When the Juncker Commission was voted in office in 2014 everyone agreed with its motto to “act big on big things and small on small things”. By the end of its term, the general consensus was that health policy fell victim to this approach and was side-lined by the European Commission. This concern was raised by public health experts during a senior level meeting organised by the Maltese Presidency of the Council of the EU back in 2017. Using Juncker’s own motto, many questioned how Public Health could be considered a “small thing”.

The situation has evolved drastically since then, when the Commission was even considering dismantling and doing away with a Directorate General for Health and assigning its competences to other DGs within the Commission. Fortunately, President Von Der Leyen, a medical doctor herself, reappointed a Commissioner for Health. With the unprecedented COVID-19 reality, we know today that this was perhaps her best decision to date.

Malta’s position has always been clear and consistent. Increased co-operation between EU Member States would bring countless benefits to European patients. Although this may be more relevant to smaller Member States, with the evolution of the health sector, where treatments and medicines are always getting more specialised and personalised, co-operation is ultimately beneficial to all.

“Increased co-operation between EU Member States would bring countless benefits to European patients.”

The Valletta Declaration Group

In recent years, Member States have taken the initiative to team up in groups to work together in order to facilitate access to medicines. The Valletta Declaration Group set up during the Maltese Presidency, which includes Malta, Italy, Spain, Portugal, Cyprus, Greece, Croatia, Ireland, Romania and Slovenia is the largest group in the field, with a population coverage of more than 160 million. This demonstrates that there is a will and a need for greater cooperation by all Member States irrespective of the size.

The COVID-19 crisis is all but over, yet we already have a long list of lessons learnt, in the field of health and in other areas. The Commission already came up with proposals for legislative acts to upgrade the current EU infrastructure which proved not to be fit for purpose during a crisis situation. These proposals include the strengthening of the health security framework, and providing more extensive powers to the European Medicines Agency and the European Centre for Disease Control. A proposal to set up a Health Emergency Preparedness and Response Authority’ (HERA) is also in the pipeline.

Momentum is also building to strengthen the health dimension of the European Union. Malta has been strongly advocating a revamp of the pharmaceutical regulatory framework to ensure better access to medicines. As things currently stand, it is up to the industry to decide on whether to place a pharmaceutical product on the market of a Member States and this decision is usually based on commercial viability and ultimately, on the resulting profits.

Hence, small countries like Malta find it difficult to have medical products placed on the Maltese market, and this explains our reliance on the UK market over the years. Malta is pushing for a more patient oriented approach, where the public health dimension of the pharmaceutical product is given substantial weight to ensure that patients in all member states have equal access to pharmaceutical products.

Malta has been a strong advocate of joint procurement and price transparency. These are amongst the main goals laid down in the Valletta Declaration. The joint procurement of COVID vaccines has confirmed the added value achieved when Member States team up to procure medicines. The European Union secured many large contracts, at comparatively low prices and with the best conditions. Contract clauses through which liability remained under the responsibility of the companies, appear to have been included only within the contracts secured by the European Union. Malta is pushing to build on this success story and to utilise a similar Joint procurement mechanism for the procurement of other medicines, which Member States are facing difficulties in securing at competitive pricing. Joint procurement also ensures price transparency and averts competition among the Member States.

“The joint procurement of COVID vaccines has confirmed the added value achieved when Member States team up to procure medicines.”

European Hospitals?

The time has now come for EU Member States to pool together on the provision of treatment. The EU has set up the European Reference Network (ERN) which is a useful tool to disseminate expertise among health professionals in order to diagnose and treat rare diseases. It’s time to build on ERNs and to set up European Hospitals, set up and co-managed by Member States and the European Commission. The European Scholl governance model could be a reference in this regard.

These hospitals, which should be set up in an easily accessible location in the EU for all Member States, should provide specialised treatment to EU citizens. The pooling of resources by Member States to set appropriate infrastructure and to have the required number of patients to ensure the maximisation of investment, is the path to be considered. This joint effort could lead to the creation of global centres of excellence which the potential to attract the best medical experts.

These European Hospitals should be designed for cross-border treatment, thus providing accommodation and infrastructure for pre and post treatment procedures. Apart from the added value to cross-border treatment, they can also serve as bases for training programme for European Health Professionals who need continuous upskilling to keep up with technological and scientific progress.

With its decades of experience in cross-border treatment, Malta could prove to be the EU’s most valuable asset in the development of these European Hospitals!