An opinion piece by Tadeusz Hawrot,
EFNA Senior Advocacy Coordinator
EU project strengthened by reaching mutual agreement on the budget but health and research suffer from massive cuts
Should you just be back from a mission to the moon, on July 21st the EU leaders agreed on a historic plan to jointly borrow €750 billion, in response to the coronavirus pandemic. A recovery fund was born which will be linked to the next seven-year budget, in Brussels jargon called the ‘Multiannual Financial Framework (MFF)’, both amounting to a €1.8 trillion budget.
Unfortunately, the EU4Health Programme – the Commission’s proposal to help cope with the health consequences of COVID-19 on an EU-wide basis, rather than country-by-country, with measures ranging from addressing drug shortages, to stockpiles, to health systems resilience – saw a massive cut as compared with what the EC proposed in May. The Commission put a figure of €9.4 billion on the table, which comprised of €7.7 billion from the Recovery Fund and the remaining €1.7 billion from the MFF. This was slashed by national leaders to €1.7 billion, taking recovery funds off the table.
It is fair to mention here that, while this represents a huge missed opportunity for Europe, this reduced sum is still more than triple what the Commission had proposed in 2018. Additionally, the Health Programme will remain a stand-alone item rather than being nested within the European Social Fund +, as per the 2018 proposal.
Also the research budget has seen significant cuts – from an originally proposed €94.4 billion it was trimmed to €80.9 billion. This will, in turn, negatively impact the budgetary allocation for health research.
It’s worth adding that health and research budgets are but a tiny drop in the ocean compared with agriculture and regional funding which will receive €336.4 billion and €330 billion respectively.
The Parliaments response
The Parliament, as co-legislator, will now have to provide its approval to the MFF for it to take effect. In a resolution it has already stated that it does not accept the political agreement on MFF 2021-2027 as it stands. Its main concern is avoiding and reversing cuts in policies including health and research.
An absolute majority is needed for an agreement in the parliament. If reached, MEPs will pass an updated budget back to EU leaders, who must then give their unanimous approval by the end of the year.
At EFNA, we believe that it has never been clearer that good health is our most important value and it must be reflected in the appropriate level of attention, priority and funding that the EU awards to public health. With this in mind, in May 2020 EFNA called for an expansion of EU health competences, the stand-alone EU Health Programme and increased funding for public health and health research (see our full analysis and call in this article: Will COVID-19 lead to increased EU oversight of public health?).
Against this backdrop, we are now shaken and puzzled by the EU Member States decision taken during the biggest health crisis of our times, a decision to look for savings and political gains by wiping out most of the proposed funding for EU4Health.
We also want to take this opportunity to welcome that fact that the programme, albeit now facing significant reduction in its targets and ambitions, recognises the impact of non-communicable diseases (NCDs). We concur that they are amongst the biggest challenges facing EU health systems.
Neurological health and patients’ involvement must become one of key NCDs priorities
At the same time, we regret that the initial health programme proposal did not recognise neurology as an integral part of the response to NCDs, despite our addition as the 5th big NCD group by the UN in 2018 (alongside mental health). This is also difficult to understand given the evidence on the immense prevalence and burden of neurological illnesses, not just on healthcare systems but also socio-economically.
We have voiced our concerns in an open letter to the leaders of the Commission and Parliament, co-signed by the European Academy of Neurology and endorsed by nearly twenty organizations. Read the letter here.
In parallel, we sat down to analyse the Commission’s legislative proposal from May and prepared nine amendments which, we believe, can better reflect both a necessity to increase the presence of neurology in the programme as well as increase meaningful involvement of patients across the whole spectrum of healthcare and health research ecosystems. Whilst welcoming an increased focus on cancer, we suggested that its common shared risk factors and synergies with other major NCDs such as neurological disorders, be equally addressed. ‘Europe’s Beating Cancer Plan’ may provide a template for other major disease areas.
In terms of patients’ involvement, we suggested i) more resourcing and capacity building opportunities for patient organisations to increase patients’ contribution to designing and implementing health policies; ii) fostering a supportive environment for meaningful patient and public involvement in clinical trials, starting with the design phase and ending with dissemination.
“Due to exceptional diseases burden and increased global prioritization I believe that also neurological disorders should become one of the priorities in the EU4Health programme” – Ms. Katarina Konečná
MEPs had their first discussion on the initial EU4Health programme at the health committee (ENVI) meeting on July 7th. We are particularly grateful for one of the shadow rapporteurs of the health programme, Ms. Katarina Konečná, who said during the meeting: “Due to exceptional diseases burden and increased global prioritization I believe that also neurological disorders should become one of the priorities in the EU4Health programme”. She also emphasised a role of patient organisations and will be submitting amendments on all those issues.
Difficult decisions will have to be made now that the funding for the EU Health Programme has been cut so drastically. However, there is no doubt that NCDs, including neurological conditions, must remain at the top of European priorities and we will continue to work with EU Institutions and Member States to make this happen.
The budget battle seems to have been lost but the war is not quite over yet
We are also getting ready for the next big battle that will be taking place at the so called ‘Conference on the Future of Europe’ – a project to give Europeans a greater say on what the Union does and how it works for them – during which a topic of increasing EU health competences will undoubtedly be on the table. The Commission Vice President Margaritis Schinas pointed to an ‘asymmetry of expectations’ between the vital importance of health, as expressed by EU citizens, and the insignificant role that the European Commission and particularly its health directorate DG SANTE, is still playing. National governments now need to be convinced that it is in the best interest of individual countries and EU citizens to increase EU health capacities.