< Previous20TRACK I - RESILIENT SYSTEMSEHFG 2020 CONFERENCE REPORT Mitigating COVID-19’s impact on health inequalities At the beginning of the outbreak, COVID-19 was sometimes referred to as the “Great Equaliser”. Time and insight have shown that this could not be further from the truth. Not only has the pandemic highlighted existing inequities - it has in fact deepened them and created new ones. The session on mitigating COVID-19’s impact on health inequalities brought together an expert panel to discuss this issue and offer fresh ideas for an equitable and sustainable recovery from the crisis. Setting the tone for the ensuing inputs and debates, Caroline Costongs, Director, EuroHealthNet, advocated for the need to consider this crisis as a syndemic rather than a pandemic: the impacts of COVID-19 are interdependent with long-lasting and unresolved health inequities, often brought about by known socioeconomic risk factors. COVID-19 and social determinants of health Nico Dragano, Professor of Medical Sociology, University of Düsseldorf, pointed out that both the direct and indirect effects of the pandemic, such as the mental health burden resulting from the fear of infection, social isolation, and increased financial insecurity, have disproportionately affected the less fortunate, thereby increasing already existing social and economic inequalities. Working from home, for example, has proven to be a privilege not available to everyone. Ghazala Mir, Associate Professor of Health Equity and Inclusion, University of Leeds, added to this by highlighting that these inequalities and health risks tend to disproportionately affect those from Black, Asian and Minority Ethnic (BAME) backgrounds. Studies from different contexts show that BAME communities are more severely impacted by the pandemic in terms of worse health and economic outcomes. Importantly, there is a political and social dimension to the issue, namely entrenched structural racism and discrimination as well as non-representation in policy processes, which then lead to policy environments that are particularly hostile to these communities. The effects of this trickle right down to the individual level. Members of BAME communities have in many instances been blamed for Organised by EuroHealthNet, The Health Foundation and Trimbos Instituut, The Netherlands Institute of Mental Health and Addiction the spread of the virus, tend to work in lower paid jobs with higher exposure to the virus, and are disadvantaged in terms of risk factors such as housing, education and healthcare access. Structural racism and discrimination can therefore be seen as underlying and transgenerational determinants of health in general, and especially so during the COVID-19 pandemic. More research is needed to properly define the high-risk groups and then better understand the mechanisms by which they experience higher numbers of infections. The answers can help us to design holistic strategies consisting of short- and long-term interventions, some of which may be broad and applicable to the whole population (for example income support measures) and others which are specifically targeted at these vulnerable groups. Investing in an equitable and resilient recovery21TRACK I - RESILIENT SYSTEMSEHFG 2020 CONFERENCE REPORT Mental health consequences of the pandemic Besides the above-mentioned fear of infection and social isolation, the impact of the pandemic on educational attainment and unemployment is reinforcing the substantial negative impact on the mental health of large parts of the population. As Laura Shields-Zeeman, Head of the Department of Mental Health and Prevention, Trimbos Instituut, pointed out, this is consistent with the mental health impact of previous crises, such as the 2008 economic crisis. Experience from these provided strong evidence for an association between economic and social risk-factors and poor mental health status. Moreover, increasing mental health inequalities have been associated with negative developments in terms of other health indicators, such as life expectancy at birth. As studies on the mental health effects of COVID-19 have shown for several countries, the pandemic has led to increased levels of stress, depression, anxiety and sleep problems. While symptoms decrease following the easing of restrictive measures, they still require attention and support. Shields-Zeeman called for both short and long-term interventions on the social and economic determinants of health that focus on mental health and target not only the whole population, but also vulnerable groups in particular. These interventions need to include actors from sectors beyond health. Developing multisectoral solutions The call for more intersectoral cooperation was echoed by Pilar Aparico Azcarraga, Director-General for Public Health, Spanish Ministry of Health, Consumer Affairs and Social Welfare. Also in Spain, COVID-19 has highlighted existing clinical, social and epidemiological vulnerabilities among certain population groups that can only be addressed by interventions involving employment, social protection and education. In line with this, Dana Burduja, Senior Health