A message from the capital of Europe
em 2020-05-06 Ano: 2020
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Pascal GAREL
European Hospital and Healthcare Federation (HOPE)

Since Europe became the most impacted continent of the COVID-19 disease, being in an executive position at the European Hospital and Healthcare Federation (HOPE) was and still is quite challenging. In this context, trying to support members and their professionals to cope with the multiple difficulties got a different meaning to the previous daily activity.

Following attentively in January and February the situation in China, warned also late February by the shortages of medical devices produced in China, we first developed a systematic exchange of information and knowledge to then customized it to the different needs. But the WHO rightly reminded all of us to get facts, not rumours, misinformation, out-dated information or commercial interest. This is why we preferred to limit information on our website. We advised instead to follow information provided by public authorities in national languages and later redirected to appropriate links. Contacts were made late February with the WHO Regional Office for Europe on the preparation of hospitals in countries with potentially issues with handling the COVID-19 crisis. Then together with other European stakeholders HOPE has also addressed the European Commission to welcome efforts and measures taken to get out of the crisis.

European countries were and still are at different stages, some of high emergency at hospital level, other still getting limited number of patients but things are changing fast, in waves. Feedbacks from HOPE members have provided the first lessons notably the importance of a comprehensive approach that integrates all components of social and health care, from home care, primary care and hospital care connection of health system and social home care. To avoid putting hospitals in deadlock measures at community level, social and long-term care institutions are important to avoid the transmission of SARS-CoV-2.

Our role was of course to follow as well how the European institutions were facing the crisis.
Concerning this kind of health threat, we will need to evaluate the present role of the EU, not limited to the role of the Commission, and how it worked in the present crisis. How in particular, taken on the basis of the treaty (article 168-5), the 2013 Decision on strengthening the EU's capacity to coordinate responses to health emergencies did work well or not.

Beyond the struggle to tackle the Covid-19 pandemic, the European Union institutions’ role in public health, and particularly in the provision of health technology, will certainly be impacted. More specifically concerning pharmaceuticals, medical devices, protection equipment and information technologies, the COVID-19 massively showed what had already been clear for quite some time: de-industrialisation of Europe and dependency to China. This is also the case in other fields, like rare earth and metals, particularly needed for IT but also for greening the energy production.

The issue of shortages of medicines was already all over the news last summer in France and in the Netherlands in particular and this dependency on China was one of the factors identified. Several European countries have proved with COVID-19 to be deficient both in the availability and supply of necessary assets for responding to many low-tech needs (notably PPE, but also basic ICU equipment, devices and infrastructure), but also inadequate provision for high-tech procedures and processes, for testing (both for infection and for immunity), for symptomatic treatment (shortages of medicines notably), for any curative therapy, and for preventive vaccines.

The deficiencies where they took place were mainly due to the fast development, the information coming from China in terms of length of stay in ICU beds for example and then of course of the availability of equipment to increase the number of ICU beds. How could the Grand Est hospitals in France expect to have to triple their capacity in ICU in two/three weeks? Should health care systems planed to be able 365 days to triple capacity in ICU beds?

Other pressing questions concerning pharmaceuticals have been highlighted by the crisis: do private-sector commercial interests handicap effective responses to health needs? Should the scope of patents (and notably the role of compulsory licensing) be reviewed in that light? Should companies be obliged to share research results? Is it time for different business models, or medicine pricing controls, or mandatory joint procurement? Should requirements be tightened to oblige companies to make their products available? Or are private-sector responses handicapped by inadequate intellectual property, insufficient profits, or excessive regulation?

More long-term questions have also been raised about Europe’s manufacturing capacity, with the pandemic accentuating Europe’s dependence on imports of health-related assets that have been systematically outsourced. This is already in the mandate of EU Commissioner for health if you consider the letter of President Von Der Leyen. We were indeed waiting for a proposal of the European Commission on 11 March concerning the pharmaceutical strategy to be adopted at the end of 2020… This will have to balance several elements, the costs of such a strategy, including the environmental cost, but also the real efficiency of drugs, the prescriptions, the amount of drugs wasted because not taken, etc…

The pandemic changed the context for considering what were – until a month or so ago – burning issues such as EU cooperation on HTA, or research incentives for orphan and paediatric medicines, or the use of biosimilars, or anti-microbial resistance, or parallel importing, or artificial intelligence/digital health, or adaptive licensing. For artificial intelligence it is obvious and clear that there is a lot on-going on the field, as well as for application of the General Data Protection Regulation...

To conclude, on this on-going crisis, tremendous work is done at all level by professionals in home care, in social and healthcare and hospital settings. This makes one very proud of working for the health sector.

Brussels, 30th April 2020