SWEDEN URGES THE EU-US SUMMIT NOTE COOPERATION ON

UNCLAS SECTION 01 OF 03 STOCKHOLM 000604

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TAGS: PHUM PGOV EU SENV PGOV PREL SW
SUBJECT: SWEDEN URGES THE EU-US SUMMIT NOTE COOPERATION ON
ANTI-MICROBIAL RESISTANCE AND E-HEALTH

REF: (A) 9-14-09 Memorandum from the Swedish Presidency of the
European Union on Antimicrobial Resistance


1. (U) Summary: Sweden's Minister of Health has urged the U.S. to
support Sweden's efforts to have the Leaders Declaration from the
US-EU Summit state that the US and EU will work together against the
silent pandemic of antibiotic/antimicrobial resistance, especially
on providing needed incentives for the pharmaceutical industry to
develop new antibiotics. The Minister would also like to see the
Summit note the importance of US-EU cooperation on e-Health. End
Summary.

Summit Should Note US-EU Efforts on Antibiotic Resistance
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2. (U) Minister of Health Goran Hagglund asked to meet the
Ambassador to discuss a possible deliverable for the US-EU Summit on
antibiotic/antimicrobial resistance and e-health. He requested U.S.
support to have the Leaders' Declaration from the November 2009
US-EU Summit note the importance of combating antibiotic resistance,
and that the US and EU would work together against this threat.
Although the Leaders would not discuss the issue at the Summit,
Hagglund said their noting it would provide much needed political
leadership.

What the US and EU Could Do on Antibiotic Resistance
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3. (U) Hagglund said a first step in tackling antibiotic resistance
would be formation of a US-EU Task Force. Pressed by the Ambassador
to identify what the Task Force would accomplish, Hagglund said it
would be given a precise mandate and short time frame to produce
results, such as within six months, i.e. before the next US-EU
Summit. Hagglund agreed with the Ambassador's suggestion to
concretely identify what measures needed to be done at the US-EU
level. He said the Task Force could work from a report commissioned
by the Swedish EU Presidency highlighting possibilities for
government incentives for the pharmaceutical industry to develop new
antibiotics. He suggested the Task Force identify which of the nine
possibilities in the report could be useful tools, recognizing that
appropriate tools for the US and Europe may differ. The report was
prepared by Professor Elias Mossialos of the London School of
Economics, and presented at a September 16-17 experts' conference
hosted by the Swedish Presidency in Stockholm.


4. (U) Hagglund explained that funding to develop new antibiotics
was a secondary problem to the need for "mechanisms," including
regulatory muscle, to get pharmaceutical companies to focus on
antibiotics given the lack of profit in developing antibiotics.


5. (U) Hagglund cited the importance of raising public awareness,
but noted the need for solutions. He said he would ask experts about
low hanging fruit on antibiotic resistance that the US and EU could
harvest in the near term, but noted the need for a long-term
commitment to ensure a solution to the problem.


6. (U) Hagglund noted that the US and Sweden are both working on
antibiotic resistance and doing research, but were not seeing the
research result in new medicines over the next few years. Because
the US and Europe face the same problem, he said, this is a good
opportunity to work together to apply resources in a way that
reduces costs and maximizes outcomes. As an example, he praised the
recent U.S. commitment to set aside resources to combat pandemic
flu. He noted that antibiotic resistance is a silent pandemic,
especially in developing countries. Because resistant bacteria
spread between countries, Hagglund noted that this is a global
problem, not one that can be solved by countries acting alone.


7. (U) The Minister said the recent experts' conference gave him
confidence that a Task force could quickly come up with a way
forward. He was pleased that "some of the most important experts"
turned out for the conference, as did U.S. officials. The
Minister's press secretary Petra Kjellarsson said the conference
elicited an "extreme response" from the experts who thanked Sweden
for hosting it and urged them to take the issue to the US, EU member
states and other governments.


8. (U) Hagglund said most of the conference discussions were based
on the Mossialos report, and a paper on what would happen over the
next few years if we do almost nothing to develop new antibiotic
drugs.


9. Comment: To help clarify what a US-EU Task Force might
accomplish over six months, a Stockholm-based official from the U.S.

