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#EAPM – More funding for health care, French drugs shortages and Cancer Congress on the horizon

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Good day to one and all, and welcome to the European Alliance for Personalised Medicine (EAPM) update for the middle of September. There’s news ahead of health amendments to the EU budget and consequences from cancer during COVID-19, writes EAPM Executive Director Denis Horgan.

As ever, a brief shout-out for EAPM’s upcoming events – we have our ESMO meeting on Friday (18 September), register here, agenda here, and EAPM is looking forward to participating in the German EU Presidency conference on 12 October, agenda here, register here, so lots to look forward to.

EU eyeing ‘substantially more funding’ for health in next EU budget 

Brussels is looking to create a greater role for itself in the coronavirus recovery by gaining a bigger health budget and more powers to intervene in member health systems. “We are working on a health programme that would have substantially more funding,” the European Commission’s director-general for health and food safety, Anne Bucher, told MEPs. 

Her comments confirmed the contents of a leaked proposal to create a standalone EU health programme, which mixes in new powers on health, in the commission’s redrafted long-term budget. This move would unwind the decision by the previous EU administration under Jean-Claude Juncker to consolidate health spending with several other programmes into an enlarged programme called the European Social Fund. 

Following the COVID-19 crisis, Brussels needs to have a bigger role in “stress-testing” member state health systems, Bucher told members of the Environment, Public Health and Food Safety committee. “Strengthened surveillance will definitely be a priority in years to come.” Currently, the EU has some role in overseeing health preparedness plans – although this is limited to “desk analysis” from Brussels, Bucher said. Powers to stress test hospitals and other health facilities, involving physical on-site inspections from EU officials are proposals under discussion. 

Cancer consequences

The effect of COVID-19 on the EU health-care system has been seismic, a crisis that has been shared globally. The medical profession had to think on its feet responding to the demands of the pandemic. But, in doing so, every medical discipline from general practice to palliative care has taken a hit. Of particular concern is how delays to screening, diagnosis and treatment of cancer have already impacted morbidity and mortality rates, with cancer death rates looking likely to rise significantly over the coming years. 

While devastating, these diagnostic and treatment delays are also compounding a pre-existing problem – a worrying lack of knowledge amongst the public of some of the least-survivable cancers and their symptoms. 

Various predictions have been made about the impact of the pandemic on cancer deaths, with some experts warning that up to 35,000 excess deaths may occur as a result. Many of these deaths may occur due to delays in treatment – the ripple-effect from canceled surgeries, chemotherapy and radiotherapy sessions. The impact COVID-19 has had on the level of care for cancer patients is widespread and other countries, like the US, are experiencing delays in cancer care. Research found that 44% of breast cancer survivors had experienced a delay in care, with 79% stating that the main setback was in follow-up appointments. 

That said, the majority of respondents stated that their treatment had been modified instead of cancelled. To add to this, many patients – fearful of the virus – will not have presented themselves at their GPs in the first place. The League Against Cancer has also called for patients to supply evidence of shortages of cancer drugs. According to a survey commissioned by the organization, 75% of health care workers in oncology have faced shortages of these medicines.

Gallina to act as SANTE chief from October

Sandra Gallina will become the acting director general of DG SANTE starting on 1 October 1, a Commission official has confirmed. Gallina, currently the deputy director general of the DG, will operate as its head until a successor is appointed and enters office, the official added. DG SANTE is being reorganized in a process that began earlier this year. summer. The current head of DG SANTE, Anne Bucher has confirmed that she will retire at the end of September.

French drug shortages

With those worst hit by the virus facing an agonizing death from asphyxia, palliative care specialists in France are struggling amid drug shortages to give victims the most humane end possible. Care teams in the badly hit east of the country have been sharing their experiences of how they made tough decisions on who should and should not be given precious intensive care beds. 

For some patients, such treatment may be both pointless and cruel, argued Professor Olivier Guerin, who heads the French Gerontology and Geriatrics Society (SFGG). "Making the choice of who should be resuscitated is what intensive care teams do all the time," he said. Even before the coronavirus, for certain patients with chronic problems who experience extreme "breathing problems... we know that resuscitation is not beneficial in the long run," said Dr Thibaud Soumagne, a lung specialist, who works in an intensive care unit in Besancon near the Swiss border. 

Professor Regis Aubry, a former head of the French Palliative Care Society (SFAP), who is working in a special COVID-19 unit in another hospital in eastern France, said with victims dying without the comfort of friends and family - for fear of infection - they had to make their end of life as comfortable as possible. "Just because we are in an emergency situation, we should not forget about being humane," he told AFP. SFAP has set up a hotline to advise staff in old people's homes, where more than 2,000 have died in France since the epidemic began. 

