Committee on Public Health Ordinary meeting
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SANT European Parliament
Follow its sittingsSpeaker 6
We need a separate health program within the next MFF, or at a minimum, a clearly earmarked and ring-fenced financial envelope that guarantees continuity for prevention, preparedness, and public health action. As a shadow rapporteur, I intend to table amendments in this direction, and this will be a key priority for our group in the negotiations. Under the current financial period, EU-level health investment reached around 70,000,000,000 when including the Recovery and Resilience Facility. And in the next MFF, €35,000,000,000 must be considered the absolute minimum. Anything less would mean lowering our level of ambition at a time when risks are increasing.
COVID-19 told us that prevention preparedness cannot be improvised. Prevention is not an expense. It is one of the smartest economic investments we can make. At the same time, strengthening Europe's strategic autonomy in medicines and medical technologies is essential; reducing dependency on third countries, supporting EU-based manufacturing, and reinforcing our health value chains are necessary steps. But competitiveness must go hand in hand with affordability and equitable access.
Innovation that citizens cannot afford is not a success. A healthy population, resilient health systems, and secure supply chains are not obstacles to competitiveness. There is a foundation. Thank you.
Speaker 8
Chair. Ladies and gentlemen, we'd like to thank the reporters for the work done in the SANT opinion to add the health perspective to the debate on the European Competitiveness Fund. We share the idea that health needs to be a priority when talking about competitiveness in Europe, avoiding this, funding, two narrow visions whereby Brussels would decide what sectors are strategic and how to use resources in health. It's essentially a national competence because the needs and requirements are different across member states. To that end, we would add amendments related to subsidiarity.
And, with such a huge financial tool, there could be an indirect influence on national health priorities, which is something we need to be aware of. We agree with the fact that there's a dilution of health resources. We need to guarantee autonomy and security, and give patients hope by investing in new therapeutic tools.
And that's something good for all Europeans. Health.
We shouldn't be competing with other industrial interests within this big, common fund. The last point we'd like to stress is the risk of excessive red tape and the requirements to operate within the European field. We need to make sure that projects that aren't usually profitable are feasible as well, and avoid overly complicated procedures, which could slow down or hold up the most important activities. It is important that the resources are invested smartly and that they have the biggest positive impact on Europeans' health possible. So, we need to increase transparency and democratic controls. This size of fund needs to have clear accounting and accountability in national parliaments.
The European Competitiveness Fund can be a useful tool if it respects national competence, guaranteeing that health isn't diluted because of other issues, including ideological ones. It needs to respect the life and dignity of human beings. This is a particularly sensitive week with the commission that has a citizen initiative to support abortion across member states, and that is not something we all agree with. This ideological turn in health isn't good for patients who need a united Europe that is proportional in terms of giving the best health care possible.
Speaker 10
Thank you. So, dear colleagues, first of all, thanks to the rapporteur for his good work so far. I appreciate your intentions to ensure that DG Herre and its work on medical countermeasures are appropriately funded. So, the renewed priorities for the ECF are organized around three pillars. First, innovation.
Here, we need a strong focus on pharma innovation in AMR and rare diseases, and ensure that there is funding with the right risk profile for biotech. Second, the EU for Health budget should, of course, be restored to its previous size, and civil society grants should be restored as well. The European Health Data Space and the European Reference Network are public goods that are key for our patients and for our competitiveness. We had that discussion earlier today. And as you heard me say then, and hear me say now, we need all our good intentions to go into our funding in these areas.
Speaker 11
Thirdly, we must be clear that health is part of civil and military preparedness. We need to ensure that critical manufacturing, like vaccines and antibiotics, does not leave Europe. These products are dual-use. We clearly need to strengthen our supply chains in this area. So, these will be the renewed priorities, and I look forward to continuing the good work.
Thank you.
Thank you. Catarina Martins?
Thank you.
Speaker 12
You, chair. Following the pandemic, the European Union has tried to do more in terms of commitment to public health. We're now up against this draft budget, and it's clear that we've forgotten the lessons we should have learned from the pandemic. I'd like to thank the reporters for their work. We do agree with the number of priorities as reflected in the amendments lodged.
However, the amendments from the left will have two main thrusts. Firstly, we need a full health budget because if we don't have a very clear budget for health under a larger budget, then the danger is that it will be diluted. We don't believe that the reasoning underlying the competitiveness fund is in the interest of health for a number of reasons. Firstly, because any profit generated by health shouldn't be considered profit. It should be a benefit that helps the whole of society, as opposed to being privatized.
Speaker 14
So, we should support vulnerable people, namely patients. And both of these points are linked, and that's nothing to do with free competition and the private market. So, we're up against a twofold problem. Firstly, guaranteeing health investment and then making sure there is public investment in health. That's very important.
Speaker 13
And then, when the rapporteur talks about the issues with health care professionals reducing competitiveness in terms of what member states do. Well, I think that's important. We need to see to what extent that's possible. That's a very different point from competitiveness itself. I think we can work together on that.
Speaker 2
Yeah. Now I give the floor to the Commission representative, Mr. Dirk Van der Stan, head of the unit DG SANTE C3, for his reaction for 2 minutes, please.
Speaker 15
Thank you, Chair. We would like to thank the Senate Committee for the draft opinion on the ECF proposal. The commission has examined it carefully. We have also listened to interventions from the rapporteur and the honorable members today. The Commission's proposal for the new MFF demonstrates that investing in population health and strong health systems is the foundation for social resilience, economic growth, and competitiveness.
And this is why the proposed ECF, Horizon Europe, and Union Civil Protection Mechanism, Health Emergency Preparedness, all cover thematic priorities of Eo4Health. The ECF will support actions to improve public health, strengthen health systems, and enhance population health outcomes in the EU. And those, in turn, will improve productivity and competitiveness in our economy. And this is firmly embedded in the proposed ECF regulation. It will deliver on core policies: health security, Europe's beating cancer plan, safe hearts plan, and the European health data space, among others.
In addition, the ECF will support medical innovation as well as strategic autonomy in medicines, medical devices, and medical countermeasures, in line with the critical medicines and biotech acts and the medical countermeasures strategy. With the tight connection to Horizon Europe, the ECF will deliver a seamless investment journey to ensure industry leverages Union-funded research results to further innovate and produce in Europe. Flexibility is a key design feature of the next MFF. It ensures Europe has the capacity to act and react fast when new policy priorities need to be addressed. For this reason, the ECF outlines indicative envelopes at the level of the policy windows to ensure predictability and flexibility in designing ECF operations and the tools to be used.
Thank you very much.
Speaker 2
Thank you. Finally, I would like to ask if, Mr. Kanev, you would like to react to the comments made by Maps, please.
Speaker 4
Yes. Thank you, Chair, and thanks to all the shadows and the commission. Very brief reaction. First, I must say I'm happy to see that we start working in a spirit of cooperation, and I'm rather hopeful that we'll end up the same way. I'm a bit sorry that we don't hear the reactions of the Greens and the ECR groups today, two groups that I have worked with very fruitfully in the past.
So, I can say close to my heart, although very different in many ways, I hope that they will be part of this spirit of cooperation as well once they're ready with their positions. I see a very interesting proposal on behalf of the SND group to frame a comprehensive health envelope within the MFF. I'm still a bit afraid that it will be considered out of our competence, as an opinion-giving committee, but I'm open to the idea, an idea we heard from the left group as well. As for the Patriots for Europe position, I would only object that it's a huge envelope we are discussing. I'm afraid it's a rather limited one, bearing in mind the inclusion of health, biotech, bioeconomy, and agriculture within this envelope.
But I'm very happy that I also see the support for ring-fencing against dilution of health policies in their position as well. And I fully share the idea that red tape should be cut as much as possible within this competitiveness policy. On the renewal, except for an obvious agreement that we have on the general policy, I would underline that I'm very much open to working more on defense and civil protection within this envelope. And so here I end, while thanking once again the shadows, and looking forward to our negotiations, hopefully not very tough ones.
Speaker 2
Thank you, Radan. Thank you, colleagues, for this discussion. I announce now the deadline for tabling amendments, which is set to the 2nd of March at noon. Okay. Dear colleagues, we now move to the next point on our agenda, which is the public hearing entitled "Brain Health: Policy Challenges and Opportunities to Manage Neurological Diseases."
Speaker 16
We can see she needs to take the seat next to you. So, okay. Need a moment to arrange the podium. Okay, colleagues. Let's continue.
Speaker 2
Our next point on our agenda is the hearing entitled "Brain Health Policy: Challenges and Opportunities to Manage Neurological Diseases." Neurological diseases are one of Europe's most urgent and rapidly expanding health, social, and economic challenges. Being the leading cause of disability, neurological diseases are set to affect 1 in 3 people in Europe. This challenges health care systems, social support structures, and caregivers. Furthermore, neurodegenerative conditions such as dementia, Parkinson's disease, and ALS are estimated to increase in an aging society.
For instance, Alzheimer's disease is the most common cause of dementia, while Parkinson's disease is the fastest growing neurological disorder worldwide. ALS through RAR is severe and progressive, with rising prevalence. Today, we will discuss brain health, an important public health issue. We will address scientific and technological developments in this field and policy options to manage the growing economic and societal burden of neurological disease. To discuss this, we have invited leading experts from academia and non-governmental organizations.
A warm welcome to all the speakers. We have a photographer to take pictures of the finalists for the first half hour. We start this public hearing with the presentation of a briefing entitled "Strengthening Brain Health Policy Recommendations to Tackle the Rising Burden of Neurological Diseases," drafted upon the request of our internal research service, the policy department, specifically to support this hearing. Professor Ellie M. Hull is the author of this briefing, together with Jerome Pasterkamp. Professor Hull is Professor Ellie Hull, Vice Dean of Research at UMC Utrecht, neuroscientist, and Professor of Glia Biology of Brain Disease.
