The Science|Business interview: Top EU health official outlines a push for better performance, crisis management – linked to Juncker economic agenda
The European Commission’s health officials are pushing for more productivity, economic growth and jobs from Europe’s huge health system – including measures to modernise and analyse the effectiveness of national services, manage crises better, speed up drug approvals and fight antimicrobial resistance.
Xavier Prats Monné, the new Director General for Health and Food Safety, said in an interview that a department strategy is being built around the theme of “Jobs, Growth, Investment and Competitiveness.” While many of the individual measures he described aren’t new, the overall economic thrust of the policy is noteworthy – and implements the marching orders given to his boss, EU Health Commissioner Vytenis Andriukaitis, when he took office a year ago with a new Commission.
As in other sectors, so in health the Commission policy highlights the economic impact. Health represents 10 per cent of gross EU gross domestic product (GDP), 15 per cent of public expenditure, and has lots of room for innovation. Poor health costs 2.5 per cent of GDP in lost work. Food safety, for which Prats Monné’s directorate-general is also responsible, affects the EU’s largest manufacturing sector and 25 million jobs. His challenge, he said, is getting the right policy framework “to promote growth, create new jobs and trigger productivity gains through innovative technologies and treatments.”
State of Health
Among the highlights: The Commission is preparing to introduce stronger country assessment of health systems, Prats Monné said. It will team up with the Organisation for Economic Cooperation and Development, an intergovernmental think-tank based in Paris, early in 2016 to conduct a seminal study on the ‘State of Health in the EU.’ It will provide data on public health performance, health technology effectiveness, and patient outcomes with greater country-to-country consistency than has been possible hitherto. It will also turn a spotlight on the way countries handle chronic diseases, alcohol abuse and primary care.
This could be controversial. It’s not within the Commission’s legal power to tell member-states how to run their health systems – but Prats Monné said that isn’t the goal. “It’s about being useful and supporting states as they look to modernise their health systems. There’s no conspiracy to take away any powers from the member states.”
The Commissioner, a Lithuanian medical doctor, made a similar point in March: “I am committed to working closely with member states to help them improve the efficiency and sustainability of their health systems, so that they can provide all citizens with equitable access to care.”
As an example of the problem, Prats Monné noted that in the 28 EU member-states there are more than 50 national agencies that perform Health Technology Assessments, measuring how cost effective new medicines or medical technologies are likely to be in the context of their respective healthcare systems. Each uses different methodologies, placing a profusion of competing demands on companies and delaying access for patients. There is no consistent EU-wide view of the value of medical treatments, although pharmaceutical companies would like to see one emerge.
A similar problem arises when national health services measure the efficiency or effectiveness of their hospitals and clinics – so-called Health Systems Performance Assessment. Better data could help boost economic efficiency, the Commission reasons. Also important, Prats Monné said, is new investment in innovative health services or products – and his DG is working with the European Investment Bank to finance them.
The innovation DG?
This kind of strong economic focus, outlined in new policy notes circulating within the Commission for the past few weeks, is in line with Commission President Jean Claude Juncker’s growth-and-jobs agenda – but it’s also close to Prats Monné’s instincts. Before becoming on September 1 head of DG Santé, he was head of the Commission’s education and culture department which is responsible for the European Institute of Innovation and Technology, the EU body created to get educators, researchers and business people collaborating on job-creating innovations.
One forthcoming change at Santé will be a reorganisation, trimming the number of units within the 960-person directorate-general to 37 from 40 to provide more staff depth in some areas and reassigning several senior officials, to get new ideas circulating. “You cannot ask anybody to be creative, enthusiastic, and innovative on the same topic indefinitely – I’m the first example of that,” said Prats Monné. Overall, he says, he aims to get the DG better known for innovation.
The new Santé push Prats Monné outlined in the interview includes five ways to trigger growth: Helping health systems modernise, promoting better collaboration among business, academia and regulators, strengthening crisis response in health and food safety, handling emerging macro-economic threats from health problems like antimicrobial resistance or endocrine disrupters, and promoting EU health and food safety standards as international benchmarks.
