With national health systems under unprecedented stress, a European Health Union is badly needed

Ahead of Friday’s (21 June) Health Council, Frank Vandenbroucke writes that Europe needs a ‘true’ European Health Union to guarantee the survival of national health systems.

Frank Vandenbroucke is Belgium’s deputy prime minister and minister for social affairs and public health.

There is no denying that European health systems will face ten years of unprecedented stress. Demographic ageing, the rising tide of obesity and other chronic diseases, medicine shortages, and health worker retirement waves cause increasing strain.

We must prepare for the disruptive effects of climate change—pandemics, heat stress, flooding, and tropical diseases—as well as the transformative potential of AI. 

This forces us to rethink health systems. We must review the division of labour and skills in the health workforce and exploit technological innovation to respond to shortages of health professionals.

We must reconsider how medicines are produced and procured to secure their supply. We must embrace prevention, not only in firm words but also in firm acts, to mitigate the disease burden on our systems. And then, living in a world of multifaceted risks, we must be prepared for the unexpected. 

Europe must step in to avoid implosion of parts of our national health systems. This is not done by replacing national policies but by creating a supportive ‘holding environment’: that is what a true European Health Union is about.

During six months, EU health ministers discussed intensively what such a European Health Union should undertake.

An ambitious programme for the next Commission emerged, answering eight challenges: medicine shortages, shortages in the health workforce, prevention of non-communicable diseases, targeting unmet medical needs, combatting antimicrobial resistance, developing an EU ecosystem for clinical trials, crisis preparedness, an agenda on health and climate change, and improving EU implementation tools. Rather than elaborating on each of them, I will give two examples.

Shortages of medicines

Basic medicines have disappeared from our markets. In the past few months, we have lacked life-saving drugs such as cancer treatments, antibiotics and blood thinners. Patients are told to postpone treatment or drive hundreds of kilometres across Europe to find their medicine. 

Underlying this is a deficient economic model that rewards producers for producing cheaply rather than considering the security of supply or environmental and working conditions in which products are made.

This explains why essential medicines now come mainly from China and India. Global dependence on Asia has a dark downside: war, a factory fire, quality problems, or a ship stuck in the Suez Canal can quickly have disastrous consequences for patients worldwide. 

While the EU had already outlined plans to reduce our dependence on chips, green energy and critical raw materials, it has ignored medicines for too long.

This changed with the announcement of the Critical Medicines Alliance, a partnership between the Commission, governments, industry and civil society tasked with drafting solutions to enhance security of supply.

Contrary to chips, net zero industries, or critical raw materials, however, we still lack a legal framework to guide actions on the production and procurement of medicines. The next Commission should, therefore, prepare a Critical Medicines Act, like it has drafted a Chips Act, Net Zero Industry Act, and Critical Raw Materials Act.

Responding to increasing health needs

Most countries report severe shortages of healthcare professionals. The answer is multifaceted. To reduce the pressure of ageing and chronic diseases on our systems, people should stay healthy for longer.

Hence, we must reinforce the fight against tobacco and excessive alcohol consumption and have more nutritious food in our supermarkets. With its legislative powers, the EU can enable member states to take much more efficient action – consider tobacco taxation or alcohol and food labelling.

Most of these levers were identified in the Europe Beating Cancer Plan but never brought to fruition. An ambitious EU policy on disease prevention would buttress national policies significantly. 

In parallel, we must reform healthcare professions so that nurses, doctors and other carers are employed much more efficiently, and we can make the most of what new technologies, such as AI, have to offer.

The EU can also play a positive role here by being at the frontier of innovative thinking and organising the necessary dialogue with member states and social partners on future healthcare professions.

We all enter into unchartered territory: we must learn from one another. Legislative action might follow, as the EU internal market rules, through the professional qualifications directive, have considerable influence on the organisation of the workforce. 

Time to launch the action

Not so long ago, health ministers were reluctant to encourage the European Commission to put health centre stage, given the sensitivity of national competencies. The times have changed with the COVID experience, international market failures and climate change. We simply need a true European Health Union if we want our health systems to survive. 

Therefore, for the first time ever, the EPSCO Council pushes for an ambitious health agenda. The ministers defined the areas for EU action. It is now up to the next Commission to take up the baton.