# CE2010184EN.01040401.xml

| 8.7.2010 | EN | Official Journal of the European Union | CE 184/404 |
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8.7.2010

EN

Official Journal of the European Union

CE 184/404

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Thursday 23 April 2009Rare diseases *

P6_TA(2009)0288

European Parliament legislative resolution of 23 April 2009 on the proposal for a Council recommendation on a European action in the field of rare diseases (COM(2008)0726 – C6-0455/2008 – 2008/0218(CNS))

2010/C 184 E/75

(Consultation procedure)

The European Parliament,

The European Parliament

having regard to the Commission proposal to the Council (COM(2008)0726),

having regard to Article 152(4), second subparagraph of the EC Treaty, pursuant to which the Council consulted Parliament (C6-0455/2008),

having regard to Rule 51 of its Rules of Procedure,

having regard to the report of the Committee on the Environment, Public Health and Food Safety and the opinion of the Committee on Industry, Research and Energy (A6-0231/2009),

| 1. | Approves the Commission proposal as amended; |
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1.

Approves the Commission proposal as amended;

| 2. | Calls on the Commission to alter its proposal accordingly, pursuant to Article 250(2) of the EC Treaty; |
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2.

Calls on the Commission to alter its proposal accordingly, pursuant to Article 250(2) of the EC Treaty;

| 3. | Calls on the Council to notify Parliament if it intends to depart from the text approved by Parliament; |
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3.

Calls on the Council to notify Parliament if it intends to depart from the text approved by Parliament;

| 4. | Asks the Council to consult Parliament again if it intends to amend the Commission proposal substantially; |
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4.

Asks the Council to consult Parliament again if it intends to amend the Commission proposal substantially;

| 5. | Instructs its President to forward its position to the Council and Commission. |
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5.

Instructs its President to forward its position to the Council and Commission.

| TEXT PROPOSED BY THE COMMISSION | AMENDMENT |
| --- | --- |
| Amendment 1 |
| Proposal for a recommendation


  Recital 1 |
| (1) | Rare diseases are a threat to the health of European citizens insofar as they are life-threatening or chronically debilitating diseases with a low prevalence and a high level of complexity. |

TEXT PROPOSED BY THE COMMISSION

AMENDMENT

Amendment 1

Amendment 1

Proposal for a recommendation

Proposal for a recommendation

Recital 1

Recital 1

(1)

Rare diseases are a threat to the health of European citizens insofar as they are life-threatening or chronically debilitating diseases with a low prevalence and a high level of complexity.

| (1) | Rare diseases are a threat to the health of European citizens insofar as they are life-threatening or chronically debilitating diseases with a low prevalence and a high level of complexity
  , but since there are so many different types of rare disease, the total number of people affected is quite high
  . |
| --- | --- |

(1)

Rare diseases are a threat to the health of European citizens insofar as they are life-threatening or chronically debilitating diseases with a low prevalence and a high level of complexity
  , but since there are so many different types of rare disease, the total number of people affected is quite high
  .

, but since there are so many different types of rare disease, the total number of people affected is quite high

Amendment 2

Amendment 2

Proposal for a recommendation

Proposal for a recommendation

Recital 2

Recital 2

| (2) | A Community Action Programme on Rare Diseases, including genetic diseases, was adopted for the period 1 January 1999 to 31 December 2003. This programme defined the prevalence for a rare disease as affecting no more than 5 per 10 000 persons in the European Union. |
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(2)

A Community Action Programme on Rare Diseases, including genetic diseases, was adopted for the period 1 January 1999 to 31 December 2003. This programme defined the prevalence for a rare disease as affecting no more than 5 per 10 000 persons in the European Union.

| (2) | A Community Action Programme on Rare Diseases, including genetic diseases, was adopted for the period 1 January 1999 to 31 December 2003. This programme defined the prevalence for a rare disease as affecting no more than 5 per 10 000 persons in the European Union
  , a number to be judged on a statistical basis subject to a scientific review
  . |
| --- | --- |

(2)

A Community Action Programme on Rare Diseases, including genetic diseases, was adopted for the period 1 January 1999 to 31 December 2003. This programme defined the prevalence for a rare disease as affecting no more than 5 per 10 000 persons in the European Union
  , a number to be judged on a statistical basis subject to a scientific review
  .

, a number to be judged on a statistical basis subject to a scientific review

Amendment 3

Amendment 3

Proposal for a recommendation

Proposal for a recommendation

Recital 2 a (new)

Recital 2 a (new)

| (2a) | Based on this statistical incidence, rare diseases should be meticulously catalogued and reviewed regularly by a scientific committee to determine the need for possible additions. |
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(2a)

(2a)

Based on this statistical incidence, rare diseases should be meticulously catalogued and reviewed regularly by a scientific committee to determine the need for possible additions.

Based on this statistical incidence, rare diseases should be meticulously catalogued and reviewed regularly by a scientific committee to determine the need for possible additions.