Economist, European Investment Bank (EIB), referred to the EIB’s commitment to investing in sustainable, long-term recovery processes which include the whole of society and are based on partnerships, with equity being front and centre. International cooperation and the European Union (EU)’s role in recovery Bart Vanhercke, Director, European Social Observatory, recalled that the initial reaction of Member States at the beginning of the pandemic was to safeguard their national interests, making limited use of the cooperation tools available to them. However, after this initial phase, remarkable levels of solidarity and collaboration arose, amongst others also sparking a public debate about the potentially broader role for the EU in health, despite its currently weak legal basis. The need for extending the EU’s competence on health, recognised by many researchers for some time now, has received wider recognition in recent months. Questions from the audience drew attention to the pandemic’s particular impact on students and young people as well as the lack of an eviction ban in Europe, similar to the one implemented in the United States of America, which could help prevent homelessness during the economic crisis. Towards the end of the session, there remained one elephant in the room that did not have a chance to dance: gender. Both audience and panelists agreed that the impact of the pandemic on women deserves more attention and future discussion. Tim Elwell-Sutton, Assistant Director of Strategic Partnerships (Healthy Lives), The Health Foundation, concluded that despite its negative consequences, the pandemic has also created opportunities to address long-standing structural short-comings. However, to make a sustainable recovery possible, the multi- disciplinary approaches that are being discussed and promoted during the crisis need to be realised and carried forward into the future. Learn more Session recording Programme22TRACK II - ADVANCING INNOVATIONEHFG 2020 CONFERENCE REPORT Digital Childhoods Protecting children’s well-being in the digital age Organised by Fondation Botnar and the The Lancet & Financial Times Commission ‘Growing up in a digital world: Governing health futures 2030’ The European Health Forum Gastein 2020 session on Digital Childhoods, organised by Fondation Botnar and the The Lancet & Financial Times Commission ‘Growing up in a digital world: Governing health futures 2030’, was opened by Ilona Kickbusch, Founding Director Global Health Programme, Graduate Institute Geneva, with a question to the audience: Should national digital health strategies be adapted to reflect the needs and vulnerabilities of children and youth, or do we need to develop dedicated strategies specifically for this group? A majority voted for a combination of both integrated and individual solutions, underlining the urgency of devising a consistent and comprehensive framework for advancing digitalisation in a way that caters to the needs and concerns of all of its (future) users. Interestingly, children and youths themselves may not even feel like they are currently experiencing a process of digital transformation, as digitalisation has long been part of their lives and influencing their realities in positive and negative ways. Apart from clear advantages such as the immense potential to close access gaps in areas like mental healthcare, digitalisation carries some downsides. Young people may for example be impacted by anxiety, isolation, bullying, stigmatisation and depression related to the use of new technologies, as well as disrupted sleep routines or reduced physical activity. The impact of digitalisation runs deep and can be fundamental in young people’s lives. As Mark Khurana, Co-founder, JOHO, put it: “It’s a question of identity. We are redefining who we think we are, and who we think other people are.” In moving back and forth between virtual reality and real world, unattainable expectations can be created that may negatively impact young people’s self-image and affect both their physical and mental health. This potentially substantial negative effect on children and youths requires us to be more mindful of the quality of new technologies and the frequency with which they are used. One vital aspect for moving forward in this regard is the sustainable establishment of channels for consultation with youths to allow for the co-creation of both digital technologies themselves as well as the regulations surrounding them. Youth is often ahead of the curve and an early adaptor of new technology - engaging in digital transformations that concern young people without consulting them results in solutions that are already outdated when implemented. It is also crucial to promote both digital literacy and health literacy – separately and taken together - in order to empower individual decision-making around how to appropriately use digital tools and when. Additionally, there is a need to reinforce “civic literacy” to help navigate the blurred lines between real and virtual world, always remembering that our behaviors in both do have the potential to help or harm others. Barbara Bulc, Co-creator, OurCity Initiative, Fondation