Response to interpellation 2024/25:219 on joint Nordic pharmaceutical procurement and preparedness
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
1 KD argues that the Nordic cooperation regarding crisis preparedness and pharmaceuticals already exists 1. 1 KD argues that different regulations and systems for procurement make joint procurements difficult 1 2. 2 KD emphasizes that Sweden has a good balance in antibiotic use 2. 3 KD argues that the costs for pharmaceuticals will increase 3. 3 KD considers it currently impossible to carry out joint procurement because Sweden lacks such a system 3. 3 KD wants to review the pharmaceutical cost and function through a large investigation 3. KD argues that S stands by its budget proposal where patient fees increase. 4 S wants to investigate possibilities for joint procurement of pharmaceuticals, vaccines, and preparedness stocks 4. 4 S wants to avoid the high-cost protection being worsened 4. 5 S wants to increase cooperation in order to be able to procure more 5. 5 S does not want to contribute to the high-cost protection being negatively affected 5.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! Eva Lindh has asked me if I intend to take measures to strengthen Nordic cooperation regarding the procurement of pharmaceuticals and common preparedness stocks.
Nordic cooperation regarding pharmaceutical issues and preparedness takes place today in various forums. Within the Nordic Council, there has long been cooperation between the Nordic countries on crisis preparedness. In 2002, the Nordic countries signed the Nordic health preparedness agreement NordHels. Cooperation in NordHels takes place mainly in the Nordic health preparedness group called the Svalbard Group, which is a cooperation body for the Nordic health preparedness authorities.
In the pharmaceutical area, cooperation takes place in the Nordic Council's working group for the exchange of information and experiences within the pharmaceutical area. The working group's name is abbreviated WGEMA. It primarily consists of agency representatives from Sweden, Norway, Denmark, Iceland and Finland. The focus is on the accessibility and cost-effectiveness regarding pharmaceutical products as well as on increasing cooperation and research at the EU level.
There is also a Nordic cooperation between the authorities that conduct health economic evaluations regarding pharmaceuticals, where the Dental and Pharmaceutical Benefits Agency, TLV, participates from Sweden.
Some of the particularly prioritized areas during Sweden's presidency of the Nordic Council of Ministers this year have been antimicrobial resistance, access to medicines, and how cooperation regarding preparedness within healthcare in the Nordic region can be developed. During the Swedish presidency, a conference was organized in November, among other things, to strengthen access to antibiotics in the Nordic region.
The Medical Products Agency has conducted a mapping of Nordic and Swedish pharmaceutical production from a production capacity perspective, which was reported in December 2023. Earlier this year, work has also been carried out to map production capacity regarding antibiotics and vaccines.
A common Nordic market can be more attractive, for example from a preparedness manufacturing perspective, for pharmaceutical companies that manufacture larger volumes of medicines. When it comes to the issue of joint procurement of medicines, one needs to consider, among other things, the different regulatory frameworks and systems for the purchase of medicines that we have in each respective country. Cooperation has, however, occurred in connection with the purchase of vaccines during the covid-19 pandemic, when Sweden, in connection with the EU-wide joint procurements, undertook to sell vaccines further to Norway and Iceland.
The well-functioning Nordic cooperation within health preparedness is important to safeguard, not least due to the changed global situation. Sweden shall work to continue strengthening the Nordic cooperation regarding preparedness within health and social care.
Eva Lindh (S)
Madam Speaker! I thank you for the answer, which gives a picture of part of what is happening regarding cooperation between the countries in the Nordic region. Thank you very much for that, Minister!
The experiences from the pandemic taught us that alone is not strong and that the Nordic region is at its best when we solve challenges together. There are both economic and security gains in us in the Nordic region increasing cooperation regarding securing a joint procurement of vaccines and medicines, medical technology equipment, as well as preparedness stocks both in times of crisis and in normal cases.
Madam Speaker! We in the Social Democrats wrote a so-called member proposal in the Nordic Council a couple of years ago, against the background of precisely the pandemic and the need we then saw to improve cooperation both in general and in this area in particular. We must all be honest that what we believed to be a strong cooperation and a strong collaboration in the Nordic region was not quite as strong as we thought or desired.
Just as the Minister read out, there was a lot that was done well, but there was also a lot left to be desired. We were perhaps not so close to achieving the vision of the most inclusive region as we intended. We also saw that other countries in the Nordic region – and by that I mean Finland – were better at preparedness, and we learned from them. It also made a difference that we in Sweden helped Norway and Iceland with the procurement of vaccines. It was a good example.
