Editorial word
Welcome to the first Euractiv’s health newsletter in 2024. Some key files for health are in store in the coming months, with the European Health Data Space (EHDS) and ongoing revision of the pharmaceutical strategy.
As the new year gets into full swing, our health editor, Giedrė Peseckytė, is reporting back from a press trip to Moldova organised by The Global Fund to explore the challenges that remain in efforts to end the tuberculosis epidemic by 2030, as set in the Sustainable Development Goals (SDGs).
Drug resistance, HIV hampering fight against tuberculosis in Moldova
Vladimir, 60, sat on the edge of his bed in the Chiril Draganiuc Institute of Phthisiopneumology, a medical unit for the Republic of Moldova in the capital Chișinău. He and his two other roommates, Igor, who is 50, and Georgi, who is 26, were diagnosed with tuberculosis (TB) – an infectious disease usually caused by bacteria that attack the lungs.
“I got scared,” said Vladimir, asked how he felt when he heard his diagnosis: “How could this have happened?”. He was already familiar with the disease before his diagnosis – Vladimir’s father passed away from tuberculosis after a relapse 40 years ago.
But even nowadays, while TB is a preventable and usually curable disease, it was the world’s second leading cause of death from a single infectious agent in 2022, after COVID-19 and caused almost twice as many deaths as HIV/AIDS, WHO Global Tuberculosis report found.
Ending the tuberculosis epidemic by reducing incidence by 80% and deaths by 90% before 2030, compared to 2015, is part of the UN Sustainable Development Goals (SDGs). Despite that, the TB incidence rate in the past years has not declined. Instead, it rose by 4% between 2020 and 2022, reversing declines of about 2% per year for most of the past two decades.
The Stop TB Partnership, a United Nations-hosted organisation, estimated that while Moldova is close to successfully treating at least 90% of notified people with TB, reaching all infected with TB needs more work as it is less than 60%.
The disruptions during the COVID-19 pandemic, multi-drug resistant (MDR) TB, co-infections with HIV and poor living conditions are among the burdens to tackle the disease.
“Our challenge in the region is that MDR [multidrug-resistant TB] and the co-infection with TB and HIV is high,” said Dumitru Laticevschi, a former TB doctor from Moldova, who currently leads Global Fund’s programmes in Eastern Europe and Central Asia. Moldova is among the WHO European Region’s 18 high-priority countries for TB control.
Vladimir is on a treatment plan that should last six months. He is among 30,000 patients with tuberculosis and non-specific affections of the breathing apparatus that are treated yearly in the institute.
A number of the patients here have co-infection with HIV. WHO estimated that in Moldova, a country with 2.5 million people, there were 280 HIV/TB patients in 2022, which stands at the rate of 8.5 per 100,000 population. The rate in the WHO Europe’s region is nearly three times lower, at 3 per 100,000 population.
HIV increases the chances of falling ill with TB disease by 16-fold, according to the WHO. TB is an opportunistic infection which occurs more often or is more severe in people with weakened immune systems than in people with healthy immune systems. As HIV weakens the immune system, it increases the TB risk. Additionally, TB is the leading cause of death among people with HIV.
The WHO also estimates that TB is deadly without proper treatment for 60% of HIV-negative people with TB on average and nearly all HIV-positive people with TB.
The burden of drug-resistant TB
While co-infection with TB and HIV is hampering progress, multidrug-resistant tuberculosis is causing the biggest concerns. Moldova is among 30 countries worldwide with a high burden of multidrug-resistant tuberculosis, according to the WHO Global Tuberculosis Report 2023. In 2019, it was estimated that one-third of people newly diagnosed with TB had a drug-resistant infection.
Multidrug-resistant TB (MDR TB) is resistant to more than one first-line anti-TB drug and at least isoniazid (INH) and rifampin (RIF). Some forms of TB are also resistant to second-line medications and are called extensively drug-resistant TB.
Globally, about two in five people with drug-resistant TB accessed treatment in 2022. Oxana Rucsineanu, a former teacher, a TB survivor and co-founder of the NGO Society of Moldova against Tuberculosis (SMIT), could not access treatment when she fell ill in 2007 as well.
When Oxana was diagnosed with MDR TB, second-line drugs were not yet available in Moldova. “I followed the treatment with first-line drugs for the first year, and there was no use,” she said.
The drugs to tackle the resistant bacteria came to Moldova in 2008, only then she could switch from first-line drugs for an additional two years.
