“European funding is critical to be at the forefront of public health”
The meeting 'Public Health: researching and progressing with Europe' highlighted the importance of the European Union in improving public health
Laura Sesma, leader of the Health Area of Zabala Innovation, recently participated as moderator in one of the round tables of the meeting ‘Public Health: researching and progressing with Europe’, organised by the biomedical research centre Navarrabiomed in Pamplona. This event highlighted the need to make the European Union’s public health strategy more visible, and also the importance of making research part of all areas of the health system. In this interview, Laura Sesma analyses some of the most relevant aspects that came to light at the meeting.
With Covid-19 we have seen that health threats know no borders. Should the responses to combat them be more coordinated?
Yes, the pandemic has shown that European health systems can work in a coordinated way, they can share data or make centralised purchases of medicines and vaccines to avoid inequalities in access to health between member countries, but this has not been established on a continuous basis and therefore there are still many inequalities between territories. And it is not really possible to establish comprehensive and coordinated public health strategies in Europe if European countries make decisions individually. In fact, it is still not easy for a chronically ill person to have access to the same treatment in different countries, and the price of such treatment can fluctuate up to 50 times.
What initiatives is European Union working on to improve this international coordination in public health?
The pandemic has shown the importance that the European Medicines Agency (EMA) can play in this international collaboration, because it has played a crucial role in ensuring rapid patient access to Covid-19 vaccines that meet all safety, effectiveness and quality requirements. In addition, the European Centre for Disease Prevention and Control (ECDC) has taken on a much greater role in strengthening Europe’s defences against infectious diseases.
But the most significant development has been the creation of the Health Emergency Preparedness and Response Authority (HERA) to prevent, detect and respond rapidly to health emergencies. The HERA will anticipate health threats and potential crises by gathering information and developing the necessary response capacities. When an emergency occurs, HERA will ensure the development, production and distribution of medicines, vaccines and other medical countermeasures, such as gloves and masks, which were often lacking in the first phase of the coronavirus response. HERA fills a major gap in the EU’s health emergency response and preparedness.
What are the benefits of international health cooperation?
The main benefits are related to improving the quality of life of citizens and the strategic improvement of health systems. Health problems cannot be solved individually and collaboration makes it possible to address them in a more comprehensive way. Cooperation has to take into account the differences between countries and actors in order to have a much greater replicability and impact.
And what are the main obstacles it faces?
They depend on the type of collaboration: from competencies that are not shared between countries (e.g. an ambulance cannot cross a border or the qualifications or licences are different), to different organisational models, information systems (electronic records), interoperability, equipment and policies that make cooperation difficult, especially when it can really be applied to the patient.
In addition, the market for medicines and medical devices is not a free market. This would be beneficial for the pursuit of equitable public health in Europe, but it makes it difficult for innovations to actually be implemented.
Does basic medical research reach the patient or does a lot of it get left by the wayside?
In the development of new therapies, many things fall by the wayside because they cannot demonstrate the clinical efficacy seen in animal models or early phases of clinical trials, and although they advance knowledge, they are not applied to the patient. Not to mention that the average development time for a new medication is 10 to 13 years, and that only 1 in 10,000 compounds finally reaches the market. It is also a very costly process, because the companies’ investment is very high, around 2.5 billion euros per medication.
And in other types of research more closely related to the application of decision support systems for doctors, artificial intelligence tools or medical devices, there are also problems related to market access and changes in established healthcare processes.
Are there guarantees for the intellectual protection of research?
Yes there are, but they must be taken into account from the beginning of the research and it is often the case that researchers are not trained in these issues. For them it is not a concern and they focus more on publications and projects. Efforts are being made to change this concept in order to move towards a researcher with a more entrepreneurial or business vision, although it is difficult to reconcile the two.
Has European health legislation been speeded up or is it still too slow?
The problem with health regulation is that it has to ensure the safety and efficacy of medicines and therapies, so legislative requirements cannot be reduced either. However, it is possible to reduce the time needed for new therapies to enter the market, as has happened with the Covid-19 vaccines. It is essential to streamline procedures and allow for a more open and rapid dialogue between the different actors, and this must be maintained.
Will we see a European Health Data Space, or is it too complex to materialise?
The European Health Data Space is really important for that future where we see coordinated health actions that strengthen health systems and reduce inequalities. However, it has been launched in a very ambitious way in terms of deadlines, and achieving the objectives set for 2025 seems quite complicated. But the important thing is that the foundations will be laid to achieve the European Health Data Space, even if it will take longer.
What are the most important financial instruments for health?
The most important is the Public Health Programme, which for the period 2021-2027 has the highest budget in its history, more than 5 billion euros (eight times more than in previous editions).
In addition, both basic and translational research is funded under the Horizon Europe programme, under pillar 2 in the health cluster, and under pillars 1 and 3 in the framework of the ERC, Marie Curie and the EICs. But in addition to the health cluster, there is the whole Mission Cancer programme, the Innovative Health Initiative (IHI) and the future co-funded partnerships that are starting to be created.
Finally, why is it critical to apply for these funds in order to obtain financing?
To be able to advance and position ourselves at the European level and to be able to improve the quality of patient care. It is necessary to be at the forefront of health services and public health technologies, as well as changes in care, in order to be able to offer the best health services to citizens.