A Decade Defining Moment for Health

by H/Advisors Cicero

Health has moved to the very top of the European Commission’s agenda and to the epicentre of policymaking over the last three years, as the COVID-19 pandemic laid bare the urgent imperative to build a resilient and strong European Health Union.

We have seen the strengthening of agencies (ECDC, EMA), the creation of a new authority (HERA), and a range of new actions and goals for digital transformation and global health security. However, with medicines accounting for roughly one-fifth of Europe’s health spend, the major channel through which the EU shapes health systems is invariably via pharmaceutical legislation. The Commission’s November 2020 Pharmaceutical Strategy is a response not only to internal market issues, but also to global competition pressure in the sector.

A key pillar of the Strategy – the highly anticipated legislative proposals overhauling the EU’s pharmaceutical legislation – is finally expected to be published in March. The Commission says it is trying to balance a range of interests: equitable access for patients to therapies and cures, the success and
competitiveness of industry, the sustainability of national health systems and incentives that encourage research into AMR.

Industry is hoping that the revision of the decades-old legislation will seek to fix long-standing problems, create a first-class, 21stcentury regulatory framework that will help reduce regulatory burden, speed up access and ensure Europe is a globally competitive region for medical innovation. Patient advocates are hopeful the legislation will help bring down prices by allowing greater competition across the bloc and by introducing more transparency to the cost of medicines.

Once published, the stage is set for at least two years of very intensive discussions between the institutions and stakeholders. With high aims, high stakes, strong competing positions, and a European populace more engaged in health than ever before, this re-evaluation of many of the basic concepts of pharmaceutical law will have widely felt economic and social consequences.

For more information please contact aideen.ginnell@h-advisors.global

With a General Election expected in 2024, politics has never felt so tumultuous. With Keir Starmer’s Labour Party 20 points ahead in the polls, the next election seems like a foregone conclusion – or does it? Could the ‘comeback kid’ Rishi Sunak defy all polls and lead the Conservative Party to an unexpected victory? His recent departmental reshuffle shows he’s serious about policy delivery but will it work?

Cicero’s Associate Directors, Alice Perry and Sonia Khan explore the state of the current Labour and Conservative parties, how this reflects on their chances for electoral victory and what it will mean for business.

For more information please contact alice.perry@h-advisors.global or sonia.khan@h-advisors.global

It was just last month that Nicola Sturgeon told Laura Kuenssberg she had “plenty left in the tank” and was “nowhere near” ready to quit as Scotland’s First Minister. Her announcement this morning was a genuine surprise that almost nobody saw coming – at least not yet. Yes, it is true that Sturgeon has been having an unusually tough time politically of late – and also true that over the past 12 months ‘life after Sturgeon’ has come to be a more frequent topic of conversation among the Scottish commentariat. Nevertheless, the abrupt nature of this announcement has caught everyone off guard.

Although leader of Scotland, Sturgeon has been a figure of real UK-wide significance throughout her 8+ year tenure as First Minister. She was the first SNP leader to take part in a UK General Election leaders debates in 2015 and has been a fixture on the UK political stage ever since. She has led her party through three Westminster elections and two Holyrood elections, remaining comfortably the largest party in each contest. Even as her personal and party poll ratings have taken a small hit recently; the SNP remains the dominant force in Scottish politics by a distance. And as long as the SNP remain the dominant force in Scottish politics, there will always be question marks over the stability of the Union and the prospects for another referendum on secession.

So, what does Sturgeon’s departure mean for the future of Scottish and UK politics?

The first thing to say is that the SNP will not find it easy to find another leader with Nicola Sturgeon’s political experience, skill and profile. When she herself took office as First Minister, it was after a 10-year spell as Deputy Leader to Alex Salmond, in which a clear succession plan had been in place. There is no such obvious successor right now, and recent polling shows the public in Scotland overwhelmingly “don’t know” who should be the next SNP leader. The party has become increasingly fractious, with the debate over the Gender Recognition Reform Bill proving particularly contentious. There are also real differences of opinion over the correct strategy for pursuing independence and whether the next UK General Election should be a “de facto referendum” on the matter. All of this points to a potentially heated leadership contest in which there could be a wide field of candidates and a less unified party emerging.

