EUs health care tug of war

Nearly 70 percent of voters want the EU to intervene more when it comes to their health care. The next wave of Brussels politicos will have to work hard not to disappoint.

Major aspects of health care remain under the control of national governments. And when the EU tries to assert more control, countries often balk at being told what to do — leading to years-long battles over legislation.

The latest example: National governments have so far failed to come to an agreement on an EU-level proposal to join up assessments on the value of medicines.

But members of the European Parliament standing in the 2019 election say thats not going to stop them spending the next five months campaigning on the promise that Brussels can help improve health.

The tension between European and national policies will define electioneering around health care during the 2019 European election, as candidates seek to show their relevance to voters and lift the consistently low election turnout without bumping too hard against the limits of EU law.

“[Its] very important to send a message that DG SANTE should stay as a department” — Biljana Borzan, Croatian Socialist & Democrat MEP

“When citizens say, I want the EU to do more, they dont necessarily mean, I want power taken from the national to the EU level, ” said Robert Madelin, chairman of the public affairs consultancy Fipra and a former director general for health in the Commission. “They want more open flow of cooperation. And the bureaucrats on both sides tend to see this as a game of more or less power.”

A battle of wills

One major health issue on voters minds that the EU cannot touch: vaccines.

Even as measles cases have skyrocketed in Europe, countries have drawn a line in the sand when it comes to giving Brussels more influence over vaccination programs. Health ministers recently pledged to “examine the feasibility” of aligning national vaccination schedules by 2020, a move Health Commissioner Vytenis Andriukaitis called a “vital step” towards tackling EU-wide skepticism.

Vytenis Andriukaitis, the European commissioner for health | John Thys/AFP via Getty Images

But the final Health Council recommendation, which took seven months to be approved, was watered down from the Commissions proposal, underscoring the weak role of the European institutions.

The EU faces a similar conundrum when it comes to the regulation of medical devices. While medicines can be authorized through a centralized process run by the European Medicines Agency, medical devices are certified by a decentralized system of largely for-profit companies that have been signed off on by national authorities.

Europes patchwork systems for device approvals is back in public consciousness because of the “Implant Files” investigations by the International Consortium of Investigative Journalists. A steady stream of scandals from leaking breast implants to failures of vaginal mesh have called into question who is responsible when it comes to protecting citizens from faulty and sometimes life-threatening products.

While new EU-level regulations set to apply from May 2020 could raise the standards for device approval, there is no EU-wide reporting system for adverse events related to medical devices. Given it took more than four years to pass the updated medical device regulations, theres also concern about whether Europe is prepared to regulate new products as technology continues to evolve.

As Brussels considers its effectiveness on health, there have been suggestions the next Commission might do away with its health and food safety department DG SANTE as a standalone beyond 2019. The proposal has been justified as an effort to incorporate health policies across the board — but some fear that it will cause the issue to slip through the cracks.

“We want to fight cancer, and in 20 years no child should die from cancer” — Peter Liese, German European Peoples Party MEP

“[Its] very important to send a message that DG SANTE should stay as a department,” Croatian Socialist & Democrat MEP Biljana Borzan said at POLITICOs EU Health 2024 event in Brussels. “Im afraid if it doesnt happen then it would mean that health issues will be even lower on the agenda, and other DGs will take this job and it will be more industry-oriented and less patient-oriented.”

A coalition of 28 health care groups set out its pitch for the next Commission to appoint a vice president for health. That would help ensure a “health perspective in all policies,” the organizations — including patient groups, hospitals, pharmaceutical and biotech companies and regional health care providers — wrote in their manifesto.

Multiple campaigning MEPs said they would back such a vice president role but not as a replacement for DG SANTE.

Campaign season open

Still, many in Brussels believe the EU can do more when it comes to the health of European citizens.

“We have a strong role of health in the treaties. It is just not true that [the] EU has no competence,” said German European Peoples Party MEP Peter Liese, who is standing for reelection.

As the campaign for the European Parliament kicks into gear, POLITICO will be discussing the EUs health care agenda through 2024 with a series of survey-driven online debates laying out what experts think the priorities should be for the next Commission.

While Brussels cant promise to bring down the prices of expensive prescription medicines or reduce long hospitals waiting times, one way it could promise to bend the health-cost curve is by focusing on disease prevention.

Manfred Weber, the EPPs lead candidate in the 2019 European election | Jussi Nukari/AFP via Getty Images

Life expectancy in Europe has been steadily increasing, but the World Health Organization in September warned this progress risks backsliding amid growing rates of obesity, smoking and alcohol consumption. Heart disease and cancer are the leading causes of death among EU residents.

“Unfortunately — or fortunately — [all countries] have the same problems. We as politicians should do more to [put] non-communicable diseases on the agenda,” Borzan, the Croatian MEP, said. She wants EU tobacco regulation to be a template for action on other disease risks, such as alcohol, sugar and salt.

The powerful center-right European Peoples Partys lead candidate in the election, German MEP Manfred Weber, is campaigning on a mission to double investment in cancer research by 2024.

“We want to fight cancer, and in 20 years no child should die from cancer,” said Liese, the German MEP from Webers party. “That is something that people understand, and we will put a lot of money in this mission.”

The manifesto from health groups pointed to digital health as an area in which Brussels could capitalize on its competencies.

Liese is also pushing action on the rise of antibiotic-resistant superbugs, which the European Center for Disease Prevention and Control estimates are killing more than 33,000 people a year in Europe.

“We could legally [pass] legislation for antibiotics in human health,” Liese said, arguing new EU rules on veterinary medicines and medicated feeds are proof the legal framework exists but that countries lack the “political will.”

Petra De Sutter, a Belgian senator who is running as a Green party MEP candidate, listed the privacy and security of patient data as an election priority. De Sutter, a physician who runs the department for reproductive medicine at Ghent University, said that in particular applies to the reams of genetic information now being collected.

The manifesto from health groups pointed to digital health as an area in which Brussels could capitalize on its competencies.

As campaigners push their agendas, there may be one pressure point to lean on: the weight of health care costs on national budgets. Countries looking to cut spending might be willing to yield some of the powers, if it can be proved that doing so will make things cheaper, said Madelin, the former Commission director general for health.

When it comes to EU cooperation on health, “the search for efficiency will progressively trump the search for autonomy,” he added.

This article is part of “Health Care 2024,” a survey-driven series of online debates in which POLITICO will explore how the European Union can best tackle health policy.

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