Over the last decade, the EU economy has experienced slow growth, and it is not expected to grow substantially in the coming years. Additionally, the ongoing demographic and epidemiological transition is increasing pressure on public finances, particularly healthcare and social expenditure. The current permacrisis – encompassing geopolitical and climate-related challenges – exacerbates these issues and directly threatens fiscal sustainability through slower economic growth, increased Government deficits, and consequently, higher public debt levels. Addressing these intertwined challenges is essential to ensure the long-term sustainability of healthcare, social care, and welfare systems across the EU.

In this context, there is a need to share a new paradigm that shifts the healthcare model from a reactive (treating sickness) to a proactive system (promoting health), leveraging investments in health prevention. At this critical juncture, the EU has introduced the New Economic Governance Framework (NEGF), which provides an opportunity to consider investments in the healthcare sector – especially in prevention – as “social security investments,” similar to what has been done for investments in defence and the digital and green transitions. Given this new framework, including healthcare investments within the scope of the NEGF would not only allow for greater flexibility in an unstable economic scenario but also lead to increased spending in areas with positive effects on the health and well-being of the population.

There is already extensive literature discussing the potential advantages of preventive healthcare (promotion of healthy lifestyles, screening programs, and particularly, immunisation strategies). Preventive healthcare not only translates into increased life expectancy and improved quality of life but also yields economic advantages, such as savings in healthcare spending and increased worker productivity, thereby supporting the country’s economic and social growth and resilience. Moreover, the containment of public spending frees up resources that could be dedicated to improving the quality of services provided, R&D for treatments of currently untreatable diseases, and investments in sectors like education or employment.

Studies suggest that every 1 euro spent on preventive healthcare generates a 14-euro return to the health and social care economy. Regarding immunisation, a recent report has shown that adult immunisation returns 19 times its initial investment to the society and economy, and up to 33 times in the case of pneumococcal immunisation.

However, today, only a small percentage of national healthcare budgets is spent on prevention, and even less on immunisation (0.5%).

As these studies show, by focusing on prevention, European countries can mitigate the future burden on their healthcare and welfare systems and promote long-term economic and social resilience. As EU Member States prepare to submit their National Medium-Term Fiscal-Structural Plans to the European Commission by September 20th, 2024, there is a critical window of opportunity to prioritise investments in health prevention. In the future, spending on preventive healthcare can be considered an “investment,” as it entails potentially higher growth and reduces future expenditure:

• In the short term, it is necessary for investments in prevention to be recognised as beneficial for long-term fiscal sustainability and granted greater flexibility within the Member States’ fiscal-structural plans.
• In the medium/long term, new revised fiscal rules should exclude prevention and immunisation investments from the calculations of Member States’ deficit or debt levels when assessing compliance with fiscal rules.

It is imperative to recognise that the current permacrisis needs to be addressed and overcome with concrete solutions. In this context, embedding preventive healthcare – and in particular immunisation – into EU Member States’ fiscal strategies is paramount to promote the economic sustainability of healthcare, social care, and welfare systems, enabling them to adapt and flourish amidst the challenging and unpredictable conditions Europe is facing. Member States must seize this moment to advocate for and implement these changes within their fiscal plans, while EU institutions should endorse this approach when evaluating these plans.