If the SNP does retreat into a period of introspection and even infighting, this is likely to be good news for their Unionist opponents. Scottish Labour, already rallying under Anas Sarwar’s leadership, will be buoyed by this news and will feel that their prospects in many of their former heartlands in the central belt have been boosted. Douglas Ross and the Scottish Conservatives will likewise sense an opportunity in SNP-Tory battlegrounds, for instance in the North East. It may be time to start engaging seriously with the opposition in Scotland again.

If – and it remains a big if – the SNP do lose significant ground at the next General Election, the opportunity to regain a stronghold in Scotland would be a major help to Keir Starmer’s prospects of becoming Prime Minister. This in turn would put a dent in prospects for another independence referendum, with the SNP deprived of one of their most potent lines of attack – that Scotland must vote for independence to escape permanent Tory rule at Westminster.

Sturgeon’s resignation follows clashes with the UK Government over the Scottish Parliament’s Gender Recognition Reform and its impact on UK-wide equalities legislation, which saw the UK Government invoking Section 35 of the Scotland Act 1998 for the first time. Sturgeon hoped that this unprecedented stance from the UK Government in vetoing devolved legislation was further evidence of Westminster’s disregard for Scotland and would fuel support for independence. However, recent polling by the Sunday Times and YouGov suggests otherwise.

Who are the frontrunners to succeed Sturgeon?

As noted above, there is no single natural successor to the First Minister.

The Finance Secretary, Kate Forbes, has been spoken of as a future leader, but at 32 there will be question marks over her experience levels. She is currently on maternity leave, so the timeline for the leadership election will also be crucial to her prospects as she may be forced to return earlier than planned if she chooses to run.

The former SNP Westminster leader Angus Robertson, now a Cabinet Secretary in the Scottish Government, is another likely candidate who may be seen as having sufficient experience and standing within the party to bring different factions together. Deputy First Minister John Swinney, himself a former leader of the party, could be another ‘safe pair of hands’ option, but he was not a successful leader first time around and that could count against him. Scottish Health Secretary Humza Yousaf has long been mentioned as a party rising star, but difficulties in the NHS may be a significant obstacle to overcome.

Less well-known figures from the newer generation of SNP MSPs such as Mairi McAllan and Neil Gray could also throw their hats into the ring. Wesminster MP Joanna Cherry has previously talked of running but is significantly hampered by not being an MSP and is also out of step with the current leadership on gender recognition reform.

Overall, it is clear that the SNP is entering the most uncertain period in its recent history. That in turn may actually strengthen the political stability of the UK as a whole.

For more information please contact simon.fitzpatrick@h-advisors.global

Jeremy Hunt made much of the difficult decisions he faced in his first proper fiscal event as Chancellor of the Exchequer. Tax rises and spending cuts in equal proportion would, he argued, provide fairness. This is, in reality, an arbitrary choice that seeks to politically balance the calls from those that would prefer spending cuts and those that would prefer tax rises. There is no denying the overriding aim the Government today was to consolidates its fiscal position and reassure markets after the fallout from the previous Chancellor’s disastrous “mini-Budget” mere months ago.

Hunt may not have been Rishi Sunak’s personal choice for Chancellor however the tone struck between the two in recent days suggests that they have taken to heart that the Conservative Party needs to ‘unite or die’. That unity has to last across a supremely economically difficult period if it is to reap any political windfalls. Real household disposable income per person is set to fall 4.3% this year, and 2.3% the year after as inflation remains stubbornly above target. Unemployment is due to increase from 3.6% to 4.9% in 2024. Interest rates will likely continue to rise while the Bank of England seeks to reduce the inflation rate. In the meantime, the Conservatives will say that their policies are seeking to strike a balance between maintenance of public services, while not raising taxes to the point that it chokes off economic growth required to pay for them.

The political choice to introduce two new fiscal rules, that within five years debt has to fall as a proportion of GDP and public sector borrowing must be below 3% of GDP, shows a Chancellor that has his eyes both on restoration of national economic credibility in international capital markets but also political credibility in the eyes of an electorate burned by the short and tumultuous Truss premiership. They also represent an attempt to corner the Labour Party, following their economic playbook and challenging them not to make policy pledges that expand the size of state spending. This trap is extended further by government pledges to support capital projects such as the building of Sizewell C nuclear power station, continuation
of HS2, and Northern Powerhouse Rail, as well as with R&D funding increasing while at the same time keeping development spending below the 0.7%. Taken together these could force the opposition into a debate on spending framed in Tory terms.

