Public Health

EU countries to propose excise tax for e-cigarettes and heated tobacco products

EU member states will ask the European Commission this week to place novel tobacco products, electronic cigarettes and heated tobacco products under the EU Tobacco Excise Directive, meaning they would be taxed just like traditional tobacco products, according to draft Council conclusions seen by EURACTIV.com.

“The current provisions of Directive 2011/64/EU have become less effective, as they are either no longer sufficient or too narrow to address current and future challenges, concerning some products, such as liquids for e-cigarettes, heated tobacco products and other types of next-generation products, which are entering the market,” the draft conclusions read.

“It is therefore urgent and necessary to upgrade the EU regulatory framework, in order to tackle current and future challenges in respect of the functioning of the internal market by harmonising definitions and tax treatment of novel products (such as liquids for e-cigarettes and heated tobacco products), including products, whether or not containing nicotine, that substitute tobacco, in order to avoid legal uncertainty and regulatory disparities in the EU,” the conclusions add.

The Council Conclusions are expected to be endorsed tomorrow (27 May) at a COREPER II meeting.

EU member states also ask the EU executive to present a legislative proposal to the Council, with the objective of “resolving, as appropriate, the concerns set out in these conclusions”.

Although novel tobacco products are regulated under the Tobacco Product Directive focusing on the health aspect, there is currently no EU-wide excise framework as there is for traditional tobacco products.

The situation in the EU single market is quite fragmented, as some member states tax e-liquids and heated tobacco products at different rates while others do not tax them at all.

In January 2018, the lack of sufficient data prompted the European Commission not to propose a harmonised approach for excise taxation of e-cigarettes and other novel tobacco products until further information about these products was available.

However, in February 2020, the executive published a report suggesting that for recent and new products, the lack of harmonisation is a source of concern from the internal market perspective.

“On the market side, developments have accelerated within new e-cigarettes, heated tobacco products and a new generation of modern products are coming into the market (containing nicotine or cannabis),” the report read.

“The current lack of harmonisation of the tax regulatory framework for these products is also restricting the possibility to monitor their market development and control their movements,” it added.

The tobacco industry says novel tobacco products and electronic cigarettes have significantly reduced health risks compared to traditional smoking and should therefore be treated accordingly.

On the other hand, EU policymakers insist that they are still harmful, albeit, perhaps, a little less than cigarettes, and all these years have adopted a cautious approach.

The next challenge will now be the pressure that the tobacco industry is expected to put on national governments in order to get the lowest excise tax possible.

Originally published here.


The Consumer Choice Center is the consumer advocacy group supporting lifestyle freedom, innovation, privacy, science, and consumer choice. The main policy areas we focus on are digital, mobility, lifestyle & consumer goods, and health & science.

The CCC represents consumers in over 100 countries across the globe. We closely monitor regulatory trends in Ottawa, Washington, Brussels, Geneva and other hotspots of regulation and inform and activate consumers to fight for #ConsumerChoice. Learn more at consumerchoicecenter.org

Perché il Sistema Tedesco Funziona

l servizio sanitario in Germania ha retto molto meglio la pressione della crisi Covid-19 rispetto al quello italiano. Stiamo pagando scelte di spesa e investimenti sbagliati, e una burocratizzazione estrema del sistema ospedaliero. Cosa potrebbe succedere qualora in autunno il virus tornasse con forza?

PERCHÉ È IMPORTANTE   Sia in Italia che in Germania circa lo 0.4% della popolazione è risultato positivo al Coronavirus. Mentre la curva dei contagi sembra seguire la stessa traiettoria, la percentuale di morti su 1000 casi è di 3,5 volte superiore in Italia che in Germania.

Perché? Gli ospedali tedeschi hanno una maggior resistenza in tempo di crisi, grazie ad una forte competizione tra di essi, siano essi pubblici o privati.

TESTARE LA DIFFERENZA   Al contrario di quanto avviene in Italia il governo centrale tedesco, insieme ai lander, ha dato via libera ai laboratori privati ai test e nel momento in cui scriviamo più del 3% della popolazione è stata testata. In Italia invece i test si limitano allo 0.5% della popolazione fermandosi a quota 3 milioni circa di cui la metà nelle regioni di Lombardia, Veneto e Piemonte.

Ricordando che in Germania l’epidemia è iniziata circa 10 giorni dopo rispetto l’Italia possiamo ampiamente notare come il governo a guida Merkel abbia reagito diversamente da quello Italiano.

CENTRALISMO VS. FEDERALISMO   Infatti non solo in Germania sono i cittadini a decidere se fare il test e dove, ma il governo federale ha anche istituito grazie al supporto di aziende private, i cosiddetti laboratori drive in dove i tamponi vengono fatti direttamente dal finestrino dell’auto.

In Italia al contrario si è deciso per centralizzare tutto in alcuni laboratori statali, e seguendo le direttive OMS, si è deciso di fare i tamponi solo ai soggetti fortemente sintomatici (fatta eccezione per il Veneto dove invece il governo locale ha deciso di testare tutta la popolazione sia essa sintomatica o meno), portando questi laboratori al quasi totale collasso.

SPESA PUBBLICA E POSTI LETTO   Ma veniamo ad un’altra domanda che in tanti si chiedono. Come mai abbiamo così pochi posti di terapia intensiva quando la spesa sanitaria è la seconda voce per volume della spesa pubblica dopo le pensioni? ln Germania i posti letto a inizio pandemia erano circa il triplo di quelli Italiani (8,6 ogni 100 mila abitanti in Italia contro i 33,9, tedeschi) arrivando a circa 50.2 letti ogni 100 mila abitanti a inizio Maggio. 

Se si considera che la maggior parte dei posti in terapia intensiva sono nelle regioni del Veneto, Lombardia, Piemonte ed Emilia Romagna (circa 3600 su un totale di 9200) si può ampiamente dire che una buona parte dell’Italia è quasi completamente scoperta.

