So far 2016 is proving to be a tumultuous time for the European region. Estimates suggest that in the first three months of the year, over 150,000 migrants reached Europe by sea and many more arrived by land. Terrorists have struck at the very heart of the European capital and fear hangs over the region like a cloud. Politically, the rise of populism in Austria, France, Germany and the UK is mirroring that of Donald Trump’s seemingly inexorable march to his party’s nomination for the US Presidency. Meanwhile, the UK will hold a referendum in June allowing its citizens to vote on whether they wish to stay within the European Union or leave. Many, if not all, of these factors will have huge impact on the health sector in Europe.
Meeting the health needs of refugees
Managing the displacement of more than one million people is perhaps placing the most apparent strain on already stretched healthcare systems. Many of the 40,000 people, which the UN estimates are seeking asylum each day, arrive in Europe with existing chronic conditions (physical and mental). More still are spending time in camps where living cheek-by-jowl offers a fertile breeding ground for communicable diseases including TB. So Europe’s healthcare providers are having to provide service both at point of entry and where the refugees finally settle. This is placing an almost intolerable burden on multiple countries across the region.
Enhancing emergency response plans
Terrorist attacks in Brussels and Paris have tested the emergency response plans of those cities like nothing before. When extremists struck at the heart of Paris with a series of coordinated attacks on November 13th, the city deployed its “White Plan” for the first time since it was first created more than 20 years ago. Paris, at least, proved to be well-prepared and able to deal with an exceptional event like this, at least from a medical perspective. Just 24 hours after the attack began, all 302 patients had been discharged from the emergency rooms and trauma units where they were first treated, and all emergency surgeries were completed. Only four of these patients died, an astonishingly low mortality rate of 1 percent. The flipside of the experience though, was that it was clear that these incidents had stretched the system as far as it could go. Should anything on a larger scale occur, there would simply not be sufficient resources to deal with it (ranging from medical professionals to blood supplies).
Preparing for Brexit
Ironically, at a time when the European union (note the small U) is working more closely than ever to find solutions to the challenges posed by an almost unceasing influx of would-be new Europeans and the dark cloud of terrorism, the European Union (big U) is in danger of breaking up. There are economic challenges, such as that posed by Greece, and political, with the looming referendum in the UK creating the possibility for the UK to leave the EU (Brexit). Clearly this would have innumerable consequences in the UK and the wider European region, but there are many clear and direct impacts on health care.
Among these, is Brexit could necessitate a complete overhaul of the current European drug approval system, which has been in place since 1995. The European Medicines Agency is located in London. British scientists are the greatest contributors within the system (leading 27 NDAs in 2014 compared to the next greatest, Germany with 15). The UK is a reference state for European drug pricing. Beyond the single-market approval process, there are other issues such as exportation of drugs, free movement of healthcare professionals and how citizens receive care when they take ill outside their home country.
Political upheaval is also likely to impact the health sector, with healthcare provision and drug pricing key topics of debate in the U.S. presidential election and widespread dissatisfaction with the “established order” in many European countries potentially heralding a time of immense change. It has never been easy to forecast what the future holds for healthcare in any part of the world, but in Europe, more so than ever before, what lies ahead of us is arguably less clear than at any time post the end of World War II. Keeping pace with the swiftly shifting tides across Europe and crafting multiple scenarios in real time are essential if we are to be able to counsel and guide our clients appropriately in these incredibly challenging times.
Carolyn Paul, global managing director, Health and European Health Chair.