Why do we need a pan-European PrEP campaign?
The PrEP in Europe Initiative was set up to fill a gap in campaigning and policy around HIV pre-exposure prophylaxis (PrEP) in Europe.
There are many reasons PrEP has been adopted much more slowly in Europe than the US. The four-year gap between approval by the US Food and Drug Administration (FDA) in 2012 and its European equivalent, the European Medicines Agency (EMA) in 2016, was one of them.
But, as France showed, EMA approval was not necessary for a country to start a PrEP programme. France approved PrEP in late 2015.
Additional reasons Europe was slower than the US to adopt PrEP:
- Centralised/reimbursable healthcare systems. The US healthcare system is a patchwork of private health insurance and employer schemes, bolstered by state and federal programmes for the elderly and disabled. Individual insurance companies, in consultation with healthcare providers, could therefore decide to pay (or not) for PrEP, at least for the ‘first wave’ of well-insured PrEP seekers. Gilead Sciences, the manufacturer of Truvada, also provides supplemental support for those without adequate health coverage.
In Europe, with its free-on-demand or full-reimbursement healthcare systems, PrEP provision has had to be agreed at health-ministry level from the start. It is therefore more vulnerable to national budget constraints, and to political opinion.
PrEP in Europe will provide information and news about policy decisions and debates on PrEP throughout Europe, for the benefit of advocates dealing with healthcare systems.
- Because PrEP would be directly funded by taxpayers from the start, the issue of its cost and cost-effectiveness was also central to discussions of whether to provide it from the start. Politicians worry that the public would not agree to pay for a more expensive method of preventing a sexually transmitted infection (STI) affecting a quite small number of people, when cheaper prevention methods were available.
PrEP in Europe will provide a guide to the findings of cost-effectiveness studies of PrEP and chart negotiations towards the provision of cheaper generic drugs.
- Complex and devolved public health systems. There are at least as many different healthcare systems in Europe as there are countries. In many countries, different bodies run different sorts of health care – emergency care, specialist care, primary care. PrEP is an administrative challenge; it means providing a medicine for public health that had previously been provided for a specialist medical condition.
Public health deals with everything from smoking cessation to nutrition advice, and in many European countries is the responsibility of regional or local authorities, not the healthcare system.
PrEP in Europe will provide a discussion space and a guide to the complexity of different public healthcare systems and encourage dialogue on how to navigate them on a policy level.