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Give patients more access: We need zero VAT on medicines in Europe

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As Europeans face a public health crisis, we should increase patient accessibility by abolishing VAT on the most essential of goods, writes Bill Wirtz.

The COVID-19 pandemic has put health policy back into the hearts and minds of European decision-makers. Before the outbreak, Europe had been in a debate about drug pricing, but it only involved the upper echelon of political institutions. Often blamed are pharmaceutical companies, as well as a lack of price transparency. But having a closer looks at the costs of drugs shows that one of the main drivers for high costs is sales taxes on medicines.

Informed patients will know that all but one European country charge VAT on over-the-counter (OTC) medicine and prescription medicine. Germany charges as much as 19% VAT on both types of medicines, while Denmark ranks the highest, with rates at 25% - that is a fifth of the total price for a drug!

There is only one country that does not charge VAT on prescription or over-the-counter drugs: Malta. Luxembourg (3% each) and Spain (4% each) also show that modest VAT rates on drugs are not a crazy idea but something millions of Europeans already benefit from. Sweden and the UK both charge 0% VAT on prescription medicine, yet 25% and 20% respectively on OTC.

One of the significant roadblocks towards more patient access to drugs is the unfair tax policies of some EU member states. Before talking about eroding intellectual property rights and price setting across the block, we should discuss whether we should have a VAT on medicines.

Especially on prescription medicine, where cancer drugs can reach substantial price levels, VAT rates of up to 25% significantly burden patients and their health insurance. On prescription medicine, there is little sense in first charging value-added tax, and then have national health insurance providers pick up the tab. As for OTC medicine, the implication that just because it isn't prescribed, it therefore isn't an essential good, is a blindspot of policy-makers.

Many OTC meds, ranging from drug headache pain relief, heartburn medicine, lip treatments, respiratory remedies, or dermatological creams are not only essential medicines for millions of Europeans; they often act as preventative care. The more we tax these goods, the more we are burdening MDs with non-essential visits.

Following the example of Malta, European countries should lower their VAT rates to 0% on all medicines. The purpose of VAT is to take a cut out of commercial activity, making sure that all commercial transactions pay what is considered their fair share, even those businesses who traditionally don't pay any company taxes. However, regarding the sale of medicine as a purely commercial transaction, from the standpoint of patients, misses the point. Millions of patients need specific prescription medicine every day, and others rely on the help of over-the-counter drugs to relieve pain or treat problems that do not require professional medical attention.

It is time for European nations to agree on a binding Zero VAT agreement on medicine or at least a cap at 5%, which would reduce drug prices in the double digits, increase accessibility, and create a fairer Europe.

Bill Wirtz is the Senior Policy Analyst for the Consumer Choice Center. He tweets @wirtzbill

coronavirus

German vaccine seekers getting aggressive, doctors say

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Germans desperate to be vaccinated against the coronavirus are becoming increasingly aggressive, doctors said on Wednesday (12 May), as frustration mounts after six months of lockdowns even though infection rates are now falling.

"The pressure on vaccination centres and doctors' practices is growing. People pushing for vaccination are becoming more demanding," Anke Richter-Scheer, the deputy head of the German association of family doctors, told the Funke media group.

As Germany extends priority for vaccines to more groups, it is becoming less comprehensible to many people why they should have to wait behind others, Richter-Scheer said.

People are showing up at doctors' practices and trying to get vaccines even though it is not their turn, with the mood getting more aggressive, she said.

Some people are also demanding their second shot early so they can go on holiday or profit from advantages such as shopping without needing a COVID-19 test.

​ Older patients who have been assigned AstraZeneca are also demanding a different vaccine.

After a sluggish start, Germany has been ramping up its vaccination campaign and has now given a first dose to a third of the population, with about 10% fully vaccinated.

It started by vaccinating its oldest citizens and has been gradually expanding shots to younger groups and other priority professions such as teachers, journalists and those working in critical infrastructure.

Several German states, including the capital city Berlin, announced plans on Tuesday planning to loosen coronavirus restrictions in coming days as the number of new infections keeps dropping nationwide. read more

On Wednesday, another 14,909 new cases were reported, bringing the total to 3,548,285, while the death toll rose by 268 to 85,380. However the seven-day incidence per 100,000 people dropped to 108 from 115 on Tuesday.

The government should give citizens clear guidelines on whether and where they can go on holiday by the end of May, Finance Minister Olaf Scholz told the Rheinische Post newspaper.

Holidays should be possible within Germany and in some other countries due to rising vaccinations and falling infections, he said. The northern state of Mecklenburg-Vorpommern, popular with holidaymakers, will open up its tourism sector from June 14.

However, Germany's vaccine committee, known as STIKO, dampened expectations for a speedy approval for vaccination of children and adolescents.

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Delaying second COVID-19 vaccine doses can help reduce deaths - study

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Vials with Pfizer-BioNTech and Moderna coronavirus disease (COVID-19) vaccine labels are seen in this illustration picture taken March 19, 2021. REUTERS/Dado Ruvic/File Photo
A medical worker prepares a dose of the "Comirnaty" Pfizer-BioNTech COVID-19 vaccine inside the exhibition palace transformed into a vaccination center in Nice as part of the coronavirus disease (COVID-19) vaccination campaign in France, April 29, 2021.  REUTERS/Eric Gaillard/File Photo
A phial of the Pfizer/BioNTech COVID-19 vaccine concentrate is diluted with 1.8ml sodium chloride ready for use at Guy's Hospital. Victoria Jones/Pool via REUTERS

Giving a first dose of COVID-19 vaccine but delaying a second dose among people younger than 65 could lead to fewer people dying of the disease, but only if certain conditions are met, a predictive modelling study showed.

