Covid-19 highlighted both the need for a unified EU approach to healthcare and Brussels’ ability to intervene meaningfully despite its lack of formal powers in this space. The European Commission united member states in joint procurement for vaccines and common spending was increased to boost the efficiency of the EU’s response systems.
Since then, however, the bloc’s focus has shifted. The EU4Health programme’s initial budget of €5.3 billion for 2021 to 2027 was cut to €4.4 billion in last year’s mid-term revision. The money has been redirected to defence spending and to support the new priority of competitiveness.
Luxemburgish MEP Tilly Metz (Greens/EFA), vice-chair of the European Parliament’s Committee on Public Health (SANT), told The Parliament in an interview that cutting back on healthcare spending was a mistake.
“There is the risk to now blindly invest in military defence. I think it's very important to consider that health is also an element of competitiveness and an element of security,” Metz said.
Adopting a One Health approach
Metz is also concerned about the decision in December 2024 to establish SANT as a separate forum for health policy, removing it from the broader Committee on Environment, Public Health and Food Safety (ENVI).
She said this risked undermining the One Health approach, a way of inserting health considerations into a wide range of policy areas. The EU has worked hard to instill the approach across its institutions.
This article is part of The Parliament's latest policy report, "Building a healthier Europe."
“How we treat our environment, how we treat animals is also linked to our health; for me I see it as a whole in a very holistic view,” said Metz. “I think it's even more important than ever to have voices defending that [the One Health approach] in SANT.”
The One Health approach remains at the centre of much of the Commission’s work – the Cross-agency One Health task force met in May — but hard work is needed to keep this holistic perspective inside the Parliament, particularly as other topics take precedence.
Another reason to take a broader perspective is that the EU’s powers on healthcare are limited, with this policy area being primarily the responsibility of member states.
But one way the EU can have a positive impact on health is through social policies, Metz said: “Health policies for me fall under the social pillar, so we need improving social policies in order to guarantee access to healthcare for everybody.”
For instance, policies to tackle air pollution passed by ENVI have had a positive impact on public health, while the ‘right to disconnect’ has improved working conditions and bolstered mental health.
In this light, Metz prefers to see healthcare as a “shared competence” with member states, something which works to cement the importance of SANT.
Working with the health industry
If the EU’s power over health policy is limited, you wouldn’t guess it from the activities of the pharmaceutical sector. Corporate Observatory Europe placed the sector fifth in last year’s ranking of EU lobbying spending, behind big tech, banking and finance, energy, and chemicals and agri-business.
Recent sector lobbying has focused on the revision of EU pharmaceutical legislation. Some efforts have brought about controversy, such as the late 2023 withdrawal of an independent report which was critical of the industry. The withdrawal followed intensive lobbying efforts aimed at influential MEPs.
Nevertheless, Metz said that working with the industry is vital, as it holds the keys to research and innovation and can contribute positively to legislative discussions. “It's good to work in a constructive way with the pharma industry, but we need transparency and clear conditions,” she said.
These conditions should also govern EU grants to the industry, according to Metz. Public money has been provided to pharmaceutical companies for research and development, particularly in the area of rare diseases.
On some occasions, companies have priced consumers out of the market on demands for exclusivity and intellectual property assurances. For Metz, this is incorrect and must change. “If we give you the money, we want accessible and affordable medicine afterwards… for patients [with] rare diseases,” she said.
Metz believes one solution is greater government resources for essential medicines in the pharmaceutical sector to ensure no shortages or unfair prices hit patients in need something which could feature in the EU’s proposed Critical Medicines Act.
“In essential medicine we should guarantee production by public authorities. We should not leave 100% of the production only to the pharma industry,” said Metz. This, she added, should be a key lesson the EU takes from the Covid-19 pandemic, during which pharmaceutical companies, including Pfizer, raised the prices of their vaccines in the EU’s supply contracts.
Another solution could be a “guaranteed fixed income at every important step you make in the R&D” as a way to provide fair financial reimbursement, Metz said.
This demand for fairness stems from Metz’s core belief that good healthcare should be available to all. “I want a stronger legal basis for health equity to ensure that every citizen in Europe has access to high quality and affordable care,” she said.
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