A moonshot in healthcare thinking – EURACTIV.com

Five years ago, I described the European Health Forum Gastein (EHFG) as “a marketplace for good ideas to drive the health reform agenda” and spoke confidently about our collective ability to implement and manage these ideas. Today, as we celebrate EHFG’s 25th anniversary and meet in hybrid form for the first time, the mood may be more sober or even sombre. Still, we remain more determined than ever to embrace a quantum leap in our thinking and, crucially, in our planning on how to deliver health for all.

The world is clearly in a permacrisis: war in Ukraine, climate emergency, energy crisis, rampant inflation, and a surge in migration prompted by hunger, famine and civil strife. And all of this comes on top of the baleful legacy of the worst pandemic in a century, a new public health emergency in monkeypox and the near certainty of worse crises ahead. Think of antimicrobial resistance (AMR).

Healthcare systems in Europe and around the world are under severe stress. The long-standing problems of funding to cope with an ageing population in need of ever greater care are intensified by high inflation, staff shortages, ever longer queue for diagnosis and treatment and, increasingly, shifts in policymakers’ spending priorities towards defence and security. The liberal world order and, with it, democracy is at risk of collapse.

There are, nevertheless, some grounds for optimism about the global community’s ability to pull together to manage crises better. Earlier this year, the WHO’s Executive Board, based on a resolution I proposed, agreed to set up a new standing committee on health emergency prevention, preparedness and response – an echo, if you like, of the EU’s own new body, the Health Emergency Preparedness and Response Authority (HERA). The World Health Assembly agreed on a historic increase in Member States’ contributions to the WHO budget. Instead of 17 (sic!) per cent, they will account for 50 per cent of the total

budget. And there is an intergovernmental process set up to negotiate a new legally binding instrument to better deal more effectively with health emergencies. Then there was a partial lifting of the TRIPS agreement (Intellectual Property Waiver), which I consider a sign of good faith towards the Global South that equity in vaccine access for all is a crucial objective. This month, we saw the official launch of the Financial Intermediary Fund (FIF), a $1.2bn fund designed to fill critical gaps in low- and middle-income countries’ (LMICs) health systems – and help overcome glaring health inequalities that are continuing to widen.

Not cosy consensus but a great leap forward

However, these small steps are inadequate in facing the challenges we face. It is my fervent wish that this year’s EHFG will set the bar high by rebooting the process of thinking the once unthinkable, shaking us out of what a colleague once described as “our European bubble”, proposing/embracing radical solutions to those multiple health challenges and, last but not least, not being afraid to disagree. We do not need yet another cosy consensus among well-meaning policymakers and stakeholders that gathers dust on a Berlaymont shelf like those so-called visionary reports on the Future of Europe. What we need is what I call the fire: fired-up debate and a bonfire of the old platitudinous certainties. This is why we are calling for a moonshot when it comes to new ways of healthcare thinking.

Mariana Mazzucato, one of our keynote speakers and Chair of the WHO Council on the Economics of Health for All, puts it well when she talks about putting health for all at the heart of government investment and innovation decisions while keeping  the common good in mind. She calls for moving from a “healthy” economy to an economy based on health for all. It is indeed time to stop measuring economic success as GDP growth and to start measuring it in terms of human and environmental well-being.

That means a new social contract around very different socio-economic models. Of course, human societies are not yet ready to move toward what the youthful Scottish philosopher, William MacAskill, calls “effective altruism” (making charitable giving work best). But the current course in health and energy use can only mean millions of deaths around the globe and even planetary exhaustion.

The great financial crisis of 2008 ushered in a period of misguided austerity. In contrast, the COVID-19 pandemic and now the war in Ukraine have seen even “frugal” countries like my own mitigate or even abandon what Professor Mazzucato calls “false fiscal constraints.” But we must go further and adopt state budgets geared to achieving desirable outcomes with actual value – most notably, better health for all and shared well-being. Genuine ESG thinking must become core to policymaking.

A real European Health Union

In my opinion, this year’s forum should serve as a call to action for government ministers and others to learn the lessons of the current and looming pandemic and other crises: out-of-silo thinking, collaboration, pooled sovereignty, solidarity above all. By bringing together so many players in health and other policy areas, the EHFG can set the agenda for extending and completing the EU Health Union.

A large majority of Europe’s people favour greater EU competence in crisis management, rejecting the Fortress Europe approach at the same time. As well as dealing with pandemic preparedness and responsiveness, including vaccine supply, Europe is spearheading measures to promote the digital transformation in healthcare delivery – and this has only just begun. This must lie at the heart of the EU’s global healthcare strategy that DG Sante will present in Gastein on September 28.

So, too, must the future role of Europe’s pharmaceutical sector, including R&D and competitiveness, and market entry barriers. And one must not forget the need to make medicines more affordable and easily accessible in many EU-27 countries. Europe has only just begun discussing novel ways of funding healthcare and, in the context of AMR, incentivising the discovery of new and effective antibiotics. Greenfield thinking about innovative financing is at the top of our agenda here.

This, one might add, is all very well but do we have the professional staff to deliver the enhanced care and treatment we are promising ourselves in Europe? Shortages among general practitioners and hospital-based nurses and consultants are growing at an alarming pace. So, the Commission and Member State governments, which have the greater competence in this field, need to work together with public agencies, including trade unions, in devising workable strategies to recruit and retain and train more significant numbers of motivated professionals.

So that is why it is appropriate for this year’s Forum to ask the fundamental question: European Health Union – if not now, then when. Given our society and the world’s challenges, we might say, “if not now, it will be too late!”.