Il motivo di questa scelta è da vedersi nelle scelte dei governi degli ultimi 10 anni in cui si è deciso di investire sul welfare più che sulla cura della persona, e dove si è deciso di non copiare i modelli del nord d’Italia ma di proseguire una politica dedicata a sussidi pubblici ad enti burocratici non funzionanti.

UN PAESE A RISCHIO   L’emergenza è passata e ora c’è da chiedersi siamo pronti per una nuova ondata, che molti esperti dicono arriverà in autunno. Siamo attrezzati per una nuova pandemia?

La risposta è no. Dobbiamo lasciare i privati investire, seguire il modello lombardo di organizzazione sanitaria, che in tanti criticano ma che ha resistito ad uno tsunami, e aggiungere il campionamento a tappeto fatto in Veneto. Bisogna insomma riformare la nostra sanità in stile tedesco, lasciando spazio ai privati di fare competizione al pubblico, senza mai dimenticarsi il principio di universalità del sistema sanitario nazionale.

È necessario riformare il nostro sistema e farlo alla svelta, i modelli vincenti ci sono. Sarà la nostra classe politica pronta a fare questa riforma oppure sarà ancora schiava di logiche clientelari?


The Consumer Choice Center is the consumer advocacy group supporting lifestyle freedom, innovation, privacy, science, and consumer choice. The main policy areas we focus on are digital, mobility, lifestyle & consumer goods, and health & science.

The CCC represents consumers in over 100 countries across the globe. We closely monitor regulatory trends in Ottawa, Washington, Brussels, Geneva and other hotspots of regulation and inform and activate consumers to fight for #ConsumerChoice. Learn more at consumerchoicecenter.org

Public Health Agencies Care More About Controlling You Than Prepping For Pandemics

Public Health Agencies Care More About Controlling You Than Prepping For Pandemics

What were public health officials at every level of government doing last year? Were they preparing for a pandemic? Or were they using their office to meddle with your lifestyle choices?

The partisan political sniping over Covid-19 is completely predictable and counter-productive. There’s plenty of fault to go around, but the blame-gaming should be ignored or discounted for what it is: self-aggrandizing grandstanding.

It is, however, worthwhile to examine a tension that has been brewing in the public health world for decades. That dichotomy is: should we focus on communicable diseases, as has long been the mission of public health institutions, or do we have enough bandwidth and resources to venture out into the much more controversial area of non-communicable diseases (NCDs)?

To get to the answer, think about this. What were public health officials at every level of government doing last year? Five years ago? Were they first ensuring that their track and trace systems were in place for a pandemic? Or were they using their office to meddle with your lifestyle choices?

The discipline of public health has long been rooted in fighting contagious diseases. For the most part, it has done very well. Notwithstanding the current Covid-19 pandemic, sanitation, vaccines and therapies—mainly drugs—have dramatically reduced the toll of communicable diseases.

That success has led many in public health agencies, especially in the United States, to argue that we must now use our limited resources to combat NCDs, and that we can address both effectively. It isn’t exactly working out that way.

Efforts to fight non-contagious diseases such as heart disease and diabetes frequently raise questions about individual liberty, including the freedom to make poor choices. All too often, the politicized debate causes both sides to overstate or manipulate the science supporting their viewpoints.

When former New York City Mayor Michael Bloomberg, the biggest booster of today’s public health movement, campaigned against sugary drinks like soda, it landed the city’s health department in hot water. For instance, a taxpayer-funded ad campaign created by the Department of Health showed a photo of a man purportedly with amputated legs. The city’s ad agency had Photoshopped his legs out of the photo to support the valid claim that Type 2 diabetes can lead to amputations.

The Bloomberg administration’s antics, which even elicited criticism from within the health department, indicates the degree to which his wing of the public health movement has lost sight of its most primary and unifying functions: preparedness.

This lack of preparedness is not partisan. It exists in the current Republican administration, as it did in the prior Democrat administration. Cities, counties, and states long governed by each party were equally ill-prepared for a pandemic.

Commentators on the left and the right have referred to Coronavirus and Covid-19 as a “black swan event.” But it doesn’t meet the definition. A pandemic of this type was not only predictable, it was something communicable disease experts have warned about rather specifically for many years. The warning signs were ignored, and we were ill-prepared.

A 2007 review article in the American Society for Microbiology’s publication, Clinical Microbiology Reviews, entitled, “Severe Acute Respiratory Syndrome Coronavirus as an Agent of Emerging and Reemerging Infection,” concluded: “Coronaviruses are well known to undergo genetic recombination, which may lead to new genotypes and outbreaks. The presence of a large reservoir of SARS-CoV-like viruses in horseshoe bats, together with the culture of eating exotic mammals in southern China, is a time bomb. The possibility of the reemergence of SARS and other novel viruses from animals or laboratories and therefore the need for preparedness should not be ignored.”

Rather than marshal finite resources towards preparedness for a coming communicable disease, lots of public health resources, including taxpayer dollars, media attention, and legislative priorities, were deployed to address non-communicable diseases, from domestic violence to gun regulation.

Think back to a different time not so long ago. During the second half of 2019, federal, state and city health officials throughout the country were busy confronting a new and scary lung disease. The health reporters covering them churned out news articles, regularly garnering front-page placement. Major charities such as Bloomberg Philanthropies were making large public health grants. So it should come as no surprise that the American public and political leaders were keenly focused on this emerging health threat.

The disease wasn’t Covid-19, of course. It was a something the Centers for Disease Control called e-cigarette or vaping product use-associated lung injury, or EVALI.

At the time, public health activists were, for years, calling for bans on the types of e-cigarettes used to quit smoking. Despite strong evidence that nicotine e-cigarettes are 95 percent less harmful than smoking and can help smokers quit, public health agencies treated e-cigarettes as the most important threat to public health. Yet they still failed to convince policymakers to institute widespread bans on the most popular e-cigarettes.

