The right to breathe: how policymakers can tackle severe asthma

Asthma impacts over 330 million people worldwide. While severe asthma makes up only 5-10 percent of cases, it is accountable for over half of asthma-related costs globally.[1] It profoundly affects patients’ lives, undermining their physical, mental and economic well-being, and increasing the risk of preventable deaths. Despite its significance, severe asthma is often overshadowed by other health priorities, leading to inadequate resource allocation and substandard care, further straining already pressured health systems.

Severe asthma outcomes, like many other chronic diseases, are deeply entangled with a wide range of environmental and socio-economic factors. Therefore, addressing it is not merely about medical intervention, but about creating and implementing comprehensive, holistic strategies.

The challenges presented by severe asthma are not beyond our capabilities. Around the globe, there is a wide range of best practices, treatments, and approaches to asthma management. Yet, the path to transformation demands a unified commitment from a broad set of stakeholders, from policymakers to medical professionals, industry, patients and beyond. While the blueprint for a future unburdened by severe asthma exists, it is up to decision-makers to realize it together.

While the blueprint for a future unburdened by severe asthma exists, it is up to decision-makers to realize it together.

And the good news is that progress is already underway. Since autumn 2022, we have collaborated as an international expert group to support the development of the Copenhagen Institute for Futures Studies’ (CIFS) Severe Asthma Index. This tool assesses how 29 OECD countries manage severe asthma across various indicators, such as national strategies, treatment access, hospitalizations, societal costs and air quality, among others.

While the Severe Asthma Index is an important stride in tackling severe asthma, the true test lies in how its insights are applied in practice. Among the many actions needed to be taken to improve severe asthma care, the most pressing concern is policy change.

We have identified three actions, derived from the work we have conducted to date, for policymakers to kickstart strengthening health systems’ approaches to and management of severe asthma:

  1. Development and implementation of national asthma plans and strategies

The Severe Asthma Index has found that less than half of the countries analyzed have a national strategy for asthma, prevention, and management. There is, therefore, a need to formulate and actively implement dedicated national asthma programs, tailored to the unique challenges of individual health systems. These programs should not only emphasize prevention, early detection and diagnosis but also adapt best practices to specific national and local contexts.

Importantly, plans should be situated in the context of long-term strategies for improving population health outcomes.

“In England, work around respiratory illness is gaining traction,” notes Sir David Behan, chair of Health Education England, NHS, and expert group member. “Part of the initiative being developed [is] to ease pressure on the emergency care pathways and hospitals.”  

All approaches should promote awareness on respiratory diseases, support personalized care plans, empower patients and improve training and opportunities for training health care professionals working in respiratory care.

2. Coordination and harmonization of policies and care guidelines

There is a patchwork of country approaches to severe asthma, illustrated by the observation that more than two-thirds of the country guidelines assessed in the Severe Asthma Index do not fully align with the Global Initiative for Asthma’s (GINA) guide for Difficult-to-treat and Severe Asthma in Adolescence And Adult Patients. Policymakers must strive to coordinate their approaches to severe asthma by harmonizing policies and guidelines for asthma care to the greatest possible extent, with the aim of reducing outcome disparities, bolstering equity and promoting health system sustainability.

In doing so, there should be an emphasis on identifying and scaling best practices, promoting cross-border collaboration, and championing holistic solutions informed by the widely-acclaimed Health in All Policies approach.

The Australian National Asthma Council’s Australian Asthma Handbook is a strong example of a best practice in this area that policymakers could draw inspiration from in acting on this point.

3. Supporting improved data collection and the development of a more robust evidence base for severe asthma

Policymakers should incentivize and ultimately mandate improved production, recording and utilization of asthma- and severe asthma-specific data, as well as identifier data such as prescription data, adherence to treatment regimes, lung function analysis and demographic and socioeconomic indicators, following a set of common standards.

Currently, despite the existence of clinical codes for severe asthma, the condition remains significantly underreported in clinical settings due in large part to inconsistent coding practices, leading to an increased probability of patients receiving inadequate care and suboptimal allocation of health system resources. The dearth of severe asthma data and barriers to accessing the few datasets that do exist render it difficult to develop a comprehensive and consistent understanding of the full impact of severe asthma.

National policymakers need to prioritize financial and logistical support for country-level asthma research. Research activities should aim to produce a solid evidence base that will offer a nuanced understanding of each country’s needs, challenges and opportunities regarding asthma care. Support for research activities granted over the long term will enable longitudinal studies so that national trends and progress can be accurately tracked.

Only 3 percent of the European Union’s budget for health [is] spent on lung health, although 13 percent of Europeans have lung disease.

“Only 3 percent of the European Union’s budget for health [is] spent on lung health, although 13 percent of Europeans have lung disease,” says Susanna Palkonen, director of the European Federation of Allergy & Airways Diseases Patients’ Associations (EFA) and expert group member.

The International Severe Asthma Registry (ISAR) initiative provides a strong basis for continued work in this area.

The path ahead requires that these actions evolve in tandem with the latest advancements in respiratory care and approaches to the management and prevention of noncommunicable diseases. This is not simply about updating and developing new policies — it’s about crafting robust and well-rounded solutions that proactively address a health challenge that is both global and local and supporting a much-needed vision for improved respiratory health outcomes.

As we look forward, we cannot just treat asthma. We must transform our approach to ensure that every patient’s right to breathe becomes a global reality.


Author(s):
Patrick Henry Gallen, senior advisor and futurist at Copenhagen Institute for Futures Studies

Bogi Eliasen, director of health at Copenhagen Institute for Futures Studies

Professor Dr. Vibeke Backer, MD, DMSci, chief respiratory physician at Department of ENT and Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark

Sir David Behan, chair Health Education England, National Health System (NHS), U.K.​

Dr. Mark Levy, board member, Global Initiative for Asthma (GINA), U.K.​

Mikaela Odemyr, chair European Lung Foundation (ELF) Patient Advisory Committee; chair Swedish Asthma and Allergy Association, Sweden

Susanna Palkonen, director, European Federation of Allergy and Airways Diseases Patients’ Associations (EFA)  

Professor Dr. Arzu Yorgancıoğlu, chair European Respiratory Society (ERS) Advocacy Council; member of Global Initiative on Asthma (GINA) Board; chair of GINA Dissemination and Implementation Committee; chair of the WHO GARD Executive Committee Turkey 


References:
[1] Al Efraij K, FitzGerald JM. Current and emerging treatments for severe asthma. J Thorac Dis 2015;7(11):E522-E525



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Speed is everything for patients: together we can bring medicines faster

Working in our industry brings huge responsibility. We deal with people’s lives, and our  medicines give people an opportunity to improve their health, often at the most overwhelming time for them. I had a strong reminder of that recently.

Last month, I met with a colleague, Heiko, who lives in Germany. His young daughter has central nervous system (CNS) neuroblastoma — a type of cancer that tends to affect children under the age of five.

