Joint Committee on Health and Children debate -
Thursday, 22 Jan 2015

Public Health and Food Safety: European Commissioner for Health and Food Safety

Chairman

I remind members to have their mobile telephones switched off and also that a vote on a Bill is due to take place. I formally welcome the new European Commissioner for Health and Food Safety, Dr. Vytenis Andriukaitis. He is very welcome and I extend to him a ceád míle fáilte. I also welcome his officials who have accompanied him this morning. We are extremely privileged that he has chosen to visit us today. We know he had a number of meetings before this meeting and he will have more afterwards. We hope he has a very productive series of meetings.

We are pleased that he sought a meeting with the Oireachtas Joint Committee on Health and Children. It is important that the European Union institutions reach out and connect with committees in parliaments, in particular this committee which has been a very proactive committee of the Houses of the Oireachtas. I like to think that this committee has worked on a cross-party basis and in a non-confrontational and non-adversarial way to promote public health. We have achieved good success in many policy areas which the Commissioner will hear about later. We are very pleased that the Commissioner has a very distinguished background in the area of health, both as a policy-maker and a medical practitioner. We will learn a lot from this engagement with him and I commend him on his work as a policy-maker and as a medical practitioner.

This meeting is a very important opportunity for the committee. We look forward to hearing his priorities for his term as Commissioner. In return, we look forward to highlighting to him some areas that are of concern to us and what we have worked on as a health committee. I thank the committee secretariat and EU policy clerk for organising the meeting and for their help and assistance. With that, I welcome the Commissioner formally to the meeting and ask him to make his opening remarks.

Dr. Vytenis Andriukaitis

I wish to say to the Chairman, Vice Chairman and honourable members of the committee go raibh maith agaibh for giving me this opportunity to exchange views with the committee on health policy in Europe and share some of my ideas for the years to come.

As members may know, in my previous life I was a member of the Lithuanian Parliament for six consecutive mandates so I naturally think dialogue with national parliaments is very important. There are many parallels between Ireland and Lithuania. I would like to mention Lithuania but instead I shall call it the country that I know best because I am now a Commissioner. This country which I know best is similar to Ireland and both countries are of a similar size. We are close to our bigger neighbours even though we have different opportunities, practices and experiences as nations. We are also mostly a Catholic country but there are other religions, as in France. A great number of Lithuanians live in Ireland. One of the most famous pop stars in Lithuania is Irish and sang for us in the Eurovision Song Contest. We are very happy to have such an excellent Irish singer. Last but not least, our two countries have shaped the policy of the EU during our Presidencies in 2013. Today, I would like to say thanks for Ireland's support. When Ireland, Lithuania and Greece worked together we followed Ireland's good advice. Ireland was our coach and we studied its experiences, learned from it and followed its steps. For example, on tobacco issues we were successful only because we worked together.

However, I am here to speak about an issue that is central to the future of all EU citizens, that is, the issue of health. I am well aware that the formulation of national health policies is for each of the 28 EU member states to decide. The Union's role is to complement national actions where possible and add value where it is appropriate and beneficial to do so. The EU has also a decisive role to play in the field of public health and food safety.

Member states share many similar health challenges. We know them well. They include tobacco, alcohol, nutrition, physical inactivity, infectious diseases, antimicrobial resistance, suicide rates and children's health. In my presentation, there is a slide on life expectancy in the European Union and how significant are the differences between the central and eastern part of the European Union and the western part. Of course, Ireland is green. My job, as European Commissioner, is to follow good examples and make more green this part of European Union. I have only five years in office. I ask the committee to join our forces to see our continent become more Irish, more green.

We can clearly see the inequalities in health status, both across and within countries. The slide portraying life expectancy in the EU shows social determinants in health, both within and between countries. There are 29 million European Union citizens in poverty, which means they have less possibilities to be healthier and less possibilities to have better access to health, and, of course, they suffer more. My job is to make this map greener.

I want to ensure that the European Union instruments help member states close the gaps in the area of health. President Junker presented his investment plan. I would like to present an investment plan for health. The logic behind this is clear – economic benefits arise from having a healthy society. Evidence-based prevention results in increased productivity and improved quality of life. A great deal can be achieved through increased co-operation between all 28 states.

Ireland has a few good examples of initiatives that could inspire other member states, and I will mention a few. I would like to start with tobacco and alcohol. As the committee will be aware, there is a specific line in Article 168 of the Treaty on the Functioning of the European Union referring to "the measures which have as their direct objective the protection of public health regarding tobacco and the abuse of alcohol". We need to work together to put this part of the treaty into action.

A slide in the presentation shows the country best in alcohol consumption in the first position. Ireland is fifth. On tobacco consumption, one sees the same picture in which we must act together. My job is to support member states to introduce measures which are more effective at reducing the use of both tobacco and alcohol. Smoking rates in Ireland are slightly higher than the EU average but Ireland responds with a strong and committed policy and has even introduced as a goal a tobacco-free Ireland by 2025. This is excellent. I congratulate Ireland-----

Chairman

May I stop Dr. Andriukaitis for one moment? As he will be aware, parliamentary democracy continues. There is a vote in the Chamber. With the permission of the meeting, given the importance of the visit, if Deputy Ó Caoláin and I would be-----

Deputy Caoimhghín Ó Caoláin

I would be happy to propose that we continue our attendance with the Commissioner. The importance of it speaks for itself.