But as consciousness of EVALI reached a crescendo, states began to ban most flavored e-cigarettes, and the FDA further tightened the regulatory screws on nicotine-containing e-cigarettes.

It turned out that none of these nicotine e-cigarettes were ever responsible for the lung disease that bears their name. It took until late December for the Centers for Disease Control to (partly) acknowledge that the lung injuries were caused not by vaping liquid nicotine e-cigarettes such as Juul, but by the use of THC oil contaminated with vitamin E acetate.

Public health agencies were so ideologically opposed to e-cigarettes as a tool for tobacco harm reduction that they sowed panic, promulgated misinformation, and actually caused a failure to identify the true culprit in a life-saving and timely way. Still, nobody has been held accountable.

So, back to the question about communicable and non-communicable disease: Has public health been able to “do both” well? It turns out, that when purportedly trying to do both, public health hasn’t been able to do either effectively.

I’m not suggesting that public health’s EVALI scandal was the only or even primary culprit for the failure of public health departments around the country to ensure that their communities had an adequate supply of personal protective equipment in the event of a predictable communicable disease outbreak, or that the CDC was otherwise preoccupied. Instead, the EVALI episode was more of a symptom of something wrong in public health.

The institution of public health has largely been co-opted by those with a desire to control individual choices to such a degree that it has largely lost sight of its fundamental role of pandemic preparedness. At this point, taxpayers should realize that we are giving the keys to the public health car to people who have long been driving in the wrong direction.

Originally published here.


The Consumer Choice Center is the consumer advocacy group supporting lifestyle freedom, innovation, privacy, science, and consumer choice. The main policy areas we focus on are digital, mobility, lifestyle & consumer goods, and health & science.

The CCC represents consumers in over 100 countries across the globe. We closely monitor regulatory trends in Ottawa, Washington, Brussels, Geneva and other hotspots of regulation and inform and activate consumers to fight for #ConsumerChoice. Learn more at consumerchoicecenter.org

The folly of opposing patents on a Covid vaccine

The folly of opposing patents on a Covid vaccine

Doctors Without Borders does incredible work in the interest of patients around the globe. It has an exemplary track record of bringing doctors to the front lines of combat zones, famines, and pandemics — helping those patients that are left alone and victims of large crises.

During the 2014-2015 Ebola epidemic in West Africa, MSF (to use its French acronym) was the leading organisation fighting for patients — far more so than the World Health Organization, which is bureaucratic and has slow response times. For that and its previous 48 years of service, it needs to be applauded.

However, its current opposition to patents on drugs treating Covid-19 misunderstands the importance of intellectual property rights for medical innovation.

MSF is also running a campaign on access to medicines which distorts the realities of the drug market, while calling for solutions that would harm scientific innovation. The “Campaign for Access to Essential Medicines” wants to increase the availability of medicines in developing nations by addressing drug pricing and intellectual property rights. In the eyes of MSF, producers and researchers are enriching themselves off the backs of those who can least afford it.

What MSF gets wrong is that intellectual property rights and patents do not hinder innovation but actually enable medical progress.

Dozens of pharmaceutical companies have not only started searching for a vaccine against Covid-19 but have also thrown a lot of resources into getting millions of tests produced, looking at what existing drugs might be able to treat the disease, and donating money and materials to health systems across the world.

In fact, the philanthropic efforts of pharmaceutical companies are impressively underreported. By any standard, these companies are offering charitable support, including to organisations working with patients on the ground. However, Doctors Without Borders has said that it will not accept in-kind donations of drugs from pharmaceutical companies, but instead purchase them at market prices. Donors to MSF would probably be stunned by the idea that their donations are spent on drugs that MSF could have got for free.

While the industry also cares about access a lot, dysfunctional health systems and infrastructure are often the barrier between a patient and a treatment or vaccine. We need to realise that charitable acts are only possible if profits are also encouraged. Pharmaceutical companies develop drugs, protect their inventions and make profits. If you cut out patent rights from the equation, the incentive to innovate disappears, and life-saving medicines that cost billions to develop will stay off the market.

Doctors without Borders calls for preventing drug profiteering on the novel coronavirus, while ignoring the significant donations being made to help stop this virus. In fact, most efforts to combat the disease are public-private partnerships, much like the fight against Ebola was.

Remember too that stopping companies making a profit from drugs both eliminates incentives and ignores both the risks and the costs of working on a new drug. Who are we to tell lab workers to come into work every day for free, when there are risks associated with going to work and interacting with fellow employees?

The idea of so-called compulsory licenses, which de facto takes a patent away from a manufacturer in one country and gives it to another, might even delay the introduction of a Covid-19 vaccine even more. It takes know how and supply chains to manufacture and deliver a working vaccine. It is questionable whether a vaccine produced under compulsory licensing would actually be less expensive than the original one.

Much can be said about drug manufacturing and access to essential medicines. But a proper debate needs to be held on the basis of certain basic facts. Among these is that pharmaceutical companies invest vast sums of money to provide life-saving medicines, and those same companies have also taken action to help those in the most need. With Covid-19, we are facing one of the biggest public health crises ever – Innovation and medical breakthroughs are needed now more than ever. Undermining the ownership of innovations will definitely not lead to the breakthroughs that will ultimately get us out of this nightmare.

Originally published here.


The Consumer Choice Center is the consumer advocacy group supporting lifestyle freedom, innovation, privacy, science, and consumer choice. The main policy areas we focus on are digital, mobility, lifestyle & consumer goods, and health & science.

The CCC represents consumers in over 100 countries across the globe. We closely monitor regulatory trends in Ottawa, Washington, Brussels, Geneva and other hotspots of regulation and inform and activate consumers to fight for #ConsumerChoice. Learn more at consumerchoicecenter.org

I celebrated World IP Day but many didn’t

Last Sunday (April 26th) marked World Intellectual Property Day. While the existence of IP has allowed innovators to enjoy the rewards of their invention, more and more voices speak up against patents and IP in general. So while I celebrated World IP Day many didn’t even want to show up to the party.