Speeding up drug approval
Plans for industry-regulator cooperation include measures to speed up drug approvals, he said. Every year, following scientific evaluation by the European Medicines Agency (EMA), Santé authorises around 80 products, and issues some 700 marketing authorisations. These decisions are made within 67 days of the EMA recommending approval; but while the department is looking into ways to speed this up, the key issue is to shorten the many years it takes to bring a drug from lab to market, without compromising safety, said Prats Monné.
Authorisation is valid for all EU states but reimbursement decisions have to be sought from multiple country authorities. This adds cost and delays. The EU will continue to call on member states to try and coordinate their pricing and reimbursement better, according to the director general.
Bringing experts together
Another efficiency-boosting measure the Commission is planning for 2016 is creating several ‘European Reference Networks’. These link specialised clinicians, researchers and patients in specific disease areas – starting with rare diseases, where fast-changing medical knowledge can be slow to spread across the EU’s fragmented health systems. Prats Monné said networks will be open to experts from all 28 member states, along with Iceland, Liechtenstein and Norway; the first call for proposals to create networks will be in February, and they are due to start operating by end-2016.
Boosting crisis response
Prats Monné rates the EU’s ability to handle crises highly. In the past few years it has trialled new risk assessment mechanisms, alert and communication systems, and testing facilities for crisis management plans. “It’s a silent mission – the better we are at it, the less you’ll know about it,” he said.
“But member states don’t have the same level of preparedness for plant diseases, which could mean enormous costs in the future,” he said. EU countries flag around 200 plant outbreaks every year.
In recent years, the continent’s ash and olive trees have been in the firing line. In October 2013 the bacterium Xylella fastidiosa was found to be infecting olive trees in the region of Apulia in southern Italy. The disease was causing a rapid decline in olive plantations and by April 2015 it was affecting the whole Province of Lecce and other zones of Apulia. A report by the European Food Safety Authority concluded the chances were high of bacteria like this spreading to neighbouring countries.
With the continent exposed, Brussels sees a role it can fill. “I hope to do with plant health what we’ve managed to do with animal health,” said Prats Monné. “By the end of the mandate, we want to have a qualitative change in how we address it.”
Another ongoing crisis Santé is involved in is the huge influx of refugees from Syria and North Africa.
On top of the standard scrambling together of money – for border shelter and medical checks – Santé commissioned a study from the Stockholm-based European Centre for Disease Prevention and Control to establish the general health of the continent’s new visitors, said Prats Monné. Some cases of dysentery were detected, but the threat of infection to the greater population was considered low.
We learned that Syrians come weak, thirsty and hungry but they are otherwise healthy, Prats Monné said. Along with the EU Health Security Committee and International Organization for Migration, Santé prepared a small health booklet to distribute around refugee hotspots. “It’s for building a record of refugees’ health which they can take in their pocket with them to the next border. It took some time to coordinate, but it’s simple, practical help,” he said.
Battling antimicrobial resistance
Then there are emerging medical threats that could have big macro-economic effects. An example, he said, is antimicrobial resistance.
In 2009, in a bid to cajole public awareness, the EU announced the annual European Antimicrobial Awareness Day, with the message, “everyone’s responsible.” However, it’s debatable how much progress has been made in bringing the issue to the forefront of people’s minds, to try and encourage more responsible use of antibiotics and to improve infection control.
“We need better early diagnostics: too many people are prescribed antibiotics they don’t need,” said Prats Monné. The Commission will continue to provide more guidance for health and veterinary workers, he added. “This is the frugal innovation agenda – it doesn’t always have to be flashy.”
It’s rare for Andriukaitis to make a speech without mentioning antimicrobial resistance, which the EU says contributes to 25,000 deaths each year, and costs over €1.5 billion in healthcare expenses and lost productivity. More than half of the antibiotics used around the world are used in animals, often to make them grow more quickly (the practice was banned in the EU in 2006).
By one estimate, the loss of effectiveness of current products and the limited number of replacements coming through clinical development means that by 2050 there could be 10 million deaths per year from infections that were previously treatable – more than the number of people currently dying from cancer, he warned.
This is in the league of climate change,” said Prats Monné. Antimicrobial resistance is putting the world on the road to the pre-antibiotic era. “It’s so serious that it could bring us back to the age before Fleming and Pascal,” he said.