Amendment 4

Amendment 4

Proposal for a recommendation

Proposal for a recommendation

Recital 4

Recital 4

| (4) | It is estimated that between 5 000 and 8 000 distinct rare diseases exist today, affecting between 6 % and 8 % of the population in the course of their lives. In other words, between 27 and 36 million people in the European Union. Most of them suffer from less frequently-occurring diseases affecting one in 100 000 people or less. |
| --- | --- |

(4)

It is estimated that between 5 000 and 8 000 distinct rare diseases exist today, affecting between 6 % and 8 % of the population in the course of their lives. In other words, between 27 and 36 million people in the European Union. Most of them suffer from less frequently-occurring diseases affecting one in 100 000 people or less.

| (4) | It is estimated that between 5 000 and 8 000 distinct rare diseases exist today, affecting between 6 % and 8 % of the population in the course of their lives. In other words,
  although rare diseases are characterised by low prevalence for each one of them, the total number of people affected is quite high, ranging
  between 27 and 36 million people in the European Union. Most of them suffer from less frequently-occurring diseases affecting one in 100 000 people or less. |
| --- | --- |

(4)

It is estimated that between 5 000 and 8 000 distinct rare diseases exist today, affecting between 6 % and 8 % of the population in the course of their lives. In other words,
  although rare diseases are characterised by low prevalence for each one of them, the total number of people affected is quite high, ranging
  between 27 and 36 million people in the European Union. Most of them suffer from less frequently-occurring diseases affecting one in 100 000 people or less.

although rare diseases are characterised by low prevalence for each one of them, the total number of people affected is quite high, ranging

Amendment 5

Amendment 5

Proposal for a recommendation

Proposal for a recommendation

Recital 5

Recital 5

| (5) | Because of their low prevalence
  and
  their specificity, rare diseases call for a global approach based on special and combined efforts to prevent significant morbidity or avoidable premature mortality, and to improve quality of life and socio-economic potential of affected persons. |
| --- | --- |

(5)

Because of their low prevalence
  and
  their specificity, rare diseases call for a global approach based on special and combined efforts to prevent significant morbidity or avoidable premature mortality, and to improve quality of life and socio-economic potential of affected persons.

and

| (5) | Because of their low prevalence
  ,
  their specificity
  and the high total number of cases
  , rare diseases call for a global approach based on special and combined efforts
  , including in partnership with third countries such as the United States,
  to prevent significant morbidity or avoidable premature mortality, and to improve quality of life and socio-economic potential of affected persons
  in developed and developing countries. |
| --- | --- |

(5)

Because of their low prevalence
  ,
  their specificity
  and the high total number of cases
  , rare diseases call for a global approach based on special and combined efforts
  , including in partnership with third countries such as the United States,
  to prevent significant morbidity or avoidable premature mortality, and to improve quality of life and socio-economic potential of affected persons
  in developed and developing countries.

,

and the high total number of cases

, including in partnership with third countries such as the United States,

in developed and developing countries.

Amendment 6

Amendment 6

Proposal for a recommendation

Proposal for a recommendation

Recital 8

Recital 8

| (8) | In order to improve the coordination and coherence of national, regional and local initiatives addressing rare diseases, all relevant national actions in the field of rare diseases should be integrated into national plans for rare diseases. |
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(8)

In order to improve the coordination and coherence of national, regional and local initiatives addressing rare diseases, all relevant national actions in the field of rare diseases should be integrated into national plans for rare diseases.

| (8) | In order to improve the coordination and coherence of national, regional and local initiatives
  and cooperation between research centres
  addressing rare diseases, all relevant national actions in the field of rare diseases should be integrated into national plans for rare diseases. |
| --- | --- |

(8)

In order to improve the coordination and coherence of national, regional and local initiatives
  and cooperation between research centres
  addressing rare diseases, all relevant national actions in the field of rare diseases should be integrated into national plans for rare diseases.

and cooperation between research centres

Amendment 7

Amendment 7

Proposal for a recommendation

Proposal for a recommendation

Recital 13

Recital 13

| (13) | The Community added-value of European reference networks is particularly high for rare diseases by reason of the rarity of these conditions, which implies both limited number of patients and scarcity of expertise within a single country. Gathering expertise at European level is therefore paramount to ensure equal access to high quality care to rare disease patients. |
| --- | --- |

(13)

The Community added-value of European reference networks is particularly high for rare diseases by reason of the rarity of these conditions, which implies both limited number of patients and scarcity of expertise within a single country. Gathering expertise at European level is therefore paramount to ensure equal access to high quality care to rare disease patients.

| (13) | The Community added-value of European reference networks is particularly high for rare diseases by reason of the rarity of these conditions, which implies both limited number of patients and scarcity of expertise within a single country. Gathering expertise at European level is therefore paramount to ensure equal access
  to accurate information, appropriate and timely diagnosis and
  to high quality care to rare disease patients. |
| --- | --- |

(13)

The Community added-value of European reference networks is particularly high for rare diseases by reason of the rarity of these conditions, which implies both limited number of patients and scarcity of expertise within a single country. Gathering expertise at European level is therefore paramount to ensure equal access
  to accurate information, appropriate and timely diagnosis and
  to high quality care to rare disease patients.

to accurate information, appropriate and timely diagnosis and

Amendment 8

Amendment 8

Proposal for a recommendation

Proposal for a recommendation

Recital 14 a (new)

Recital 14 a (new)

| (14a) | On 12 October 2008 the Pharmaceutical Forum adopted its final report, which proposes guidelines to enable Member States, stakeholders and the Commission to step up their efforts to guarantee easier and swifter access to orphan medicinal products within the European Union. |
| --- | --- |

(14a)

(14a)

On 12 October 2008 the Pharmaceutical Forum adopted its final report, which proposes guidelines to enable Member States, stakeholders and the Commission to step up their efforts to guarantee easier and swifter access to orphan medicinal products within the European Union.