What was possible to do during a very tough time, we thought should also be possible to do in normal times. That is why we in the Social Democrats wrote this membership proposal, and we received a very good response in the Nordic Council. The entire Nordic Council stood behind our proposal. Good so - we are happy about that! But the Nordic Council has no powers.
In the Nordic Council, we decide and resolve, but it is more like an exhortation. By standing behind a member proposal, we show that we are united, that is to say that parliamentarians in all the Nordic countries actually think something in common. What feels important now is to follow up on that decision and see what we can do to make this a reality. Accordingly, we also want to involve our governments - hence, among other things, this debate today.
What we want and wish for is that cooperation increases regarding the procurement of vaccines, medicines, and medical technology equipment. The latter was supplemented by the member proposal, which I think was very good. We want to investigate the possibility for the Nordic countries to procure certain medicines and vaccines, as I mentioned, as well as investigate the possibilities for common preparedness stocks for medicines and healthcare materials.
I have, of course, taken note of the Minister's response. I would like us to be able to move forward, so I hope that the Minister can nevertheless provide an opening for the possibility of moving forward with precisely those proposals that the Nordic Council has agreed upon.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! I thank the member for the question.
The desire to cooperate more and procure jointly is frequently raised at the European level. That we cannot do so on a larger scale has the same reasons as the fact that we cannot do it in the Nordic region, namely that we have different systems for handling pharmaceuticals.
In Sweden, we do not procure for Sweden. There is no one who procures medicines for Sweden. The exception was during the pandemic, when we knew which vaccine we needed. We could choose between a few different variants, but we knew what we were going to have and for which population. Therefore, we could conduct a procurement.
Just as the member points out, it was so good that we could support other countries in the Nordic region that were not part of the European community. It showed precisely that several good things were still done, even if the cooperation – just as the member also points out – was not optimal during the pandemic. We saw both sides during the pandemic, therefore.
However, it is not possible to procure medicines in general, partly because it is each region that is responsible for procuring what are requisition medicines, that is, those used in hospitals or institutions. What then exists within the benefit system – i.e., what we collect at pharmacies – is entirely dependent on companies putting it on the market and a doctor having prescribed it. There is therefore no one who decides which medicines someone should have. Therefore, this differs from the question of vaccines, where we have clear political decisions and know what we should have.
It also differs partly from the question of antibiotics. Let me delve into that a bit for a moment, and then we will, of course, return to the rest. When it comes to antibiotics, we have a situation where we would prefer that antibiotics are not used unnecessarily, if I may express myself a bit generally. If we use too much antibiotics, both on humans and on animals, it leads to resistance, and it happens very quickly. This means that the antibiotics which are normally very effective and powerful lose all their effect and do not bite on the bacteria.
Antibiotics must, therefore, exist, but we must use them in the right amount. Those who primarily need antibiotics are patients who have cancer and who often need an antibiotic treatment – or many – during their cancer treatment due to infections and many other conditions. Antibiotics are needed somewhat less for what we perhaps think of first, that is, when we get a cold or get that kind of infection. It is a slightly smaller part; more serious is it with all those who have severe diseases and need antibiotics to survive.
The risk of antibiotic resistance has led to the fact that we in Sweden for very many years have worked with the registry Strama, where the use of antibiotics is listed. We have found a good balance - I actually believe that we are almost the best in the world - where we use antibiotics where it is needed but refrain where it is not needed. That makes it so that we in Sweden have a better situation when it comes to resistance than the greater part of the world has.
We have, however, the problem today that we must keep the antibiotics on the market even though not much of them may be sold. How are we to solve that? At the same time, we also need to develop new types of antibiotics, both narrow-spectrum antibiotics and broad-spectrum antibiotics, to manage what we need to manage.
That is why we in Sweden work with different models that are somewhat unfamiliar to us. Put simply, we pay for the production of antibiotics even though one cannot sell everything. We need a preparedness to meet the antibiotic supply that is required, and the companies need to ensure that the antibiotics are on the market. One needs to develop new and better antibiotics but also maintain those that are already developed without being able to sell them in the normal way and get all the money back. Therefore, we are currently developing different methods to ensure the availability of antibiotics in Sweden.
I am very pleased that that kind of cooperation is spreading in the Nordic region and that we are working together on these issues. However, it is tougher in the EU, I want to say if I may draw that parallel. Not all countries find reasons to establish such systems. I am therefore pleased that we in the Nordic region find different ways to work with antibiotic resistance. There, procurement is also a possible way forward, but then it is again a question of what kind of antibiotics one should have and for which groups. But there is an opportunity to cooperate when the different countries find that it can be done based on the different financing systems and procurement systems they have.
