The EU and health policy: a ‘coming of age’ moment?

Blog by David Earnshaw – Associate Vice-President, Public Policy Europe

The thirty-year rise of EU health policy

The European Union’s role in health policy has grown steadily since it became a formal ‘competence’ of the EU in 1993, with the Maastricht Treaty.

Debates and decisions in Brussels and Strasbourg are now crucial to shaping European health policy, but Europe was involved in health long before it was formally introduced in the treaties, with the EU regulating pharmaceutical products since the 1960s under the guise of industrial policy.

A ‘European Health Union’

The COVID-19 pandemic clearly demonstrated the need for a stronger European health policy framework, and in October 2020 Commission President Ursula von der Leyen (pictured) launched plans for a ‘European Health Union’. The plan has been driven forward under Health Commissioner Stella Kyriakides and is likely to be a key priority for whoever succeeds her in the Commission.

As part of that plan, the Commission established in September 2021 the Health Emergency Preparedness and Response (HERA) as a Directorate-General under the supervision of the Health Commissioner. Aiming to swiftly respond to cross-border health emergencies, HERA will likely play a key role in EU health policy in the future, equipped with the legal emergency powers to coordinate the manufacturing and procurement of critical medicines, vaccines, and other medical countermeasures, ensuring the availability of these key resources across all member states.??

A role growing in importance?

The Health Commissioner is the face of EU health policy, but the role has generally been filled by a commissioner from a smaller member state (Cyprus has provided three health commissioners, including Kyriakides - pictured).

The European Health Union may offer an opportunity for a new commissioner to ‘make a mark’ on a topic that directly affects millions of Europeans. Added to the responsibility for the new pharma legislation, the health role for 2024-29 could be an enticing prospect.

Since COVID-19, the Health Commissioner's responsibility for coordinating the EU's efforts on health preparedness has gained newfound importance and allure. At the end of last year, a Commission report emphasised the need for improved coordination among member states to guarantee the availability and accessibility of medical countermeasures. HERA and the incoming Commissioner will play pivotal roles in these ongoing discussions and initiatives.

A significant but restricted player

The new commissioner must still contend with the EU’s limited formal health policy powers, as the organisation and financing of healthcare is a national competence.

The Commission (through DG Health and Food Safety) proposes rules on patients' rights in cross-border healthcare, pharmaceuticals, medical devices (including clinical trials), health security, digital health, and organs, blood, tissues and cells. It also financially supports and oversees the work of agencies such as the European Centre for Disease Prevention and Control (ECDC) and the European Medicines Agency (EMA, which plays a key role in evaluating medicines before authorisation by the Commission).

The European Parliament - health policy emerges from the shadows?

As a co-legislator with member state governments, the European Parliament has a major say in health policy, although it has long been overshadowed by environmental policy in the Committee on the Environment, Public Health and Food Safety (ENVI).

While voting continues in ENVI, the new permanent Subcommittee on Public Health (SANT) should boost the prominence of health policy, possibly leading to formal Committee status.

Health policy in Europe: is this a moment or a movement?

Von der Leyen is set to secure a second term in office, but the direction of her second Commission will be guided by the majority she secures in the European Parliament, and a more right-leaning majority could stymie progress on a European Health Union. A change in the health portfolio is likely in any case, with Kyriakides unlikely to be renominated.

Her replacement will have the opportunity to advance the European Health Union and steer the flagship pharmaceutical policy through the institutions. The personality and drive of the nominee - and the appetite of MEPs to support them - could determine whether they seize this opportunity. It could also determine whether this is just a ‘moment’ for European health policy in the wake of the pandemic, or a movement towards a more coordinated, continent-wide approach to health.