The current COVID-19 crises triggers many voices that ask to ban all patents of COVID-19 related tests, drugs, and vaccines. I stumbled ac ross some very wrong statements and want to highlight these and explain what their authors got wrong.

Happy World IP Day to me…

Michael Barker for instance writes:

Flowing from the relentless drive for super-profits, we can also understand the process by which big pharma makes decisions on the type of drugs they will prioritise for mass production. Medicines that can be sold to wealthy consumers in developed countries, are fast-tracked, while drugs and treatments that might benefit the poorest billions simply fall by the wayside. Human life is secondary to the pursuit of profits.

The author might not know that depending on the country you live in and the insurance you have, drug prices can vary enormously, not because of the decisions of the manufacturer, but because of the local reimbursement models. However, producers also sell at different initial costs in developing countries. The British company GlaxoSmithKline usually caps their drug prices in emerging markets at 25% of the price they ask for in developed countries. In many cases the price is way below the 25% cap. The same company offers their HIV/AIDS treatment at merely variable cost in South Africa. Since 2001 the Swiss company Novartis supplies the fixed-dose artemisinin-based combination therapy (ACT) without profit to public-sector buyers. Over 850 million antimalarial treatments have been delivered to patients in more than 60 malaria-endemic countries. American biotechnology company Gilead has an access partnership campaign that licenses out their drugs to local partners in low- and middle-income countries, selling drugs at cost.   

Another group that sometimes totally misunderstands the pharmaceutical research industry is the well-respected NGO Doctors without Borders (MSF). While I am a personal fan of their work on the front lines of health conflicts, I wholeheartedly disagree with their understanding of patents and profits.

MSF states:

The international medical humanitarian organisation Médecins Sans Frontières/Doctors Without Borders (MSF) today called for no patents or profiteering on drugs, tests, or vaccines used for the COVID-19 pandemic, and for governments to prepare to suspend and override patents and take other measures, such as price controls, to ensure availability, reduce prices and save more lives.

Price controls will actually lead to shortages – We have seen this in the past and see this in the current COVID-19 crisis. Whenever a government limits the price of a good, its supply tends to go down. To controlling prices and at the same time ensuring availability is just and oxymoron. If MSF genuinely wants to save more lives (which I believe), they should encourage flexible prices and patent-protection – At the same time they might want to reconsider their own policy of not accepting in kind donations of the pharmaceutical industry…

MSF campaigners raise a point in favour of eliminating private property protection, saying that the ownership hasn’t even been established through private funds. Since manufacturers receive public grants for their work, their results should also be public ownership. While it is true that one in three Euros spent on pharmaceutical research is public money, it is also true that this public expenditure is offset by the taxes paid. The industry, employees, and customers pay directly a much higher amount of taxes than is received subsidies. Total R&D expenditure in the UK in 2015 was 4.1bn GBP (of which roughly 1.2 GBP are public funds) and direct tax contribution was 300% higher at 3.7. Billion.

A roadmap for the NHS: lessons from Germany

In both Germany and the United Kingdom, around 0.18 per cent of the total population has recently tested positive for coronavirus. While the spread of the pandemic is roughly equal in these countries, the fatality rate is 420 per cent higher for patients treated by the NHS compared with those treated in Germany. This is because Germany’s hospitals are better placed to be resilient in times of crisis, thanks to the private and competitive aspects of the country’s healthcare system.

Germany’s decentralised and private laboratory network had already tested over two per cent of its population when the UK’s figure still stood at a meagre 0.7%. Britain’s centralised testing system, and its failure to scale up Covid-19 tests, might explain part of this mortality gap. One could assume that only very severe cases are being tested by the NHS and, as such, the fatality rate of this more concentrated group is higher.

Even if you make very generous adjustments to the figures and assume that Britain’s fatality rate would remain unchanged even if the NHS tested as many people as the German system, the UK would still have a 49 per cent higher death rate.

Not only are the NHS’s testing facilities incapable of dealing with black swan events, the entire healthcare system simply doesn’t have sufficient resilience to minimise the harm caused to patients by a virus such as Covid-19.

Conversely, Germany’s mainly private and non-profit hospital system leads the way in Europe when it comes to successfully facing this wave of patients. In early March, hospitals had already freed up beds in intensive care by pushing back elective surgeries, and the total capacity of ICU beds was ramped up 40 per cent within a month. Germany’s hospitals now have a total of 40,000 ICU beds and 30,000 beds with respiration units.

And all of this was achieved while still ensuring the provision of critical services such as cancer care and screening, which is something that the NHS is struggling to do – a problem that may cause more harm than Covid-19.

Thanks to the recent increase, Germany has now 48 ICU beds per 100,000 inhabitants, which is more than seven times the capacity the UK currently has. This month, the NHS published the occupancy rate of critical care beds in February, which showed over 80 per cent of those were in use. And while Germany was deploying a new public database showing critical care capacity per hospital, which is updated at least once a day, the NHS paused the publication of many of its own statistics, and those that are released are at least a month old.

What’s more, Germany’s new online ICU capacity register was built overnight, a tool that provides patients and doctors with invaluable guidance. One map, for example, shows that in Bavaria, which is the state worst-hit by Covid-19, just 16.1 per cent of ICU beds are occupied by patients with coronavirus. It also shows the available number of empty ICU beds. Bavaria still has 37 per cent of all its ICU beds empty and can, therefore, comfortably treat three times more Covid-19 patients than now.

This successful approach has taken place within a system where the government owns less than 30 per cent of all hospitals. Germany’s universal healthcare system embraces competition and private ownership of hospitals and outpatient services. So while the social insurance system covers 90 per cent of the population, the provision of care is mainly carried out by private for-profit hospitals or charities. 