On 12 October 2008 the Pharmaceutical Forum adopted its final report, which proposes guidelines to enable Member States, stakeholders and the Commission to step up their efforts to guarantee easier and swifter access to orphan medicinal products within the European Union.

Amendment 9

Amendment 9

Proposal for a recommendation

Proposal for a recommendation

Recital 20

Recital 20

| (20) | Patients and patients’ representatives should therefore be involved at all steps of the policy and decision-making processes. Their activities should be actively promoted and supported, including financially, in each Member State. |
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(20)

Patients and patients’ representatives should therefore be involved at all steps of the policy and decision-making processes. Their activities should be actively promoted and supported, including financially, in each Member State.

| (20) | Patients and patients’ representatives should therefore be involved at all steps of the policy and decision-making processes. Their activities should be actively promoted and supported, including financially, in each Member State
  , but also at EU level in terms of pan-EU patient support networks for specific rare diseases
  . |
| --- | --- |

(20)

Patients and patients’ representatives should therefore be involved at all steps of the policy and decision-making processes. Their activities should be actively promoted and supported, including financially, in each Member State
  , but also at EU level in terms of pan-EU patient support networks for specific rare diseases
  .

, but also at EU level in terms of pan-EU patient support networks for specific rare diseases

Amendment 10

Amendment 10

Proposal for a recommendation

Proposal for a recommendation

Recommendations to Member States – paragraph 1 – introductory part

Recommendations to Member States – paragraph 1 – introductory part

| 1. | Establish national plans for rare diseases in order to ensure to patients with rare diseases universal access to high quality care, including diagnostics, treatments and orphan drugs throughout their national territory on the basis of equity and solidarity throughout the EU, and in particular: |
| --- | --- |

1.

Establish national plans for rare diseases in order to ensure to patients with rare diseases universal access to high quality care, including diagnostics, treatments and orphan drugs throughout their national territory on the basis of equity and solidarity throughout the EU, and in particular:

| 1. | Establish national plans for rare diseases in order to ensure to patients with rare diseases universal access to high quality care, including diagnostics, treatments and orphan drugs
  , as well as rehabilitation and habilitation for those living with the disease
  throughout their national territory on the basis of equity and solidarity throughout the EU, and in particular: |
| --- | --- |

1.

Establish national plans for rare diseases in order to ensure to patients with rare diseases universal access to high quality care, including diagnostics, treatments and orphan drugs
  , as well as rehabilitation and habilitation for those living with the disease
  throughout their national territory on the basis of equity and solidarity throughout the EU, and in particular:

, as well as rehabilitation and habilitation for those living with the disease

Amendment 11

Amendment 11

Proposal for a recommendation

Proposal for a recommendation

Recommendations to Member States – paragraph 1 – point 1

Recommendations to Member States – paragraph 1 – point 1

| (1) | elaborate and adopt a comprehensive and integrated strategy, by the end of
  2011
  , aimed at guiding and structuring all relevant actions in the field of rare diseases in the form of a national plan for rare diseases; |
| --- | --- |

(1)

elaborate and adopt a comprehensive and integrated strategy, by the end of
  2011
  , aimed at guiding and structuring all relevant actions in the field of rare diseases in the form of a national plan for rare diseases;

2011

| (1) | elaborate and adopt a comprehensive and integrated strategy, by the end of
  2010
  , aimed at guiding and structuring all relevant actions in the field of rare diseases in the form of a national plan for rare diseases; |
| --- | --- |

(1)

elaborate and adopt a comprehensive and integrated strategy, by the end of
  2010
  , aimed at guiding and structuring all relevant actions in the field of rare diseases in the form of a national plan for rare diseases;

2010

Amendment 12

Amendment 12

Proposal for a recommendation

Proposal for a recommendation

Recommendations to Member States – paragraph 1 – point 3

Recommendations to Member States – paragraph 1 – point 3

| (3) | define a limited number of priority actions within the national plan for rare diseases, with concrete objectives, clear deadlines, management structures and regular reports; |
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(3)

define a limited number of priority actions within the national plan for rare diseases, with concrete objectives, clear deadlines, management structures and regular reports;

| (3) | define a limited number of priority actions within the national plan for rare diseases, with concrete objectives, clear deadlines
  , substantial and clearly designated funding
  , management structures and regular reports; |
| --- | --- |

(3)

define a limited number of priority actions within the national plan for rare diseases, with concrete objectives, clear deadlines
  , substantial and clearly designated funding
  , management structures and regular reports;

, substantial and clearly designated funding

Amendment 13

Amendment 13

Proposal for a recommendation

Proposal for a recommendation

Paragraph 1 – point 3 a (new)

Paragraph 1 – point 3 a (new)

| (3a) | Declare whether they have any specialised centres and compile a catalogue of experts; |
| --- | --- |

(3a)

(3a)

Declare whether they have any specialised centres and compile a catalogue of experts;

Declare whether they have any specialised centres and compile a catalogue of experts;

Amendment 14

Amendment 14

Proposal for a recommendation

Proposal for a recommendation

Recommendations to Member States – paragraph 1 – point 5

Recommendations to Member States – paragraph 1 – point 5

| (5) | include in the national plans provisions designed to ensure equitable access to high quality care, including diagnostics, treatments and orphan drugs, to all rare disease patients throughout their national territory with a view to ensuring equitable access to quality care on the basis of equity and solidarity throughout the European Union. |
| --- | --- |

