Overcoming fragmentation of health research in Europe: lessons from COVID-19
Authors: Karin R Sipido, Fernando Antoñanzas, Julio Celis, Laurent Degos, Richard Frackowiak, Valentin Fuster, Detlev Ganten, Steffen Gay, Hans Hofstraat, Stephen T Holgate, Gabriel Krestin, Michael Manns, Francoise Meunier, Wolfgang Oertel, Susanna Palkonen, Dainius Pavalkis, Helga Rübsamen-Schaeff, Ulf Smith, Bente Merete Stallknecht, Tomáš Zima
Journal: The Lancet (2020)

We face an unprecedented crisis in our interconnected world where health and wellbeing, security, and economy affect populations across borders. Individual and societal health is valued widely, with care for the planet and health top priorities for European citizens. Europe's answer to COVID-19 comes with long-term geopolitical and economic consequences and, in this intense spotlight, EU health policy weaknesses are starkly apparent. The EU's focus has always been the economy: health and health care are not primary competences. For this reason, the COVID-19 response has suffered intensely from a lack of coordination and consequent inequity in access to care. The health and economic crisis has been a wake-up call. On May 27, 2020, the European Commission (EC) presented its recovery plan, Europe4Health, integrated in the proposal for the next Multiannual Financial Framework 2021–27. Although the economy is still the primary focus, EU initiatives for health and health care are prominent. Health research is a gateway to better health, and it is an EU competence. EU framework programmes and initiatives have shown the power and impact of research collaborations that cross borders and sectors. In response to COVID-19, substantial research funding was quickly made available. However, most initiatives remain with member states who provide more than 85% of total spending for publicly funded research. European funding policy, by contrast with policies from other large regions,1Dzau V Fuster V Frazer J Snair M Investing in global health for our future.N Engl J Med. 2017; 377: 1292-1296Crossref PubMed Scopus (35) Google Scholar is fragmented through lack of continuity and coordination, within the EU and between EU and member states. This threatens the quality of health research, health care, crisis responsiveness, and EU health innovation competitiveness. Research for health should not be hampered by programme boundaries between basic research, innovation, implementation in treatment, and diagnosis and prevention; evaluation of cost-effectiveness and ensuring an affordable health-care system across Europe are an integral part of health research. The COVID-19 pandemic painfully highlights the need for a pan-European coordinated approach in crucial areas of research including data collection and access, diagnostics implementation, and strategy for the development of innovative treatments. Even if the next framework programme, Horizon Europe, takes an inspiring step in aligning health research across EC directorates, more is needed. The new EU policies under discussion should look beyond crisis management and threats of infectious diseases. More research funding within a fragmented system is not sufficient. A coordinated One Health approach that involves all stakeholders is needed for structured priority-setting on complex, diverse challenges. It should be based on an ambitious vision, with a comprehensive strategy and dedicated leadership. The Scientific Panel for Health expert group within the Horizon 2020 programme2Celis JE Gago JM Shaping science policy in Europe.Mol Oncol. 2014; 8: 447-457Crossref PubMed Scopus (15) Google Scholar, 3Sipido K Degos L Frackowiak R et al.Scientific Panel for Health: better research for better health.Lancet. 2016; 388: 865-866Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar convened experts across sectors and research fields throughout Europe to formulate recommendations for health research (appendix).3Sipido K Degos L Frackowiak R et al.Scientific Panel for Health: better research for better health.Lancet. 2016; 388: 865-866Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar, 4Scientific Panel for HealthBuilding the future of health research.https://ec.europa.eu/programmes/horizon2020/en/h2020-section/scientific-panel-health-sphDate: 2018Date accessed: April 20, 2020Google Scholar To address fragmentation a coordinating body, a European Council for Health Research (EuCHR), was considered an urgent, necessary first step. A multistakeholder policy board would develop a long-term vision and strategy, and a scientific translational board would enhance synergies between research programmes and implement action through funding mechanisms. Rather than adding an organisational layer, a EuCHR would build on existing structures and mandates in the spirit of health in all policies. Four key strategic priorities are listed in the panel.PanelAims and recommendations in four strategic areas for EuropeFocus on healthy life, wellbeing, and public health•Promote health, implement public health, and innovate health-care systems•Convergence of social and behavioural sciences, epidemiology, environmental research, and digital innovation•Cross-sectoral collaboration for pan-European policies for public healthInvestment in translational research•Secure a pipeline of ideas to reach the stage of implementation•Invest in research on health-care organisation, outcomes, financing models, and attrition of ineffective treatments for affordable health careCapacity building•Reduce unacceptable health inequalities across Europe•An adequately trained workforce for health research, translation, and innovation in health care, placing patients and citizens at the centre•Pan-European infrastructures for digitalisation and artificial intelligencePartnerships•A European strategy to ensure bundling of activities, including national research themes where appropriate, between academic and industrial research•Associated countries and a post-Brexit UK must be partners when setting out a long-term health planMore details on these recommendations are available in the appendix. Focus on healthy life, wellbeing, and public health •Promote health, implement public health, and innovate health-care systems•Convergence of social and behavioural sciences, epidemiology, environmental research, and digital innovation•Cross-sectoral collaboration for pan-European policies for public health Investment in translational research •Secure a pipeline of ideas to reach the stage of implementation•Invest in research on health-care organisation, outcomes, financing models, and attrition of ineffective treatments for affordable health care Capacity building •Reduce unacceptable health inequalities across Europe•An adequately trained workforce for health research, translation, and innovation in health care, placing patients and citizens at the centre•Pan-European infrastructures for digitalisation and artificial intelligence Partnerships •A European strategy to ensure bundling of activities, including national research themes where appropriate, between academic and industrial research•Associated countries and a post-Brexit UK must be partners when setting out a long-term health plan More details on these recommendations are available in the appendix. Under the Finnish presidency of the 2019 EU Council, conclusions were to "… put people and their wellbeing at the centre of policy design".5European CouncilEconomy of wellbeing: the Council adopts conclusions.https://www.consilium.europa.eu/en/press/press-releases/2019/10/24/economy-of-wellbeing-the-council-adopts-conclusions/Date: Oct 29, 2019Date accessed: April 20, 2020Google Scholar The European model for health is based on societal value, and Europe should be one of the master builders for global health. Now is the time to act and implement a structured, visionary and value-based European health union, with performant health research at its core. STH is undertaking a COVID-19 clinical trial and is a Non-Executive Director of Synairgen. SP is employed by the European Federation of Allergy and Airways Diseases Patients Associations and has voluntary functions as chair of the Patient Access Partnership. All other authors declare no competing interests. This Correspondence draws on the work of the Horizon 2020 Scientific Panel for Health. The authors thank the participants of Scientific Panel for Health conferences and workshops for sharing their ideas, and the P95 secretariat for support in drafting the manuscript. The opinions expressed in this Correspondence are those of the authors only and should not be considered as representative of the European Commission's official position. Download .pdf (.21 MB) Help with pdf files Supplementary appendix