As the coronavirus pandemic continues, there is debate over whether to extend the gap between doses to give as many people as possible some protection, or stick to the intervals designated in clinical trials.

For example, Pfizer (PFE.N) has said there is no clinical evidence to support Britain’s decision to extend the gap between doses of its vaccine to 12 weeks, but data from the rollout in England shows protection against death of around 80% from one dose, with a 70% decline in infections.

The US study, published in the BMJ British medical journal, used a simulation model based on a "real-world" sample of 100,000 US adults and ran a series of scenarios to forecast potentially infectious interactions under different conditions.

These included varying levels of vaccine efficacy and immunisation rates, and varying assumptions as to whether the vaccine prevents transmission and serious symptoms or only prevents serious symptoms, including death.

"The results suggest that under specific conditions a decrease in cumulative mortality, infections, and hospital admissions can be achieved when the second vaccine dose is delayed," wrote the researchers, led by the Thomas C Kingsley of the Mayo Clinic in Rochester, Minnesota.

The specific conditions include having a vaccine with a one dose efficacy of at least 80% and having daily immunisation rates of between 0.1% and 0.3% of a population - but if they are met, a delayed second-dose strategy could prevent between 26 and 47 deaths per 100,000 people compared to the usual schedule.

The study did not recommend an optimum schedule.

"Decision makers will need to consider their local vaccination rates and weigh the benefits of increasing these rates by delaying a second dose versus the risks associated with the remaining uncertainty in this strategy," the team said.

Separately, an Oxford University-led study on giving shots from different manufacturers for the two doses reported its first findings - on the frequency of common post-vaccination symptoms such as sore arm, chills or fatigue.

It found that people vaccinated with a shot of Pfizer's vaccine followed by a dose of AstraZeneca's, or vice versa, were more likely to report mild or moderate symptoms such as headaches or chills than if they received two of the same type.

Pfizer and AstraZeneca were the first vaccines available in Britain to be trialled in the “mix-and-match” study. Shots by Novavax and Moderna have since been added to the research.

Key data on immune responses generated by the different combinations of mixed or regular dose schedules is expected to be reported in the coming months, according to Matthew Snape, the Oxford University professor leading the trial.

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Airline launches airbridge to bring relief to virus-stricken India

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The airline Emirates has set up a humanitarian airbridge between Dubai and India to transport urgent medical and relief items, to support India in its fight to control the serious COVID-19 situation in the country, writes Martin Banks.

Emirates will offer cargo capacity free of charge on an “as available” basis on all of its flights to nine cities in India, to help international NGOs deliver relief supplies rapidly to where it is needed.

In the past weeks, Emirates SkyCargo has already been transporting medicines and medical equipment on scheduled and charter cargo flights to India. This latest airbridge initiative takes Emirates’ support for India and for the NGO community to the next level.

HH Sheikh Ahmed bin Saeed Al Maktoum, Emirates’ Chairman and Chief Executive, said: “India and Emirates are deeply connected, since our first flights to India in 1985. We stand with the Indian people and will do all we can to help India get back on its feet. Emirates has a lot of experience in humanitarian relief efforts, and with 95 weekly flights to 9 destinations in India, we will be offering regular and reliable widebody capacity for relief materials. The International Humanitarian City in Dubai is the largest crisis relief hub in the world and we will work closely with them to facilitate the movement of urgent medical supplies.”

The first shipment sent as part of the Emirates India humanitarian airbridge is a consignment of over 12 tons of multi-purpose tents from the World Health Organization (WHO), destined for Delhi, and coordinated by the IHC in Dubai.

Giuseppe Saba, CEO of International Humanitarian City, said: “His Highness Sheikh Mohammed bin Rashid built the International Humanitarian City (IHC), so Dubai, in coordination with humanitarian agencies, would be able to assist communities and families, most in need – around the world. The creation of the humanitarian airbridge between Dubai and India, facilitated by Emirates SkyCargo, Dubai’s International Humanitarian City and UN agencies, to transport urgent medical and relief items, is another example of His Highness Sheikh Mohammed bin Rashid’s vision for the IHC, being brought to life. Last year over 1,292 shipments were dispatched from the IHC in Dubai, setting the standard for humanitarian response globally. We appreciate the great efforts by IHC’s partner Emirates SkyCargo establishing this humanitarian airbridge between Dubai and India in this time of need”.

The freight division of Emirates has a close partnership with IHC, developed over several years of delivering relief materials to communities across the world impacted by natural disasters and other crises. IHC will support Emirates SkyCargo in channelling relief efforts to India through the airbridge.

Following the Port of Beirut blasts in August 2020, Emirates also leveraged its expertise in humanitarian logistics to set up an airbridge to Lebanon to assist with relief efforts.

Emirates has led the aviation and air cargo industry in its efforts to help markets around the world combat the COVID-19 pandemic. The air cargo carrier has helped transport thousands of tonnes of urgently required PPE and other medical supplies across six continents over the last year by rapidly adapting its business model and introducing additional cargo capacity through its modified mini freighters with seats removed from Economy Class on Boeing 777-300ER passenger aircraft along with loading cargo on seats and in overhead bins inside passenger aircraft to transport urgently required materials.

In addition, Emirates SkyCargo has partnered with UNICEF and other entities in Dubai through the Dubai Vaccine Logistics Alliance, to transport COVID-19 vaccines rapidly to developing nations through Dubai. So far, close to 60 million doses of COVID-19 vaccines have been transported on Emirates’ flights, equating to nearly 1 in 20 of all COVID-19 vaccine doses administered around the world.

Through its scheduled cargo flights to close to 140 destinations across six continents, Emirates helps maintain unbroken supply chains for vital commodities such as medical supplies and food.

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