Chairman

Deputy Ó Caoláin and I might be paired. If members from the other parties want to go to vote, Deputy Ó Caoláin will pair and the Senators will remain.

Deputy Caoimhghín Ó Caoláin

I would point out that, in 18 years, I have never done that before.

Chairman

Neither have I. I thank Deputy Ó Caoláin.

Deputy Caoimhghín Ó Caoláin

It is out of respect.

Dr. Vytenis Andriukaitis

I congratulate Ireland as one of the front-runners in this area and I invite other member states to follow this example. I welcome the good news last night that in the United Kingdom the Secretary of State for Health pronounced officially that the United Kingdom will follow Ireland's example and implement plain packaging. It is excellent.

Let me say a word about alcohol. Alcohol consumption in Ireland, compared with other countries, is relatively high. However, in 2013, the Irish Government approved ambitious measures aimed at improving health, including minimum pricing, regulation of advertising and marketing and health labelling of alcohol products. I share Ireland's commitment to strengthen action to promote good health. If we invest in prevention today, we will save on the money we spend on the consequences of alcohol abuse tomorrow. Today we discussed those issues with the Irish Ministers. They raised sensitive questions about possibilities, and how to act on a European level, especially with regard to different prices in different countries, and excise. Advertising, especially through the Internet, is a significant challenge because we cannot regulate advertising through the Internet at national level. We must seek common actions.

I want to touch upon obesity. Ireland has the third highest prevalence of obesity among adults in the EU. Daily fruit eating among adults is the third lowest in the EU and as for daily vegetable eating, it is the lowest. The slide shows that this is so important. It looks very challenging. Speaking about the younger generation, which lives under considerable pressure on the market side, one can see from the beginning in all the supermarkets how many market instruments are used to encourage consumers to buy sweets, especially if one has small children. If one sees tendencies and behaviour, such as use of the Internet and low physical activity, of course, we have the picture, but our activities on obesity must be long term. We will all be ready to say we will have a long-term strategy around 28 countries. It is not a five-year job. It is a job for ten years or 15 years. In continuity, along the way, we must always be implementing different measures using different instruments in different structures. This is why are we ready to propose health in all political sectors.

We must encourage and reward all stakeholders to speak about such huge challenges. If we do not speak about cancer, mental disease, cardiovascular diseases, about all evidence-based diseases, we must look at this picture and see how it is important to encourage our governments, our national parliaments, our European Parliament and our Commission to be interactive. We must go through different sectors and have a multi-sectoral approach to agree on and implement concrete instruments, and to monitor and have some indicators, some targets. We must go step by step every day looking at the results. For example, in my term of office in five years, I want to see the results of working together accurately, of course, at national levels. We must see those pictures and keep them in our eyes.

The Commission's proposals about introducing a milk scheme and fruit and vegetables in schools are so important. Today we see different tendencies and interpretations but all operating on evidence-based arguments. Of course, we must promote milk schemes and encourage our member states to support open access to fruit and vegetables, especially for our younger generation, because we have the possibility to act and to be effective. I would like to say that together with my colleague, Commissioner Phil Hogan - we are currently on the same floor - I am thinking about possibilities to introduce agricultural food safety plans, not only food safety but also food health, because safe food is not the same as healthy food.

We must discuss possibilities to raise those questions, and of course it is all so sensitive - nutrition profiles, labelling, cultural traditions, salt, sugar - but we must continue in our dialogues, trialogues, multi-dialogues and polylogues, going in the same vein to solve those issues. I see considerable benefits of such possibilities to improve access to the milk scheme, to vegetables, but I would like to see more member states taking part in these actions together. The numbers I see on these slides are the facts - nobody can dispute them. We work towards change. Five years will pass by very quickly.

Health must be considered in all policies as well as disease prevention. I would like to see Commissioners Hogan, Hahn, Bienkowska and Timmermans, Commissioners responsible for health. We all have our competencies in different areas. It it not just for health ministers or health specialists. It is for all parts of government and for all policy-makers. Let us consider article 168 of the Treaty on the Functioning of the European Union. It says, "a high level of human health protection shall be ensured in the definition and implementation of all Union policies and activities". It is my job. I must act in this way. Therefore my approach can be simply summarised as health in all policies. Let me repeat the mantra - the more health systems focus on health promotion and disease prevention now, the less they will spend on treatment in years to come. Such a basic mantra needs to be applied in everyday activities and in result-oriented steps. Fostering healthier lifestyles, screening for cancer, providing vaccination are just a few examples of actions contributing to prevention of diseases which would cost several thousand times more to treat than to detect. Co-operation with the health system is a huge area.