Simply put, private hospitals and competition lead to much more efficient structures, and Germany’s decentralised healthcare system, which allowed for a speedy mitigation strategy, is now showing its value by saving thousands of lives. Indeed, Germany is not only weathering this storm better than the NHS but it is even able to fly in and treat hundreds of patients from Italy, France and Spain.

British policymakers will need to show courage in the coming months and be honest about the failings of the UK’s healthcare system during this crisis. There are two crucial lessons that will need to be learned in order to prevent, or at least mitigate, another lacklustre response in the future.

The first is that introducing more market mechanisms in the NHS would not mean that patients were denied care – you can have universal healthcare in a social insurance model too. And the second is that having more private hospitals does not necessarily lead to fewer hospital beds, but a better allocation of skills and resources. Indeed, it allowed Germany to scale up its ICU capacity, as well as keeping services such as cancer treatments and screenings open in different locations.

The centralised nature of NHS does not allow for any part of the chain to fail. Unfortunately, failure is in our nature and less centralised systems are therefore necessary in order to achieve resilience and adaptability in times of urgent need.

We should make the UK fit for the next nasty virus by decentralising testing and allowing for more private sector involvement in our healthcare system. It’s high time we faced the facts about the NHS and stopped ignoring success stories from around the world.

Originally published here.


The Consumer Choice Center is the consumer advocacy group supporting lifestyle freedom, innovation, privacy, science, and consumer choice. The main policy areas we focus on are digital, mobility, lifestyle & consumer goods, and health & science.

The CCC represents consumers in over 100 countries across the globe. We closely monitor regulatory trends in Ottawa, Washington, Brussels, Geneva and other hotspots of regulation and inform and activate consumers to fight for #ConsumerChoice. Learn more at consumerchoicecenter.org

What the NHS can learn from Germany’s Hospital System

Post-Coronavirus, the UK should not shy away from debate over the NHS, and how to achieve better patient outcomes, argues Fred Roeder

When contrasting how countries around the world are coping with COVID-19, over the past few weeks one country has stood out. Germany’s health system has received regular praise for its resilience in facing the COVID-19 pandemic, but what are they doing right?

Germany is one of the most affected countries in Europe but the mortality rates are significantly lower than in most other European countries dealing with the coronavirus. Germany’s capacity to test widely and early has definitely contributed to this but an often underappreciated factor is its very competitive, modern, and often private hospital system.

While the UK currently has fewer confirmed COVID-19 cases, this is probably due to the lack of testing capacities of the NHS, the more interesting and shocking number is that the death rate per 1 million people is four times higher in the United Kingdom compared to Germany. Germany’s mainly private and decentralized testing infrastructure happens mostly outside of hospitals, in private laboratories, and has enabled Germany to conduct as many as 150,000 tests per week. To put that in comparison, the UK has managed less than 10,000 a day so far.

Being the relative of an NHS patient, I had to assist her to go through its byzantine and centralized testing regime, even for simple blood samples. GPs send patients to hospitals just to get their blood taken and analysed. Scaling up such a centralized testing system allows no mistakes to be made. A decentralized and independent system however allows for some parts in the chain to fail and the other still to perform, and crucially allows room for innovation.

Merely 28% of the roughly 1,950 hospitals that participate in Germany’s universal health system are owned by the government. 37% are private for profit hospitals that treat patients covered by the public health insurances and receive the same amount of reimbursement per case as the public ones or the 34% that are operated by churches and other charities. Despite charging the same as government hospitals private for-profit hospitals have the highest investment per case (about 64% higher than public hospitals), which leads to more state-of-the-art treatment and newer medical equipment.

It is also very interesting to look at how private hospitals perform better compared to government hospitals in Germany. Within the first four years one can observe an increase in efficiency of between 3.2% and 5.4% above those hospitals that had not been privatised. Despite its mainly private character Germany has nearly three times as many beds per 100,000 people compared to the UK. It gets even worse when looking at intensive care beds per 100,000. Germany has over 4 times the intensive care capacity compared to the NHS. In recent weeks Germany added another 40% additional capacity to its already high intensive care beds. This number is not reflected in the comparison.

Given that we are currently facing a massive pandemic it is shocking to see how poorly prepared the centralized NHS was, from a lack of protective equipment for clinicians, to its failure to prepare for mass testing. While the hard work of individuals within the health service has done what seemed impossible only weeks ago, and has prepared the NHS to cope with coronavirus, structural issues remain.

A pluralistic hospital system that endorses competition and patient choice such as the German one seems to be in a much better position to cope with potentially tens of thousands of severe COVID-19 cases.

Yes, also in this comparatively better German hospital system patients die and doctors contract COVID-19. Healthcare workers in Germany are also overwhelmed with the amount of cases and patients. But overall it looks like Germany can endure and face this wave in a much more prepared and resilient fashion compared to the NHS which is still facing huge problems mastering this mammoth task.

After we are all through with this we should not shy away from a debate if it’s not time to open up bigger parts of the NHS hospital systems, allow competition and make the health of British patients a priority.

Originally published here.


The Consumer Choice Center is the consumer advocacy group supporting lifestyle freedom, innovation, privacy, science, and consumer choice. The main policy areas we focus on are digital, mobility, lifestyle & consumer goods, and health & science.

The CCC represents consumers in over 100 countries across the globe. We closely monitor regulatory trends in Ottawa, Washington, Brussels, Geneva and other hotspots of regulation and inform and activate consumers to fight for #ConsumerChoice. Learn more at consumerchoicecenter.org

Testing – not lockdowns – may explain why some countries handle Covid-19 better

This is a post by a Guest Author
Disclaimer: The author’s views are entirely his or her own, and don’t necessarily reflect the opinions of the Consumer Choice Center.