Professor Hall, the floor is yours for 8 minutes, please.
Speaker 17
Thank you, Mr. Chairman. Dear members of the European Parliament, thank you for the opportunity to speak to you today about the topic that affects us all: the health of our brains. My name is Eli Hull. I'm a professor of neuroscience at the University Medical Center Utrecht. Together with my colleague, Jeroen Pastekamp, we recently wrote an expert briefing on neurological health.
We are both researchers, and we study how brain diseases develop and how we can prevent, delay, or treat them. Today, I want to highlight why neurological health requires urgent, coordinated action at the European level, and what concrete steps can be taken to strengthen neurological health in Europe. Next slide, please. Neurological disorders are one of the fastest-growing health challenges in Europe. Today, one in three people live with a neurological condition, which means that more and more people are becoming dependent on caregivers.
And the economic impact is large, around €368 billion per year in Europe. More than half of these costs are related to informal care. This means that family members, often women of working age, have to reduce or leave their jobs to care for loved ones. The rise in neurological diseases is driven by aging. Therefore, this picture of this aging woman is driven by aging, but also by our genes and our lifestyle choices, such as an active lifestyle or healthy eating.
And environmental exposures, such as air pollution or toxic substances. Aging plays a particularly important role. Many of these diseases begin slowly, and long before the symptoms appear, there are already things going wrong in the brain, and this becomes noticeable only later in life. That's why prevention and delaying the onset are so crucial. Because these conditions are chronic and progressive, the pressure on healthcare systems and informal caregivers will only intensify unless we act now.
And we start with a European health plan dedicated to neurological health. Can I have the next slide, please? So, let me briefly outline three major neurodegenerative diseases. On the left side, you see an example of an Alzheimer's disease brain. The brain on the bottom is of a healthy person who, of course, died because this is post mortem but did not have a neurological disorder.
The brain on the top is that of an Alzheimer's patient. It's very clear that this brain is smaller, so it has shrunk a lot. It's also much lighter, and this is because many cells have died in the brain. The majority of patients who get Alzheimer's disease are over 65 years of age. And over the age of 80, almost one-third of all people in that category are living with dementia.
On the right side, it's Parkinson's disease. That is the fastest-growing neurological disorder worldwide. In this disease, people often have a tremor or stiffness, which causes sleep problems, anxiety, and, in some cases, dementia. It's caused by the loss of a very specific neuron, a dopamine neuron in a very specific brain area, which is also depicted in the top right picture. And this is also an age-related disorder.
But in one out of 10 patients, the disease already started before the age of 50. Then, the last disease is ALS, which stands for amyotrophic lateral sclerosis. This is a less common but very devastating neuromuscular disorder. Most people who have this disorder die within 3 years after diagnosis. The patients progressively lose all voluntary muscle control, including breathing.
As in other neurodegenerative diseases, also in ALS, you see a buildup of toxic proteins. Can I have the next click? So those diseases are all different, but if you look under a microscope, what you see here are a few examples of aggregates of proteins, so protein clumps. And therefore, we think that the progress we made scientifically in one of these disease areas is a big help for the other disease areas because there are common mechanisms going wrong in the brain. And I forgot to mention that Alzheimer's disease is the most common form of dementia.
So, people talk about dementia. Most often, that's Alzheimer's disease, but there are many more mixed forms. Next slide, please. What I would like to draw your attention to is dementia, and this is a website. So, on the right side, you see a QR code, which goes to the website of Alzheimer Europe and directly leads to an interactive website where you can search for your specific country to find the number and the prevalence of persons living with dementia in that country.
So, these are the numbers for 2025. So, on the left side, you see the prevalence in blue. The lighter the blue, the lower the incidence for people with dementia living in those countries. If you give me another click, then we see on the right side, it's not 2,050. I'm sorry about the change in the numbers.
But in 25 years, we expect that the number will massively increase. So today, there are 9.1 million citizens in Europe living with dementia. In 2050, it will be over 14 million. The largest increase will be in people over 80 years old. Can I have the next slide?
So, this is all from the recent Alzheimer Europe report. And this is a very complex slide, but what you see are different age categories starting from 20 to 30 up to 90 on the right. Each column in the lighter blue represents women, and the darker blue represents men. And these are different years. So, the first column is always 2025, and the last column is 2050.
And then you see, for instance, in the age group 80 to 90, which are both on the right, that the number of these people living with dementia will dramatically increase. And that will go up to €19,000,000 in total. Can I have the next slide, please? Neuro, sorry. Neurological health is a concern to us all, but for me, it is also very personal.
What you see here is my mother. She passed away two months ago, and she lived with dementia during the last years of her life. She was a very strong and independent woman, and it was devastating to see how she lost herself. When she eventually moved to a nursing home, it brought my sisters, my brother, and me some relief because we knew that she was safe. She still remembered, although she had dementia, that I was studying Alzheimer's disease, and she always told me to hurry up and find a cure.
But unfortunately, I could not help her because it's not easy to find a cure. But it motivates me even more now to act. The good news is that we can make a difference. I think neurological health is indeed a concern to us all, and it is not only shaped by our genes, but also by our lifestyle, education, social connections, and environmental factors. So, prevention is very important, and hopefully, this can delay the onset of the disease by a few years.
Even a few years can make a huge difference to someone's independence at a later stage in life. In addition, we must strengthen the support system in Europe for both formal and informal care. Many Europeans today rely on unpaid care from family members, often women of working age. I think that is very important to do. And finally, we must enable innovation.
We are seeing important medical advances, and the first disease-modifying treatments for Alzheimer's and ALS are emerging. They are not cures, but they slow the progression of the disease. And to benefit patients, however, health systems must be prepared to diagnose earlier, deliver complex treatments safely, and make them accessible. Next slide, please. Also, the scientific opportunities are growing rapidly, and this is a nice picture from my research.
It's also a personal input. In my work, but also in other work by people in my department, we use a lot of human postmortem brain tissue from people who donated their brains for research and science, but we also make a lot of use of human-based cell models, which are at the bottom of the picture. We also call them NAMs, or new approach methodologies. These are, for instance, so-called organoids or mini brains. So we can make mini organs for many parts of our bodies, and they are made from patient stem cells.
So, to study disease, it is very important to study disease mechanisms and to test potential treatments more precisely for specific people. We also have a lot of large data sets, or omics. So this is the spot with all these dots. And we're producing many of these data sets daily, and this will lead to new targets for therapy. Advances in brain imaging, diagnostic monitoring, and neurotechnology are opening new doors as well.
To fully benefit from all these developments, we need strong European collaboration. We need good data infrastructures. We need shared standards and close partnerships between academia, biotech, and industry. Next slide, please. That's why we proposed that it's time for a European neurological health plan based on four priorities: first, promote prevention across the lifespan and integrate neurological health into public health, environmental, and education policies; raise awareness of risks such as inactivity, poor diet, air pollution, and pesticides. Second, reduce inequalities in access to care.
Today, access to specialists, biomarkers, and therapies has risen widely across Europe. We recommend minimum EU standards for neurological care pathways and stronger support for informal caregivers, including flexible working arrangements and training. 3. Invest in early detection, biomarkers, and innovative diagnostics. So, earlier diagnosis is essential, especially as new disease-modifying therapies emerge. The EU should expand research infrastructure to harmonize data sharing and support equitable access to advanced diagnostics, from neuroimaging to digital tools. Finally, it should accelerate research innovation and translation into therapies, and strengthen the European pipeline for scientific discovery to real treatments, including advanced technologies such as gene therapy and new approach methodologies, such as organoid-based cell models for testing and research.
In research with data and tissue of patients, for instance clinical data, genetics, and organoids from patient cells, data protection is key. However, the rules of the EU General Data Protection Regulation can sometimes be experienced as an obstacle. Final slide, please. In conclusion, neurological diseases are among the biggest health challenges of our time. Postponing the onset of the disease or delaying its progression will have a major impact on the independence of the elderly generation.
Science is advancing rapidly. And with coordinated European action, we can transform the lives of many patients, caregivers, and future generations. I would also like to thank Alzheimer Europe and Parkinson's Europe, who gave a lot of input for our expert review, and my colleague Jurgen Passerkam for working together on this with me. And thank you very much for your attention.
Speaker 2
Thank you, Professor Hall, for your great work and inspiring presentation today. Dear colleagues, we will now move directly to the two panels of this public hearing. Each panel is followed by a round of coordinators' remarks and eye-catching comments. Then I will give the floor to the experts to react to the members' remarks and questions. We begin with the first yes.
We need a moment to rearrange the podium. The first two speakers can come up. And I'd like to ask our guests to join us: Mr. Professor Zombek and Anna Verdello. Professor Anna Verdello.
Speaker 21
Thank you. Thank you, bless her. Okay. We begin with the first panel on the success and challenges of cutting-edge research on neurology and the potential of neurotechnology. I would like to welcome Miroslaw Zombek, professor and head of the neurosurgery clinic at Manaviv Masovitsky Brudnovsky Hospital in Warsaw, and Anna Vardello, neurologist in the department of neurosciences at Santa Maria Hospital in Lisbon. He's also a professor at the medical school of the University of Lisbon.
Speaker 2
I invite colleagues who would like to take the floor during the session to indicate it to me and to the secretariat. I would like now to give the floor to our first speaker, Professor Anna Vardella, for 8 minutes. The title of her intervention is "Neurocognitive Disorders." Is it possible to prevent it? The floor is yours, please.
Speaker 20
Thank you. Dear members of the Parliament, it is an honor to be here today. And as a neurologist specially dedicated to cognitive disorders and dementia, I thank you for taking the time to hear my concerns and thoughts. I would like to give you some key points, and I hope to leave you with hopeful ideas. Next slide, please.