I used to serve my country as a Minister of health. Drawing from my experience to date, I see scope for closer co-operation among member states in the field of health. I would like to mention Article 4 of the Treaty on European Union, which states, "Pursuant to the principle of sincere co-operation, the Union and the Member States shall, in full mutual respect, assist each other in carrying out tasks which flow from the Treaties". I hear at Council level, please do not touch questions about so-called harmonisation of health systems. Of course, it is a misperception, a misunderstanding. Do not speak about harmonisation. However, we look at criticism and assist each other in carrying out tasks which flow from the treaties in full mutual respect, in co-operation. There is a lot that member states can learn from each other by co-operating more closely.

Among other things, President Junker asked me to look at developing expertise on the assessment of the performance of health systems. A new expert group on health system performance assessment, chaired jointly by Sweden and the Commission, started work in November. We are confident that the group can and will develop effective tools and methods, having agreed on some indicators, to assess and ultimately improve the performance of our health systems. Many member states are taking part in this group and I have just discussed with the Minister for Health, Deputy Varadkar the possibility for Ireland to join this group. We agreed on the situation.

The European Commission and President Junker are determined to see new legislation deliver real results to citizens. For me, health is a way to bring the EU closer to its citizens. We will seek to ensure the directive on patients' rights in cross-border health care truly results in better citizens' access to quality healthcare through our European Union. The directive introduces several areas of co-operation among member states, for instance the creation of European reference networks of highly-specialised health care providers from different EU countries to share knowledge and pool expertise. I want these networks to become fully operational by 2016. I also want to promote and expand co-operation among member states on e-health and health technology assessment. The latter could help member states avoid duplication in their assessments and enable an effective exchange of information among national authorities. Moreover, member states and MEPs seem to be getting more interested in exchanging information on medicine pricing policies and the impact they have on patient access to medicine.

I would like to touch on the question of the Ebola virus. In addition to health systems, emergency preparation is another crucial area to which I will dedicate my energy and attention. Communicable diseases and other health threats know no borders. Therefore, European co-operation is vital. Recurrent Ebola virus epidemics in west Africa show the importance of EU collaboration to prevent and respond to such epidemics. Ireland is making an important contribution for which I am thankful, in terms of its collaboration with other member states and international organisations and its financial support, but its most telling contribution is the work of brave volunteers from Ireland on the ground.

I was in those countries two months ago and saw the real situation on the ground in Sierra Leone and Liberia. I met those volunteers.

Today the situation is manageable. Our effort produced results and we can now start speaking about control. In March, a high-level conference will be devoted to Ebola to discuss the long-term strategies in the affected countries. Over a year ago, a new European Union law on serious cross-border threats to health came into force. This law requires member states to share information on serious cross-border threats to health and on the measures they take to prepare for and respond to health threats. This law is in place thanks largely to the Irish Presidency and its extensive efforts to find a political compromise.

My priorities for health can be summed up in three simple words: promotion, prevention and protection. Thanks to my young followers on Twitter I would also like to add an additional "P", participation in the other three "P"s. This participation must involve all stakeholders, and my job is to encourage, communicate, discuss and see possibilities for participating in democracy. We all need to play our part in full, be it in Brussels or in the European capitals, regions, towns or villages. I will therefore be open to dialogue and I invite the committee to communicate with me. My work is driven by the values of equity and solidarity. I truly believe in health for all. I thank the committee for its attention.

Chairman

I thank Commissioner Andriukaitis for his very challenging presentation of priorities for the year. Our committee is very proactive in dealing with many of the issues he raised, and we have a broad remit extending from the health area to children's rights and the care of the elderly. At the end of our meeting I will present to the Commissioner a copy of a related report dealing with the issue of concussion in sport. It is a growing concern across our continent. It is important that the committee welcomes feedback from the Commissioner on the issue of concussion in sport, and I hope he finds it merits action by the European Union.

The committee has been very proactive about many of the issues raised by the Commissioner. For example, recent meetings have included discussion on the area of rare diseases and their prevention, coeliac disease, food labelling issues, the response to Ebola, legislation to ban smoking in cars with children present and regulation of the cosmetic industry. Before the Commissioner arrived this morning, we heard about the challenging cost of medical indemnity insurance, which is becoming an international phenomenon.

Deputy Caoimhghín Ó Caoláin

I warmly welcome the Commissioner. I hope his name is being pronounced properly, as people sometimes have difficulty pronouncing my name here at home.

I listened to the Commissioner very carefully and he spoke about identifying another "P" in the form of "participation". I give him credit, as another "P" has struck me that applies to his presentation and what I believe is a sincere and genuine personal commitment: it is "passion". He demonstrated a passion this morning in his presentation and the briefing notes, and his very sincerely held interest in health protection measures is something which we welcome and on which we commend him. We wish him continued success in his endeavours across the European Union in this regard.

