2024 is a pivotal year for European healthcare. We’ve entered into a new EU political cycle, one that promises to put prevention in the spotlight. In her Mission Letter to Health Commissioner-designate Olivér Várhelyi, the European Commission’s President Ursula von der Leyen called for stepping up the Commission’s work on preventive health. The letter emphasised that a comprehensive approach to disease prevention is needed across the life-course, and that investing in effective prevention measures to reduce the burden of non-communicable diseases (NCDs) will help lighten the load on healthcare systems and support healthy longevity.
As part of this, vaccination as an essential preventive measure was highlighted in a communiqué of the G7 Health Ministers, highlighting the crucial role of routine immunisation for preventing infectious diseases transmission and for reducing the burden of antimicrobial resistance (AMR).
The benefits of preventive healthcare are especially important in addressing the significant global challenges facing Europe today. Tackling slow economic growth, geopolitical conflicts, climate change, the cost-of-living crisis, social tensions all require comprehensive solutions. Adding to this, Europe’s health systems are facing a perfect storm of challenges, with budget cuts, ageing population and a shrinking health workforce threatening long-term stability.
This environment provides a timely opportunity to reiterate the value of investing in prevention, including immunisation, to help ensure the sustainability and resilience of healthcare systems, societies and economies. However, considering that EU governments are requested to keep their budget deficits within 3 percent of GDP and their public debt within 60 percent of GDP, the natural question that arises is: how can governments spend more on prevention? The answer: smart investments via a new economic tool.
On 30 April 2024, the New Economic Governance Framework (NEGF) entered into force. The main objectives of the new framework are to strengthen Member States’ debt sustainability, and promote sustainable and inclusive growth in all Member States through growth-enhancing reforms and priority investments. Unlike the traditional “accounting” notion of investment, the new approach defines investment (“growth-enhancing expenditure”) in “economic” terms – as an expense today that can reduce future costs and boost future growth.
This redefinition has significant implications for healthcare spending, especially in the realm of preventive healthcare.
This means that member states now have the opportunity to consider investment in the healthcare sector – especially prevention – as social security investments, similarly to what’s been done for investments in defence and the digital and green transitions. This is a critical opportunity to champion investment in preventive healthcare.
Preventive healthcare is the application of healthcare measures to prevent diseases, for example by promoting healthy lifestyles, screening programmes and immunisation – with immunisation having a particularly high return on investment and cost-benefit ratio.
The positive impact of immunisation on public health has been well documented, with recent studies finding that vaccination has saved 154 million lives over the last 50 years worldwide, and 1.4 million lives during the COVID-19 pandemic in Europe alone. Immunisation can also help tackle the burden of NCDs. For example, research shows that people with cardiovascular disease (CVD) who are diagnosed with flu have a 6 times higher risk of experiencing heart attacks, but there is evidence of 33% reduction in CVD-related deaths when vaccinated against flu.
Vaccines are a vital, but underused tool in the fight against antimicrobial resistance. The World Health Organization estimates that vaccines could prevent over half a million AMR-related deaths each year, reduce antibiotic use by 22%, and save US$ 30 billion annually in treatment cost. Notably, while AMR-related deaths in young children have dropped by over 50% since 1990, they have surged by more than 80% in adults over 70 – making the case for adult vaccination even stronger.
Consequently, immunisation offers significant economic and fiscal benefits – it lowers the prevalence of infectious diseases, reduces workforce absenteeism and decreases the cost of treatment of communicable and non-communicable diseases. Studies suggest that adult immunisation programmes generate up to 19 times return on investment. Taken together, these benefits mean lower spending and increased productivity of the population.
Despite these significant benefits, in nearly 80% of EU Member States, only 0.5% of the healthcare budget is dedicated to immunisation. This is insufficient to increase vaccination rates, accommodate for demographic changes and take advantage of vaccine innovation currently in development. Vaccination programmes across Europe need to be sustainably funded to protect people’s health throughout the life course, including in adulthood. Adult immunisation programmes bring short-term return on investment through increased productivity, reduced healthcare system costs and contribution to the economy.
Prevention is no longer merely an option but a necessity to preserve the European healthcare, social care and welfare systems as we know them and guarantee their long-term sustainability. We urgently need a paradigm shift towards prevention-based healthcare models.
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