Heiko and his family have been navigating the health system for months, including an overload of information in the form of complex ‘oncological-speak’, treatment guidelines and health insurance claims. They have also been dealing with constant travel to specialist centers — all while juggling the emotional burden of caring for a sick child and the daily challenges of home and work life.

He shared something that stuck in my mind the night I spoke with him, which serves as an important reminder for all of us working in health care.

“Trust must be bigger than fear.”

When their health is at stake, friends, families and colleagues put their trust in their local health care system — every part of it, including industry — in the hope of protecting the future for them and their loved ones.

As Heiko put it to me, “Speed is everything. If you gain enough speed, you gain enough time. And if you have time, you have the hope of more options that can help you.”

Faster, more equitable access to new, life-saving medicines for people living in Europe is a goal that I believe we all share. There are challenges in achieving this, but we at Roche are committed to addressing these, together with everyone involved.

It is the inequality in access to medicines that is untenable.

Teresa Graham, CEO, Roche Pharmaceuticals, and chair EFPIA’s Patient Access Committee | via EFPIA

The average time that patients in the EU wait to get access to a new medicine is around 517 days. Uptake of new technologies can be low and slow, but it is the inequality in access to medicines that is untenable. If you have cancer in Germany, you may need to wait, on average, 128 days to access a new medicine, but if you are a patient in Romania it will take you 918 days to receive the same treatment.

I am concerned that Europe’s policymakers believe this can be fixed with legislation alone. And, even if it could, families like Heiko’s do not have the luxury of waiting four to five years for the ongoing revision to the EU pharmaceutical legislation to attempt to resolve these issues.

Improving access to medicines requires solutions that are developed in partnership with everyone who has a stake in their delivery: industry, member states, health regulators, payers, patients and health care providers. With the right ambition and desire for collaboration, we can act now.

The crucial first step is for governments and policymakers to treat spending on health care and innovation as an investment in economic growth and societal advancement. Improving health care and expanding access to innovation are vital for reducing pressure on health care systems, maintaining a healthy and productive society, and driving future economic growth.

Governments and policymakers have a pivotal role in enabling and encouraging this cycle of improved health and economic benefit. We must take a strategic view of investing in innovation, acknowledging the wider societal value it provides, and find sustainable ways to manage immediate fiscal challenges that do not limit or delay access to new medicines and technologies.

The industry is also driving changes. One concrete commitment pharmaceutical companies have made is to file new medicines for pricing and reimbursement in all member states within two years of EU approval of a new medicine. This will improve timely access to the latest innovations.

The industry has also established a portal for tracking access delays and ensuring companies are held accountable in meeting the two-year filing commitment.

With the right ambition and desire for collaboration, we can act now.

With multiple ongoing legislative changes currently taking place in Europe — from the revision of the EU’s Pharmaceutical Legislation, to the EU’s reform of Health Technology Assessment (HTA) and the introduction of the European Health Data Space (EHDS) — we have a unique opportunity to build a stronger and better European environment for life sciences and health care that serves patients’ best interests. One major opportunity for collaboration is the implementation of the EU’s HTA regulation. This aims to address access delays by streamlining and accelerating highly fragmented HTA processes across Europe. There is only one year to go before this either becomes a meaningful contributor to faster access decisions for patients or — if not adequately in focus during 2024 — risks becoming an additional hurdle for patient access to essential treatments. In order to avoid this scenario, industry involvement in the implementation of EU HTA is crucial to leverage expertise, co-design relevant processes, and ultimately ensure a workable system.

Such actions can reduce some of the delays in accessing new medicines, but they will not solve everything. The majority of delays come from the variation and delays in individual countries’ reimbursement and health care systems. That is why it is critical that member states, payers and health systems collaborate with industry to develop tailored access solutions. 

However, there are also proposals on the table today that are concerning and at face value will not lead to improved access for patients. For instance, the EU Commission is proposing to reduce a company’s intellectual property rights — specifically regulatory data protection (RDP) — if a medicine is not available in all member states within two years of receiving marketing authorisation. This would only hinder innovation, without delivering faster, more equitable access to new medicines.

If this were to go ahead as proposed, Europe would become a less attractive place for research. A recently-published study on the impact of the European Commission’s proposal estimated that it would reduce Europe’s share of global R&D investment by one-third by 2040.

I firmly believe this proposal must be reconsidered and focused on policy solutions that ensure patients in Europe continue to benefit from innovation.

As Heiko says, speed, time and hope are all people have. Often, patients are waiting for the next innovation, during which time, their disease progresses or their condition deteriorates. This makes the next clinical trial, the next regulatory approval, the next standard of care, the next reimbursement decision absolutely vital for those who simply cannot wait.

Across industry, there are more than 8,000 new medicines in the global pipeline today. This is the hope Heiko needs, and families like his are trusting us all to deliver.

Speaking with Heiko reminded me that the most effective treatment is the one that makes it to the patient when they need it. It is now our collective responsibility to find the path to making this happen for patients everywhere in Europe.



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Making water the engine for climate action

Much progress has been made on water security over recent decades, yet for the first time in human history, our collective actions have pushed the global water cycle out of balance. Water is life: it is essential for health, food, energy, socioeconomic development, nature and livable cities. It is hardly surprising that the climate and biodiversity crises are also a water crisis, where one reinforces the other. Already, a staggering four billion people suffer from water scarcity  for at least one month a year and two billion people lack access to safely-managed drinking water. By 2030, global water demand will exceed availability by 40 percent. By 2050, climate-driven water scarcity could impact the economic growth of some regions by up to 6 percent of their Gross Domestic Product per year.

Meike van Ginneken, Water Envoy of the Kingdom of the Netherlands

Right now, the world’s first Global Stocktake is assessing the progress being made toward the goals of the Paris Agreement and global leaders are convening at COP28 in Dubai to agree on a way forward. We have a critical opportunity to catalyze global ambition and recognize that water is how climate change manifests itself. While wealthier, more resilient nations may be able to manage the devastating impacts of climate change, these same challenges are disastrous for lesser developed, more vulnerable communities.

Rainfall, the source of all freshwater, is becoming more erratic. Changes in precipitation, evaporation and soil moisture are creating severe food insecurity. Droughts trap farmers in poverty, as the majority of cultivated land is rain-fed. Extreme drought reduces growth in developing countries by about 0.85 percentage points. Melting glaciers, sea-level rise and saltwater intrusion jeopardize freshwater supplies. Floods destroy infrastructure, damage homes and disrupt livelihoods. The 2022 Pakistan floods affected 33 million people and more than 1,730 lost their lives, while 2023 saw devastating floods in Libya among other places.  

Now more than ever, it is urgent that we work together to make water the engine of climate action. Already, many countries are investing in technology and climate-resilient water infrastructure. Yet, we need more than technology and engineering to adapt to a changing climate. To advance global water action, we must radically change the way we understand, value and manage water with an emphasis on two necessary measures.

First, we need to make water availability central to our economic planning and decision-making. We need to rethink where and how we grow our food, where we build our cities, and where we plan our industries. We cannot continue to grow thirsty crops in drylands or drain wetlands and cut down forests to raise our cattle. In a changing climate, water availability needs to guide where we undertake economic activity.