Along with the aging of the global population, we are facing a steep increase in the number of people living with neurological disorders, mainly cognitive impairment and dementia. My first key idea is that we now know neurodegenerative disorders probably result from the combination of factors through aging, and all research supports that an agent that only alters a single aspect will not have an impact. Next slide, please. In that sense, and knowing that 45% of dementia cases can be attributed to 14 potentially modifiable risk factors, we urgently need to increase efficient measures to promote prevention. And I'm speaking about very well-known risk factors: hypertension, diabetes, hyperlipidemia, sedentarism, obesity, but also other modifiable factors such as education, brain trauma, and even pollution.
So prevention needs to be done at any moment in life. As you can see in this schematic graphic of the Landsat Commission, the risk factors start very early in life. So, implementing prevention strategies needs to cover all moments of an individual's life. Next slide, please. Following the growing body of information on risk factors and on the evolution of the numbers of dementia, the World Health Organization promoted, for the first time, a guideline with recommendations for the risk reduction of cognitive decline and dementia.
Although they were published seven years ago, it is an extremely important document, very easy to read, and it includes most of the risk factors that we need to control. Next slide, please. The second idea I want to leave you with is that there is very hopeful information. We just heard about the evolution of the numbers of dementia across Europe. But what I can tell you is that while there is no curative therapy for any of the degenerative dementias, we have data supporting that there is a decrease in incidence, meaning new cases, over a time frame in several points of the globe.
So, you can see on your left side, you have aggregated data from 11 cohort studies from both Europe and the United States that analyzed more than 50,000 people. And what they found is that, in fact, over the last 20 years, there was a consistent reduction of 30% per decade in the new cases of dementia for some countries, some age groups, and some sex groups. And on the right side, you can see three cohorts from Sweden that aggregated more than 1,000 people over 80 years of age; you can see that the same result was found. They were born in 3 different decades. And over the three decades, there was a reduction in new cases.
And this study also approached the total cases, meaning the new and the existing cases. And they also find a diminished result in the existing cases for people older than 80 years old. So it seems that the last decade, with better economic status, better education, and better access to medical treatments, has been a result. Next slide, please. But it is important to note that this downward trend may not last, as was pointed out by the English study of aging that analyzed trends in more than 20,000 people.
And they found that after a decline in incidents, or new cases, there was a U-shaped curve recovering again. So the authors warn that, probably as a result of modern life—more time behind screens, more sedentary time, more, perhaps, mental problems, and more addictive problems—may change the good tendency. So, the reduction in incidents is not like seeing something we won. It's something that we need to fight for. So, next slide, please.
My last idea I would like to leave you with concerns public perception, because we might have a problem with what the public thinks about the risk factors and what they want to fight for. So, if we don't have people sensitized to a better way of dealing with life and risk factors, we are not going to change attitudes. So, again, we have studies from different parts of the world, and the responders were asked the question: what are the factors that are important for my risk of cognitive decline in dementia? In fact, people recognize genetic heritage and aging as the most relevant risk factors, and they don't consider the impact of vascular risk factors such as hypertension and diabetes. As you can see in this Irish study on your right side, more than half of the responders were against the idea that controlling hypertension or diabetes could prevent dementia.
And I should notice that the higher level of education of the responders was positively associated with better health literacy. So, next slide, please. There are already instruments that identify concrete actions to implement better health control and better rules for controlling health in general. So the instruments are there to be mobile and healthy for the whole organization with the ITU. So, the instruments are there.
So, my last slide, please. So I would like to say that, to end, that prevention is desirable and achievable. It is not expected that any revolutionary change in science will cure dementia, but health policies can do so or are doing so. We are already reaping that. So, we urgently need to change our attitudes.
So any type of action needs to be transversal to all interveners and must be multimodal to use different approaches. And at last, I need citizens to be involved, empowered, and to understand that they also become active in preventing. Thank you for your attention.
Speaker 2
Thank you, Professor Vardello. I will now give the floor to Professor Zombeg. Professor Zombeg is specialized in neurosurgery and neuro-rheumatology. He's head of the Department of Neurosurgery and Injuries of the Nervous System at the Postgraduate Medical Education Center at Mazovitsky Hospital in Brudno. He will speak about brain gene therapy.
Professor Zambach was the first in Europe to apply this technique clinically and was able to perform it in a large number of patients. Professor, the floor is yours, please.
Speaker 22
Mister Chairman, honored chairs, dear members of parliament. It's a really great honor for me to be here with you on the stage in the European Parliament. So, thank you very much for the invitation. I was invited here to share with you my unique and very promising experience in brain surgery, especially in gene brain therapy. Next slide, please.
Speaker 24
Many years ago, we introduced in Europe the kind of surgery, the surgery in real time using magnetic fields. What does it mean? That means that the surgery is performed not in the operating theater, but in the gantry of the magnetic resonance device. This technique enables us to observe in real time what is going on in the brain. We see the tip of the needle.
Speaker 22
We can observe the distribution throughout the brain of injections via vectors. This was the beginning of gene therapy in Europe, and I was also the first to introduce this kind of surgery in Europe. Please, the next one. There are two mechanisms of gene therapy action. We can introduce a copy of the missing gene in the brain, or we can introduce a gene that will block the function of the wrong gene which produces pathological, harmful protein for the brain.
Speaker 23
Next one, please. There are two types of gene therapy: germinal, which means manipulation of gametes. From the ethical point of view, it is prohibited. And it is also somatic gene therapy. This refers to everything about the sales expect gamuts.
Speaker 22
Next one, please. Regarding shipment, we are the leading center in Europe in performing gene therapy for multiple system atrophy, which is a very horrifying neurological disorder. Also, as a first in the world, frontotemporal dementia is popularly called Bruce Willis disease. As a first year in Europe, we performed studies on Huntington's disease, Parkinson's disease, and AADC deficiency syndrome. About this pathology, I will tell you just a moment later.
Now we have received the grant from the European Union for the treatment of Alzheimer's disease and Parkinson's disease using gene therapy. How important is it? It suffices to say that about 10 to 12 million people in Europe are suffering from Alzheimer's disease. And about 1.5 million people in Europe are suffering from Parkinson's disease. Please, the next one.
Please click the same slide again. AADC deficiency is a horrifying disease. Children suffering from this disease usually die within the first or second decade of life. All the children are like this baby now, on the slide. It's a congenital disease, and the reason for this disease is the lack of one gene in the brain, which codes for amino acid aromatic decarboxylase, an enzyme needed to produce dopamine and serotonin.
Please, the next one. And the next one. During the surgery, we introduced a copy of the missing gene to a very crucial part of the brain: the brain stem, specifically the substantia nigra. And this gene is distributed via regular physiological translocation and neuronal transportation. Next one, please.
We have operated on many children from all over the world, including America and Canada. Next one. This is the child from "I Can Take." This is a girl from Canada, still at home. Can the voice sound be louder?
Speaker 22
Yeah. This is a girl who became ill before coming to us for the treatment. Next one, please. Yeah. Next slide, please.
During the surgery, in a very precise procedure lasting many hours, we introduced to the brain stem a substantial IGRA, a very small amount of viral vectors, about 500 microliters, but we can't completely save the life of such a child. This child is usually reborn. Next one, please. Next, please. This is the same girl.
A few months after the surgeries. Now she is in Canada.
Speaker 22
Next one, please. The following was after the surgery. As a left side, I would like to present to you a very short film, three and a half minutes, to describe, in short, the history of the child. Once again, please. Click.
Our daughter, Ryan, was born with...
A rare.
The voice is louder.
Speaker 27
This is the story of how gene therapy has given her a second chance at life. Living with AADC meant that Ryan could not move. She never reached any physical milestones, and the only thing she had control over was her smile, which was her one way to communicate with us. Ryan couldn't stand on her own, sit on her own, or even hold her head up. She needed full-body support at all times and couldn't even use her hands to play.
Ryan was so weak and dismayed that she spent most of her life either sleeping, regardless of where we were, or crying even during happy celebrations. She was so medically fragile that even catching a simple cold would land her in the hospital, often pushing her little body to its absolute limits. Ryan never gained the ability to eat or drink and relied on a feeding tube. Every two to three days, she would have painful seizure-like spells called OGCs, which made her body stiff and her eyes roll to the back of her head. An OGC could last anywhere from 4 to 8 hours.
Watching her suffer so terribly for nearly 5 years was heartbreaking, but we never lost faith that our miracle would come, and it did. We flew to Warsaw, Poland, and I laid Ryan down on the operating table. On 09/03/2019, she received gene therapy. This was the day my daughter was reborn. Brian had her last OGC ever on the plane ride home from Poland.
And then, Brian, you're holding your head up. Head control, then using her hands to play, followed by eating and then drinking.
And.
Speaker 27
Learning how to sit independently. It seemed as if we traded all of our past days at the hospital for new days of therapy, getting stronger and learning more every day. From being so frail that she wasn't even on the growth chart to becoming at the fifty-eighth percentile months after surgery. From being held like a newborn to learning how to stand independently, from being tube-fed to eating Happy Meals, from needing full support to learning how to support herself—standing, playing, learning—Ryan entered a whole new world. From only ever being able to taste a small amount of icing from her birthday cakes to eating as much as she wants and feeding herself.
Speaker 22
I think that gene therapy is really the future in medicine, not only in neurosurgery, but probably in other kinds of specializations. Thank you for your attention.
Speaker 2
Thank you, professor. Very impressive presentation. It's good to see the success in the treatment of neurologist's diagnosis. Now I open the floor to our colleague Mab, and we're starting with Thomas Alfsocola. So, first, please.
