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Europe’s Beating #Cancer Plan

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Europe’s Beating Cancer Plan will form a core part of Health Commissioner Stella Kyriakiades’ term in office. A pan-European strategy to combat cancer is long overdue and we welcome Commissioner Kyriakiades’ initiative in tackling what is the second leading cause of death in Europe, write Dr Delon Human and Dr Anders Milton.

On 10 September, the Commission held a town hall on the Beating Cancer Plan. Unfortunately, this town hall did not fill us with hope - it seems that the Commission may be about to miss out on the chance of a lifetime and fail to sufficiently tackle preventable cancers in Europe.

Not only did the town hall fail to pay heed to the most obvious preventable cause of cancer in smoking, it seemed to disregard the opinion of EU citizens. Of the submissions to the Plan’s public consultation, nearly 20% supported the adoption of harm reduction plans for alcohol and tobacco. One in every six recommended policies which encourage the use of reduced risk nicotine products by smokers, such as e-cigarettes.

As stated at the launch of the consultation by the Commission, 3.5 million people in the EU are diagnosed with cancer annually, and 1.3 million die from it, yet over 40% of cancer cases are preventable.

The WHO estimates that one in every two smokers will develop a tobacco-related disease with 700,000 Europeans dying from smoking every year. 90% of lung cancers alone can be prevented by eliminating tobacco use in Europe.

What is often forgotten, however, is that smokers consume cigarettes for nicotine but get cancer from the tobacco, tar and thousands of other additives in cigarettes. Nicotine itself is not a carcinogen. This raises the question; what if there was a way to offer smokers the nicotine they desire while removing carcinogens?

Tobacco harm reduction presents the clear and obvious answer to this question. The use of alternative, potentially reduced risk products, like e-cigarettes, could eliminate smoking induced cancer in Europe within a generation.

A study of the results of the 2014 Eurobarometer survey by several European academics emphasised this point. The study found that the vast majority of EU citizens consuming e-cigarettes on a regular basis were former smokers or smokers attempting to quit.

Countries like Sweden have shown a way forward for Europe to reduce tobacco-induced cancers through the adoption of science-based approaches to reduce smoking prevalence and smoking-related deaths. Sweden offers tobacco alternatives like snus and this has helped them to achieve the lowest tobacco-related mortality rate of all EU countries relative to its population size.

In an attempt to mitigate the devastating effects of the pandemic, which has so far taken the lives of almost 200,000 Europeans, EU institutions and member state governments immediately turned to science and evidence to inform policy. Lockdowns, social distancing and working from home have all become normalised as part of the effort to overcome COVID-19.

This sense of pragmatism and efficiency must be mirrored by the Commission’s Beating Cancer Plan.

Harm reduction policy, particularly tobacco harm reduction, has extraordinary potential to reduce avoidable smoking induced cancers. It can save the lives of countless Europeans. We are calling on the Commission to recognize this potential, to hear the voices of European citizens, and leave no stone unturned in the fight to beat cancer.

Delon Human M.B.Ch.B., M.Prax.Med, MFGP, DCH, MBA is a French citizen and physician qualified in family medicine and child health, with an MBA from the Edinburgh Business School. He has acted as adviser to WHO Director-Generals and UN Secretary-General Ban Ki Moon. Formerly, he was secretary-general of the World Medical Association (WMA), the global representative body for physicians and thereafter Secretary General of the International Food and Beverage Alliance (IFBA).
Anders Milton B.Sc., M.D., Ph.D. is the president of ERNA, a member of the government appointed Catastrophe Commission and a consultant within the health care sector. He has previously been both CEO and secretary general of the Swedish Medical Association, chairman of the Council of the World Medical Association, chairman of the Swedish Red Cross and chairman of the Swedish Confederation of Professional Associations (SACO), as well as government appointed co-ordinator of psychiatric services in Sweden.

