Correspondence
Overcoming
fragmentation of health
research in Europe:
lessons from COVID-19
We face an unprecedented crisis in our
interconnected world where health
and wellbeing, security, and economy
affect populations across borders.
Individual and societal health is valued
widely, with care for the planet and
health top priorities for European
citizens. Europe´s answer to COVID-19
comes with long-term geopolitical
and economic consequences and, in
this intense spotlight, EU health policy
weaknesses are starkly apparent.
The EU’s focus has always been
the economy: health and health care
are not primary competences. For
this reason, the COVID-19 response
has suffered intensely from a lack
of coordination and consequent
inequity in access to care. The health
and economic crisis has been a
wake-up call. On May 27, 2020, the
European Commission (EC) presented
its recovery plan, Europe4Health,
integrated in the proposal for the next
Multiannual Financial Framework
2021–27. Although the economy is still
the primary focus, EU initiatives for
health and health care are prominent.
Health research is a gateway to better
health, and it is an EU competence. EU
framework programmes and initiatives
have shown the power and impact
of research collaborations that cross
borders and sectors. In response to
COVID-19, substantial research funding
was quickly made available. However,
most initiatives remain with member
states who provide more than 85%
of total spending for publicly funded
research. European funding policy,
by contrast with policies from other
large regions,1 is fragmented through
lack of continuity and coordination,
within the EU and between EU and
member states. This threatens the
quality of health research, health
care, crisis responsiveness, and EU
health innovation competitiveness.
www.thelancet.com Published online June 16, 2020 https://doi.org/10.1016/S0140-6736(20)31411-2 1
Research for health should not be ambitious vision, with a comprehensive
hampered by programme boundaries strategy and dedicated leadership. The
between basic research, innovation, Scientific Panel for Health expert group Published Online
implementation in treatment, and within the Horizon 2020 programme2,3 June 16, 2020
https://doi.org/10.1016/
diagnosis and prevention; evaluation convened experts across sectors and S0140-6736(20)31411-2
of cost-effectiveness and ensuring an research fields throughout Europe
affordable health-care system across to formulate recommendations for
Europe are an integral part of health health research (appendix).3,4 To address See Online for appendix
research. The COVID-19 pandemic fragmentation a coordinating body, a
painfully highlights the need for a European Council for Health Research
pan-European coordinated approach (EuCHR), was considered an urgent,
in crucial areas of research including necessary first step. A multistakeholder
data collection and access, diagnostics policy board would develop a long-
implementation, and strategy for term vision and strategy, and a
the development of innovative treat­ scientific translational board would
ments. Even if the next framework enhance synergies between research
programme, Horizon Europe, takes programmes and implement action
an inspiring step in aligning health through funding mechanisms. Rather
research across EC directorates, more is than adding an organisational layer,
needed. a EuCHR would build on existing
The new EU policies under discussion structures and mandates in the spirit of
should look beyond crisis management health in all policies. Four key strategic
and threats of infectious diseases. More priorities are listed in the panel.
research funding within a fragmented Under the Finnish presidency of the
system is not sufficient. A coordinated 2019 EU Council, conclusions were
One Health approach that involves all to “… put people and their wellbeing
stakeholders is needed for structured at the centre of policy design”.5 The
priority-setting on complex, diverse European model for health is based
challenges. It should be based on an on societal value, and Europe should
Panel: Aims and recommendations in four strategic areas for Europe
Focus on healthy life, wellbeing, and public health
• Promote health, implement public health, and innovate health-care systems
• Convergence of social and behavioural sciences, epidemiology, environmental
research, and digital innovation
• Cross-sectoral collaboration for pan-European policies for public health
Investment in translational research
• Secure a pipeline of ideas to reach the stage of implementation
• Invest in research on health-care organisation, outcomes, financing models,
and attrition of ineffective treatments for affordable health care
Capacity building
• Reduce unacceptable health inequalities across Europe
• An adequately trained workforce for health research, translation, and innovation
in health care, placing patients and citizens at the centre
• Pan-European infrastructures for digitalisation and artificial intelligence
Partnerships
• A European strategy to ensure bundling of activities, including national research
themes where appropriate, between academic and industrial research
• Associated countries and a post-Brexit UK must be partners when setting out Submissions should be
a long-term health plan made via our electronic
submission system at
More details on these recommendations are available in the appendix. http://ees.elsevier.com/
thelancet/
 Correspondence