There are ongoing debates about who has been better handling the Covid-19 pandemic: testing or lockdown?

Covid-19

With so many people confined to their homes, passions are running high, and there are ongoing debates about who has been better handling the Covid-19 pandemic. So much so that it feels like comparing and contrasting countries and their trajectories has become sort of a global pastime.

Nearly all developed countries (and others) have put their populations under severe lockdowns and emphasized social distancing as the silver bullet against the spread of the virus. Sweden, however, has recently been castigated for failing to put its population under a lockdown like every other country, especially other Nordic countries which it is compared and contrasted against. 

The problem is that it is quite hard to compare the performance of two randomly selected countries. For instance, on every level Norway seems to be doing much better than Sweden. That said, one can always find a bunch of other countries that are doing much worse despite having been under lockdown for some time.

It should be noted that Sweden has made some questionable decisions, regardless of social distancing. It failed to ramp up testing with increasing cases around March 20, and it only closed its nursing homes for visits in early April.

But aren’t lockdowns clearly working? 

Many people have still argued that lockdowns are clearly working because the epidemic has slowed shortly after their imposition. However, it is important that we are careful when inferring that lockdowns were responsible for the decline. There may be a correlation between the two, but as everyone should know, correlation does not necessarily mean causation, and there may be other intervening variables. It is vital that we not jump to conclusions too fast. While many people believe, and many epidemiological models assume, that unchecked epidemics just grow exponentially until more than half of the population gets infected, the evidence for Covid-19 increasingly suggests otherwise. 

Several research papers (e.g. here and here) argued that the dynamics of the Covid-19 pandemic are well-described by exponential functions only at the early stage, after which so-called power-law functions are a much better fit. A detailed study of the outbreak in the initially hit communes in Lombardy also suggests that in each commune, it started slowly, then briefly became exponential and then slowed, all that before any significant intervention.

To help you better understand what the mathematical jargon above means and why it is so important, consider two simple functions, y=2x and y=x2. The first function is exponential and the second function is a power-law one. You will better see the crucial difference between them if they are plotted together.

If these functions were describing an epidemic, then the x-axis would mean rounds of transmission. In the beginning there is one infected person in both cases. Then, until the fifth round the functions seem to grow in at an almost similar speed but afterwards, they diverge dramatically.

When researchers talk about an epidemic growing first exponentially and then in accordance with a power law, they mean that the growth of the epidemic looks like the hybrid function (first, y=2x and y=x2 after round 5) below. Its growth clearly slows a lot after the fifth round.

Why could an epidemic grow exponentially, first, and then slow down on its own? Here, it is important to remember that real societies are complex. Instead of interacting with random people every now and then, people tend to form groups (or clusters, in scientific terminology) and live in local areas within which interactions are much more intense than outside of them. With obvious implications for infection transmission.

What probably changes at the early stage of the epidemic is that so-called superspreader events are much likelier. Such events, where single infected people spread the virus to scores, hundreds or even thousands of people, have clearly played an enormous role in Covid-19. It is enough to mention the Shincheonji Church of Jesus in South Korea, the tragic gathering of French catholics in Mulhouse and the first coronavirus-hit hospitals in Lombardy. At these events, infected people have an opportunity to spread the virus way beyond their clusters of interactions.

After the initial stage, when everyone becomes aware that the epidemic is in the community and significant events are cancelled, the infection may get increasingly isolated within clusters, first, grow slower and then start falling off. The available data is increasingly hinting at this process in play. In Italy, cases appear to have peaked on the day the national lockdown was announced. In the US, they appear to have peaked on March 20.  

Lockdowns could even be counterproductive

A more speculative but still plausible idea is that lockdowns could, in fact, not merely coincide with the slowing-down of Covid-19 without causing it but actually create more damage than they prevent.

Many people believe that if some social distancing (like closing bars or canceling events) is desirable than extreme social distancing like lockdowns that keeps most people at home most of the time must be even more beneficial. However, this potentially ignores two important facts about Covid-19 and viral diseases in general.

First, it is abundantly clear that Covid-19 overwhelmingly spreads in closed, often poorly ventilated spaces and through close contacts. Secondly, as Robin Hanson convincingly argued, there is a wealth of evidence that the severity of viral disease depends on the viral dose received. This means that if families are forced to stay at home together all the time, this may create perfect conditions for the virus to spread and especially cause severe disease.

The data from Google about actual social distancing patterns in several countries hit by Covid-19 shows that Italy, Spain and France have had by far the most extreme social distancing, and the UK was starting to catch up with them after its lockdown. Yet, these four countries have some of the highest fatality rates in the world per population and detected cases.    

Could testing explain things better?

A better way to try to make sense of the causation is to try to identify a bunch of countries that have something important in common. The most important thing in any epidemic is to minimize deaths, and there is a group of countries that seem to have far fewer deaths by population size, and per identified infections, than others. These countries include Iceland, Germany, South Korea, Taiwan, Austria, and Norway. You can see how low their case fatality rates are compared to other countries with a lot of cases here (see the “death rates” column).

What makes those countries succeed in driving down deaths? One would actually be surprised to learn that none of these countries is, or was, under total lockdown. South Korea hasn’t even closed bars and restaurants. This shows that extreme social distancing measures are not necessarily the best explanation.

The real answer may largely lie in how many tests those countries have been doing compared to others. Testing may reduce fatality rates by giving public health responders valuable information and helping to isolate and quarantine those that carry the virus before they spread it to vulnerable groups like the elderly.

Iceland is the absolute champion at testing. It has already conducted 28,992 tests, which is more than 8% of its entire population. It also has the world’s lowest case fatality rate from Covid-19 at 0.38%. Iceland isn’t an anomaly, and using Iceland as an example isn’t cherry picking. Researchers Sinha, Sengupta and Ghosal showed that country death rates from Covid-19 are significantly correlated with the intensity of testing. They did not, however, control for the potential impact of lockdowns and other stringent social distancing measures.

