Predicting the Future of European Health Policy

By the time this article appears, part of the destiny of the European Union for much of the next decade will be a little clearer. And that should throw some light on how European health policy will evolve in the coming years, and what sort of place medicines will be able to claim in it. Will the drug industry continue to enjoy support on patents, or suffer cutbacks in incentives? Will research grants continue to promote drug innovation, or will regulation be tightened up with a new emphasis on relative efficacy? Will medicines even retain their place in health policy, or will the focus shift increasingly toward programs of prevention and promotion? 

The results of May’s European Parliament (EP) elections will provide some guide to the still more influential issue of what the next European Commission is likely to do.

But only some guide. And things are only a little clearer. Because although there is a connection between the outcome of the EP election and the shape of the next European Commission, it doesn’t provide a definite answer.

In principle, the new EP, when it takes up office this month, will decide who should be the president of the new Commission, which is due to start work in November. Whoever gets that job will have a determining role in EU strategy, because it is the Commission that proposes EU legislation, and because the person at the top decides which are the policy areas to concentrate on over the next five years, and who should be in charge of each of them.

Again, in principle, the person the EP nominates is supposed to receive automatic endorsement from the governments of the EU member states. But that is only in principle. When the national prime ministers and presidents get together at a summit meeting, they just might decide on an outsider instead.

Top contenders

What we know so far is who the main candidates are, and what their manifestos say-or don’t say-about their attitudes to health and to innovation.

One of the strongest candidates is a center-right German MEP, Manfred Weber, who is broadly industry-friendly and favors joint action at the EU level, particularly against cancer. He has said he wants the EU to work together on “an ambitious approach on medicine research” because “nobody thinks that one single country can win the fight” against the disease. 

Weber’s main rival, Frans Timmermans, is a Dutch socialist (and currently a vice president of the Commission). He emphasizes “strong welfare states, social safety nets, and quality public services,” and the “duty to protect people if they fall sick” with “the right to quality healthcare.” But his manifesto displays attitudes to industry that are a little more ambiguous. “Europe’s industrial strategy must channel investment into research and innovation,” he says, but “we will not bow to uncontrolled market forces.” In his view, “the concentration of wealth and property in the hands of a privileged few must stop.”

Another senior official from the current Commission is also campaigning, but as a liberal: Margrethe Vestager, a former Danish economy minister, better known in the European health sector over the last five years as the competition supremo who has been pursuing anti-trust actions against drug manufacturers for impeding generic launches. In her view, “Europe is a place where it’s great to do business. Everyone is welcome. But you have to play by the European rules.” She firmly endorses the need for equality, but health gets scarcely a mention in her manifesto, except in relation to women’s sexual and reproductive rights, and in her calls for “a healthy planet.”

The Greens have fielded two candidates, Ska Keller and Bas Eickhout, both current MEPs, who advocate “a social Europe, making sure that globalization is not just a playground for multinationals,” but say little or nothing about health itself.

On the more extreme left wing of the political spectrum, a Belgian trade unionist, Nico Cué, and a Slovenian MP, Violeta Tomic, back equal access to health through modernized public services with guaranteed social rights, but their manifesto for the European Left In Europe-which has not been updated since 2004-is overtly hostile to “globalized capitalism” and “big capital and lobbies” that seek to make health “subject to market rules.”

By contrast, the right-wing European Conservatives and Reformists group is represented by a Czech MEP, Jan Zahradil, who opposes compulsory vaccination, and insists on the merits of a common market as a means to promote prosperity but that “must not be used as a pretext for creating additional regulation such as attempts to harmonize taxes, as well as social and healthcare systems.”

Depending on the political arithmetic of the new European Parliament, on the ability of MEPs to reach a clear view among themselves, and on the readiness of EU leaders to accept that view, Weber, or Timmermans, or Vestager might well be putting together a new Commission by midsummer, ready for launch in the autumn. 

But there are some dark horses that may still appear. The most conspicuous non-declared candidate is Michel Barnier, who has won wide admiration (except perhaps in the UK) for his role as the European Commission’s Brexit negotiator over the last two years, and more of a technocrat than an ideologue. 

Another longer shot might be Josep Borrell, foreign minister of Spain’s socialist government, and a former president of the EP. As always in the EU, the final decision will be the result of a complex compromise forged among more than two dozen conflicting national views.

Lost in shuffle?

Meanwhile, a coherent EU health policy is conspicuous by its absence, and the prospects for seeing one emerge remain slender. For the last two months, the EU has not even had a commissioner for health, since the incumbent, Vytenis Andriukaitis, took time off to contest (unsuccessfully) the presidential election in his native Lithuania.

The few health-related initiatives undertaken by the health department are either insignificant-such as gathering statistics or discussing health service performance assessments-or blocked by broader political conflicts, which is the fate of the proposal on health technology assessment or the planned review of research incentives.

The very idea of an EU health policy lives under the perpetual shadow of the limits that the treaties impose on EU powers in this area. For two years now, uncertainty has reigned over whether the health department

Andriukaitis is responsible for will even continue to exist in the new Commission. That has left its recently-appointed director-general apparently paralyzed, with no scope for new initiatives. The limited activities that the health department now carry out could be redistributed among other more vigorous Commission departments responsible for research, industry, digital, or social affairs. A new Commission boss is entitled to shuffle the Commission cards whichever way he or she chooses.

The signs were not promising when the leaders of the EU met for a set-piece discussion of the future of the EU in early May. Health was not even mentioned in the main preparatory document that the current Commission provided for the conference, “Preparing for a more united, stronger, and more democratic Union in an increasingly uncertain world.” There were passing mentions of health in other more detailed policy documents, but they were hard to find among the more substantial passages on defense, sustainable consumption and production, or a multilateral, rules-based global order.

Pivotal stretch

The coming six months, while the leadership of the new European Parliament and the new European Commission are agreed and policies are formulated, will determine many of the options and opportunities for pharmaceutical and life sciences executives through to the late 2020s.

Reflector is Pharmaceutical Executive’s correspondent in Brussels