Medicine shortages, dependence on distant supply chains for essential raw materials, strained budgets and rising geopolitical tensions all have consequences where they matter most: at the patient’s bedside, in clinics and pharmacies. Everyone warns that we cannot assume that the months and years ahead will be easy. How do we prepare for uncertainty, build a health system resilient enough to withstand the pressures ahead, and still keep innovating? Tilly Metz, Group of the Greens/European Free Alliance (Luxembourg) and Vice-Chair of the European Parliament Committee on Public Health, reflects on the priorities, pressures and possibilities ahead.
What are your key priorities for the EU health agenda this autumn?
First of all, I think we need to work better together in health, including having more cooperation and stop looking at health in separate silos.
Also, if we want to be serious about prevention, we need a much more holistic approach, and this is where the One Health concept is particularly important.
Prevention for instance is about the environment in which people live. Air pollution, chemicals, food, working conditions, housing and lifestyle all have an impact on our health.
We need to look at these different determinants together, rather than treating them as completely separate issues.
Tobacco will also be an important priority, particularly as we move towards the revision of the EU tobacco control framework. We need to address the commercial determinants of health and make sure that the regulatory framework keeps pace with the rapid development of new nicotine and tobacco products, including vapes, nicotine pouches and heated tobacco products. The way these products are designed, marketed and made attractive, particularly to young people, needs much closer attention.
We have also recently voted on the European Parliament’s cardiovascular health report, and I have been working on the European Beating Cancer Plan. These are two different health areas, but they are a very good example of why we need to break down silos. Many of the risk factors and determinants are shared, and prevention is where these agendas can really reinforce each other.
We need to be much more ambitious on prevention and on addressing the factors that make people ill in the first place. And this also means looking critically at the commercial interests that can work against public health.
For me, the precautionary principle is another core value. I am currently working on the Food and Feed Simplification Package, and I think we need to make sure that the drive for simplification does not come at the expense of health and environmental protection.
Simplification can be useful when it removes unnecessary bureaucracy, but it should not mean weakening the safeguards that protect people and the environment. The EU’s food law is built around a high level of protection of human health and the precautionary principle, and we need to preserve that.
This all comes back to prevention. Prevention is often seen as a cost, but the cost of people becoming ill — for individuals, for health systems and for society — is much higher. We should invest much more in keeping people healthy in the first place.
And that means looking at the conditions in which people live. Clean air, clean water and healthy food should not be a privilege for people who can afford them. We also need to look at housing, working conditions and inequalities. If we are serious about health, we have to address these determinants.
Finally, none of this can happen without proper investment. If we want to build a real European Health Union, health needs to have a strong and visible place in the next EU budget. We cannot keep treating health as the budget we look at when there is money left over. If we are serious about prevention, resilient health systems and European health security, we need to invest in them properly.
If we talk about the pillars of EU health sovereignty and how we can strengthen them through effective policy instruments, what needs to be done to boost all these ideas?
We need to move forward faster. If you look at the Eurobarometer, health is almost always among the top five, even the top three concerns of Europeans.
It should not depend on where you live whether you have access to the treatment or access to that medication, etc. And it should also not depend on what you are earning. And if we first of all look inside the EU, there is still this fragmentation that we see, or these differences between countries, but also the lack of coordination that we see right now on supply chains.
And also, in order to allow cross-border healthcare, what we definitely need is better cooperation between the Member States. I worked on this revision. We need better information for citizens about what is being reimbursed, as a lot of them are not even aware.
Healthcare is mainly a national competence, so we also need to guarantee that we have sound healthcare systems in every country. And that is another point we need to tackle. We saw how fragile our health systems are during the pandemic. So, I think we have not yet taken all the lessons learned from the pandemic. It was very nice to go out onto the balcony and applaud the healthcare professionals, but that is not enough. And it’s not only about a good salary for these people. It’s also about the working conditions. The violence at their workplace. We also need to improve and have general standards for the healthcare profession.