Cancer

EAPM: Virtual cancer institute on the cards, EMA reform and infectious disease agency

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Good afternoon and welcome, health colleagues, to the European Alliance for Personalised Medicine (EAPM) update – it is the last shout for the upcoming EAPM Slovenian EU Presidency conference (1 July), so don’t forget to register and download your agenda, writes EAPM Executive Director Dr. Denis Horgan.

EAPM Presidency conference a few days away...

The EAPM conference will act as a bridging event between the EU Presidencies of Portugal and Slovenia on Thursday 1 July.

We’ll be discussing, at some point during the day, most or all of what we’ll be talking about below. The conference is divided into sessions which cover the follows areas:   Session 1: Generating alignment in the regulation of Personalized Medicine: RWE and Citizen Trust; Session 2: Beating Prostate Cancer and Lung Cancer - The Role of the EU Beating Cancer: Updating EU Council Conclusions on Screening; Session 3: Health Literacy - Understanding Ownership and Privacy of Genetic Data and Session 4: Securing patient Access to Advanced Molecular Diagnostics.

Each session will comprise panel discussions as well as Q&A sessions to allow the best possible involvement of all participants, so now is the time to register here, and download your agenda here.

Virtual cancer institute proposed by Committee draft report 

As highlighted last Friday, the draft report from the European Parliament’s special cancer committee was made available last week.  Presently, this will be open to amendment from European politicians. 

One additional aspect which was included in the report was the proposal of creation of a “virtual European Cancer Institute” was made public today (29 June).  EAPM supports this. 

As discussed last week, the report, authored by France’s MEP Véronique Trillet-Lenoir (Renew Europe), reiterates many of the points and concerns raised in the Commission’s Beating Cancer Plan.

In the report, which aims at strengthening the EU’s response to the disease, Trillet-Lenoir suggests the creation of a virtual cancer institute. The aim of the organization would be to create a road map to co-ordinate “large-scale prevention campaigns and effective communication campaigns on health promotion in educational programmes.” 

The planned institute would also be responsible for connecting and helping to implement many of the elements introduced by the Commission Cancer Plan. For example, it could host the planned Knowledge Centre on Cancer. It could also help create best practices between European Reference Networks and Comprehensive cancer centers. The institute could also help with “identifying research priorities and possibly enable the development of a coordinated and efficient cancer research force in Europe.” 

Of course and as ever, the issue of budgeting is also tackled in the report with a call to member countries to put aside enough money to implement the Commission’s plan, as well as their own national-level cancer plans. “No more than 30 [percent] of Europe’s Beating Cancer Plan should be allocated to the implementation of the [National Cancer Control Programs]”.  A limited budget of €4 billion is set aside at the pan-EU level. 

Parliament's health committee OKs mandate change for infectious disease agency

The European Parliament’s health committee voted today (29 June) in favour of bolstering the mandate of the European Centre for Disease Prevention and Control (ECDC). Sixty-seven MEPs voted in favour, eight against and one abstained, according to the health committee press service. 

Rights and wrongs during pandemic

Commission Vice President Margaritis Schinas spoke to MEPs in the health committee on Monday (28 June), detailing the Commission’s COVID-19 lessons learned document, concerning the rights and wrongs during the pandemic’s past 16 months. The overall lesson? The EU has “not taken health preparedness seriously enough before the pandemic”, Schinas said. 

Schinas didn’t hold back when he said the EU’s early response was “fragmented, ad hoc, temporary,” and measures “were patchy and unco-ordinated” at the EU level. He reminded MEPs of the export bans and personal protective equipment fights colouring the early days of the pandemic, which were an embarrassment for the EU. 

Schinas used the lessons learned to push for more health coordination at the EU level, arguing that only someone with “ill faith … would challenge” that things were better when countries worked together. Schinas drew a parallel to the 2008 financial crisis, which prompted the EU to establish the “banking union”, saying: “There again the EU action was decisive.” 10 different proposals in the lessons learned would help establish a similar health union.

