AA15CR30

AS (2015) CR 30

2015 ORDINARY SESSION

________________

(Fourth part)

REPORT

Thirtieth sitting

Tuesday 29 September 2015 at 10 a.m.

In this report:

1.       Speeches in English are reported in full.

2.       Speeches in other languages are reported using the interpretation and are marked with an asterisk.

3. The text of the amendments is available at the document centre and on the Assembly’s website. Only oral amendments or oral sub-amendments are reproduced in the report of debates.

4.       Speeches in German and Italian are reproduced in full in a separate document.

5.       Corrections should be handed in at Room 1059A not later than 24 hours after the report has been circulated.

The contents page for this sitting is given at the end of the report.

      (Mr Rouquet, Vice-President of the Assembly, took the Chair at 10.13 a.m.)

      THE PRESIDENT* – The sitting is open.

1. Election of judges to the European Court of Human Rights and the Secretary General to the Parliamentary Assembly

      THE PRESIDENT* – This morning the agenda calls for the election of a judge to the European Court of Human Rights in respect of the Slovak Republic and for the election of the Secretary General to the Parliamentary Assembly.

      The list of candidates and biographical notices for the judge are to be found in Document 13861 and the Committee’s opinion is in Document 13872 Addendum 2. The list of candidates and biographical notes for the Secretary General to the Parliamentary Assembly are to be found in Document 13853.

The voting for both elections will take place in the area behind the President’s chair. At 1 p.m. the ballot will be suspended. It will re-open at 3.30 p.m. I shall close the ballot at 5 p.m. As usual, the count for each election will then take place under the supervision of two tellers. The following names have been drawn from the ballot.

      For the election of judges, the names of Mr Deniz Baykal and Mr Stefaan Vercamer have been drawn. For the election of Secretary General to the Parliamentary Assembly, the names of Mr Jean-Yves Le Déaut, Mr Denis Jacquat, Mr Andrej Hunko and Ms Marietta Kalamanli have been drawn, but they are unable to serve as tellers, so Mr Alain Destexhe and Ms Marie-Christine Dalloz, the substitute for Ms Kalamanli, will serve as tellers. They should go to the back of the President’s chair at 5 p.m.

      I hope to announce the result of both elections before the end of the sitting this afternoon.

      I now declare both ballots open.

2. Debate: public health and the interests of the pharmaceutical industry: how to guarantee the primacy of public health interests

      The PRESIDENT* – The next item on the agenda for this morning is the debate on the report, “Public health and the interests of the pharmaceutical industry: how to guarantee the primacy of public health interests?”, Document 13869, presented by Ms Lilian Maury Pasquier on behalf of the Social Affairs, Health and Sustainable Development Committee.

      I call Ms Pasquier, who has 13 minutes to speak, which she may divide between presentation of the report and answering questions.

      Ms MAURY PASQUIER (Switzerland)* – This morning’s subject is a delicate one that sometimes gives rise to hostile reactions and certainly to lively debate. Why? Public health, stakeholders in the sector and medicines concern all of us, because we are talking about spending millions of taxpayers’ money. Most of our countries are fortunate enough to have social security systems that cover most of our health expenditure.

      Those lively responses can also be explained by the will to impose limits on the practices of the pharmaceuticals industry – one of the most powerful and lucrative sectors in the world. I am Swiss and therefore know what I am talking about.

      It is important to establish some clarity. This report is not an attack on the pharmaceuticals industry and it recognises the sector’s key role in research and development for new medicines that have improved the health of our populations. That is the noble side of the industry’s activities.

      As I have tried to express in my report, the industry has, however, a less noble side. I am a member of parliament. I care about the quality and sustainability of our health systems and it is our duty to ensure that the private interests of the industry do not trample over public health interests or impose too much of a burden on our budgets.

      Let me give a few examples to illustrate what I mean. What is the relationship between the pharmaceuticals industry and health actors? We know that today the industry is in contact with all stakeholders, including academia, hospitals, doctors, nurses, chemists, those responsible for scientific publications, health insurance schemes and patients’ associations. I understand that interaction and co-operation between the two is necessary and I do not call the principle into question – far from it. However, I should like to pose a question. If these interactions are not in any way regulated could they not have harmful, detrimental effects on public health?

      I remind members of the Mediator case in France and scandals of the ilk, in the light of which we can agree that unfortunately things can go wrong if nothing is settled. Fortunately, over the past few years progress has been made. Our laws guarantee transparency of contacts and avoid conflicts of interest. The industry has become involved in self-regulation, which is laudable, although for the time being the system is non-binding. Progress has, however, been limited, and we take due note of that. For instance, there is no monitoring of laws whereby the declaration of linked interests becomes compulsory. No one assesses the position; nobody knows whether linked interests could give rise to conflicts of interest. The core of the problem – the industry’s considerable investment in promotion activities – is not being tackled. These amounts are being spent because they allow the industry to increase its turnover and sales figures, but this is not always for the right reasons.

That being the case, why should we not have a compulsory levy on these PR activities? The money collected could be used to feed a public fund to help train health professionals independently and to help promote independent research. The measure would also be an incentive for pharmaceutical companies to reduce their PR budgets and promotion activities. It would therefore serve both purposes. We also need to overcome the reticence of health professionals when it comes to accepting the fact that, unfortunately, they are influenced by publicity right from the beginning of their training. That has to be said.

The second big issue addressed by my report is R and D in the pharmaceuticals industry. This activity is premised on a system of patents, which is how the industry can maintain a monopoly over its products for a limited period, negotiate prices with no competition and ensure a return on its investment, which is considerable as a result of this system. Those who are involved in the field know that R and D for medicines is a risky, costly, long-term process. Once again, I am not calling that into question. The arguments are perfectly sound and valid. What I call into question is the efficiency of the present system. By that, I mean its ability to produce new medicines that represent real advantage and respond to real health needs while being economically sustainable.

Let us not forget that it is our health systems that we are talking about. They are the ones that pay the price for all these medicines, so it is in our interest to ensure that the system gives us innovative medicines that are useful and affordable. Unfortunately, at present, that is not really the case. Prescrire magazine, which is known for its independence vis-à-vis the pharmaceuticals industry, has published a report saying that out of the 1 400 new medicines that were placed on the market between 2000 and 2013, 51% did not contribute anything new. Only 2% represented a real advantage over previous medicines. For some years now, the costs of medicine, including cancer medication, have spiralled.

The most revealing example is hepatitis C, the new medicine for which costs €13 700 for one box. I do not know about you, but I cannot see how that price can be justified, even if the medicine was a big step forward in treating the illness. One could argue that the medicine allows savings elsewhere because less will be spent on other less efficient treatments, but it is nevertheless very expensive. Do we really know how much the research has cost? No, we do not. The figures have been advanced but are controversial and we do not know the detailed breakdown, simply because the industry is not transparent in this area. We do not know the proportion of public research involved in the discovery of new medicines, yet public research plays a very important role – more than we think – in this field. We can conclude that the system is not terribly efficient.

The Assembly is perhaps not the best placed assembly to propose alternatives. The World Health Organisation is in a better position to do that. However, we can propose measures that would better protect public health interests, such as the requirement for greater transparency on the cost of Research and Development, in particular where public funding is involved. We could adopt stricter policies for authorising the placing of medicines on the market by introducing criteria such as added therapeutic value or the compulsory publication of all clinical trials and tests. Medicines whose efficiency has been established should stay on the market and, if needs be, we could have mandatory licensing in exchange for the payment of royalties. Where the pharmaceuticals industry has unlawful practices, we must be able to speak out against them, such as any measures the pharmaceuticals industry takes that solely serve the purpose of trying to delay the placing on the market of certain generic products.

The needs of patients must be centre stage, along with health concerns and public safety. This is all the more important at a time of budgetary restrictions. We want to ensure that our public health services can survive. The proposals in the draft resolution serve that purpose and I ask colleagues to support them. I look forward to our debate.

THE PRESIDENT* – Ms Maury Pasquier, you have a little more than four minutes to reply to the debate. I call Ms Kyriakides to speak on behalf of the Group of the European People’s Party (EPP).

Ms KYRIAKIDES (Cyprus) – I congratulate my dear colleague Ms Maury Pasquier on this ambitious and far-reaching report. The EPP welcomes this discussion because it is one that affects us all. We all, unfortunately, need medicine from time to time, both as consumers and patients. Therefore, we need access to accurate information about the drugs we use and their potential side effects, in addition to their availability at the best possible price. This becomes all the more relevant when we are talking about the treatment of patients with life-threatening diseases who must undergo complex surgical and other treatments necessitating the use of expensive drugs.

The pharmaceuticals industry is also intrinsically linked to the progress and development of new drugs that have improved the lives of millions of patients. Investment in new technologies and continued financial support of medical research constitute the future of the health and pharmaceutical sectors. Conflicts of interest exist in all sectors of economic activity but regulators need to be even more vigilant with the very sensitive health sector. Self-regulation of the pharmaceuticals industry should be bolstered by binding legislation in all our member States.

Comprehensive cost-benefit analysis should be carried out systematically, as costs incurred by many chronic patients, such as cancer patients, are in many cases overwhelming and on the rise. Despite the progress of research and development, only a few drugs have verified therapeutic benefit while the vast majority remain experimental and need further testing. However, this does not mean that we should hinder the pharmaceuticals industry in Europe through excessive regulation in its effort to achieve life-changing breakthroughs for millions of people. Rather, we should fight for more transparency in the marketing of generic medicines.

Patient groups are very important in voicing the rights of patients and they should not be overly dependent on private funds from the pharmaceuticals industry because that could result in the promotion of the interests of the industry and its main stakeholders rather than the legitimate demands of patients. As the report says, public funding should be assured and increased to counter that growing trend. The EPP supports this report, but we are concerned about imposing over-stringent measures that might ultimately cripple the viability of the pharmaceutical industry and lead to negative consequences for patients. We support the Assembly’s calls for further transparency, for declaring conflicts of interest, for lower prices and for everyone to have access to medicines.

      THE PRESIDENT* – Thank you. I call Mr Destexhe, who speaks on behalf of the Alliance of Liberals and Democrats for Europe.

      Mr DESTEXHE (Belgium)* – The ALDE group will not be supporting this report for reasons that have just been explained by the representative of the EPP group. We are bothered by excessive regulation. We share the report’s objectives to ensure more transparency, greater information flow and the avoidance of conflicts of interest, thereby allowing research to happen. All of that is in the report, but it is already largely regulated in national law. The resolution is not very practical and will not be easy to apply.

      First, the rapporteur is suggesting an alternative to the patent system, but removing the ability to protect medicines will be the end of research and innovation. The patent system is at the heart of research and pharmaceutical production, and without patent protection there would be no medical research. Secondly, the rapporteur referred to a binding contribution, a specific tax on marketing, to create a medicines fund, which is not practical. One of our main budgetary principles is unity and universality, and we do not think there should be a specific tax in this area.

      The third aspect is the cost of research. If research is financed by public funds, everything has to be very transparent and the public authorities have the right to know how the research is used, but we are talking about private companies. A private company has the right to commercial confidentiality, including on manufacturing costs. The resolution talks about absolute transparency, and every time I see the word “absolute” I think about the absolutism of the divine right of kings in France. We have all read “Nineteen Eighty-Four” by George Orwell, and we want transparency, but we must be careful about the word “absolute.” We do not want to live in a society in which we are constantly surveilled.

      I have worked with Médecins Sans Frontières for 12 years, and I am sensitive to the needs of the public, but the resolution is divorced from medical value. It talks about added medical value, but the question is not whether a medicine is efficacious; it is a question of proportion. Twenty per cent. of one group might experience an improvement, whereas 40% of another group might experience such an improvement. That determines whether a medicine is efficacious. If a medicine is 20%, I would use it if I were in a parlous State—it depends on the efficaciousness of the medicine. We should be careful about such concepts, which sound very good but are not necessarily applicable in practice.