Trump unveils drug cost plans 

US President Trump has signed a series of executive orders on drug pricing policies and is claiming his unilateral actions are a success. The four executive orders are mixture of past proposals and older promises. These orders include: The revival of the White House proposal allowing certain drugs to be imported from Canada, including insulin. Allowing federally qualified community health centers, clinics that treat low-income patients to acquire discounted insulin and EpiPens to buy other drugs at a discount. 

An order to Department of Health and Human Services to finalize rules removing the legal protections for rebates paid by drug makers to Pharmacy Benefit Managers (“PBMs”) and requiring those discounts be passed along to Medicare Part D consumers at the pharmacy counter. The renewal of a long-promised component of his prescription drug pricing policy that ties the price that Medicare pays for drugs administered by doctors to prices negotiated by foreign governments.

Commission starts testing interoperability gateway service for tracing and warning apps 

To exploit fully the potential of mobile proximity contact tracing and warning apps to break the chain of coronavirus infections and save lives, the Commission is setting up an interoperability gateway service linking national apps across the EU. An important milestone has been reached as a group of member states starts testing the infrastructure. 

The Commission has kicked off test runs between the backend servers of the official apps from the Czech Republic, Denmark, Germany, Ireland, Italy and Latvia, and a newly established gateway server. Single Market Commissioner Thierry Breton said: “Many member states have implemented national contact tracing and warning applications. It is now time to make them interact with each other. Travel and personal exchange are the core of the European project and the Single Market. 

The gateway will facilitate this in these times of pandemic and will save lives.” Health and Food Safety Commissioner Stella Kyriakides added: “Coronavirus tracing and warning apps working across borders can be powerful tools in our efforts to contain the spread of COVID-19. With cases on the rise again, apps can complement other measures like increased testing and manual contact tracing. If used widely enough, they can help us break the chains of transmission. We will not stop fighting on all fronts against the pandemic.”

Brexit...yet again

British Prime Minister Boris Johnson lashed out at the European Union on Monday (14 September) as he won initial approval for a plan to breach the Brexit treaty, saying the move was needed because the bloc had refused to take a “revolver off the table” in trade talks. Johnson won the so-called second reading parliamentary vote on the Internal Market Bill 340 to 263. A wrecking amendment was defeated shortly beforehand, though more will follow as he faces a growing rebellion in his party.

End in sight? (as with this update)

There’s an end in sight to the coronavirus pandemic, but people need to hang on a little longer, Italy’s Health Minister Roberto Speranza said in an interview with la Repubblica published over the weekend. “We need to maintain distancing, wear masks and wash our hands,” Speranza added, saying this would not last forever but likely just through the fall and winter. “The key word is proximity: the first place where people are cured should be in the home. We have one of the oldest populations in the world and the numbers of chronically ill patients are increasing, and they aren’t treated in hospitals,” Speranza added.

And that’s everything from EAPM for now – have an excellent week, stay safe, see you later this week for an update again.

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EU's Barnier still hopes trade deal with Britain possible, sources say

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The European Union’s Brexit negotiator told the bloc’s 27 national envoys to Brussels that he still hoped a trade deal with Britain was possible, stressing that the coming days would be decisive, diplomatic sources with the bloc told Reuters, write and

Michel Barnier addressed the gathering on Wednesday (16 September) and the three sources either participated in the discussion behind closed doors or were briefed on its content.

“Barnier still believes a deal is possible though the next days are key,” said one of the EU diplomatic sources.

A second diplomat, asked what Barnier said on Wednesday and whether there was still a chance for a new agreement with the UK, said: “The hope is still there.”

The first source said tentative concessions offered by the UK on fisheries - a key point of discord that has so far prevented agreement on a new EU-UK trade deal to kick in from 2021 - were “a glimmer of hope”.

Reuters reported exclusively on Tuesday (15 September) that Britain has moved to break the deadlock despite that fact that publicly London has been threatening to breach the terms of its earlier divorce deal with the bloc.

A third source, a senior EU diplomat, confirmed the UK offer but stressed it was not going far enough for the bloc to accept.

Brexit talks descended into fresh turmoil this month over Prime Minister Boris Johnson’s plans to pass new domestic laws that would undercut London’s earlier EU divorce deal, which is also aimed at protecting peace on the island of Ireland.

US Democratic presidential candidate Joe Biden warned Britain that it must honour the Northern Irish peace deal as it extracts itself from the EU or there would be no US trade deal for the United Kingdom.

The third EU source, who spoke under condition of anonymity, said that the bloc would take a more rigid line in demanding a solid dispute settlement mechanism in any new UK trade deal should Johnson press ahead with the Internal Market Bill.

“There is unease about what Britain is doing but Barnier has stressed he will keep negotiating until his last breath,” said a fourth EU diplomat, highlighting the bloc’s wariness about being assigned blame should the troubled process eventually fail.

Asked about an estimate by Societe Generale bank, which put at 80% the probability of the most damaging economic split at the end of the year without a new deal to carry forward trade and business ties between the EU and the UK, the person said:

“I would put it around the same mark.”

