Online live event 30 September – 2 October As discussed in Gastein: Conference Outcomes Dancing with elephants New partnerships for health, democracy, business CONFERENCE OUTCOMESOUTCOMESEHFG 20202 Dancing with elephants New partnerships for health, democracy, business The determinants of health and well-being are often driven by the interests of big players, which are not always aligned with public health agendas. The 2020 digital edition of the European Health Forum Gastein (EHFG) set out to conceptualise new ways of working with these giants and build fresh models of collaboration among all stakeholders in health – “dancing with elephants”. The COVID-19 pandemic has thrown into even sharper focus the need to work together differently and more constructively but might also offer the momentum needed to create real and sustainable change. As we contend with an ongoing crisis that has made health a political issue like never before, can we mobilise the will to regulate, form intersectoral partnerships, and adopt a whole of society approach that accommodates each other’s strengths and limitations? Recovering from the pandemic Health politics beyond COVID-19 A year of disturbance and disruption “I am confident that the pandemic has created a momentum for real and sustainable change. We now have the prospect to rethink and transform health policymaking and multilateralism at its core.” Clemens Martin Auer, President, EHFGOUTCOMESEHFG 20203 Access to medicines Incentivising the fight against AMR Moving forward on cancer Health systems resilience Tackling health inequity Participatory decision-making in health. More voices at the table! Empowering patients – and consumers! Empowering young people Health literacy Leveraging data & digitalisation in health, across borders & systems Universal Health Coverage Commercial determinants of health Protecting the rights and well-being of children Dancing with elephantsOUTCOMESEHFG 20204 Including marginalised communities in decision-making - leaving no-one behind European solidarity Access to vaccination for all Re-thinking the interface of science and policymaking Green recovery New economic paradigms –serving all people Road to recoveryOUTCOMESEHFG 20205 Re-thinking the interface of science and policymaking European responsibility in global health Building trust between governments, experts & people through better communicationOUTCOMESEHFG 20206 1.Resilient systems In the early months of the COVID-19 outbreak, it was referred to as “the great equaliser” affecting people across the world regardless of their background. However, “the data shows the opposite of an equal experience” argued Laura Shields-Zeeman, Head of Department of Mental Health and Prevention, Trimbos Institute, in a session on mitigating the impact of COVID-19 on health inequalities. Instead the pandemic has spotlighted the inequities and environmental hazards produced by our current economic systems: people from the most disadvantaged backgrounds have been hardest hit by the virus, the measures to contain it and the subsequent economic impact. This means that in many instances we are facing a syndemic which needs to be effectively addressed by a more nuanced approach than purely biomedical-based interventions. It also makes apparent the dangers of disrupting access to essential healthcare services during the pandemic and the high health burdens of its indirect consequences. The current crisis has reinforced the importance of good health and well-being as a prerequisite for everything else, and this must translate into investment in well functioning, solidarity-based and resilient health systems that make health promotion and prevention a key concern. Outcomes from a session on health system resilience emphasised that such a response requires good governance – while recognising that it is not easy to achieve. Solid governance structures foster trust and enable health system functions to operate properly, thereby strengthening the system as a whole. Echoing the oft-cited recent mantra of “never waste a good crisis”, a session steered by young health professionals highlighted the importance of political will to work towards resilient health systems that go beyond bouncing back to where we were before but transform and evolve into something better, supported by a digital health infrastructure in which we can capitalise on the digital literacy of young people. OUTCOMESEHFG 20207 But while we look back for lessons on preparedness, Anna Sagan, Research Fellow, European Observatory on Health Systems and Policies, reminded us that building resilience requires that we take action on the threats we are already aware of, antimicrobial resistance (AMR) being a case in point: “It is one of the greatest challenges of our time and a predictable and preventable crisis.” Samantha Vanderslott, Lecturer, Oxford Vaccine Group, stressed the importance of horizon-scanning, forecasting that five years down the line we will be preparing for the next pandemic. Healthcare professionals and other key workers have been hailed as modern- day heroes during the crisis. However, the pandemic has magnified existing health workforce weaknesses, caused primarily by chronic underinvestment in training, education, deployment and retention. Health professional mobility was recognised as an “elephant in the room”: Corinne Hinlopen, Global Health Policy Researcher, Wemos, emphasised that while we cherish our freedom of movement and enjoy its benefits we need to learn to manage it better to prevent increased health inequalities between EU countries. As cross-border migration is a trans-national issue the EU can play a stronger role here. Ensuring health workforce governance mechanisms at a national level are balanced with the collective interests of the EU and aligning EU policies across sectors so they reinforce rather than counteract each other, will protect health workers