Prior to our meeting this morning, we agreed to apportion responsibility to particular areas. It falls to me to be the first the speak, and I am anxious to address two matters briefly that are not part of his presentation. I do not expect a detailed answer today but I wonder if the Commissioner and his colleagues could revert at some point about these two areas of particular concern to us with a European dimension. The first relates to medical devices and the sector which develops medical technology. It is a very important sector in Ireland. The genesis of our concern goes back to 2012 and the advent of breast implant prostheses by Poly Implant Prothèse, PIP. The Commissioner might be aware of this. They were manufactured in and supplied from the Continent, and although the consequences were not unique to Ireland, there were adverse effects. We know that subsequently two draft Bills were presented. It is of great concern to women in this country as to why there has been a delay. We are now in 2015. Is the Commissioner in a position to share with us at what point the draft legislation is? We need to see the sector properly regulated and we want to ensure that every measure is employed to avoid a recurrence at any point in future. Is the Commissioner able to shed any light as to the current status of the proposals contained therein? The committee is kept informed of developments in the European Union across the health sector and we are anxiously awaiting greater evidence of movement in this respect. This question is not only in the interest of Irish women but the Irish population in general. Not only does it take in medical implants for female use, but there are issues across the board relating to medical devices. It must be seen in the round and holistically.

My second issue relates to what we unfortunately refer to as "legal highs" or substances that are mind-altering. In 2010, we introduced legislation - it is unique among all member states of the European Union - banning the import, distribution and sale of mind-altering substances. There had been a proliferation of what were described as head shops in towns across this country. As a result of the introduction of that legislation, they have, by and large, been closed. However, access to these substances continues through the Internet and we are anxious to encourage the addressing of this issue across the European Union. There is no way we can domestically address the use of the Internet. We must tackle the issue on a shared basis at the very least, and even a European basis may not be enough. If the European Union gave the lead in this respect, the positive consequences would be significant. Will the Commissioner comment on that during the course of today's visit? I thank him for his presentation.

Senator Jillian van Turnhout

I welcome the Commissioner to Ireland and thank him for today's presentation. The committee would endorse many of the proposals put forward. I wish to raise the issue of childhood obesity, which was highlighted in the presentation. Children today will form the first generation whose life expectancy may be less than that of their parents because of childhood obesity. It is a strong criticism of all of us. We must take action and we cannot let that statement stand.

In Ireland, one in four children is overweight or obese.

A total of four out of five children do not meet the physical activity guidelines. We know the issues and the problems. The Commissioner rightly focused on the areas of prevention and early intervention. Is the Commission willing to consider a sugar tax or a way to incentivise healthier eating, with the money derived from such a tax going towards healthier foods, as the Commissioner mentioned in his presentation? In Ireland, one in eight children lives in consistent poverty. There has been an increase in poverty during these tough economic times. We also know food poverty is a real issue and we must find a way to have policies which support healthy eating and healthier lifestyles.

In the overall budgetary process of the Commission, how do we ensure prevention and early intervention? With the deficit targets, governments are very focused on the immediacy of actions, and the committee sees this with regard to our budgets for health and children. We must focus on the year-to-year, so there is no incentive for the Government. We all know what will happen to the population in ten and 20 years' time with regard to alcohol, tobacco and childhood obesity. Where will the EU do to incentivise us to take actions today in our budgets and make investments now which will reap rewards in ten or 20 years' time? With the deficit targets, there are no incentives for the Government to do this. What does the Commissioner plan to do, and does he plan to set aside money for prevention and early intervention programmes? Everybody agrees on their importance, but we need to see action and leadership from the EU.

Senator Colm Burke

I welcome the Commissioner and wish him every success in his role in the coming five years. I thank him for his presentation. I will focus on the issue of tobacco and the changes required throughout Europe. The tobacco products directive went through on 20 May 2014 and member states have two years to transpose the new rules. What additional changes to existing directives and what new directives does the Commissioner believe he can bring forward in the coming five years which will help to reduce the purchase and use of tobacco and tobacco products? We have a particular problem in Ireland, as the age profile of those starting to smoke here is the lowest in the European Union. We have a major challenge, which is why we have followed Australia in introducing standardised packaging. A number of submissions have been received from member states. Does the Commissioner see the changes which have occurred in Australia and what we are trying to do in Ireland being introduced throughout Europe in the coming five years? Does he believe individual member states will resist it? The use of tobacco products results in a huge cost to our health services and it must be given priority.

I had the privilege of being in the European Parliament from 2007 to 2009. I was involved in the internal market committee and worked on the cross-border health care directive, which I believe is extremely important. What initiatives need to be taken by the Commission and member states to encourage and increase the level of co-operation in providing health care? Ireland is a small country with a population of 4.6 million, and as such there is no way we can afford to have sub-specialisation in medical care. Therefore, there is a need for much more co-operation between member states. What new initiatives will the Commissioner introduce in the coming five years to encourage and increase co-operation between member states, particularly with regard to rare diseases, which the Chairman mentioned, and unusual medical conditions? Does the Commissioner have measures he could introduce which would help co-operation? My biggest criticism is that although the cross-border health care directive was passed in February 2011, Ireland has not yet transposed it. It is something we need to do.