Eva Lindh (S)
Madam Speaker! I also cannot refrain from saying a few words about antibiotics and antibiotic resistance. We in Sweden have done a lot and truly worked hard together to reduce the use of antibiotics.
We who have a grasp of this issue feel great concern, because it is a challenge for health in the entire world if this spreads and people become increasingly resistant. One must reduce the use - it is important.
Here, Sweden has led the way. The Welfare Committee in the Nordic Council has prioritized this issue for even longer than the six years I have sat there. We have wanted to press the governments so that they jointly prioritize this issue. We are very pleased that it has been done. It is an important work.
When representatives from the Welfare Committee were down and met some of the highest-ranking officials at the EU level within the health and healthcare area - if I may be a bit loosely broad - they said that they wish for us in the Nordic region to lead the way. This applies to both this area and the area we spoke about originally, which my question concerned. They want us in the Nordic region to pave the way for things.
Sometimes one is given the answer that the EU is in the process of introducing something and that one should wait. The Welfare Committee has received this as an answer to many questions. The EU says exactly the opposite, however: Go ahead! It would facilitate things for the entire EU.
This is also a joint submission. We can go ahead – we do not need to wait. Then it also goes faster. We can lead the way in those policy areas where we actually have competence and can truly lead the way.
Why do I then ask the question about joint procurement of medicines, vaccine production, emergency stockpiles and cooperation in these issues in the Nordic countries? The reason is, as I began by saying, that we are stronger together. We could do more. If we could jointly find a way to procure medicines, it would also lower the costs for medicines. We know how it usually is if one is larger and stronger – it makes a difference when it concerns a large procurement area.
We could do better, but it sometimes concerns orphan drugs that we do not procure much of and that each individual region really does not procure much of. Therefore, this issue becomes even more relevant now as drug costs are increasing. The original reason why we wrote the membership proposal becomes extra important now, because we need to find ways to lower the costs for medicines.
We do not want to worsen the high-cost protection. It is an important issue. If it is stated that the increased costs of medicines are a reason for this, we want to help find a way to lower the costs for medicines so that we do not need to worsen the high-cost protection, which is so important for many.
Several different investigations have shown that this would be needed and that we should work more jointly in this area in the Nordic region. I wish that we go that way. I know that there are difficulties, but let us begin to take the difficult path in order to get somewhere.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! I thank the member for the additions.
Let me begin with the high-cost protection. The member's party has indeed submitted a budget proposal which implies that patient fees will increase. Now there is a discussion about how they shall increase, but this budget proposal is in the Riksdag's documents.
I agree with the member that this is not desirable from any perspective, but it may be necessary. I assess that it is necessary given that pharmaceutical costs are increasing so much. That is why I agree with the member's assessment: We need to do what we can so that the increase does not become so large.
Costs will increase because more and more rare diseases can be treated, due to new, innovative therapies, and because we are now seeing truly effective medicines against major diseases entering on a broad front. How are we to pay for this collectively? It is a major challenge that means we need to look at this differently. I note that the Social Democrats agree that patient fees need to increase; that is indeed how it looks in their budget proposal. It now remains to be seen how, because it is also about how the whole thing is distributed.
When it comes to antibiotics, we are leading the way from the Swedish side. We are pleased that a declaration has been adopted in the UN – I was there in September and was able to participate in making this happen. It is an important declaration that, from a one health perspective, covers both humans and animals. There were quite a few proposals – if I remember correctly, there were 29 of them. We would have liked many more and, above all, more powerful proposals, but I am still very pleased that steps forward are being taken within the entire UN cooperation.
At the EU level, we have good cooperation regarding antibiotics. We pushed through council conclusions during our presidency and continue to work with them.
I do not perceive that the Nordic countries are being told to wait, but there is absolutely a consensus between the Nordic ambition, what is being done in the EU, and what is being done in the UN, even if it is a bit weaker there.
Regarding the member's direct question about procuring more jointly, I want to be clear that it is not possible to do so now, because we have no system for joint procurement in Sweden that we can apply to this. It is completely impossible.
However, the government judges that we need to review the cost and function of pharmaceuticals. Therefore, it is included in the financial plan that we shall appoint a larger investigation of the entire pharmaceutical system.