Testing and outcomes by region

In addition to national data, one can also look at regional data where it is available and see if the testing/fatality relationship still holds. Italy has been publishing detailed regional statistics on Covid-19 starting from February 24. If we plot tests per confirmed cases in each region with reported fatalities per million inhabitants, we get the following picture:

The chart surprisingly shows us that Italy’s worst hit region isn’t Lombardy, and that it is actually the little-known Aosta Valley. We also see that there is a clear negative relationship between the intensity of testing and fatality rates. In fact, the former seems to explain more than half of the variation in the latter, and the regression coefficient is statistically significant (the p-value is 0.0003).

To conclude, it will take a long time and careful research to sort out why some countries and regions have gone through the Covid-19 pandemic much less damaged than others. That said, one thing seems to be increasingly clear. When the dust settles it will be clear that testing will be a significant factor, and that the importance of social distancing will be diminished. 

Guest Author: Daniil Gorbatenko


The Consumer Choice Center is the consumer advocacy group supporting lifestyle freedom, innovation, privacy, science, and consumer choice. The main policy areas we focus on are digital, mobility, lifestyle & consumer goods, and health & science.

The CCC represents consumers in over 100 countries across the globe. We closely monitor regulatory trends in Ottawa, Washington, Brussels, Geneva and other hotspots of regulation and inform and activate consumers to fight for #ConsumerChoice. Learn more at consumerchoicecenter.org

Il Sistema Lombardo Funziona

Nelle ultime settimane la gestione dell’emergenza in Lombardia è stata oggetto di grande dibattito. Le critiche maggiori sono state rivolte al sistema sanitario regionale. Gli aspetti problematici potrebbero, però, risiedere altrove e le cause di una gestione non ottimale andrebbero ricercate più a fondo.


PERCHÈ È IMPORTANTE?   Una polemica oramai quotidiana riguarda il ruolo della sanità privata, soprattutto in Lombardia, e di come il sistema di cooperazione tra strutture pubbliche e private avrebbe fallito. Proviamo a capire se veramente è il sistema sanitario lombardo a non aver funzionato oppure qualcosa d’altro.

LA RIFORMA   La sanità privata è figlia di una riforma voluta dall’allora maggioranza di centrodestra guidata dal Presidente Roberto Formigoni, che pose erogatori privati e pubblici sullo stesso piano, purché il sistema rimanesse universale (tutti i cittadini hanno accesso alle cure nello stesso modo) e solidale (le prestazioni sono pagate dalla fiscalità generale e non direttamente dal singolo paziente).

Per il paziente nulla cambia, ci si può rivolgere agli ospedali pubblici o privati senza distinzione. Al contrario, secondo i dati ANGES – Regione Lombardia del 2018, gli ospedali lombardi sono parimenti nei primi 10 ospedali italiani, come per esempio il San Raffaele di Milano, il San Matteo di Pavia, l’Istituto dei Tumori di Milano e il Papa Giovanni XXIII di Bergamo.

INVESTIMENTI E RICERCA   Inoltre andrebbe considerato che questa competizione tra pubblico e privato ha fatto sì che la spesa sanitaria privata e pubblica dedicata alla ricerca e alla cura della persona crescesse di quasi il 28% annuo (dati UniBocconi), creando centri di eccellenza riconosciuti in tutto il mondo, sia privati sia pubblici, come ad esempio gli Spedali Civili di Brescia, il Gruppo San Donato, Humanitas e tanti altri.

Questo è un tempo di emergenza, come dimostrano le parole di medici ed operatori sanitari che parlano di una vera e propria guerra, guerra nella quale combattono a nostra difesa sia operatori privati sia operatori pubblici.

Gli operatori privati si sono impegnati a mettere a disposizione il proprio personale sanitario nelle strutture pubbliche, nonché le loro stesse strutture. Regione Lombardia ha riorganizzato la rete ospedaliera creando hub specializzati divisi per patologia e prestazione sanitaria, al fine di liberare posti per pazienti COVID-19.

IL PRIVATO FUNZIONA?   Se tutto questo è stato possibile lo si deve anche alla capacità della sanità privata di riorganizzarsi in tempi brevissimi per poter ospitare il maggior numero di pazienti provenienti dalle strutture pubbliche sommerse dall’ondata di pazienti affetti da Coronavirus, spesso fatto senza attingere a risorse pubbliche, come dimostra il nuovo reparto di terapia intensiva realizzato con donazioni private al San Raffaele di Milano. Ovviamente, la sanità privata è in prima linea anche nella gestione diretta di pazienti COVID lombardi, con circa il 30% di quest’ultimi ospitato presso strutture private.

COME LA COREA DEL SUD   Se il sistema è andato in tilt non è per colpa della competizione pubblico privato, la quale ha fatto sì che i lombardi potessero ancora usufruire di cure ospedaliere di qualità, grazie alla maggiore flessibilità della quale l’erogatore privato è portatore. Ad ulteriore prova dell’assoluta bontà dell’apporto privato nella gestione della crisi dovuta al Coronavirus, andrebbe ricordato che il sistema sud-coreano, portato da molti come modello, è costituto per la grande parte da operatori sanitari privati, e dove la ripartizione della spesa sanitaria tra pubblico e privato è quasi paritetica.

Purtroppo, restano le migliaia di morti e quindi la necessità di porsi una domanda: perché la politica lombarda non ha attuato una strategia di contenimento e di prevenzione come quella veneta, fondata su un intervento di test preventivi, che è risultata più efficace? Se finora non lo si è attuato, perché, alla luce degli evidenti risultati, ora non si procede in questa direzione?


The Consumer Choice Center is the consumer advocacy group supporting lifestyle freedom, innovation, privacy, science, and consumer choice. The main policy areas we focus on are digital, mobility, lifestyle & consumer goods, and health & science.