(5)

include in the national plans provisions designed to ensure equitable access to high quality care, including diagnostics, treatments and orphan drugs, to all rare disease patients throughout their national territory with a view to ensuring equitable access to quality care on the basis of equity and solidarity throughout the European Union.

to

| (5) | include in the national plans provisions designed to ensure equitable access to high quality care, including diagnostics,
  primary preventive measures,
  treatments and orphan drugs,
  as well as rehabilitation and habilitation for those living with the disease for the benefit of
  all rare disease patients throughout their national territory with a view to ensuring equitable access to quality care on the basis of equity and solidarity throughout the European Union
  following the principles agreed in the High Level Pharmaceutical Forum paper entitled ‘Improving access to orphan medicines for all affected EU citizens’
  . |
| --- | --- |

(5)

include in the national plans provisions designed to ensure equitable access to high quality care, including diagnostics,
  primary preventive measures,
  treatments and orphan drugs,
  as well as rehabilitation and habilitation for those living with the disease for the benefit of
  all rare disease patients throughout their national territory with a view to ensuring equitable access to quality care on the basis of equity and solidarity throughout the European Union
  following the principles agreed in the High Level Pharmaceutical Forum paper entitled ‘Improving access to orphan medicines for all affected EU citizens’
  .

primary preventive measures,

as well as rehabilitation and habilitation for those living with the disease for the benefit of

following the principles agreed in the High Level Pharmaceutical Forum paper entitled ‘Improving access to orphan medicines for all affected EU citizens’

Amendment 15

Amendment 15

Proposal for a recommendation

Proposal for a recommendation

Recommendations to Member States – paragraph 1 – point 5 a (new)

Recommendations to Member States – paragraph 1 – point 5 a (new)

| (5a) | encourage efforts to avoid rare diseases which are hereditary, through:










  (a) | genetic counselling of carrier parents; and |
| --- | --- | --- |

(5a)

(5a)

encourage efforts to avoid rare diseases which are hereditary, through:

encourage efforts to avoid rare diseases which are hereditary, through:

(a)

(a)

genetic counselling of carrier parents; and

genetic counselling of carrier parents; and

| (b) | where appropriate and not contrary to existing national laws and always on a voluntary basis, through pre-implantation selection of healthy embryos. |
| --- | --- |

(b)

(b)

where appropriate and not contrary to existing national laws and always on a voluntary basis, through pre-implantation selection of healthy embryos.

where appropriate and not contrary to existing national laws and always on a voluntary basis, through pre-implantation selection of healthy embryos.

Amendment 16

Amendment 16

Proposal for a recommendation

Proposal for a recommendation

Recommendations to Member States – paragraph 1 – point 5 b (new)

Recommendations to Member States – paragraph 1 – point 5 b (new)

| (5b) | provide for exceptional measures within the national plans in relation to making available medicinal products which have no marketing authorisation, when there is a real public health need; and, in the absence of appropriate and available therapeutic alternatives in a Member State, and when the risk/benefit balance is presumed to be positive, ensure that patients affected by rare diseases have access to the medicinal products in question. |
| --- | --- |

(5b)

(5b)

provide for exceptional measures within the national plans in relation to making available medicinal products which have no marketing authorisation, when there is a real public health need; and, in the absence of appropriate and available therapeutic alternatives in a Member State, and when the risk/benefit balance is presumed to be positive, ensure that patients affected by rare diseases have access to the medicinal products in question.

provide for exceptional measures within the national plans in relation to making available medicinal products which have no marketing authorisation, when there is a real public health need; and, in the absence of appropriate and available therapeutic alternatives in a Member State, and when the risk/benefit balance is presumed to be positive, ensure that patients affected by rare diseases have access to the medicinal products in question.

Amendment 17

Amendment 17

Proposal for a recommendation

Proposal for a recommendation

Recommendations to Member States – paragraph 1 – point 5 c (new)

Recommendations to Member States – paragraph 1 – point 5 c (new)

| (5c) | establish at the national level multi- stakeholder advisory groups comprising all interested stakeholders to guide governments in the setting up and implementation of national action plans for rare diseases. These should ensure that governments are well-informed and that the decisions taken at national level reflect the views and needs of society. |
| --- | --- |

(5c)

(5c)

establish at the national level multi- stakeholder advisory groups comprising all interested stakeholders to guide governments in the setting up and implementation of national action plans for rare diseases. These should ensure that governments are well-informed and that the decisions taken at national level reflect the views and needs of society.

establish at the national level multi- stakeholder advisory groups comprising all interested stakeholders to guide governments in the setting up and implementation of national action plans for rare diseases. These should ensure that governments are well-informed and that the decisions taken at national level reflect the views and needs of society.

Amendment 18

Amendment 18

Proposal for a recommendation

Proposal for a recommendation

Recommendations to Member States – paragraph 1 – point 5 d (new)

Recommendations to Member States – paragraph 1 – point 5 d (new)

| (5d) | encourage treatments for rare diseases to be funded at national level. Where Member States may not wish or may not be able to have Centres of Excellence, this central national funding should be used to ensure that patients can travel to a Centre in another country. However, it is also vital that this separate budget is annually reviewed and adapted on the basis of the knowledge about patients needing treatment in that given year, and about possible new therapies to be added. This should be done with the input of the multi-stakeholder advisory committees. |
| --- | --- |

(5d)

(5d)

encourage treatments for rare diseases to be funded at national level. Where Member States may not wish or may not be able to have Centres of Excellence, this central national funding should be used to ensure that patients can travel to a Centre in another country. However, it is also vital that this separate budget is annually reviewed and adapted on the basis of the knowledge about patients needing treatment in that given year, and about possible new therapies to be added. This should be done with the input of the multi-stakeholder advisory committees.

encourage treatments for rare diseases to be funded at national level. Where Member States may not wish or may not be able to have Centres of Excellence, this central national funding should be used to ensure that patients can travel to a Centre in another country. However, it is also vital that this separate budget is annually reviewed and adapted on the basis of the knowledge about patients needing treatment in that given year, and about possible new therapies to be added. This should be done with the input of the multi-stakeholder advisory committees.