Botnar, strongly supported the idea of including youths in all aspects 23TRACK II - ADVANCING INNOVATIONEHFG 2020 CONFERENCE REPORT of digitalisation, and outlined how their initiative supported the emergence of new solutions for young people by truly including them in the debate and ensuring that different actors join them around the table, from academia to civil society. With almost 50% of the European population being made up of people under 30 years of age, it seems obvious that young voices are needed for a successful approach to digitalisation, across all disciplines and sectors. The session organisers were also curious to hear more about which aspects related to health technologies should be prioritised by digital policies, specifically when bearing in mind the needs and vulnerabilities of young people. Session participants weighed in with issues concerning privacy, safety, isolation, exploitation and marketing as well as the growing digital divide. The European Union (EU) has so far pioneered solutions in particular in the area of privacy policy, for instance through the General Data Protection Regulation (GDPR), and can hopefully achieve similar progress in other areas. From a national perspective, Hrovje Belani, Head of e-Health and Cybersecurity, Ministry of Health, Croatia, commented on the challenges in addressing the digital divide. He stated that the main difficulty we are facing today is no longer the equitable provision of access to digital technologies in terms of their affordability and availability, but the inequalities in terms of digital literacy and skill. This can hinder the successful implementation of telemedicine and other technologies in healthcare settings. Belani however also pointed to the high proportion of young persons in the EU with considerable digital skills and stressed that the responsibility of policymakers now is to design digital healthcare delivery so as to serve also a new generation of users. Another highly contested issue that was touched upon were access rights: Should parents for example hold access rights to the health records of their children, or should these be accessible to the children only? Here, Belani pointed to how possible approaches could be inspired by for example the education sector, where some e-learning tools have been designed to allow for differential access allowance between parents and children. It is likely that we need similar solutions also for the health sector, where parents can grant access to their children for selected parts of a given platform or service - and vice versa. Andrej Rys, Director, Health Systems and Products Directorate, European Commission (EC), went further into the topic of data Learn more Session recording Programme security and privacy. The EC is involved in digitalisation through tools such as Structural Funds, which amongst other things provide support in building suitable and safe infrastructures within Member States that aim to further decrease inequalities in digitalisation in terms of access e.g. for schools. At the same time, the EC continues to work towards safe structures for data sharing and on new challenges such as the advent of Artificial Intelligence as well as the regulations that need to accompany it. It is important to remember that the policy decisions we take today both on EU and Member State level shape the digital future in Europe and how children will grow up. Lucy Fagan, Global Focal Point, UN Major Group for Children and Youth, reminded us that the digital world is, in the end, a mirror of what is happening in other areas of life and society. She outlined how this means that digitalisation can be a double- edged sword: While it can for example empower women to access information about health that may otherwise not have been accessible without the consent of a male relative, digitalisation can also make vulnerable groups more vulnerable by exposing them more, and reinforcing long-standing problems such as marginalisation, racism and sexism. One of the recurrent themes throughout the debate was the issue of marketing: Algorithms on social platforms can push content in a targeted way, without the individual necessarily realising that they are being presented with only selected pieces of information. An understanding of these dynamics and the ability to critically engage with them is required to safely navigate these environments, something that especially youths may still lack. Moreover, the selection of content tailored to a user’s preferences and characteristics can contributes to the development of addiction disorders in vulnerable individuals. For all of the issues highlighted during the session, engagement and participation of young people were considered key to developing sustainable solutions. Bulc also stressed the importance of supporting and following through with those problem-solving processes that are already taking place in communities and societies. Empowering people by giving them access to decision-making processes is a fundamental step to building digital security and equity – not only but also for Europe’s youngest.24TRACK II - ADVANCING INNOVATIONEHFG 2020 CONFERENCE REPORT