Tomislav Sokol
Thank you, Chair. Thank you for being with us and presenting some successes and positive stories, which is always good to see—that actually what you're investing in health and everything that health science is doing is bringing some results. So, I would like to congratulate you for that. The topic of brain health is, unfortunately, a pretty neglected issue here in the European Parliament. We speak a lot about cancer.
We speak a lot about cardiovascular diseases, about alcohol, tobacco, the usual things, which are all obviously extremely important. But, unfortunately, brain health is definitely a topic that is not talked about often, even though it impacts a large number of people. It's not just that it impacts them, but I think it impacts their everyday life in very profound ways, in a way that most other diseases don't. So I think that for that reason, brain disease and brain health in general should play a much more prominent part in the discussions in the European Parliament, and that this is why I'm glad that we have such a hearing here and that we'll continue to work also on concrete documents, concrete proposals to actually resolve the topic, to try to make some improvements also on the European level. What was mentioned is that, unequally, access to treatment is one of the biggest problems in the EU.
So, we still have first- and second-class citizens. We still have different medicines that can be accessed in different member states, in different regions, and different therapies. Definitely, we can speak about having first- and second-class citizens. So, those who are entitled and have access to the most up-to-date advanced health treatments, and those who do not. So, I have two questions. So first, is the question for both of you?
What can we do at the European level to stimulate, incentivize, and make it easier for the development of such highly advanced therapies? New medicines, new treatments, research into the most advanced therapies. So, what can the EU do to actually make this easier? Whether it's more funding, more investments, less red tape, better regulation, or more access to cross-border health care. So, what should be the priorities at the EU level to make access for patients to the most advanced treatments easier?
And the second question is: what can we do to make this access easier but also more equal? So, what can we do to make it easier for patients across the EU so that all patients have access to the most advanced therapies, medicines, and treatments available now in the EU? Thanks.
Speaker 30
Thank you, Adam. Thank you very much indeed for your excellent presentation, Professor Mikroslav. It's really so nice to see such a brilliant effect. But may I raise two questions? One question is more general.
You know that we have a comprehensive approach on mental health, which was published by the European Commission. Now we are discussing brain health. But from my point of view, brain health and mental health must be united because, generally, they are two sides of the same coin. And sometimes, you know, separation from mental health, from brain health, creates a lot of silo effects and a lot of challenges because it prevents us from understanding an integrated approach. And now, my question is: do you see the possibility to integrate brain health and mental health as one comprehensive strategy?
And the second issue, you just mentioned The Lancet. Lancet probably declared very clearly all risk factors which are common to cancer, common to cardiovascular diseases; all those risk factors also allow us to understand. But they need to send to our, you know, colleagues that if you...
Are treating.
Speaker 30
Hypertension or treating air diseases, please keep in mind that you can prevent something in the future, like dementia or Alzheimer. It means that we need to see multi-team, multi-modality in this issue. My question is, do you agree that we need to introduce much broader prevention strategies in all specialties, including, you know, general practitioners?
Thank you very much.
Just picked it up.
Speaker 8
Well, that was amazing. The example that you had of gene therapy. I am a pharmaceutical expert in biotechnology, and this is exactly the crux of the work: thinking about this kind of thing. This is something that we can actually make happen. And I understand that here, you've brought us an example of correction of a congenital condition, but this is the kind of thing that can be used for other types of diseases that may well need adjustments throughout life. Now I'd like to talk about research into this kind of treatment.
What kind of impact does animal research have? We know that in Europe, there is a move to try and not use animal research, but maybe the cerebral complexity is not the same between animals and humans. What will happen if we don't invest in this kind of research? And we may well lose such an important career as biotechnology. Another point: the population in the EU is going to go up by 100% over the next 20 years.
And what you talked about is an important factor in terms of predisposition. What can we do in terms of the factors of predisposition and their influence? Now we've heard about the incidence of Parkinson's going up very quickly. It's not known why it may want to be done in rural areas. It may be due to pesticides.
How can we invest in assessing the risk factors, given that prevention isn't necessarily profitable? We're not looking at medication that can be put on the market, but more basic research that isn't necessarily going to be backed by investments.
Thank you, Chair.
Speaker 12
First of all, let me thank you for your presentations. Very interesting, and this really contributes to and feeds into our work. I have a brief comment. First off, to Miroslav. You talked about this very impressive, innovative approach, which could have a huge impact on the future lives of many people.
So my question is, at a European level, where do you see possible contributions of the EU to provide the most benefit, or to provide as broad an access as possible to these tools and approaches? And then, well, society is suffering from Alzheimer's and other forms of dementia. This has a huge impact on the health system as a whole. So, on health care, as well as carers and families of the people affected. So, prevention has to start as early as possible, ideally decades before the first symptoms manifest.
So, how do we adapt our healthcare systems to the needs of so many people who are affected by diseases like Alzheimer's? How do we provide prevention at the European level? Where is the added value of the European Union? Of course, this is a national-level competency, but we can have solidarity. Thank you.
Thank you, mister.
Speaker 37
Chair, and congratulations for this wonderful treatment that you have really provided to this Canadian child. Obviously, it is very moving and impressive. I have a simple question. I know that adenovirus could be used to put different genes in the brain, and the procedure is obviously complex but possible. And I wonder why it's not used more often with diseases like Parkinson's disease and motor neuron disease because, obviously, you can treat these diseases as well with adenovirus gene injection in the brain.
And my question is: is it just because of a shortage of money or a shortage of centers studying this kind of technology, or are there any other reasons?
Speaker 40
Thank you, Chair, and thanks to our speakers for the excellent, interesting presentation. You know, there are really impressive advances in neuroscience and neurotechnology, and we are just witnessing that. But, you know, in many cases from the policy perspective, the real challenge is translating that innovation into real life, into practice. And here, I'm talking about early detection and early diagnosis because Europe is still diagnosing many neurological conditions far too late, when the window for intervention is already closing. So why is there still such a gap between neurological research and clinical implementation across the EU?
Speaker 39
How can we improve translation from lab discoveries to patient access? And what about Horizon Europe and EU funding for health? I mean, it doesn't seem to be very well aligned with the real socioeconomic burden of these diseases. Thank you.
Thank you.
Speaker 41
You, chair. I'd like to thank both of you for your presentations. I'll be speaking a bit more to Miss Virgilor, if I may. You mentioned the important role of cardiovascular factors when it comes to cognitive decline. I am a professor and a doctor.
Speaker 42
Now, I want to talk about hearing loss, which we don't talk about very often. This happens in old age and is often tied to social isolation, depression, and less access to treatment. You mentioned meta-analyses and assessment of cohorts where there is more dementia if people do not have access to hearing aids. You also mentioned randomized samples and a publication from The Lancet, which showed that access to hearing aids could help prevent dementia. Now, my question is: where do you see the place of early access to hearing aids as a preventative measure to prevent dementia, in addition to cardiovascular approaches?
Thank you.
Speaker 2
Thank you very much. To answer the questions, Professor Vardello, could you start?
Five minutes per person.
Okay. If I
Can limit.
Speaker 20
Okay. So, if I can start with you. You are correct. I did not list all the causes. And yes, you are correct.
Auditability as well as visibility is important, but they are listed in those. I didn't just say all the risk factors that are there. I did not list them. They are there, but you are correct. We need to implement that early in life because not only older people have difficulties and get restrictions in social interactions due to not hearing or not seeing, but in childhood, children don't learn enough if they don't hear or see.
So, exactly the same, and you are correct. We need to implement a better system to do it. Fortunately, in Portugal, we do it. We do it systematically, and we can do it to all. I will try to say something that I think many of you have asked. One of the answers I could give to many of you is that I need the citizens to be more educated on the sense of knowing what the risks are for themselves.
They need to know what they are going to gain by investing in their own health. And I think it's our job as health professionals to teach that. And I think this is a good initiative to create a plan to better reach each person with the information they need to have to make better-informed decisions. So, getting back here, you ask about the gap between the investigation that we have from the Europeans like Curizon. And I think the problem is that we have many trials on the cell, in the lab, on the animal, but we don't have enough trials trying to translate these findings to the person and to the real environment.
And we need that. There's a call now that was open in Portugal that is really to implement our findings from our academic research in the community. And this is a very good idea, and I think we need more of it. How to implement what we find from research in the usual places where people live. And I think that is going further away than primary care starting in school education.
I think we need to implement better health literacy starting very early in life, as you pointed out before. And I think it's really important to consider that we are a continuum from birth. Probably, pre-birth factors are just as important as well. And we know that if you have a healthier birth, you will have a healthier life, and you need to do this throughout your life. And someone asked me why I insisted on prevention.
I think it was from this side why I insisted on prevention. Because after thirty years working in the dementia field, it has been a failure after failure in each trial. And we try, and we don't have for more than 25 years any new drug, any new good effective drug that we can say is effective. It's going to change in the field of dementia. And this is why we need to change our view a little bit, and it took me 30 years to rethink it a little bit.
I think you asked me here about mental health and brain health, and you are right. It's an artificial difference. Of course, mental health is more from the psychiatry field, and brain health is more from the neurological field. But yes, we depend on each other. We work very well together.
And, of course, depression is a risk factor for dementia. And if you have cognitive problems, you have a higher risk of depression, so they are mixed. It's kind of artificial, but we need to work on them together. Somehow, mental health has gained more importance. Brain health is a little behind, and we are taking more time.
And I think the reason is that we are not reaching very good results. We are studying some specific diseases, and we have large data that we have put together. And I would like to stress that I think Europe is working very well together. We have a very good experience in doing studies with other countries in Europe, and we can manage to find a way. And I think we can be successful, but we need trials that are very well designed, with very good objectives and a high ethical standard.
And I think I'm...
Speaker 38
Thank you, Professor Verdello. Professor Sandberg, could you please comment on the question?