and result in lasting improvements in health and care for all citizens. Speakers agreed on a need to look beyond national planning and engage in proper workforce forecasting with medical associations and civil society organisations. “A fair distribution of Europe´s health workforce is a matter of concern for all Europeans – we can do it, let´s work for it” advocated Hinlopen. “A revolutionary moment in the world’s history is a time for revolutions, not for patching”, posited Katherine Trebeck, Advocacy and Influencing Lead, Wellbeing Economy Alliance, echoing the words of economist and social reformer William Beveridge. She challenged participants to demand a fundamental transformation and repurposing of our economies, so they are designed to deliver sustainable and equitable human and ecological wellbeing. What are the practical steps towards creating such resilient economic systems? Examples include considering measures of progress beyond GDP, what we tax and reward, the kind of business models incentivised and cultivated, how we design cities and how we conduct decision- making – with the central aim of more citizen involvement. While the pressures of returning to business as usual will be significant, to truly “build back better” we need to support and learn from pioneers and channel their ideas to policymakers, demanding compassionate, collegiate leadership and cooperation across political and sectoral divides. “Let' s raise our game and be more ambitious: how do we fundamentally transform and repurpose our economies so that they are designed to deliver human and ecological wellbeing at their core?” Katherine Trebeck, Advocacy and Influencing Lead, Wellbeing Economy AllianceOUTCOMESEHFG 20208 The COVID-19 pandemic, while undoubtedly the biggest health, economic and social crisis of our times, is also a window of opportunity for innovation: firstly, it means “all eyes on health”, as Jan-Philipp Beck, CEO, EIT Health, pointed out. Secondly, it shows what is possible if there is a perceived sense of urgency in the health community, and - more importantly - beyond it. The most prominent example, or, as Clemens Auer, Special Envoy for Health at the Austrian Federal Ministry of Labour, Social Affairs, Health, Care and Consumer Protection and EHFG President, put it, a real “success story” for health in the European Union, is the unique collaboration on a COVID-19 vaccine. This includes the comprehensive agreement of all 27 Member States on tackling the pandemic together, implying both increased efforts on sharing data and knowledge as well as an unprecedented willingness to share financial risks e.g. in the form of upfront investment in parallel research endeavours and production capacities, resulting in a uniquely speedy progress in the history of pharmaceutical development. The process raises hope that similar efforts may soon materialise in areas where the realisation of urgency is far from comparable to the pandemic. As highlighted throughout the conference, AMR is one of these danger zones, and one where the new Pharmaceutical Strategy for Europe currently being drafted by the European Commission Directorate- General for Health and Food Safety may prove vital for continued and accessible innovation, by providing a regulatory framework that facilitates targeted and sustainable investment in underfunded areas. One thing was made very clear by panelists such as Jeremy Knox, Policy and Advocacy Lead AMR, Wellcome Trust: initiatives like the AMR action fund can only be a bridge in the short term but do not address the root causes of why we need them in the first place. It is paramount to rethink our incentive systems and establish mechanisms that counter- balance the market failures which, particularly in the area of vaccines or novel antibiotics, continue to threaten progress and hence also population health. 2. Advancing innovation OUTCOMESEHFG 20209 When talking about innovation, digitalisation and data will almost invariably be discussion topics on the table, and even more so with COVID-19 challenging us to advance responsibly in fields such as surveillance and telemedicine. Here, it is key to bear in mind that novel digital structures need to be in the public interest, need to be purposeful and serve the user - be it the health professional, the patient or the epidemiologist. One particular hindrance to this goal lies in private interest currently owning and harnessing much of the data and data infrastructure available. A structured investment in levelling up public capacities and expertise on matters related to data and digitalisation is needed to facilitate collaboration and dialogue between stakeholders on eye-level, as experts such as Casper Klynge, Vice President for European Government Affairs, Microsoft Corporation, pointed out. And, since we are not simultaneously making progress on all fronts, it is important to distinguish between long- and short-term goals. In several sessions, panelists including Andrea Ammon, Director, European Centre for Disease Prevention and Control, commented that one of the current key shortcomings is the lack of standardisation and interoperability of data. It is crucial to tackle this now, for as Mike Ryan, Executive Director, World Health Organization Emergencies Programme, reminded us, “Data can defeat disease,” with smallpox and polio being two prominent examples of successful surveillance efforts. Today, we do have plenty of data, but we need to invest in the quality, infrastructure and appropriate political and professional alignment to realise its full potential for the worldwide improvement of health. “Putting out a vaccine against COVID-19 should have nothing to do with political timelines – scientists across the globe, regulators, physicians, industry need to work together as fast as we can, without compromising on safety standards.” Mikael Dolsten, Chief Scientific Officer, PfizerNext >