COVID-19 Vaccines are coming Magic bullet or a load of blanks? Organised by Vital Transformation Right on its first day, the European Health Forum Gastein featured a session about one of the hottest topics of 2020: will a COVID-19 vaccine become available and if so, when and at what cost? Given the considerable societal and economic impact of the new coronavirus and the measures put in place to contain it, everyone is hopeful that COVID-19 vaccines will soon be at hand to provide a route out of the pandemic. At the same time, and after billions of euros have been invested by governments both individually and through the European Union (EU), many are still skeptical about the safety of a vaccine which is being developed in such a hurry. The general trust around the EU’s management of COVID-19 and towards vaccines in Europe has been steadily decreasing, and it is estimated that 25-50% of Europeans would currently be willing to take the jab if a COVID-19 vaccine was available. Vaccines typically require years of research and testing before reaching the clinic, but in the face of the ongoing pandemic pharmaceutical companies moved at unprecedented speed to produce a safe and effective coronavirus vaccine by next year. Work began in January, with the deciphering of the SARS- CoV-2 genome. The first vaccine safety trials in humans started in March, and nine have reached the final stages of testing to date. If the vaccines work, mass production will start right away at a scale and speed never seen before. However, some trials have failed, and others have been stopped on account of safety concerns, indicating that the path to a vaccine is not all that straightforward. Will some of the candidates succeed in stimulating the immune system to produce effective antibodies against the virus? And if so, will they offer only temporary immunity, with a booster dose needed at a later date? These were some of the questions the panel aimed to answer. Also Pfizer is working on one of the nine vaccines currently under development, using specific parts of the new coronavirus’ genetic code to trigger an immune response. According to Mikael Dolsten, Chief Scientific Officer and President, Worldwide Research, Development and Medical, Pfizer Inc, there are no short-cuts in clinical trials. Pfizer would stand by science and not give in to any political pressure to put forward 25TRACK II - ADVANCING INNOVATIONEHFG 2020 CONFERENCE REPORT a vaccine that did not meet the safety standards. Dolsten emphasised that Pfizer began clinical work and large-scale manufacturing at their own risk to ensure the product would be available immediately if the clinical trials proved successful and the emergency use authorisation was granted. According to Dolsten, collaboration and around the clock dialogue with regulators and the US government were key in this endeavor. After emergency use authorisation is granted, Pfizer plans to monitor the vaccine safety and efficacy for 2 years in a clinical study. Clemens Martin Auer, President, European Health Forum Gastein, highlighted how the EU had demonstrated strong leadership by joining forces in record time to secure equitable access to vaccines once they become available. The European Commission (EC) proposed an EU strategy to accelerate the development, manufacturing, and deployment of vaccines against COVID-19. As part of this strategy, the EC signed seven advance purchase agreements with promising COVID-19 vaccine producers, making substantial upfront payments to secure production capacity and using its negotiation power to bring down the price. Auer also reminded the audience that governments must agree to a sustainable global approach for successfully tackling the pandemic. Therefore, the EU committed to securing production capacities that reach beyond its borders, contributing for example to the work of the Coalition for Epidemic Preparedness Innovations (CEPI), an innovative partnership between public, private, civil and philanthropic organisations. Beate Kampmann, Director, The Vaccine Centre, London School of Hygiene and Tropical Medicine, talked about the COVAX facility, a joint initiative between the World Health Organization, CEPI and GAVI, the Vaccine Alliance, designed to ensure the equitable distribution of a coronavirus vaccine throughout the world by avoiding “vaccine nationalism”, a scenario in which countries with more resources would dominate the vaccines’ landscape. By the end of 2021, CEPI, GAVI and WHO aim to have two billion doses available globally. Access to a vaccine should not be a privilege - unless everyone is safe, no one is safe the panel emphasised. According to Samantha Vanderslott, Lecturer, Oxford Vaccine Group, there has never been so much interest in and scrutiny of vaccine development. This has forced pharmaceutical companies to become more transparent and timelier in their communication around vaccine production. The politicisation of vaccine development and approval, like US President Donald Trump’s claim that a vaccine would be ready before election day, is most unfortunate. When it comes to mandatory vaccination policies, Kampmann said she was not in favour until