Speaker 22
Thank you for your question. I'm very sorry. I don't remember your name, the member of Parliament. So, I will start answering from the last question. And all these questions were close to each other, very similar.
So sometimes, maybe in my answer, it will respond to many questions. What should be done for the last question? How can the diagnosis be made very early? For the time being, it is possible to make the diagnosis before the symptoms occur. So the patient must present the clinical symptoms and maybe the fever, and at that moment, it's possible to make the diagnosis. Sometimes, it's not so easy.
For instance, a tremor. Tremor is a very important symptom in many diseases. Essential tremor, Parkinson's disease, Parkinsonian plus syndromes, and many other neurological and neurodegenerative diseases. So sometimes we perform very rare radioisotopic investigations to establish the diagnosis. Referring to the adenovirus.
Yes. In all trials, we use adeno-associated virus. But, of course, adeno-associated virus is only the part of nucleic acid. But this part of the nucleic acid is the only messenger that carries the active substance. Of course, it's possible to produce almost everything, but for the treatment of Parkinson's, this is still a clinical trial.
This is really just the beginning. The group cohort observed and treated 2016, 15, and 8. So it's a small, very small group. The treatment is really very sophisticated and very difficult. It's only a few centers in Europe who were the first.
The treatment is extremely expensive. Gene therapy, which is registered, has a reimbursement of at least €2,000,000 for one patient. But what is good in such a treatment if the treatment is given only once in life? It's not necessary to repeat. So, for the time being, this treatment is not very popular.
It's the beginning, but everything has to start at the moment. You ask about congenital pathology, but there are, of course, diseases that do not occur from delivery, but in some part of the brain. What we do now is work and treat the patient in a very small group. Parkinson's disease, Huntington's disease, multiple system atrophy, AADC deficiency syndrome, and mild forms of cognitive disorders. It's Alzheimer's disease.
This year, in the end, we will start the treatment of Alzheimer's disease. But in this case, we will not use other associated viruses; instead, we use a trophic substance which will renew the damaged structure in the brain. But I would like to say again that it's really just the very beginning, and the treatment surgery for one patient lasts ten to twelve hours. The personnel acting during such a surgery is about 20, 23, or 25 persons. So, for a long time, it will not be a very popular treatment.
But we are trying to shorten the surgery and make it cheaper. And I think that we will be able to operate on three patients a day, not one for twelve hours.
Speaker 2
Thank you, professor. Thank you, Professor Bardello. Thank you for your time and your very impressive presentation. We are keeping our fingers crossed for your research and successful treatments for our patients. I thank you all for a meaningful discussion in the first panel.
Speaker 16
And let's go further to the second point. Thank you very much. Okay, colleagues. Welcome to the second panel on European collaboration on neurological health, in particular in the field of dementia and other neurodegenerative diseases. For this panel, we welcome Professor Samuel Zuberi.
Speaker 2
He is president-elect of the European Brain Council and past president of the European Pediatric Neurology Society. Let us also welcome Doctor Orla Galvin, Executive Director of the European Federation of Neurological Associations, which is an organization that represents the neurologic patient voice in Europe and acts at the interface of research, innovation, policy, and regulation. As for the first panel, I invite colleagues who would like to take the floor to indicate it to us. Now, I would like to give the floor to our first speaker of the second panel, Dr. Galvin. You have the floor for 8 minutes, please.
Speaker 44
Thank you for the invitation to share insights from the patient voice across Europe today. So, for those of you maybe entering the room who don't know, neurological conditions affect the brain, central nervous system, and peripheral nervous system. So that is everything from the top of your head to the soles of your feet, and everywhere in between. And the age of onset can be at any time. That really depends on the condition.
Speaker 45
Throughout the talk, you will see that we are in full support of the recommendations for the European health plan dedicated to neurological conditions, as presented by the first speaker today, Professor Doctor Ali Hall. Next slide, please. I will speak more slowly. Yes. So today, I'm speaking on behalf of AFNA, representing the neurology patient voice, a community centered on collaboration.
Some, but not all, of our collaborators are referred to on this screen. They include patient groups, clinical groups, researchers, policymakers, and regulators. Each one of these stakeholders, entities, and partnerships would benefit immensely in their objectives if we, the citizens of Europe, had a European strategy for neurology. Each partner could deliver more effectively and more expeditiously to improve the quality of life of people with neurological conditions while saving each country within the EU some money. Next slide, please.
Let's look at the numbers and absorb the data. I'm going to ask you to look at the person to your left and then at the person on your right. And among you, at least 1 in 3 will be affected by a neurological condition. Some of you already know the neurological condition that you have, and some of you are yet to find out. We know that among noncommunicable diseases, neurological conditions account for 13% of the total disability-adjusted life years lost, that they are responsible for 20% of the deaths in Europe, and that annually, they cost Europe over €1,000,000,000,000.
Next slide, please. What we need to do is address some of the data gaps and knowledge gaps, and patients and caregivers are already willing to do this. So the next number of slides are indicative of the responses of 4,900 people across Europe living with a neurological condition. This slide indicates that we, as European citizens, absolutely lack neurology-related health literacy, and that has resulted in over 80% of people not being believed when they attend their health care professional and not receiving adequate treatment. Why? Over 56% of people had difficulty describing their symptoms.
And naturally, this is in part the reason why two-thirds of people are initially misdiagnosed. Next slide, please. On this screen, TI refers to treatment intervention. And you can see in the dark blue, only one in five people with a neurological condition have the best available care, which means they have good access to treatment and intervention. They can afford their treatment intervention, and it satisfactorily manages their condition.
They have it good, but they are not cured. It's only an intervention. Next slide, please. Behind every patient is a life impacted daily by their neurological condition. We see that 3 quarters of people find education very difficult.
And in that environment, around half of the people cannot make friends or sustain friendships because of their neurological condition. And only a small percentage of educators, 17%, were understanding about this. Next slide, please. Employment challenges are very real. 70% of people had to make some adjustment to their working environment.
Only 35% of employers were supportive. And again, two-thirds indicated that their neurological condition made their work life more difficult. Next slide, please. Financial anxiety can be crippling. Over seventy percent of people pay higher costs than lower-income individuals because of their condition, and one third were denied mortgages or insurance because of this too.
Next slide, please. All of this is against the backdrop of stigma. 88 percent of people living with a neurological condition face stigma regularly. And now I'm going to share some testimonies from three patients who kindly were willing to share their insights with you. Behind all of this data, there are real people.
The first is on the next slide. His name is Gary. In 2007, Gary was a successful HR manager with a young family, and he had a sore hand, which he thought was from overuse of the computer mouse. In 2008, he could hardly read his own handwriting. In 2011, he was finally diagnosed with early onset Parkinson's disease, at the age of only 44.
He had no idea what this meant for him or for his family. And, unfortunately, by 2015, his condition had deteriorated so much that he had to step down from his job. In his own words, my confidence collapsed, my outlook became foggy, and the future I had taken for granted felt so limited. But Gary is not alone. Next slide, please.
This is not Julia. Her name has been changed for protection, and the following is the testimony of her parents. In infancy, Julia appeared shocked and disoriented. Her parents didn't know what was happening, only that something was wrong. That was until seizures became so dominant in her life.
After seeing multiple doctors, she received her diagnosis of epilepsy. Despite treatment intervention, family life became one lived on high alert, always preparing for a crisis. Her parents live with constant stress and anxiety while also grieving the loss of the life she could have had. They say other children playing can be very cruel, and other parents keep their distance too. It's not fair on her or her siblings, but her parents try to maintain a loving, as normal as possible family home.
Next slide, please. The last person I want to introduce you to, but by no means least, is Ines. Ines is a young scientist with a master's degree in biology and genetics. At age 20, her mother noticed her first symptoms. She was slower, more fatigued, and anxious about everything.
At 26, she was diagnosed with Huntington's disease, inherited from her father who died at age 54. Unfortunately, we will never know the scientific and medical discoveries a nurse could have made. Next slide, please. Because within three years, a nurse required full-time care and is now in the late stage of Huntington's disease, bedridden and without independence. Her mother is 67 years old, and she cannot retire because she needs the money to pay for a nurse.
During the week, she has someone to help her. But at night and on weekends, Ines' mother is alone. Next slide, please. All of this is to say that we, as a European society, very much need coordination and strategy around a European plan for neurological conditions. A European coordination for neurological conditions is essential precisely because national systems alone cannot close the data gaps, address the treatment and care gaps, or address the financial gaps that every single country is bearing the brunt of.
For a European strategy to be effective for people living with neurological conditions, it must include their insights and expertise. Neurological health requires an integrated, life-course-based approach and not siloed specialties. We talk about prevention, but for many, this refers to risk reduction, and it must be understandable, inclusive, and linked to early recognition—not just lifestyle slogans, but impactful health literacy. Thank you for listening today.
Speaker 2
Thank you, Doctor Galvin. Now I will give the floor to Professor Zuberi. Please.
Speaker 47
I'd like to thank the committee for inviting me to speak today. I'm a pediatric neurologist from Scotland, past president of the European Paediatric Neurology Society. I want to talk about brain health in the broadest sense, including neurological disorders and mental health disorders. Next slide, please. The European Brain Council represents professional societies comprising more than 250,000 neuroscientists, psychiatrists, adult neurologists, pediatric neurologists, as well as EFNA and GAMIAN Europe, which represent millions of EU citizens.
Speaker 46
Next slide, please. So, we've heard about the burden of neurological disorders: the number one cause of disability and the number two leading cause of death. So, we need to find solutions for this in Europe. Next slide, please. This is the WHO's definition of brain health.
Now, when we think about brain health, we should be thinking about mental health and neurological conditions together because the brain is our key driver of competitiveness, leadership in technology and life sciences, and productivity. We've heard about prevention. We need to have more research support, and we need innovation-enabling reforms. And this should be public health, but beyond that. So there's a significant policy overlap between mental health and neurological disease, and the EU has the scale to make a tangible impact.