I have previously highlighted in the debate that we probably need to take a look at Denmark, as they procure more collectively. I would not say that they have significantly lower costs than Sweden has, but they have a way of managing their costs – by finding better functions – that is better than what Sweden has. I cannot answer how Iceland's system looks; it is possible that the member can help me with that.
If we in Sweden can achieve a development that makes us more similar to Denmark - and thus also Norway and Finland - we can have a different discussion. Today, however, it is not possible, because there are 21 different principals for requisitioned medicines and because it looks the way it does regarding benefit medicines. There are no tools for a government to use because we do not procure medicines jointly.
The following is also important information: When something is missing, it is not because someone has forgotten to order it, but it is almost always because it is not available on the market. The pharmaceutical companies have either been unable to produce the product or have chosen not to place it on the Swedish market. Therefore, the issue of competition is very important, as are the emergency stocks that the member mentioned in their interpellation. How large are the stocks? We have now strengthened the legislation so that one shall have the healthcare products one needs. We will return to the question of stocks. It is, of course, about turnover stocks – one does not pile things up and wait, but rather one uses them continuously.
If we introduce this right now, we contribute to a medicine shortage the next day. Therefore, it must be introduced gradually. There is also an agreement within the EU to introduce this gradually in order not to cause a medicine shortage in the EU due to the building up of stocks.
We have emphasized this from the Swedish side, and all parties in the Riksdag agree that this is how it should proceed. We need turnover stocks, but they must be built up gradually so that we do not cause shortages the next day. This applies to both the regions in Sweden and the entire EU.
Eva Lindh (S)
Madam Speaker! Finland has now helped Sweden with how similar stockpiles should be built up here. It is a good cooperation. We do, however, envision a broader and larger cooperation when it comes to emergency stockpiles.
We learn from the tragic things we experienced during the pandemic. Sometimes we might forget some of what we learned during the pandemic, but I truly believe we should take the consequences we saw with us and do better next time. That is part of our political mandate. One of our perhaps most important mandates is to learn both from failures and from what works, and to do it better moving forward. I have sometimes said that the best thing is if we risk cycling into the ditch but don't do it, and if people don't even notice that we were there. We have a large and broad mandate.
The Minister said that it is not possible today. I also see that there are difficulties; I am not pretending that this would be easy in any way. I still hope that the Minister leaves an opening to make the attempts that can be made to get there. I believe it would be very good to increase cooperation in this area so that we can procure more. Investigations have shown that one can at least start with the rare medicines. The same applies to the common emergency stocks. I hope for a positive development there.
In conclusion, I want to return to the high-cost protection. It hurts the heart. There are so many people who are having an incredibly tough time, and this would particularly affect those who are already struggling. That is something we do not want to contribute to.
Statsrådet Acko Ankarberg Johansson (KD)
Madam Speaker! No, the Social Democrats do not wish to participate. But you have submitted such a budget proposal, and it is reasonable, after all, that one stands by the budget proposals one submits to the Riksdag. It becomes a bit strange otherwise – then we would have to remove everything you propose within the Social Affairs Committee's area, because in that case, none of it would apply.
When it comes to orphan drugs, it is a special area. For Sweden's part, TLV will soon present a report on how we can better provide orphan drugs.
There are also some medicines that are very regional. Therefore, we currently have assignments underway to review how they are distributed in the country. Some regions have to take a greater responsibility because they have a population with a certain severe disease that is actually geographically determined. There are more such ones than one might think - not just Skellefte disease but more. Therefore, we are looking at how we can take a greater collective responsibility within the country but also find a system.
If a medicine has been developed for very few, we intuitively understand that it will become a bit more expensive, and we are prepared to pay more. We already do that today. But how can we ensure that it does not become so expensive that it pushes out other medicines that other patients also need? TLV has that assignment and will return in January, I believe, with its report on finding a method to manage that.
If a good method is found, as the member of Parliament points out, it is absolutely possible to cooperate also within the Nordic countries. TLV has a good cooperation with its colleagues. But, again, it is not TLV that orders medicines. Every region does that, and that is where the challenge lies for us moving forward.
I think the member, with their question, highlights all the issues that are connected to it – preparedness and procurement so that there are enough medicines that patients need. That question is becoming increasingly important because medicines can achieve so much today. Ten years ago, it was quite rare that we talked about medicines. Now it needs to take up a larger place in the debate.
The committee thus raises a highly topical issue where we jointly need to find long-term proposals that ensure we can manage to provide the medicines that patients need, both in Sweden and in the Nordic region.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.