This year we have worked on and finished the Critical Medicines Act. We have a list of 270 medicines in order to fight medicine shortages.
To guarantee that we have reserves, I pushed for solidarity between the Member States. For example, if Luxembourg is lacking Ventoline, a medication for asthma, we should be able to ask another country: “Do you have it? It’s a critical medicine. Do you have Ventoline?”
Europe is heavily dependent on imports for health innovation — most cutting-edge medicines, medtech, and health technologies come from the US or China, and roughly 80% of the active pharmaceutical ingredients we use are sourced from China and India. Given that dependency, is it realistic that Europe builds meaningful domestic capacity in this space within the next decade?
With the Critical Medicines Act, we will define strategic projects. And for production in Europe, it will be an asset. We want the pharma industry, and especially active ingredient production, to come back to the EU. So we need to give them incentives. We specifically also need to analyse, for example, which medications really bring added value to people’s daily lives and how to support their production.
But also, can it really be produced again in Europe? And what can we do in order to make the industry come back? Because, I mean, that is not something that will happen from one day to another. I would already be happy if a certain percentage of active ingredients were again produced here. For decades, we neglected the sector.
If we look at the United States, there are clearly official orders by the government to certain pharma companies or corporations to produce certain medications. And I think the public authorities should do better coordination or public – private partnership.
I dream of a situation where we would have, like, 15-20% of critical medicines also produced in public hands, not depending on private industry, because we saw also during the pandemic how the power was not on our side. It was in the hands of the pharma industry. The European Union worked with six different companies in order to have a vaccine, which was good. And all 27 of us negotiated together.
Coming from a small country like Luxembourg, and having to negotiate with the pharma industry on vaccine prices, we would have been lost. I think a lot of people acknowledge that we need to work and bargain together, also as 27 Member States in the healthcare sector – not to create competitiveness and medical deserts throughout Europe.
The US, especially, puts a lot of money into innovation. That’s true. They have – and it is astonishing – a more centralised approach regarding the coordination of research, etc. But if you look at who has access to innovative treatments in the end, it’s a minority. So that is the model.
I don’t want it for Europe. I want to stick to our European model. We have our national health services, where everybody has access to innovative treatments and medical devices, and not only an elite that can afford them.
Some major pharmaceutical companies receive EU funding for R&D, while some treatments remain very expensive. How can we ensure that innovative treatments remain accessible to patients?
This is exactly what I always said. It cannot be that we pay three times. First, we pay with our data. We give the pharma industry a lot of data. It’s also important to have better cooperation between the Member States in the European Health Data Space. I have a lot of hope in that concept, but it takes time to implement. If I look already in Luxembourg, that’s another story. Then we give them money to do research. The third time we pay is for access to sometimes very expensive medication.
I think that is why I say we have to rebalance the power a little bit. If we give money to a pharma company to develop a certain medication or an innovative treatment, it must come with conditions. It must come with transparency on the cost, which most of the time they don’t want, and it must come with conditions. If we give you so much public money to develop a medicine, I want to have guarantees on the supply chain. On the price.
If we give you money, we want transparency on the cost, and we want to be sure that people in Europe have access, and that they do not choose: “This country? It’s not so interesting. We don’t put it on the market there.” Everybody must have access, and at a price that is still affordable, because we already give you money for the research.
If the EU funds pharmaceutical companies, shouldn’t that funding come with a guarantee that every patient in Europe has equal access to the resulting treatments?
I think this is fundamentally about making Europe fit for the future. We need to be realistic about where we stand: we have an aging population, and that brings very specific demands in care, in medication, in how we manage age-related and chronic diseases. This is personal for me too. My father recently passed away at 94, and it’s made me think a lot about what aging populations actually need from a health system.
So we have to put health more at the centre of our priorities – not only as a geopolitical and strategic issue, but as a matter of people’s well-being and a response to what citizens genuinely expect from us.