The EPP’s Peter Liese blamed both the Greens and the Left for being wary of advance purchasing agreements for vaccines. He also pushed for more investment on manufacturing capacity, pointing to how the EU allowed exports “without any control” for too long. Michele Rivasi from the Greens, meanwhile, wanted more in the Commission’s communication on the vaccine delivery delays and the “fiasco” on joint purchasing of vaccines, as well as the transparency — or lack thereof — over their contracts and costs. 

WHO says Biased AI health tech could disadvantage poorer countries

While artificial intelligence has the potential to make healthcare more accessible and efficient, it also is vulnerable to the social, economic and systemic biases that have been entrenched in society for generations.

The truth is, humans choose the data that goes into an algorithm, which means these choices are still subject to unintentional biases that can negatively impact underrepresented groups. These biases can occur at any phase of AI development and deployment, whether it's using biased datasets to build an algorithm, or applying an algorithm in a different context than the one it was originally intended for. The most common source of bias is data that doesn't sufficiently represent the target population. 

This can have adverse implications for certain groups. For example, women and people of color are typically underrepresented in clinical trials. As others have pointed out, if algorithms analyzing skin images were trained on images of white patients, but are now applied more broadly, they could potentially miss malignant melanomas in people of colour.

Italian PM Draghi backs EMA reform 

“We need a reinforcement and reform of the EMA,” Italian Prime Minister Mario Draghi has said. As for vaccines: “The controversy is that Sputnik failed to get EMA approval and probably never will. The Chinese vaccine is not enough to fight the epidemic.” 

“The epidemic is not over, we are not out yet. A few weeks ago the UK had more or less equal cases compared to France today. Today they are twenty times more likely, so the epidemic needs more determination, attention and awareness. 

“We need to keep the pressure on the swaps high and we continue to do them. It is very important to immediately identify the development of new variants and infections. We are deploying a lot more,” Draghi added. 

Draghi later responded to a question about how the announced EMA reform would work. “It’s very quick to say, but I’m raised this issue myself. There’s been a certain co-ordination. I hope that other agencies use it in other countries and think about the United States.

That is all from EAPM for now – enjoy the rest of your week, stay safe and well, and don’t forget, it’s your last chance to register for the EAPM Slovenian EU Presidency conference on 1 July here, and download your agenda here!

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EU health chief: Access to gynaecological cancer treatment differs widely across EU

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There is a large inequality in access to women’s cancer services and treatments across the EU, according to the bloc’s health chief, who highlighted the role of Europe’s Beating Cancer plan in bridging these disparities.

Health Commissioner Stella Kyriakides said there is a need to “break the silence” and talk openly about gynaecological cancers. 

The EU, she added, has “to assure that all women in all corners of the EU, get the support, have access to the screening and the vaccination, the information and the multidisciplinary care that they should be having”.

Her hopes are on Europe’s beating cancer plan, which must bring “real change”. 

“This is what European citizens expect from us. And I also believe that we don’t have a right to fail them. We have an opportunity and we need to seize it,” Kyriakides said.

Europe’s Beating Cancer Plan was set in 2020 to tackle the entire disease pathway, from prevention to treatment, with the goal to equalise access to high-quality care, diagnosis and treatment across the block.

Inequalities across the bloc

However, access to cancer detection and treatment currently differs widely across the bloc. 

Antonella Cardone, director of the European cancer patient coalition (ECPC), said screening programs lead to a remarkable reduction in incidence and mortality but “there are major disparities in screening between the different EU member states”.

This means many women are not being diagnosed early enough when the disease is still treatable and “often curable”.

The highest incidence among all women cancers is breast cancer, which accounts for 88% of cancer cases among women. 

But the access to screening that helps early detection of cancer for people at risk ranges from 6% to 90% among member states. Screening for cervical cancer for people at risk ranges from 25% to 80% in the EU.

“These statistics represent […] early detection, which leads to early treatment, and life saved. Or late detection, which often leads to life lost,” said Kyriakides. About 40% of cancer cases are preventable through effective cancer prevention strategies. 