In a changing climate, water availability needs to guide where we undertake economic activity.  

Second, we must restore and protect natural freshwater stocks, our buffers against extreme climate events. Natural freshwater storage is how we save water for dry periods and freshwater storage capacity is how we store rainwater to mitigate floods. 99 percent of freshwater storage is in nature. We need to halt the decline of groundwater, wetlands and floodplains. But our challenge is not only about surface and groundwater bodies, or blue water. We also need to preserve and restore our green water stocks, or the water that remains in the soil after rainfall. To reduce the decline of blue water and preserve green water, we need to implement water-friendly crop-management practices and incorporate key stakeholders, such as farmers, into the decision-making process.

Addressing the urgency of the global water crisis goes beyond the water sector. It requires transformative changes at every level of society. National climate plans such as Nationally Determined Contributions (NDCs) and National Adaptation Plans are key instruments to make water an organizing principle to spatial, economic and investment planning. Much like the Netherlands did earlier this year when the Dutch parliament adopted a policy that makes water and soil guiding principles in all our spatial planning decisions. Right now, about 90 percent of all countries’ NDCs prioritize action on water for adaptation. NDCs and National Adaptation Plans are drivers of integrated planning and have the potential to unlock vast investments, yet including targets for water is only a first step.

To drive global action, the Netherlands and the Republic of Tajikistan co-hosted the United Nations 2023 Water Conference, bringing the world together for a bold Water Action Agenda to accelerate change across sectors and deliver on the water actions in the 2030 Agenda for Sustainable Development and the Paris Agreement. To elevate the agenda’s emphasis on accelerating implementation and improved impact, the Netherlands is contributing an additional €5 million to the NDC Partnership to support countries to mitigate the impacts of climate change, reduce water-related climate vulnerability and increase public and private investments targeting water-nexus opportunities. As a global coalition of over 200 countries and international institutions, the NDC Partnership is uniquely positioned to support countries to enhance the integration of water in formulating, updating, financing and implementing countries’ NDCs.

One example showcasing the importance of incorporating water management into national planning comes from former NDC Partnership co-chair and climate leader, Jamaica. Jamaica’s National Water Commission (NWC), one of the largest electricity consumers in the country, mobilized technical assistance to develop an integrated energy efficiency and renewables program to reduce its energy intensity, building up the resilience of the network, while helping reduce the country’s greenhouse gas emissions. With additional support from the Netherlands, the International Renewable Energy Agency (IRENA) and the United Nations Development Programme (UNDP), together with Global Water Partnership (GWP)-Caribbean, the government of Jamaica will ensure the National Water Commission is well equipped for the future. Implementation of climate commitments and the requisite financing to do so are key to ensuring targets like these are met.

Water has the power to connect. The Netherlands is reaching out to the world.

Water has the power to connect. The Netherlands is reaching out to the world. We are committed to providing political leadership and deploying our know-how for a more water-secure world. As we look towards the outcomes of the Global Stocktake and COP28, it is essential that we make water the engine of climate action. 



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How to get tech right in Europe?

As our societies navigate challenging times and undergo widespread digital transformation, fostering growth in our homegrown tech businesses has never been more critical to achieving the wider goals of the European project.

Via EUTA. Kristin Skogen Lund, president, European Tech Alliance; CEO, Schibsted

The European Tech Alliance (EUTA) represents leading tech companies born and bred in Europe. We believe that with the right conditions, EU tech companies can enhance Europe’s resilience, boost our technological autonomy, protect and empower consumers, and promote European values such as transparency, the rule of law and innovation to the rest of the world.

The European Commission’s ambitious targets for 2030 in the Digital Decade program represent a vision for a sustainable and more prosperous digital future. However, more is needed if we are to achieve our goals.

Europe must boost its tech competitiveness over the next five years. To unlock European tech leadership both at home and beyond, we need to have an ambitious EU tech strategy to overcome growth obstacles, to make a political commitment to clear, targeted and risk-based rules, and to pursue consistent enforcement to match the globalized market we are in.

An EU strategy for European tech

We need a strategy for European tech that empowers digital companies to grow and use new innovation tools to deliver the best services and products, including personalized experiences, to their users. European tech companies are valuable assets for Europe. They deserve to be nurtured and supported.

Europe must boost its tech competitiveness over the next five years.

In practice, this could take on several forms. For instance, we need to unlock the power of data as a key lever for innovation while respecting consumer privacy. Privacy-enhancing technologies and pseudonymization should be further promoted by lawmakers and regulators to empower European companies to use data, grow and remain competitive.

A European strategy for talent to enhance European companies’ attractiveness could also be pursued. Developers should be pushing the limits of innovation, using their imaginations to improve the services and products from European companies, rather than focusing their unique talents on compliance tasks.

Lastly, EU tech companies should have a seat at the table when proposed rules affect their ability to invest in Europe and to provide good services, products and experiences. Bringing in expertise from the ground up would facilitate the growth of European champions at global, national and regional level.

Smart rules for a stronger Europe

The digital world is a fully-regulated sector with a wide range of new and updated rules. It is essential to give these rules time to play out before assessing their efficiency and impact on EU tech companies.

For instance, the EU’s consumer protection framework was recently updated with the ‘Omnibus Directive’. These new rules started applying from May 2022 onward only, yet they were up for another partial revision less than a year later. Businesses need time to put rules into practice, and lawmakers need time to analyze their effects in the real world, before amending the rulebook once again.

European, national and regional measures should complement each other, not clash or duplicate efforts. The ink of the Digital Services Act (DSA) was not even dry when some EU countries added extra layers of regulation at national level, such as the French law for online influencers and the proposed bill to secure and regulate the digital space. There must be a strong focus on avoiding national fragmentation where EU laws exist. Otherwise we are moving further away from a truly single market that is the cornerstone of European competitiveness.      

Where EU rules are needed, lawmakers should focus on concrete problems and be mindful of different tech business models, for example, retailers vs. marketplaces; new vs. second-hand goods, streaming vs. social media. Rules should address problems with specific business models instead of a one-size-fits-all approach or dictating specific product designs. Any proposed solution should also be proportionate to the problem identified.

Better enforcement for fairer competition

One of the big problems we face in Europe is ensuring a level playing field for all businesses, to achieve fair competition. The EU has enshrined these values in the Digital Markets Act (DMA). We must not lose sight of this ambition as we turn to the all-important task of enforcement of the DMA.

European, national and regional measures should complement each other, not clash or duplicate efforts.

Better cooperation should be encouraged between regulatory authorities at national level (for example, consumer, competition and data protection) but also among European countries and with the EU to ensure coherent application.

Now that the European Commission takes on the new role of rule enforcer, it’s of paramount importance to place a strong focus on independence, separate from political interests. This will ensure a robust and impartial enforcement mechanism that upholds the integrity of the regulatory framework.

What’s next?

European tech companies in the EUTA believe the EU can take two crucial steps for our competitiveness, so we can continue to invest in Europe’s technological innovation and European consumers.