Tory backbenchers were muted throughout the Statement, and sombre in hearing the figures showing the real hardship that families and businesses up and down the country will face in the months ahead. There were a few exceptions though, throwing their weight behind the extra spending on the Health and Social Care budget, in education, in the maintenance of capital expenditure, and in continuing the pensions triple lock. Hunt and Sunak’s prioritisation of protection for pensioner budgets and projects in the Red Wall should be seen as a clear attempt to stymie the bleed of votes that has happened in recent months and shore up the same coalition that voted for the party in 2019 ahead of the next election.

Ahead of that election the blame game for the pain the country is feeling at present is well and truly under way. Hunt began his statement by blaming unprecedented global headwinds, before labelling the economic downturn a “recession made in Russia,” and citing the Office of Budget Responsibility as confirming that “global factors” are the “primary cause of current inflation.” The Labour Party’s response was that the problem was “made in Downing Street.”

Who voters blame for the decrease in their purchasing power and the diminished opportunities in their lives will ultimately decide the next election. Hunt and Sunak are looking to reap the benefits of prudence now and signs of growth later and hope to do so off the back of rebuilt economic credibility. “Britain is on the right track, don’t turn back” might well be something older political afficionados will recognise. The Labour Party, on the other hand, have already started to repeat the message: don’t forgive, don’t forget.

Click here to access the H/Advisors Cicero analysis in full.

The European Commission today unveiled its 2023 Work Programme, offering a glimpse into the key legislative and non-legislative priorities over the coming year with significant implications for the business community.

Key areas of focus include comprehensive reforms around the EU electricity market, adapting the Single Market to the new digital age, better fostering a resilient and skilled workforce, and the creation of a European open finance framework, among many other initiatives.

Enter your details below to access H/Advisors Cicero’s overview of the European Commission’s 2023 Work Programme.

This piece is authored by Agathe Gauthier, Consultant at Havas Paris and H/Advisors coordinator, who is participating in the H/Advisors Exchange programme. This initiative enables consultants to spend one month working inside other agencies within our global network, to help broaden our connections and to expand our international insights.

As part of this initiative, H/Advisors Cicero staff will spend time working in Paris and Washington DC. In addition to Agathe, we will also be welcoming a colleague from the H/Advisors Abernathy team from San Francisco to spend a month working in London.


The first meeting of the European Political Community (EPC) was held last week in Prague, Czech Republic. A total of 44 countries, including all 27 EU Member States, were represented. The Danish Prime Minister, Mette Frederiksen, was the only head of government not present.

The French President, Emmanuel Macron, had called for the creation of the EPC on 9 May earlier this year to mark Europe Day as part of the rotating six-month Presidency of the European Council held at the time by France, and three months after the start of the Russian invasion in Ukraine. Upon his arrival at Prague Castle, he stressed that it was an “important moment” to send “a message of unity (…) for all Europeans, whether or not they are members of the EU”. The EPC’s aim? To “build a common strategy” and to launch a “strategic conversation that did not really exist [until then] and could lead to divisions”.

In his own introduction, the Czech Prime Minister, Petr Fiala – who assumed the current Presidency of the Council from Macron himself – greeted a much broader audience than the usual EU spectrum:  with leaders joining from the six Western Balkan countries (Albania, Bosnia and Herzegovina, Kosovo, Northern Macedonia, Montenegro and Serbia), the United Kingdom, Norway, Switzerland, Moldova, Iceland, Georgia, Turkey, Armenia, Azerbaijan and Liechtenstein as well as Ukraine (with Volodymyr Zelensky speaking via video conference at the start of the session). He did not shy away from the “many difficult problems” the community faces, “the most serious” being that Europe is “undergoing an aggressive war”. In this context, he branded the EPC as a “forum for an informal exchange of views on current events in Europe and beyond”, a space “flexible enough” for “all European democratic countries to feel comfortable”. He cited the need to have “honest discussions on subjects of common interest, but also on less consensual topics” – peace and security, inflation and high energy prices, and the “dependence” on “imported resources” which threatens security.