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Centers for Disease Control and Prevention (CDC) notes that such a
Task Force could establish mechanisms for determining which
strategies, among the many proposed in the EU and US, are most
likely to be effective and consistent with current law or require
new legislation. Given the global presence of pharmaceutical
companies, the Task Force could determine which mechanisms have a
likelihood of being introduced in parallel in the US and EU. Other
activities that could be accomplished by the next Summit in the area
of antibiotic resistance include work already underway between the
CDC and its European counterpart (ECDC) for a joint campaign in the
fall of 2009 encouraging appropriate use of antibiotics with a joint
"antibiotic awareness day." Preventing antimicrobial resistance in
health care settings will be a focus of the next two EU Presidencies
in the area of health. The US and EU could possibly formalize
collaborations on infection control and surveillance for antibiotic
resistance in health care settings, a topic that has been mentioned
by U.S. Secretary for Health and Human Services Sebelius in her
discussions of patient safety in the context of health care reform.
End Comment

Antibiotic Resistance is the Silent Pandemic
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10. (U) Hagglund noted that in the European Union (EU) about 25,000
people die every year from antibiotic resistance, while in the U.S.
the number is 63,000. He compared this to deaths due to road
accidents of 40-45,000 a year each for the US and EU. He said the
cost, both in economic terms and human lives, would be extremely
high if we do nothing.


11. (U) Hagglund said the problem of antibiotic resistance had
three pillars: (1) preventing inappropriate prescribing and use of
antibiotics; (2) ensuring use of effective infection control methods
by health care facilities to prevent the spread; and (3) how we can
provide needed support in the current situation where there are no
new antibiotic drugs coming.

Need for Incentives to Develop Antibiotics
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12. (U) He said we know what to do about the first two pillars, the
third is the challenge. Although there was considerable research,
Hagglund said there were no new drugs coming in the next few years.
He explained that the pharmaceutical industry is putting money into
areas where it can achieve substantially higher profits, such as
long-term treatments rather than antibiotics that are used for one
week or so. Fredrik Lennartsson, Director of the Division for EU
Coordination and International Affairs reiterated that economic
incentives for the industry are not strong enough for antibiotics,
which are designed to be used for short periods of time.

Following Up with USEU
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13. (U) Hagglund explained how Sweden has been working on a
national level and with past and future EU Presidencies, including
Czech Republic, France, and Slovenia, to put antibiotic resistance
at the top of the EU agenda. He said they would be continuing their
discussions with USEU to get antibiotic resistance item noted at the
US-EU Summit.

Standardization in E-Health as a Summit Deliverable
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14. (U) Hagglund said antibiotic resistance could be handled better
if the health care sector had information technology (IT) solutions
in place. He explained how Sweden was working with the Czech
Republic, France, Sweden, Spain United Kingdom and Netherlands. A
report based on IT efforts in those countries noted that progress in
using IT for health care would save 9 million hospital beds. He
also discussed Sweden's efforts as the coordinator of a pilot
project involving electronic records in 12 EU countries.


15. (U) The Ambassador noted that Sweden is a world leader in the
use of IT health care. Hagglund acknowledged that although Sweden
uses electronic patient records for 100 percent of primary care and
95 percent of hospital care, it still has problems with systems that
are not interoperable. Hagglund stressed the importance of
standardization, and working with the United States. He said Sweden
has worked with the IT Coordinator for the U.S. Department of Health
and Human Services, Charles Friedman. Hagglund stressed the need
for US EU cooperation to compare outcomes in order to develop
quality in e-Health. He said he would be speaking on e-Health at a
November 18-19 EU conference on information technology to which U.S.

STOCKHOLM 00000604 003 OF 003


officials had been invited.


16. (U) The Ambassador noted U.S. challenges regarding e-Health,
such as different insurance schemes in each of the 50 states, and
the fast that most doctors work as small businesses so they view
e-Health as an unfunded mandate. He noted the need to make e-Health
profitable.

Comment
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17. (U) During the July 3, 2009 consultations with Assistant
Secretary for European Affairs Phil Gordon on possible Summit
deliverables, Foreign Ministry State Secretary Bjorn Lyrvall said
the Swedish Presidency would look to have antibiotic resistance and
e-Health mentioned by the Leaders at the Summit. Minister Hagglund
invited U.S. Secretary of Health and Human Services Sebelius to an
informal meeting of EU Health Ministers in July 2009 to discuss
anti-biotic/anti-microbial resistance and e-Health, but she was
unable to attend. Hagglund used his meeting with the Ambassador to
further define what the Swedish Presidency would like Leaders to
note at the Summit. His view of a deliverable on antibiotic
resistance was more focused than ideas Sweden presented in a paper
to USEU last week (REF A). This more narrow focus seems to reflect
feedback received from USEU and other USG officials. End comment.

Participants:
Gran Hdgglund; Minister for Health and Social Affairs
Karin Johansson, State Secretary (very knowledgeable about the
eHealth issue, came to the Ministry from Microsoft)
Petra Kjellarsson, Press secretary to the Minister
Anna Hedin, Deputy Director of the Division for EU coordination and
International affairs
Fredrik Moen, Counselor, Public Health, Permanent Representation of
Sweden to the EU

Ambassador Matthew Barzun
Deputy Chief of Mission Robert Silverman
Economic Counselor Laura Kirkconnell
Commercial Counselor Frank Carrico

BARZUN