European Union

Luigi Di Maio, the Italian deputy prime minister and leader of the 5-Star Movement (M5S), likened the French ‘yellow vests’ to his own political movement. Moreover, he openly criticised the French government. EURACTIV France reports.

Chants of "Soubry is a Nazi" against Anna Soubry, a British pro-remain MP, outside parliament in London have prompted 55 MPs to write to British police for firmer action against "an ugly element of individuals with strong far-right and extreme-right connections" guilty of "intimidatory and potentially criminal acts" targeting politicians and others. The alarm comes after Jo Cox, a pro-remain MP, was murdered by a far-right fanatic in 2016.

Elmar Brok, the longest-serving MEP in the European Parliament, might not return after May's elections because local officials in his own party, the German centre-right CDU, failed to list him as a candidate on Monday in the region of North Rhine-Westphalia. Brok, 72, a veteran of the parliament's foreign affairs committee, told German press he could appeal the decision at a national CDU congress on 26 January.

Assets worth €870bn are being moved by financial firms from the UK into the EU in preparation for Brexit according to a report by British accountancy firm EY. Some 80 out of the 222 firms surveyed were moving or had moved personnel, and other items, to Europe, in a rising trend amid fears of a no-deal scenario. The €870bn figure is a fraction of the UK's €7 trillion financial sector

Italy's populist rulers have lent vocal and technological support to the yellow vest movement after eight weeks of riots in France.

The US has threatened to impose sanctions on Swiss engineering firm Allseas unless it pulls out of Russia's project to build a new gas pipeline to Germany called Nord Stream 2, German newspaper Handelsblatt reported on Monday, citing German government sources. Allseas, which has an operational base in the Netherlands, is meant to lay 90 percent of Nord Stream 2 on the Baltic Sea bed by 2020.

The European Commission says EU states have yet to help the 49 people stranded on the Sea-Watch and Sea Eye rescue boats - because solutions have not yet been found for the 249 people already rescued by Malta.

If misinformation in the field of migration can bring a government down, as in the recent case of Belgium following the country's adoption of the UN migration pact, then it can doubtless produce a populist majority in the European parliament.

The European Union is considering ways to help Prime Minister Theresa May convince the British parliament to back the Brexit treaty she agreed with EU leaders last month but ruled out on Monday (8 January) any change to the deal.

EU Commissioner for trade Cecilia Malmström travels to Washington on Tuesday (8 January) for a new round of trade talks with US officials, as potential tariffs on cars hold on European industry’s head.

Latvia’s president nominated a current MEP as prime minister on Monday (7 January), after two other picks failed to form a government after elections held in October.

European Capitals of Culture have been chosen for the past 33 years. Typically, two cities share this title for the period of a year and in 2019 they will be in Bulgaria and Italy. EURACTIV Germany reports

The European elections campaign began just one day after the end of the Austrian Presidency of the Council of the European Union, with a special guest. EURACTIV Germany reports.

Warsaw announced to create a lobbying centre for Polish entrepreneurs in Brussels to help them exert a greater influence on EU legislation. EURACTIV Poland reports.

Public and diplomatic pressure mounted Monday (8 January) on the Democratic Republic of Congo to announce the outcome of 30 December elections to replace long-term leader Joseph Kabila.

Greece has given investors another week to 15 January to submit binding bids for three coal-fired power plants and a licence to build another one, a senior energy ministry official told Reuters on Monday (7 January).

Main agenda items, approximate timing, public sessions and press opportunities.

EU ambassadors agreed the Council's position on a new prudential and supervision framework for investment firms.

Written by Gianluca Quaglio,

Research gap between drug development and real world healthcare delivery © Pot Regnier/STOA Introduction

The STOA workshop entitled ‘Innovative solution for research in healthcare’, chaired by Paul Rübig (EPP, AT), first STOA Vice-Chair, is an opportunity to discuss the implementation of an ‘innovation-centred’ system, exploring a truly ‘patient-centred’ paradigm with systematically coordinated applied clinical research carried out in conjunction with drug development. The workshop will be held on 10 January 2019, 9:30-12:30, at the European Parliament in Brussels (Altiero Spinelli building, room 5E2).