      I am not sure that the draft report would get through our national parliaments, so I advise members to peruse the text. Some 80% of new medicines are produced in the United States, with 19% coming from Europe. If we enact the report’s recommendations in national legislation, I am afraid that the proportion would not even be 19%. For all those reasons, the ALDE group will not vote in favour of the report, even though we recognise that the principles are well meant.

      THE PRESDIENT* – Thank you. I call Lady Eccles, who speaks on behalf of the European Conservatives Group.

      Lady ECCLES (United Kingdom) – I thank Ms Maury Pasquier for her report on public health interests in relation to the pharmaceutical industry. The report recognises the importance of this industry to the public health of our populations. It raises a number of questions regarding developments within the industry. These include concerns regarding regulation, transparency and conflicts of interest.

      I will respond briefly with reference to the industry in the United Kingdom. As medicines are one of the most common treatment options in our health service, we recognise the valuable contribution of the pharmaceutical industry in helping to ensure that health service patients receive the world’s best and most advanced medicines. Our focus is to accelerate the adoption of 21st-century health science technology, transforming patient experience and ensuring that the United Kingdom is an attractive place for health and life science companies.

      The self-regulatory Association of the British Pharmaceutical Industry code of practice requires that the pharmaceutical companies routinely disclose, by 30 June 2016, all transfers of value to health care professionals and health care organisations after 1 January 2015. Recipients will be named if they refuse consent. The plan is to make that information available on a single public database. Providers of health services will be required to maintain a hospitality register, so staff will have to declare all gifts and hospitality they receive from pharmaceutical and medical devices companies. The government propose to publish a draft contract next year, which will be out for consultation shortly. It will include the proposed new requirements for providers in guidance accompanying the draft contract. The government is introducing those rules to tidy up the process, and the health service will have to reveal any gifts or hospitality it receives from such representatives. The actions being taken by my country’s government will make it easier to spot when health service staff and medical professionals are acting in the interests of big companies that are giving them gifts and hospitality in return. It will also deter such individuals from acting unlawfully on behalf of big companies.

      My country’s government wants to see greater transparency in clinical trials and continues to work closely with all parties to ensure that the United Kingdom is a robust and internationally leading place to undertake clinical research safely and openly. We recognise that there is more to be done, and we welcome the work being carried out towards greater transparency across the global industry. I hope I have helped to highlight some of the important points raised in this report.

      The PRESIDENT* – Thank you, Lady Diana. I call Mr Jónasson on behalf of the Group of the Unified European Left.

      Mr JÓNASSON (Iceland) – I thank the rapporteur, Ms Liliane Maury Pasquier, for a truly excellent report. The Group of the Unified European Left fully endorses the report and the draft resolution.

Recent developments on both sides of the Atlantic demonstrate the timeliness of this debate. In Europe, there is growing concern about the rocketing prices of medications. In the United States, Bernie Sanders, the left-wing candidate for the presidency, and in his wake, Hillary Clinton, have put the focus on the necessity of regulating the pharmaceutical industry. Clinton has suggested that a ceiling be put on the private cost of medicines for each patient of about €230 per month and that, after that, the State should step in with a helping hand. That should hold for medications that are accepted by the health authorities. I was struck by how high the suggested ceiling was – it is 10 times the level of the ceiling in my country of Iceland, which many of us regard as too high.

The example that was used by Sanders and Clinton, which hit the front page of The New York Times, was a medicine for HIV patients called Daraprim. It had been sold at $13.50 per pill, but after the company got into the hands of speculators under the label of Turing Pharmaceuticals, it rocketed to $750 a pill – a rise of 5 500%. That brings to light how exorbitant prices can get. It is an extreme example, but it throws light on the dangers that we face when the fate of very ill people is at the mercy of speculators.

Yesterday, a hearing of the Committee on Social Affairs, Health and Sustainable Development spoke to Anand Grover, the former United Nations rapporteur on the right to health, via satellite from New Delhi in India. He warned against pharmaceutical companies becoming “rent gathering tools”. That is a concern for patients, the health system at large and, of course, the taxpayer.

This is a fragile and difficult discussion, especially when the purses of the taxpayer and speculators are merged. I know that well from my experience as a former minister of health. People who are burdened with difficult health problems often blame the authorities for not going along with the demands of the providers of medicines, who they see as saving their lives or making life bearable. That is understandable and, indeed, is understood by companies that are bent on mobilising sick people for their own narrow, profiteering interests. The authorities must be careful not to brand everybody as a villain. There are the good and there are the bad.

We all recognise that research and development are necessary, but the cost is often enormous. Accordingly, a financial burden is placed on patients – sometimes, but not always, through their insurance companies – or on the taxpayer, as is the case in many European countries. We therefore ask, what is to be done to protect the interests of the payer? The report says that the answer is more transparency, but it also says that that is not enough. The pharmaceutical industry has proved that it cannot be self-regulating. Therefore, we need stricter authorisation policies; a more formal approach on the interaction between the pharmaceutical industry and health sector stakeholders; and more education on all of the dimensions involved.

      The PRESIDENT* – Thank you, Mr Jónasson. I call Ms Bonet Perot on behalf of the Socialist Group.

      Ms BONET PEROT (Andorra)* – I thank the rapporteur for the report, which is controversial and gives rise to different opinions. What cannot be disputed is that the report recognises the advances in medicine that have been made through pharmaceutical research. However, we must not lose sight of the fact that there are matters to be resolved and aspects that must be regulated. There is now a complex dynamic and it is difficult to incorporate these matters within our national health systems.

      Much has been written about this subject. The prestigious British Medical Journal has devoted editorials to this problem and denounced the conflicts of interest within the pharmaceutical industry at all levels of medical research and health regulation, including in clinical practice. Most research today is sponsored by the pharmaceutical industry, which compromises the integrity of the science. There must be mechanisms in place to avoid society losing its trust in health professionals, researchers and future developments. The obligatory declaration of conflicts of interest by researchers may influence the perception of the results of their research. This may affect public health.

There must be independent, systematic reviews to determine whether a proposed therapy is better in terms of objectivity, impartiality, ethics and the sustainability of the health system. We should redefine the objectives of clinical observations on the basis of the needs of patients and society, rather than the economic interests of pharmaceutical companies.

The growth in pharmaceutical costs has been considerable over recent years and the global impact of that on health systems generates problems in health policy. The major economic interests involved in the development and commercialisation of medicines may have given excessive power to the industry. That has an impact on medical research and on clinical practices and policies. The scientific evidence, cost-effectiveness evaluations and practical clinical guides for health professionals that are produced by the medical industry have a direct influence on the decisions of health professionals and consumers.

We must urgently regulate and redefine the mission of the pharmaceutical industry within our health systems to make it more objective. That will benefit patients and citizens. It must be free of conflicts of interest.

The hepatitis C crisis is a clear case. It has had an impact on health systems and generated political debate because people need treatment, but the pharmaceutical products are very expensive. The problem is in finding the balance between the legitimate aspiration of a patient to get the best possible treatment and the limited means of national health systems. The price is €50 000. That leads to problems with access to treatment and medicines, because whether the disease is cured may depend on the patient’s means. There are great problems with regard to political decisions and health systems.

It is fundamental that we look urgently at the protection of medical patents. Often, public funds are involved, but all the profit goes back to the private sector.

      The PRESIDENT* – Thank you, Ms Bonet Perot. The rapporteur will reply at the end of the debate, but does Ms Maury Pasquier wish to respond at this stage? As that is not the case, I call Ms Blondin.

      Ms BLONDIN (France)* – I welcome the inquiries that have been led by Ms Maury Pasquier, who has been as determined as ever. Her report is ambitious and balanced. It contains tangible proposals that would advance the primacy of public health interests.

      I agreed with our colleague when she spoke about the erosion of pharmaceutical innovation and said that the costs of some medicines have spiralled out of control. That creates problems with access to health care and, therefore, with health care, full stop. She was right not to try to stigmatise the pharmaceutical industry. After all, the industry has allowed us to make fundamental progress with medicines, because of its investments, and it is a major activity in many of our countries. Similarly, to opt for too binding a regulation would be a trap, and our colleague the rapporteur is right not to fall into that trap.

      Links between the pharmaceutical industry and various stakeholders in the health field can be found everywhere, as pointed out in the report, but they are almost inevitable; in some cases, they are even desirable and, in fact, the report rightly says so. The existence of a linked interest does not necessarily mean a conflict of interest. We have debated such issues several times in France, in particular as the result of a case that the rapporteur mentioned, the Mediator scandal. That was a sorry case, which included a whole series of failings – systemic failings in France’s health safety system – but it was also an opportunity for us to implement an ambitious reform of our medicines system.

      The reform included guaranteeing the primacy of public health interests throughout the administrative lifecycle of medicines, which was done through strengthening our ethical framework, which has become more robust, and greater efficiency in the assessment and monitoring of medicines. The second component of the reform was a culture of pharmaco-vigilance across the board and better awareness of health safety issues in society. Confidence needed to be restored.

      I refer you to the Law of December 2011, which was the outcome of our reform thinking. A number of provisions are concerned with the importance of strengthening the safety of medicines and health products. The reform text also included measures to ensure transparency where linked interests are involved and it provides for a common corpus of ethical rules. There is a French version of the Sunshine Act, which establishes a system of declarations by industry of any advantages, whether in kind or money, that might be given to stakeholders, and there is a series of criminal sanctions. In addition, a charter of health expertise is meant to ensure that any expertise commissioned by public authorities or institutions responsible for public policy or public health is clearly documented. We have debated the various health agencies in committees, councils and collegiate bodies, allowing for the agencies to be registered. Everything is available on the internet site of the agency concerned, including anything to do with authorisation for placing on the market.

      France has therefore made serious progress in this field, with a view to meeting the recommendations contained in the draft document that this Assembly is considering, although other areas still need to be explored further, such as bacteriophage medicines to fight antibiotic resisters.

      The PRESIDENT* – Thank you. I call Mrs Dalloz.

      Mrs DALLOZ (France) – Madame Rapporteur, I will pick up on some of your proposals, which I find questionable at the very least

      The function of a doctor is to treat and heal, which includes prescribing medicines. Doctors are regulated and monitored and, in several countries, declarations of interest exist. The big question is to know exactly where any conflict of interest might begin and therefore lead to a situation in which the patient could be excluded from the process of a taking a sensitive decision. In your report, you seem to claim that doctors are influenced in spite of themselves and are therefore de facto prescribing medicines under pressure from the pharmaceutical industry, rather than what is right for the patient.

      That is a serious accusation, which chimes with those made by Professor Even on cardiologists and anticoagulants. It raises the issue of the trust that is so necessary in the relationship between patient and doctor. Such accusations could be downright dangerous if patients refuse to take any anticoagulants from their prescribing physician.

      My second point of disagreement is to do with transparency and the amounts of money spent on research and development. At least in France every company is obliged to publish its accounts in full, which includes the outlay on Research and Development. Furthermore, a system of tax breaks in the modern world has helped to finance research in a totally transparent way, such as the research tax credit that prioritises the financing of innovation by European companies including the Innovation Barometer and in the Organisation for Economic Co-operation and Development (OECD) area in general. It is a pity that report does not take into account such innovative and transparent financing, which is good practice.

      The choice of authorising a medicine according to medical need might also cause problems. To know the medical need, we need to know the disease, the efficacy of the molecule concerned and the number of sufferers, all of which needs to be identified correctly. Lyme disease, for example, affects thousands of people in Europe, but it is still considered a rare disease in France. Why? Because our screening does not allow us to identify the number of people affected. In fact, most sufferers are not even screened – through lack of information and perhaps of political will. Things are not that straightforward, so doctors and the pharmaceutical industry alone are not at fault.

      Finally, the use of public money to finance patients associations seems Utopian in the current context of budget cuts across the board. Whatever happens, while those associations are clearly a source of information and psychological support for patients, part of their function is not to interfere in the process of medical research or marketing. By the same token, to consider the funding of research from public funds does not seem to be feasible for most countries.

      An interesting case is that of the Institut Imagine at the Necker hospital in Paris, where there is true co-operation, a win-win partnership between the public and private sectors. There is co-development of innovative therapies for genetic and congenital diseases, with benefits for both public and private sectors. Furthermore, the institute’s Centre for Clinical Investigation is available for clinical testing by industry. That is another good example of best practice.