Amendment 19

Amendment 19

Proposal for a recommendation

Proposal for a recommendation

Recommendations to Member States – paragraph 2 – point 1

Recommendations to Member States – paragraph 2 – point 1

| (1) | implement a European Union common definition of rare diseases as those diseases affecting no more than 5 per 10 000 persons; |
| --- | --- |

(1)

implement a European Union common definition of rare diseases as those diseases affecting no more than 5 per 10 000 persons;

| (1) | implement a European Union common definition of rare diseases as those diseases affecting no more than 5 per 10 000 persons
  , as a number for the whole European Union, but it is very important to know the exact distribution for each Member State
  ; |
| --- | --- |

(1)

implement a European Union common definition of rare diseases as those diseases affecting no more than 5 per 10 000 persons
  , as a number for the whole European Union, but it is very important to know the exact distribution for each Member State
  ;

, as a number for the whole European Union, but it is very important to know the exact distribution for each Member State

Amendment 20

Amendment 20

Proposal for a recommendation

Proposal for a recommendation

Recommendations to Member States – paragraph 2 – point 4

Recommendations to Member States – paragraph 2 – point 4

| (4) | support at national or regional level specific disease information networks, registries and databases. |
| --- | --- |

(4)

support at national or regional level specific disease information networks, registries and databases.

| (4) | support
  , in particular by financial means,
  at
  European,
  national or regional level specific disease information networks, registries and databases
  , including regularly-updated information, which is accessible to the public on the internet
  . |
| --- | --- |

(4)

support
  , in particular by financial means,
  at
  European,
  national or regional level specific disease information networks, registries and databases
  , including regularly-updated information, which is accessible to the public on the internet
  .

, in particular by financial means,

European,

, including regularly-updated information, which is accessible to the public on the internet

Amendment 21

Amendment 21

Proposal for a recommendation

Proposal for a recommendation

Recommendations to Member States – paragraph 3 – point 3

Recommendations to Member States – paragraph 3 – point 3

| (3) | foster participation of national researchers and laboratories in research projects on rare diseases funded at Community level; |
| --- | --- |

(3)

foster participation of national researchers and laboratories in research projects on rare diseases funded at Community level;

| (3) | foster participation of national researchers and laboratories in research projects on rare diseases funded at Community level
  and make use of the possibilities offered by Regulation (EC) No 141/2000 on orphan medicinal products
  ; |
| --- | --- |

(3)

foster participation of national researchers and laboratories in research projects on rare diseases funded at Community level
  and make use of the possibilities offered by Regulation (EC) No 141/2000 on orphan medicinal products
  ;

and make use of the possibilities offered by Regulation (EC) No 141/2000 on orphan medicinal products

Amendment 22

Amendment 22

Proposal for a recommendation

Proposal for a recommendation

Recommendations to Member States – paragraph 3 – point 3 a (new)

Recommendations to Member States – paragraph 3 – point 3 a (new)

| (3a) | foster knowledge-sharing and cooperation between researchers, laboratories and research projects in the European Union and similar institutions in third countries, to bring global benefits not only to the European Union but also to poorer and developing countries, which are less well placed to provide resources for research into rare diseases; |
| --- | --- |

(3a)

(3a)

foster knowledge-sharing and cooperation between researchers, laboratories and research projects in the European Union and similar institutions in third countries, to bring global benefits not only to the European Union but also to poorer and developing countries, which are less well placed to provide resources for research into rare diseases;

foster knowledge-sharing and cooperation between researchers, laboratories and research projects in the European Union and similar institutions in third countries, to bring global benefits not only to the European Union but also to poorer and developing countries, which are less well placed to provide resources for research into rare diseases;

Amendment 23

Amendment 23

Proposal for a recommendation

Proposal for a recommendation

Recommendations to Member States – paragraph 3 – point 4

Recommendations to Member States – paragraph 3 – point 4

| (4) | include in the national plan for rare diseases provisions aimed at fostering research, including public health and social research, in the field of rare diseases, especially with a view to the development of tools such as transversal infrastructures as well as disease-specific projects
  . |
| --- | --- |

(4)

include in the national plan for rare diseases provisions aimed at fostering research, including public health and social research, in the field of rare diseases, especially with a view to the development of tools such as transversal infrastructures as well as disease-specific projects
  .

