Read our first edition of “Rethink European Health Policies”, our monthly summary of European news that have the potential to change or transform current health and care policies from patient-centered to citizen/human-centered. In this edition, we present six initiatives and actions from the beginning of the year that are leading the way towards this change.
EU efforts to help the Ukrainian migrants while protecting its own citizens: policies and the role of ECDC
Since 24th of February, more than 4,5 million Ukrainians fled the country, with millions being displaced internally. Beyond the immediate threat to individual safety, this situation causes long-term trauma, emotional distress and long-term health problems.
In its March operational report, the European Centre for Disease Prevention and Control (ECDC) sets out guidelines and priorities for the control of communicable diseases in the context of the humanitarian tragedy in Europe. Experts warn that Ukrainian refugees are at an increased vulnerability in what they have identified as infectious diseases due to the living conditions they face during relocation. However, the main recommendation is for the state hosting migrants to ensure that they have access to medical services in a similar way to their local populations. Thus, possible complications of pre-existing medical conditions can be prevented, and acute conditions can be treated early (including non-communicable diseases and mental disorders). This approach not only ensures the continuity of medical care, but also helps in the early detection of communicable diseases that can cause outbreaks, such as COVID-19.
These recommendations can be put in place based on the Temporary Protection Directive enacted by the Council of the European Union on 4 March 2022 (Council Implementing Decision (EU) 2022/382) in response to refugees arriving in the EU from Ukraine. Temporary protection, which is distinct from asylum, can last up to three years depending on circumstances. When invoked, the directive compels all member states (except Denmark, which has an opt-out clause) to accept refugees, issue residence permits, minimise red tape, and take other steps to assist displaced people. Refugees are to be distributed among member states on a voluntary basis, based on member states’ capacity to host them.
However, not all the countries have the legislative basis for equal implementation and this differences affect the equal management of the Ukrainian migrants across the EU. By adding the layer of already existing inequalities between Eastern and Western EU Member States, the most noticeable being the ones regarding health and care, these vulnerabilities become exacerbated. To compensate for the current and future vulnerabilities, the EU Institutions should focus on the Eastern Europe in terms of vision, planning and funding.
Open letter to the European Parliament, the European Council and the European Commission from the Centre of Innovation in Medicine
In the context of the war in Ukraine and the humanitarian and health crisis in neighbouring countries (Hungary, Moldova, Poland, Romania, Slovakia), the Centre for Innovation in Medicine addressed to the European Union legislative bodies the following requests:
- Prioritisation of funding for CEE Member States and Eastern Partnership countries in the ongoing Funding programs: EU4Health, Horizon Europe, Digital Europe, NextGenerationEU, as well in the context of the Beating Europe Cancer Plan and Mission on Cancer.
- The establishment of a public health program, in coordination with ECDC, with a focus on vaccination and genomic and syndromic surveillance of pathogens (SARS-CoV-2, but as well pathogens involved in tuberculosis, poliomyelitis etc) for the migrants.
- The immediate start of the process to define a mechanism to provide access to healthcare for migrants, when the temporary protection mechanism will end, is coordinated at the EU level.
- The establishment of a working group designed to re-think and help the post-war transformation of the public health system and the healthcare system in Ukraine.
European Council updates the 2003 Council Recommendation on cancer screening
The Europe’s Beating Cancer Plan proposes a new cancer screening scheme, aiming to help EU countries ensure that 90% of the EU population who qualify for breast, cervical and colorectal cancer screenings are offered screening by 2025. A first step into achieving this is updating the 2003 guidance (Council Recommendation) on cancer screening based on the latest scientific advice and consider extending screening to other types of cancer, i.e. lung and prostate cancer. The Call for Evidence from Member States and civil society was launched in January 2022.
The Centre for Innovation in Medicine proposed three key recommendations:
- to include the social innovation in the screening programs design (attitudes, perceptions and behaviours)
- to take into consideration the site agnostic testing for screening
- to include real-time real-world data, digital-enabled screening
While the 2003 recommendations urged the Member States to take common actions to implement such programmes through a population-based approach, in accordance with the European quality assurance guidelines, the current scientific understanding of cancer must be reflected in the screening practices. Changes take time, but we cannot afford to screen for cancer as we did 20 years ago, not taking into consideration the molecular characteristics of the disease, the biological traits of the person, and all the health determinants that can be integrated at this point due to scientific advance.
Currently, the best case scenario in a country is to have cancer screening programmes for three types of cancer: cervical cancer, breast cancer, colorectal cancer. The EC will extend this by adding probably two others: prostate and lung cancers. You can read more in the Report of the Federation of European Academies of Medicine (FEAM).
As of 2020, 25 EU Member States had introduced in their national cancer control plans population-based screening programmes for breast cancer, while 22 member states had done so for cervical cancer and 20 member states had done so for colorectal cancer. Full implementation has not yet been achieved, and inequalities persist within and between Member States. In 2019, two-thirds (66%) of women aged between 50 and 69 years in the EU reported that they had received a mammogram (breast examination by X-ray) within the previous two years. In Romania, the percentage was 9%, while in Germany it was 66% and in France, almost 70%.
Citizen engagement in Cancer Mission, a priority at the European level, highlighted by the French Presidency for the European Council
The 5 EU Missions of the Horizon Europe programme aim at fostering the emergence of solutions and initiatives to address major contemporary challenges such as adaptation to climate change, protection of the oceans, the fight against cancer, carbon neutral cities and soil health.