      To end on a positive note, I fully agree with point 6.1.6 on regulating movement between the public and private sectors. It is right that we should have no blurred lines.

      The PRESIDENT* – Thank you. I call Mr Paul Flynn.

      Mr FLYNN (United Kingdom) – A magnificent report, which is timely, vital, balanced and harks back to 2010 and one of the most important Council of Europe reports, in which we were right and the rest of the commentators were wrong. It was about the flu epidemic that never was, stirred up by bad epidemiology from the pharmaceutical industry, which deliberately set out to frighten the world. In my country, we were told to expect an average of 65 000 deaths; in fact, we had fewer than 500 deaths of people with H1N1, and even fewer people who died of that disease – only 150.

      Let us take the courageous example of countries that rejected the claims of big pharma, supported by the World Health Organisation, which includes many people from the pharmaceutical industry on its committees. Let us compare what happened in the United Kingdom and what happened in Poland. Poland spent next to nothing on the vaccines, rightly rejecting them because they were not properly trialled. We now know of cases of narcolepsy as a side-effect of the vaccine. Poland also refuted the case for antivirals, which were almost useless. The United Kingdom spent £1.3 billion on antivirals and the vaccines. As a result, in the United Kingdom there were twice as many deaths per million of the population as there were in Poland. Ewa Kopacz, the courageous health minister in Poland, is to be congratulated, because here we had an epidemic that was not an epidemic at all. The number of flu deaths that occurred that year was normal. In spite of that, the world was conned by the pharmaceutical industry into spending huge sums of money. It might be a good idea if we look to ourselves as a Council of Europe: we were unique in the world and we spoke for the conscience of the world. National governments were defending their own positions – they had spent too much but were too embarrassed to say so – but we were the independent voice of the patients, saying to the world that this was a massive confidence trick played on the world by the pharmaceutical industry. Let us go back and have another look at that report.

      Of course the pharmaceutical industry does magnificent things, but it is Janus-faced. On one side is its noble face, producing miraculous medicines that did not exist in previous generations. On the other side is the face of marketing. The industry spends more on marketing than it does on research, and more on lobbying than almost any other industry in the world. Indeed, we have heard its words this morning.

      We know – this is not ancient history – about Daraprim, which increased its price from $13 to $750. It costs the same to make now as it did in July, when it cost $13. It is a precious drug, the only one in the United States recommended for children with a rare kidney disease, and suddenly that company is punishing those children or putting a burden on health authorities. There is a record of exploitation. We have heard about Britain’s case. The British regulatory body is controlled, financed, run and chaired by the pharmaceutical industry. For 20 years it has denied the harm of the drug Seroxat, and has only recently admitted that the research was corrupted and they lied about it – they produced only the good results, not the bad ones. We know that GlaxoSmithKline was fined billions for putting out research in America that was not true. It was also bribing doctors in China. These are not slurs or imaginings; this is the real world.

      We have to give the rapporteur our great thanks for her courage in introducing this report. We have all been lobbied by the pharmaceutical industry, which is very good at it. The industry sets up patient associations because it knows that the voice of the patient is more likely to be heard, and will receive more sympathy, than the voice of the pharmaceutical industry. So many of those associations are the voice of the pharmaceutical industry – sadly, as have been many of the pleas that we have heard this morning. We must put the patients and the public in control.

      THE PRESIDENT * – Thank you, Mr Flynn. Mr Matušić is not here, so I call Ms Kalmari.

      Ms KALMARI (Finland) – Thank you, Mr President. I thank the rapporteur for an interesting and powerful report, even though I know that there are different opinions in my political group. We need profitable medical companies and research and development of new medicines, but we also need common rules. Everyone would gain from fair competition. All patients in Europe, such as you and I, as well as patients in developing countries, would benefit from cheaper medicines. The pharmaceutical industry should be based on transparency and fair competition.

      By means of a self-regulation policy, the pharmaceutical industry is now adopting a much more ethical approach. The rules are defined in the relevant legislation. However, self-regulation is not binding, and the implementation of the legislation leaves much to be desired, as is clearly noted in the report. In many countries, new legislation on generic substitution medicines could be part of the solution. This system was introduced in Finland in 2003. Generic substitution is practice by which the pharmacist can propose to substitute the drug that the physician has prescribed with a cheaper generic product. The proposed substitute medicine has been subject to the same tests as the original prescribed medical product. Of course a client can refuse to take the cheaper drug offered by the pharmacist. However, not all drugs are covered – epileptic drugs, for example.

      The object of generic substitution is to promote cost-effective medical treatment and to reduce taxpayers’ and governments’ expenditure on drugs. In Finland, the introduction of generic substitution medicines resulted in the first year in a saving of nearly €90 million, of which €40 million was the cost saved by patients and €50 million was saved from the expenditure of the social insurance institution. At present, generic substitution is applied in some European Union countries, such as Germany, Sweden and Denmark. In conclusion, I support most of the recommendations in the report, including the development of legislation such as generic substitution.

      THE PRESIDENT * – Thank you, Ms Kalmari. I call Mr Jean-Yves Le Déaut.

      Mr LE DÉAUT (France) * – Thank you, President. I thank the rapporteur. I shall concentrate on the concerns that the report expresses. You advocate the quality of products, which is very important for a drug, and the preventative health systems. You advocate the development of research, be it therapeutic or pharmaceutical. You indicate the problem of rare or orphan diseases, which are very important; we can see that not much work has been done on malaria, for example, which is one of the most important diseases worldwide and causes the greatest ravages worldwide. You want to avoid conflicts of interest between industry, research and the health sector, and we congratulate you on that. Just like you, we may regret that today more money is spent on the promotion of a drug than on research and development. Lastly, you want to lower the cost of medicines because social security systems tend to increase considerably. For that purpose, you look to generic medicines. In the report you advocate quality and durability of health systems.

      The subject of greatest concern to you is the growing cost of research. This was not tackled this morning, but there is an explanation for the increase in the expense of research. We have moved from chemical therapy to biotechnological therapy, from the manufacturing of a chemical molecule for the purpose of curing a disease to now highly complex processes hailing from biotechnology, and obviously that costs much more. That has to be taken on board. Cell therapy and gene therapy are costly.

      There are other concerns that we should have, which have not been much touched upon this morning. On the transparency of the cost of research, you are right that we have to measure the therapeutic interest, but in some countries that is already being done. In France, for example, we have the senior health authority that assesses drugs, makes recommendations and provides certification and accreditation, and I feel that it works pretty well.

      I conclude by saying that today there are two developments in therapy that are not sufficiently taken on board in the report. First, personalised medicine has not been looked into. In future we are going to have therapies based upon the individual, rather than generalist ones. In other words, through genetic tests you can see whether you are sensitive to a particular drug. That will cost more, and this has to be foreseen.

      I turn to the second point that has not been broached. You looked into the question of generic medicines. That is good, as they lower costs. However, many drugs are manufactured by biotechnological processes. These drugs are now coming to the end of the validity of their patent. This is the case for insulin, EPO and growth hormones. In such cases, we will no longer have a system of generics but bio-similars. The system of bio-similars is totally different and it will totally modify the field of pharmacy. I have filed an amendment and would like this matter to be taken on board in the report. In future we will have to assess analytical and characterisation methods and the comparative effects of biological drugs and their bio-similars. Otherwise, like with Mediator, we will have health problems in our societies. At the Council of Europe we have a European division for the quality of health called EDQM. We should strengthen that division on the specific matter of bio-similars.

      We should develop the pharmaceutical industry in Europe. One of my Belgian colleagues said earlier that much of the research – more than 50% – is done in the United States of America and less than 20% in Europe, and today Asia is progressing, notably with China and India. This matter cannot be passed over in silence in a report such as this. I will vote for the report but I would like it to be beefed up a little bit.

      THE PRESIDENT* – Thank you. I call Mr Abad.

      Mr ABAD (France)* – This report deals with the question of the economics of healthcare, which is complex, especially in an economy that tends to pass the buck more than it should. I should like to concentrate on the cost of medicines and how that price is set, as the rapporteur says in her report. She said that Research and Development is not the only factor in setting a price. Therefore, requiring absolute transparency on the budgetary side will not necessarily lead to a drop in the price of medicines, because developing a medicine is economically hazardous; the return on one’s investment is far from a sure thing, and sometimes there are failures. We need to have a culture of success in the pharmaceutical industry, but there is a culture of failure that has to be costed as well. Even the biotechnology sector, with some rare exceptions, does not benefit from a greater return on investment than big pharma.

      Paragraph 6.2. of the resolution regarding marketing authorisations is a bit surprising, because this system exists already. In Europe, medicines are marketed only after many clinical trials. The national or European licence is a first stage that often takes several years, so making things even more strict and binding would be difficult. For example, medicines which benefit from a licence for a certain condition and could have therapeutic effects on another disease that was not foreseen at the start would have to go back for specific trials and another request for a licence for that specific application. Then we have to establish whether the medicine will be refunded. If not, the industry can set the price freely, but if it is reimbursable the State has to negotiate with industry and sometimes this is not without conflict, as in the case of hepatitis C.

      The report mentions a “need clause” for the refunding of medicines. In France, the health authority assesses each medicine’s verified therapeutic benefit, which involves the efficacy and any undesirable effects of the medicine and how it fits into the general therapeutic strategy. That assessment allows for the establishment of the refunding amount for the medicine. Its added verified therapeutic benefit is established, as well as the number of patients who might benefit. All this is published on open.data on the site of the French equivalent of NICE. Transparency is therefore total. Then there is the negotiation of the final price with the industry, bearing in mind all the scientific aspects and the arguments of the pharmaceutical industry. There is a kind of arbitration process with the Ministry of Health. It is not just up to the pharma industry what it charges.

      The rapporteur is very severe with this industry. She seems sometimes to consider it as a danger to patients’ health and to the smooth running of our healthcare systems, but we should not forget the danger nowadays of shadow markets and the sales of counterfeit medicines. From this point of view, the entry into force of the medicrime convention is a great step forward, because these illegal sales, which are less expensive and not regulated, are the real threat to patients’ health and to the survival of a genuine European pharmaceutical industry. Although there are some interesting points in the report, it is very ideologically biased and picks on certain scapegoats at a time when the health service needs more trust rather than distrust.

      THE PRESIDENT – Thank you. I call Mr Wold.

      Mr WOLD (Norway) – Securing public health for everyone is important. When held up against the interests of the pharmaceutical industry, this can provide challenges. Nevertheless, we are required to ensure safe medical products at a decent price for the patients and the opportunity for innovation, development, and profit for the pharmaceutical industry. This autumn the Norwegian parliament will debate a white paper on pharmaceuticals. The political ambitions for this paper are the same as the main focus in Mrs Pasquier’s report – namely, that how to secure better public health underlies the activities of the pharmaceutical industry. I am pleased to see that the Norwegian system seems to be in line with many of the recommendations listed in the draft resolution.

      The report focuses on conflicts of interests and how to avoid them. Although this is not the main topic of the Norwegian white paper, it clearly states that the pharmaceutical industry should not be given the opportunity to further extend its marketing opportunities, particularly not towards patients and medical personnel. Furthermore, Mrs Maury Pasquier emphasises the overarching goal of improved public health. Pharmaceutical policy shall contribute to increased security for patients, good treatment, innovation and low public costs. Therefore it is important to ensure high quality pharmaceutical products with regard to development, clinical studies, approval, diagnosing and use. In Norway, the group of those aged 65 or older consumes 47% of all sleeping drugs and sedatives. One in three residents of nursing homes takes at least one drug they really do not need. We should work to change this. In Norway, we have introduced electronic prescriptions. I would recommend other countries to do the same. Electronic prescriptions limit forgery and cheating. The system is efficient and allows for increased security.

      It is important to provide for a strong pharmaceutical industry but at the same time maintain the fundamental goal of improved public health. The goal of a lowest possible price for pharmaceuticals has remained unchanged in Norway since the mid-1980s. At the same time, prices cannot be so low that the industry loses interest in the market and pharmacies do not have the necessary conditions to fulfil their mission.