First, the EU digital single market is incomplete, we need to avoid 27 different interpretations of the same EU rules. A strong harmonization push is needed for EU companies to grow faster across the Continent.

Second, we look toward the EU, national governments and authorities to bring economic competitiveness and innovation to the core of regulation, and then to enforce these rules fairly and equally.

EUTA members are companies born and bred in Europe. The EU is a crucial market and we are deeply committed to European citizens and European values. With our EUTA manifesto, we propose a vision so Europe can succeed, and our own European champions can grow and become global leaders.



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Kosovo attack: Who benefits?

Jamie Dettmer is opinion editor at POLITICO Europe. 

The European Union and the United States have been trying to persuade Serbia and Kosovo to end their enmity and normalize relations for more than a decade.

There were finally signs of promise in April, when Serbian President Aleksandar Vučić and Kosovo’s Prime Minister Albin Kurti finally gave tacit, if begrudging, approval to an EU-brokered plan that would see the two finally sprinkle some soil over the hatchet.

But despite all the cajoling and coaxing, it wasn’t to be.

U.S. and European officials have insinuated that Kurti was more to blame here, with EU foreign policy chief Josep Borrell drawing attention to the failure to establish an association of municipalities in northern Kosovo, which would have allowed Kosovo’s Serbs some autonomy in an enclave where they’re a majority.

Behind the scenes, U.S. and European officials have also quietly praised Vučić for a slow and halting tilt toward the West, secretly supplying some arms to Ukraine and moving to reduce Serbia’s dependency on Russian energy supplies.

This is why last week’s astonishing clash between armed Serbs and police in the village of Banjska, in northern Kosovo’s Zvečan municipality, is especially perplexing — and it’s worth asking whose interests it serves.

Kosovo’s leaders quickly blamed Vučić for the attack, which also involved a siege of an Orthodox monastery. A Kosovan policeman and three Serb gunmen were killed in the clash. And Kosovo’s President Vjosa Osmani said Friday that “the (armed) group simply exercised the intentions and the motives of Serbia as a country and Vučić as the leader.”

Osmani maintains Belgrade was trying to copy Moscow’s 2014 annexation of Crimea, which began with so-called little green men infiltrating the Ukrainian peninsula. “They are trying to carry out a Crimea model in the Republic of Kosovo, but we will absolutely not let that happen,” she added.

Kurti has called for sanctions to be imposed on Serbia for what he describes as a state-sponsored terrorist attack, warning that if the crime goes unpunished, Belgrade will repeat it. Vučić planned and ordered an attack in northern Kosovo “to destabilize” the country with the goal of starting a war, he said.

In response, Vučić has angrily denied these allegations but has noticeably hardened his rhetoric, possibly as a sop to Serbian ultra-nationalists. More alarmingly, however, Serbia has been building up its forces near the border with Kosovo since the deadly clashes, which the White House has described as “unprecedented.” And according to U.S. National Security Council spokesman John Kirby, on a phone call with Vučić, Secretary of State Antony Blinken urged an “immediate de-escalation and a return to dialogue.”

If Belgrade did have a hand in the attack, however, it would appear to pull against the caution Vučić has displayed since Russia’s invasion of Ukraine, hedging his bets between the West and Serbia’s traditional Slavic ally. Vučić didn’t join in on Western sanctions against Russia but has condemned the invasion, and says he’s keen to pursue Serbia’s bid for EU membership.

If Belgrade did have a hand in the attack, it would appear to pull against the caution Aleksandar Vučić has displayed since Russia’s invasion of Ukraine | Andrej Cukic/EFE via EPA

Marko Đurić, the Serbian ambassador to the U.S., echoes Vučić’s argument that planning or approving an attack in Kosovo at this juncture would make no sense and potentially ruin Belgrade’s improving relations with the West. “We have a lot to lose by any kind of escalation in Kosovo,” he told POLITICO — including harming the country commercially.

Đurić also said the attack has complicated the country’s domestic politics, noting that “the far right in Serbia is going to try and exploit this to the greatest extent possible.”

But Kosovo’s leaders have a case against Belgrade that needs answering.

To support the allegation that Vučić endorsed the attack, they highlight the role of Milan Radoičić, the deputy leader of the Serb List — a party that dominates Serb politics in northern Kosovo and has close links with Vučić’s Serbian Progressive Party.

Nicknamed the “boss of the north,” Radoičić admitted to organizing and leading the attack in a statement issued by his lawyer, saying he was solely responsible. “I didn’t inform anyone from the government structures of the Republic of Serbia about this, nor from the local political structures from the north of Kosovo and Metohija, nor did I get any help from them, because we already had had different views on the previous methods of resisting Kurti’s terror,” he said.

But Kurti dismisses the idea that Radoičić would have gone ahead without Vučić’s approval. “I have no doubt that Radiočić was only the executor. The one who planned and ordered this terrorist, criminal attack on our state, in order to violate our territorial integrity, national safety and state security, is none other than President Vučić,” he told reporters.

Other officials in Pristina also say it would be stretching credulity to think Aleksandar Vulin, the head of Serbia’s BIA intelligence agency, would have been unaware of a planned attack.

Bojan Pajtić, a Serbian law professor and former president of the autonomous province of Vojvodina within Serbia, agrees the Banjska provocation wouldn’t have gone ahead without the security agency’s knowledge, saying it is improbable that the BIA would have failed to notice an operation being prepared by a heavily armed formation consisting of dozens of people in such a small area. “The BIA normally knows who drank coffee with whom yesterday in Zvečan,” he said.

“When an incident occurs that is not accidental, but the result of someone’s efforts, you always wonder whose interests it is in,” Paltić said. “In this case, it is certainly not in the interest of Aleksandar Vučić, because after the last attempt at dialogue in Brussels, in the eyes of the West, in relation to Kurti, he still looked like a constructive partner.”

Pajtić isn’t alone in querying who’s interest the attack was in, and so far, both Washington and Brussels have been extremely cautious in their comments. European Commission spokesperson Peter Stano said the EU will wait for the completion of the investigation before coming to any conclusions on what he described as a terrorist attack. Washington, careful to keep its language neutral, hasn’t been specific about who it blames either.

This, of course, stands in sharp contrast to Moscow, which predictably grandstanded as Serbia’s traditional protector, accusing Pristina of ethnic cleansing in northern Kosovo — the very same lie used to try to justify Russian President Vladimir Putin’s full-scale invasion of Ukraine.

“This incident, the most serious example of violence in Kosovo for years, turned the tables on Vučić,” said Dimitar Bechev, a visiting scholar at Carnegie Europe. And he, too, questioned whether the attack was a rogue operation by Serbian ultra-nationalists and Kosovo’s Serb leaders.

“Should the story of Radoičić freelancing be corroborated, it would appear that Vučić has lost control over his erstwhile proxies,” he said.