The Commissioner added that the EU cancer plan “aims to offer breast cancer screening to 90% of people who qualify for it by 2025.”

In addition to this, new European guidelines for breast cancer screening diagnosis are being finalised and will be launched at the end of June.

After several years, guidelines on colorectal and cervical cancer should be also released. 

They should “result in better screening and diagnosis, better information and awareness for women and better training for health workers”, Kyriakides said.

Treatment, as well as detection, is also unequal between member states. 

For example, survival rates following treatment for breast cancer vary by 20% among EU countries. 

“I am determined that all patients have the same opportunities for care, no matter where they live in the European Union. The cancer plan aims to support this goal,” Kyriakides said, adding that “psychological, social, nutritional, sexual counselling and rehabilitation programs” will be offered to patients.

More to be done to tackle women cancer

Detection and treatment are not the only parts of the plan that specifically focus on women. 

Human papillomavirus is another target. It causes cervical cancer, which is the second most common cancer among women aged 15 to 39.

The goal, Kyriakides said, “is to eliminate cervical cancer caused by the human papillomaviruses by vaccinating at least 90% of the EU target population of girls by 2030″. 

Romana Jerković, the Croatian socialist MEP and a member of the intergroup on cancer, said that although cervical cancer is preventable with immunisation “vaccination rates against the human papillomavirus are worryingly low in some European countries. It is about time that the member states wrap up their efforts and ensure that their target population is vaccinated”.

Kyriakides added that the plan also addresses “challenges faced by cancer survivors”. 

“We aim to launch the ‘better life for cancer patients’ initiatives, including the creation of a virtual European cancer patient digital centre. This will support the exchange of patient data, and monitoring of survivors’ health conditions,” she said. 

Jerković also highlighted the importance of digitalisation and better data management. 

“Better and faster exchange of the data and the information can be life-saving factors in someone’s treatment,” she said, adding that European health data space will play a huge role in cancer patients’ health data access. 

sra Urkmez, the previous co-chair of The European Network of Gynaecological Cancer Advocacy Groups (ENGAGe), warned that although Europe’s Beating Cancer Plan addresses the issues well, “it’s easier said than done”. She highlighted the importance of staying united “when it comes to such goals”.

Europe’s Beating Cancer Plan will have €4 billion of funding, including €1.25bn from the future EU4Health programme.

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EAPM: Stronger together against cancer and with good data sharing

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Good morning, one and all, and welcome to the European Alliance for Personalised Medicine (EAPM) update – there is much positivity concerning the battle against cancer and the consultation on the health data sharing plan, so some refreshing good news after all the recent COVID-related despondency, writes EAPM Executive Director Dr. Denis Horgan.

Porto Declaration on Cancer Research

The Porto Declaration on Cancer Research was launched during the European Cancer Research Summit 2021, held on 3 May at the Portuguese Institute of Oncology (IPO) in Porto under the Portuguese Presidency of the Council of the European Union.

The declaration presented by Portuguese Minister Manuel Heitor is the result of the work done by several researchers, scientific and clinical leaders and political decision-makers, who have reinforced the need to broaden Europe's Beating Cancer Plan over recent months, particularly through extending and reinforcing the European network of Comprehensive Cancer Centres (CCCs), based on the reinforcement of three types of research infrastructure:

Translational research infrastructure
Clinical and prevention trial infrastructure
Outcomes research infrastructure

These infrastructure components are increasingly being deemed critical to prevention, early detection, diagnosis, treatment, monitoring disease treatment and patient support and assistance. National participation in the European network of Comprehensive Cancer Centres is led in Portugal by the “Porto Comprehensive Cancer Centre”, based in the Porto IPO, in partnership with its associated laboratory, i3S, which recently received funding of around EUR 15 million for new equipment under the North Regional Operational Programme.