      THE PRESIDENT* – Thank you. I call Ms De Sutter.

      Ms De SUTTER (Belgium) – Health is both a private and a public matter, and public health should be a priority for any government that cares about its citizens. The pharmaceutical industry is an important stakeholder in health matters, but it is also driven by commercial interests, and as in all other domains there may be tensions between the interests of industry and this public interest. The excellent report by Mrs Maury Pasquier rightly draws attention to the possible danger of conflicts of interest and calls for more transparency, public funding, the highest ethical conduct in performing clinical trials, and compulsory licensing where necessary in order to ensure that public health interests are always best served.

      Besides the recommendations in the resolution, I draw the Assembly’s attention to the fact that conflict of interest is not always an easy problem to deal with. As a doctor and a clinical researcher, I notice every day that colleague researchers, paid and funded by the public sector, are increasingly encouraged to take patents for their scientific findings and start spin-off companies. In that way, the line between being a researcher and a shareholder or a CEO is a very thin one. Although that should not be a problem in itself, transparency and correctly dealing with declaring those interests is of the utmost importance. Another danger resulting from that, however, is that independent and fundamental academic research might disappear completely and be replaced by research that leads to economic valorisation only. Indeed, in that regard, shifting academic research into this direction might be directly financially rewarding to the academic researcher, to him or herself. On the other hand, it is not a secret that industry funds academic researchers to do the fundamental research for it. In the end, the question may be raised: who is without conflict of interest?

      Another worrying evolution is the heavy funding of industry with public money, such as in the European Innovative Medicines Initiative, which will invest more than €3 billion in total in pharmaceutical innovation. Although IMI is presented as a public-private partnership and the wish, as we have heard, to bring Europe to the forefront of technological innovation is comprehensible, one must understand that IMI is in fact a construction to allow public money and intellectual property to flow freely from academia to industry. Again, transparency and accountability must be guaranteed and it must be shown that public interest is shown in the best possible way.

      Finally, I hereby call for more independent academic clinical research and public investment in the research and development of drugs that are not commercially interesting, such as repurposed drugs, which have been used in other indications, but can be used in new indications. They are not interesting for the pharmaceutical industry. Most Research and Development today goes towards very expensive new drugs, especially in cancer treatment. Those are sometimes not very cost-effective and lead to little clinical benefit, or no added therapeutic value to already existing therapies—not compared with placebo, but with existing therapies. Drug repurposing, on the other hand, could save many more lives at a much lower cost.

      I end by asking for the Assembly’s support for Mrs Maury Pasquier’s report, as its message needs to be heard loud and clear in all our member States. The industry and the public sector are partners in health matters, but the primacy of public health should always be guaranteed.

      The PRESIDENT* – Thank you, Ms Sutter. I call Mr Recordon.

      Mr RECORDON (Switzerland)* – To me, the report has a welcome balance and it is regrettable that some people find it one-sided. It asks the right questions, for a start, and gives good answers to those questions. I want to concentrate my remarks not so much on conflict of interest, which has been dealt with satisfactorily by many speakers already, but on the relationship between the industry and regulators. As we know, that issue is important in many fields—for instance, with regard to money laundering and the regulation of the financial sector, on which we have done a lot of work. Today, after the Volkswagen scandal, there is the issue of regulating the automotive sector, which is in the private domain. In other words, we need to manage the delicate relationship between the public regulator and legislators on the one hand and a country’s economic actors on the other.

      In the pharmaceutical sector, as with the sectors I have mentioned, it is obvious that we need, for the sake of efficiency, to provide room for manoeuvre. It is also the case that over the years, human nature being what it is, attempts have been made to cheat, and this is important, given that this is a high-profile matter of public interest. I think the report’s proposals are reasonable and intelligent. Let us take the question of patents, in particular. Patents are an intelligent way of tackling the need to finance research and development. We need to have such a system, but if we go into the detail of intellectual property over the last few years in other fields, not just pharmaceuticals, a certain amount of leeway is possible. For instance, it could be a requirement to have licences and that those licences should be subject to various rules, such as reasonable remuneration. That would not stop the sector remaining dynamic, because we can take into account its needs and the importance of its discoveries. It is important, of course, for it to produce pharmaceuticals at a justifiable price. Even if we take extra regulatory measures, the pharmaceutical industry will not stop doing research, and I think that is the direction in which we should go for patents. Again, I will not cover subjects that have been covered by others, but I thank colleagues for their attention, and I think we should vote for the report.

      The PRESIDENT* – Thank you, Mr Recordon. I now call Mr Jakavonis.

      Mr JAKAVONIS (Lithuania)* – I will speak as an individual, given that my view is not entirely in tune with that of my group.

      I start by thanking Ms Maury Pasquier for the work that she has put into the report. The fact that the Parliamentary Assembly of the Council of Europe has tackled the issue of pharmaceuticals and information is a very good thing, because this subject is of great importance and has been for a while for all our countries. The system for regulating pharmaceuticals is one of the most important parts of our health systems, but several pharmaceuticals that are being sold at a very high price have appeared on the markets in our countries. They are simply not accessible to many of our patients. The pharmaceutical industry is a business like any other. It needs profits, and it is a shame when business considers that ethics and morals are of secondary importance. When pharmaceuticals are produced at the expense of the health of our populations, it is important to monitor the way in which pharmaceuticals are advertised and ensure that we are particularly vigilant in dealing with lobbyists for the pharmaceutical industry, and to regulate so that doctors do not fall into problems relating to conflict of interest. They should follow the Government’s position on procuring medicines; only then will we be able to uphold the interests of ordinary people.

THE PRESIDENT* – Thank you. I call Mr Hunko.

      Mr HUNKO (Germany)* – I congratulate the rapporteur on her excellent report. It is very topical because, as we have heard today, conflicts of interest in the pharmaceutical industry have played an important role in the American election campaign. That is no accident; as our colleague from ALDE said, many medicines are produced in the United States, so the issue is of particular concern there.

      In 2011 this Assembly adopted a very important report on H1N1, or swine fever, which was mentioned by Mr Flynn. At that time we found that the influence of the vaccination industry led to criteria being changed in the World Health Organisation, making it possible to nudge States into buying vast quantities of vaccines. That was anchored in contracts and had a massive influence on local health care. That goes beyond the mere question of the pricing of medicines; it also affects diseases or epidemics.

      I commend the rapporteur for her approach. She says in her introduction that “the underlying philosophy of this report…upholds the principle that in no circumstances should the private interests of the pharmaceutical industry interfere with public health interests.” It is not just a question of pointing the finger at the industry; it is about us as Members of Parliament in our own countries setting the framework to ensure that these things do not happen. We bear responsibility.

      In the last few days I read a book called “Deadly Medicines and Organised Crime” by a Danish professor, Peter Gøtzsche, which won the British Medical Association’s prize last year. It gives many examples from the last few years which give one pause for thought. I want to mention one area, psychiatry, which in the United States is experiencing the greatest growth. In the United States, neuroleptics are now the most frequently prescribed medicines. I do not think that the Americans are madder than any other population, so that could well have something to do with vested interests.

      We have all heard of attention deficit hyperactivity disorder, or ADHD, which in the last few years has been developed as a diagnostic criterion, medicalising the condition and leading to the prescription of all sorts of medicines. The father of ADHD syndrome, an American child psychiatrist called Leon Eisenberg, said in an interview just before he died at the age of 87 that ADHD is a prime example of a made-up condition. That, as well as the other questions that we have discussed, such as whether too much money is being made out of medicines and too much is being claimed in the name of research, is a big problem. It is high time that we looked closely at these matters.

      We should not point the finger at the industry but set the framework so that we can avoid such phenomena being repeated. Whenever such books are published or scandals come to the fore, the industrialists say, “That happened in the past but it couldn’t happen again. We have mechanisms to prevent it.” But as Ms Maury Pasquier points out, self-regulation is not reliable, and she is right to propose legislation.

      THE PRESIDENT* – Thank you. I call Mr Furey, Observer from Canada.

      Mr FUREY (Canada) – I thank the President for the opportunity to participate in this debate on balancing the importance of public health with the interests of the pharmaceutical industry. I thank the rapporteur, Ms Maury Pasquier, for her excellent report on this important matter.

      As noted by the rapporteur, the pharmaceutical industry plays an important role in the public health sector, notably by investing in research and development for new medicines. It also represents an important sector of economic activity. That is true in many Council of Europe member States and also in Canada, where the supervision of the pharmaceutical industry is a responsibility shared between the federal, provincial and territorial governments. The federal government is responsible for authorising the sale of medicines on the basis of their safety, efficacy and quality. The intellectual property regime, which includes the management of pharmaceutical patents, is also a federal responsibility.

      The provincial and territorial governments are responsible for administering and delivering health care, which includes deciding which medicines are covered by the public system. Because they are responsible for the regulation of professional orders, provincial and territorial governments also regulate the scope and standards of practice of health care practitioners. Provincial and territorial regulations aim to prevent undue influence of the pharmaceutical industry over health care practitioners. In 2014, the pharmaceutical industry was responsible for $31 billion in medical expenditure, which represents approximately 16% of total health care expenditure in Canada, second only to health care expenditure after hospital costs.

      Regarding the relationship between the pharmaceutical industry and the health sector, I fully support the resolution calling on the industry to increase its efforts to avoid conflicts of interest, to increase transparency and to co-operate more closely with the public authorities in the health sector. I also support the rapporteur’s conclusion that while a responsible balance must be struck between the industry’s private interests and public health interests, it is paramount that health policies be decided in line with patients’ needs, and public health and safety concerns.

      THE PRESIDENT* – Thank you. The next speaker is Mr Çonkar.

      Mr ÇONKAR (Turkey) – As a result of ageing populations, extended life spans and socioeconomic changes around the world, healthcare is among the most important topics of the 21st century. As the average life expectancy increases, innovative and efficient drugs and new treatments, which can help prevent diseases and reduce treatment costs, become increasingly important. In line with the need for efficient drugs, the pharmaceutical industry has increased its economic value, and its revenue in 2014 was almost $1 trillion. Of course, such volume throws up ethical questions about the relationship between the industry and various actors in the health sector, and there is mutual recognition of the need for regulation. I thank the rapporteur for examining the issue in depth and for presenting concrete recommendations.

      In terms of public health, Turkey has undergone great development, especially in the last 15 years. Our health care transformation programme, implemented in 2014, was accompanied by a social security transformation programme, and led to a major development in public access to health services and treatments. As a result, physician consultations per capita have increased fivefold, and the average life span, having increased by 24% in the last 30 years, has now reached 74 years.

I must stress that none of these developments in my country has been achieved in return for unjust gain by the pharmaceutical industry. Since 2004, legislation on drug prices has been updated with the aim of controlling asymmetrical increases, as affordable prices and sustainable health economics are beneficial both for public health and for firms. Under the new legislation adopted in 2012, the relationship between the industry and health sector professionals is regulated in detail. Meetings and seminars sponsored by drug firms are now registered in a database, and the number of such events that a doctor can attend is limited. Financial transfers such as donations are also registered to monitor and audit relationships in the sector. Such regulations are highly beneficial to the public and should be implemented along with the recommendations highlighted in the report.

THE PRESIDENT* – Thank you, Mr Çonkar. That concludes the list of speakers, but as we have a little time at hand, we could hear further interventions. If any of you wish to take the floor, please give your name. Who wishes to intervene? There are no further calls to speak.

In that case, I call the rapporteur to reply. Ms Maury Pasquier, the floor is yours.

Ms MAURY PASQUIER (France)* – Colleagues and friends, I thank all of you who have taken part in this debate for your comments. As I am sure you have noticed, some of those comments have been diametrically opposed, but it proves what I said at the beginning of my speech: this subject arouses a lot of interest and a lot of passion. I must say at the outset that I am a little surprised by the opposition of the ALDE group, which has been stated quite clearly in this Chamber. I am afraid that that opposition is not really in tune with what happened in the committee; the chair himself will tell you that the report was adopted with unanimous support, and members of the ALDE group were there when the vote took place.

