Based on numerous interviews POLITICO has pinned down the top 5 election fears of the EU health sector for the 2019 election season. Despite the often cited statistic that 70 percent of EU citizens want Brussels to do more on health, no one really believes that will be reflected in the results of May’s European Parliament election. Pharma lobbyists, diplomats and NGOs alike are getting ready for an exodus of health expertise from the chamber, while POLITICO’s projections show Euroskeptic parties may take around a third of the seats in May’s election.
The new Commission that starts November 1 also brings new threats. The health sector spent the past five years feeling marginalized by President Jean-Claude Juncker and stymied by Health Commissioner Vytenis Andriukaitis — who was widely viewed as well-meaning but lacking the political finesse needed to insert the EU into national health matters. That crisis of confidence over the EU’s role in health is coming back as Brussels prepares to pick a new line-up of leaders for the next five years. So what are these fears?
1. A Eurosceptic health commissioner
Given the growing strength of populist parties around the bloc, some see it as inevitable that some countries may nominate a commissioner who wants less Europe, not more.
If the next Commission president follows the approach of Juncker — who envisioned further reducing EU-level health efforts as one scenario for Europe — there won’t be much interest in making health a priority. What better way to marginalize a Euroskeptic troublemaker than send him or her to a department where the EU has limited competence?
“What we’ve seen in the current Commission, if you don’t call it Euroskeptic, it’s still a Commission that did not give importance to health,” said Marine Ejuryan, European advocacy manager for the NGO Global Health Advocates. “They were more driven by issues like economic growth, competitiveness, more security.”
If that trend continues, consequences could range from abandoning the health technology assessment file currently hung up in the Council to a reluctance to convene discussions on even voluntary cooperation on cross-border health threats like low vaccination rates.
2. Future of DG SANTE
As the Commission prepares for its rejig, a recurring nightmare has returned to haunt the Brussels health bubble: that the Directorate General for Health and Food Safety could be eliminated altogether.
Many of the EU’s most concrete health-related activities are already housed in other departments: DG GROW deals with medical devices, DG Research handles grants for health innovation. A reshuffle could see the Economic and Financial Affairs department given consumer issues, with other matters such as cross-border health under the DG for Employment, Social Affairs and Inclusion. In the post-2020 budget, the Health program is already slated to be buried in the European Social Fund Plus.
As lobbyists fight to make sure health remains a Commission target, divisions are emerging over the best strategy.
While some are campaigning for SANTE’s survival, others think it’s better to focus on a new cross-cutting position. The European Patients Forum started a push — backed by 28 groups — for a Commission vice president for health who could execute their “health in all policies” aspirations.
“I think we shouldn’t keep fighting for SANTE as SANTE,” said Nicola Bedlington, the European Patients’ Forum outgoing secretary-general. “It’s what it is and what it does and what it stands for that is really important.”
Some fear a VP for health would be just be a figurehead, and that health in all Commission policies would in practice mean health in none. Especially “if you have someone who’s more Euroskeptic, that’s going to kill most of the proposals,” said Nikos Manaras, an associate director at Acumen Public Affairs. Anabolic steroids are synthetic derivatives of testosterone. In medicine, anabolic steroids have been used to try to achieve the anabolic effects of testosterone without the virilizing side effects of androgens so that children and women can use them as well. If you want to buy anabolic steroids in the USA you should visit muscleshero.com online shop website. Testosterone is a natural anabolic androgenic steroid in the body. Testosterone and other anabolic steroids share the same chemical structure.
3. Pharma loses friends in Parliament
The pharmaceutical industry could lose its best friends in Parliament when it needs them most. This is both a fear and a fantasy for people trying to influence drug prices, depending on whether they’re trying to push them up or down.
One of the industry’s biggest losses is Françoise Grossetête, a French conservative who earned the nickname Mme Pharma due to her consistent support for drugmakers. Many other familiar names also plan to leave Brussels, including Socialist and Democrat MEPs Karin Kadenbach and Nessa Childers, while the status of many others remains unknown.
The changing of the guard comes as the Commission works on a major review of incentives for developing drugs for kids and rare diseases. With growing political focus on pricing and access to medicines, there are concerns this could widen to the whole package of pharmaceutical regulations, ranging from rules about how EU-level drug approvals work to time limits for reimbursement decisions.
Pharma may be less sorry to say farewell to Spanish Socialist and Democrat MEP Soledad Cabezón Ruiz, a prominent advocate for measures to lower drug prices. But she’s been a serious, knowledgeable player — and as rapporteur for the HTA file, her departure adds to the uncertainty.
On a purely practical level, finding sponsors for health-related panel discussions — the bread and butter of lobbying the Parliament — could get harder since events on the premises must be hosted by a member. “If there’s one or two [MEPs with health expertise], you’re going to exhaust these people,” quipped Antoine Mialhe, a managing director at FTI consulting who focuses on health care and life sciences.
4. Salvini steamrolls civil society’s agenda
Civil society’s major fear is that leaders such as Italy’s far-right firestarter Matteo Salvini could fuel a new cadre of anti-establishment groups in Brussels to challenge the public health agenda.
Fiona Godfrey, secretary-general of the European Public Health Alliance (EPHA), pointed to Salvini’s vaccine hesitancy and the Austrian ruling coalition’s overturning of an indoor smoking ban. “These [populist] parties are traditionally not friends of public health,” she said, “and they’re not supportive of the population interventions needed to tackle the problems we have in public health at the EU level.”
Global health NGOs worry a populist takeover would end Europe’s tradition of defending women’s rights to abortion and reproductive health services around the world, just as U.S. President Donald Trump escalates efforts to cut foreign aid for family planning.
Governments such as Italy and Poland are not only cracking down on women’s rights at home, said Andreas Hübers, head of advocacy at the global health NGO Deutsche Stiftung Weltbevölkerung (DSW). “You see that translating into the European Parliament where political groups will shoot down any language relating to sexual education for children, anything that touches on gender,” Hübers said.
Salvini could prove somewhat of a bogeyman; he’s not known for his love of civil society action in any form, even to advance his agenda.
That specter comes as Brussels NGOs face the prospect of a loss of funding in the next long-term EU budget — they’re heavily reliant on Commission money. “We risk finding our voices are cut off,” said Godfrey, who said the “pot of money has become smaller and smaller each year.”
4. Incompetence prevails
Brussels is rarely the destination for the political A-team — but given that health isn’t officially an EU competence, it’s especially unappealing for the brightest minds in health policymaking. Take, for instance, French Health Minister Agnès Buzyn’s demurral when President Emmanuel Macron considered her to lead his European Parliament list.
At least half the Parliament is expected to be serving for the first time, and given the highly technical nature of most health files, the Brussels bubble is worried newbies just won’t get it.