all safety data was available. All speakers concurred that the skepticism towards vaccines should be addressed with early and adequate communication as well as multi-directional engagement between governments, scientists, communication specialists, health professionals and the public. The panelists highlighted different aspects in terms of how the situation might be progressing in one year and five years from now, respectively. While Kampmann was confident we would reach a better understanding of the virus over the course of the next year, Vanderslott added a word of caution, saying she thought the world would be preparing for the next pandemic in five years’ time. Dolsten anticipated the collective number of vaccine producers to be able to supply vaccines of adequate safety and efficacy to the majority of at-risk populations one year from now, while Auer also voiced hopes for a speedy social and economic recovery. In conclusion, while the panel was confident overall, questions remained on when exactly a safe and efficacious vaccine would be on the market and how to ensure equity in distribution. Learn more Session recording Programme26TRACK II - ADVANCING INNOVATIONEHFG 2020 CONFERENCE REPORT Driving the digital transformation of health Now or never! Organised by EIT Health Digital transformation of healthcare has been high on the agendas for some time now, but the emergence of COVID-19 further underlined its relevance. This session, organised by EIT Health, focused on engaging stakeholders to debate how each sector can get involved to drive digital transformation for the benefit of patients. Jan-Philipp Beck, CEO, EIT Health, highlighted that (potential) healthcare users are expecting continuous improvement in the services they are using, and that at the same time there is an urgent need for more resilient and sustainable healthcare models in general. Although these are significant challenges that put considerable pressure on innovators and decision-makers alike even in more quiet times, the urgency brought about by COVID-19 may prove to incentivise policy makers, payers, and innovators to find adequate responses together. In addition, there is an ever- increasing readiness to embrace digital transformation, which provides new and as yet untapped potential – it seems to be truly “now or never!”. From a national government perspective, Julia Hagen, Director of Regulatory and Politics, Health Innovation Hub – an interdisciplinary taskforce dedicated to realising the benefits of digital healthcare for patients - commented on the most recent developments in Germany and introduced the audience to the DiGA framework. Until 2020, there was no specific reimbursement pathway for digital solutions in healthcare, and while much innovation was in fact already out there, it did not fit into the German regulatory scheme but was dealt with in a very fragmented way by individual insurances. To fix this, a new category of care delivery was established through the digital healthcare act, introducing digital health applications (DiGa) as an instrument of care delivery. Through the new framework, physicians and psychotherapists can prescribe low- risk digital medical devices, intended to be used by patients for the detection and monitoring of diseases, burden of illness reduction, or compensation of diseases and disabilities. As a next step, an investment of 4,3 billion euro is planned to support German hospitals in implementing digital solutions to improve the healthcare infrastructure and hospital processes. As important as all these investments are, Hagen also mentioned 27TRACK II - ADVANCING INNOVATIONEHFG 2020 CONFERENCE REPORT that one substantial additional challenge is to change the cultures surrounding current practices and processes: it will take time for digital solutions to become an integral and natural part of the existing healthcare system. Lydia Montandón, Business Development Director, Atos, expanded on the challenges of digitalisation from the perspective of a globally active industry player. She highlighted how “data is at the heart of digital transformation”, and that therefore one of the particular stumbling stones are the strict ethical and legal regulations as outlined e.g. by the General Data Protection Regulation (GDPR). While these regulations are necessary and serve to protect the user, they are so powerful that they often stand in the way of a timely adoption of digital solutions or data exchange between hospitals, for example via cloud services. More flexible regulations could be a step towards better using the potential of digital health, e.g. by empowering patients to have a bigger say in decisions regarding the use of their own data. Furthermore, innovative solutions should not represent a perceived or actual additional burden on the health workforce, which means that healthcare organisations need to be re-designed in a way that allows digital solutions to become a natural part of existing processes and routines. Hagen emphasised that digitalisation should never happen just for the sake of digitalising, but must always result in healthcare improvement. And: the empowerment of health professional