Online live event 30 September – 2 October As discussed in Gastein: Conference Report Dancing with elephants New partnerships for health, democracy, business CONFERENCE REPORTLists of abbreviations AI AMR CEE COVID-19 DG DG RTD DG SANTE EC ECDC EHDS EHU EMA EP ES EU EUR GARP GDPR HiAP HWF MS NCD OBS OECD PHC PPE PPP R&D RWE SDGs Agenda 2030 UHC UN UNDP WE WHO Artificial Intelligence Antimicrobial resistance Central and Eastern Europe Coronavirus disease 2019 (caused by Severe Acute Respiratory Syndrome Coronavirus 2 or SARS-CoV-2) Directorate-General DG for Research and Innovation DG for Health and Food Safety European Commission European Centre for Disease Prevention and Control European health data space European Health Union European Medicines Agency European Parliament European Semester European Union Euros Global Antibiotic Resistance Partnership General Data Protection Regulation Health in All Policies Health workforce Member State of the European Union Noncommunicable disease European Observatory on Health Systems and Policies Organisation for Economic Co-operation and Development Primary healthcare Personal Protective Equipment Public-private partnership Research and development Real World Evidence Sustainable Development Goals United Nations 2030 Agenda for Sustainable Development Universal health coverage United Nations United Nations Development Programme Western Europe World Health OrganizationForeword 4 EHFG 2020 in numbers 5 Opening Plenary 6 Thursday Plenary 8 Closing Plenary 10 TRACK I - Resilient systems 12 Health systems resilience 12 Universal health coverage and the role of the health workforce 14 #healsy20 - Lessons learnt from COVID-19 16 Young European Voices 18 Mitigating COVID-19’s impact on health inequalities 20 TRACK II - Advancing innovation 22 Digital Childhoods 22 COVID-19 Vaccines are coming 24 Driving the digital transformation of health 26 AMR and COVID-19 28 Unlocking the potential of data in light of early lessons from COVID-19 30 TRACK III - From data to decisions 32 “Europe Beats” Cancer Plan 32 The advisor’s dilemma 34 Pharmaceutical Strategy for Europe 36 Closing the evidence-practice gap on NCDs 38 TRACK IV - Empowerment and agency 40 Finding the common beat 40 Science of healthy living 42 Cancer care, health literacy & COVID-19 44 Tackling access inequalities in cancer care 46 Health democracy in action 48 Working and living in a new normality 50 Hackathon 52 Contributing Authors 53 Organisers & Partners 54 Imprint 56 EHFG 2020 Conference Report | TABLE OF CONTENTS 4FOREWORDEHFG 2020 CONFERENCE REPORT In October 2019, the EHFG explored ‘A Healthy Dose of Disruption? Transformative change for health and societal well-being’. Little did we know that the year 2020 would turn out to be the most disruptive and transformative year that any of us have ever experienced. The EHFG team has considerable experience in organising events and connecting health stakeholders across many divides, but this year has nevertheless been an adventurous and challenging journey for us, as we moved our annual conference online and started to host webinars under the tagline “Gastein goes online – Policy debates during the pandemic”. We pride ourselves in hosting timely, open, and at times difficult and controversial conversations, and in 2020 we set out to make sure that these Gastein-style discussions continued during this unique and turbulent time. As we are still contending with a global pandemic of unprecedented scope, there is now a greater need than ever for exchange, collaboration, and candid dialogue. From September 30 – October 2, the sessions of the first ever digital edition of the European Health Forum Gastein focused on conceptualising new ways of working with the biggest players that impact the determinants of health and well-being, and building fresh models of constructive collaboration among all stakeholders in health – “dancing with elephants”. In a year that has seen health become a political issue like never before, discussions centred around mobilising the will to regulate, form intersectoral partnerships, and adopt a whole of society approach that accommodates each other’s strengths and limitations, ultimately building back better as we look to the recovery phase of the crisis. We would like to take this opportunity to thank our partners and session organisers, as well as the EHFG Board and Advisory Committee members for their support and contribution to this year’s conference and other activities – and in particular for coming on this new journey with us and navigating the various challenges and bumps in the road! We hope that you will join us at the Forum’s 2021 edition from September 29 - October 1, and encourage you to continue to “dance with the elephants” when it comes to championing better health and well-being in Europe through 2021 and beyond. Stay safe and healthy! Your EHFG Team “I would like the EHFG to be a dance floor - we have to lead the dance with the elephants. We have to overcome the political inertia when it comes to the Health Union and to