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Why we need to improve heart health in Europe

Cardiovascular diseases (CVDs) are the number one killer in Europe. They cost the EU an estimated €282 billion in 2021, larger than the entire EU budget itself.[1] Sixty million people live with CVDs in the EU, while 13 million new cases are diagnosed annually.[2]

Behind this data are individual stories of suffering and loss, of lives limited and horizons lowered by, for example, heart attack and stroke. These diseases directly affect every community in every country. And they strain our health services which must respond to cardiac emergencies as well as the ongoing care needs of chronic CVD patients.

Sixty million people live with CVDs in the EU, while 13 million new cases are diagnosed annually.

Cardiovascular health is a priority not just because of the scale of its impact, but because of the scope we see for significant advances in outcomes for patients. We should take inspiration from the past: between 2000 and 2012, the death rate from CVDs fell by 37 percent in the five largest western European countries (France, Germany, the U.K., Spain and Italy).[2] This progress was achieved through a combination of medical innovations, and supported by a mix of health care policies and guidelines that propelled progress and improved patients’ lives.

New treatments can now help prevent strokes or treat pulmonary embolisms. Others can delay kidney disease progression, while at the same time preventing cardiovascular events.

Despite progress, this downward trend has reversed and we are seeing an increase in the CVD burden across all major European countries.

And the research continues. Precision medicines are in development for inherited CVD-risk factors like elevated lipoprotein(a), which affects up to 20 percent of the population.[3] A new class of anti-thrombotics promises to bring better treatments for the prevention of clotting, without increasing the risk of bleeding. New precision cardiology approaches, such as gene therapy in congestive heart failure, are being investigated as potential cures.

Despite progress, this downward trend has reversed and we are seeing an increase in the CVD burden across all major European countries.[4]

Getting the definitions right

This year’s World Heart Day, spearheaded by the World Heart Federation, comes amid the revision of the EU pharmaceutical legislation. The European Commission’s proposal of a narrow definition of unmet medical need, which could hamper innovation is causing deep concern across stakeholders.

Instead, a patient-centered definition of unmet medical need taking the full spectrum of patient needs into consideration, would incentivize more avenues of research addressing the needs of people living with chronic conditions. It would provide a basis for drafting the next chapter in the history of cardiovascular medicines — one that we hope will be written in Europe and benefit people in the EU and beyond. Not only would this inspire advances that help people to live longer, but it would also improve quality of life for those at risk of, and affected by, cardiovascular events.

Unmet medical need criteria currently included in the draft Pharmaceutical Legislation would do a disservice to patients by downplaying the chronic nature of many CVDs, and the importance of patient-reported outcomes and experience.[5] And many of the advances seen in recent decades would fall short of the narrow definition under consideration. This limited approach disregards incremental innovation, which might otherwise reduce pain, slow disease progression, or improve treatment adherence by taking account of patient preferences for how therapies are administered.

Much of the illness and death caused by CVD is preventable — in fact, 9 out of 10 heart attacks can be avoided.

At this moment it is unclear how the unmet medical need criteria in the legislation will apply to these and other situations. Policymakers should create a multistakeholder platform with the space to discuss patients’ needs, getting expert views from medical societies, patients and industry to better understand the innovation environment. The European Alliance for Cardiovascular Health (EACH), a multistakeholder network comprised of 17 organizations in the CVD space in Europe, stands ready to inform policymakers about the CVD burden and the pressing needs of patients. [6] EACH not only supports the EU´s endeavor to develop more policies on CVD, it also supports and promotes the idea of an EU Cardiovascular Health Plan to work towards better patients’ health care across the EU and more equal health standards. So far, structured discussions with such stakeholders do not sufficiently take place, and we risk missing those opportunities, and lose in both patient access as well as R&D attractiveness of the EU.

Primary and secondary prevention

As well as driving future innovation, Europe must also make the best possible use of the tools we have now. We must do what works — everywhere.

At the heart of this approach is prevention. Much of the illness and death caused by CVD is preventable — in fact, 9 out of 10 heart attacks can be avoided.[7] Primary prevention can dramatically reduce rates of heart attack, stroke and other CVDs. Secondary prevention, which includes screening and disease management, such as simple blood tests and urine tests, as well as blood pressure and BMI monitoring, has a key role to play in containing the burden of disease. [8]

Joint cardiovascular and diabetes health checks at primary care level, taking an evidence-based approach, would help diagnose and treat CVD before the onset of acute symptoms.[9] By following current treatment guidelines and protocols, health care professionals across Europe can help to prevent complications, improve health outcomes for patients and save health care costs. Also here, a multistakeholder approach is key. Policymakers should not miss out on listening to the CVD multistakeholder alliances that have already formed — at EU and at EU member countries level, as for example EACH. These partnerships are great ways for policymakers to better understand the needs of patients and to get the experts’ views.

Research-driven companies exist to meet the needs of patients in Europe and around the world. We need to create an environment that enables companies to embark on complex and unpredictable trials. That means having the rights incentives and clarity on the regulatory pathway for future treatments.


[1] https://www.escardio.org/The-ESC/Press-Office/Press-releases/Price-tag-on-cardiovascular-disease-in-Europe-higher-than-entire-EU-budget

[2] https://iris.unibocconi.it/retrieve/handle/11565/4023471/115818/Torbica%20EHJ%202019.pdf

[3] https://www.acc.org/Latest-in-Cardiology/Articles/2019/07/02/08/05/Lipoproteina-in-Clinical-Practice

[4] https://www.efpia.eu/about-medicines/use-of-medicines/disease-specific-groups/transforming-the-lives-of-people-living-with-cardiovascular-diseases/cvd-dashboards

[5] https://health.ec.europa.eu/medicinal-products/pharmaceutical-strategy-europe/reform-eu-pharmaceutical-legislation_en

[6] https://www.cardiovascular-alliance.eu/

[7] https://www.ahajournals.org/doi/10.1161/STROKEAHA.119.024154

[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5331469/

[9] https://www.efpia.eu/news-events/the-efpia-view/statements-press-releases/because-we-can-t-afford-not-to-let-s-make-a-joint-health-check-for-cardiovascular-disease-cvd-and-diabetes-happen/



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Armenians find themselves pushed aside yet again

Jamie Dettmer is opinion editor at POLITICO Europe. 

Last week, U.N. Secretary-General António Guterres warned that the world is “inching ever closer to a great fracture in economic and financial systems and trade relations.”

That may be so, but not when it comes to Azerbaijan.

A country a third of the size of Britain and with a population of about 10 million, Azerbaijan has faced few problems in bridging geopolitical divisions. And recently, Baku has been offering a masterclass in how to exploit geography and geology to considerable advantage.

From Washington to Brussels, Moscow to Beijing, seemingly no one wants to fall out with Azerbaijan; everyone wants to be a friend. Even now, as Armenia has turned to the world for help, accusing Baku of attempted ethnic cleansing in disputed Nagorno-Karabakh — the land-locked and long-contested Armenian enclave in Azerbaijan.

Warning signs had been mounting in recent weeks that Baku might be planning a major offensive, which it dubbed an “anti-terrorist operation,” and Armenia had been sending up distress flares. But not only were these largely overlooked, Baku has since faced muted criticism for its assault as well.