.

| (4) | include in the national plan for rare diseases provisions aimed at fostering research, including public health and social research, in the field of rare diseases, especially with a view to the development of tools such as transversal infrastructures as well as disease-specific projects,
  and rehabilitation and habilitation programmes for the duration of a rare disease as well as research on diagnostic tests and tools
  ; |
| --- | --- |

(4)

include in the national plan for rare diseases provisions aimed at fostering research, including public health and social research, in the field of rare diseases, especially with a view to the development of tools such as transversal infrastructures as well as disease-specific projects,
  and rehabilitation and habilitation programmes for the duration of a rare disease as well as research on diagnostic tests and tools
  ;

and rehabilitation and habilitation programmes for the duration of a rare disease as well as research on diagnostic tests and tools

Amendment 24

Amendment 24

Proposal for a recommendation

Proposal for a recommendation

Recommendations to Member States – paragraph 3 – point 4 a (new)

Recommendations to Member States – paragraph 3 – point 4 a (new)

| (4a) | provide adequate and long-term funding, for example through public-private partnerships, so as to support research efforts at national and European level and guarantee the sustainability thereof. |
| --- | --- |

(4a)

(4a)

provide adequate and long-term funding, for example through public-private partnerships, so as to support research efforts at national and European level and guarantee the sustainability thereof.

provide adequate and long-term funding, for example through public-private partnerships, so as to support research efforts at national and European level and guarantee the sustainability thereof.

Amendment 25

Amendment 25

Proposal for a recommendation

Proposal for a recommendation

Recommendations to Member States – Paragraph 4 – point 1

Recommendations to Member States – Paragraph 4 – point 1

| (1) | identify national or regional centres of expertise throughout their national territory by the end of 2011, and foster the creation of centres of expertise where they do not exist notably by including in their national plan for rare diseases provisions on the creation of national or regional centres of expertise; |
| --- | --- |

(1)

identify national or regional centres of expertise throughout their national territory by the end of 2011, and foster the creation of centres of expertise where they do not exist notably by including in their national plan for rare diseases provisions on the creation of national or regional centres of expertise;

| (1) | identify national or regional centres of expertise throughout their national territory by the end of 2011, and foster the creation of centres of expertise where they do not exist notably by including in their national plan for rare diseases provisions on the creation of national or regional centres of expertise;
  help compile catalogues of rare diseases and rare diseases experts; |
| --- | --- |

(1)

identify national or regional centres of expertise throughout their national territory by the end of 2011, and foster the creation of centres of expertise where they do not exist notably by including in their national plan for rare diseases provisions on the creation of national or regional centres of expertise;
  help compile catalogues of rare diseases and rare diseases experts;

help compile catalogues of rare diseases and rare diseases experts;

Amendment 26

Amendment 26

Proposal for a recommendation

Proposal for a recommendation

Recommendations to Member States – paragraph 4 – point 3

Recommendations to Member States – paragraph 4 – point 3

| (3) | organise healthcare pathways for patients through the establishment of cooperation with relevant experts within the country or from abroad when necessary; cross-border healthcare, including mobility of patients, health professionals and providers and provision of services through information and communication technologies should be supported where it is necessary to ensure universal access to the specific healthcare needed; |
| --- | --- |

(3)

organise healthcare pathways for patients through the establishment of cooperation with relevant experts within the country or from abroad when necessary; cross-border healthcare, including mobility of patients, health professionals and providers and provision of services through information and communication technologies should be supported where it is necessary to ensure universal access to the specific healthcare needed;

| (3) | organise
  European
  healthcare pathways for
  those
  patients
  suffering from rare diseases
  through the establishment of cooperation with relevant experts within the country or from abroad when necessary; cross-border healthcare, including mobility of patients
  and expertise through data-mobility support
  , health professionals and providers and provision of services through information and communication technologies should be supported where it is necessary to ensure universal access to the specific healthcare needed; |
| --- | --- |

(3)

organise
  European
  healthcare pathways for
  those
  patients
  suffering from rare diseases
  through the establishment of cooperation with relevant experts within the country or from abroad when necessary; cross-border healthcare, including mobility of patients
  and expertise through data-mobility support
  , health professionals and providers and provision of services through information and communication technologies should be supported where it is necessary to ensure universal access to the specific healthcare needed;

European

those

suffering from rare diseases

and expertise through data-mobility support

Amendment 27

Amendment 27

Proposal for a recommendation

Proposal for a recommendation

Recommendations to Member States – paragraph 4 – point 5

Recommendations to Member States – paragraph 4 – point 5

| (5) | ensure that national or regional centres of expertise adhere to the standards defined by the European reference networks for rare diseases taking into due account the needs and expectations of patients and professionals. |
| --- | --- |

(5)

ensure that national or regional centres of expertise adhere to the standards defined by the European reference networks for rare diseases taking into due account the needs and expectations of patients and professionals.

| (5) | ensure that national or regional centres of expertise adhere to the standards defined by the European reference networks for rare diseases taking into due account the needs and expectations of patients and professionals
  , by involving patients in the activities of these centres
  ; |
| --- | --- |

(5)

ensure that national or regional centres of expertise adhere to the standards defined by the European reference networks for rare diseases taking into due account the needs and expectations of patients and professionals
  , by involving patients in the activities of these centres
  ;

, by involving patients in the activities of these centres

Amendment 28

Amendment 28

Proposal for a recommendation

Proposal for a recommendation

Recommendations to Member States – paragraph 4 – point 5 a (new)

Recommendations to Member States – paragraph 4 – point 5 a (new)

| (5a) | encourage, possibly with European Union funding or co-funding, centres and hospitals of expertise to create specific training for professionals in certain rare diseases and allow them to acquire relevant expertise. |
| --- | --- |

(5a)

(5a)

encourage, possibly with European Union funding or co-funding, centres and hospitals of expertise to create specific training for professionals in certain rare diseases and allow them to acquire relevant expertise.

encourage, possibly with European Union funding or co-funding, centres and hospitals of expertise to create specific training for professionals in certain rare diseases and allow them to acquire relevant expertise.