Still, I have two or three replies to comments made in the course of this discussion. First, it has been said that as a number of measures have already been taken, the report is a little out of date. I am happy for those countries where that might be the case, but it is fairly obvious that that is not the case across the board among member States of the Council of Europe. Incidentally, Mr Anand Grover, the special rapporteur of the United Nations responsible for the right of every individual to enjoy the best possible health care, does not feel that it is either. I spoke to him recently and asked, ‘Is this something that is completely obsolete?’ He said, ‘No, far from it. It’s topical.’

If you need any kind of evidence to substantiate the fact that it is topical, I refer you to the media reports in the press of all of our countries. Every single week there is an article. Every single week a problem arises and is discussed in the media; you can read publications and debates that have taken place during the past month. I have heard reports of controversies around hepatitis C medicine and others. Of course, some controversies are a few months or years old. There is also the recent increase by 5 000% of the cost of HIV/AIDS medicine following a takeover by a new company. An intrauterine device was also found in Austria to be in breach of ethical rules of the profession. Such cases and stories arise all the time.

That brings me back to the issue of trust, which is at the heart of my report. At the end of the day, what will allow us to strengthen trust? Is it better for us not to talk about these problems and to sweep them under the carpet, bearing in mind that they are being discussed in public? That would mean no debate on the report; it would mean not tabling the report in the first place. Is that preferable, or is it preferable to list the problems and cases of abuse and then suggest some responses and measures that will allow us to prevent such things from happening again? As far as I am concerned, the second option is the appropriate one. It will help us build trust between patients and our health systems, including the doctors and hospitals that take care of our patients.

It has been remarked that the report criticises the patent-based system. If it really worked properly, more than 10% of medicines would bring about verified therapeutic benefit or real progress, and we would have more medicines to fight orphan and rare diseases, paediatric conditions and all the diseases that affect the populations of southern countries. What can we do? I mentioned earlier that this debate should be taking place within the confines of the World Health Organisation. It must be said that our resources are limited. Within those limits, we can at least make recommendations like those in the report and the resolution, which I hope will be at least a step in the right direction. I do not think we can go much further.

      We have discussed absolute transparency. We can sometimes use concepts when it comes to implementation – it will not be absolute but it might result in improved transparency. Why do I mention transparency? Our regulatory systems must negotiate tariffs and fees. Medicines covered by our health systems are subject to negotiation, thanks to which we can guarantee better accessibility to medicines. The costs of research and development must be transparent.

      I have no objection to companies making a profit, which contributes to growth and employment, but that can become a problem if companies grow to become multinational companies. In this context, I refer you to discussions that have been going on for some years in the United Nations aimed at establishing corporate social responsibility and to the so-called Ruggie principles, which propose an adequate mix of voluntary and state measures to promote environmental responsibility and corporate social responsibility. Our Assembly should support these moves.

      That issue arises when corporations produce products that constitute a public good. A product that improves public health is a public asset and should be funded by the public authorities, but that requires transparency, for which we call in the report.

      It has been suggested that the report implies that physicians are swayed by the pharmaceutical industry’s arguments to promote a particular product or medicine. We underestimate the possible influence of different attitudes, whether it be politicians adopting a particular stance or doctors prescribing drugs. It is not a question of pointing the finger at the industry, but it must be recalled that there has been research, publications, testimonies and surveys of large parts of the population, so we know that politicians and doctors can be influenced. It is easier to fend off that temptation if you are aware of it.

      I should like to reply to Mr le Déaut, the general rapporteur, on the evaluation of technology and science. The report does not mention biosimilar products. In committee I suggested that we reject his amendment and I shall do so again today because we have not discussed the issue. It is not that we do not want to take his arguments on board, but they were not discussed in committee and we preferred to stick with a list of recommendations that is as straightforward as possible. It might be argued, however, that another debate should be held on the proposal.

      The report does not cover therapeutic practices, therapeutic evaluation or person-centred treatments. We tried to concentrate on what was essential and I hope we succeeded. Having listened to you, I believe we were broadly successful.

      We discussed in committee yesterday a 2009 report from the special rapporteur of the United Nations on the right to health. States are obliged to ensure that medicines are available, accessible, affordable and can be obtained without discrimination. Developed countries should take measures to ensure that the right to health is fully exercised by everyone. That should be done through assistance and international co-operation.

      Those are the salient points to which I wanted to draw attention because they are the premise for my report and my proposals. Thank you for your support.

      The PRESIDENT* – Thank you, Ms Maury Pasquier. I understand that the chairperson of the committee wishes to intervene. I call Mr Ghiletchi.

      Mr GHILETCHI (Republic of Moldova) – I should like to deal with three items in the report.

      I assure members that the committee did its best to produce a balanced report, as we usually do. We had hearings with experts representing different spheres, including the pharmaceutical industry and public health bodies. Ms Maury Pasquier demonstrated great commitment and was open to discussion of the report’s contents.

      We discussed the title of the report a couple of times to ensure it achieved balance. Our initial title implied that the pharmaceutical industry does not do a good job, so we proposed the title that is before you.

      I accept the criticism that has been expressed today, but I must disagree slightly with the opinion of the ALDE group because the report was unanimously supported in committee. Today and in Paris there has been only one amendment. If members felt that the report should be more balanced they had the opportunity to propose amendments and express opinions in committee.

      As I said, we tried, as always, to produce a balanced report. This is not an easy subject to deal with and Ms Maury Pasquier made it clear that it does not attack the pharmaceutical industry, but we must admit that there are conflicts of interests. It is not, as Ms De Sutter said, easy to deal with them. That said, I do not agree with her rhetorical question in which she implied that everyone has a conflict of interest. We need more transparency, and even if the line is very thin, we must draw one.

      Why do want to avoid conflicts of interest? We want to ensure that public health is protected. When we speak of public health I have in mind the health of our citizens – public health is a general term – and we must ensure that our citizens’ health is taken care of. The primacy of public health is very important.

      The pursuit of happiness is an ideal that drives humanity, and one of the preconditions is to be healthy. We must ensure that our fellow citizens enjoy healthy lives.

      In my country of Moldova, as in other countries, we have common greetings and wishes, and we say in Romanian pace şi sănătate – peace and health. We want peace and health in our European States, so it is important that members vote for the draft resolution.

      THE PRESIDENT* – The debate is closed.

The committee has presented a draft resolution to which one amendment has been tabled.

I call Mr Le Déaut to move the amendment.

Mr LE DÉAUT (France)* – I had thought that we were going to go further with biosimilars, which are the equivalent of generics for biotechnologies, but the rapporteur said it might be preferable to do that in a subsequent report. That was not my point of view but I take note of what she said, so I shall not move the amendment.

THE PRESIDENT* – Amendment 1 is not moved. There are no other amendments.

We will now proceed to vote on the draft resolution contained in Document 13869.

The vote is open.

I remind members that the ballots to elect judges to the European Court of Human Rights and for the election of the Secretary General of the Parliamentary Assembly are still open. They will be suspended at 1 p.m., resume at 3.30 p.m. and close at 5 p.m. Those who have not yet voted may still do so by going to the area behind the President’s chair. I hope to announce the results of the elections before the end of the sitting this afternoon.

4. Change to the timing of the sitting and modification of the agenda

THE PRESIDENT* – I wish to propose a reorganisation of today’s business.

Given the large number of speakers registered for this afternoon’s debates on migration and the fact that 50 amendments have been tabled to the reports “After Dublin – the urgent need for a real European asylum system” and “Countries of transit: meeting new migration and asylum challenges”, we will be very short of time.

More than 110 members have registered to speak. If we change nothing, we will only be able to hear about 40 of them. In order that more colleagues can speak on these important subjects, I propose, first, to extend this afternoon’s sitting to 9 p.m. That will allow us to hear about 10 extra speakers.

I also propose to defer the debate on amendments and the votes on the draft resolution and draft recommendation to Thursday afternoon, as the first item on the agenda. That would bring the number of speakers whom we could hear in the general discussion to about 80 out of 110 who registered. Because of the importance of the subject matter, it is opportune to allow the general debate to take place untrammelled.

Does the Assembly agree to extend this afternoon’s sitting until 9 p.m.?

I call Mr Binley on a point of order.

Mr BINLEY (United Kingdom) – Many of us make our plans on the basis of the agenda as distributed to us before we come to the meeting. When you make changes of this import and size, you mess those plans up. I had wanted to be here for this debate and now I cannot be because of your changes. I find that unacceptable and ask that you review that decision.

THE PRESIDENT* – I understand, but I have to put the questions so that the Assembly can decide.

The proposal is to extend the sitting until 9 p.m. Are there any objections? That is not the case.

The proposal to extend the sitting to 9 p.m. is agreed to.

The second proposal is to postpone discussion and voting on the amendments to Thursday afternoon. Are there any objections? There is an objection, so I will now put the proposal to the vote. I remind members that modification of the agenda requires a two-thirds majority.

Does anyone wish to speak against the proposed change? I call Ms Strik.

Ms STRIK (Netherlands) – One of the reports is mine and it is impossible for me to be here on Thursday afternoon. I cannot reply on the amendments. I could write something down but it is completely different if you can take part yourself as an adviser. It is not good to have a debate with many contributions on the amendments but then separate the debate from the voting, which becomes merely a procedural matter and no longer an integral part of the debate.

      THE PRESIDENT* – We will now proceed to vote on the proposal to change the agenda.

The vote is open.

The proposal is rejected, with 32 votes for, 91 votes against and 14 abstentions.

The proposal has been rejected, so the sitting this afternoon will continue until 9 p.m., including the votes.

(Ms Brasseur, President of the Assembly, took the Chair in place of Mr Rouquet)

4. Address by His Royal Highness the Grand Duke of Luxembourg

THE PRESIDENT* – Your royal highnesses, it is a great honour for me to welcome you to our palace, which is known as the Palais de l’Europe – the house of human rights, democracy and the rule of law. I would like personally to add that welcoming you here is a moving experience, as a member of the Luxembourg Parliament.

Sir, I thank you for having kindly accepted our invitation to address the Assembly at a time when the Grand Duchy of Luxembourg holds the presidency of the European Union. When you addressed the Assembly 13 years ago, during Luxembourg’s chairmanship of the Committee of Ministers of the Council of Europe, you rightly noted the complementarity of the two institutions. Your presence today reinforces that aspect of our complementarity.

The challenges facing us today are bigger than ever: the conflict in Ukraine, terrorist threats, not to mention the migrant crisis, combined with rising intolerance, racism and xenophobia. No State can face up to those challenges alone. We must find responses based on responsibility and solidarity. Madame, I thank you for your unfailing commitment to the humanitarian cause in your work as president of the Luxembourg Red Cross and as a UNESCO good will ambassador, and in your support for the development of microcredit.

      I have the great pleasure of welcoming my successor as President of the Luxembourg Parliament, Mr Mars Di Bartolomeo. I also welcome Ms Corinne Cahen, the minister for family affairs, who with commitment and competence, in her capacity as minister for integration, is responsible for the reception of migrants.

      Your Royal Highnesses, Mr President and Minister, I can say without any false modesty that the Grand Duchy is well represented at the Council of Europe. Mr Dean Spielmann, president of the European Court of Human Rights—the most important part of the Council of Europe—will address our Assembly tomorrow. We also welcome Ambassador Michèle Eisenbarth and Ms Mireille Paulus, the secretary of the Committee of Ministers. I am particularly delighted to welcome representatives of Luxembourg’s youth parliament to the public gallery.

      I will now say a few words in my mother tongue, Luxembourgish—I thank the interpreters for their invaluable assistance. Your Royal Highnesses, your presence today offers me encouragement and support in the accomplishment of my mission as President of this Assembly, which is composed of 318 parliamentarians from 47 countries representing 820 million citizens. Mr President of the Luxembourg Chamber of Deputies, I thank both you and our fellow parliamentarians for indulging my frequent absences from parliament, which has allowed me to carry out my duties at the Council of Europe, where it is a great honour for me to represent our parliament.