Dr. Vytenis Andriukaitis

All of the questions raised are on issues which I believe are important. Yesterday I discussed with the acting director general, Ladislav Miko, how we must act together. My bible is the book Everything You Always Wanted to Know About European Union Health Policies but Were Afraid to Ask. It is written by prominent authors and makes excellent recommendations and suggestions. When I read it, I want to act on its recommendations and ideas, beginning with medical devices. Today a very important file went from my portfolio to that of the Commissioner for the Internal Market, Industry, Entrepreneurship and SMEs, Elbieta Biekowska, but we have joint responsibility.

Very sensitive questions have been raised. I am a cardiac surgeon and I cannot imagine cardiac surgery without medical devices and technology. Such devices and technology must be assessed and controlled and the relevant notified bodies must be informed. We must keep an eye on the medical devices directive. The Latvian Presidency is ready to act and we will work together. Ireland submitted huge technical files on medical devices covering many topics in detail. Such information is important to be more effective and comprehensive with regard to clinical trials data, because we must know the positive and negative aspects. We must have transparency in clinical trials. Not all 28 member states have the capacity to have a notified body for everything, so we must have a European network and mechanisms. I am ready to ask my colleagues for more detailed answers if committee members wish.

The issue of the Internet was raised. I have been asked by Finland to help stop the advertising of alcohol on the Internet because it is impossible to regulate it at member state level. At this meeting we have discussed excise issues relating to Northern Ireland and Ireland, as the price of alcohol is different in both states. It is impossible to deal with these issues in one member state, but if minimum pricing and VAT are raised at EU level various countries and stakeholders will resist it. I agree that we must keep our eye on it.

Young people buy many things, from electronic cigarettes to contraceptives and drink. The difference is that we must all act together. Let us act to together and look at the possibility of change because the situation is so dangerous. I would like to check Ireland's position.

On obesity and budgets, it is always difficult to say how much money should be allocated to public health promotion initiatives, but after one year I know enough to ask questions. I would like to present to the committee the common picture and to send this study to my government and ask that the strategic committee follow my statement to say which approach is more effective.

My final slide is on statistics for demographic, mortality, unemployment and abortion rates. In 1989 we had 3.6 million inhabitants; today we have 3 million, indicating a loss of population. Every year some 35,000 to 36,000 people die, deaths due to alcohol, tobacco and accidents, deaths which are avoidable. I view this loss of life in economic terms, noting how much money is wasted every year by not paying attention to these deaths. Now that I am speaking about the European Union, I have an idea about the investment package proposal. I propose that we call together our specialists to discuss the possibility of making additional investment of about €180 million to €200 million to introduce and co-ordinate the instruments on the table to reduce alcohol and tobacco consumption and promote public health initiatives. We must control in a co-operative manner health risks and set yearly targets. This will have implications for investment in terms of growth and employment. I would like to raise with my colleagues the possibility of calculating the proposed expenditure and agreeing on how the money should be spent. For example, we could have instruments to reduce alcohol and tobacco consumption and the level of obesity. All member states should be profiled and we should establish the instruments on which they will co-operate at European Union level. That is the route I would like to follow. I ask the committee to raise these questions in Parliament and present the outcome to the European Parliament. This message should be sent to all stakeholders because together we can improve our capacity. Today, around 1.2% of total budgets is allocated for prevention measures. Let us not discuss the need for additional moneys but discuss the possibility of using effective instruments in year one. In the second year we must be more active and encourage member states to draw attention to the need for greater investment.

I think about the budget question a lot and see a very different picture today. There are different strategies - the cancer strategy, the alcohol strategy and the tobacco strategy. My aim is to try to join all of them together. I would like to see neighbouring countries, for example, Ireland and the United Kingdom, discussing instruments. We must co-operate and adopt a coherent approach to resolving these common issues and questions and use the instruments agreed to by all member states. I have resolved to present indicators and instruments to my colleagues. Having lost three months, I have only five years and would like all of us to move forward together.

I have been asked about budgets for measures to tackle obesity and the lack of physical activity. In some countries it is mandatory to have two lessons in physical education each week. We must see the possibilities to encourage children to be more physically active. Should we encourage physical activity on the street or the corridor and give children longer breaks to allow them to be more active and change their behaviour? This is a difficult debate and one can see that this example has not been followed in all 28 member states.

I will now address the issue of implementation of the article on tobacco. Our first job is to improve our activities through delegated responsibility because it is our job to implement the tax changes and look at how all 28 member states are ready to-----

Mr. Arunas Ribokas

Transpose.

Dr. Vytenis Andriukaitis

-----transpose the directive into national law. We are ready to be very tough on the issue of control.

I was asked about the provision of reference centres and the cross-border directive. The last call for entry will be in 2016. I checked the position today and discussed the directive with Ministers and my message is that we have the instruments. If we are not ready to introduce all obligatory measures, we will start with the infringement procedures. It is a very sensitive issue. Senator John Crown raised the question of rare diseases and specialised treatments. Of course, one needs to have reference centres, but one must also speak about accident centres. Reference centres deal with rare diseases, while accident centres have competencies in some areas.