Western reaction could change, though, if Azerbaijan were to now engage in mass ethnic cleansing — but Baku is canny enough to know that.

Since Russia invaded Ukraine, Azerbaijan has been courted by all sides, becoming one of the war’s beneficiaries.

On a visit to Baku last year, European Commission President Ursula von der Leyen had only warm words for the country’s autocratic leader Ilham Aliyev, saying she saw him as a reliable and trustworthy energy partner for the European Union.

Then, just a few weeks later, Alexander Lukashenko — Russian President Vladimir Putin’s satrap in Belarus — had no hesitation in describing Aliyev as “absolutely our man.”

Is there any other national leader who can be a pal of von der Leyen and Lukashenko at the same time?

Aliyev is also a friend of Turkey; Baku and Beijing count each other as strategic partners, with Azerbaijan participating in China’s Belt and Road Initiative; and the country has been working on expanding military cooperation with Israel as well. In 2020 — during the last big flare-up in this intractable conflict — Israel had supplied Azerbaijan with drones, alongside Turkey.

That’s an impressive list of mutually exclusive friends and suitors — and location and energy explain much.

Upon her arrival in Azerbaijan’s capital last year, von der Leyen wasn’t shy about highlighting Europe’s need to “diversify away from Russia” for its energy needs, announcing a deal with Baku to increase supplies from the southern gas corridor — the 3,500-kilometer pipeline bringing gas from the Caspian Sea to Europe.

She also noted that Azerbaijan “has a tremendous potential in renewable energy” in offshore wind and green hydrogen, enthusing that “gradually, Azerbaijan will evolve from being a fossil fuel supplier to becoming a very reliable and prominent renewable energy partner to the European Union.”

There was no mention of Azerbaijan’s poor human rights record, rampant corruption or any call for the scores of political prisoners to be released.

Azerbaijan uses oil and gas “to silence the EU on fundamental rights issues,” Philippe Dam of Human Rights Watch complained at the time. “The EU should not say a country is reliable when it is restricting the activities of civil society groups and crushing political dissent,” he added.

Eve Geddie, director of Amnesty International’s Brussels office, warned: “Ukraine serves as a reminder that repressive and unaccountable regimes are rarely reliable partners and that privileging short-term objectives at the expense of human rights is a recipe for disaster.”

But von der Leyen isn’t the first top EU official to speak of Azerbaijan as such a partner. In 2019, then EU Council President Donald Tusk also praised Azerbaijan for its reliability.

Since Russia invaded Ukraine, however, the EU’s courting has become even more determined — and, of course, the bloc isn’t alone. Rich in oil and gas and located between Russia, Iran, Armenia, Georgia and the Caspian Sea, Azerbaijan is a strategic prize, sitting “on the crossroads of former major empires, civilizations and regional and global powerhouses,” according to Fariz Ismailzade of ADA University in Baku.

And Azerbaijan’s growing importance in the latest great game in Central Asia is reflected in the increase in foreign diplomatic missions located in its capital — in 2005 there were just two dozen, now there are 85.

For Ankara, and Beijing — eager to expand their influence across Central Asia — Azerbaijan is a key player in regional energy projects, as well as the development of new regional railways and planned infrastructure and connectivity projects.

Thanks to strong linguistic, religious and cultural ties, Turkey has been Azerbaijan’s main regional ally since it gained independence. But Baku has been adept at making sure it keeps in with all its suitors. It realizes they all offer opportunities but could also be dangerous, should relations take a dive.

And this holds for all the key players in the region, whether it be the EU, Turkey, China or Russia. The reason Baku can get on with a highly diverse set of nations — and why there likely won’t be many serious repercussions for Baku with this latest military foray — is that no one wants to give geopolitical rivals an edge and upset the fragile equilibrium in Central Asia. That includes its traditional foe Iran – Baku and Tehran have in recent months been trying to build a détente after years of hostility.

For the Armenians, so often finding themselves wronged by history, this is highly unfortunate. They might have been better advised to follow Azerbaijan’s example and try to be everyone’s friend, instead of initially depending on Russia, then pivoting West — a pirouette that’s lost them any sympathy in Moscow.

But then again, Armenia hasn’t been blessed with proven reserves of oil or natural gas like its neighbor.



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Poland turns toward bets on offshore wind

The development of offshore wind farms in Poland has never before taken place on such a large scale. The PGE Group is the biggest investor in offshore wind farms in the Polish part of the Baltic Sea in terms of wind turbine capacity. As part of its offshore program, the PGE Group is currently implementing three offshore wind farm projects.

Two of them are the offshore wind power plants Baltica 2 and Baltica 3, which comprise the Baltica Offshore Wind Farm with a total capacity of 2.5GW. PGE is implementing this project together with the Danish partner Ørsted. Both phases of the Baltica offshore wind farm have location decisions, environmental decisions, and grid connection agreements with the operator, and have been granted the right to a Contract for Difference (CfD).

As part of its offshore program, the PGE Group is currently implementing three offshore wind farm projects.

Last April, PGE and Ørsted took a major step in the Baltica 2 project. They signed the first of the contracts for the supply of wind turbines. Subsequently, they also signed a contract for the supply of offshore substations in June. Baltica 2 is expected to start producing green energy in 2027, while the entire Baltica Offshore Wind Farm will be completed within this decade.

Independently of the Baltica Offshore Wind Farm, the PGE Group is developing a third project, Baltica 1. Commissioning is scheduled after 2030 and its capacity will be approximately 0.9GW. The project already has a location permit and a connection agreement. In May 2022, wind measurement studies for this project started, followed by environmental studies in autumn 2022. The energy produced by all three farms will supply nearly 5.5 million households in Poland.  This means that more than a third of all Polish households will be provided with energy from wind power.

Baltica 2 is expected to start producing green energy in 2027, while the entire Baltica Offshore Wind Farm will be completed within this decade.

At the same time, the PGE Group has received final decisions on new permits for the construction of artificial islands for five new areas to be developed in the Baltic Sea, which will enable the construction of further offshore wind power plants in the future. The total capacity potential from the new areas provides PGE with more than 3.9GW. Considering the projects currently under development (Baltica 2, Baltica 3 and Baltica 1) with a total capacity of approximately 3.4GW, PGE Capital Group’s offshore wind portfolio may increase to over 7.3GW by 2040.

Offshore wind — a new chapter for the Polish economy

A long-term vision for the development of the Polish offshore wind sector, based on the carefully assessed potential of this technology, will support the development of the energy sector in Poland. The benefits of offshore wind development in Poland should be considered in several aspects — first and foremost, due to their total capacity, offshore wind farms will become a very important new source of clean, green energy for Poland in just a few years.

“Offshore wind energy will make a significant contribution to Poland’s energy mix. The three projects currently under construction by the PGE Group, with a total capacity of almost 3.5GW, will generate electricity for almost 5.5 million households. All the investments planned for the Baltic Sea are crucial for strengthening Poland’s energy security. Regarding the Polish economy, in particular the economy of the entire Pomerania region, the construction of offshore wind farms will provide a strong development stimulus. This is not only about businesses closely related to wind energy, such as companies supplying components for offshore wind power plants. Jobs will also be created by businesses willing to join the development of this new sector and take advantage of the opportunities it brings,” said Wojciech Dąbrowski, president of the management board of PGE Polska Grupa Energetyczna S.A.

