On 1 December the new President of the European Commission, Ursula von der Leyen, and her team of 26 Commissioners, began their term in office. The approval process was lengthy, with three proposed Commissioners rejected by the European Parliament and the United Kingdom refusing to nominate a candidate, but the 2019-2024 leadership of the European Union’s executive branch is finally in place.
Among them is Stella Kyriakides, the new Commissioner for Health and Food Safety, who will work with the health directorate (DG SANTE) to deliver on the EU’s health priorities. The last five years have been troubling for those who support strong EU action on health and Commissioner Kyriakides’ term will be an important one in defining the Commission’s future direction of travel. Health did not feature prominently on the agenda of the previous President, Jean-Claude Juncker, and though progress was made in some areas – the European Reference Networks for rare diseases, and the legislative proposal on Health Technology Assessment, for instance – it has been accompanied by persistent concern about the future of the EU’s role.
In March 2017, the Commission published a White Paper on the future of Europe which envisaged, under one scenario, a scale-back of EU action on health, as a policy area with ‘limited added value’. Later that year, rumours began to circulate that DG SANTE might be disbanded and its responsibilities redistributed amongst other directorates. Thus, whilst the appointment of Commissioner Kyriakides and the continuance of DG SANTE come as relief, the task ahead of them is considerable. Based on the priorities and actions that have been identified so far, what then might we expect of the EU’s health policy over the next five years?
What’s new? The 2019-2024 health agenda
In terms of priorities, we see a considerably more substantive ‘mission’ for the new Health Commissioner. In 2014, then-Health Commissioner Vytenis Andriukaitis received instructions to focus on five issues: crisis preparedness, genetically modified organisms (GMOs), pharmaceuticals, health system performance assessment and the EU’s response to Ebola. Moreover, on the latter three the Commissioner was required to work together with or in support of other Commissioners and policy portfolios. Though both Commissioner Andriukaitis and DG SANTE worked hard to make the most of this limited portfolio – the State of Health in the EU initiative being a good illustration of this effort – the mandate left little space for entrepreneurial health policy development.
By comparison, the mission letter sent to Commissioner Kyriakides by President von der Leyen presents a long and substantive set of priorities. It lists twelve in total; six on food safety and animal and plant health, and six on ‘protecting and promoting public health’. Gone are the references to the ‘limited’ health tasks given to the EU under the treaties and the need to ‘respect[…] the rules on subsidiarity and proportionality’ which filled the preamble of the 2014 letter. In their place is a statement of the need to ‘support the health sector and the professionals working within it, to invest in new technologies, to promote healthy lifestyles and to cooperate better within the EU’.
Top of the list of health priorities is the access to (affordable) medicines issue and the implementation of the new regulatory framework for medical devices – two key areas of pharmaceutical / health technology policy which are now firmly returned to the health portfolio (on which, more detail below). The Health Commissioner is also tasked with the creation of a European Health Data Space as part of an agenda to expand the use of eHealth, and with addressing three key public health challenges: antimicrobial resistance, vaccine scepticism and the fight against cancer. Furthermore, within the six priorities on food safety and animal and plant health, the Commission commits to launching a ‘Farm to Fork’ strategy for sustainable food, to improving consumer information on the health and sustainability of food products and to helping to protect against exposure to endocrine-disruptors.
At the technical level, the formal responsibilities of DG SANTE are mostly unchanged, with one exception. Responsibility for pharmaceuticals and medical devices will return to DG SANTE, five years after a decision by the Juncker Commission moved them to DG GROW (the directorate for the industry, enterprise and the internal market).
From words to action – a reinvigorated EU health policy?
Early signs from the Health Commissioner’s first two weeks in office are mixed. She opened her term by announcing that the Europe’s Beating Cancer Plan will be launched on World Cancer Day (4 February 2020). Speaking in the European Parliament, the Commissioner gave an early indication of what the Plan might focus on, specifying a horizontal approach which addresses key determinants, such as tobacco consumption, alcohol abuse, physical exercise and healthy diets, as part of a prevention-focused strategy.
Action on other priorities looks less promising. Despite a clear mandate to act on the use of pesticides and their impact upon human, animal and plant health, the Commissioner was criticised for poor responses on this issue in her pre-appointment hearing in Parliament. Moreover, it emerged last week that hard targets to reduce pesticide use were removed from the Commission’s flagship European Green Deal, raising questions about the Commission’s commitment.
More broadly, for those concerned about the decline in EU action on core areas of public health and health promotion – tobacco control, alcohol consumption, obesity, air pollution, chronic and non-communicable diseases (NCDs) – the strength of the new agenda has yet to be tested. President von der Leyen, herself a physician, has tasked the College as a whole (meaning all 26 thematic Commissioners) with the delivery of the United Nations’ Sustainable Development Goals (SDGs) and Commissioner Kyriakides with delivery of Goal 3 on health and well-being. Supporting Member States in reaching the targets on NCDs and universal health coverage is a formidable challenge and one which will require coordinated and coherent decision-making.
Particular attention should be paid, for instance, to the Tobacco Products Directive, which is scheduled for revision in 2021, the interpretation of rules on the advertising of e-cigarettes, and the potential revival of the Parliament intergroup on Wine, Spirits and Quality Foodstuffs, all within a broader climate in which the value of multi-stakeholder processes are balanced with concerns about corporate influence in Europe.
A new year, a new Commission, a renewed commitment to health?
The EU stepped back, somewhat, from its public health role under the Juncker Presidency and the more substantive priorities of the new Commission are understandably welcomed by the health advocates and civil society organisations. One of the leading EU political news organisations surmised this week that ‘There’s never been a stronger mandate for health in Brussels’, capturing the sense of optimism in the health community, and there are indeed promising signs.
Among them, the return of cancer to the top of the agenda has particular significance. A long-standing feature of EU health policy, action on cancer has traditionally been used to provide a ‘social face’ of European integration and a counterbalance to economic narratives (such as those which have dominated the post-crisis Juncker Presidency) that have less support with European citizens. Might this signal a more social policy-focused Commission?
The formal mandate of the EU in health remains unchanged but we know from the history of EU health policy that, if there is renewed political will, and if the existing treaty base can once again be utilised by DG SANTE and the Health Commissioner to expand the EU’s role in health, 2019-2024 could see the revival of health as a European priority.
Photo: Official group portrait of the von der Leyen Commission. Source: EC Audiovisual Service.
