Healthcare in times of austerity: Boosting cost-effective prevention

Transcription

1 Healthcare in times of austerity: Boosting cost-effective prevention Spring 2013 In association with Media partner

2 2 Friends of Europe Life Quality Europe

3 Healthcare in times of austerity: Boosting cost-effective prevention Report of the 'Café Crossfire' debate co-organised by Friends of Europe and Debating Europe in association with Vaccines Europe with media partner Europe s World Spring 2013 Brussels

4 This report reflects the conference rapporteur s understanding of the views expressed by participants. Moreover, these views are not necessarily those of the organisations that participants represent, nor of Friends of Europe, its Board of Trustees, members or partners. Reproduction in whole or in part is permitted, providing that full credit is given to Friends of Europe, and provided that any such reproduction, whether in whole or in part, is not sold unless incorporated in other works. Rapporteur: Lorne Cook Publisher: Geert Cami Project Director: Nathalie Furrer Project Manager: Danuta Slusarska Project Assistant: Louise Smyth Photographer: Ilaria Dozio Design & Layout: Heini Järvinen

5 Table of contents The high price of misguided health care cuts 5 Influenza vaccination targets - A bridge too far 6 Weighing the benefits 7 Challenges to overcome 8 Do what I say, not what I do 9 Business is dying 11 Annex I Programme 12

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7 Healthcare in times of austerity: Boosting cost-effective prevention Spring The high price of misguided health care cuts Disease prevention is far better than any cure and the cost savings are just the tonic EU budgets need in times of crisis. Influenza immunisation is a prime example, yet some European governments are regressing rather than progressing toward EU vaccination benchmarks, in an ill-advised reallocation of funds meant to counter the economic crisis. "Investing in prevention is definitely a win-win situation not only in ensuring longterm savings, but also in improving population health sustainably", said John F. Ryan, Acting Director for Public Health at the European Commission Directorate General for Health and Consumers. However, only 3% of the national health budgets is devoted to prevention per se and 97% to healthcare. Investing in prevention is definitely a win-win situation not only in ensuring long-term savings, but also in improving population health sustainably. However, only 3% of the national health budgets is devoted to prevention. John F. Ryan, Acting Director for Public Health at the European Commission Directorate General for Health and Consumers "As Europe struggles to shake free of economic crisis, this is a bit of a no-brainer given the costs of having people regularly off sick every winter", Giles Merritt, Secretary General of Friends of Europe told participants at the 'Cafe Crossfire' debate: 'Healthcare in Times of Austerity: Boosting Cost-effective Prevention'.

8 6 Friends of Europe Life Quality Europe Influenza vaccination targets - a bridge too far? Seasonal influenza is an infectious and communicable disease that hits around one in every 10 Europeans each year. The consequences can be felt in hospitals, but also in the work place due to absenteeism, not to mention schools, where the impact on a child's education can be considerable. In an effort to combat the problem, EU member states, via a Council recommendation, have set a benchmark of a 75 percent vaccination rate, targeting in particular vulnerable groups like the elderly, the chronically ill and very young children. But this goal, set in 2009, has only been achieved by the Netherlands, while many countries are struggling, and still others see it slip ever-further out of their grasp. The European Commission is preparing to publish its first interim report on how procedures for reaching the target are being implemented and things are not going well. As Europe struggles to shake free of economic crisis, this is a bit of a no-brainer given the costs of having people regularly off sick every winter. Giles Merritt, Secretary General of Friends of Europe "I can confirm that the news is not good, in the sense that we are actually going backwards rather than forwards", said Ryan. He noted that the target is not an EU regulation, so no one can be taken to court, but he expressed hope that the failure would cause embarrassment, including through debate in the European Parliament, and lead to 'peer pressure' which could help bring about change. "I guess the ministers whose countries have gone backwards in these tables will want to know why", he said. The EU region is the only part of the world in which flu vaccinations have gone down over the past few years added Mike Watson, Member of the Vaccines Europe Board and Vice President for Global Immunisation Policy at Sanofi Pasteur.

