The EU has big ambitions in health policy, but getting anything done over the next five years will be a political headache for the next Commission.
Rejecting the status quo
The European elections in May will take place against a backdrop of unprecedented political turbulence. After a decade of low growth following the financial crisis, the EU is facing profound social and economic challenges from global protectionist trade policies, mass migration flows, Eurozone debt, and the (possible) loss of its second largest economy.
Frustrated voters are looking for alternative leadership. An increasing number are expected to reject the established centrist parties when they cast their ballots, turning instead to an alliance of resurgent populist, nationalist, and Eurosceptic parties that are further to the political extremes of Left and Right. The prognosis: centrist parties will likely lose their majority in the European Parliament for the first time in 40 years, while emboldened Eurosceptics maximise their strength by forming a unified parliamentary bloc.
Delivering EU health policy in a more Eurosceptic setting
The political environment for advancing major healthcare initiatives in the next Parliament will be far from ideal. If you believe the Commission’s own surveys, almost 70% of voters want the EU to intervene more in health policy, but the vast majority of policy levers remain under the control of national governments. In the current climate, national governments are unlikely to transfer any further competencies over healthcare to the EU, or to accept any initiatives that could give voters the impression that the EU was asserting control over national healthcare systems.
The Commission, however, has a number of politically sensitive projects on the agenda for the 2019 – 2024 period. Its legislative proposal to introduce ‘permanent and sustainable’ cooperation on healthcare technology appraisals – which could force national governments to harmonise their methods and use the results of an EU-wide scientific assessment – has already proved controversial. While its stated intention is to improve market access and reduce duplication across the continent, national governments in countries including France and Germany are reluctant to give the EU more control over an issue as politically charged as access to medicines.
Similarly, the Commission’s proposal to develop a common vaccination schedule and EU-wide vaccination card has already been watered down by national governments.
Even in the (unlikely) event that these proposals were to advance no further due to the political tensions between national governments and the European institutions, the MEPs taking their seats in July will soon have other high-profile healthcare issues on their ‘to do’ lists. The European Parliament will have a key role in agreeing the legal basis for the Fourth EU Health Programme, running from 2020 onwards, which could include initiatives to facilitate cross-border healthcare through Electronic Health Records and improve care for rare diseases by embedding European Reference Networks into national health systems. They will also vote on the next multi-billion euro Horizon Europe research and innovation programme, which is set to include a new mission on cancer.
What does this mean for healthcare?
In the absence of a pro-EU, centrist majority in the next Parliament, officials and lawmakers who want the EU to be bold on these initiatives and others will need to work harder to build support for their proposals – or at least to minimise the outright hostility from Eurosceptic MEPs who could occupy up to a third of the seats. They will also need to compensate for the loss of experienced MEPs with a strong grip of European health policy, several of whom will leave Brussels in May. About half of MEPs in the next Parliament will be serving for the first time, with little or no understanding of the highly-technical legal and regulatory healthcare system.
There may also be less proactive leadership on healthcare from the Commission. Aware of the political sensitivities around EU action on health, the candidates vying to be the next Commission president have instead focussed their campaigns on areas like economic growth, competitiveness and border security. There are few references to healthcare in the socialist or liberal manifestos, although Manfred Weber, the centre-right’s Spitzenkandidat and potential next Commission president,has made an eye-catching commitment to develop a ‘European Masterplan against Cancer’. Conversely, the leader of the European Conservatives and Reformists, a soft Eurosceptic group, used its manifesto to spell out his explicit opposition to harmonising national healthcare systems.
In addition, European healthcare advocacy groups have worried for some time that the next Commission president could appoint a Eurosceptic commissioner – perhaps nominated by the national governments of Austria, Hungary, Italy or Poland – to lead a less activist Directorate General for Health and Food Safety (DG SANTE). Some observers suggest that DG SANTE could be abolished altogether, with its responsibilities distributed to other Directorates or taken on by a symbolic Commission vice-president for health. Either move would result in healthcare being downgraded as a policy priority, with any surviving policy initiatives lacking a strong strategic direction from the centre.
Whatever the outcome of the elections, one thing is clear – if the next Commission is to deliver on its big ambitions in health policy, it will need to demonstrate a clear ‘value add’ that national governments can position to their electorates as supporting, rather than overriding, national healthcare priorities. In what is likely to be a challenging political environment for the EU institutions, pharma will undoubtedly have a role to play in supporting new MEPs to understand the technical aspects of medicines regulation, incentives, and pricing, and communicate areas where EU-led initiatives have brought benefits to European patients.
Nick Hoile is director, Government Affairs, at Publicis Resolute