      Without further delay, I now have the great pleasure of asking His Royal Highness to address the Assembly.

HIS ROYAL HIGHNESS THE GRAND DUKE OF LUXEMBOURG* – Madame President—dear Ms Brasseur—the Grand Duchess and I wish to express our deep gratitude for such a warm reception and your cordial words of welcome.

      Madame President, Mr Secretary General, distinguished members of the Parliamentary Assembly, Excellencies, ladies and gentlemen, it is a great honour for me to address the elected representatives of more than 800 million inhabitants of a continent that extends from the Atlantic to the Urals, and beyond. That honour is accompanied by great pride, because I am called to address familiar faces that occupy prestigious positions. For those who may be concerned about the place taken by my compatriots in the institutions of the Council of Europe, I hasten to add that the situation is soon to end because both Ms Brasseur and Judge Spielmann will be terminating their missions, having given the best of themselves to the benefit of the general interest. I thank them from the bottom of my heart. To those who might congratulate themselves on those changes, I respond, slightly maliciously, by saying that Luxembourg also has the presidency of the Council of the European Union for the present semester. However, the legitimate satisfaction that we may feel as Luxembourgers carries little weight compared with the load of responsibility that some of our compatriots have to bear.

      The troubling times in which we live call for virtues such as service towards others, altruism and abnegation. It is not a time for celebrating individual glories. Although our government and its administrations have invested considerably in preparing a programme for a presidency centred on the European Union working, first, for the wellbeing of its citizens, the sudden refugee and migrant crisis has caused upheaval in political agendas. The ongoing flow of refugees fleeing war, massacre or insalubrious camps is deeply destabilising for all those who exercise responsibilities and for public opinion. Urgency bids us to act fast. The magnitude of the phenomenon obliges us to find common solutions together. What is at stake requires us to act beyond the instant situation in order to address the roots of the problem, and the challenges are considerable.

      I will not describe a problem that is difficult to grasp because of its great complexity. Instead, I will limit myself to two comments. First, I note that, after having for centuries been a land of emigration, our continent is now called upon to attract immigration in the coming decades if it does not want to experience inevitable demographic, and then economic, decline. Many countries, whose representatives I acknowledge today, will in the coming years undergo a decline in population, which in some cases may be considerable—even reaching 25%. As with economic deflation, the downward trend in demography will entail disastrous consequences. Only the contribution of new populations might lessen that effect. Each state, pursuant to its history or geography, has its own preconceptions of immigration, with more or less voluntarist policies, but that does not alter the fundamental facts.

      Secondly, the refugee crisis reveals Europe’s extraordinary capacity for solidarity while remaining faithful to our common heritage. We should co-operate more closely in times of difficulty and crisis to show that what binds us is far more important than what may divide us. We should establish a path towards the genuine community of destiny that we aspire to obtain for our continent. Responses to the migrant crisis concern us all, well beyond the limits of the European Union, which is why the Parliamentary Assembly of the Council of Europe is the apposite venue to debate the matter. All member States of the Council of Europe, who are also faithful partners of the European Union, must contribute to the resolution of the immediate challenges, as well as contributing more sustainable solutions. The question is not only one of effectiveness but of principle. Indeed, the values of the Council of Europe are the fundamental guide of our action. It is important that, in the present context, Secretary General Jagland calls a series of councils among the 47 member States of the Council of Europe on the treatment of migrants and asylum seekers with a view to guaranteeing the respect of their human rights.

Let us not forget that the refugees used to live a peaceful and often comfortable life before civil war drove them to abandon everything and take to the road, buffeted by fate. When people face such distress, our moral and legal duty is to treat them with respect and dignity. The fear of the alien is the worst of enemies. Refugees are people just like us. The values that we defend may not ebb and flow according to the circumstances. It is for that precise reason that they have been elevated into principles.

      Madame President and distinguished members of the Parliamentary Assembly, Europe is known throughout the world as the fatherland of humanism. Humanism is the 1 000-year-old fruit of our Greco-Latin civilisation and our Judeo-Christian roots. Democracy, human rights and the rule of law are their contemporary and legal expression. That triptych is at the basis of the actions of the Council of Europe and provides its patent of nobility.

      In 2002, when I addressed your eminent Assembly, I said: “What I find most attractive in the Council’s approach is its faith in the future and its obstinate belief in what is best in human beings. The oldest political organisation on our continent steers clear of the purely spectacular and carries on quietly working for the common good. It has been doing so with considerable patience and perseverance, and with all the qualities of a builder, for more than fifty years. Its assets are persuasion, dialogue, co-operation and assistance.” Those sentences have preserved all their pertinence.

      Today, as yesterday, Luxembourg wishes to be an exemplary partner within the Council of Europe. Its values echo within our country due to our tormented history. Our inhabitants feel deep within them what the respect for democratic principles, the rule of law and human rights has contributed to the country. We, too, intend to strengthen those three pillars in our present and future action within these institutions.

We can contribute what is unique to us. First, there is our openness to others, which has been proven by our capacity to integrate tens of thousands of immigrants and political refugees over decades. That has led to our often being considered a laboratory for a new Europe. Next, there is our plurilingualism – an old advantage that is still valuable in a continent where the learning of the languages of neighbouring countries progresses slowly.

We accept our role seriously and with humility. Thus, the judgments of the European Court of Human Rights have led to fundamental changes in our legislation, such as when we reshaped our administrative courts. Likewise, the monitoring reports of the Council of Europe receive all our attention.

To seek to be a deserving pupil is to have the capacity to listen and learn in order to make progress. It is not about having knowledge, but about being ready to change. Since we have to make fundamental principles tally with moving realities, that can guide us in the best attitude to adopt in constructing the Europe of the future. The value of your actions, distinguished members of the Parliamentary Assembly, emanates from exchange and discussion, which ultimately lead to new ideas. The priority is not to be right, but to reason together and engage in dialogue, so as to move forward.

      In 2014, in this very place, Pope Francis expressed the wish that our continent, in rediscovering its historical heritage and the depth of its roots, should return to the youthful spirit that made it so fertile and great. That is the finest objective that there can be for our old Europe; it must surrender its weapons. I hope that your institution and the Assembly will contribute to the radiance of a Europe that is ever young and always ready to reinvent itself. That ambition we owe to ourselves and to the rest of the world.

      The PRESIDENT* – Thank you very much for your words of support for our actions, and for your personal undertaking to uphold the values of the Council of Europe. I recall, in particular, the strong passage in your speech on the challenge of migration that awaits us. We must work on it together because human dignity is at stake. We must take that message to our national parliaments in order to find solutions and concrete actions. We thank you infinitely for that.

      His Royal Highness has agreed to respond to questions from the leaders of the political groups. The first speaker is Mr Agramunt on behalf of the Group of the European People’s Party.

      Mr AGRAMUNT (Spain)* – Your Royal Highness, I congratulate you on your anniversary as Grand Duke of Luxembourg. You referred to the crisis of refugees in Europe that we have seen over recent months. That phenomenon has gained the attention of European society and European leaders. As you are the head of State of a member State of the European Union, the Grand Duchy of Luxembourg, may I ask how your country is coping with the integration of all the people who are coming from Syria, Iraq and Afghanistan?

      THE GRAND DUKE OF LUXEMBOURG* – Thank you for your congratulations. Fifteen years is quite some time!

      If I may, I will put your question in the historical context in Luxembourg, so that you can understand the position of my country vis-à-vis the refugees that we are witnessing today. In the 19th century, the Grand Duchy of Luxembourg was a very poor country and there was a great flow of emigration. Almost a third of the population left the Grand Duchy to go to the United States of America or Brazil. In all, 60 000 people left. America was the continent that attracted the greatest number of migrants. The issue of migration has not arisen recently; we have had the phenomenon for hundreds of years, possibly more. We must recall that Europe used to be a continent of enormous emigration. At the time, we considered ourselves fortunate to find a country of shelter and asylum such as the United States of America.

With industrialisation, we found minerals and iron in particular in the southern part of the country. As a result, the migratory flow – the demographic curve – fluctuated and we experienced the opposite trend: we had waves of immigration to our country.

      First, Italians came to work in our mines. Our delegation today includes Mr Mars Di Bartolomeo, who is the Speaker of the Luxembourg Chamber of Deputies, and he is living proof of that wave of immigration from Italy at the beginning of the previous century. Italians came to work in our steelworks and mines. A second wave of immigration was Portuguese. We now have about 100 000 citizens of Portuguese extraction in the Grand Duchy of Luxembourg, which represents almost a fifth of our population. In the 1990s a further wave of immigration came from the Balkans, this time around as a consequence of war there. Several tens of thousands of refugees from the former Yugoslavia were welcomed to our country. Today 49% of the population resident in the Grand Duchy of Luxembourg are foreign. In addition, 160 000 border workers cross the borders to work in the Grand Duchy every day.

      In other words, we have experience of immigration and of integration. As far as I am concerned, social cohesion is one of the most essential issues to settle. How do you organise integration? You do it through schools, language or languages, employment and jobs, and acquisition of nationality in the host country. For some years now we have had a law that allows for dual citizenship, or dual nationality, once someone has been resident in the country for seven years. So as things stand we have a lot of experience of integration, which is why we can welcome the new wave of refugees into our country. I am very proud of my country, of our political authorities and of our people, because they have welcomed the refugees with open arms. The new wave of migrants have come from parts of the world with difficult economic situations and terrible conditions of war. We have welcomed them with open arms.

      How do we organise their reception? Here I pay tribute to our minister for integration and family affairs – madame, you are present in the Chamber – because you have worked unstintingly to find solutions. Many municipalities and communes in our country have opened multi-purpose centres to allow refugees to find at least a temporary place of abode and to provide them with assistance and the welcoming warmth that our country wants to give them.

      Finally, in our experience immigrants are often highly motivated people. They want to do well and they work extremely hard. In fact, some children have arrived in our country and they work really well at school – they work hard and acquire new languages quickly. In addition, it is a real cultural asset for Luxembourg to have these people with us. Luxembourg would not be the developed economy that it is today if we did not have this contribution and effort by all the immigrants who have come to our country. Thanks to the influx, our population, which now comes from the whole rest of the world, is one of the youngest populations in Europe. We are very young and among the most dynamic. I want to make it clear that we should not be afraid of those who come from outside our borders; they are an asset of value for all of us.

      The PRESIDENT* – Thank you very much, Your Highness. I now call Mr Gross, who will speak on behalf of the Socialist Group.

      Mr GROSS* (Switzerland) – Good afternoon, Your Highness. I thank you for the opportunity and I ask you to explain to us republicans why we have a monarchy in our democratic era?

      THE GRAND DUKE OF LUXEMBOURG – Thank you for that question. I point out that you come from Switzerland, which is one of the oldest republics in the world, so I understand the legitimacy of your question – or I almost understand it. You are, however, putting me in a slightly embarrassing position, because I am both judge and defendant. I will certainly not defend monarchy, because I am at the centre of the system, but I will make one or two comments on your question.

      Some republican regimes are democratic, but others are not. Some monarchies are democratic, but others are not. In Europe we have about 10 monarchies, which is quite a big figure, but they are all constitutional or parliamentary monarchies. At least in Europe, we cannot separate the idea of monarch from the idea of democracy; on the contrary, they tend to go together and can be combined well. You can ask the Luxemburgers present in the Chamber, but I think they will say that the system works.

      In addition, look at where democracy comes from. Who is the mother of democracy? England. What is England, the United Kingdom? It is a monarchy. I do not see that there is any problem there. Secondly, to come back to Luxembourg, my grandmother was supported in a plebiscite. In a referendum, there was 90% support for Luxembourg as a Grand Duchy, so she had a democratic basis for her position. One more example is in Spain. What did the King do when there was a military coup? He kept the democratic institutions – so monarchy can defend institutions in a democracy. That is my answer to your question.

      The PRESIDENT* – Thank you, sir, for your reply. You said that you were both judge and defendant. If one accepts a mandate in the Assembly, one has always to declare a conflict of interest, so you have complied with the recommendations for our members.

