Innovating for Sustainable Health Systems in the European Union

In December 2019, just before the coronavirus crisis, European Commission President Ursula von der Leyen wrote a “mission letter” to Stella Kyriakides, the newly confirmed European Commissioner for Health and Food Safety. The Commission’s health agenda at the time consisted of ensuring a supply of affordable medicines, implementing a new regulatory framework for medical devices, creating a new European “eHealth” data space for the exchange of anonymized health information for preventive analysis, fighting growing resistance of many microbes to common antibiotics and a new Europe’s Beating Cancer Plan. Vaccinations were mentioned—but in the context of fighting the sadly widespread myth that they are ineffective or even dangerous. Pandemic preparedness wasn’t mentioned.

How times have changed! Just three months later the Commission and in fact most of the world were in full crisis management mode, struggling to contain the COVID-19 pandemic which the World Health Organisation declared—far too late, it turns out—on the 11th of March.

The good news is that the crisis rudely exposed many of the weaknesses of the European Union’s reliance on a public health system largely managed by its 27 Member States.

In the light of the pandemic, EU Member States reluctantly assigned the Commission the task of coordinating contact-tracing apps that would work across borders; procuring COVID-19 vaccines on behalf of the bloc; coordinating travel restrictions and permissions within the bloc; and shoring up economies that went into freefall after coronavirus-related lockdowns closed borders, shops, stadiums, theatres and offices. This is good news because the EU was born in crisis and historically has made its biggest lasting gains in terms of integration, innovation and effectiveness as a direct result of crises.

The €5.1 billion EU4Health initiative, agreed by the European Parliament and European Council in March 2020, will finance a further transformation in the EU’s role in coordinating and improving resilience to public health threats across the bloc going forward. Among other provisions, it will create a reserve of medical supplies for crises, train a reserve of healthcare staff and experts to be mobilised in future crises and lead a digital transformation of health services including mining anonymised health data from across Europe to prevent, spot and better manage future health crises, including chronic crises such as anti-microbial resistance, which many healthcare practitioners believe to be the next pandemic.

Health First Europe applauds EU Member States’ rapid adoption of digital health tools during the course of the pandemic and hopes that temporary permissions for non-traditional healthcare services including tele-medicine will be made permanent now that doctors, nurses and the public have embraced them.

At the same time, healthcare professionals across Europe have highlighted the need for the introduction of new technology to be accompanied by relevant training and up-skilling for doctors and nurses. The EU could help drive this by creating EU curricula for healthcare professionals and common definitions of professions and specialisms across Europe (Why are intensive care doctors and nurses a recognised specialism in some EU countries, but not in others, limiting their mobility in times of crisis?); including digital literacy and skills among the core competences needed for the healthcare workforce of the future; and promoting cross-border e-learning opportunities.

At a recent meeting of the European Parliament’s Interest Group on Innovation in Health and Social Care, organised by Health First Europe, MEP István Ujhelyi (S&D, Hungary) cited the experience of the COVID-19 pandemic response in Europe to conclude that Europe needs to “step up efforts to establish effective prevention systems within our existing healthcare systems.” Dr. Loukianos Gatzoulis, a policy analyst in DG SANTÉ in the Commission, agreed that the EU’s current health system lacks capacity, facilities, staff, supplies and digital technologies and said Europe needs to “reform, transform and invest” in order to improve resilience, resource efficiency and the overall level of care in health crises. The Commission, he said, can help with knowledge brokering, better exchange of best practices and providing access to EU funding. Maria Teresa Parisotto, representing the European Specialist Nurses Organisation, called on EU Member States to facilitate access to predictive health care data.

Ultimately, transforming Europe’s healthcare systems to better face the next major public health threats, including anti-microbial resistance and the next pandemic, depends on the willingness of EU Member States to delegate authority to the European Commission to do things that are better done centrally as opposed to country-by-country.

Health First Europe, along with most healthcare professionals, patients organisations and people working with the EU institutions in Brussels, are convinced of the logic of doing so. The question is whether the EU Member States will listen.

As I wrote this article, the World Health Organisation published the highly critical results of an independent study of its own and of national governments’ handling of the coronavirus crisis. The study’s co-chairs, former New Zealand Prime Minister Helen Clark and former Liberian President Ellen Johnson Sirleaf, said the whole world needs the same thing. The EU has an opportunity to lead the way.