Europe's health imperative: Seven strategic tensions reshaping the sector

The European Health Summit (2-3 December 2025 in Brussels, Belgium) presented a continent at a crossroads, where policy ambition collides with implementation reality, and where the gap between rhetoric and resource allocation has become a major obstacle. 

When farmers arrive in Brussels with tractors, ministers listen. However, when 36 million people living with rare diseases face diagnostic delays measured in years rather than months, the policy response remains fragmented, underfunded, and disturbingly slow. This stark contrast, articulated by former EU Health Commissioner Vytenis Andriukaitis at the European Health Summit, captures the sector's fundamental challenge: health has become everyone's priority in principle, but remains nobody's urgent business in practice. 

Across two intensive summit days, a pattern emerged that transcends individual disease areas or policy initiatives. Europe's health infrastructure faces seven interconnected strategic tensions, each demanding resolution if Europe hopes to transform its post-pandemic preparedness rhetoric into operational reality. For association leaders and events professionals navigating this landscape, these tensions define both the challenges and opportunities shaping the next decade of health collaboration. 

The most fundamental tension operates at the level of perception and accounting practice. European policymakers consistently frame health as an investment in prosperity, yet national balance sheets record healthcare spending as pure cost. This contradiction undermines every subsequent policy ambition. 

The mathematics are compelling. Patrick Horber, President of Novartis International, highlighted that pharmaceutical innovation creates a 5:1 employment multiplier, where every industry job generates five additional positions across the economy. Prevention delivers an 8:1 return, with every pound spent avoiding eight pounds in treatment costs. Yet European countries systematically underinvest, with some nations requiring a fourfold increase in GDP-per-capita spending on innovative medicines simply to match peers, let alone compete with the United States or China. 

For trade associations: This tension directly impacts conference programming and partnership opportunities. Organisations that help quantify health's economic contribution (such as through research collaborations, data partnerships, or advocacy platforms) position themselves as essential partners rather than indistinct bodies in the ecosystem. The shift from "health cost management" to "health investment optimisation" creates new opportunities for those ready to seize them. 

Tension Two: Sovereignty versus fragmentation, the procurement paradox 
 

The Critical Medicines Act represents Europe's first serious attempt to assert pharmaceutical sovereignty through demand-side mechanisms. For the first time, the European Commission proposes EU preference criteria in public procurement. A "Buy European" philosophy historically championed by the United States and China but resisted within the EU's single market logic. 

The procurement battlefield reveals how quickly sovereignty rhetoric confronts practical obstacles. Dutch tenders remain 100% price-focused, whilst Belgian approaches incorporate multiple criteria. The consequences are tangible: when economic viability collapses under price pressure, 300 immune globulin patients were forced to switch treatments overnight as manufacturers withdrew products. Hospital pharmacists, informed at the last minute, scramble for alternatives whilst patients bear the clinical risk. 

The proposed procurement solution is mandatory minimum weighting for non-price criteria including security of supply, with transparent cost composition. However, this faces resistance from larger member states protective of national prerogatives. Smaller nations advocate forcefully for joint procurement that pools purchasing power, whilst larger countries worry about losing flexibility. 

For trade associations: Organisations operating across multiple member states can become procurement intelligence hubs, documenting outcome variations between price-only and multi-criteria approaches. Convening procurement directors, patient organisations, and manufacturers to develop shared evaluation frameworks addresses a capability gap that national governments struggle to fill independently. 

China now approves regulatory submissions 30–40% faster than Europe's EMA. Medicines submitted simultaneously to both authorities increasingly receive Chinese approval first. 30% of global biotech innovation now originates in China, compared to negligible levels a decade ago. For European researchers, this represents both competitive threat and practical frustration; the regulatory environment meant to ensure safety has become a bottleneck constraining the innovation it should protect.  

The pharmaceutical package negotiations illustrate the challenge. Industry sought extended data protection to incentivise European R&D investment; the initial Commission proposal suggested reducing protection from eight to six years. The compromise, maintaining the eight-year baseline with contested provisions around market protection, represents staying still whilst competitors accelerate. 

For trade associations: Scientific societies and research networks face a strategic choice: position as defenders of European regulatory standards, or as reformers demanding process modernisation that maintains safety whilst matching competitor timelines. They will need to contend with regulatory arbitrage, where trials locate based on approval speed rather than scientific infrastructure. The trick that forward thinking organisations will want to master is how to develop fast-track pathway proposals for specific disease areas whilst simultaneously demonstrating how to accelerate without compromising. 

Tension Four: Ambition versus delivery, the rare disease scale challenge 

The European Reference Networks (ERNs) represent a genuinely innovative policy achievement: 24 disease-specific networks connecting 1,620 Centres of Excellence, coordinating over 16,000 healthcare professionals, serving 20–30 million people with rare diseases. From an initial 2017 pilot targeting perhaps ten diseases and a few hundred thousand patients, the scope expanded to encompass the principle that no one should be left without a specialist home. 

Yet the paediatric cancer network coordinator, Professor Ruth Ladenstein, frames even this success story as "too slow." Despite 90% cure rates for acute lymphoblastic leukaemia, a condition uniformly fatal within months, systemic inequalities persist. Comprehensive diagnostic infrastructure, clinical trial readiness, long-term data registries, and seamless research–care integration remain aspirational in many centres. 

The autoimmune rare disease challenge exemplifies the gap. Where cancer innovation accelerates, autoimmune conditions show flat development curves. Argenix, Europe's fifth-largest biotech by market capitalisation, required 24 clinical sites globally to recruit 24 patients for a myasthenia gravis proof-of-concept trial. Patients endure multi-year ‘diagnostic odysseys’, cycling through misdiagnoses and inappropriate treatments whilst their conditions progress. 