Amendment 29

Amendment 29

Proposal for a recommendation

Proposal for a recommendation

Recommendations to Member States – paragraph 5 – point 1 – point b

Recommendations to Member States – paragraph 5 – point 1 – point b

| (b) | European guidelines on population screening and diagnostic tests; |
| --- | --- |

(b)

European guidelines on population screening and diagnostic tests;

| (b) | European guidelines on population screening and diagnostic tests
  , including genetic tests like heterozygote testing and polar body diagnosis, ensuring high- quality testing and appropriate genetic counselling while respecting ethical diversity in the Member States
  ; |
| --- | --- |

(b)

European guidelines on population screening and diagnostic tests
  , including genetic tests like heterozygote testing and polar body diagnosis, ensuring high- quality testing and appropriate genetic counselling while respecting ethical diversity in the Member States
  ;

, including genetic tests like heterozygote testing and polar body diagnosis, ensuring high- quality testing and appropriate genetic counselling while respecting ethical diversity in the Member States

Amendment 30

Amendment 30

Proposal for a recommendation

Proposal for a recommendation

Recommendations to Member States – paragraph 5 – point 1 – point c

Recommendations to Member States – paragraph 5 – point 1 – point c

| (c) | sharing
  Member States’ assessment reports on the
  therapeutic
  added value of orphan drugs at EU level, in order to minimise delays for access to orphan drugs for rare disease patients; |
| --- | --- |

(c)

sharing
  Member States’ assessment reports on the
  therapeutic
  added value of orphan drugs at EU level, in order to minimise delays for access to orphan drugs for rare disease patients;

sharing

States’

therapeutic

| (c) | establishing
  Member States’ assessment reports on the
  clinical
  added value of orphan drugs at EU level
  within the European Medicines Agency (EMEA) where the relevant European knowledge and expertise is gathered
  , in order to minimise delays for access to orphan drugs for rare disease patients; |
| --- | --- |

(c)

establishing
  Member States’ assessment reports on the
  clinical
  added value of orphan drugs at EU level
  within the European Medicines Agency (EMEA) where the relevant European knowledge and expertise is gathered
  , in order to minimise delays for access to orphan drugs for rare disease patients;

establishing

States’

clinical

within the European Medicines Agency (EMEA) where the relevant European knowledge and expertise is gathered

Amendment 31

Amendment 31

Proposal for a recommendation

Proposal for a recommendation

Recommendations to Member States – paragraph 5 – point 1 – point c a (new)

Recommendations to Member States – paragraph 5 – point 1 – point c a (new)

| (ca) | structural support for investment in the Orphanet database to ensure ease of access to information concerning rare diseases. |
| --- | --- |

(ca)

(ca)

structural support for investment in the Orphanet database to ensure ease of access to information concerning rare diseases.

structural support for investment in the Orphanet database to ensure ease of access to information concerning rare diseases.

Amendment 32

Amendment 32

Proposal for a recommendation

Proposal for a recommendation

Recommendations to Member States – paragraph 6

Recommendations to Member States – paragraph 6

| 6. | Empowerment of patient organisations |
| --- | --- |

6.

Empowerment of patient organisations

| 6. | Empowerment of
  independent
  patient organisations |
| --- | --- |

6.

Empowerment of
  independent
  patient organisations

independent

| (1) | take action to ensure that patients and patients’ representatives are duly consulted at all steps of the policy and decision-making processes in the field of rare diseases, including for the establishment and management of centres of expertise and of European reference networks and for the elaboration of national plans; |
| --- | --- |

(1)

take action to ensure that patients and patients’ representatives are duly consulted at all steps of the policy and decision-making processes in the field of rare diseases, including for the establishment and management of centres of expertise and of European reference networks and for the elaboration of national plans;

| (1) | take action to ensure that patients and
  independent
  patients’ representatives are duly consulted at all steps of the policy and decision-making processes in the field of rare diseases, including for the establishment and management of centres of expertise and of European reference networks and for the elaboration of national plans; |
| --- | --- |

(1)

take action to ensure that patients and
  independent
  patients’ representatives are duly consulted at all steps of the policy and decision-making processes in the field of rare diseases, including for the establishment and management of centres of expertise and of European reference networks and for the elaboration of national plans;

independent

| (2) | support the activities performed by patient organisations, such as awareness-raising, capacity-building and training, exchange of information and best practices, networking, outreach to very isolated patients; |
| --- | --- |

(2)

support the activities performed by patient organisations, such as awareness-raising, capacity-building and training, exchange of information and best practices, networking, outreach to very isolated patients;

| (2) | support the activities performed by
  independent
  patient organisations, such as awareness-raising, capacity-building and training, exchange of information and best practices, networking, outreach to very isolated patients; |
| --- | --- |

(2)

support the activities performed by
  independent
  patient organisations, such as awareness-raising, capacity-building and training, exchange of information and best practices, networking, outreach to very isolated patients;

independent

| (2a) | ensure that funding for patient organisations which is not directly linked to single pharmaceutical companies is provided; |
| --- | --- |

(2a)

(2a)

ensure that funding for patient organisations which is not directly linked to single pharmaceutical companies is provided;

| (2b) | facilitate patient access to information existing at European level concerning medicines, treatments or treatment centres in the Member States or third countries providing medical care specifically suited to their illnesses; |
| --- | --- |

