The world is changing rapidly and important choices have to be made. In times of change, nothing can be taken for granted anymore. Europe, and certainly the Netherlands, must make choices to invest in resilience and strategic autonomy. This also affects health and healthcare, including medical innovation and drug development.

Good starting position at stake
The Netherlands is doing well, at least that is what many people think when it comes to healthcare and innovation, and that is how we like to explain it to the outside world. There is innovation, a great deal of ambition, a healthcare system based on solidarity, a high level of specialist knowledge and a good academic infrastructure, a strong presence of companies and clinical research. All the elements seem to be in place. But that good starting position and the ability to capitalize on it are seriously at risk.

The coherence of all this and the policy on it must be strengthened, based on a long-term vision. Things go wrong when, at the beginning of the innovation chain, a lot of effort is put into the development of new medicines, but all these innovative products do not reach their final destination, the patient.

Be at the forefront, follow the crowd, or opt out altogether?
European countries are increasingly coordinating their pharmaceutical policies, but they still have their own national policies and systems for reimbursement, including the Netherlands. Within a clearly defined framework, we make choices about budget allocation and policy direction with the best of intentions. The challenge, however, lies in the fact that the world around us is changing very rapidly and that issues such as availability, innovation, investment, and even health do not stop at the Dutch policy borders.

Seen in that light, alarm bells should be ringing. The Netherlands’ lag behind neighboring countries in terms of patient access to new treatments is not getting any smaller; on the contrary. Ultimately, this has an impact on the availability of medicines, on the attractiveness of pharmaceutical investments, and on the practical possibilities for conducting future clinical research in the Netherlands. The assumption in the past that investments from pharmaceutical companies in, for example, clinical research and R&D facilities would continue to flow despite everything is no longer valid today.

And this despite the fact that the need to tackle issues differently in a structural manner is becoming increasingly clear. After all, there are several challenges ahead. For example, a reform agenda for healthcare and society is needed, in which medical innovation, among other things, can provide a response to an aging population and a tight labor market. There is also a challenge to invest primarily in good health as an outcome, rather than focusing on curbing short-term expenditure. Finally, a geopolitical reality and necessity has arisen to be strategically autonomous, particularly in the areas of healthcare, health, and the availability of medicines and medical devices.

Attractiveness put to the test
Europe risks losing its competitiveness as a global hub for life sciences and innovation because it continues to lag behind the US and China in terms of attractiveness for pharmaceutical R&D, the initiation of clinical trials, and approval times for new innovative medicines. Europe therefore finds itself at a critical crossroads. In order to regain a leading role in drug development, European countries must make joint decisions.

Within Europe, the Netherlands presents a dual picture when it comes to healthcare and, more specifically, spending on medicines: the Netherlands spends relatively above average on healthcare in general, but is almost at the bottom of the European spectrum in terms of what we spend on medicines as a country (both as a percentage of total healthcare expenditure and as a percentage of GDP). Although there are calls in Europe to better value pharmaceutical innovation, we are seeing a movement in the opposite direction in the Netherlands. This is cause for concern, especially given the geopolitical reality and what is needed for a future-proof innovation model. The current short-term focus is leading to stagnation, and stagnation in the context of the rapid changes currently taking place worldwide leads to decline. This results in a deterioration of healthcare.

Towards investing in health
However, the Netherlands can certainly contribute to an attractive and competitive research and investment climate for medicines. On the one hand, by keeping pace with Europe in terms of spending on medicines and looking at how to reserve budget for targeted further investment in innovative treatments. On the other hand, by allowing innovative treatments to find their way more quickly and responsibly into the standard of care that patients can expect. After all, by ensuring that Dutch practice does not deviate further from European practice, you can continue to attract future clinical research to the Netherlands, because you can still compare it with a relevant European standard of care. This is a good example of how national reimbursement policy has direct consequences for investment, research, and availability, among other things.

Dialogue and making choices
Let’s ensure that the innovation and investments we desire are well aligned with our healthcare system, a so-called end-to-end approach. Only then can Wennink’s advice on this strategic pillar be realistically implemented. Do this in structural dialogue with all parties and with an eye for international reality. The urgency to do so is high, very high. Because access to and availability of innovative treatments, and with that strategic autonomy, is at stake and does not stop at the border. Now is the time to see the bigger picture and make choices together.

Jan Güse is Head of Public Affairs at Novartis Netherlands, where he has been responsible since March 1, 2023, for strengthening public-private partnerships and engaging in dialogue with policymakers, healthcare professionals, and other stakeholders on current issues in the healthcare landscape. In his role, he focuses on topics such as affordability and accessibility of care, innovation policy, and the future-proofing of the Dutch healthcare system.