Speaker 47
Next slide, please. So, we need to be thinking about the brain across the life course. The human brain is the most complex structure in the known universe. Now, President Trump may produce something out of the known universe in the next few weeks when he releases all these files from Area 51, but so far, this is the most complex structure. It only runs on 20 watts of power and 400 calories a day.
So, we should be investing in the human brain, perhaps much more than in these really massive data centers, because the human brain can achieve much more. Next slide, please. The human brain has 100,000,000,000 neurons at birth. If you look at the first picture on the top left, the brain is 3 millimeters long at 3 weeks of age, and this is how it changes throughout pregnancy. We have 250,000 nerve cells being produced per minute.
Can you imagine that? So, the first 1,000 days of pregnancy and the first two years of life are when the brain changes more than at any other time. So, if you want to prevent or influence the life course of disease, you really have to be thinking from the beginning of life and even through pregnancy. By three years, we've got 100,000,000,000,000 neurons. We don't, sorry, 100,000,000,000,000 connections exist between our brain cells.
After that, we don't get any more connections. What happens? They get pruned and modified by our experiences, the life we live. So, if we live a traumatic life through childhood and have 3 adverse childhood experiences, then we're at very high risk of having mental health problems later in life. So, we prevent mental health problems by making the lives of our children better.
Speaker 46
Next slide, please. So, brain health is critical to global well-being and planetary health. So, this is how brain health influences the UN Sustainable Development Goals. So, we can think about brain health influencing our physical and mental health, social health, and ultimately planetary health. Next slide, please.
We've heard some of these facts and figures before about the total disease burden in the EU. 30% can be attributed to brain health conditions. Disability-adjusted life years means a year of life that you lose of good health due to a condition. So, this is really important. Next slide, please.
Speaker 47
So, there is an opportunity to intervene, and we should intervene early. Mental disorders, substance use disorders, self-harm, and neurological disorders have determinants early on in life. The brain continues to develop and change until you are 25 years of age. Then, anyone over 25 is getting older now, but before that, you are still developing and growing, and that's the time that we can really make change. Next slide, please. We've heard about rare diseases.
Speaker 46
36 million EU citizens are affected by rare diseases. 70% of those affect the brain, and 70% begin in childhood. We've heard a lot about dementia affecting old people, but many of you won't know about early childhood dementia. I'm probably the only person in the room who knew about AADC deficiency that Professor Sarbeck presented because it's a very rare disease. But if you put all these rare diseases together, collectively, they become important.
So, childhood dementia in the US causes around the same number of deaths as childhood cancer. But we don't hear about that because these are all individually rare diseases, particularly affecting the brain. So, we need these collective terms to address these conditions, and we need to address them on an EU-wide basis. Next slide, please. So, we've got a growing international momentum on brain health.
We have the WHO plans on mental health, the IGAP for epilepsy, and other neurological disorders. Next slide, please. So, we need European authorities to devise and implement a plan to tackle brain health. We need to highlight the argument to support basic and clinical research in Europe, and we need to optimize support for patients and research. So, we need to also ensure that basic research is translated into concrete applications, and we can do this at the EU scale.
Speaker 47
Next slide, please. So, we should have, as many of the speakers have talked about, an EU coordination plan for the brain, and this is something that the European Brain Council, with all the stakeholders, is beginning work on. So, we think about research collaboration, overarching approaches, and national brain strategies. Next slide, please. So, this is a busy slide, but you can access it later, looking at all the areas which the European Union can address: early intervention, quality of life, equity of care, workforce, carers, and patients.
Speaker 46
Next slide. So, we can avert the burden early through prevention and risk reduction during those critical first years of life, and then we can introduce the therapies, as we've heard about. Next slide, please. So, if we scale these brain health interventions, they could contribute €666,000,000,000 to the EU GDP in 2050. So, not intervening is going to cost the EU a lot of money.
Speaker 2
Thank you. Thank you, professor. Now, we start with the discussion. Could you please comment?
Speaker 30
My question is the same. Like in the previous panel, you know, now I see reality. Brain and mental health should be part of one strategy. My question is, are you ready to raise those ideas to the European Commission so that they can also present a more or less comprehensive approach on brain and mental health, including all components, because you have a lot of evidence that we need to move in such a direction? Thank you.
Thank you. Margarita.
Thank you.
Speaker 8
You. Now, my comments are for both speakers. Sorry. I'll be speaking Spanish. It's channel two for English.
Speaker 8
Do you hear the interpretation into English? Now it's great that the EU has made this important step in terms of a more integrated focus on brain health, such as the Brain Health Partnership, which aims to coordinate research between member states. But we know that there are very promising projects here, but the funding model has changed. Previously, it was ERANET or JPND, and now it's the Brain Health Partnership. So how is this affecting progress in your neuroscience research?
I imagine that investments are different, and Italy, for example, is funding a lot of projects. But in Spain, for example, we don't have enough, and there are differences in various areas. There's a big difference between brain health and mental health, with priority often given more to mental health. So why should we focus more on psychiatry than neuroscience? At the same time, in neuroscience research, it's very important to be able to experiment and use models that replicate brain complexity.
So, animal experiments, such as those on primates, how important are they in terms of making progress? Do you have difficulties with using those medicines or therapies on people? And finally, in terms of deep-reaching socioeconomic changes and automatization of productive systems, investing in brain health is investing in the capacity for creativity and innovation in humans. So, how can the EU think better about the strategic dimension of the brain and all its policies?
Speaker 37
I have a simple question from what I listened to and learned. You know, obviously, the brain develops from the embryo to many years after we are born. And many of these diseases, you know, need several years to develop fully. In your opinion, how much are we doing to conduct regular screening and catch the disease as early as possible, giving the patient more opportunity to recover or possibly be entirely cured?
Thank you. Romano Yerkavich.
Speaker 40
Thank you, Chair. I want to thank you for the board presentations. It was very interesting. I have a question for you, Professor Zuberi. If we were to set three or four measurable EU-level targets for brain health by, let's say, 2035, what should they be?
You mentioned a coordinated EU plan for brain health, and, of course, we all agree. But I'm sure you know that we already have an important reference point at the EU level with Europe's Beating Cancer Plan. So, if we consider a similar approach for brain health, then my question would be: what should we do differently from the cancer plan? Thank you.
Speaker 49
Thank you. It was the last question. So, I'd like to ask our expert to answer this question. Mr. and Mrs. Galvin, could you start, please?
Speaker 45
Sure. So, the first question came around the topic of uniting mental health and brain health. And for those living with a neurological condition, they go very much hand in hand. The vast majority of neurological conditions are chronic and progressive. So, over time, people with neurological conditions very often develop depression, anxiety, and financial stress.
In answering the next question that refers to the European partnership on brain health, health and neurological health go hand in hand. And in fact, the patient community, Aetna, representing the neurological community, and GAMMEAN, representing the mental health community, very much insisted on having patient oversight within that framework, and we're very pleased to see that moving forward. But rightly so, you have indicated that, of course, member states need to take up this challenge as well, invest, contribute, and support the European efforts. The next question was about animal use in research. I'm a scientist by background, and we absolutely advocate for the appropriate use of animals in research, which is essential for neurological conditions due to their complexity and the lack of available treatments.
In fact, many of our advocates in training attend universities to witness the advances being developed across Europe in this space. And if we don't have research in Europe, it will go elsewhere, where it may not be as tightly regulated. I think the second-to-last point that was addressed to me was around the socioeconomic impacts, the capacity that we have in Europe, and what we can do better. Well, actually, there's a lot of talk about brain capital, brain skills, innovation, and solution-oriented minds. And, actually, this is something that applies to anyone who has a chronic progressive neurological condition and has to adjust their life, finances, and family.
And what we're talking about here is really the resilience of people with neurological conditions. So, we have that, and we should harness the power behind it more. And the last question was about the early identification of conditions, with respect to screening. This is something anyone who is an advocate in the rare disease space will know: we don't have a united or unified approach to newborn screening across Europe. Some countries might test for eight conditions, other countries might test for 40 conditions.
And this also reflects the need for enhanced investment in the workforce in Europe because we need more genetic counselors to support the diagnosis as and when they come. And I believe one of the harder questions at the very end was left to you. Thank you.
Speaker 47
Yeah, the first question was on brain health and mental health together, or neurological health and mental health together. I think that is critical. As a children's neurologist, the person I work with most closely is the child psychiatrist. We cannot really divide it. And in Italy, you have joint training in neuropsychiatry and neurology.
So, it is seen as the same discipline in certain parts of Europe. So, we cannot divide the two, and I think our strategy should be to put them together because we were at a rare diseases meeting today, and we heard from questionnaires of families of individuals who have rare diseases. And they all described the hidden burden of their rare disease, which was the anxiety, the depression, and all the other issues that are hidden away and not seen as part of their illness. So, we cannot divide them. The second question was about the European Brain Health Partnership.
Speaker 46
I think it's too early to know how that will change the funding landscape because the first calls have just come out. I think the deadline for the first call is March 10. What is good about the European Brain Health Partnership is that it encourages teams around Europe to collaborate and has a model of funding from national research organizations alongside European funding as well. So, that will encourage collaboration, and these are the sorts of things that the EU should be doing. But it is too early yet to know the impact. In terms of research on animal models, I would agree with all of the brain studies.
And as I said, it is the most complex organism in the known universe. So, it is very difficult to do scientific research and say this is reflecting the brain if you're doing it on one cell in a little dish. You have to do it in a more complex organoid. Now, that may require animal experimentation. That should be minimized as much as possible.
