Some More Equal Than Others

Just as the new US President is starting to dismantle the wider healthcare provision initiated by his predecessor, Brussels this week threw its own spotlight on health equalities – or inequalities – and the issues of access – or not – to healthcare. The trigger this time was a European Union conference on social rights, but the message for the pharma world was the same as at many recent European and international encounters: access should be widened, and this needs a better balance between innovation and affordability.

In his remarks to the Brussels conference, the European health commissioner, Vytenis Andriukaitis, pinpointed some of the "difficult questions that we need to address at all levels" - how to reduce inequality and ensure healthy lives, how to tackle the poverty associated with poor health, how to reduce chronic diseases… "And how can we do any of this, without appropriate social protection for all?" His conclusion? "We need to step up efforts to deliver on these goals for all people in Europe."

The desire to act is widely shared. On the eve of the conference, a statement from a score of health campaigning organizations urged the EU and its member states "to put health inequalities at the forefront of their health related priorities." They want action to harmonize European health system performance analysis tools and to agree on common indicators and methodologies to assess national health system performances. Many of the NGOs are also using the opportunity to deliver calls for wider access and cheaper prices for new medicines. But again, expressions of pious aspirations are not in themselves a solution to the acknowledged challenge.

The underlying dilemma isn't just flavor of the month. It is becoming flavor of the year, and even of the decade. A joint report from the EU and the Organization for Economic Cooperation and Development last year enjoined policy makers to balance the access of patients to new effective medicines with incentives for innovation and with the limits on healthcare budgets. The EU's own health council and the European Parliament have reflected repeatedly on the clash between costs and care – particularly when new drugs are concerned. The latest result of these debates is an ongoing assessment of whether EU incentives for drug development are justified, instigated by the Dutch presidency of the EU last year. And recent United Nations reports on drug research have questioned the legitimacy of prices charged for innovation.

In February, the European Patients Forum is to launch a one-year campaign on access to healthcare, backed by left-wing MEP Kateřina Konečná from the Czech Republic and center right Bulgarian MEP Andrey Kovatchev. This will focus on the barriers patients face in accessing healthcare, and will aim to promote closer EU cooperation in dismantling them. Specifically, it wants to "make universal access a reality for EU patients by 2030" – a deliberate echo of the goal set under the United Nations' recently-adopted Sustainable Development Goals. And right up among the top priorities in the campaign will be EPF's concerns about pricing and reimbursement of innovative medicines." Patients will only reap the benefits of the new therapies if, once they are on the market, they are accessible and affordable to all who need them," says EPF. It says it is time to "overturn the current trends of short sighted decisions on investment in healthcare."

The concern about medicine prices as a component of the challenges is reflected in many contributions to the debate. Just at the end of January, the European Public Health Alliance spoke of "the access & innovation crises Europe faces primarily due to the exorbitant prices of medicines," and told drug manufacturers that "they need to invest in real innovation and not towards a proliferation of me-too medicines."

The baton about affordable treatments was taken up by EFPIA President Joe Jimenez. He argued that the opportunities from innovation in healthcare should not be perceived as threats, but that healthcare funders should instead be ready to make "tough trade-offs" that defy current thinking. This, for Jimenez, means scrutinizing the overall cost of healthcare more precisely, stopping the provision of low value care, and being willing to finance a single high-cost intervention upfront if it creates a long-lasting benefit and savings down the line.

At the end of their twice-in-a-decade meeting in January, OECD health ministers issued conclusions stressing the "need to consider the most effective uses of new health technologies." They too put their finger on the importance of ensuring access to effective health care treatments and protecting people’s wellbeing and needs,  "while ensuring the sustainability of our healthcare systems." But they accepted – in principle at least – that there is some merit in maintaining incentives for health innovation.

Everyone agrees on the questions. How long before real answers start appearing to them?