Health systems are in crisis following two years lived under the weight of the pandemic. With summer approaching, tensions are rising once again as health professionals fear that demand will overwhelm capacity, and they will not be able to care for all patients.
In most EU countries, health spending has declined since 2019, according to the Organisation for Economic Co-operation and Development (OECD).
For instance, figures show that, before the pandemic, France spent 12.4% of its gross domestic product (GDP) on health care, compared with 11.1% in 2020. Likewise, health spending in Italy decreased by roughly 1% of GDP between 2019 and 2020.
The number of available beds in hospitals is also falling. In Germany in the 2000s, there were 8.2 beds per 1,000 inhabitants, compared to 7.9 today, again according to the OECD.
The Spanish ministry of health has recently sounded a similar alarm: as of December 31, 706,740 patients were on the waiting list for surgery and 140,000 people are waiting more than six months for often life-saving operations.
What role for EU budgetary rules?
According to Pascal Garel, Chief executive, European Hospital and Healthcare Federation (HOPE), the impact of EU budgetary rules on health investments is not a straight line.
“There is a lack of information on each country. There is still too much diversity to make generalisations,” he warned in an interview with EURACTIV.
Isabelle Marchais, a researcher associated with the Jacques Delors Institute in health policy, confirmed: “The picture of the hospital is not the same everywhere and varies according to the criteria used. But the situation of health systems is better overall in the northern countries.”
For example, Denmark recently added two points of its GDP to long-term care to promote the autonomy of the elderly.
Another criterion that differs from one country to another is the remaining cost for patients. France has the lowest out-of-pocket expenses and has even decreased in recent years from 9% to 7%. But in Latvia, it still amounts to 42%.
On the other hand, certain EU budgetary policies can have an influence on public health spending in member states.
“Member states agreed to look at their public spending in the wake of the 2007-2008 crisis, including spending on social protection and the health system. The EU insisted on ‘avoiding public debt’ and ‘saving on health care spending’,” HOPE’s Garel explained.
Some countries, such as Latvia and Greece, have followed these guidelines. “But once again, there is no European homogeneity, since Germany, on the other hand, has continued to spend money on health care,” he added.
Healthcare professionals’ shortages
There is, however, one common denominator that European hospitals have had to face: the lack of health professionals. This ‘general phenomenon’ existed well before the COVID-19 crisis, according to Delors Institute’s Marchais.
Already pressed by low pay, working overtime, lack of labour recognition, the pandemic has exhausted healthcare workers and further deteriorated their quality of life.
“With COVID-19, the phenomenon has increased, but the human resources problem was already there. People are leaving, young people are losing interest in health studies, you see it everywhere. There is a recruitment and retention problem,” said Garel.
“This pandemic has accentuated the crisis in hospitals. It has served as an eye-opener in all European countries,” echoed Marchais.
Summer is coming
However, the COVID crisis has brought conversations on public health back to the forefront, particularly in the framework of the recently launched EU4Health program, added Marchais, saying that “this should help improve access to health care, put more emphasis on caregivers, and reflect on the revaluation of the profession.”
Indeed, the new EU4Health programme plans to invest €5.3 billion euros to support the national health policies of the member states until 2027.
In addition, a ‘European hospital label’ will be created on a voluntary basis. The project was first discussed on January 18 during a meeting between EU health Commissioner Stella Kyriakides and the 27 member states.
A week later, the former French health minister, Olivier Véran, gave his support to the project during the French presidency of the EU Council.
But with summer approaching and staffing shortages, tensions are rising in European hospitals, which will have to try to cope with a greater influx of patients, as they do every summer and winter holiday.
Some countries have deployed emergency plans, such as France, which plans a “damage control” mission to “stop the bleeding,” according to François Braun, appointed by Emmanuel Macron to manage the hospital crisis.
But Braun acknowledged himself on Tuesday (June 7) in front of the Senate that “we won’t get the caregivers back in three months,” – further proof that this is a complex problem that will require sweeping changes.
By Clara Bauer-Babef
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The push for a TRIPS waiver agreement next week
More than 20 months have passed since India and South Africa jointly proposed a waiver in October 2020 from certain parts of the World Trade Organisation’s (WTO) agreement on Trade-Related Aspects of Intellectual Property Rights – also known as the TRIPS Agreement – in order to make it easier for low-income countries to look past intellectual property (IP) rights in the context of the COVID-19 pandemic and start producing vaccines.
As has been reported, the current document negotiated by the Quad – India, South Africa, the US, and the EU – on the table is nowhere near as ambitious as the original proposal and excludes COVID-19 treatments and diagnostics to fight the virus.
Since the Quad document was made public, lots of work has been going on in the WTO to reach a final agreement amongst all WTO members at the WTO’s 12th Ministerial Conference taking place next week on 12-15 June.
It is the WTO itself in particular, who wants this agreement to happen now as they are facing accusations of not being fit for purpose. On Tuesday (7 June), WTO Director-General Ngozi Okonjo-Iweala called on all members to deliver results on the TRIPS waiver issue, alongside the other topics on the agenda.
“While the negotiations have been difficult, I strongly believe that we have a real chance to deliver. We should seize the current opportunity while a credible response remains relevant,” Okonjo-Iweala said in a WTO press release.