I ask the committee to help me on the issue of e-health and e-health technologists and the possibility of using such services, especially where people live a long way from centres. It would be excellent to have prevention and-or professional problems solved through the use of mobile phones throughout the European Union.

Some scientists have programmes, under which a patient types on the phone and has a cardiogram. The centre will then tell him or her that it is ok, that he or she should not worry, or that he or she should go to the doctor or to the centre because it is an emergency. It is about the prevention of stroke and cardiovascular diseases. We speak about digital Europe, but we must speak about digital health. I know how important sovereignty and subsidiarity are, but I would like to speak only about treaties which I will follow strictly. There is a discussion about the cross-border initiative on rare diseases and the possibilities in this regard. We are ready to continue this year and into the middle of the year to the summer recess. I encourage some regions to be pioneers because the differences are huge. Health systems are of different type - the Mediterranean model, the Beveridge model, the Bismarck model, the Scandinavian model and central European models - but we must create a pilot project between regions.

I am sorry to be so general in my responses to the questions asked and, in the same way, ask my colleagues to expand on their positions.

Mr. Michael Scannell

The Italian Presidency made huge efforts to secure agreement on the issue of medical devices before the fall of the European Parliament. Unfortunately, as it did not succeed, essentially we are in a new political environment. The Parliament has adopted its position on the proposals, but the Council has yet to decide. It is a difficult issue which involves the approval of medical devices at member state level. Under the new proposals, we propose a hybrid model. Approval would rest with individual member states, but in the case of more sensitive medical devices, there would be opportunities to review the position at European level. It is a huge industry which is hugely important. First and foremost, everybody agrees that medical devices must be safe. Secondary to this is the huge economic significance of the sector, of which Ireland is well aware, as it has a huge medical devices sector. It has a well functioning medical products regulatory agency which is world renowned and making an important input.

It is important to highlight the fact that we are not doing nothing while the legislation is being discussed. In parallel with the legislative procedures, we have put in place a range of measures to strengthen national procedures. A so-called joint action plan was agreed between the Commission and member states in recognition of the fact that we could not simply sit and wait for the new legislation to take effect. We must do something in the interim. For example, we now carry out audits in all member states to review the performance of the notified bodies referred to by the Commissioner to see that they are working to the appropriate standards. We have identified a good number of problems that are being pursued with member states.

Deputy Mary Mitchell O'Connor

I thank the Commissioner for his comments. I have specific questions about alcohol, one of which relates to the EU alcohol strategy. Despite the work undertaken on the EU action plan, there has been no EU-wide alcohol strategy in place since the end of 2012. Why is this and when can we expect one to be implemented? Alcohol harm is a serious issue across Europe, particularly in Ireland where the Government is taking proactive steps to address the burden in the forthcoming public health (alcohol) Bill. Why is this not a priority issue for the European Union? The EU action plan to tackle youth drinking and heavy episode drinking primarily focuses on the targeting of alcohol abuse by young people. How exactly will it limit the accessibility of alcoholic drinks?

Last week in the European Parliament the Commissioner welcomed the fact that member states could now decide to grow their own GM vegetables and produce. I am told that Spain already grows 150,000 hectares of GM maize. The United States has in recent times approved the production of a new modified potato and we know that the production of GM crops and vegetables is spreading throughout the rest of the world. Does the Commissioner anticipate that allowing national governments to take decisions in this area will lead to a surge in GM crop cultivation throughout the European Union?

One of the Commissioner's first actions following his appointment was to visit some of the countries affected by Ebola in west Africa. Does he think the European Union is doing enough to conquer the virus? What developments does he anticipate taking place in 2015?

Senator John Crown

I welcome the Commissioner. I am a fellow doctor. I was reading his interesting career history and commend him for his many professional and personal achievements. I also serve on the public affairs committee of the European Society of Medical Oncology, the group that regulates medical oncology. With other groups with a strong research focus, we are concerned about the potential implications of the EU data protection regulation and the chilling effect it could have on medical research in Europe. The regulation is being discussed at the Council and a trialogue is set to begin once the Council reaches agreement on its approach. Since the proposals were introduced in 2012, the European Society of Medical Oncology has been trying very hard to raise awareness of the potentially negative impact of the regulation on health research. However, the European Parliament's position on this topic has been very strict and limited. It has not fully appreciated the potentially negative effect the regulation could have on the conduct of research on cancer, diabetes, cardiovascular and other diseases. That we are having a regulation, as well as a clinical trials regulation, gives us a unique opportunity to ensure this will not happen and that there will be a harmonised interpretation of articles and recitals pertaining to health research across the European Union. I request that the Commissioner try to ensure the final outcome of the regulation will create an environment that will foster, instead of restricting, health research, especially via a harmonised interpretation of the text across member states. I have been asked by my society to give the Commissioner a confidential briefing document which outlines the possibility of securing this from other national representatives in the European Society of Medical Oncology.

