With the global realities of the COVID-19 pandemic becoming more and more devastating in early 2020, deafening alarm bells began ringing in the corridors of buildings of EU institutions in Brussels. It was clear from the start that the EU lacked the legal tools and immediate practical know-how to handle a health-crisis.

Being restricted by very limited competences in this area, the EU had never invested much energy in health policy. The road to finding effective and long-term solutions was going to be long and hard. But as we are seeing, this long road seems to be shaping a new chapter in the history of health policy for the European Union.

We are seeing many initiatives being proposed by the European Commission to strengthen its resilience to future health emergencies and to build the foundations of a stronger European Health Union. However, whether the European Commission will manage to use this golden opportunity to push forward the need for a Treaty change to increase EU competences on health policy remains unclear.

Being the smallest EU Member State, Malta stands to benefit significantly from more EU action on health policy, whether it is a result of stronger cooperation between Member States or a direct result of increased EU powers in this area. The reality of our situation is that we face numerous challenges with regard to access to medicine and specialised treatments. Big pharma companies hesitate to put medicinal products on our market in view of its limited size and the limited return on investment. In order to address this reality, we have in the past relied heavily on the UK market. But just like the pandemic, Brexit brought with it a turn of events which we weren't anticipating. We are therefore forced to find new solutions and new pathways to meet our future pharmaceutical needs. 

Unfortunately, as things stand today, pharmaceutical companies are under no legal obligation to place their products on the markets of all Member States. European patients are therefore at the mercy of their decisions and they are currently at liberty to pick and choose between countries and to withdraw medicines from specific markets when the situation is longer commercially viable. The system currently in place is therefore centred around the needs of pharmaceutical companies rather than a more patient-centred approach.

These realities are common to other Member States and the challenges with regard to unequal access to healthcare within the EU are one of the most predominant issues highlighted in ongoing discussions in this area, at EU level. The European Commission has listened to this plea and has come out with a Pharmaceutical Strategy for Europe towards the end of last year. One of the flagship initiatives of this Strategy aims to tackle this issue through a revision of the system of incentives for pharmaceutical companies and a review process for pharmaceutical legislation with a view to addressing market competition considerations.

The Strategy also seeks to tackle similar challenges with regard to access to specialized treatments and treatments for unmet medical needs. This is especially important with regard to treatments for diseases such as those of a neurodegenerative nature and rare diseases including paediatric cancers. With regard to rare diseases, many initiatives have already been put in place at EU level especially through the creation of European Reference Networks which aim at creating a sharing of best practices and expertise between European medical professionals. However, we still have a long way to go in this area and we still see great discrepancies in survival rates between Member States.

With more limited options for specialised treatments for Maltese patients in view of Brexit, Malta needs to be a force of change in the EU fora and push forward ambitious and innovative ideas to find new solutions for facilitated access. Investment in the setting up of European Hospitals, which would serve as centres of excellence for the development and performance of specialised treatments, is one of the solutions which the EU should be looking at.

Malta's challenges in this sector should be turned into opportunities for us to be leaders in the EU's move towards a strengthened and patient centred European Health Union.