Health in (not quite) all policies: Why health remains central to the von der Leyen II Commission

There has been much discussion on the place of health within the new European Commission. Some commentators argue that health has fallen down the list of EU concerns. However, this overlooks the fact that health-related objectives are included in numerous Mission Letters and Commissioner portfolios. It is perhaps more accurate to say that, in the von der Leyen II Commission, responsibility for health has been re-distributed.

The public health community has long called for EU health policy to be based on an inter-sectoral approach, widely known as ‘health in all policies’. Without fanfare, the new Commission has moved some distance in this direction. Health-related objectives are now embedded in the mandates of numerous Commissioners and Executive Vice-Presidents (EVPs). These objectives are in many cases closely connected with overarching priorities of the new Commission: competitiveness and the ‘twin’ digital and green transitions.

What appears to be missing, however, is a clear governance structure to ensure overlaps and synergies are identified and effectively managed. In the absence of that, external stakeholders must be agile and consider carefully how best to contribute to health-related policy. At FIPRA, we are here to provide expert counsel on your best path forward.

During his Parliamentary hearing, the new Health Commissioner Oliver Várhelyi emphasised the economic and competitiveness drivers of his priority files. These include ensuring a ‘strong, competitive, and innovative pharmaceutical sector’ and leading on the European Biotech Act which, according to von der Leyen, should focus on ‘the need for a regulatory environment conducive to innovation’.

A focus on 'life-course prevention', while having significant merit on purely health grounds, is also influenced by the economic burden of the major non-communicable diseases (notably cancers, cardiovascular diseases and diabetes). More effective prevention policies, it is hoped, can contribute to more financially sustainable health systems, which over time should reduce pressure on already stretched public finances.

The connections between health and competitiveness do not end there. The Commissioner for Startups, Research and Innovation, Ekaterina Zaharieva, will lead the development of a European Strategy for Life Sciences, a European Innovation Act, and contribute to the European Biotech Act. EVP for Prosperity and Industrial Strategy, Stéphane Séjourné, to whom Zaharieva reports, will also contribute to both the Strategy on Life Sciences and the Biotech Act.

The connections between the digital transition, tech security and health are reflected in von der Leyen’s request for an action plan on the cybersecurity of hospitals and healthcare providers within the first 100 days of the new Commission. This will be led by Várhelyi with input from Henna Virkkunen, Executive Vice-President for Tech Sovereignty, Security and Democracy.

Várhelyi is also tasked with completing the European Health Data Space, promoting uptake of artificial intelligence, ‘notably through clear and timely guidance on its use in the lifecycle of medicines’, and with developing ‘proposals to scale genome sequencing capacities’.

While anti-microbial resistance (AMR) and most aspects of vaccination remain within the remit of the Health Commissioner, responsibility for health security, including oversight of the Health Emergency and Response Authority (HERA), has been transferred to the Commissioner for Preparedness and Crisis Management, Hadja Lahbib.

Vaccine hesitancy and the fight against vaccine-related misinformation was the focus of one of the ‘additional questions’ sent to Várhelyi following his Parliamentary hearing. Incoming US President Trump’s nomination of an overt vaccine-sceptic as secretary for health, likely contributed to MEPs concern in this area. 

Lahbib’s mandate includes developing a strategy to support medical countermeasures as well as an EU stockpiling strategy. The decision to place HERA under Lahbib (another demand of MEPs) is in some ways a logical extension of the division of responsibilities already laid out in the Mission Letters.

Health considerations, including abortion rights and potentially other issues related to women’s health, are also expected to form part of Lahbib’s work on gender equality. This includes developing a ‘Roadmap for Women’s Rights’ in 2025, feeding into a new Gender Equality Strategy. According to von der Leyen, the strategy should update EU actions on all issues affecting women, including discrimination in health.

Mental health is emphasised in several Mission Letters. Roxana Mînzatu, EVP for People, Skills and Preparedness, is tasked with ‘ensuring healthier workplaces and mental health at work’ as part of her mandate on occupational health and safety. Mînzatu will also guide work on intergenerational fairness, led by Commissioner Glenn Micallef, including ‘supporting mental health among children and young people’.

Várhelyi, with support from Micallef, will focus on ‘the impact of social media and excessive screen time on people, especially young people, and their wellbeing and mental health’. He will also lead an EU-wide inquiry ‘on the broader impacts of social media on wellbeing to start an evidence-based debate on the issue’.

Teresa Ribera Rodríguez, EVP for a Clean, Just and Competitive Transition, has been tasked with ensuring that ‘the environment-health nexus’ is embedded ‘in all of our policies’. Air pollution is the most obvious example of that nexus. It is also reflected in the ‘zero pollution ambition’, which forms part of the mandate of Jessika Roswall, Commissioner for Environment, Water Resilience and a Competitive Circular Economy.

Meanwhile Valdis Dombrovskis, Commissioner for Economy and Productivity has been tasked to further integrate the Sustainable Development Goals (SDGs), which includes health, social and environmental objectives, into the European Semester – the EU’s annual cycle of economic and social policy co-ordination.

An area of EU health action that remains somewhat unclear, at least in terms of political responsibility, is global health. In line with dispersing health-related responsibilities across portfolios, global health topics sit within the mandates of several Commissioners. Várhelyi, for example, is responsible for anti-microbial resistance and Lahbib for gender equality.

In parallel, Jozef Síkela, Commissioner for International Partnerships, is tasked with promoting the SDGs as part of the EU’s approach to international co-operation and development. Meanwhile the European External Action Service, headed by the EU’s High Representative for Foreign Affairs, Kaja Kallas, can be expected to represent the EU in many international fora relevant to health, including both the United Nations and the World Health Organization.

The case of global health is indicative of a broader governance question that surrounds the von der Leyen II Commission. While health considerations are to be found in multiple Commissioner and EVP portfolios – a point that should be welcome to the health community – it remains far from clear whether and how potential overlaps and connections will be co-ordinated and managed. From the perspective of health stakeholders, additional complexity may follow from the fact that, in some cases, more than one Commissioner/EVP is responsible for developing a particular policy.

The health community will therefore need to be flexible and energetic in contributing to policy development. Consideration should be given to which Commissioners/Commission services are relevant to policy files and, in parallel, connections made across policies that might not be obvious.

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