ENVI

Honourable Members,

I will start my discussion today with Jacques Delors, who sadly recently departed. I had the privilege of meeting Delors at a gathering of European ministers of foreign affairs, when I was a foreign affairs minister myself in the early 90’s. There was an unbelievable fire burning in this man. When he spoke, you could hear a needle drop. “Il ne peut y avoir d'intégration économique sans intégration sociale”. There can be no economic integration without social integration. That was his mantra. 20 years later, the financial crisis and Brexit proved him right.

I think that what is true for social rights, is also true for health.

This truth was exemplified during the pandemic. Just imagine what it would have meant if some countries had gotten vaccines faster than others. What it would have meant for young Europeans – who will soon vote in the European elections – if you could have partied in Berlin, but not in Warsaw; could have visited your grandparents in Lille, but not 30 km further down the road in Wevelgem; could have opened your business in Trieste but not in Ljubljana.

Honourable members,

What was true during the pandemic is also true today. Where you live in Europe determines how healthy you are; which treatments you get access to; how many nurses and doctors there are in your neighbourhood. In many ways, it determines whether you live or die.

In this post-pandemic era, Europeans will no longer accept this. Neither should they, for they have seen that the EU is perfectly capable of enabling access to better health care services if it wants to. In other words: whether the EU delivers on health is a political decision, made by the political parties in this very room.

The Belgian Presidency has therefore set out an ambitious health programme under the banner “a Europe that cares, prepares and protects”. It identifies a number of structural challenges for our health care systems, which member states cannot solve on their own anymore. We hope that this programme can feed into the strategic agenda of the next Commission, and ensure that health remains a top priority for the next term.

The first challenge is a market challenge: the basic medicines which are essential to the functioning of our health care systems, are rapidly disappearing from our markets. Some industry numbers are shocking: according to one analysis, 26% of generic medicines disappeared from the EU market in the past 10 years. For 69% we only have 1 or 2 producers left.

You know that the Council and Commission have been acting fast on this issue. We now have a solidarity mechanism, a Union List of Critical Medicines and a Critical Medicines Alliance – all of which will be further tested, refined and implemented under the Belgian Presidency. The Presidency will prioritise the chapter on shortages in the negotiations on the pharmaceutical legislation, and try to reach an intermediate compromise, allowing member states to already start implementing some parts of the proposal. We also await the publication of a stockpiling strategy and guidelines on the public procurement of medicines before the end of term.

Next to shortages, we have another market challenge. New therapies are becoming increasingly unaffordable to our health systems, and do not always address the highest societal and patient needs. The Commission has tried to address this problem in the pharmaceutical legislation, and we hope that we can identify possible avenues for compromise on the topic of incentives under the Presidency.

However, at the same time we are also working on the question on how to proactively steer research & innovation to the highest medical needs, rather than to wait for what industry offers to us. We are working towards an analytical grid to identify priority needs at the EU level, and to inform incentives like research funding, regulatory data protection and reimbursement procedures accordingly. To this end, we are organising a conference on needs-driven innovation, which will delve deeper into these questions.

Secondly, we have a demographic challenge, with an aging population and a rapidly shrinking health workforce. In 2019, 35% of all doctors in OECD countries were over 55 years old, compared to 20% in 2000. This means that we must anticipate a retirement wave among professionals, while at the same time the demand rises. Most European countries by now report severe shortages of health care professionals.

Now, health workforce is clearly a national competency. However, the EU does have considerable influence over how we can organise the workforce through its internal market rules, and more specifically the professional qualifications directive. We think that this framework should be re-evaluated; on the one hand to see whether it is conducive to solving today’s problems, on the other to see if it sufficiently protects the quality of healthcare services. Moreover, we think that member states and stakeholders should regularly exchange on the problem, and learn from each other.

Honourable members,

I believe that the impact of our aging population on our healthcare systems has been severely underestimated. We have a rough few years ahead of us. It is now more important than ever that people age well, that they remain as healthy as possible for as long as possible. Prevention is therefore a key priority in our programme.

We don’t want to invent the wheel here: the Europe Beating Cancer Plan sets out numerous points of action that would be very impactful, such as food and alcohol labelling and tobacco control. But let’s call a spade a spade: these actions have been undermined by powerful industry interests, at the cost of Europeans’ health. We understand that the Council recommendation on smoke-free environments will be delayed AGAIN, even though it was foreseen for 2023, despite all the efforts deployed by Commissioner Kyriakides. I would therefore like to appeal to you as members of this health & environment committee to ensure that we can move ahead in the field of prevention.

Lastly, there is a crisis challenge. The climate crisis should keep policy makers awake at night. We do not anticipate nearly enough the heat waves, air pollution, tropical diseases and pandemics that are yet to come. Europe took big steps in the field of crisis preparedness, and has to take yet many more. First, there is the question of the crisis governance structure that was established during COVID-19. We strengthened the mandates of the EMA, ECDC and the Health Security Committee. At the same time, we established HERA and a Health Crisis Board. The result is that the workflow and division of tasks is sometimes unclear, and there are turf wars about who should do what. We need to clear out the weaknesses in our crisis governance. To get a clear view on the problems that should be addressed, we have published a study from CEPS on the topic.

Secondly, we have the work on AMR, for which we are organising a conference which will focus on one health, prevention, and push & pull incentives. The idea is to pursue the momentum created by previous Presidencies.

Last, there’s an initiative to establish a coordination mechanism for EU-wide clinical trials. This should ensure that Europe disposes of a large clinical trial network that to develop and test countermeasures faster in a next crisis, and to prevent member states from duplicating work and wasting resources.

This brings me to my two last points. The Council really wants to keep momentum and finish the trilogues on the European Health Data Space under the Belgian Council Presidency. Our health systems need EHDS, and there is definitely no reason to tilt the file over the elections. We count on your cooperation and comprehension for the delicate compromise that was struck in Council on a number of issues.

Secondly, the Commission published an amendment to the Medical Device Regulation (MDR) and the In-Vitro Diagnostic Medical Device Regulation (IVDR). Here too, we will need to act swiftly to ensure that medical devices can stay on the market. We really count on your constructive cooperation.

Honourable members,

Before I leave the floor to Mr. Jarubas, I would like to echo the words of our old friend Jacques Delors: Il ne peut y avoir un marché européen robuste, sans systèmes de santé européens solides. There can be no robust European market without solid European health systems.

I have laid out the challenges for which we think European collective action is necessary. These issues were selected after more than a year of careful preparations and concertation with the other health ministers. But we know that nothing moves in Europe without the support of this house, for Europe is a powerful democracy. I treasure that, and therefore hope to count on your help to ensure that the next European Commission will also be a health Commission. Thank you.