#EAPM: Inequitable health care - a one-way ticket to undermine the EU

Just imagine if the EU fell apart due to an inequality of access to the best medicines. It’s not as impossible as it may first sound, writes European Alliance for Personalised Medicine Executive Director Denis Horgan.

The European Union has equality for all citizens as one of its basic tenets - arguably the most important one - but with the dissatisfaction of many Europeans and populist politicians having become prevalent in recent times (not least in the case of the looming Brexit) a scenario where citizens wash their hands of an under-performing EU is not beyond the realms of possibility.

Recently installed French President Emmanuel Macron at least appears to have grasped this, while the likes of top MEP and former prime minister of Belgium Guy Verhofstadt has always understood it.

But, on the other side, we have the likes of Marine Le Pen (also in France), Germany’s AfD party, Heinz-Christian Strache with his Eurosceptic FPÖ in Austria, and Geert Wilders in the Netherlands striving to constantly question and ultimately undermine the European project.

There is clearly a disconnect between the EU and its population. Finally, the EU seems to have admitted this. Voting figures are extremely low in European Parliament elections, few people seem to grasp (or care) how the European Commissioners are appointed and, let’s face it, it’s a rare person in any Member State who can name their MEP.

And when it comes to health, we only have to take a look at the Brexit ‘Leave’ campaign - and its fake-news battle bus slogan about an extra £350 million per week going to the NHS after the UK departs - to see how much healthcare matters to the man and woman in the street.

While the claim was a patent nonsense, the willingness of many to believe it is indicative of how much people value health care. Especially as the population ages across the EU and health systems risk becoming unsustainable (if they aren’t already).

Remember, individual member states have competency for their own healthcare systems. So it is not too much of a stretch to find the population in countries with sub-optimal health services arguing that sending money to the EU is not the best use of resources when it could be used to boost healthcare at home.

It’s a simplistic argument, but a powerful one, as we saw in the UK.

The Brussels-based EAPM argues that, instead of health being a ‘local’ competence, it should ideally be supra-national (ie at EU level). While this is currently impossible given the Treaties, ‘more EU’ would surely help to ensure a level playing field for the bloc’s member states.

Health care needs modernizing and, while top-down legislation on clinical trials, IVDs and data protection and sharing has helped in recent times, arguably the EU should be doing more from a centralized point, at the very least in encouraging countries to share more information on health from data banks, cooperate more fully, get out of their specialist silos, work to avoid research duplication and so on, for the benefit of the citizenry.

Working together, the European Parliament, Council and Commission need to find ways to guarantee the sustainability of EU public health-care systems. As mentioned, these are now under considerable pressure due to fiscal belt-tightening, ageing populations and the growing issue of co-morbidity.

Better access for 500 million potential patients across the current 28 member states has never been more necessary.

The arrival and spread of the personalised medicine ethos - the right treatment for the right patient at the right time - has highlighted inequalities across richer and poorer countries in the EU bloc and even within regions of individual nations.

The European Parliament’s Committee on the Environment, Public Health and Food Safety did, to be fair, produced a report on EU options for improving access to medicines. So the issue is at least on the political radar.

Most politicians with a health-care brief know that there are many and varied reasons to explain why patient access is being delayed, blocked and made inequitable. In short, the ’system’ of getting efficacious drugs affordably to those who need them across member states is patently not fit for purpose.

EAPM has always argued that modern treatment should be about putting patients at the centre of their own health-related decisions as well as allowing and facilitating innovation, through investment in research and workable reimbursement policies at the pan-European level.

Today’s patients are more-and-more often demanding to be included in decision making that will affect their own health and will have an impact on their families. Better-trained health-care professionals are certainly needed, as is a higher degree of health literacy across the board.

Many readers will recall that, in December 2015, at the end of the Luxembourg Presidency of the EU, the European Council issued its conclusions on personalised medicine for patients, highlighting how ‘the development of personalised medicine may offer new opportunities for the treatment of patients in the European Union’.

The conclusion stressed that the adoption of personalised medicine on an EU-wide basis would allow healthcare professionals to offer better-targeted treatment, avoid medical errors and reduce adverse reactions to medicinal products.

However, issues such as those ever-increasing costs, inequitable access, and the need for a relevant ethical, regulatory and reimbursement environment are among the barriers to implementing this fast-moving and innovative form of treatment at European and national levels.

The kickback against society of long waiting times, a lack of the best drugs available (in, say, cancer treatment), inadequate implementation of cross-border healthcare, a shortage of hospital beds and other barriers is huge, leading to loss of quality of life for citizens and even loss of life itself.

European citizens, as they age, and worry more about their health and life expectancy, may very well use the issue of inequitable access as a reason for even more EU-scepticism than there is already. If the EU wants to be strong and healthy, it needs to understand this, before member state citizens start to turn their backs on the grand project.

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