The CCC represents consumers in over 100 countries across the globe. We closely monitor regulatory trends in Ottawa, Washington, Brussels, Geneva and other hotspots of regulation and inform and activate consumers to fight for #ConsumerChoice. Learn more at consumerchoicecenter.org

What we should be thankful for: A CORONA SELF HELP GUIDE

The last couple of weeks were probably some of the strangest times in most of our lives. Only few of us have seen such a massive restriction of travel and social life prior to the coronavirus. Even as an aviation geek and frequent traveler, the grounding of entire fleets of planes is something I haven’t even seen in the aftermath of 9/11.

Physical business meetings, conferences, or sports events seem to be off for at least the next six to eight weeks. It is probably only a matter of time until most countries close down gyms and pubs. This will not only be a challenge for the economy but also for our social lives. Keeping up morale and mental health will be important and I figured out that regular but very casual video chats with friends and colleagues (over a drink) can help a lot to ease the anxieties built up by media hysteria and the feeling of not being in control of the situation (helplessness).

So while we are all trying to adjust to a new reality for the next 6-10 weeks there are also reasons why I am very happy that this crisis happens in 2020 and not in 2000. There are many innovations that happened in this new millennium we should be extremely thankful for.

First and foremost we should of course be thankful for all the nurses and doctors helping patients at the frontlines of the outbreak. This will be some challenging months for all healthcare professionals and they should receive all necessary support.

And before diving into medical innovation and the search for a vaccine let’s look who else is helping us to social distance, self-isolate, and flatten the curve.

Remote working tools such as Zoom, Asana, or Google Suite have already revolutionized the workplace. Most meetings can be switched to a video call. So at least the knowledge economy or advocacy jobs such ours can still keep being productive. But obviously there’s also life beyond work and that needs to be taken care of (including child care).

Thanks to grocery delivery services such AmazonFresh and Ocado I was able to build up a good amount of supplies of canned and dried foods and bathroom supplies even without having to fight for the last products in some nearly empty supermarkets. For the next few weeks we have regular deliveries of fresh foods so I won’t run fully on Mac n Cheese until corona is defeated. 

Food delivery services make it even easier to work from home, still create value, and being fed by Papa John’s, Nando’s, or our local Indian restaurant. Domino’s Pizza went even further and just sent me an email announcing ‘Contact Free Delivery’ in the UK and Ireland:

“By introducing Contact Free Delivery, we believe that we will give our customers peace of mind when ordering a Domino’s, while also protecting our delivery drivers.

You can select a Contact Free Delivery at the checkout on our app or website when placing your order. Your driver will call you when they arrive to agree where you want your food left. Once the order has been placed in the agreed location, the driver will stay at least two meters away while you collect your order.  To ensure the service is truly contact free, all Contact Free Delivery orders must be pre-paid online or over the phone.”

Having taken care of all the pizza and toilet paper I need for the foreseeable future it is now time to look at what entertainment needs will be important. Netflix and Amazon stream directly into my living and as my colleague Maria pointed out “It’s a plague with WiFi”. So no need to go to the defunct video rental store but be excited to stream all seasons of Buffy (and if this goes longer than expected even Angel) directly into your home.

My gym just emailed me that they had a case of COVID-19 and they are currently shut down for deep cleaning. Good that Kelli and Daniel of Fitness Blender have over 500 free workout videos on YouTube. Get your Yoga Mats out!

But there’s only so much of Buffy and HIIT you can take a day. Fortunately video games (which I haven’t paid attention to for a long time) are now mainly also being streamed or downloaded. My social media friends recommended me Red Dead Redemption 2, The Witcher 3, and Europa Universalis IV (probably too complicated for me). So I think we are all set here as well!

Now to one of the greatest inventions of the past decades: Online pharmacies! Coming from Germany and having worked in health policy I am always puzzled how much vested interest fights against online pharmacies and e-prescriptions. In times of self-isolation and social distancing these two words sound like music to my ears. 

I was able to reorder and stock up all sorts of prescription only drugs such as asthma medicine, proton pump inhibitors, and antibiotics without even leaving my flat – and all of this LEGALLY (disclaimer: I do have asthma)! You just have an online consultation with a doctor or take a quiz and receive an electronic prescription. This is definitely a massive relief on the already challenged health system as patients don’t flood clinics just to ask for prescriptions and pharmacists can focus on producing more sanitizers.

Most of these above mentioned services and companies did not even exist two decades ago. Thanks to innovation and competition entrepreneurs carved out these new ways of servicing customers. This is amazing and while it might have been a mere gimmick some weeks ago, everything from videoconferencing to electronic prescriptions makes this crisis much more manageable. We should be thankful for that!

Obviously there are vulnerable groups and many people will suffer heavily from the virus. That’s why we need more innovation. There’s already a race to the first vaccine and other pharmaceutical companies are working on repurposing antivirals that are being used for instance in fighting the Ebola Virus. Some studies suggest that certain Malaria medication might be helpful to boost the immune system of severely sick corona patients. These are often recently discovered drugs that require a lot of time and capital to be developed. 

We should be thankful for innovation in medicine and acknowledge that these breakthroughs are only possible thanks to keen researchers and a risky appetite for innovation shown by the private sector. This is why we at the Consumer Choice Center keep fighting (from our laptops) for choice, innovation, and evidence-based policy making. We will benefit in the next crisis from it (a child care robot included)!


The Consumer Choice Center is the consumer advocacy group supporting lifestyle freedom, innovation, privacy, science, and consumer choice. The main policy areas we focus on are digital, mobility, lifestyle & consumer goods, and health & science.

The CCC represents consumers in over 100 countries across the globe. We closely monitor regulatory trends in Ottawa, Washington, Brussels, Geneva and other hotspots of regulation and inform and activate consumers to fight for #ConsumerChoice. Learn more at consumerchoicecenter.org

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