The Porto Declaration on Cancer Research strengthens the commitment of the Trio Presidency of the Council of the European Union (Germany, Portugal and Slovenia) to significantly reduce cancer mortality by 2030, with a goal of 75% of cancer patients in Europe surviving for at least 10 years. Ensuring this goal across Europe means reinforcing the development of a continuum of research activities, from basic to clinical research, including the reinforcement of the European network of Comprehensive Cancer Centres and the three research infrastructure components mentioned above, as well as active participation by the patients and their associations in order to mitigate social and economic inequalities.

The Porto Declaration on Cancer Research thus calls on all European citizens and their Member States to stimulate the synergies in the areas of regional, national and European funding so that cancer research infrastructure access will be easier and fairer.

Speaking at the Cancer Research Summit on 3 May, Health Commissioner Stella Kyriakides said that it’s key the Commission’s Cancer Plan “works hand in hand” with the Horizon Europe Mission on Cancer in order to “ensure coherence between research goals and policy objectives.”  screening program was suspended five years ago due to low turnout and needs to be upgraded, she explained. 

Consultation on health data sharing plan opened by Commission

On 3 May, the Commission published an open public consultation on the European Health Data Space (EHDS) - an important building block of the European Health Union. The EHDS aims to make full use of digital health to provide high-quality healthcare and reduce inequalities. It will promote access to health data for prevention, diagnosis and treatment, research and innovation, as well as for policy-making and legislation. The EHDS will place individuals' rights to control their own personal health data at its core. The consultation will remain open for responses until 26 July 2021. Health and Food Safety Commissioner Stella Kyriakides said: ″The European Health Data Space will be a crucial component of a strong European Health Union. It will enable EU-wide collaboration for better healthcare, better research and better health policy making. I invite all interested citizens and stakeholders to take part in the consultation and help us leverage the power of data for our health. This will have to rest on a strong foundation of non-negotiable citizens' rights, including privacy and data protection.″

Innovative solutions and digital technologies including artificial intelligence (AI), can transform healthcare systems. They make them more sustainable and improve people's health. The development of these technologies requires secure access by researchers and innovators to substantial amounts of health data.

This public consultation focuses on:

the access to and use of health data for healthcare provision, research and innovation, policy-making and regulatory decision;

fostering a genuine single market for digital health services and products, including innovative ones.

The creation of a European Health Data Space is one the key priorities of this Commission in the area of health. The purpose of the EHDS is to promote health-data exchange and support research on new preventive strategies, as well as on treatments, medicines, medical devices and outcomes. In the Communication on the European Strategy for Data, the Commission announced its objective to deliver concrete results in the area of health data and to understand the potential generated by developments in digital technologies. The collection, access, storage, use and re-use of data in healthcare present specific challenges that need to be addressed.

This requires a regulatory framework that best serves individuals' interests and rights, especially as regards the processing of sensitive personal health data. In this context, the Commission adopted its Data Governance Act proposal (2020) with conditions regarding access to data, and provisions to foster trust in voluntary data sharing. Facilitating better access to, and exchange of, health data is essential to ensure increased accessibility, availability and affordability of healthcare. It will stimulate innovation in health and care for better treatment and outcomes, and encourage innovative solutions that make use of digital technologies, including AI.

Health commissioner offers sweeping ambitions for pharma reform and health committee publishes draft response to pharma strategy

No patient in Europe should have to go without medicines that he or she needs due to money or other obstacles, Health Commissioner Stella Kyriakides has said. 

Speaking at an event organized by the European Commission and the Portuguese EU presidency, Kyriakides pledged that EU’s pharmaceutical strategy will tackle the core issues that make medicines unavailable to those who need them. 

The strategy will culminate with a legislative proposal, planned for 2022, revising the EU’s basic pharma rules, which will open the door to the overhaul. 

Kyriakides’ willingness to tear up the current rules may make drugmakers nervous, since they rely on perks like market exclusivity to protect their bottom line. The 2022 reform will take into account “the relationship with intellectual property rights to address aspects that impede the competitive functioning of markets,” she noted. “The failures of markets should not be the failures of our health systems.”