be one of the master builders for
global health. Now is the time to
act and implement a structured,
visionary and value-based European
health union, with performant health
research at its core.
STH is undertaking a COVID-19 clinical trial and is
a Non-Executive Director of Synairgen. SP is
employed by the European Federation of Allergy
and Airways Diseases Patients Associations and has
voluntary functions as chair of the Patient Access
Partnership. All other authors declare no competing
interests. This Correspondence draws on the work of
the Horizon 2020 Scientific Panel for Health.
The authors thank the participants of Scientific Panel
for Health conferences and workshops for sharing
their ideas, and the P95 secretariat for support in
drafting the manuscript. The opinions expressed
in this Correspondence are those of the authors only
and should not be considered as representative of
the European Commission’s official position.
1 Dzau V, Fuster V, Frazer J, Snair M. Investing in
global health for our future. N Engl J Med 2017;
377: 1292–96.
2 Celis JE, Gago JM. Shaping science policy in
Europe. Mol Oncol 2014; 8: 447–57.
3 Sipido K, Degos L, Frackowiak R, et al. Scientific
Panel for Health: better research for better
health. Lancet 2016; 388: 865–66.
4 Scientific Panel for Health. Building the future
of health research. 2018. https://ec.europa.eu/
programmes/horizon2020/en/h2020-section/
scientific-panel-health-sph (accessed
April 20, 2020).
5 European Council. Economy of wellbeing:
the Council adopts conclusions. Oct 29, 2019.
https://www.consilium.europa.eu/en/press/
press-releases/2019/10/24/economy-of-
wellbeing-the-council-adopts-conclusions/
(accessed April 20, 2020).

*Karin R Sipido, Fernando Antoñanzas,

Julio Celis, Laurent Degos,
Richard Frackowiak, Valentin Fuster,
Detlev Ganten, Steffen Gay,
Hans Hofstraat, Stephen T Holgate,
Gabriel Krestin, Michael Manns,
Francoise Meunier, Wolfgang Oertel,
Susanna Palkonen, Dainius Pavalkis,
Helga Rübsamen-Schaeff, Ulf Smith,
Bente Merete Stallknecht, Tomáš Zima
karin.sipido@kuleuven.be
Department of Cardiovascular Sciences, KU Leuven,
3000 Leuven, Belgium (KRS); Department of
Economics, University of La Rioja, Logroño,
Spain (FA); Danish Cancer Society Research Center,
Copenhagen, Denmark (JC); Department of
Hematology, University of Paris Diderot, Paris,
France (LD); Faculté des sciences du vivant, Ecole
Polytechnique Fédérale de Lausanne, Geneva,
Switzerland (RF); Centro Nacional de Investigaciones
Cardiovasculares Carlos III, Madrid, Spain (VF);
Mount Sinai Medical Hospital, New York, NY,
USA (VF); Max Planck Institute of Molecular Plant
Physiology, Potsdam, Germany (DG); Center of
Experimental Rheumatology, University Hospital of
Zurich, Zurich, Switzerland (SG); Philips Research,
Eindhoven, Netherlands (HH); Faculty of Medicine,
Clinical and Experimental Sciences, University of
Southamptom, Southampton, UK (STH);
Department of Radiology, Erasmus Medical Centre,
Rotterdam, Netherlands (GK); Hannover Medical
School, Hannover, Germany (MM); Federation of
European Academies of Medicine, Brussels,
Belgium (FM); Department of Neurology, Philipps
University Marburg, M–rburg, Germany (WO);
Patient Access Partnership, Brussels, Belgium (SP);
Astana Medical University, Astana, Kazakhstan (DP);
AiCuris, Wuppertal, Germany (HR-S); Department of
Molecular and Clinical Medicine, Sahlgrenska
Academy, Göteborg University, Gothenberg,
Sweden (US); Department of Biomedical Sciences,
University of Copenhagen, Copenhagen,
Denmark (BMS); and Charles University, Prague,
Czech Republic (TZ)

2 www.thelancet.com Published online June 16, 2020 https://doi.org/10.1016/S0140-6736(20)31411-2