Barnier is due to meet his UK counterpart, David Frost, around 1400 GMT in Brussels on Thursday.

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Biden warns UK on #Brexit - No trade deal unless you respect Northern Irish peace deal

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US Democratic presidential candidate Joe Biden warned the United Kingdom that it must honour the Northern Irish peace deal as it extracts itself from the European Union or there would be no US trade deal, write and

“We can’t allow the Good Friday Agreement that brought peace to Northern Ireland to become a casualty of Brexit,” Biden said in a tweet.

“Any trade deal between the US and UK must be contingent upon respect for the Agreement and preventing the return of a hard border. Period.”

Johnson unveiled legislation that would break parts of the Brexit divorce treaty relating to Northern Ireland, blaming the EU for putting a revolver on the table in trade talks and trying to divide up the United Kingdom.

He says the United Kingdom has to have the ability to break parts of the 2020 Brexit treaty he signed to uphold London’s commitments under the 1998 peace deal which ended three decades of sectarian violence in Northern Ireland between pro-British Protestant unionists and Irish Catholic nationalists.

The EU says any breach of the Brexit treaty could sink trade talks, propel the United Kingdom towards a messy exit when it finally leaves informal membership at the end of the year and thus complicate the border between Northern Ireland and EU-member Ireland.

The EU’s Brexit negotiator told the bloc’s 27 national envoys that he still hoped a trade deal with Britain was possible, stressing that the coming days would be decisive, three diplomatic sources told Reuters.

Michel Barnier addressed the gathering on Wednesday and the three sources either participated in the discussion behind closed doors or were briefed on its content.

“Barnier still believes a deal is possible though the next days are key,” said one of the EU diplomatic sources.

Johnson told The Sun that the EU was being “abusive” to Britain and risking four decades of partnership.

He said the UK must “ring-fence” the Brexit deal “to put in watertight bulkheads that will stop friends and partners making abusive or extreme interpretations of the provisions.”

Societe Generale analysts said on Thursday they now see an 80% chance that Britain and the EU will fail to strike a trade deal before the end of the year.

Biden, who has talked about the importance of his Irish heritage, retweeted a letter from Eliot Engel, chair of the Foreign Affairs Committee of the US House of Representatives, to Johnson calling on the British leader to honour the 1998 Good Friday peace deal.

Engel urged Johnson to “abandon any and all legally questionable and unfair efforts to flout the Northern Ireland protocol of the Withdrawal Agreement.”

He called on Johnson to “ensure that Brexit negotiations do not undermine the decades of progress to bring peace to Northern Ireland and future options for the bilateral relationship between our two countries.”

Engel said Congress would not support a free trade agreement between the United States and the United Kingdom if Britain failed to uphold its commitments with Northern Ireland.

The letter was signed by Representatives Richard Neal, William Keating and Peter King.

Johnson is pushing ahead with his plan.

His government reached a deal on Wednesday (16 September) to avert a rebellion in his own party, giving parliament a say over the use of post-Brexit powers within its proposed Internal Market Bill that breaks international law.

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UK sees 'a way through' parliamentary maze for #Brexit treaty breach bill

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British Prime Minister Boris Johnson’s government sees a ‘way through’ the parliamentary maze for his bill that would break the Brexit divorce treaty as it talks with rebels in the Conservative Party, a minister said on Wednesday (16 September). write Guy Faulconbridge and Kate Holton.

Johnson’s Internal Market Bill, which the EU has demanded he scrap by the end of September, is currently being debated in parliament, though he is facing a rebellion by some members of his Conservative Party.

“I believe there is a way through,” Robert Buckland told the BBC when asked about negotiations with rebels in parliament over the bill, adding that London wanted a deal with the EU.

“In terms of shared understanding, I have already seen quite a difference,” he said when asked about a possible compromise in parliament.

Asked if he had been involved in negotiations with Bob Neill, a Conservative lawmaker, Justice Secretary Robert Buckland said: “There are lots of discussions going on with all MPs from all parts of the debate, not just Bob Neill.”

“We want to get this bill through, we want to make sure that we are ready for any disagreements or disputes that might arise if we don’t get agreement in the joint committee,” he said. “For me, I just want Brexit sorted.”

Buckland told Times Radio that the bill was needed as an insurance policy in case the EU made a “material breach” of their obligations but that the talks were not yet at that stage and that London would use current mechanisms to find a compromise.

The EU says Johnson’s bill could collapse trade talks and propel the United Kingdom towards a messy Brexit while former British leaders have warned that breaking the law is a step too far that undermines the country’s image.

Johnson said it was essential to counter “absurd” threats from Brussels including that London put up trade barriers between Britain and Northern Ireland and impose a food blockade - steps he said threatened the United Kingdom’s unity.

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