      I now call Mr Xuclà, who will speak on behalf of the Alliance of Liberals and Democrats for Europe.

      Mr XUCLÀ (Spain) – Sir, I wish to welcome you on behalf of the Liberal group of the Parliamentary Assembly. Luxembourg’s affairs are now directed by a Liberal prime minister, so I welcome you to this home of the defence of human rights and democracy. As you said, the deep, tranquil force of Europe is creating this pan-European institution that goes beyond the 28 members of the European Union to reach 47 member States.

      Your country is an example of plurilingualism. You have your own language, but the President, Mrs Brasseur, spoke in her opening address in her own language and you are fluent in French and German. Luxembourg is an example of how a country can be governed with different languages. The university of Luxembourg, for many years directed by a good friend of mine, Professor Tarrach, also constitutes an example of how that is possible. Will you tell us how we could extend plurilingualism in our other European States?

THE GRAND DUKE OF LUXEMBOURG * – This is a fascinating question, especially when we are building up the European Union and exchanges between us are becoming increasingly important. I shall begin by telling you a little story that is rather symptomatic. A few years ago, perhaps even 25 years ago, President Mitterrand came on a State visit to Luxembourg. At the gala dinner I was seated next to a minister in the Mitterrand government – I shall not mention the person’s name. We spoke about education and language. I explained to him the rather particular situation of Luxembourg and how we called upon children at a very young age to listen to different languages, which allowed them to learn languages far more easily. The French minister responded, “You know, French people are totally unable to learn a language other than French; it’s impossible for them”. I said, “That is not possible. Why should Luxembourgers be more intelligent than the French?” He did not much appreciate that reply.

      The story shows that, in the mentalities of some of our countries, people perhaps do not have access to the possibility of imagining that they can be capable of learning a new language. In Luxembourg we are obliged, perforce because of our size, to learn at least the languages of our neighbours, German and French, alongside Luxembourgish, which is our national language. To this we add a fourth language, English, the international language. I shall give you a family example. My spouse here speaks six languages fluently, I speak only four, our children speak five to six languages, and this is perfectly normal. In Luxembourg we constantly move from one language to another during the day: we read and speak in German, then in French and then English. These are the mental gymnastics that we have learnt.

      Luxembourg has always supported the initiatives of the Council of Europe in the field of languages. I also believe that linguistic diversity in Europe is very important; you, as a Spaniard and as a Catalan, know what that represents. It is part of culture. I believe that our brains are sufficiently supple and intelligent to allow us to learn at least one or two extra languages, and we will increasingly do so in future. We are going to see ministries of national education in Europe looking increasingly into this matter. We can also see that parents are interested in their children learning foreign languages. This is important for communication in Europe.

      THE PRESIDENT * – Thank you. I call Mr Chope on behalf of the Conservative Group.

      Mr CHOPE (United Kingdom) – Madame President, on behalf of the European Conservative Group I thank His Royal Highness for his speech and his very full answers to these questions. He has demonstrated the benefit of requiring seven days’ advance notice of questions. Our question is this: does His Royal Highness agree that keeping a strong sense of national identity within the individual countries that belong to the Council of Europe is fundamental to ensuring the future security and democracy of our continent, and how is this to be achieved?

      THE GRAND DUKE – Thank you very much. Yes, I have to prepare for seven days to answer these kinds of questions!

      (The Grand Duke continued in French.)

      In my view, democratic security in Europe is first and foremost a collective effort and a shared responsibility between the member States of the Council of Europe. National identity, however, is a positive notion when it comes to culture, language or tradition. There is nothing finer than cultural diversity in Europe and we are fortunate to have it; each country is so different. Take Great Britain. It is different from Luxembourg or Italy, but what a tremendous asset it is. We absolutely must seek to preserve this cultural diversity as there is no doubt that it constitutes the value of our continent, but we have common values too, and that is where we have to be firm. These values are the values of the Council of Europe – democracy, the rule of law and human rights, which constitute the three pillars of the Council – and these comprise the acquis, which in my view is undoubted. We have to work together in order that these values be shared by all the 47 countries of the Council of Europe.

      THE PRESIDENT * – Thank you. I call Mr Kox, the leader of the Group of the Unified European Left.

      Mr KOX (Netherlands) – Madame President, it is true that we sent our questions in writing in advance. That is not our normal procedure but, coming from the Netherlands, I am aware that being the head of State of a constitutional monarchy and a parliamentary democracy is not the easiest job on earth, so I appreciate very much that the Grand Duke is answering our questions. I hope that in the near future the Queen of Great Britain will come and address our Assembly under the same conditions.

      My question is as follows: since the fall of the Iron Curtain, the strength of the Council of Europe and its Parliamentary Assembly has always been the membership of nearly all the European countries, from small countries such as Luxembourg and the Netherlands to the big ones: Russia, Ukraine, Turkey and the United Kingdom. Since the outbreak of the conflict in Ukraine, however, relations here with the parliament of Russia have been put on hold, while in the United Kingdom in recent years there has been growing criticism of the functioning of the European Court of Human Rights. Meanwhile, countries such as Azerbaijan refuse to implement the Court’s verdicts. Also, we have recently seen that in Ukraine part of the European Convention on Human Rights has been put on hold. How do you, as the head of a State that was a founding member of the Council of Europe, envisage the chances of overcoming this growing divide among the Council of Europe member States? How might we rebuild the Council’s strength in the near future?

      THE GRAND DUKE * – If I may, I shall answer your question by drawing an analogy. I cannot really enter into the detail of all the debates and the Council of Europe’s difficulties vis-à-vis some of the member States. I am sure that you will understand my predicament.

      It seems to me that the Council of Europe should be seen as a big family. What happens in a family? In a family, sometimes its members behave in a way that is perhaps not entirely appropriate - they distance themselves and depart from the general rules that normally apply within a family, or argue with other members of the family. Within a family, you have the father and the mother, and the parents should always make sure that a dialogue is maintained with the person who might be acting differently under particular circumstances. Dialogue is essential if you want to preserve family unity.

Why is it, at the end of the day, that we set up these major international organisations, whether it is the United Nations, the European Union or the Council of Europe? The first reason was to maintain peace. Think of the United Nations, for instance. It is an enormous structure – absolutely gigantic – and yet it is essential because it means we have diplomacy behind the scenes. This behind-the-scenes diplomacy is often far more important than what happens within a debating chamber such as this one. Dialogue is essential, be it within a family or elsewhere. I would argue that we should always do our utmost to find a place where we can come together and exchange our points of view. In fact, I spoke to Madame Brasseur about this earlier. She has been extraordinary because she really has tried to reach out to countries that are having problems, to meet their leaders, and to come up with options for a compromise.

      Be that as it may, the Council of Europe has a moral authority, and that is key – essential. It is backed up by its legal arm, the European Court of Human Rights. These two components make your Organisation a very strong institution. Very often, not necessarily always, little by little, step by step, you are able to bring back into the fold the countries that have departed somewhat from the common ground. How long did it take us to become democrats? These countries have to be afforded a little bit of time so as to make sure that they can really anchor this culture of democracy properly. It is very important for them, too, to be here in the Council of Europe in order to learn everything that democracy has given us.

      THE PRESIDENT* – Sir, thank you for having responded to the questions of Assembly members. Yes, Mr Chope, they were framed ahead of time, but we have the good fortune to have a representative of a monarchy who was kind enough to respond to them. I would like to reiterate Mr Kox’s invitation of the Queen of England to come here to respond to our questions. Sir, I thank you for your speech and for the manner in which you responded to the questions. To conclude, I would like to say something in Luxembourgish, which you all understand – villmols merci.

      The ballot for electing the judge in respect of the Slovak Republic to the European Court of Human Rights and the ballot for electing the Secretary General to the Parliamentary Assembly are now suspended until this afternoon’s sitting.

      Voting will reopen at 3.30 p.m and close at 5 p.m.

5. Next public business

      THE PRESIDENT* – The Assembly will hold its next public sitting this afternoon at 3.30 p.m. with the agenda which was approved on Monday morning.

      The sitting is adjourned.

      The sitting was closed at 12.55 p.m.

CONTENTS

1. Election of judges to the European Court of Human Rights and the Secretary General of the Parliamentary Assembly

2. Public health and the interests of the pharmaceutical industry: how to guarantee the primacy of public health interests

Presentation by Ms Maury Pasquier of report, Document 13869, on behalf of the Social Affairs, Health and Sustainable Development Committee

Speakers:

Ms Kyriakides (Cyprus)

Mr Destexhe (Belgium)

Lady Eccles (United Kingdom)

Mr Jónasson (Iceland)

Ms Bonet Perot (Andorra)

Ms Blondin (France)

Mrs Dalloz (France)

Mr Flynn (United Kingdom)

Ms Kalmari (Finland)

Mr Le Dėaut (France)

Mr Abad (France)

Mr Wold (Norway)

Ms De Sutter (Belgium)

Mr Recordon (Switzerland)

Mr Javakonis (Lithuania)

Mr Hunko (Germany)

Mr Furey (Canada)

Mr Çonkar (Turkey)

Mr Ghiletchi (Republic of Moldova)

Draft resolution contained in Document 13869 adopted.

3. Change to the timing of the sitting and modification of the agenda

4. Address by His Royal Highness the Grand Duke of Luxembourg

Questions: Mr Agramunt, Mr Gross, Mr Xuclà, Mr Chope, Mr Kox

5. Next public business

Appendix I

Representatives or Substitutes who signed the Attendance Register in accordance with Rule 11.2 of the Rules of Procedure. The names of Substitutes who replaced absent Representatives are printed in small letters. The names of those who were absent or apologised for absence are followed by an asterisk