associations is a key factor. With adequate support, these organisations can function as trusted contact points for individual healthcare providers when guidance is required on adopting digital tools. When asked about her priorities in the endeavor of advancing digitalisation, Montandón picked interoperability as the most important item from the virtual “wish list”. This would be a real asset for improving the collaboration between the different actors in and levels of healthcare, i.e. across professions, individual providers, departments or hospitals. In this vein, relevant decision-makers should also more broadly facilitate interdisciplinary collaboration between all relevant stakeholders inside and outside the healthcare sector. Hagen added to this by also highlighting the importance of learning from past experiences and avoiding the overengineering of digital transformation - 100% perfection is hard to achieve and “good enough” solutions can also bring significant benefits to the health system. As important actors in digital transformation, two startup representatives also shared their insights: Hans Maria Heyn, CEO, Smart4Diagnostics, explained how their solution aims to revolutionise the pre-laboratory phase through digitisation, ensuring that laboratory samples are collected with maximum safety and quality from the very beginning. Luis Valente, CEO, iLof, presented a solution intended to enhance personalised medicine by creating a cloud-based library of disease biomarkers and biological profiles. The Artificial Intelligence (AI) and photonics-based tool supports both patient selection for clinical trials and identification of the right medication during treatment. Both entrepreneurs identified data sharing standards and data privacy as the biggest challenges, which should be harmonised in order to fully realise the potential of innovation. In addition, an adequate health workforce skill-mix as well as the digital literacy of all end-users, such as patients and health professionals, were mentioned as key enablers for enhancing digital transformation. The session highlighted the importance of multidisciplinary collaboration, bottom-up innovation, interoperability, data security, and the adjustment of current healthcare processes to accommodate innovation. Speakers and participants agreed that key facilitators in the process of introducing new digital solutions have to be identified in order to promote adoption – as summarised by Hagen, we need to realise that “transformation is never easy, but it is worthy”. Learn more Session recording Programme28TRACK II - ADVANCING INNOVATIONEHFG 2020 CONFERENCE REPORT AMR and COVID-19 How can Europe incentivise R&D to protect our future? Organised by MSD This panel debate brought together representatives from the pharmaceutical industry, philanthropy and academia as well as policy makers to discuss challenges in antibiotic research and development (R&D) as well as possible steps at both European Union (EU) and national level to develop sustainable incentives which can support innovation in the field of antimicrobial resistance (AMR). Participating in a live poll, 67% of the audience believed that there is currently a lack of appropriate measures to encourage the development of new antimicrobials, and many were supportive of a mix of both pull and push incentives to improve the situation. But what exactly are the gaps that need to be filled in antibiotic R&D? Christine Årdal, Senior Adviser, Antimicrobial Resistance Centre, Norwegian Institute of Public Health, spoke about the worrying trend of lacking access to and availability of new antibiotics in Europe, and illustrated this through two concrete examples: The first case presented was that of an innovative antibiotic against a critical priority pathogen, i.e. a pathogen resistant to several antibiotic classes, which has been developed by a medium-sized US company and received US and EU regulatory approval in 2017 and 2018, respectively. However, the company faced insolvency in 2019. The novel antibiotic is now, after two years on the market, only available in a handful of European countries, which means that access across the EU remains heterogenous – and that the drug, though theoretically available, does not reach all those who would benefit from it. The second example discussed by Årdal was an antibiotic candidate that is considered as innovative, i.e. new, by the World Health Organization (WHO), and that is also intended for treating a critical priority pathogen. It is being developed by a small US company and currently in the last stage of human clinical trials but does not have a European commercialisation partner yet. However, the company has secured a licensing agreement with a Chinese company and the Global Antibiotic Resistance Partnership (GARP), which - if the antibiotic is approved - would grant access to it in China and most low- and middle-income countries. The European market is less attractive due to low sales and low prices. In this context, Årdal emphasised that the intention must be to keep sales numbers low - new antibiotics to treat critical priority pathogens should be reserved exclusively