(2b)

(2b)

facilitate patient access to information existing at European level concerning medicines, treatments or treatment centres in the Member States or third countries providing medical care specifically suited to their illnesses;

| (3) | include in the national plans for rare diseases provisions on the support to and the consultation of patient organisations as referred to in paragraphs (1) and (2). |
| --- | --- |

(3)

include in the national plans for rare diseases provisions on the support to and the consultation of patient organisations as referred to in paragraphs (1) and (2).

| (3) | include in the national plans for rare diseases provisions on the support to and the consultation of
  independent
  patient organisations as referred to in paragraphs (1) and (2)
  ; ensure that national plans provide for the identification of national or regional centres of expertise and for the compilation of catalogues of experts on rare diseases. |
| --- | --- |

(3)

include in the national plans for rare diseases provisions on the support to and the consultation of
  independent
  patient organisations as referred to in paragraphs (1) and (2)
  ; ensure that national plans provide for the identification of national or regional centres of expertise and for the compilation of catalogues of experts on rare diseases.

independent

; ensure that national plans provide for the identification of national or regional centres of expertise and for the compilation of catalogues of experts on rare diseases.

Amendment 33

Amendment 33

Proposal for a recommendation

Proposal for a recommendation

Recommendations to the Commission – paragraph -1 (new)

Recommendations to the Commission – paragraph -1 (new)

| (-1) | To support, in a sustainable way, ‘Orphanet’, a European website and ‘one-stop shop’ providing the following information:









  (a) | on the existence of specific research into rare diseases, the findings thereof and their availability to patients, |
| --- | --- | --- |

(-1)

(-1)

To support, in a sustainable way, ‘Orphanet’, a European website and ‘one-stop shop’ providing the following information:

(a)

(a)

on the existence of specific research into rare diseases, the findings thereof and their availability to patients,

on the existence of specific research into rare diseases, the findings thereof and their availability to patients,

| (b) | on available medicines for each rare disease, |
| --- | --- |

(b)

(b)

on available medicines for each rare disease,

on available medicines for each rare disease,

| (c) | on the treatment existing in each Member State for each rare disease, |
| --- | --- |

(c)

(c)

on the treatment existing in each Member State for each rare disease,

on the treatment existing in each Member State for each rare disease,

| (d) | on existing specialist medical centres in Member States or third countries for each rare disease. |
| --- | --- |

(d)

(d)

on existing specialist medical centres in Member States or third countries for each rare disease.

on existing specialist medical centres in Member States or third countries for each rare disease.

Amendment 34

Amendment 34

Proposal for a recommendation

Proposal for a recommendation

Recommendations to the Commission – paragraph 1

Recommendations to the Commission – paragraph 1

| 1. | To produce an implementation report on this Recommendation addressed to the Council, the European Parliament, the European Economic and Social Committee and the Committee of the Regions on the basis of the information provided by the Member States, not later than in the end of
  the fifth year after the date of adoption of this Recommendation, to consider the extent to which the proposed measures are working effectively, and to consider the need for further action
  . |
| --- | --- |

1.

To produce an implementation report on this Recommendation addressed to the Council, the European Parliament, the European Economic and Social Committee and the Committee of the Regions on the basis of the information provided by the Member States, not later than in the end of
  the fifth year after the date of adoption of this Recommendation, to consider the extent to which the proposed measures are working effectively, and to consider the need for further action
  .

the fifth year after the date of adoption of this Recommendation, to consider the extent to which the proposed measures are working effectively, and to consider the need for further action

| 1. | To produce an implementation report on this Recommendation addressed to the Council, the European Parliament, the European Economic and Social Committee and the Committee of the Regions on the basis of the information provided by the Member States, not later than in the end of
  2012, the year in which it will propose the implementing actions covering inter alia:










  a) | the budgetary measures necessary for the Community Programme on Rare Diseases to be effective; |
| --- | --- | --- |

1.

To produce an implementation report on this Recommendation addressed to the Council, the European Parliament, the European Economic and Social Committee and the Committee of the Regions on the basis of the information provided by the Member States, not later than in the end of
  2012, the year in which it will propose the implementing actions covering inter alia:

2012, the year in which it will propose the implementing actions covering inter alia:

a)

a)

the budgetary measures necessary for the Community Programme on Rare Diseases to be effective;

the budgetary measures necessary for the Community Programme on Rare Diseases to be effective;

| b) | the creation of relevant networks of centres of expertise; |
| --- | --- |

b)

b)

the creation of relevant networks of centres of expertise;

the creation of relevant networks of centres of expertise;

| c) | the collection of epidemiological data on rare diseases; |
| --- | --- |

c)

c)

the collection of epidemiological data on rare diseases;

the collection of epidemiological data on rare diseases;

| d) | the mobility of experts and professionals; |
| --- | --- |

d)

d)

the mobility of experts and professionals;

the mobility of experts and professionals;

| e) | the mobility of patients; and |
| --- | --- |

e)

e)

the mobility of patients; and

the mobility of patients; and

| f) | consideration of the need for other actions to improve the lives of patients affected by rare diseases and those of their families. |
| --- | --- |

f)

f)

consideration of the need for other actions to improve the lives of patients affected by rare diseases and those of their families.

consideration of the need for other actions to improve the lives of patients affected by rare diseases and those of their families.

---