All the investments planned for the Baltic Sea are crucial for strengthening Poland’s energy security.

The construction of offshore wind farms will ensure Poland’s energy security

The development of offshore wind is also crucial to Poland’s energy security and independence. Thanks to the production of energy from renewable sources, there is no need to import fossil fuels from abroad or rely on dwindling domestic coal resources.

This means that Poland will not be dependent on external fuel suppliers or various international developments. The ability to generate electricity independently contributes to strengthening the country’s energy sovereignty.

Energy, environmental and social benefits

Poland has ambitions and capabilities to become one of the leaders in offshore wind energy development in the Baltic Sea and even in Europe. We have plenty of resources for the development of offshore wind farms because of our favorable geographical location and natural conditions — strong, stable winds and the relatively shallow considerable area of the Baltic Sea, located in the exclusive economic zone. The Baltic Sea has some of the best wind conditions not only in Europe but also in the world, which are comparable to those in the North Sea.

Offshore wind energy is a key element of sustainable development. For Poland, green wind energy means savings, security and energy independence at the same time. Electricity from renewable sources is less expensive than that generated from fossil fuels. By choosing green energy, consumers can save on their electricity bills while at the same time supporting the development of a green energy sector. As a zero-emission energy source, it contributes to achieving climate policy goals and minimizing negative environmental impact. It is a huge step towards reducing greenhouse gas emissions. The creation of an infrastructure for the construction of alternative energy sources with wind farms will ensure the diversification of energy sources.



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Vienna seeks to calm Selmayr ‘blood money’ furor

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Austrian Foreign Minister Alexander Schallenberg signaled his government was de-escalating a row with the EU’s senior representative in the country, Martin Selmayr, who last week accused Vienna of paying “blood money” to Moscow by continuing to purchase large quantities of Russian gas.

“Everything has already been said about this,” Schallenberg said over the weekend in a written response to questions from POLITICO on the affair. “We are working hard to drastically reduce our energy dependency on Russia and we will continue to do so.”

Austrian officials insist that the country’s continued reliance on Russian gas is only temporary and that it will wean itself off by 2027 (over the past 18 months, the share of Russian gas in Austria has dropped from 80 percent to an average of 56 percent).

Some experts question the viability of that plan, considering that OMV, the country’s dominant oil and gas company, signed a long-term supply deal with Gazprom under former Chancellor Sebastian Kurz that company executives say is virtually impossible to withdraw from.

Those complications are likely one reason why Vienna — even as its officials point out that Austria is far from the only EU member to continue to rely on Russian gas — doesn’t want to dwell on the substance of Selmayr’s criticism.

“We should rather focus on maintaining our unity and cohesion within the European Union in dealing with Russia’s war of aggression on Ukraine,” Schallenberg told POLITICO. “We can only overcome the challenges ahead of us in a united effort.”

Schallenberg’s remarks follow a decision by the European Commission on Friday to summon Selmayr to Brussels to answer for his actions. A spokesman for the EU executive on Friday characterized the envoy’s comments as “not only unnecessary, but also inappropriate.”

Given that the Austrian government is led by a center-right party, which is allied with European Commission President Ursula von der Leyen’s European People’s Party bloc, the sharp reaction from Brussels is not surprising. An official close to the Austrian government said Vienna had not demanded Selmayr’s removal.

Selmayr made the “blood money” comment, by his own account, while defending the Commission chief. He told an Austrian newspaper that he made the remark during a public discussion in Vienna on Wednesday in response to an audience member who accused von der Leyen of “warmongering” in Ukraine and having “blood on her hands.”

“This surprises me, because blood money is sent to Russia every day with the gas bill,” Selmayr told the audience.

Selmayr expressed surprise that there wasn’t more public outcry in Austria over the country’s continued reliance on Russian natural gas, which has accounted for about 56 percent of its purchases so far this year. (A review of a transcript of the event by Austrian daily Die Presse found no mention of the comments Selmayr attributed to the audience member, however.)

Austria’s deep relationship to Russia, which has continued unabated since Moscow’s full-scale invasion of Ukraine, has prompted regular criticism from its European peers.

Even so, the EU envoy’s unvarnished assessment caused an immediate uproar in the neutral country, especially on the populist far right, whose leaders called for Selmayr’s immediate dismissal.

Europe Minister Karoline Edtstadler called the remarks “dubious and counterproductive” | Olivier Hoslet/EPA-EFE

Schallenberg’s ministry summoned Selmayr on Thursday to answer for his comments and the country’s Europe Minister, Karoline Edtstadler, called the remarks “dubious and counterproductive.” Some in Vienna also questioned whether Selmayr, who as a senior Commission official helped Germany navigate the shoals of EU bureaucracy to push through the controversial Nord Stream 2 pipeline — thus increasing Europe’s dependency on Russian gas — was really in a position to criticize Austria.

Nonetheless, Selmayr’s opinion carries considerable weight in Austria, given his history as the Commission’s most senior civil servant and right-hand man to former Commission President Jean-Claude Juncker.

Though Selmayr, who is German, has a record of living up to his country’s reputation for directness and sharp elbows, even his enemies consider him to be one of the EU’s best minds.

His rhetorical gifts have made him a considerable force in Austria, where he arrived in 2019 (after stepping down under a cloud in Brussels). He is a regular presence on television and in print media, weighing in on everything from the euro common currency to security policy.

After Austrian Chancellor Karl Nehammer recently pledged to anchor a right to pay with euro bills and coins in cash-crazed Austria’s constitution, for example, Selmayr reminded his host country that that right already existed under EU law. What’s more, he wrote, Austrians had agreed to hand control of the common currency to the EU when they voted to join the bloc in 1994.

A few weeks later, he interjected himself into the country’s security debate, arguing that “Europe’s army is NATO,” an unwelcome take in a country clinging on to its neutrality.

Though Selmayr’s interventions tend to rub Austria’s government the wrong way, they’ve generally hit the mark.

The latest controversy and Selmayr’s general approach to the job point to a fundamental divide in the EU over the role of the European Commission’s local representatives. Most governments want the envoys to serve like traditional ambassadors and to carry out their duties, as one Austria official put it to POLITICO recently, “without making noise.”

Yet Selmayr’s tenure suggests that the role is often most effective when structured as a corrective, or reality check, by viewing national political debates through the lens of the broader EU.  

In Austria, where the anti-EU Freedom Party is leading the polls by a comfortable margin ahead of next year’s general election, that perspective is arguably more necessary than ever.

Victor Jack contributed reporting.