health in general.” Clemens Martin Auer, President, EHFG 5ABOUT USEHFG 2020 CONFERENCE REPORT Gastein brings together the worlds of politics, science and academia, the private sector, and civil society in a setting where everyone is equal. Hundreds of leading experts participate in the annual conference - the unparalleled mix of participants is especially critical to the success of our event. EHFG 2020 in numbers6OPENING PLENARYEHFG 2020 CONFERENCE REPORT Opening Plenary Recovering from the pandemic The COVID-19 pandemic has left no corner of the world untouched. Societies and individuals’ lives have been upended. Governments grappled with the response to the pandemic by imposing lockdowns and movement restrictions to control the situation. With the relaxation of these measures, a resurgence of cases has occurred. As the northern hemisphere heads into winter, policymakers and scientists are still trying to figure out the best strategies to manage the pandemic. One train of thought is that the economy, already facing the worst recession since the great depression, cannot sustain another hard lockdown or stringent movement restrictions. Some even argue that current public health measures are too restrictive and that public support for them is eroding. These proponents believe that the economy should be prioritised over any health measures to control the disease. An alternative view is that controlling the pandemic should take precedence over boosting economic performance. In the short term, the resurgence in COVID-19 cases across Europe is forcing governments to impose new lockdowns – with one major difference being that this time many schools have remained open. In the long term, it is unclear for many what the future will hold. The EHFG 2020 Opening Plenary asked whether looking to the future the pandemic could be a catalyst for “building back better”? A well-being society Colin Crouch, External Scientific Member, Max Planck Institute for the Study of Societies, and Katherine Trebeck, Advocacy and Influencing Lead, Wellbeing Economy Alliance, argued that even prior to COVID-19 our economies were not delivering for enough people in enough ways. Now we have witnessed that the pandemic has exacerbated inherent inequalities. Many people in higher paying jobs worked from home and thus reduced their risk of being exposed to the virus while maintaining their income. On the other hand, those in low- paid or low-skilled jobs were forced to choose between going to work (placing themselves at increased risk of contracting COVID-19) or not having an income and thus not being able to pay for their basic needs. Could this predicament mark the tipping point for society to transition to a wellbeing economy? “Let´s raise our game and be more ambitious,” challenged Katherine Trebeck, urging decisionmakers to go beyond simply “patching-up” economies to fundamentally transforming and repurposing them to focus on human and ecological well-being over economic growth. Countries that are leading the way in this are New Zealand, Scotland and Wales. Both Crouch and Trebeck believe that public support for this idea is there. The question is, will politicians follow? Organised by European Health Forum Gastein A wake-up call for a well-being society?7OPENING PLENARYEHFG 2020 CONFERENCE REPORT Political perspectives Maggie De Block, Belgium’s Minister of Social Affairs, Public Health, and Asylum and Migration, agreed that the current crisis is an opportunity for politicians to build back better. Maja Fjaestad, State Secretary, Swedish Ministry of Health and Social Affairs, went even further, arguing that politicians need to use the pandemic to create a mandate for change. But she also asserted that a crisis doesn´t automatically translate into an opportunity: for this political will is needed. Both lamented the initial lack of solidarity across the EU and the fact that transnational bodies have not always delivered during this crisis, as well as the challenge of policymaking at a time when science rarely provided clear and quick answers. The pandemic does not respect borders and has emphasised the need to work together, within countries between the scientific community, private sector, civil society, citizens and decisionmakers, as well as between countries, with a more pronounced role for the EU, they agreed. Supranational views Hans Kluge, Regional Director for Europe, World Health Organisation (WHO), said a key lesson learned had been that “Strong health systems based on strong people-centred blanket healthcare, mean strong national health security.” We must ensure we have a dual track response to the pandemic, he stated, controlling and treating COVID-19 while continuing to treat other diseases – and he provided examples demonstrating that delays to treatment of some cancers are costing lives. Kluge gave the uplifting message that nothing is impossible when four key factors are present: necessity, innovation, courage and collaboration. In this regard he highlighted the WHO’s new Monti Commission, a pan-European Commission