I became involved in the issue of producing anti-tobacco legislation and was shocked to discover the scope of the lobbying effort on behalf of the tobacco industry in Brussels. There are extraordinary levels of lobbying on the agriculture, manufacturing and commercial sides. Would the Commissioner like to make any comment on how we can combat the influence the tobacco companies are trying to have in thwarting the introduction of an appropriate tobacco regulation policy?

Deputy Peter Fitzpatrick

I welcome the European Commissioner for Health and Food Safety and thank him for his presentation. There is no hiding from the fact that obesity is a problem in Ireland. The joint committee recognises that much has been written in recent years about the long-term dangers of childhood obesity. We all know the underlying causes: a sedentary lifestyle, poor diet and lack of education. We have had many sectors represented before the committee, including food production, health, sport and fitness, as we want to be better informed and reflect on and identify the key issues involved. One of the elements of dealing with a complex and multi-faceted problem such as the obesity epidemic is a willing and co-ordinated response from the Government at both a political level and Departments.

The response should be imaginative, forward thinking and courageous. We need ministerial consensus with regard to the facts that whatever strategies are agreed must be implemented regardless of the short-term cost because the cost of the future failure would be both high and potentially unsustainable.

Some of the key issues are education and public awareness. We must create an environment where an effective education policy in relation to healthy nutrition is promoted and funded by the Government on an ongoing basis. An environment should be created so that young entrepreneurs aged between 17 and 23 years old who wish to enter the health and fitness sector are not penalised by commercial rates. Supermarkets should be encouraged and given an objective of ensuring that at least as much food and shelf space is given to whole food, unprocessed fresh meat, fruit and vegetables as given to crisps, pizzas, confectionary, desserts, chocolate and alcohol, etc. The excessive consumption of junk food not only adds high levels of fat, salt and sugar but also strips constituent ingredients of vitamins, iron and fibre.

This is an opportune time to use tax incentives in a positive way to promote healthy living. By offering tax breaks, commercial rate exemptions and VAT exemptions to businesses such as juice bars, gyms, tennis clubs, farm shops, cookery schools, yoga, aerobic and dance classes, hill walking, aqua sports, paintball and other sports activity, we can stimulate economic activity, create jobs and build a long-term positive social infrastructure. As a sports fanatic I believe we need to promote a healthy lifestyle and to encourage our children to get out and about from the start.

I am very grateful to my colleagues for nominating me as rapporteur of the child obesity study. These are only some of the key issues. I would also like to present the Commissioner with a copy of the report on childhood obesity. I would appreciate if he could comment on it.

The Commissioner mentioned budgets earlier. Does he have any plans to provide some funding to Ireland to combat the obesity problem in our country?

Deputy Mary Mitchell O'Connor

I wish to raise the issue of labelling on alcohol products. In the public health (alcohol) Bill we will include measures on the health labelling of alcohol products. We recognise that consumers can look up the ingredients and know what they will consume. This was thwarted at EU level. I wonder why that happened and what will be done to ensure that consumers know what they are drinking and that this information is on the labels of alcoholic drinks?

Chairman

The Commissioner can see we are very passionate, as he is, about our health.

Dr. Vytenis Andriukaitis

I would like to summarise and then respond to the five questions. I will look at data protection and its implications in respect of cancer. We fully agree with the joint committee's statement on obesity. In regard to dealing with GMO, I will ask my colleagues to add to my comments.

The alcohol strategy was raised. The way to deal with alcohol and tobacco products will not be in a five year but a 20 year strategy. It will be adopted at European Parliament and European Council levels and agreed with member states. The vast number of evidence based articles and studies have provided what we need to know. Some 75 of my friends worked on the risk factors of non-communicable diseases at the WHO in Geneva and Copenhagen. In our universities, we established a public health faculty. However, there are always opponents who raise questions and pose riddles on how we deal with issues. We must introduce agreed instruments which are effective based on the evidence. The most effective measure to deal with alcohol is education but education is a long-term measure. However, there is evidence of its effectiveness. It is one plus. Effectiveness comprises a number of elements. Firs, there is long-term political law; second there is pricing; third, there is advertising; fourth is the necessity to reduce accessibility to buy alcohol an to regulate the rules in supermarkets about buying alcohol; and fifth, there is the necessity not to use alcohol in cars. There are many effective measures that reduce the use of alcohol but they in turn reduce business and lower profits. There are always those who will want to veto such initiatives. We are medical doctors. We know from the evidence-based studies about the problems caused by alcohol.

My vision is to create a concrete plan of measures every year. I made a presentation to my government on concrete coherent measures that must be implemented together and must be implemented over the current and following five year terms of the Parliament. We have a ten year action plan to work together and step by step we hope to see the result of reducing the consumption of alcohol.

