ENRICO LETTA Enrico Letta served as prime minister of Italy from 2013 to 2014. He is currently the dean of the IE School of Politics, Economics and Global Affairs at IE University and president of the Jacques Delors Institute. In September 2023 the European institutions tasked him with producing a Report on
Health cannot be treated as a silo; it must be embedded into Europe’s broader climate, industrial and digital agendas. This requires investment in prevention and vaccination, the development of climate-smart and digitally enabled health systems, and, above all, the political will to coordinate at the European level. Fragmented national responses can no longer match the scale of the risks. The first priority is to ensure Europe’s capacity to prevent and respond to crises collectively, since preparedness is non-negotiable. Swift, unbureaucratic protocols and clear chains of command are essential when a new threat emerges. Antimicrobial resistance deserves particular attention. Stimulating antibiotics research requires a balance of push incentives for early discovery and pull incentives to make late-stage development commercially viable. Prevention is equally important. Vaccination campaigns, especially among children, the elderly and the frail, are among the most effective tools to reduce the burden of viral and bacterial infections that drive resistance. A second priority is to restore a degree of strategic sovereignty in medicines and technologies. Europe’s dependence on external suppliers for active pharmaceutical ingredients has risen dramatically, with production inside the European Union having fallen from more than half two decades ago to less than a quarter today. This leaves patients vulnerable to shortages and weakens Europe’s innovation capacity. Targeted incentives for European production can reduce dependence without sliding into protectionism. A third priority is to harness digital and data-driven innovation responsibly. The European Health Data Space has the potential to make patient data accessible across borders and to unlock vast research opportunities. Yet harmonised rules and safeguards are vital to ensure public trust. AI, telemedicine and robotics can improve efficiency and care delivery, but they must be deployed in ways that reduce inequalities rather than exacerbate them. Public investment and an innovation-friendly regulatory framework are essential to ensure equitable uptake. Finally, the One Health approach must become central to European policy. With most emerging diseases originating in animals, health security requires better surveillance of zoonotic diseases, stronger coordination between human, veterinary and environmental authorities, and closer cooperation between agencies. Climate adaptation and biodiversity protection are therefore part of the same resilience agenda as pandemic preparedness.
the Future of the Single Market. From 2015 to 2021, he was dean of the Paris School of International Affairs at Sciences Po Paris. X-TWITTER @EnricoLetta www.ie.edu/school-politics-economics- global-affairs | institutdelors.eu/en
reality is that Europe still lacks a true single market for health. Marketing authorisations remain partly national, access to medicines is uneven and structural disparities persist in healthcare outcomes. Citizens expect the EU to deliver security in health, yet fragmentation undermines trust. Europe must deepen health integration, from harmonised clinical trials to interoperable digital health records, so that innovation benefits all citizens equally. Europe must also invest in prevention and resilience, blending EU and national funding to support screening centres, long-term care and climate-smart infrastructure, particularly in peripheral regions. This implies embedding solidarity at the core of the health agenda, avoiding a two-speed Europe in which smaller or poorer member states are left behind. Inspiration can be drawn from Europe’s Beating Cancer Plan, which showed how political ambition, scientific innovation and strategic investment can be mobilised for a common cause. Similar determination is now required for antimicrobial resistance, mental health and neurodegenerative diseases. These challenges, if left unaddressed, could fragment societies and erode Europe’s resilience. Europe’s healthcare sector is at a decisive moment. Compounding threats cannot be met with fragmented responses. They demand a coherent, cross-border strategy that strengthens resilience, restores self-sufficiency and deepens integration. By choosing to invest in resilience and solidarity, Europe will not only protect its citizens but also reinforce its strategic autonomy and unity. In a turbulent global environment, a stronger European Health Union is more than a public good. It is a cornerstone of Europe’s security, prosperity and credibility. ▪
SOLIDARITY IN ACTION None of these priorities will be realised without decisive political choices. The
Health: A Political Choice – The Future of Health in a Fractured World 15
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