Dr. Vytenis Andriukaitis:

These five topics could take five hours to answer but I only have a few minutes. First, I will address the question about the harmonisation of basics around the EU. The Lisbon treaty was very clear on subsidiarity, that it was up to member states to decide on their health care and on the basic standards to be covered by national health care systems. We do however have the cross-border health care directive and the European Court of Justice decision in the case of Kohll v.Luxemburg. This was a very important decision on cross-border health care that ruled that the rights of patients to access treatment in different countries must be respected. This helped us to start the cross-border health care directive.

The directive in turn raises questions as to how to reimburse services from one country to another. If patients are going from Ireland to Lithuania this means that there must be a reimbursement agreement between the two countries. Such principles of the reimbursement of basics are enshrined in the health care directive. When we ask countries to dedicate some public money guaranteeing payments for patients going from one country to another, they must be ready to guarantee financial coverage of their costs.

We have a very good example of cross-border health care directive co-operation between France and Belgium, which decided to adopt some areas in which cross-border health care is achievable. They provide ID numbers to people in particular cities along the border in France who then have free access to go to the other side in Belgium and have medical treatment and services there. This is then automatically entered into accounts for the national reimbursement system which are then calculated between France and Belgium without involving the patients. This is a brilliant example of how IT tools such as electronic identification and signatures can be used in an absolutely secure manner to guarantee access to treatment. This means that the countries involved have to discuss a lot of reimbursement compositions and issues and technically speaking this is very time-consuming. They have done it however, and from 40 km either side of the border people are taking the opportunity to use each other's facilities. This means that, step by step, we are moving closer and closer on some basics and on possibilities to understand different financial mechanisms which will provide some instruments to help us guarantee access to modern treatment.

A further issue concerns the European reference network. If I am here in Dublin and have a very rare disease - there are now 6,000 diseases on our list - I have the possibility of being treated in Warsaw in Poland. This means that we need common treatment technologies which will be acceptable to medical doctors and medical societies. We then have to consider how we can guarantee payment from both sides. As we move forward, step by step, we will see possibilities to destroy the silo mentality in every country and in this way achieve more and more in practical ways.

The third question concerned cross-border health care threats. It means pandemics and vaccines and, of course, possibilities to buy vaccines together and to harmonise countries' vaccination calendars. Again, it means money. Today there are more than 30 million people working in different countries with their families, which is very challenging. For young families moving from Italy to Poland, for example, they have one vaccination calendar in Italy and another in Poland and their children fall in between. We ask member states, say, France, to realise in practice how they can harmonise vaccination calendars so as to keep children vaccinated. They are not citizens in the countries in question, but they are living there with their parents and need to be covered by vaccines. I again ask Ministers of the member states to discuss vaccination calendars and how to move forward to avoid such silo mentalities. In the Single Market we have common goods, common movement and a lot of infectious diseases. If we are not ready to understand we are obliged to address these issues from Lisbon to Helsinki, it will be a disaster. There are 4,000 cases of measles in Romania, for example. There are also cases in Spain because the movement of people is very intensive; it is not like what it was 20 years ago when the Schengen agreement was not in place. We need to change the silo mentality and step by step see more harmonisation. This is not because it is legally binding but because of the reality in which we will address these issues together.

I will ask my team to say something about the position on animal health because they are very much involved in dealing with the matter. The director of our food and veterinary department is Ms Paola Colombo.