For trade associations: Medical societies governing reference network specialties face extraordinary coordination demands from standardising care pathways and maintaining virtual advisory boards to providing cross-border training systems and data platforms. Organisations that build operational capacity for these networks address infrastructure gaps no single centre can solve alone. 

Tension Five: Prevention versus treatment, the HIV regression paradox 

Whilst Europe congratulates itself on pandemic preparedness infrastructure, HIV tells a different story. Against 2030 targets demanding 95% diagnosis rates, 95% treatment uptake, and 95% viral suppression, Europe has achieved only the final metric. Instead of the targeted 75% reduction in new infections, the WHO European region saw a 5% increase. AIDS-related deaths, meant to fall 90%, instead rose 37%.   

The causes are political as much as clinical. Civil society organisations (the "front line" for community testing, PrEP (HIV Pre-Exposure Prophylaxis) access, and harm reduction) face systematic funding cuts and ideological attacks. As a result, Europe is failing to test and treat HIV early, with over half of all diagnoses being made too late for optimal treatment. The highest late-diagnosis rates affect heterosexual men and people who inject drugs, precisely the populations targeted by decades of intervention, suggesting fundamental strategy failure rather than insufficient effort. 

The solutions exist: opt-out testing in emergency departments (UK model), PrEP rollout beyond infectious disease specialists to gynaecologists and urologists, community-led outreach sustaining trust in marginalised populations. What's missing is the political will to sustain these investments between crises and defend them against culture-war attacks on sexual health programming. 

For trade associations: HIV organisations navigate an increasingly hostile political environment where evidence-based prevention confronts ideology. Coalitions that frame HIV elimination within broader non-communicable disease strategies, or integrate with antimicrobial resistance and pandemic preparedness agendas, may secure more durable political support than standalone HIV advocacy. 

Commissioner Hadja Labib outlined an impressive preparedness architecture: a €10+ billion budget proposal for the next Multi-annual Financial Framework, the European Vaccine Hub coordinating prototype development across priority pathogens, reserved manufacturing capacity through EUFAB and industry contracts, and €1+ billion supporting African manufacturing capability to prevent the equity failures that plagued COVID response. 

Virologists and public health officials appreciate these initiatives whilst questioning their sustainability. Four-year funding cycles undermine research continuity and industrial planning. Candidate vaccines developed with public funding then require "shopping" to pharmaceutical companies for commercialisation, without guaranteed follow-through. The H5N1 avian influenza threat receives fragmented national responses rather than coordinated European strategy, precisely the coordination failure pandemic preparedness should prevent. 

Spanish Health Minister Mónica García articulated the core challenge: "If a policy has a permanent budget line, it has a permanent future." The One Health concept, promoted by Ab Osterhaus, must transition from crisis response to state policy, embedded in cross-party frameworks and permanent institutional structures rather than commissioner-specific initiatives vulnerable to political cycles. 

For trade associations: Organisations need to successfully transition from project-based to core-infrastructure positioning. Demonstrating permanent value propositions (surveillance networks that operate continuously, training systems that build permanent capability, and data platforms that compound value over time) creates funding resilience in times of political instability. 

Tension Seven: Awareness versus action, the sleep medicine blind spot 

Of all the summit's revelations, perhaps the most striking came from the sleep and cardiovascular health panel: medical students in one of Europe's largest health systems receive 45 minutes of sleep medicine education across six years of training. A condition affecting one-third of human lifespan, newly recognised by the American Heart Association as the eighth essential cardiovascular health factor, remains the "Cinderella of clinical medicine."  

The consequences are measurable. CPAP (Continuous Positive Airway Pressure) therapy adherence reduces cardiovascular hospitalisations, emergency department visits, and both general and cardiovascular mortality. Yet sleep disorder screening remains unsystematic, sleep laboratory wait times reach 24 months in Germany, and diagnostic protocols rely on single-night testing in artificial environments with 40 cables attached; this is hardly representative of typical sleep patterns. 

The education gap extends beyond clinicians to patients, policymakers, and health system planners. Without awareness that disrupted sleep elevates blood pressure, increases stroke risk, and accelerates heart disease, prevention strategies omit a modifiable risk factor with population-level impact. 

For trade associations: Cardiology societies that integrate sleep medicine into core curricula, accreditation standards, and practice guidelines lead a genuinely under-developed field. Cross-specialty collaboration with pulmonology, neurology, and primary care creates new professional development markets. 

These seven tensions share common DNA: the gap between Europe's policy ambition and operational delivery stems from misaligned incentives, fragmented governance, inadequate investment, and political momentum that surges during crises but dissipates in recovery. No single initiative resolves these systemic challenges. The pharmaceutical package, Critical Medicines Act, cardiovascular health plan, and preparedness strategy each address important elements whilst leaving fundamental tensions unresolved. 

For trade associations, these tensions define the strategic landscape for the coming decade. Organisations will become indispensable when they position not stakeholder voices but as solution infrastructure with operational platforms enabling coordination, data sharing, standard-setting, and cross-border implementation. 

The 2025 European Health Summit demonstrated that European health leaders understand their challenges with uncomfortable clarity. The test ahead is whether understanding translates into the sustained political will, resource allocation, and institutional reform required to resolve these tensions rather than simply document them. For those building the professional infrastructure supporting this transformation, the opportunities are as substantial as the challenges are daunting. 

Discover how MCI can help your association turn Europe’s health challenges into opportunities for impact. Partner with us to build operational platforms, drive cross-border collaboration, and transform strategic tensions into sustained growth. 

Contact us today.