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In 2015, the Council of the EU, while accepting that there is no common definition of the term precision (personalised) medicine, noted at the same time that this is generally understood to refer to a medical model, which uses the characterisation of individuals’ phenotypes and genotypes for tailoring the right therapeutic strategy for the right person at the right time, and/or for determining the predisposition to disease, and/or for delivering a targeted prevention strategy.

As the number of authorised drugs that target specific proteins implicated in the disease phenotype increases on the market, and as next-generation sequencing and other technologies bring comprehensive genome-wide analyses to affordable levels, precision medicine begins to play a much wider role in routine practice.

However, once a drug enters the market following regulatory approval, each EU Member State determines its real-world use based on its own criteria: pricing, reimbursement and clinical indications. Such an innovation-centred clinical research landscape might neglect patient-relevant issues in a real-world setting. There is a demand for reform of the current system to create a truly ‘patient-centred’ paradigm, with systematically coordinated treatment optimisation in conjunction with the drug development process.

Two disconnected stages: from drug development to real-world application

In Europe, most of the clinical research dedicated to therapeutic innovations in drugs aims primarily at regulatory approval. In this first stage, scientific issues on the efficacy of a new drug are addressed in selected patient populations and lead up to European Medicine Agency (EMA) approval.

Once a drug enters the market, the second stage begins, where research addresses clinically relevant questions to tailor the therapeutic indications to ‘real-life’ clinical practice. Due to this discontinuity between the first and the second stage, research during the second stage results – for various reasons – in suboptimal uptake of findings into practice or clinical guidelines.

Administration of improper treatment may generate unnecessary toxicity for patients, but also affects national healthcare budgets and adds cost to already highly priced treatments. Therefore, following the drug development phase, independent investigations are needed on the optimal use of medicines (known as ‘treatment optimisation’).

Regulatory approval

The regulatory approval of new treatments does not address clinical issues relevant to patients in real-world settings, such as: (i) how to combine new treatments with the existing therapeutic options; most patients may need some form of combination therapy, which is determined individually, based on a number of clinical and biomarker predictors; (ii) how to evaluate the clinical outcomes when new treatments are administered in off-label indications; (iii) how to determine the optimal scheme/treatment duration and at which benefit/risk ratio; (iv) what the long-term issues related to the treatment are. When addressed, the above-mentioned issues are studied mostly following EMA’s approval and rely on the goodwill and agendas of independent research groups.

Reasons for a lack of real-world evidence

There are a number of reasons for such lack of real-world evidence, mentioned briefly here. First, regulatory approval of new treatments requires data on ‘quality, safety and efficacy’ and not on ‘comparability’. This approach is centred on the innovative treatment, as its value is assessed in absolute terms, not relatively to the pre-existing therapeutic armamentarium of medicines, equipment and techniques available. Second, in order to maximise the experimental treatment effect, patients included in clinical trials represent only 2-4% of the overall targeted population, leading to a poor external validity of clinical trials. Finally, there is a lack of evidence that would make it possible to rank the multiple therapeutic options available and define the conditions for optimal care.

Aim of the STOA workshop

This workshop will provide patients, clinicians, payers, Health Technology Assessment (HTA) agencies, regulators, pharmaceutical companies, researchers, policy-makers and the public at large with an opportunity to present their point of view and their innovative suggestions for future drug development in Europe.

The establishment of a new developmental framework through close collaboration between industry, patient representatives, and regulatory, governmental, academic and other stakeholders would hopefully facilitate comparisons of assay performance before regulatory approval, harmonising the approval process. Such a framework could mitigate the somewhat problematic current situation. The issue is ubiquitous in modern biomarker/drug development processes and is not related to particular targets or pathways.

Media and the Cultural and Creative Industries are underrepresented in policies and actions aimed at promoting research and innovation in the EU. Luciano Morganti and Heritiana Ranaivoson present their reflections and recommendations for the future of these sectors.