The World Health Organization’s (WHO) vast European region – 53 countries, including the entire European Union, Russia and even Israel – is often excluded from cheaper medicine deals because of member states’ high- and middle-income status.

But one of the flagship programmes of WHO regional director Dr Hans Kluge is the Novel Medicines Platform (NMP), aimed at enabling access to innovative new medicines such as gene therapy for cancer, that are effective but extremely expensive.

Norway was the inspiration for the NMP, Kluge told Health Policy Watch in a recent wide-ranging interview.

Before Kluge was elected regional director in 2021, he visited Norway, one of the richest countries in the region, and discovered that it was anxious about the financial sustainability of its universal health coverage if it were to open the door to these effective but costly medicines.

“Because they have universal health coverage, this means if they allow one medicine on the market, they’re obliged to give it to everyone. And they were concerned about these innovative cancer and diabetes medicines,” said Kluge.

Norway had started an initiative for cheaper novel medicines, and this was transformed into the NSP,  a multi-stakeholder collaboration that has country, pharmaceutical and patient representatives.

“Recently, [3-4 July] for the first time in two years, we had a physical meeting of the NSP where we convened all 53 member states, big pharma, patients and the insurers,” said Kluge.

The upshot of the meeting was the establishment of four time-limited working groups focused on transparency, solidarity, sustainability, and novel antimicrobials, which will conclude their work by December 2025. 

Joint procurement for non-EU countries?

For the first time, countries outside the European Union (EU) may have access to joint procurement for novel medicines, particularly the smaller countries in the region with little buying clout with pharmaceutical companies, said Kluge.

Describing the NSP as a “policy lab”, Kluge hopes it will open the door to access to cheaper medicines in the region – not just novel medicines.

The WHO has also resolved to second a representative to the EU’s Health Emergencies Preparedness and Response Agency (HERA) to assist non-EU members to get better access to medicines.

“We have been telling the EU that they will never be safe without the Western Balkans, countries such as Georgia, Ukraine and Moldova. We have said, ‘Guys, if you are procuring mpox vaccines, H5N1, don’t forget your neighbours’,” said Kluge, who hails from Belgium. 

He points to a recent EU meeting chaired by Germany on the price of multi-drug-resistant tuberculosis drugs, currently costing $15,000 a year.

“I would like to give some a positive example because I’m a born optimist,” added Kluge. “In Poland, through their parliament, they got concessional prices and also registered them for the Ukrainian refugees. So if there’s political will and determination, it is possible.”

Hepatitis medicines are also cheaper because of advocacy, while Sweden is spearheading an initiative on antimicrobial resistance (AMR),  he added.

The ‘magic bullet’ of primary healthcare

Kluge is also urging all member states to move from expensive hospital-based care to integrated primary health care (PHC), including health education.

“I used to say there is no magic bullet, but I have changed my mind. The magic bullet is called primary health care. We need to strengthen primary health care and make it multidisciplinary.”

PHC, involving “task shifting” to nurses and more digital solutions, can help to address “medical deserts” – found everywhere from Ukraine to rural France.

“Cardiovascular disease is the biggest killer in our region, but two-thirds of people with hypertension don’t know they have it. And only a minority of those who know are adherent to treatment,” says Kluge. “This is basic case management that should be decentralised to primary level.”

He adds that Europe controlled mpox by “empowering trusted messengers in the community”. 

However, the lack of agency of such civil society messengers in certain member states concerns Kluge – such as the criminalisation of LGBTQ groups and civil society organisations that can reach “key populations” most vulnerable to HIV.

“In the EU, and in whole or region, we have to hold the fort, even on basic issues like sexuality education in school. There is a call for family values, but the data shows an increase in infertility because of unsafe abortion; because of the rise in sexual infection related to no condom use. All of a sudden, the European region is not doing well on condom use.”

Ukraine and Russia

Both Ukraine and Russia are in Kluge’s region.

“We have about 300 people in Ukraine double the number of people we had before the war,” says Kluge. “They work on what we call three Rs: response, recovery and healthcare reform.”

This ranges from providing trauma kits at the frontline to assisting with mobile services and modernising Ukraine’s healthcare with the focus on PHC.

“Thanks to the cooperation of civil society, Ukraine has one of the best HIV responses in the region,” Kluge notes.

While the WHO still has a country office in Moscow and continues to provide Russia with technical support, the regional committee decided to move the regional office on NCDs from Russia to Copenhagen. 

Concern for LGBTQ communities, attacks on healthcare

“I am concerned about what are called the key populations, LGBT communities,” Kluge says. “We need to stand strong for those people.  I worked for two years in the former [Russian] gulags with  Medecins sans Frontieres in TB control so I know the situation quite well. 

“What happens with HIV patients in Donbas [the Ukraine territory under Russian control] is a bit of a black hole. The international community needs to ensure these people get access to treatment. I strongly believe dialogue is very important.”

Kluge also condemns the attacks on healthcare – “be it in Ukraine or in Gaza, the second war in my region”. 

“This is a major concern. People get used to this. But each time, we should scream heaven and earth. You cannot attack a doctor. We already have a lack of doctor and nurses.  It is completely unacceptable to kill them.”

Kluge, who is the only candidate staning for regional director in the WHO Europe elections, is expected to be re-elected unopposed at the regional conference in October.