Increasingly, there will be opportunities through organoids, which are when you can grow a brain in a dish in the lab, and we heard a little bit about that in the first talk today. So, I think we will learn more because that will recapitulate the complex network of the brain. The brain should always be thought of as an interconnected network, and that's why we need more complex models. So, we need to invest in brain health, as we talked about. You know, if we invest in brain health, we will invest in the economy of Europe as well.
We know we have an aging population, so we need to keep the working population as healthy as possible, keep them working, and keep them wanting to work for as long as possible. And the only way we will do that is by making everyone feel that their brain is active, vibrant, and ready for the day. And we can only do that by improving the general brain health of the EU population. In terms of early diagnosis, screening is critical. There are now more programs for whole genome screening that are beginning to be tested even at birth.
So that they will teach us whether, if we do that at birth, we can prevent diseases or diagnose them rapidly. We heard about the wonderful new gene-targeted therapies that are coming in. But in order to treat those, it's much better to treat them before the symptoms appear rather than when they appear. So, you need to find the genetic change first through genome testing and gene screening. So the EU needs to provide support to allow that around Europe.
And then education, so that every doctor, every physician, every health care worker knows about the early signs of neurological disease and refers patients early. And for that, we need European rare disease reference networks as we've got, but we need those reference networks to inform national networks for care pathways. And then I've left the difficult questions to the end, on the, you know, measurable targets. So, obviously, we need more research investment, and we need to show that we are getting more research investment into the brain. We can have IGAP, which is the Intersectoral Global Action Plan for epilepsy and neurological disorders, with measurable targets.
So, the targets are disease-specific. It will be difficult to have targets for all aspects of brain health. But I think you can have model diseases such as epilepsy, ensuring that 80 to 90 percent of people with epilepsy are diagnosed within two weeks and that they get the appropriate medication as seen by a specialist. So we can measure those targets, but we need systems in place to be able to audit our clinical practice so that we can then measure, feedback, and show that we're improving. But Professor Vidella, my last point, showed that if you have good public health interventions in some of the Nordic countries and parts of the US, you can reduce age-specific dementia.
So, we can prevent and reduce dementia levels if we intervene early.
Speaker 2
Thank you, professor. Thank you all for this fruitful discussion. I would like to especially thank our guests for the very interesting presentation and for being with us today. We will share all the slides from our expert with you as usual. It is clear that we have to keep high neurological health high on the EU public health agenda.
Thank you all for this good discussion. Thank you. Dear colleagues, we continue with today's agenda. Point nine, exchange of views with Mikhail Loradutsky, chairman of the committee on public health of the Verkhov Narada of Ukraine, but we need a moment to check our connection with Ukraine. And from what I know, we are planning to start at 4:45.
Okay.
Oh, yeah. We've got the connection.
Okay. We can start.
Speaker 2
So, if you want, I guess. Yeah. So if we have a good connection with Virchow Narada, please stay in the room, and we will continue our agenda. Please take your seats. Dear colleagues, dear Mr. Radutsky, this morning, Ukraine's president Volodymyr Zelensky addressed members of the European Parliament.
It's very loud. Let's wait for a minute. Dear colleagues, please. As I said this morning, Ukraine's president, Volodymyr Zelensky, addressed members of the European Parliament at an extraordinary plenary session, as today marks four years since Ukraine began and has been maintaining its heroic resistance against Russia's unprovoked and unjustified invasion. Opening this extraordinary plenary session, European Parliament President Roberta Metsola underlined that the European Parliament has not let Ukraine down.
Ukraine's security is Europe's security. Ukraine's freedom is Europe's freedom, and Ukraine's future is in Europe. Following the exchange with the president of Ukraine, the parliament adopted a resolution with an overwhelming majority that calls, among other things, for increased sanctions against Russia and for continued decoupling from Russian energy. In November, parliament already approved a €90,000,000,000 Ukraine support loan package, which now needs to be implemented. As Russia continues its attack on Ukraine, its civilians, hospitals, and critical infrastructure, not only the budget but generally a strong and effective health care system is more important than ever.
Ukraine needs it not only for its brave soldiers, but for all its citizens, independently from their location, profession, or age. Last April, together with other members of the sound committee, I visited Kyiv. During this mission, we visited the Akhmatid Hospital, which had been barbarously bombed by Russia. That's only one of many sad examples of how difficult it is for Ukraine to provide the necessary health services to its citizens during the war and how much our help is needed. Today, we have the opportunity to meet Mr. Mihaywal Radutsky, the chairman of the Committee on Public Health, Medical Care, and Health Insurance of the Verkhovna Rada of Ukraine.
Unfortunately, he can join our meeting only via a remote connection. I will first give the floor to Mr. Radutsky, and after his intervention, I will open the floor to the sound coordinators and to other members who wish to take the floor. I invite members who want to take the floor to indicate it to us. With no further delay, I give the floor to Mr. Mihairo Radutski. Mihairo, the floor is yours, please.
Thank you.
Speaker 51
Thank you very much, Chair, distinguished colleagues, dear friends. First of all, before I start my presentation, I'd like to thank all of you, and through you, every citizen of your country, for the assistance that we have been receiving over the last four years of our fight for independence and self-determination. And most importantly, Ukraine is the bastion of security and safety for the whole European family. We are very grateful. Believe me.
Speaker 52
We know how to be grateful. And Ukrainians never forget the help that they have received, for which we are very grateful to each one of you and to each country that you represent. Colleagues, four years ago, Ukraine woke up to the sound of explosions. The enemy attacked us in the most dastardly way, but we continue to work and conduct reforms that bring us closer to reuniting with our European family. We can feel the consequences of this war.
Speaker 51
They're catastrophic. Four years of war have made the health care system a part of the critical infrastructure, together with communications, energy, and transport. We are not just a sphere of social services. We're working in extreme circumstances. We are constantly under attack.
2,600 buildings of health care facilities have been damaged. A great number of them have been completely destroyed. According to our data, we will need to rebuild this sector, and it will cost us more than $12,000,000,000. The war has changed the rationale behind the functioning of the health care system, and the key challenges are systemic. The ruination of hospitals in the frontline territories happens every night and every day.
We experience a great shortage of personnel because people are relocating and burning out. The burden between the regions is unevenly distributed. In the frontline regions, civil health care professionals provide health care to the military and to the civilians. Also, in other regions, we have refugees and internally displaced persons. Another challenge that we are facing is a greater need for autonomy.
Because, as you know, after the brutal attacks from the enemy, we have problems with electricity, water, communications, and, unfortunately, even oxygen. The system has had to respond by decentralizing and creating mobile teams of telemedicine, and we are very grateful for the international support with equipment. This year, we approved a very important document, which is the strategy for the development of the health care system up to 2030. It identifies a clear path of transformation in the face of these persistent challenges, providing access to health care through primary health care, the development of a system of medical guarantees, accessible medicines, and prevention activities. There's a greater need to treat complicated war trauma and to provide rehabilitation for conditions such as irritation from heart attacks and strokes. Our cooperation with international partners is very important.
We have peer-to-peer cooperation, which opens up access to modern knowledge and modern technologies. And I can speak from my own personal experience. Currently, many colleagues from European countries are using our experience because, unfortunately for Ukraine, we are the only country in Europe that has this kind of experience. But we are happy to share it. And I believe that this makes our system, but also the European system of health care, more resilient to any kind of challenge.
For us, it is also very important that there is an integration dimension because approximation to European approaches is not just a requirement for accession to the European Union, but also a way to improve medical services for our patients today. We have a law on pharmaceuticals that brings us closer to European standards. We are creating a Ukrainian pharmaceutical agency and implementing decoding of labeling. This is our path towards a visa-free regime with the European system. We have also conducted negotiations in this area, and we have a high level of implementation of the association agreement.
As regards the health care system, we have completed 88% of our objectives. And I would like to thank all of the members of the standing committee because we have used a lot of their experience and many of their recommendations. In our report for 2025, we have received a good progress mark, which is 4 out of 5. Among the priority areas for development are transborder medicine, transborder security, and modern approaches to transplantation of tissues, transplantation compatibility, and the use of successful IT solutions. In the future, we can see certain challenges and the things that we will need to do for the sustainable development of our system.
Today, we are facing the job of leaving reactive decisions and solutions behind because that is what the war demands from us. But we hope the war will end with our victory, and we will be able to move on to proactive decision-making. And we'll be taking into account all the changes in our demographic makeup. The health of our nation is a very important factor. And, of course, budgetary decisions will be important.
Even during the war, we were able to increase budget allocations towards the health care system, and this year is no exception. We have also strengthened our parliamentary oversight of the efficiency of implementing international assistance. For us, it's a matter of principle because we want to be able to look our partners in the eyes when they ask us about how the money they provided to Ukraine was spent. Also, we want to adapt the legislation for the veterans who have suffered the consequences of the Russian aggression. We are paying great attention to the capacity of the health care system.
We need investment through public mechanisms and public-private partnerships. We are focusing on quality indicators, and we are also using AI. Our goal today is to become a part of the single medical area of the European Union and a good supplier of medicines. Thank you very much for your attention, colleagues.
Speaker 2
Thank you, Mr. Radutsky, for your statement. Now, we start the discussion. Bithenis, Androcitis, could you start?
Speaker 30
I would like to say the following. We are proud. We are really proud of Ukrainian men, women, children, girls, boys, and elderly people. You are incredibly brave, and your influence on us and on the world has been paramount so far. You have chosen the road of peace and victory, the side of international law.
Like nobody else, you prove how it is possible, even in this situation, to strengthen and consolidate the nation and its health. You have built up incredible, unique experience by withstanding this challenge of war. We can now learn from you about the progressive methods of war medicine. We can also learn from you how to manage crises and how to train society to withstand civil emergencies. No other European country has similar experience in that field, and you are now our teachers.