Throughout a total of three years of treatment, Oxana could not work and was suffering from side effects such as nausea after taking pills, difficulties when walking and losing vision.
“I was told that side effects would improve, but this never happened to me. The side effects stayed with me until the end of treatment,” she said.
“Within that period, I met Pavel,” she said, nodding towards a man standing at the door in SMIT’s office in the basement of an apartment block in Bălți, the second biggest city in Moldova.
“Pavel is my husband, we met in the hospital,” she continued. “He was not as lucky as I because he was fighting TB for 10 years.”
Pavel and Oxana Rucsineanu co-founded the NGO in 2010, aiming to help TB patients with the main task being “to detect people and get them on treatment”, according to Oxana.
They work closely with communities and “go from door to door and see if a person is at high risk or not” based on verbal testing. If someone mentions coughing, fatigue or other TB symptoms, they accompany the individual for X-ray screening.
“If TB is confirmed, we help to get enrolled on treatment, and it all happens within one to three days,” Oxana said.
Treatment plans can last months or – as in the example of the Rucsineanu family – years, often with unwanted side effects. To help stick to the treatment, members of another NGO in Bălți, Speranta Terrei, go to the patients and deliver the pills directly, staying close until the pill is swallowed. Virtually assisted treatment is also available in Moldova, where instead of physical meetings, the meeting happens virtually.
“It remains a very complex diagnosis and treatment for the patient. Still, with all the improvements, a treatment that lasts months and sort of takes away the patient from his job, from his normal life,” said Laticevschi.
Despite all the burdens, Oxana remains optimistic about reaching 2030 targets.
“We need to be optimistic. If the progress is stable, we can reach it by 2030; I hope so.”
EU News
-
- EU watchdog finds maladministration in the Commission’s interactions with tobacco lobbyists
- PFAS pose risks to fetuses, a study found.
- The EHDS debate continues.
- Progress on SoHO after the agreement was reached.
- French health authority optimistic on endometriosis saliva test.
- EU watchdog finds maladministration in interactions with tobacco lobbyists. EU Ombudsman Emily O’Reilly confirmed her findings of maladministration in the European Commission’s compliance with article 5(3) of the Framework Convention on Tobacco Control (FCTC) of the World Health Organization (WHO). While Directorates-General for Health and Food Safety (DG SANTE) and Taxation (DG TAXUD) comply with the obligations, the inquiry found that other departments fell short. Particularly of concern was the failure to keep meeting minutes with tobacco lobbyists and make these available. Additionally, O’Reilly criticised the lack of systematic assessment across all DGs of whether meeting requests with tobacco interest representatives is necessary. While the Commission’s answer to the inquiry reiterated the steps they had already taken, they also promised an assessment of the risk of exposure to the tobacco industry across all departments. The Ombudsman has asked for a report back by 30 June 2024.
- PFAS pose risks to foetuses, a study found. Several countries proposed a universal ban on per- and poly-fluoroalkyl substances (PFAS) a year ago. The proposal is currently being looked at by the European Chemical Agency (ECHA)’s committees, which are also reviewing feedback received during a six-month consultation. In this context, a new study published in the scientific journal The Lancet on Monday (8 January) found that PFAS affect people as early as the fetal stage of development. “This timely and thorough study shows what we have long feared – PFAS have the potential to negatively affect future generations even before they are born, and exposure is difficult to avoid. This is why the proposed EU PFAS restriction is now more important than ever,“ Health and Environment Alliance (HEAL)’s director, Génon Jensen, said in a press release on Tuesday (9 January).
Giedrė Peseckytė has more on this here. - The EHDS debate continues. The European Health Digital Space (EHDS) discussions are back on the table after the Christmas and New Year celebrations. On Monday (8 January) the co-legislators met for the first technical trilogue, with the second expected to occur this Friday (12 January). So far, the meetings are just warming up – but the clashes that can be expected are provisions around opt-in and opt-out as well as storing location and involvement of third countries. The first classical “handshake” trilogue took place on 14 December, with the Parliament setting their position the day before. The Council agreed on its mandate a week earlier, on 6 December.