on health and sustainable development that will rethink policy priorities in light of the pandemic while taking into account the interdependency of health, social cohesion and economic and sustainable development. Does the EU have the means to simultaneously protect its citizens from COVID-19 and recover from an economic crisis? Sandra Gallina, Deputy Director- General, European Commission Directorate-General for Health and Food Safety, was convinced that the means are there, as demonstrated by the EU´s COVID-19 recovery and resilience package and a reinforced EU budget from 2021-2027. She emphasised a number of key priorities for health in the EU in the months and years to come, including investing in the social infrastructure for health and long-term care (there is a €70 billion gap); ensuring enough emergency stocks of PPE, medicines and testing kits; and ensuring affordable and accessible healthcare through universal health coverage. She also highlighted the importance of having a well-trained and better geographically distributed health workforce with improved working conditions. “We have the means and now need the courage of politicians,” she stated. Mental health The panel then discussed a specific health challenge; the mental health problems exacerbated and caused by the pandemic. All agreed the disruption to lives and livelihoods caused by COVID-19 has adversely impacted mental health, from the loneliness caused by people having to isolate, to the insecurity and poverty for those losing their jobs, to the fear and anxiety of catching COVID-19 for frontline workers such as health professionals and teachers. Maja Fjaestad mentioned that in Sweden the risk of increased mental health problems for children and wider family members was one of the reasons behind their decision not to close schools. Hans Kluge described a new Mental Health Coalition recently launched by WHO Europe to address mental health as a critical priority for public health across Europe. The way forward This session ended with a single question to all panellists: what should be prioritised moving forward? There was unanimous consent. We should invest in public health, especially in services for those most vulnerable. Cooperation across disciplines and countries was deemed essential. If there was one overarching message from the session it is that investment in public health will result in healthy communities and sustainable economic development. Ultimately, good health policy is a cornerstone for a fair and equitable society. Learn more Session recording Programme8THURSDAY PLENARYEHFG 2020 CONFERENCE REPORT Thursday Plenary Thanks to the COVID-19 pandemic, humanity has faced its most turbulent year in decades. In a welcome address at the outset of the plenary, Rudolf Anschober, Federal Minister of Social Affairs, Health, Care and Consumer Protection, Austria, lauded the value of cross-sectoral partnerships that generate added societal value, but commented that while it is essential that technology keeps on progressing, we need to ensure that we have the necessary safeguards in place to protect citizens from potential harm – and looking to the future we have to think much more broadly than ever before. Increased surveillance and techno-solutionism in the COVID-19 era Carly Kind, Director, Ada Lovelace Institute, discussed the range of new technologies for health surveillance deployed during the COVID-19 pandemic, from digital contact tracing apps to the use of temperature detection systems and location monitoring to ensure curfew and quarantine compliance. She commented that while the use of data has clearly been incredibly beneficial during the crisis, we have seen an “epidemioloigcal shift in surveillance” which could lead to mission creep or a normalisation of the use of such technologies. She lamented the fact that the social value of data is much better realised by the private sector than by the public sector, commenting: “Data generated by the public is rarely used in the public interest but is used in the private interest for private gain.” The pandemic has also underlined how most of our digital infrastructure is under the control of a few private companies. In terms of COVID-19 digital contact tracing, Google and Apple (who control about 96% of the world´s smartphones) decided which kind of technology to deploy – ultimately making a privacy-preserving choice. However, it was a stark reminder that power does not lie in the hands of the public authorities - and next time the decisions could be different. Casper Klynge, Vice President for European Government Affairs, Microsoft Corporation, pointed out the huge geopolitical impact of big tech companies. Technology in its widest sense has been a positive gamechanger in helping Europe cope with the pandemic, from telemedicine to homeworking, Klynge posited. And looking to the future, it will also be essential to help recreate jobs lost and address COVID-19 in myriad ways. “There is an enormous responsibility for the tech sector to get it right Organised by European Health