The European Parliament’s Committee on the Environment, Public Health and Food Safety has published a draft response to the Commission’s Pharmaceutical Strategy. The draft report is authored by Spanish MEP Dolors Montserrat from the European People’s Party who is rapporteur for the pharmaceutical strategy. The document calls on the Commission to push ahead with a number of priorities that it identified in the pharmaceutical strategy, which it published in November. Among the demands made in the draft is a call on the Commission “to incorporate new criteria into the system of incentives for research into and the development of new medicines for unmet therapeutic needs.” It also asks the Commission to review incentives and improve price transparency.

EU pharma vulnerabilities

The executive arm of the European Union on Wednesday (5 May) moved to reduce the bloc's dependence on foreign supplies of products in key fields such as pharmaceuticals and digital technology. The initiative forms part of an updated industrial strategy aimed at strengthening the EU's single market, and was presented alongside a proposal for new regulations to tackle distortions caused by foreign subsidies in the bloc.

The European Commission's new industrial strategy is an update from one made in March 2020, before the World Health Organization declared COVID-19 a pandemic. Coronavirus has wreaked havoc in the 27-member EU, making itaware that over-reliance on imports for key components such as those required in drug production and semiconductors could disrupt entire sectors.

"We are updating our industrial strategy, applying the knowledge we have accumulated during the pandemic, drawing on lessons learned and the available evidence," European Commission Executive Vice President Valdis Dombrovskis told a news conference on Wednesday. He said that three key factors have influenced the thinking on the new strategy. The pandemic has highlighted some fragilities in the single market when exposed to particular types of disruption. There has been a growing trend in many jurisdictions to analyze vulnerabilities in key strategic value chains. And the business case for the EU's green and digital transition has become even stronger, Dombrovskis said.

Europe depends on third countries, primarily China and India, in its pharmaceutical supply chains, according to a Commission staff working document.

WHO’s emergencies programme ‘can't deal with multiple crises’

The coronavirus pandemic has revealed that the World Health Organization’s health emergencies programme is “inadequately equipped to deal with a global pandemic while simultaneously responding to other emergencies”, with chronic under-funding and under-staffing leaving it overstretched in some areas, a new report has found.

The report, penned by the Independent Oversight and Advisory Committee for the WHO’s health emergencies programme, covers May 2020 to April 2021 and will be presented at the World Health Assembly later this month. The committee is chaired by Felicity Harvey, a visiting professor at Imperial College London’s Institute of Global Health Innovation.

The programme had to leverage the entire organization during the pandemic and strengthen partnerships with member countries and expert groups to overcome those challenges, the panel found.

The report made specific mention of the Access to COVID-19 Tools Accelerator, of which COVAX is part of, noting that it has “struggled with shortfalls of political will and global solidarity, limited production capacity of vaccines and insufficient financial investment.”

Digital Green Certificate

The EU’s so-called COVID passport – the Digital Green Certificate – to travel freely during the pandemic should be ready for use from the end of June, according to Justice Commissioner Didier Reynders. At the Committee on Civil Liberties, Justice and Home Affairs (LIBE) of the European Parliament on Tuesday (4 May), Reynders said that the certificate will be in use before the summer. “We want to ensure that all EU citizens receive the same treatment when member states lift restrictions on free movement for holders of vaccines, recovery or test certificates,” he said. Last month, the European Commission presented its proposal for the certificate, which will provide proof that a person has been vaccinated against COVID-19, has natural immunity from it, or has a recent negative test result.

On 26 March, the European Parliament launched an accelerated procedure to fast-track the certificate’s approval, and the Parliament and the Member States are currently negotiating the practical details. In principle, however, the individual member states decide which consequences are attached to the document. These could include, for example, free access to the territory without mandatory quarantine.

And that is all from EAPM for this week – stay safe, stay well, have an excellent weekend, and see you next week.

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