EFPIA’s “Integrated Strategy”: Out of the Frying Pan, Into the Fire?

It’s difficult to open an email or an envelope in Brussels these days without yet another agenda falling out of it, carrying the promise of a new start. With a new European Parliament installed, a new European Commission president appointed and a new Commission on the way, and guarded optimism that the worst of the recession is over, this outpouring of recommendations and recipes is hardly surprising.

One of the most grandiose of the manifestos and strategy proposals from industry, regulators and campaigning organizations currently doing the rounds in Europe is the self-styled “groundbreaking vision towards a life sciences strategy for Europe”, launched in high summer by the European Federation of Pharmaceutical Industries and Associations (EFPIA).

It is reasonable to expect that new European leaders and policymakers will begin work to improve Europe’s future. But given the notorious absence of political collaboration in European health affairs, it is imprudent to assume that all that work will improve the situation for the drug industry.

Given the fundamental nature of the challenges that Europe is facing, what emerges may actually be worse than the current imperfect context for medicines. EFPIA and other industry advocates of radical change run the risk of jumping out of the frying pan only to find themselves in the fire.

The essence of the EFPIA call to arms is a plea for “a new generation of partnerships and collaborative solutions to address the EU’s growing health and competitiveness challenges”. It urges changes in perception, more “thinking outside the box”, better understanding of future demands and of the value of investment, and the “need to address the system as a whole” in order to create sustainable systems. Of course the central refrain of the vision is “ensuring that the pharmaceutical and life sciences industries – jewels in Europe’s economy – continue to thrive”. Consequently, much of the content is devoted to the need for the industry to be “highly competitive” and for “innovation-led growth”. The merits of the industry - in terms of those familiar claims relating to products, jobs, exports, or research commitment - occupy much of this manifesto.

So too does the catalogue of the economic problems the industry faces. EFPIA warns against “making it difficult to obtain innovative medicines, increasing user charges, or delisting services from the benefits catalogue”. It complains about the distortion that international reference pricing creates in the European market for medicines - going so far as to call for an urgent review of “the practical operation of the free movement of goods principle in medicines”. It blames “the current patchwork of valuation and assessment criteria across Europe” for being “arbitrary and politicized”, and “leading to wasteful and costly duplication of effort”. And it cautions that “arbitrary financial policies” are inhibiting investment in research.

But there is a form of selective myopia in the EFPIA strategy vision. Its president, Christopher Viehbacher, who is also CEO Sanofi, said as he outlined the strategy: “Only a significant improvement in health outcomes, supported by increased innovation, can keep healthcare expenditure under control.”

This is not strictly speaking true. It presupposes that the long-hallowed approach to healthcare expenditure remains intact: that is, seeking better and better medicines to treat more and more illnesses.

That presumption is at the very least questionable, and at worst may be rendered invalid by seismic shift in European health strategy that could profoundly modify the resource-allocation between treatment and prevention.

If the allocation of resources was inverted (it is customarily estimated that less than 5% of current healthcare spending is devoted to prevention, with the rest devoted to treatment), it might also be possible to keep healthcare expenditure under control and improve health outcomes without the contribution from increased innovation that Viehbacher and EFPIA appear to be counting on.

EFPIA quotes European Commission estimates that, without new approaches, average healthcare spending could rise from 7 to 9 per cent of GDP by 2060, placing a strain on national finances. The conclusion EFPIA draws, that “halting and reversing the progression of chronic diseases is the best investment that health systems can make”, may be correct - but it may also be true that the objective might be achieved by prevention rather than by treatment.

Against this background, EFPIA may not win the backing it expects for its priorities of “removal of inequalities to better patient benefits”, support for “systems to speed access to medicines”, or “the building of a thriving innovative life sciences sector”. If the outcome of all this radical re-thinking and new partnerships is that much greater priority is given to prevention, EFPIA’s ambitions for a “new European life sciences strategy that will benefit patients and society as a whole” may prove to be of no benefit whatever to the drug industry.

On the contrary, budgets for treatment might be subject to cuts much sharper than those that industry currently complains of, and the trends in spending might move resources irreversibly from treatment to prevention. Industry optimists would do well to remember the sombre conclusion of that famous couplet about hope springing eternal in the human breast. It concludes tartly: “Man never is, but always to be, blest”.