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Labs: the (overlooked) building block of Universal Health Coverage

Hepatitis C (HCV) — a potentially life-threatening virus that infects 1.5 million new people around the world every year — is highly treatable if diagnosed early.[1]

Unfortunately,  access to quality screening is far from universal. Countries like Egypt — one of the countries with the highest prevalence of HCV in the world — demonstrate the impact screening can have. In 2015, HCV was prevalent in an estimated 7 percent of the country’s population and accounted for 7.6 percent of the country’s mortality, presenting a significant health care and societal burden.[2]

But since then, Egypt has turned a corner. In 2018, the Egyptian Ministry of Health and Population launched a massive nationwide HCV screening and treatment campaign as part of its 2014-2018 HCV action plan.[3] The campaign’s results were inspiring: by July 2020, Egypt had screened more than 60 million people[3] and treated 4 million residents.[2] Today, Egypt is set to be the world’s first country to eliminate HCV within its borders.[2]

The results of Egypt’s HCV screening program speak to diagnostics’ power in contributing to improved health outcomes around the world. Among the essential components of any health system is the capacity for prevention, which includes timely screening and detection. But a preventive approach based on timely diagnosis won’t work without the right infrastructure in place.

Strong laboratories as a cornerstone of building better health care

Matt Sause, CEO Roche Diagnostics | via Roche

The World Health Organization (WHO) highlights the critical role well-functioning laboratory services play in health systems with good reason.[4] Around the world, clinicians increasingly rely on  laboratory tests for diagnostic and treatment decisions. These tests help them make more informed decisions that result in better care and potentially improved outcomes for patients.

The challenges facing labs today — and tomorrow

Two key challenges facing laboratory systems today are underfunding and insufficient resources. Despite their central importance, laboratories struggle to garner the political and financial support they need to be as effective as possible. For example, it’s estimated that while lab results drive approximately 70 percent of clinical decision making, laboratories make up only 5 percent of hospital costs.[5]

After all, it’s the health care systems with strong, resilient labs that will be best placed to manage future pandemics and ever-growing health threats like heart disease and dementia.

What’s needed is a political commitment to provide everyone with access to accurate and timely diagnosis that paves the way to effective treatment and health. And putting this commitment into practice can only be achieved and sustained through coordinated multistakeholder efforts and public—private partnerships. This is not just a worthwhile investment for patients, but also the wider health care system in the long run. After all, it’s the health care systems with strong, resilient labs that will be best placed to manage future pandemics and ever-growing health threats like heart disease and dementia.

Another challenge is the health care workforce. Effective use of diagnostics requires qualified people to drive it, with expertise in pathology and laboratory medicine. Yet the world currently faces a laboratory staffing shortage. For diagnostics in particular, baccalaureate degree programs in laboratory science have previously been on the ‘endangered list’ of allied health professions.[6] In the end, inadequately trained staff, frequent turnover and scheduling problems all make quality lab results more difficult to guarantee.

This UHC ambition is only possible when backed by a network of strong laboratories that help ensure individuals can access high-quality diagnostics services without financial burden in all health care systems.

And that’s not all: inadequate infrastructure and staffing shortages are more present in low-income, rural communities, which exacerbate the broader diagnostics gap troubling global health care today. Many low-income countries lack an integrated laboratory network that can fully provide high-quality, accessible and efficient laboratory testing services for the entire population. In fact, a commission convened by The Lancet concluded that 81 percent of these populations have little or no access to diagnostics.[7]

The path to Universal Health Coverage

Put simply, innovative diagnostics are only meaningful if they reach people where and when they’re needed. Advancing this equity is at the heart of the WHO’s vision for Universal Health Coverage (UHC) by 2030. The goal? To guarantee all people have access to high-quality services for their health and the health of their families and communities, without facing financial hardship.

This UHC ambition is only possible when backed by a network of strong laboratories that help ensure individuals can access high-quality diagnostics services without financial burden in all health care systems. To do this, UHC should explicitly include diagnostics services. Financially, it’s savings from screening, early diagnosis and targeted treatment that make UHC feasible. Health care systems will have to undergo a systemic shift from focusing on treatment to focusing on prevention. And that’s just not possible when clinicians don’t have access to fast, accurate and cost-efficient lab results to inform their clinical decision-making. Policies and regulations that safeguard UHC goals of access and health equity are essential to make progress toward UHC.[8] The Saving Access to Laboratory Services Act (SALSA), in the United States, is an example of how national policies can help to ensure sustainable laboratory networks and contribute to equitable access to essential healthcare.

Stronger labs can not only help health care systems make savings in the routine management of population health; investing in them also helps to reduce costs and prepare in advance for any future public health crises.

This year has already seen encouraging progress toward achieving UHC through enhanced diagnostics capacity. The adoption of the resolution on strengthening diagnostics capacity at the World Health Assembly in May was an important signal of growing international political support for diagnostics. It was also a call to action. The next step for this month’s United Nations General Assembly and Sustainable Development Goals (SDG) Summit is channeling political support for diagnostics into the development of an action-oriented declaration.

To put us closer to UHC, this declaration should commit to ensuring that national health plans include access to timely detection and prevention. That starts with supporting laboratory systems and establishing National Essential Diagnostics Lists that identify the most critical diagnostic tests to help diagnose patients quickly and accurately so that they can receive needed treatment. At Roche, we’re advocating that governments, industry, civil society and other policy stakeholders will come together around concrete plans and shared resources that strengthen diagnostics and the lab infrastructure that makes them effective. In line with our commitment to increase patient access to important diagnostic solutions by 2030, we plan to do our part.


[1] Hepatitis C. World Health Organization. Available at: https://www.who.int/news-room/fact-sheets/detail/hepatitis-c (Accessed 22.08.2023)

[2] Egypt’s Ambitious Strategy to Eliminate Hepatitis C Virus: A Case Study. Hassanin, A. et al. Available at:   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8087425/ (Accessed 22.08.2023)

[3] Hepatitis C in Egypt – Past, Present, and Future. Roche Diagnostics. Available at: https://diagnostics.roche.com/global/en/article-listing/egypt-s-road-to-eliminating-hepatitis-c-virus-infection—a-stor.html (Accessed 22.08.2023)

[4] Monitoring the Building Blocks of Health Systems. World Health Organization. Available at: https://apps.who.int/iris/bitstream/handle/10665/258734/9789241564052-eng.pdf (Accessed 14.07.2023)

[5] The Cost-effective Laboratory: Implementation of Economic Evaluation of Laboratory Testing. Bogavac-Stanojevic N. & Jelic-Ivanovic Z. J Med Biochem. Volume 36, Issue 3, 238 – 242. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287218/

[6] Ensuring Quality Cancer Care through the Oncology Workforce: Sustaining Care in the 21st Century: Workshop Summary. National Academy of Sciences. Available at: https://www.ncbi.nlm.nih.gov/books/NBK215247/ (Accessed 14.07.2023)

[7] Essential diagnostics: mind the gap. The Lancet Global Health. Available at: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00467-8/fulltext (Accessed 14.07.2023)

[8] Private Sector Commitments To Universal Health Coverage. UHC Private Sector Constituency 2023 Statement. https://www.uhc2030.org/fileadmin/uploads/UHC2030_Private_Sector_Commitments_Statement_April2023.pdf (Accessed 29.08.2023)



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