Bernard Merkel: U-turn on the European Commission’s health portfolio still leaves unfinished business

bernard_merkelIt is not often that an issue about how the European Commission is organised in relation to a specific part of its work on health comes to the top of the political agenda. Yet that is exactly what has happened in the past month.

On 10 September, the president elect of the European Commission, Jean-Claude Juncker, announced his new team of commissioners and their job portfolios. Among the raft of proposals he made, one change stood out for the Brussels health community: responsibility for pharmaceuticals and medical technology would be transferred from the incoming health commissioner (Vytenis Andriukaitis, an ex-health minister of Lithuania) to the new Polish commissioner responsible for the single market, industry, and enterprise (Elżbieta Bieńkowska).

No reason was given for the proposed change, which would restore the position to what it had been until 2010. It could be seen as part of Juncker’s declared new focus on strengthening Europe’s industrial base. Less charitably, it could be viewed as an attempt to weaken the Commission’s growing regulatory role in this area.

Whatever the real reason, the proposal still came as a big surprise, not least to the directorate general for health and consumers of the European Commission (DG SANCO). This was already having to cope with the news that Juncker intended to transfer all its work on consumer affairs to the directorate general for justice. To lose pharmaceuticals and medical devices as well could greatly undermine its credibility, its technical capacity, and its role in developing the Commission’s work in healthcare and health systems in Europe.

However, it was not only some European Commission bureaucrats who were upset at the proposals. Several health ministers, most outspokenly the health minister of Belgium; a number of MEPs, particularly the socialists; and many European public health and health professional organisations also expressed strong concerns.

Of course, their issue was not about the partial dismemberment of DG SANCO. What alarmed them was the idea that, in future, policy making on pharmaceuticals and medical devices would be treated simply as industrial products, not as key components of public health systems, and that when it came to decisions about pricing, access, information, and patient safety, the interests of the manufacturers would prevail over those of patients and the general public. Did this represent a “victory for profits over public health,” as an editorial in The BMJ put it.

But this story had not yet run its course. An incoming president of the European Commission has to secure the support of the European Parliament for his new team and his plans. This gives the Parliament great power and it tends to use it. It will typically find one or two Commission nominees or policy plans that it dislikes sufficiently enough to threaten to block the whole new Commission. In this case, it demanded a number of modifications: replacing a Slovenian commissioner candidate here, changing the role of a Hungarian there, as well as putting more priority on the major issues of tackling European unemployment and promoting the sustainable development agenda. It also made a very specific demand: medical products should remain under the control of the health commissioner.

In the face of this pressure, Juncker eventually capitulated. In his statement to the European Parliament on 22 October, he confirmed that, “Responsibility for medicines and pharmaceutical products will stay with the directorate general for health because I agree with you that medicines are not goods like any other.”

In return for his various concessions, the European Parliament gave its confirmation to Juncker and his Commission by a substantial majority, and the new Commission will begin its work on 1 November.

However, in relation to medical products, there is still some unfinished business. In his statement to Parliament, Juncker added a rider saying that the two commissioners, for health and for industry, will develop policy jointly (a move that is not unprecedented, but by no means common either) on pharmaceuticals. What this means in practice remains to be seen.

Moreover, by accident or design, Juncker said nothing in his statement about medical devices and technology, and in the absence of anything explicitly being said about them, there seems to be every reason to think that they will be transferred from the health commissioner, as originally proposed.

So in all likelihood, the situation about who precisely takes the lead in policy making in this area, and what the priorities should be, will remain rather messy for some time. Let’s hope that the celebrations of some in the health community at their apparent victory do not turn out to be premature.

Bernard Merkel recently retired from the European Commission, where he played a central role in the development of the EU’s actions in health, including the public health programmes; the overall health strategy; and, more recently, the growing work on health systems. Before he joined the EU, he was a civil servant in the Department of Health for many years, including a spell as a ministerial private secretary.

Competing interests: I am receiving a pension from the European Commission and I will also be doing the odd piece of work for them.