There is a pattern of binge drinking among young people. There is a need to build an architecture, a programme of streamlined measures to reduce alcohol use. The scientist Robert Brown describes zigzag, irregular motion known as Brownian motion. We need to establish common goals and then look at the common results. I want to emphasise not only strategy but the complexity of combining all risk factors and seeing the possibilities to implement our findings. We must use the results of broad and chronic diseases and must prevent early deaths. We must avoid the harm that is caused by alcohol. It is a complex issue.

I will ask Mr. Ladislav Miko, the deputy director general for the food chain of the Directorate-General for Health and Consumers for the European Commission to speak at this point.

Mr. Ladislav Miko

Good afternoon, I will be brief as I am aware of the time scale. It should be well understood that the use of GMOs is not a tool that would allow member states to decide on what they would like to plant in their fields that is the opposite from what is assessed as safe. At European level, countries can decide to opt out of using GMOs in their country or region.

It remains still be to be assessed and safety-confirmed at the European level. It is clearly specified in the proposed text that if something other than a safety consideration is relevant for a particular country or region - it may relate to a cultural issue, a public order matter or a certain system of agriculture - the country or region can opt out of using the particular variety to be planted. It is important to understand that we recognise that a member state may decide, for reasons unconnected to safety , that it does not want to cultivate the variety in question. That is the logic of the proposal. I do not foresee any increase in cultivation in Europe based on that. I would rather say the opposite - we will have clean information about the real reasons. If it is a question of safety, we will simply ban it at European level. We will not allow unsafe varieties to be produced or cultivated. If the safety issue is resolved, at least we will know it is not wanted for this reason or that reason. That is perfectly okay.

Dr. Vytenis Andriukaitis

I agree with the Senator that data protection is a complicated issue. I am on his side because it is very dangerous. It is a huge challenge to send a patient register via the Internet from one reference centre to another. We need to use our possibilities to act in a more efficient way. I fully agree with the Senator's statement. I would like to take it and discuss its possibilities in our college. We are looking at how to change data protection law. We know that this question is related to the discussion on terrorist attacks. The same question arose during the discussion on passenger name records. There must be checks and balances between the human rights package and the reality. Of course the same thing applies vice versa in the sense that having effective tools to defend people's health helps to defend human rights. I am on the Senator's side.

I was also asked about obesity. I would like to read about Ireland's situation. We are ready to answer. Perhaps it would be possible to collect the various questions together so that we can answer them in more detail. I am ready to go to Grange because that is where we must be for our next meeting. It is a little far from this Parliament.

Chairman

I wonder whether the Commissioner might comment on the issue of the Ebola virus. We are anxious to hear about the visit he made in that regard.

Dr. Vytenis Andriukaitis

We are ready to organise a conference in March. We are inviting all stakeholders. Of course I am speaking about vaccination possibilities. Two vaccines are on the way. They are going through a second clinical trial period. Some scientists envision that these vaccines will be ready for approval in the middle of this year. If they are successful, first of all we will vaccinate our medical staff who are on the front line. Then we will see about the possibility of disseminating the vaccines in a broader context.

The Ebola virus is under control today, but the challenge is huge. I would like to say openly that I was there. I saw huge poverty and illiteracy on the ground. They do not know anything about minimum hygiene standards. They have no water, no sanitation, no toilets and no electricity. Millions of people have no possibilities to wash their hands. Can the members of the committee imagine such an environment? The Ebola virus is transmitted through direct contact rather than through the air. All the human figures must make contact as they go around because of the way the sinks are on the ground. We must strengthen their sanitation capacities. Simple measures are needed to stop ways of transmission. The same thing applies to all infectious diseases. I remember the effective use of sanitation stations during the Soviet period.

They live in conditions that are like the descriptions of London in the 19th century. Charles Dickens famously described this picture. I saw this picture on the ground. Can members imagine such a situation? They do not speak about the health care system in such countries. It does not exist. There are 76 doctors in Guinea for 9 million inhabitants. That is the system about which we are speaking. We must use nurses and social workers to help low-level workers to improve their sanitation capacities. It is so evident. I would like to say that we are ready to act. Of course the EU is on the higher level. Frankly speaking, we do not have an environment for spreading this. It is impossible. It is dangerous for countries which have the same economic conditions, but not for the European continent. Of course it is of concern individually and personally. We have preparedness. Our system works very well. It is okay.

Chairman

I thank Dr. Andriukaitis on my own behalf and on behalf of the committee for his active participation in this morning's meeting. As Deputy Ó Caoláin rightly said, he spoke about the three Ps and he certainly showed passion in his presentation. I thank all of his cabinet members and members of staff who were here with him this morning. I thank Mr. Scannell and Mr. Miko, who were here as well. I thank everybody for the organisation of everybody's event. It has been a great occasion. We have learned from Dr. Andriukaitis. We look forward to working in collaboration with him in the promotion of public health across the EU.

Dr. Vytenis Andriukaitis

We are all like-minded. I do not see any of the colours of politics. All colours - yellow, green, red, blue - will be united.

The joint committee adjourned at 1 p.m. until 5 p.m on Tuesday, 27 January 2015.