Macron cited six areas of potential future common work for the EPC:

  1. Protecting critical infrastructure (gas pipelines, cables, satellites)
  2. Protecting against cybercrime attacks
  3. Dealing with the exposure to “uncooperative external powers” in the Black Sea, the Baltic Sea, the North Sea and the Caucasus
  4. Contributing to a resilience fund for Ukraine
  5. Creating an integrated energy strategy – with non-EU gas producers Norway and Azerbaijan being conspicuously present at the table
  6. Contributing to a “common youth policy” – a broadly-defined topic encompassing education and integration

The underlying aim of this first EPC meeting was also to provide both a show of unity in condemning the escalating Russian aggression, and an illustration of the unity of states from across the European political arena. The EPC’s next meeting will be held in Chișinău, Moldova – only 111 miles from Odessa, Ukraine – then Spain, and the UK.

Areas of focus

  • Fallout from the energy crisis

The EPC has no coercive power to make any decisions on the current energy crisis. However, the presence of two notable non-EU gas producers Norway and Azerbaijan suggests that dialogue could be facilitated.

The MidCat project was one of the meeting’s hot topics: a 260-kilometre pipeline linking Hostalric (north of Barcelona) to Barbaira (near Carcassonne, France) to bring Algerian gas to the EU and allow northern Europe to benefit from the Iberian Peninsula’s large regasification capacity for liquefied natural gas (LNG). In the longer term, this pipeline could also circulate green hydrogen.

Before the outbreak of war in Ukraine, the project had been shelved due to a lack of French interest, before coming back to the fore, pushed by Germany and Spain. At the summit, Macron questioned the relevance of building a project that would take “five to eight years” to complete and insisted on his current priority: ensuring the stability of electricity interconnections in Europe. With Germany and Spain also strongly at odds over MidCat, this specific case perfectly illustrates how EU countries intently wish to maintain the image of a united front against Russia, whilst increasingly exposing their differing opinions on just how to manage the current energy crisis.

  • A reset of French-UK diplomacy?

Over the past five years, UK-French relations had degraded as events over Brexit, AUKUS, migration and common fisheries reduced political unity between the two states. The EPC meeting potentially marked a turning point as Macron welcomed the UK’s participation: “I hope that this is a new phase in our common relationship. We want to work together for the unity of our continent, especially in these very difficult times.” In the evening, a joint communiqué between France and the United Kingdom was published, in which Macron and UK Prime Minister Liz Truss underlined their determination to provide Ukraine with all the support necessary to enable it to restore its sovereignty and territorial integrity and to resist Russian aggression, as well as their determination to hold Russia accountable for its actions.

They also recalled “the close and long-standing ties between their two countries” and agreed “to hold the next Franco-British Summit in France in 2023 to take forward a renewed bilateral agenda” – the first such Summit since 2018. This bilateral reset is both strategic – France and the UK are the two largest military and nuclear powers in Europe – and a political win, helping Macron assert his position as Europe’s post-Merkel natural leader and offering Truss the opportunity to build a key diplomatic relationship.

For the UK, the EPC could lead to a closer alignment on defence and energy policy, leading to a kind of “proto-institutional” cooperation between the UK and the EU. Both sides could also review the Trade and Cooperation Agreement – scheduled for 2026 – and smooth out its edges, for example by allowing Britons to travel briefly to the EU for work without a visa (with EU citizens enjoying reciprocal rights). Truss was also guaranteed by the Czech Republic that it would push forward the issue of the UK’s rejoining of the North Seas Energy Cooperation group on renewable energy for approval to fellow EU members in the coming weeks.

  • The EPC as “antechamber” of the EU of accession countries

In Eastern Europe, including Ukraine, the announcement of the EPC project had raised fears that it would create a perpetual EU antechamber for accession countries. The EPC does allow them a form of European integration, at least politically and diplomatically, in which they can focus on gaining the EU members’ goodwill before ticking all of the accession boxes (the “acquis communautaire”).

Sticking out among the crowd, Turkish President Recep Tayyip Erdogan was urged by Macron to finally stop “circumventing” sanctions against Russia. He also expressed his “concern” about the situation in the Aegean Sea, the scene of recurring tensions between Greece and Turkey – who are both NATO allies, calling for the “resumption of dialogue between the parties to avoid escalation and preserve respect for international law”.

Turkey, which is heavily dependent on Russian oil and gas, refused to join the Western sanctions against Russia and continues to rely on their strategic relationship with Russia to build its first ever nuclear power plant. The country also remains a popular destination for Russian citizens and has seen thousands arrive since the beginning of the war. The participation of “fringe” leaders like Erdogan is in itself a victory for the EPC, and a recognition by the EU that it needs to engage with those states outside of Brussels’ sphere of influence to address the region’s most pressing issues.