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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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UK sends two navy boats to Jersey after France threatens blockade

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The Mont Orgueil Castle is seen behind an island flag at Gorey Harbour in Jersey, in this February 26, 2008 file photo.  REUTERS/Toby Melville

Britain is sending two navy patrol boats to the British Channel Island of Jersey after France suggested it could cut power supplies to the island if its fishermen are not granted full access to UK fishing waters under post-Brexit trading terms, write Richard Lough and Andrew Macaskill.

Prime Minister Boris Johnson pledged his "unwavering support" for the island after he spoke with Jersey officials about the prospect of the French blockade.

Johnson "stressed the urgent need for a de-escalation in tensions," a spokesperson for Johnson said. "As a precautionary measure the UK will be sending two Offshore Patrol Vessels to monitor the situation."

Earlier, France's Seas Minister Annick Girardin said she was "disgusted" to learn that Jersey had issued 41 licences with unilaterally imposed conditions, including the time French fishing vessels could spend in its waters.

"In the (Brexit) deal there are retaliatory measures. Well, we're ready to use them," Girardin told France's National Assembly on Tuesday (4 May).

"Regarding Jersey, I remind you of the delivery of electricity along underwater cables ... Even if it would be regrettable if we had to do it, we'll do it if we have to."

With a population of 108,000, Jersey imports 95% of its electricity from France, with diesel generators and gas turbines providing backup, according to energy news agency S&P Global Platts.

Jersey's government said France and the European Union had expressed their unhappiness with the conditions placed on the issuance of fishing licences.

Jersey’s external relations minister, Ian Gorst, said the island had issued permits in accordance with the post-Brexit trade terms, and that they stipulated any new licence must reflect how much time a vessel had spent in Jersey's waters before Brexit.

"We are entering a new era and it takes time for all to adjust. Jersey has consistently shown its commitment to finding a smooth transition to the new regime," Horst said in a statement.

The rocky island sits 14 miles (23 km) off the northern French coast and 85 miles (140 km) south of Britain's shores.

The French threat is the latest flare-up over fishing rights between the two countries.

Last month, French trawlermen angered by delays to licences to fish in British waters blocked lorries carrying UK-landed fish with burning barricades as they arrived in Boulogne-sur-Mer, Europe’s largest seafood processing centre.

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Brexit barriers in focus as Northern Ireland's DUP kicks off leadership contest

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Democratic Unionist Party's (DUP) Edwin Poots makes a statement to the media outside Stormont Castle in Belfast, Northern Ireland June 28, 2017. REUTERS/Clodagh Kilcoyne/File Photo

Northern' Ireland's biggest party was set for its first ever leadership election after its Westminster chief Jeffrey Donaldson threw his hat into the ring, promising to focus on the divisive issue of post-Brexit trade barriers.

Donaldson will stand against Edwin Poots to lead the Democratic Unionist Party at a time of heightened instability in the British province and unionist anger over the installation of a customs border in the Irish Sea.

Both Donaldson and Poots, Northern Ireland's agriculture minister, stopped short of making detailed campaign promises. But Britain, Ireland and the rest of Europe will be watching for any hardening of stances on Brexit or social issues including abortion that could alter the political balance ahead of elections next year.

The DUP currently leads Northern Ireland in a power-sharing government with its Irish nationalist rivals Sinn Fein.

Donaldson or Poots will take over the leadership from Arlene Foster who announced last week she was stepping down as Northern Ireland's First Minister at the end of June, bowing to pressure from party members unhappy at her leadership. Read more

Her departure has added to instability in the region, where angry young pro-British loyalists rioted in recent weeks, partly over the barriers that they feel have cut them off from the rest of the UK.

"I will develop and swiftly implement an agreed programme of meaningful reform and clear policy direction on key challenges like the protocol," Donaldson said in a video announcement, referring to the post-Brexit trading arrangements.

Like Foster, Donaldson, 58, is a former member of the more moderate Ulster Unionist Party. He was part of the negotiating team that stuck a deal to prop up the government of former British Prime Minister Theresa May in 2017.

Once the DUP's support was no longer needed, May's successor Boris Johnson broke the party's "blood red line" and agreed to erect the trade barriers.

Poots, 55, is one of a number of DUP ministers who have protested against the Brexit arrangements by refusing to attend meetings with Irish counterparts established under the 1998 peace deal that ended 30 years of violence in Northern Ireland.

Poots, a young earth creationist who rejects the theory of evolution, announced he was standing last week.

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Statement by Commission Vice President Maroš Šefčovič following the conclusion of the EU-UK Trade and Co-operation Agreement

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European Commission Vice President Maroš Šefčovič warmly welcomes the ratification of the EU-UK Trade and Co-operation Agreement, which will now be fully applicable as of 1 May 2021. This comes after an overwhelming vote of consent by the European Parliament on 27 April and subsequent Council decision today, thereby concluding the ratification process. The EU and the UK will exchange letters to that effect.  

"The ratification of the Trade and Co-operation Agreement is good news for European citizens and businesses. It provides a solid foundation for our longstanding friendship, co-operation and partnership with the United Kingdom on the basis of shared interests and values.

"In practice, the Agreement helps avoid significant disruptions, while protecting European interests and upholding the integrity of our Single Market. It also ensures a robust level playing field, by maintaining high levels of protection in areas, such as climate and environmental protection, social and labour rights, or state aid. Moreover, the Agreement includes effective enforcement, a binding dispute settlement mechanism and the possibility for both parties to take remedial measures.

"Democratic scrutiny will continue to be key in the implementation phase of the Agreement in order to ensure faithful compliance. Unity among EU institutions and member states will remain a cornerstone during this new chapter in our EU-UK relations." 

Vice President Šefčovič reiterates that the European Commission looks forward to a strong, constructive and collaborative partnership with the United Kingdom, based on mutual trust and respect. We have far more in common than that which divides us. He will reach out this week to Lord David Frost, co-chair of the EU-UK Partnership Council, to prepare the launch of its work, including the work of Specialized Committees.  

Finally, the Commission will continue to work tirelessly for joint solutions so that the Withdrawal Agreement, and the Protocol on Ireland / Northern Ireland in particular, is also fully implemented and works for the benefit of everyone in Northern Ireland.

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