9 Healthcare in times of austerity: Boosting cost-effective prevention Spring Weighing the benefits Yet the benefits of prevention, particularly in the case of the flu, could not be clearer. According to figures published by the World Health Organisation (WHO), seasonal influenza can cost 6 million euro per 100,000 residents each year in countries like France and Germany. Mike Watson said that "at the moment, vaccinations help avoid flu deaths each year and a further fewer deaths would occur if the target was reached. If vaccination rates went up to 75 percent 1.7 million more cases of flu could be prevented. In addition, achieving this target would reduce the number of visits to GPs by approximately 770,000 annually. We're missing out on huge amounts of benefits", he said, noting that the 27 EU nations as a whole are around two-thirds of the way to the target. If vaccination rates went up to 75 percent 1.7 million more cases of flu could be prevented. Mike Watson, Member of the Vaccines Europe Board and Vice President for Global Immunisation Policy at Sanofi Pasteur Roberto Bertollini, Chief Scientist and WHO Representative to the EU, warned nations against the misconception that success is only something that would come in the long run. "It's not true that prevention is something that only produces results in decades. Prevention produces returns in a few years. This has been shown", he told participants in a video message. "Prevention is really the only way if you want to the health system to become sustainable in a reasonable time".

10 8 Friends of Europe Life Quality Europe Challenges to overcome So how do you change things? Watson said that like all prevention methods, immunisation faces a particular challenge. "The benefits are invisible. Whilst we all know that we should eat less and exercise more, we don't all manage to do it all of the time. There's a big gap between the recommendation and the implementation", he said. The panelists largely agreed that a more coherent publicity programme is needed, given the benefits from an injection that costs about the price of a cup of coffee. Currently only three percent of total health budgets in the European Union is spent on disease prevention. Karin Kadenbach, a Member of the European Parliament Committee on the Environment, Public Health and Food Safety, said that governments routinely respond to economic problems and the need for austerity by cutting funds aimed at preventing diseases, but that this is misguided. "Most money is spent on cures, on dealing with diseases, and lots of this money could be spent more wisely", she said. "Immunisation is probably one of the most successful interventions in our system and really doesn't cost that much money." She also said that the very success of vaccinations in preventing illnesses might be their enemy, because people struggle to see the need for them when there are few outbreaks of disease. As they stop vaccinating themselves, the disease can return, as in the recent outbreak of measles. "So one of our most important tasks is to show that only with community immunisation programmes will we really be safe from these diseases" she said. Kadenbach said that a lot of information about immunisation is publicly available, particularly over the Internet, but that much of it is unreliable. She and other participants blamed the media, including social media, in part for the problem. They said it was important for people, and particularly the elderly, to have access to information that they can trust and which is based on reliable data and facts. Participants also raised the issue of employers, and wondered why companies aren't doing more to promote immunisation, given losses in growth and productivity

11 Healthcare in times of austerity: Boosting cost-effective prevention Spring as a result of the amount of time off that workers are taking due to illness. Ryan, from the Commission, highlighted what he felt was a huge communications gap. "What strikes me as strange is that for over a year now I have been receiving representatives of the alcohol industry and the big food companies three or four times a week in my office. I receive the vaccine producers or vaccine advocates, maybe twice a year. This shows the relative weight of pressure on my time from these different interest groups", he said. Most money is spent on cures, on dealing with diseases, and lots of this money could be spent more wisely. Immunisation is probably one of the most successful interventions in our system and really doesn't cost that much money. Karin Kadenbach, a Member of the European Parliament Committee on the Environment, Public Health and Food Safety Beyond that, Marc Van Ranst, Chairman at the Department of Microbiology and Immunology at the University of Leuven and Head of the Diagnostic Virology Laboratory, University Hospitals Leuven, also called for more investment, to produce better vaccines, and to help overcome the image problems that programmes have suffered from in the past, notably the plan to combat H1N1, commonly known as swine flu, in 2009, which resulted in vaccine shortages and high prices. While acknowledging that this would cost a lot of money, he called for a discussion about public-private partnerships to take up the challenge. "If you make better vaccines and you show beyond a shadow of a doubt that they work, and they work very well, then I think we should be willing to pay a little more for that", he said. Do what I say, not what I do Doctors and hospital staff are in the front-line of the information campaign. But while many doctors recommend that their patients get immunised against the flu, relatively few medical workers are getting vaccinated themselves. Physicians and

