30 September 2016

Cambre Gastein Diary – Day One

The European Health Forum Gastein (EHFG) brings together over 600 leading experts to Gastein Valley in Austria every year. The unparalleled mix of delegates including country and EU-level representatives from the areas of health policy, science, business and industry and patient organisations has developed the forum into an indispensable institution in the area of European health policy.

Cambre associates’ Senior Adviser for Health & Wellbeing practice, Ben Duncan, is at the European Health Forum Gastein. Ben will be bring you daily updates on most important debates from the forum in our very first Cambre Gastein Diary.

Ben Duncan
Senior Adviser

Gastein Day One – Overview

  • Business and industry representatives make up only 10% of delegates at Gastein this year.
  • Globalisation is causing the rise of discontent with the European Union.
  • Health systems need to be protected from unsustainable spending.
  • Health policy experts threatened by Brexit and the rise of populism.
  • Health official says 56% percent of new medicines licensed in recent years have no added benefit for patients
  • Academics, activists and pharma take their disagreement on pharmaceutical innovation online

Gastein in numbers

Day one of the European Health Forum Gastein and what have we learned? In the opening plenary session we learned, via interactive voting on people’s Smart phones, that 35% of delegates come from “Government & administration”, 28% come from “Science and academia”, 16% “civil society” and only 10% from “Business & industry”, that the type of people who come to Gastein are more accepting of ethnic diversity and less worried about globalisation than the average European, and they reckon that “insufficient knowledge about the EU’s actual role and real impact” is the main reason that the EU has become increasingly unpopular with European citizens.

What is the root cause of discontent with the EU?

Nick Fahy, a former DG SANCO official turned Oxford University academic (and freelance health expert) took a different view. Nick gave what was termed an “input speech” at the start of the opening plenary. This was basically a short (12 minutes), punchy, opinion piece designed to provoke some debate among the assembled panel of luminaries and eminences – WHO Regional Director for Europe Zsuzsanna Jakab, Deputy Director-General of DG SANTE Martin Seychell and Austrian Chief Medical Officer Pamela Rendi-Wagner.

His thesis was that Britain voted to leave the EU because too many citizens felt left behind by globalisation. Unskilled and semi-skilled workers felt left behind because they have borne the costs of globalisation, in terms of lost jobs and falling or stagnant wages, but seen none of the benefits. This is the same reason that citizens in France and the Netherlands voted against the EU when they had referendums on the proposed EU Constitution.

Over the past decade or so the EU has focused too much on the market and not enough on social protection. The standard defence of the Commission and EU Institutions that social protection is the responsibility of Member States is not credible: it is an excuse for inaction and lack of leadership. Furthermore, blaming poor communication or a hostile media is not credible either. It is an excuse for not acknowledging there is a problem and that the EU has to change.
Sustainable healthcare: doing more with less

In the panel discussion that followed Zsuzsanna Jakab of WHO agreed with most of Nick Fahy’s analysis, though without linking the “loss of trust” in Europe with Brexit. She said “We need to regain the trust of European citizens. And in order to do that we need to address the problems that are of most concern to them. First of all, unemployment and youth unemployment. Secondly, the economic and social inequalities that starve the European society”.

Unsurprisingly perhaps, Martin Seychell of the Commission did not buy into Nick Fahy’s analysis. “Austerity is not a European Commission policy. It is the result of unsustainable spending. What we need to protect health systems from is unsustainable spending” he said. The Commission’s prescription for Europe’s health systems is to use new technologies such as eHealth to “do more with less” and to invest more in disease prevention programmes.

The “spend more” versus “spend better” debate in health policy is an old one. What was new and striking about the opening plenary was the extent to which the assembled health policy experts felt threatened by Brexit and the rise of “populism”. The sentiment was nicely summed up by the Forum’s President, Professor Helmut Brand, in his opening speech: “Post-truth politics threatens our core values. All these years we have been arguing for evidence based policies. Now, however, people can just make things up and not be held to account for it. Experts are ignored and mistrusted.”
Academics and pharma fight over healthy innovation

If health policy academics and activists feel ignored and mistrusted perhaps this will give them insight into how representatives of “Big Pharma” felt during certain parts of the conference. A session on Healthy Innovation in the afternoon of Day 1 featured speakers from Health Technology Assessment (HTA) bodies and civil society groups like the Open Society Foundations that campaign on access to medicines issues. Beate Wieseler of the German HTA body IQWiG presented an analysis that claimed that 56% of new drugs licenced in recent years produced no added benefit for patients.

This sparked the conference’s first, and so far only, Twitter storm on the hashtag #healthyinnovation. Academics and activists Tweeted en masse that the current system of pharmaceutical innovation is broken, while industry representatives Tweeted back in the opposite direction. Day 2 of the Forum will be attended by Nobel Prize winning economist Paul Krugman so maybe he will be able to settle the debate.