Putting the EU plan into action

An EU-wide partnership to tackle inequalities in cancer prevention and control will be launched in Brussels by the European Commission on 29 September 2009. It is to   decide how goals set out in the EU cancer action plan, adopted in June 2009, are to be achieved.

The plan was developed in consultation with a wide range of stakeholders, and includes targets for coordinating cancer research, collecting accurate and comparable data for benchmarking, and reducing the burden of cancer on society. It also envisages integrated national cancer plans in all EU member states by 2013.

The Commission hopes that the momentum generated by the consultation will carry over into the partnership, and it is inviting stakeholders to express their interest in taking part. The aim is to bring in people from national authorities, regulatory bodies, healthcare professionals, patient groups, civil society, the research community, the pharmaceutical industry, health insurers and academia. The tobacco industry has been excluded.

Informal discussions with stakeholders will take place in autumn 2009, with a view to setting up a formal structure that can begin work early in 2010. The present thinking is that four working groups will deal respectively with prevention, healthcare, research and data, and operate under a steering committee and forum.

With virtually no new funding available before 2013, the partnership will have to work with existing resources. However the Commission can generate a certain amount of leverage using “joint actions”, a legal instrument which allows it to direct funds from EU health and research programmes, and pool them with national resources. Regional development programme funding could also be used to support actions on infrastructure and training, for example.

This means that EU governments will also have to show some commitment. “This whole enterprise depends on political will,” says Nick Fahy, head of health information in the Commission’s directorate general (DG) for health and consumers. “If it turns out that member states are not willing to put real effort and commitment into doing this, then it won’t work.”

He is optimistic about what can be achieved. “This is all innovative, all something that hasn’t been done before,” he says. “I’m hoping that, in at least one or two of these areas, we will end up actually doing something that will really surprise me.” 

The action plan is most ambitious in its desire to reduce the duplication of cancer research. It sets a target of co-ordinating one-third of cancer research from all funding sources, private and public, by 2013. “It has never been done before, as far as I know, in any research field. So it’s quite new and it’s quite brave,” says Fahy, adding that there is a broad consensus that such coordination is necessary. “The figure is a pragmatic and slightly ambitious one on our part, [based on] what might be feasible. […] What this requires is people like the cancer societies, the public funders and even industry to actually be willing to sit down and work together.”

On benchmarking, the Commission wants to have accurate and comparable data on cancer incidence, prevalence, morbidity, cure, survival and mortality in the EU by 2013. “We have registry data for every member state of the EU of wildly varying levels of coverage, but we do have data,” says Fahy, who is convinced that the target can be reached. “There’s concern about how data are generated and used, and concerns about data protection. It’s still politically difficult, [but] I’m sure we can bring together the existing structures into something that can be very effective at European level.”

The plan also seeks to reduce the burden of cancer by stepping up screening for breast, cervical and colorectal cancer to 100% population by 2013. This would provide 125 million examinations to citizens per year. When it comes to tackling healthcare inequalities, the Commission considers a 70% reduction in the disparity between the best and worst performing member states by 2020 to be feasible. This will be supported by guidelines for models of best practice in cancer-related care which take into account national, regional and local contexts.

The plan includes a set of actions that might be considered under each objective. However many of these – such as an EU-wide pilot accreditation scheme for breast cancer screening, diagnosis and management -- are already underway, which has led to accusations that the plan is too limited in its ambitions.

“There’s nothing fresh in the plan, and with no new money it’s just a talking shop,” says Richard Sullivan, director of the European Cancer Research Managers’ Forum.

He is particularly critical of the plan’s “naïve” approach to research overlaps. “The co-ordination of cancer research is already being undertaken, and it will happen through the NOCI [Network of Core Institutions] and through increasing major institute-to-institute relationships,” he explains. “Everybody is going that way.” Expecting governments to co-ordinate is not realistic, he adds. “The federal funders are all ferociously in competition with each other and it’s not in their best interests to co-operate.”

Nevertheless, ECRM will be attending the preliminary stakeholder meetings this autumn, as will ECCO. “We are committed to play an active role in the partnership, across all the stakeholder working groups,” says public affairs manager Ingrid Van Den Neucker, “but we still need to decide internally how that is going to happen.”