Forum Gastein A year of disturbance and disruption Digital influences on health, democracy and business9THURSDAY PLENARYEHFG 2020 CONFERENCE REPORT whether we talk about privacy or fundamental rights,” he said. Redressing the public and private sector technological imbalance How then to address the mismatch that the global data ecosystem is skewed to support commercial use rather than the public interest? Kind commented that during the pandemic we have seen lots of regulatory barriers fall and yet data sharing and use was still not optimal. This reveals it is not just about getting regulatory frameworks right but also about getting “getting a culture of data use, good data governance and ethical data standards in place – it is about data standardisation and interoperability of digital infrastructures” she advocated. Kind put forward very practical solutions, focussed on investing in the capacity and upskilling of regulators and governments, and potentially involving an accountability mechanism such as an agile regulatory body for each sector. “This will mean hiring data scientists and ethicists with a speciality in technology issues and investing in the core infrastructure of regulatory mechanisms,” she stated. She also argued for a system similar to pharmaceutical regulations where new technologies are only released to the public after they have met a certain set of criteria. Casper Klynge agreed that the tech sector needed to step-up to the plate, help address the digital divide and partner with the public sector to ensure that regulatory frameworks are effective: “We need to promote a governance system that is transparent and creates accountability around these new technologies. In order to unleash the potential of new tech it is important to get that balance right,” he agreed. Klynge concluded that he has sensed an increased scrutiny from governments and civil society on the issues discussed in the plenary, and that big tech will be called to account in the not-too-distant future. “There will be a judgement day after COVID-19 about how big tech responded and how helpful it was,” he predicted. The COVID-19 infodemic Whether through websites, social media channels or word of mouth, information in the modern age is spreading faster than ever before, and misinformation even faster. In a second panel addressing the COVID-19 infodemic, Andrei Baciu, Secretary of State, Ministry of Health Romania, described a number of fake news stories underplaying the severity of the COVID-19 pandemic that circulated in Moldova, in turn undermining the public health response. The World Health Organization recognised this phenomenon and labelled the COVID-19 “infodemic” a serious threat that contributed to a broader environment of fear and panic. Sylvie Briand, Director of Global Infectious Hazards Preparedness Department, World Health Organization, discussed the WHO response, including making new partnerships with “networks of amplifiers” to whom people turn for trusted information in times of crisis, such as faith-based organisations. Infodemiology was also founded as a new discipline, with the first global conference held online during summer 2020. Raffael Heiss, Postdoctoral Researcher, Management Center Innsbruck, discussed research in Austria that revealed people receiving COVID-19 information through public broadcasting are better informed, more knowledgeable about COVID-19, and less likely to believe conspiracy theories and fake news than those who mostly rely on social media. Social media abounds with fake news, with few gatekeepers to filter out inaccuracies. But misinformation is easier to correct than the phenomenon of strongly held misperceptions, Heiss emphasised. He called for more health, media and politics education in schools, to help people navigate the tsunami of information from all quarters that we have witnessed during the pandemic. European health data space To conclude the session, Andrzrej Rys, Director, Health Systems and Products Directorate, European Commission (EC) Directorate General for Health and Food Safety, discussed the European health data space (EHDS). “We are sitting on billions of data, but their benefit to society is still very low,” he acknowledged. Through the EHDS, the EC hope to mobilise the system and structure the regulatory framework in a cleverer way to capture technological development while allowing the movement of data. This requires a solid infrastructure to allow data collection, exchange and sharing across the continent. Further considerations include how we improve data quality and stimulate semantic interoperability. Last but not least realising all this depends on people skills and developing a culture of data use and sharing between citizens and healthcare providers, as discussed in the first part of the session. There is a lot of work ahead and the session showed how Europe´s role will be crucial as a pacemaker for setting a health data governance standard to protect people’s rights in this area in the future. Learn more Session recording ProgrammeNext >