for patients experiencing drug resistance. Regarding the pricing, she outlined how almost all new antibiotics appear to enter the European market at the same price as older generic antibiotics, which disincentivises innovators. Studies on antibiotic innovation have increasingly shown that even the largest pharmaceutical companies’ antibiotic R&D divisions have left the market or downsized their activities. However, countries 29TRACK II - ADVANCING INNOVATIONEHFG 2020 CONFERENCE REPORT such as the United Kingdom and Sweden have undertaken pilot initiatives to guarantee both access to innovative antibiotics for patients and adequate annual revenues for manufacturers. Incentivising antibiotic innovation also means that public funds will essentially pay for new antibiotics which may never be used, but which have to be available in case of need. However, as Årdal stressed, not all governments have the financial capacities to absorb these costs, which exacerbates access disparities. Jeremy Knox, Policy and Advocacy Lead AMR, Wellcome Trust, reminded the audience of initiatives such as the AMR Action Fund as a positive first step in filling urgent funding gaps particularly in late stage R&D development, which can significantly support a given portfolio in getting onto the market over the next decade. In addition, there are initiatives such as CARB-X, which support early stage development and have helped the neglected antibiotic R&D field get back on its feet. Nonetheless, throughout the session there was consensus that a broader suite of interventions is needed at different stages across the R&D process to in the end create a sustainable R&D system. Furthermore, a dry pipeline for novel antibiotics is only one side of the problem. The other is sustaining access to already existing effective antibiotics. Cristian-Silviu Busoi, MEP, European Parliament, said that while political support and securing appropriate EU funding for AMR and AMR-related research under the EU4Health Programme and Horizon Europe are important, they are not enough. He noted that the European Commission (EC) is currently implementing several AMR initiatives, including best practice exchange and healthcare professionals training. However, it is now also time for national governments as well as regional and local authorities to take bold action, making the most of the current political momentum to gain some ground in the fight against AMR. And what more can the EU do, e.g. through its forthcoming Pharmaceutical Strategy to ensure sustainable investment in the antimicrobial pipeline? Busoi was hopeful that the ambitious strategy will successfully address market failures and provide concrete opportunities for sustainable investments and industry incentives. In addition, he emphasised that the EU must consider the strategic importance of building further capabilities for European production of new antimicrobials. Jenelle Krishnamoorthy, Associate Vice President of Policy, Communications, and Population Health, MSD, also highlighted that while push incentives for R&D are important, there is a need for additional suitable pull incentives. This may involve establishing mechanisms such as market entry rewards and transferable exclusivities to reward innovation earlier in a product’s lifecycle and help get new antibiotics across the pathway and into the market. John Ryan, Director of the Commission Public Health, Country Knowledge, Crisis Management Directorate, European Commission, outlined how AMR needs to be tackled holistically, from R&D investment for new antimicrobials to investment in infection prevention in healthcare settings and stewardship of already existing tools for this purpose. In this vein, also the EU might need to rethink its focus as to date, it has invested substantially in AMR-related research while e.g. interventions focusing on reducing hospital acquired infections may warrant more attention and support than they currently receive. Can we draw lessons from COVID-19 to AMR and emulate good examples such as joint EU procurement for vaccines? Ryan’s clear answer was ‘Yes’. This is why the EC is working on a COVID-19 lessons learnt package, which will not only reinforce the mandate of the European Center for Disease Prevention and Control (ECDC) and the European Medicines Agency (EMA), but also strengthen the EU framework legislation on cross-border health threats. Furthermore, novel institutions such as a European Biomedical Advanced Research and Development Authority (BARDA) can be important contributors to tackling AMR. However, the panellists reiterated that there is no silver bullet: The issue requires different actors on both EU and national levels to take a multitude of measures that, amongst other things, strengthen R&D, strengthen the concept of One Health, and foster investment in rapid diagnostics. Finally, it was also recognised that a top-down driven political agenda on AMR may lead to patients being side-lined in the debate. Therefore, more action is needed to help patient groups mobilise on the topic of AMR and engage in an open and frank dialogue with other stakeholders. Learn more Session recording ProgrammeNext >