12 10 Friends of Europe Life Quality Europe their medical organisations have a responsibility to be advocates for vaccination and promote it", said Birgit Beger, Secretary General of the Standing Committee of European Doctors. "We should also do our homework ourselves, to ensure that physicians are vaccinated when they move through the health care system". For Van Ranst it is a question of leadership. He said that 70 percent of general practitioners in the Flemish speaking part of Belgium vaccinate themselves for flu, but that in hospitals, among nurses and doctors, the figure is closer to 25 percent. "We are lacking leadership. The CEO at the hospital, the head of the department; if they have themselves vaccinated visibly, on the Intranet, then it works. If they don't then these campaigns fail". Yet even under those circumstances, van Ranst said, the figure rarely rises above 50 percent. "It is concerning that so few healthcare workers understand the importance, by advocating to patients and forgetting themselves", added Marc Sprenger, Director of the European Centre for Disease Prevention and Control (ECDC), in a video message. If you make better vaccines and you show beyond a shadow of a doubt that they work, and they work very well, then I think we should be willing to pay a little more for that. Marc Van Ranst, Chairman at the Department of Microbiology and Immunology at the University of Leuven and Head of the Diagnostic Virology Laboratory, University Hospitals Leuven Van Ranst cited the United States as an example of how the problem can be fixed. "They've solved that. It's mandatory. If you want to work in my hospital, then you have to be vaccinated. If you don't like that then in some of the more friendly hospitals you have to wear a mask during the 10 weeks that influenza is around. You can guarantee that one year later, more people are vaccinated, because wearing a mask is not really a lot of fun".

13 Healthcare in times of austerity: Boosting cost-effective prevention Spring Business is dying Ultimately the danger is that the industry might stop making vaccines altogether and that diseases which are slowly disappearing might resurface and cause major health problems before any immunisation programme can get underway again. "Global production capacity is starting to outstrip demand. Market economics dictate that at a certain point people are going to say: 'we can't make money anymore'", said Watson. "If we find ourselves in five or ten years' time with not enough vaccine, that will be too late. They're not factories that you put a big white sheet over and go off and make something for a while, then come back 10 years later and pull the sheet off and get on with it. Once that competence has gone, and that capacity has gone, it's gone forever", he warned. Birgit Beger, Secretary General of the Standing Committee of European Doctors

14 12 Friends of Europe Life Quality Europe Annex I Programme Welcome and registration of participants Café Crossfire Lunch Debate Healthcare systems across Europe are among the best in the world but expenditure is mainly allocated to diagnosis and treatment, with cost-effective prevention accounting for less than 3% of healthcare budgets. As a result, influenza, one of the most known preventable diseases, afflicts approximately 1 in 10 Europeans annually and still claims more lives than traffic accidents. It also results in a considerable economic burden in terms of healthcare costs, lost days of work or education and general social disruption that, according to the World Health Organization, can reach US$ 6 million per inhabitants annually in countries like Germany or France. What are the public health and economic benefits of an influenza vaccination and what can be done to raise public awareness of these? Seasonal influenza vaccination coverage rates remain limited in many countries across Europe, with a widening gap between western and eastern Europe, jeopardising the achievement of the Council s recommended target of 75% vaccination coverage amongst atrisk groups by the winter of 2014/2015. What barriers still exist to the successful implementation of influenza immunisation programmes? More generally, how can Europe s healthcare spending model be re-shaped to boost prevention and reduce the social and economic costs of diseases? How can the various stakeholders from politics, industry and civil society work together to address these challenges and what role should the EU play in this area? Speakers: Karin Kadenbach MEP John F. Ryan Marc Van Ranst Mike Watson Additional video contributions by: Member of the European Parliament Committee on the Environment, Public Health and Food Safety acting Director for Public Health at the European commission Directorate General for Health and consumers Chairman at the Department of Microbiology and immunology at the University of Leuven and Head of the Diagnostic Virology Laboratory, University Hospitals Leuven Member of the Vaccines Europe Board and Vice president Global Immunisation Policy at Sanofi Pasteur Marc Sprenger Director of the European Centre for Disease prevention and Control (ECDC) Roberto Bertollini chief Scientist and WHO Representative to the EU Moderated by Giles Merritt, Secretary General of Friends of Europe End of debate and coffee

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