- Progress on SoHO after the agreement was reached. Just before the holiday break, the EU institutions agreed on the new regulatory framework for substances of human origin (SoHO), a file which was one of the flagships of the Spanish presidency’s health agenda. Now, French MEP Nathalie Colin-Oesterlé, rapporteur of the file in the European Parliament, is set to report back on the outcome of the negotiations in the public health committee on Thursday (11 January). The new framework applies to blood, plasma, skin, embryo, sperm, and corneas, adding breast milk and microbiota as new SoHO substances. The deal also aims to provide the donors and patients with a future-proof and harmonised framework for transplants and donations while maintaining some limits on the supply side of these therapies. The deal was reached during the first interinstitutional meeting despite the more controversial aspect of regulating donor compensation, where the principle of ‘financial neutrality’ was agreed upon.
Marta Iraola wrote about this here. - French health authority optimistic on endometriosis’ saliva test. On Monday, the French health authority (Haute Autorité de Santé – HAS) opened the path for a saliva test to detect endometriosis, deemed “promising”. Endometriosis is a chronic disease that affects around one in ten women, usually resulting in severe pain at the time of menstruation or fertility problems. The test, developed by Lyon-based biotech company Ziwig and called Endotest, “has demonstrated very good diagnostic performance”, the HAS pointed out. According to the first studies, the reliability of this saliva sample is around 95%. However, the HAS is waiting for further studies “to assess its clinical usefulness in current practice” before widespread reimbursement. The Endotest is already available in Austria, Switzerland, Italy, Luxembourg, Germany, Hungary, Estonia, Lithuania, Latvia, Norway, Finland, the UK and Denmark, where the cost is around €1,000.
News from the Capitals
DUBLIN
Ireland’s main nursing organisation has slammed the Irish government after hospitals finished the year with overcrowding, long delays, and inadequate bed space, citing chronic underfunding and unsafe staffing levels. Read more.
Ireland’s 1000-day drug delays: Faster access to innovative medicines needed. The Irish Pharmaceutical Healthcare Association (IPHA) has expressed concern to Ireland’s parliament – the Oireachtas – over delayed access to innovative medicines, with some patients waiting up to 1,000 days for access. Read more.
///
BERLIN
Germany embraces digital prescriptions, yet European integration lingers. While the German public health sector has taken a step towards digitalisation, making electronic prescriptions obligatory, the road to the European Health Data Space is still long. Read more.
///
STOCKHOLM
Survey: Sweden struggles with high levels of hospital infections. Healthcare-associated infections seem to be much higher in Sweden than in most of Europe and the country needs to step up the combat against this problem, according to infectious disease experts. Read more.
Sweden uses drones to fight cardiac arrest. Flying drones with defibrillators to help cardiac arrest patients is faster than ambulances in two out of three cases, a new Swedish study published in The Lancet Digital Health found. Read more.
Stockholm hospital to use AI to estimate breast cancer risk, in world first. A new AI-based model that can predict women’s breast cancer risk will now be tested in clinical practice at a hospital in Sweden. Read more.
///
SOFIA
Battle for control of major Bulgarian hospitals creating political instability. The political struggle for control of the large state hospitals in Bulgaria is becoming a risk factor for the government, which is supported by a broad but unstable tripartite coalition in the National Assembly. Read more.
Bulgaria is facing lawsuits because of the pandemic. Three legal complaints have been filed against Bulgaria related to the failure of the vaccination campaign and the authorities’ response during the pandemic, which led the country to the highest death rate from COVID-19 in Europe, Euractiv has learned. Read more.
///
BRATISLAVA
WHO pandemic accord under disinformation attacks in Slovakia. As the World Health Organisation’s global accord on pandemic preparedness, prevention, and response is slowly progressing toward a final draft, Slovak Prime Minister Robert Fico and some of his MPs are targeting it with disinformation while the Health Ministry remains tight-lipped. Read more.
Slovakia delays law on maximum waiting times for medical procedures. The Slovakian parliament voted to delay a reform that would cap waiting times for hundreds of medical procedures, as the state did not prepare the necessary mechanisms – making the planned January 1 2024 start date unfeasible. Read more.
///
THE HAGUE
Dutch hospital info chief as medical chatbot is rolled out: Let’s not regulate AI to death. The University Medical Centre Groningen uses an AI chatbot to help answer the hundreds of questions it receives from patients weekly to help ease the workload of already overstretched healthcare providers. Read more.
///
WARSAW
Poland’s innovative approach to reducing prostate cancer mortality rate. With prostate cancer the most frequently diagnosed malignant tumour among men in Poland, the country is hoping that PRAISE-U – a multi-country screening and detection initiative – will help reduce mortality rates. Read more.
[Edited by Nathalie Weatherald]
