From her vantage point as associate vice president for MSD’s Central & Eastern Europe (CEE) cluster, Gabriele Grom outlines the disparity that still exists in terms of access to cancer treatments across Europe and what must be done to bridge this gap.
Despite the existence of innovative treatments, cancer is quickly becoming the biggest cause of disease burden in the EU
Over recent decades, the scientific community has achieved remarkable progress in cancer care. Today, people with cancer live longer and enjoy a better quality of life than ever before. Thanks to investments in R&D, there are more cancer treatments available. As a result, fewer people die of cancer than 20 years ago. I was pleased to take part in a conference organized by the European Association for Personalised Medicines (EAPM) on 9 April, 2019 to discuss these issues and what needs to be done to help cancer sufferers across Europe benefit from the strides forward in cancer care that have been achieved.
Clearly, innovative treatments such as personalised medicine have demonstrated significant benefits for patients, society and healthcare systems. Personalised medicine, which uses patients’ individual characteristics to identify the most appropriate care, has achieved significant progress in the treatment of many types of cancer. For example, due to personalized medicines, there has been an overall reduction in mortality from breast cancer in Europe, and an increase in ten-year survival to 78 percent.
However, despite the existence of innovative treatments, cancer is quickly becoming the biggest cause of disease burden in the EU – more than 3.4 million people are diagnosed with cancer annually. Barriers such as significant delays in access to innovative treatments stand out as a major challenge to better patient outcomes. Living in Austria, as well as being responsible for MSD’s operation in Central Eastern European markets (CEE), I get to see the stark disparities exist across Europe, and sometimes a cancer patient’s survival can depend on where they live.
In Austria, cancer treatments are available nearly immediately after approval by the European Medicines Agency (EMA), yet patients in the Czech Republic have to wait three times longer than in Austria for a new cancer medicine to be made available (EFPIA, 2019). In Poland, only three in ten newly approved cancer medicines are available, while in Austria it is nearly 10. The upshot of all this is that survival rates are much lower in Central Eastern Europe: only four out of ten cancer patients in Bulgaria survived five years (Jönsson B., Hofmarcher, Lindgren, & Wilking, 2016), which is 20 percent less than in Sweden.
The EAPM Conference provided stakeholders with an excellent forum to restate that improving patient access is a joint responsibility that requires collaboration among all stakeholders. Policymakers play a critical role in providing the right frameworks which ensure that all citizens across Europe have equal access to high-quality healthcare. The stark differences in access to treatment exist, not simply because income and economic wealth is lower Central Eastern European countries than in the rest of Europe. It is true that the GDP per capita in Hungary, Poland or Romania is indeed more than 30 percent lower than the EU average. However, it is worth pointing out that the CEE countries are among the fastest growing economies in the European Union. For example, Poland’s growth rate in 2018 was twice as high as the EU average (Eurostat, 2018). At the same time, their spending on health as a share of GDP is much lower too, in some cases half of what the EU average spends. (OECD, 2018). Therefore, policymakers need to start prioritizing healthcare and view increased health budgets as an investment, rather than a cost.
In Belgium, we have worked together with various stakeholders on innovative access schemes: the so-called multi-year, multi-indication agreements
In addition, the pharmaceutical industry also has a role to play in ensuring equal patient access. Besides the significant investment into the development of new treatments of cancer, the industry must work together with the governments on agreements that ensure the affordability of medicines and the importance of sustainable healthcare systems. At MSD, we are committed to working with governments and payers towards flexible access agreements such as multi-year, multi-indication contracts. For example, in Belgium, we have worked together with various stakeholders on innovative access schemes: the so-called multi-year, multi-indication agreements. Due to these agreements, we were able to reduce the time to access significantly.
We must ensure that health inequalities between Eastern and Western EU countries do not continue to diverge. At MSD and in the pharmaceutical industry as a whole, we are committed to working together with policymakers and all key stakeholders, to provide the necessary framework which allows for equal access to high-quality healthcare across Europe.
 Cancer Research UK – Breast Cancer (C50), Age-Standardised Ten-Year Net Survival, Women (Aged 15-99), England and Wales, 1971-2011 – Data provided by the London School of Hygiene and Tropical Medicine on request, 2014.
 In Belgium, 10 of every 100 euros goes into healthcare. In Hungary, Poland and Romania, the rate is two thirds or half as much.