possible exemptions for medical research in key areas of legislation on Big Data.

Yet, as far back as the 1990s, the European Court, charged with the task of protecting individual rights, required member states to allow citizens to seek a variety of health care services across national boundaries, and to pay for those services from public funds.

EAPM certainly believes that the EU giving citizens the right to obtain care, which their own health system is slow or unable to provide, constituted and constitutes an aspect of health security - at an individual level.

For the future, it is clear that the EU’s role in healthcare will continue to grow, and that its decision-making will have a crucial impact on the funding and delivery of services in this large and complex arena.

EAPM welcomes this, believing that there is a solid argument for more, not less ‘Europe’, certainly in the area of health.

Lest we forget, one of the key tenets of the EU is the improvement of the lives of its citizens and billions of euro are being poured annually into, for example, research into cures for illnesses. At the same time, many EU laws have given citizens more, and more equal rights to better access to treatment.

But how to sustain this? In health and with a view to health security, the EU’s members can only benefit in the long term from working and acting together. It is clear that no single nation can tackle its own health problems alone in the face of rapidly changing demographics that threaten health security.

Times are tough, and more collaboration means more sharing of resources, which will allow for the improvement of healthcare systems – especially in smaller Member States and in the regions of some larger ones.

European health policy must continue to be based on the premise that the funding and delivery of health services is a social good. Allowing health care to be bought and sold on the open market – single or not - is a recipe for disaster in terms of citizens’ health security.

There is an argument that publicly funded healthcare arrangements that do not deliver what better-off citizens can purchase in the private sector will put the future of these very healthcare systems at serious risk. The damage that explicit rationing does to health security - as well as to the whole idea of universal healthcare - suggests the need for alternatives. These must involve improved efficiency plus innovative research and sources of funding.

Having said that, providing health security for all citizens does not necessarily mean public funding for all services, but it does entail that all citizens have access to services to the highest standard available – the right treatment for the right patient at the right time..

In the area of health, the EU cannot provide security without investment in research and innovation. Such EU-funding will not only improve Europeans' quality of life but will also enhance the EU's global competitiveness.

Horizon 2020, for example, has a budget of almost 80 billion euro. Under this scheme, and with this budget, the EU argues that researchers and businesses will benefit from increased and simplified EU support.

It will support innovation through investment in key technologies, greater access to capital and support for SMEs, as well as helping to cope with the significant challenges of an ageing population, while helping to bridge the gap between research and the market. Such work can drastically improve – and often save – the lives of a growing body of citizens who will all, at some point, need treatment.

Despite not having an overall competency for health, an example of EU money spent as a benefit to every Member State’s citizens is the Innovative Medicines Initiative (IMI) which has been working to improve health by speeding up the development of, and patient access to, innovative medicines.

In a similar way to personalised medicine it encourages and facilitates collaboration between key players involved in healthcare, in this case particularly research, including universities, the pharmaceutical and other industries, SMEs, patient organisations, and medicines regulators.

It is a partnership between the EU and the pharma industry, represented by EFPIA and has a €3.3 billion budget for 2014-2024. Just over half of this comes from Horizon 2020 with the balance from EFPIA companies, making IMI the world's biggest public-private partnership in the life sciences.

IMI, launched in 2008, now has almost 50 ongoing projects, with more on the way.

Such initiatives, and the growing influence of personailsed medicine in EU healthcare, can only help to ensure health security across the Union. There is, however, a long way to go and, as Mr Juncker says, it’s ‘time to roll up the sleeves and get down to work’. In this case, for the health security and benefit of all Europeans.

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