“I’m feeling cautiously optimistic now that we will get this text ready for adoption by ministers in time for the coming weekend,” added the TRIPS Council chair, Ambassador Lansana Gberie of Sierra Leone.
The prospect of an agreement taking form is unsure. This current document is only endorsed by the EU, and the other Quad members did not take any ownership, leaving the text orphaned.
Many others are much less optimistic, with organisations continuing to urge governments to reject it as it currently looks.
Pharmaceutical companies are not happy either, but for different reasons of course. Voices from this camp argue that the focus should be on building capacity in developing countries instead.
A TRIPS waiver could help some problems, but it cannot solve everything, as lawyer Ellen ‘t Hoen told EURACTIV. She emphasised that you also “need know-how and technology transfer” which a waiver cannot guarantee because the ones who have the know-how must collaborate.
So far the will to collaborate has not been overwhelming. Even within the TRIPS Agreement’s existing flexibilities for compulsory licences for export, there has been a lack of political will as experienced by Bolivia back in May 2021 when the Canadian government failed to take action.
That leads to a question we have not discussed much, which is what governments and companies would do with a TRIPS waiver, regardless of what it looks like in the end.
According to Antony Taubman, director of the Intellectual Property Division at the WTO Secretariat, this is key as IP laws only exist within countries, that must collaborate to make a potential deal have a real-world impact.
Stay tuned for an update following the WTO Ministerial Conference to give you the ins and outs of the final conclusions.
Advance Purchase agreements. A coalition of 10 EU countries has asked for an amendment to the advance purchase agreements (APA) made with COVID-19 vaccine manufacturers, as vaccine quantities exceed countries’ needs.
Pharmaceutical strategy. The revision of the pharmaceutical strategy should include action to ensure equality in access to medicines, so there is no need to rely on voluntary industry initiatives to tackle the issue, Ancel·la Santos Quintano from the European Consumer Organisation (BEUC) told EURACTIV.
Cannabidiol oil (CBD) as novel food. Cannabidiol oil (CBD) as novel food has been put on hold by the EU’s food safety agency (EFSA) as more data on the effect of this lighter chemical compound extracted from hemp plants on human health is needed. According to Ana Afonso, EFSA head of nutrition and food innovation, “stopping the clock on a novel food assessment is not unusual when information is missing.”
Ombudsman. The European Ombudsman, Emily O’Reilly, has confirmed her finding of maladministration in a case where the European Commission refused public access to documents about 1.5 million faulty medical masks.
Legionella. Surveillance of Legionella in tourist facilities of a major European holiday destination found the pneumonia-causing bacteria present in over half of the evaluated areas.
Ukraine. As of Friday (3 June), 500 patients have been transferred from Ukraine, Moldova, and bordering EU member states to hospitals around Europe so they can receive continued treatment or urgent medical help, the European Commission has announced.
Obesity. The obesity rate in the EU could reach a critical point that will be difficult to manage if actions promoting health education are not taken now, according to Romanian lawmaker Tudor Ciuhodaru.
COVID-19 medicines. The EU’s medicines agency (EMA) adopted the first list of critical medicines for the COVID-19 public health emergency on Tuesday (7 June). The published list contains all the approved vaccines and therapeutics in the EU to prevent or treat COVID-19.
Marketing authorisation holders (MAHs) of medicines included in the list are required to regularly update EMA with relevant information, including data on potential or actual shortages and available stocks, and forecasts of supply and demand. In addition, member states will provide regular reports on the estimated demand for critical medicines at the national level.
French left-wing alliance on health. As French President Emmanuel Macron recently promised to overhaul the functioning of hospitals, EURACTIV France takes a closer look at what the new left-wing alliance formed by Jean-Luc Mélenchon is proposing for the ailing health sector.
Finland preparing for new South African COVID variant. Finland is boosting its COVID-19 vaccination campaign in preparation for the new COVID-19 BA.5 variant first detected in South Africa in January which has now hit the country. By Pekka Vanttinen | EURACTIV.com
Portugal restricts indoor smoking as of 2023. Smoking indoors will only be allowed in places such as restaurants, bars, and nightclubs from January next year if they have an area equal to or greater than 100 square metres and a minimum ceiling height of three metres, according to a new decree published on Thursday. By Helena Neves | Lusa.pt
Dutch ministry shuns German help for hospitals struggling post-COVID. The Dutch health ministry is sceptical of the German offer to relieve the long waiting lists for hospital care which have been exacerbated due to the COVID-19 pandemic, although some 300 German hospitals could receive Dutch patients, NL Times reported. By Sofia Stuart Leeson | EURACTIV.com
Albania second-worst regionally for COVID and inflation support. The Albanian government provided the second-lowest amount of COVID-19 support to the needy in the region, according to the World Bank. By Alice Taylor | exit.al
Emergency services. French President Emmanuel Macron, together with his new Health Minister, Brigitte Bourguignon, has proposed changing the way emergency services in hospitals are run, one of the sore points of the country’s health system, and called for a stakeholder conference on health. EURACTIV France reports.
6-9 June | European Parliament’s plenary in Strasbourg
7-9 June | World Congress on Rare Skin Disease
7-9 June | WHO talks on food safety
14 June | Public health in the EU: 30 years since the Maastricht Treaty, conference organised by the EPC
14 June | World Blood Donor Day
[Edited by Nathalie Weatherald]