The Mission on Cancer was launched on 29 September 2021 and together with the Europe’s Beating Cancer Plan adopted on 3 February 2021 aims at improving the lives of more than 3 million people by 2030 through prevention, treatment and overall, for those affected by cancer, including their families, to live longer and better. Missions are a novel instrument in Horizon Europe – the Framework Programme for Research and Innovation.
The four Cancer Mission objectives include: understanding cancer, prevention and early detection, optimise diagnosis and treatment and support quality of life. Over the years, the approach in the cancer care continuum was patient-centred. The pandemic showed us more than ever that this paradigm must end, that health and care should be citizen-centred. A citizen-centric model is more suitable for cancer because first of all, prevention refers to ‘healthy’ or at least cancer-free citizens. With more than 40% of cancers being preventable, this means that prevention should play a major part in addressing cancer. And second of all, cancer should be addressed from the citizens perspective because of the stigma attached to cancer survivors. We are all citizens, humans, and getting cancer doesn’t make us less.
Citizen engagement is one of the topics that the French Presidency of the EU Council (1st of January 2022 – June 2022) is trying to address. The first step was the conference held on the 21st of March: Conference on Civic Engagement in EU Missions.
Romania, through the activities of the Centre for Innovation in Medicine, has the potential to become a pioneer and a model regarding the citizens’ engagement in cancer. During the high-level online event “From Cancer Plan to Action and Mission. Implementation of the cancer agenda in Romania” organised by InoMed in collaboration with the Romanian Parliament, this model was discussed and detailed.
“A key focus is on prevention. We must see what methods we must perform screening; we must work with citizens to make them understand the need for screening and change their behaviour. We must ensure that survivors of cancer live the life of a citizen not of a patient. This involves another level of engagement.”Christine Chomienne, Professor of Cellular Biology at the Université de Paris, France, Vice-Chair, Cancer Mission, Phase I.
The first draft of the European Partnership for Personalised Medicine was published
The writing of the birth certificate for personalised medicine in the European Union, in 2015, was a major policy success of the European Alliance for Personalized Medicine. The Luxembourg Presidency Council Conclusions of December 2015 recognized that “personalized medicine refers to a medical model that uses the characterization of personal phenotypes and genotypes (e.g. molecular profiling, medical imaging), lifestyle data) for tailoring the right therapeutic strategy for the right person at the right time, and/or to determine the predisposition to disease and/or to deliver timely and targeted prevention.” Personalized medicine refers to the broader concept of patient-centered care and states that, in general, health care systems need to better meet the needs of patients and/or citizens (we might now add).
Less than one year later, in 2016, the International Consortium for Personalised Medicine was initiated during several workshops organised by the European Commission. The basis for this was the previous project, PerMed, that was funded from 2013-2015 by the European Union’s 7th Framework Programme and brought together many organisations active in the area.
One of the main current activities of ICPerMed is promoting the establishment of a European Partnership for Personalised Medicine, EP PerMed, together with the closely connected ERA-Net ERA PerMed.
As the next step towards a European Partnership for Personalised Medicine, a drafting group was established by the Member States in close collaboration with the European Commission. With support and guidance from the European Commission, they developed a draft proposal for the Partnership that was published by the European Commission in February 2022. The next step is the establishment of the partnership for personalised medicine to be co-funded by the EC in the European Union’s 9th Framework Programme for Research and Innovation, Horizon Europe.
The EP PerMed aims to align and promote national and regional priority setting and funding for research and implementation projects in the area of personalised medicine between the EU Member States (MS), regions and associated countries as well as international partner countries.
Centre for Innovation in Medicine contributes with recommendations for setting AMR public health objectives in the European Union
In February 2022, the European Commission launched a call for public evidence in setting the concrete objectives and activities to strengthen Member States’ action against AMR mainly in the area of public health, where the EU has only supporting and complementary competence.
The Centre for Innovation in Medicine emphasised the AMR threat coming from and within the Eastern European countries. Many experts argue that the next pandemic will be a bacterial pandemic. Eastern Europe already had high levels of AMR and by adding the migration generated by the war in Ukraine – more than 4,5 million people displaced in neighbouring countries – creates the perfect outbreak point. Poland, Moldova, Slovakia, Hungary, Romania are their new homes, in some cases for a couple of days or for longer in others.
Communication campaigns on antibiotics usage awareness were created in the one size fits all manner. One of the main components of a public health policy aiming to prevent AMR by reducing irresponsible antibiotic use should be the understanding of what are the main factors that influence antibiotic consumption in countries from Eastern Europe, like Romania, with a history of communism, with conservative views, high rate of emigration in young populations, with 45% population living in rural areas and many more living in disadvantaged areas and in small, isolated communities. By understanding these factors, communication campaigns and personalised (targeted) preventive actions could be employed.
- To prioritise the social innovations when creating communication campaigns for prevention of antibiotics use.
- To asses periodically, on multiple layers the attitudes, perceptions and behaviours of the citizens with regards to antibiotic consumption, identifying vulnerable groups.
- To build a new model of personalised communication, education and engagement for reducing the risk of AMR, based on individual behaviour, influencers and perceptions.
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