We realize how much you have achieved in decentralizing the administration of your systems. And you have managed to retain the provision of basic health care services through mobile teams. With Chairman Adam Yarubas, we visited Kyiv, and we had a chance to visit the mother and child hospital, where we witnessed with our own eyes how we managed to rebuild it. We also went to the railway station. We saw wagons bringing the wounded from the frontline.
I am a surgeon by profession, and I was really impressed by seeing how well organized all of the activities are. I was impressed by the efficient and rapid help given to the wounded who are being delivered to the specialized centers. You are our teachers, and we must make every effort to ensure that your committee and our science committee in the European Parliament meet as often as possible and work together in joint programs. We should also discuss where you could become observers in our work and how we could join your programs, for example, by choosing the twinning programs. I have a question and a proposal for other members of parliament.
It is now time to embark on pilot projects with Ukrainian regions and cities. We should provide this assistance in order to speed up Ukraine's integration, whereby we will bring peace faster. I am convinced that winning joint projects could play an important role in these efforts, and we could strengthen health care in this way. Hlavní Ukrajina. Thank you.
Speaker 58
I would very much like to thank Mr. Radotsky. Thank you very much for participating in our committee meeting today. Today, as the European Parliament, we have honored Ukraine, and we are proud to stand beside men and women, youngsters and the less young, the courageous people who have shown the whole world how you can defend democracy over the course of 4 years of an unjust war, a ferocious war launched by an aggressor, Russia. Today, the words that you've said, looking at things from a health care perspective, we are proud to be able to
Hear.
Speaker 57
How extremely courageously and efficiently you have been able to deal with such a dramatic situation, such a deep crisis. In spite of all this, you have been able to provide health care services and support to your compatriots. We have a lot to learn from you. I was listening very attentively to what you were saying about your objectives: increasing your budget even against such a dramatic backdrop in the health care sector. Parliamentary oversight ensures that funds are correctly allocated and that care and support are provided for your veterans.
Speaker 59
I was listening very attentively to the objective that you have of working towards a single health market together with Europe. And I think this should also be our objective. I think that, on the one hand, we can learn from you how to manage dramatic crises. At the same time, we can try to provide support, harnessing the experience that we've gained for a multilevel project involving the EU, member states, regions, and cities. So, I would like to say that I'm ready and willing to work together with you to give hope to all the Ukrainian people because that is what they deserve.
Thank you.
Speaker 56
Thank you, Chair. I will speak in Hungarian. Thank you.
Thank you very much for talking to us about what has been happening in Ukraine over the last four years. The strength that you've shown, and the mental and physical strength of the people living in Ukraine, is constantly tested by blackouts, loss, and unpredictability that pervade everyday life. And I have a question about mental health. Traumas and burnout are on the rise. What can we do to counter that?
Speaker 60
I think that mental health care is definitely necessary in Ukraine. New centers are being opened in Ukraine. There is support for those who are suffering from trauma and stress in terms of dealing with loss. So, my question is: what mental health projects have already been put into place in Ukraine? Is there a possibility for the needs of individuals belonging to national minorities to be addressed?
Speaker 56
Because, of course, in times of crisis, your identity, language, culture, and community are very important, especially for people in Transcarpathia. And I know that the Hungarian minority that lives there, if they can have access to this care in Hungarian, it would help them deal with the stress of the war. I am convinced that healing is only possible through peace. But until peace arrives, every effort needs to be made to ensure that people are not left alone to shoulder the psychological burdens of war and to make sure that everybody has access to mental health care in their own mother tongue. Thank you.
Speaker 37
I am really impressed by the incredible work in almost impossible conditions that you have done so far to protect and defend democracy in your country. But I listened to you. I was thinking that I had the experience to work for a number of years in a veteran hospital in the United States, and I believe that, you know, the emergency will not end with the war because there will be a lot of people who lost limbs and a lot of people with post-traumatic stress disorder. And we are talking about thousands and thousands of people who will need help in reeducating, in moving with artificial limbs, and people who need to recuperate their mental health because of post-traumatic stress disorder. So, I think our help as Europe should continue, also thinking about this tragic disease that will follow the end of the war.
Speaker 62
Thank you, Charles. Vous parlez français. Chairman, you mentioned what would happen after the war. The budget you mentioned seems huge to reconstruct a healthcare system. And then, you also mentioned that the budget allocated to health by your own powers was still increasing.
Have you assessed the difference between the cost of reconstruction you mentioned and what your current health care budget can actually cover on its own? And then another question on the specific case of women and the demographics in Ukraine. We know that demographics will be critical when it comes to rebuilding the country. Have you assessed the number of births, the birth rates since the war, and the impact this war was having on the health of mothers and infants? I'm active in the firm committee, and this, I believe, feeds into the work of both committees.
Thank you.
Speaker 61
Speak in my mother language, Polish. Please provide the text you would like me to correct.
Speaker 2
Ladies and gentlemen, if our guest wants to react to any of the statements made here, of course, go ahead. But the format we assumed was that we would have a speech from our guests, and then we would just react to it and to what is going on in Ukraine. I think we heard a great speech from both President Zelenskyy and Mr. Radutskyy, and it shows us the scale of the challenges that Ukraine is facing. The nation, as mentioned by Commissioner Andrew Kaitis, is facing a huge challenge. We had the opportunity to visit Kyiv to see how this country operates under these extreme conditions, whether people are suffering.
And we were able to see this wounded, exposed system that is subject to brutal daily attacks and daily threats from the Russian invaders. The future of Europe, as somebody recently said, is being played out in the fields of Ukraine. And I agree with the statements we heard here that we do have to keep up our support for Ukraine, our solidarity support, our defensive support, but also we have to maintain the functionality of the state. This is what we owe to the people of Ukraine, who are currently fighting for our security. As we heard, we can really learn a lot from you.
We will continue our support. We are open to many different formats of cooperation. Vitanis mentioned bilateral projects where we could potentially invite Ukrainian partners who would receive funding from the European Union. What is ahead of you is the great work of rebuilding Ukraine, hopefully under conditions of a just peace that most of all requires your consent as the Ukrainian people. So, we are your allies.
We are your supporters, and we hope to see you again soon within a joint project of an integrated Europe. Thank you very much, Chairman. Huge applause for you! Thank you very much. Much respect.
Speaker 51
Colleagues, I'm very grateful for the words I heard from you. Believe me, it is very valuable. If you allow me, Mr. Chairman, I will take just two or three minutes of your time to try to answer my colleagues' key questions. If you allow me, I will start with a question from my Hungarian colleague.
We will be very grateful to Hungary if you stand together with us in Transcarpathia for our heroes, because believe me, the Hungarians living in Transcarpathia are our heroes fighting for the independence of Ukraine. And you know many of those people by name. The whole world knows them. They also require mental health assistance. And I'm ready, together with you, to initiate today the establishment of the Centers for Mental Health Assistance, where, together with Ukrainian experts, Hungarian experts will work, who will speak the native language of the Hungarian minority in Transcarpathia, and who will be helping our heroes and our civilians in Transcarpathia in terms of mental health.
I would very much like us to have this joint project together with SANT, with our committee, and with Hungary. Thank you very much for your question. And I hope that we will follow up on it. As to you, dear Mr. Chairman, as regards our joint work of our committees, I propose, if my colleagues from Sandd agree, that we inform you about every meeting of our committee and give you access to participate as observers, listeners, and advisors on the draft laws and other issues we discuss.
Your experience is very important to us, especially as many bills that our committee has been discussing recently, I think, are relevant for the European countries as well. I would also like to respond to you. You know, Lithuania for us is not just a word. It's a country that was the first one, together with Poland. They never asked us about what is going to happen next. They started helping us in the very first seconds after the invasion, and it is very valuable for us.
We really appreciate the twinning programs provided by three countries: Poland, Germany, and Lithuania, and we see the results of this cooperation. We are open. If we start together with youth, this cooperation in other areas, not only in pharmaceuticals, not only regarding the Ukrainian Pharmaceutical Agency but also in other areas, the same twinning projects or the bilateral projects, we are ready to join them and advocate for them vis-à-vis the government of Ukraine, the parliament of Ukraine, and your government so that we can start such projects. And also, as regards rehabilitation, it's true that we have huge needs in that area. Almost every small town in Ukraine has rehabilitation centers set up together with shops where prosthetics are produced for patients.
We have now introduced multidisciplinary teams. And when a person has a leg cut off, when there is an amputation, there is a prosthetics expert to make it easier for the person and to provide proper mechanisms. Ergo, therapists are working with them. We are open to them. And as regards renovation and reconstruction, the minister and I have this idea.
Some governments have already accepted that. We have a very interesting idea. If a country, such as Hungary or France, wants to rebuild a very specific hospital destroyed by the aggressor, we are ready not only to do that together with that country, but also to provide the possibility for the country that has rebuilt that hospital not only to rebuild it and invest in it, but also to manage that hospital within a single health care system for many years, with managers coming from that country, region, or city that has invested money into the reconstruction of the facility. We think it's an interesting proposal. And of course, in some time, we would very much like to hear your feedback.
In general, we are open to and believe that SAND is a committee that is very useful and important for us because, in terms of many laws, we have consulted you just like with colleagues from the Bundestag and their health care committee, and your experience is very important for us. Once again, I invite you to participate in all the meetings of our committee at the Ukrainian Parliament. Thank you.
Speaker 2
Thank you all for this exchange. On behalf of the SANT committee, I would like to express my deepest support and admiration for the courage and resilience of the Ukrainian people. Thank you, colleagues. Point 10: Any other business? Point 11: Date of next meetings.
I close today's meetings. Our next SANT meeting will take place on the 2nd of March. I invite the coordinators. We start our meeting at 05:30. So we have 15 minutes.
Thank you.
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