Pedro AGRAMUNT

Alexey Ivanovich ALEKSANDROV*

Brigitte ALLAIN/Pascale Crozon

Jean-Charles ALLAVENA*

Werner AMON*

Luise AMTSBERG*

Athanasia ANAGNOSTOPOULOU*

Lord Donald ANDERSON

Paride ANDREOLI

Sirkka-Liisa ANTTILA

Ben-Oni ARDELEAN*

Khadija ARIB

Volodymyr ARIEV

Anna ASCANI*

Egemen BAĞIŞ/Ahmet Berat Çonkar

Theodora BAKOYANNIS*

David BAKRADZE

Gérard BAPT/Jean-Claude Frécon

Doris BARNETT*

José Manuel BARREIRO/Ángel Pintado

Deniz BAYKAL

Marieluise BECK*

Ondřej BENEŠIK/Jana Fischerová

José María BENEYTO*

Levan BERDZENISHVILI

Deborah BERGAMINI/Giuseppe Galati

Sali BERISHA*

Anna Maria BERNINI/Claudio Fazzone

Maria Teresa BERTUZZI*

Andris BĒRZINŠ

Gülsün BİLGEHAN

Brian BINLEY

Ľuboš BLAHA/Darina Gabániová

Philippe BLANCHART

Maryvonne BLONDIN

Tilde BORK

Olga BORZOVA*

Mladen BOSIĆ

António BRAGA

Anne BRASSEUR/Marc Spautz

Piet De BRUYN/Petra De Sutter

Beata BUBLEWICZ/Iwona Guzowska

Gerold BÜCHEL*

André BUGNON

Natalia BURYKINA*

Nunzia CATALFO*

Elena CENTEMERO

Irakli CHIKOVANI

Vannino CHITI*

Christopher CHOPE

Lise CHRISTOFFERSEN

Henryk CIOCH/Marek Borowski

James CLAPPISON

Igor CORMAN/Valentina Buliga

Telmo CORREIA*

Paolo CORSINI

Carlos COSTA NEVES*

Celeste COSTANTINO/Ferdinando Aiello

Yves CRUCHTEN

Zsolt CSENGER-ZALÁN

Katalin CSÖBÖR

Joseph DEBONO GRECH

Reha DENEMEÇ

Renata DESKOSKA*

Alain DESTEXHE

Manlio DI STEFANO*

Arcadio DÍAZ TEJERA

Peter van DIJK

Şaban DİŞLİ

Sergio DIVINA*

Aleksandra DJUROVIĆ

Namik DOKLE

Elvira DROBINSKI-WEIß/Gabriela Heinrich

Daphné DUMERY

- Alexander [The Earl of] DUNDEE*

Nicole DURANTON

Josette DURRIEU

Mustafa DZHEMILIEV*

Mikuláš DZURINDA/Helena Mezenská

Lady Diana ECCLES

Tülin ERKAL KARA

Franz Leonhard EßL

Samvel FARMANYAN

Joseph FENECH ADAMI

Cătălin Daniel FENECHIU

Vyacheslav FETISOV*

Doris FIALA/Eric Voruz

Daniela FLIPIOVÁ*

Ute FINCKH-KRÄMER

Axel E. FISCHER

Gvozden Srećko FLEGO

Bernard FOURNIER

Hans FRANKEN

Béatrice FRESKO-ROLFO

Martin FRONC

Sir Roger GALE

Adele GAMBARO*

Karl GARÐARSSON

Iryna GERASHCHENKO*

Tina GHASEMI

Valeriu GHILETCHI

Francesco Maria GIRO

Pavol GOGA

Carlos Alberto GONÇALVES

Mustafa Sait GÖNEN*

Alina Ștefania GORGHIU*

Svetlana GORYACHEVA*

Sylvie GOY-CHAVENT

Fred de GRAAF/ Tuur Elzinga

François GROSDIDIER/Damien Abad

Andreas GROSS

Dzhema GROZDANOVA

Mehmet Kasim GÜLPINAR/ Ali Şahin

Gergely GULYÁS/Mónika Bartos

Jonas GUNNARSSON

Nazmi GÜR*

Antonio GUTIÉRREZ

Maria GUZENINA/Susanna Huovinen

Márton GYÖNGYÖSI

Sabir HAJIYEV

Alfred HEER Maximilian Reimann

Michael HENNRICH/Bernd Fabritius

Martin HENRIKSEN

Françoise HETTO-GAASCH

Oleksii HONCHARENKO/Vladyslav Golub

Jim HOOD/David Crausby

Anette HÜBINGER

Johannes HÜBNER

Andrej HUNKO

Ali HUSEYNLI/Sahiba Gafarova

Rafael HUSEYNOV

Vitaly IGNATENKO*

Ekmeleddin Mehmet İHSANOĞLU

Florin IORDACHE/Daniel Florea

Tadeusz IWIŃSKI

Denis JACQUAT/Jacques Legendre

Gedimnas JAKAVONIS

Gordan JANDROKOVIĆ*

Tedo JAPARIDZE/Zviad Kvatchantiradze

Michael Aastrup JENSEN

Mogens JENSEN

Frank J. JENSSEN*

Florina-Ruxandra JIPA*

Ögmundur JÓNASSON

Aleksandar JOVIČIĆ/Dejan Kovačević

Josip JURATOVIC*

Anne KALMARI

Mustafa KARADAYI/Hamid Hamid

Marietta KARAMANLI/Marie-Christine Dalloz

Niklas KARLSSON/Eva-Lena Jansson

Vasiliki KATRIVANOU*

Ioanneta KAVVADIA*

Danail KIRILOV*

Bogdan KLICH/Helena Hatka

Manana KOBAKHIDZE

Haluk KOÇ/Metin Lütfü Baydar

Igor KOLMAN*

Željko KOMŠIĆ

Unnur Brá KONRÁÐSDÓTTIR/Brynjar Níelsson

Ksenija KORENJAK KRAMAR

Attila KORODI

Alev KORUN/Andreas Schieder

Rom KOSTŘICA/Gabriela Pecková

Elvira KOVÁCS

Tiny KOX

Borjana KRIŠTO

Julia KRONLID/Johan Nissinen

Eerik-Niiles KROSS*

Marek KRZĄKAŁA/Killion Munyama

Ertuğrul KÜRKÇÜ

Athina KYRIAKIDOU/Stella Kyriakides

Serhiy LABAZIUK*

Inese LAIZĀNE

Olof LAVESSON

Pierre-Yves LE BORGN’

Jean-Yves LE DÉAUT

Igor LEBEDEV*

Valentina LESKAJ

Terry LEYDEN

Inese LĪBIŅA-EGNERE

Georgii LOGVYNSKYI

François LONCLE*

George LOUKAIDES

Yuliya L’OVOCHKINA

Philippe MAHOUX

Thierry MARIANI*

Soňa MARKOVÁ/Pavel Holík

Milica MARKOVIĆ

Meritxell MATEU PI

Ana MATO

Frano MATUŠIĆ

Liliane MAURY PASQUIER

Michael McNAMARA*

Sir Alan MEALE*

Ermira MEHMETI DEVAJA*

Evangelos MEIMARAKIS/Liana Kanelli

Ivan MELNIKOV*

Ana Catarina MENDES*

Attila MESTERHÁZY

Jean-Claude MIGNON

Olivia MITCHELL

Igor MOROZOV*

João Bosco MOTA AMARAL

Arkadiusz MULARCZYK

Melita MULIĆ*

Oľga NACHTMANNOVÁ

Hermine NAGHDALYAN/Naira Karapetyan

Piotr NAIMSKI

Sergey NARYSHKIN*

Marian NEACȘU*

Andrei NEGUTA

Zsolt NÉMETH*

Miroslav NENUTIL

Baroness Emma NICHOLSON*

Michele NICOLETTI

Aleksandar NIKOLOSKI

Julia OBERMEIER*

Marija OBRADOVIĆ

Žarko OBRADOVIĆ

Judith OEHRI

Carina OHLSSON/Lotta Johnsson Fornarve

Joseph O’REILLY

Maciej ORZECHOWSKI/Michal Stuligrosz

Sandra OSBORNE/Joe Benton

Tom PACKALÉN*

José Ignacio PALACIOS

Liliana PALIHOVICI

Judith PALLARÉS CORTÉS

Ganira PASHAYEVA*

Florin Costin PÂSLARU

Waldemar PAWLAK/Jan Rzymełka

Jaana PELKONEN

Vladimir PLIGIN*

Cezar Florin PREDA*

John PRESCOTT

Gabino PUCHE

Alexey PUSHKOV*

Lia QUARTAPELLE PROCOPIO*

Carmen QUINTANILLA/Jordi Xuclà

Kerstin RADOMSKI

Mailis REPS/Andres Herkel

Andrea RIGONI*

François ROCHEBLOINE

Soraya RODRÍGUEZ*

Alexander ROMANOVICH*

Maria de Belém ROSEIRA*

René ROUQUET

Rovshan RZAYEV/Fazil Mustafa

Àlex SÁEZ

Vincenzo SANTANGELO*

Milena SANTERINI

Nadiia SAVCHENKO/ Sergiy Vlasenko

Deborah SCHEMBRI/Joseph Sammut

Stefan SCHENNACH

Ingjerd SCHOU

Frank SCHWABE

Urs SCHWALLER/Luc Recordon

Salvador SEDÓ

Predrag SEKULIĆ

Ömer SELVİ/Suat Önal

Aleksandar SENIĆ

Senad ŠEPIĆ

Samad SEYIDOV*

Jim SHERIDAN*

Bernd SIEBERT/Thomas Feist

Valeri SIMEONOV/Kancho Filipov

Andrej ŠIRCELJ

Arturas SKARDŽIUS/Dalia Kuodytė

Jan ŠKOBERNE

Leonid SLUTSKY*

Serhiy SOBOLEV

Olena SOTNYK

Lorella STEFANELLI/Gerardo Giovagnoli

Yanaki STOILOV/Valeri Jablianov

Karin STRENZ

Ionuț-Marian STROE*

Valeriy SUDARENKOV*

Krzysztof SZCZERSKI*

Damien THIÉRY/Dirk Van Der Maelen

Lord John E. TOMLINSON

Antoni TRENCHEV*

Goran TUPONJA

Ahmet Kutalmiş TÜRKEŞ*

Tuğrul TÜRKEŞ*

Theodora TZAKRI*

Ilyas UMAKHANOV*

Dana VÁHALOVÁ

Snorre Serigstad VALEN*

Petrit VASILI

Imre VEJKEY/Rózsa Hoffmann

Stefaan VERCAMER

Birutė VĖSAITĖ*

Nikolaj VILLUMSEN

Dimitris VITSAS*

Vladimir VORONIN

Viktor VOVK

Klaas de VRIES

Nataša VUČKOVIĆ

Draginja VUKSANOVIĆ/Snežana Jonica

Piotr WACH

Robert WALTER

Dame Angela WATKINSON/Paul Flynn

Tom WATSON*

Karl-Georg WELLMANN/Johann Wadephul

Katrin WERNER

Morten WOLD

Bas van ‘t WOUT*

Gisela WURM

Maciej WYDRZYŃSKI

Leonid YEMETS/Pavlo Unguryan

Tobias ZECH

Kristýna ZELIENKOVÁ

Sergey ZHELEZNYAK*

Marie-Jo ZIMMERMANN

Emanuelis ZINGERIS

Guennady ZIUGANOV*

Naira ZOHRABYAN

Levon ZOURABIAN

Vacant Seat, Cyprus*

Vacant Seat, Estonia*

Vacant Seat, Turkey*

Vacant Seat, Turkey*

Vacant Seat, Turkey*

Vacant Seat, United Kingdom*

ALSO PRESENT

Representatives and Substitutes not authorised to vote

Boriana ÅBERG

Sílvia Eloïsa BONET PEROT

Observers

Héctor LARIOS CÓRDOVA

George FUREY

Partners for democracy

Hanane ABOULFATH

Najat AL-ASTAL

Mohammed AMEUR

Mohammed Mehdi BENSAIDI

Nezha EL OUAF

Bernard SABELLA

Mohamed YATIM

Appendix II

Representatives or Substitutes who took part in the ballot for the election of the judges to the European Court of Human Rights in respect of the Slovak Republic and in the ballot for the election of the Secretary General of the Parliamentary Assembly of the Council of Europe

Pedro AGRAMUNT

Brigitte ALLAIN/Pascale Crozon

Lord Donald ANDERSON

Paride ANDREOLI

Sirkka-Liisa ANTTILA

Volodymyr ARIEV

Egemen BAĞIŞ/Ahmet Berat Çonkar

David BAKRADZE

Gérard BAPT/Jean-Claude Frécon

Doris BARNETT/Harald Petzold

José Manuel BARREIRO/Ángel Pintado

Deniz BAYKAL

Ondřej BENEŠIK/Jana Fischerová

Levan BERDZENISHVILI

Deborah BERGAMINI/Giuseppe Galati

Andris BĒRZINŠ

Gülsün BİLGEHAN

Brian BINLEY

Ľuboš BLAHA/Darina Gabániová

Philippe BLANCHART

Maryvonne BLONDIN

Tilde BORK

Mladen BOSIĆ

António BRAGA

Anne BRASSEUR/Marc Spautz

Piet De BRUYN/Petra De Sutter

Beata BUBLEWICZ/Iwona Guzowska

André BUGNON

Elena CENTEMERO

Christopher CHOPE

Lise CHRISTOFFERSEN

Henryk CIOCH/Marek Borowski

James CLAPPISON

Igor CORMAN/Valentina Buliga

Telmo CORREIA

Celeste COSTANTINO/Ferdinando Aiello

Yves CRUCHTEN

Zsolt CSENGER-ZALÁN

Katalin CSÖBÖR

Joseph DEBONO GRECH

Reha DENEMEÇ

Arcadio DÍAZ TEJERA

Şaban DİŞLİ

Aleksandra DJUROVIĆ

Namik DOKLE

Elvira DROBINSKI-WEIß/Gabriela Heinrich

Alexander [The Earl of] DUNDEE

Nicole DURANTON

Josette DURRIEU

Mikuláš DZURINDA/Helena Mezenská

Lady Diana ECCLES

Tülin ERKAL KARA

Franz Leonhard EßL

Samvel FARMANYAN

Joseph FENECH ADAMI

Cătălin Daniel FENECHIU

Doris FIALA/Eric Voruz

Ute FINCKH-KRÄMER

Axel E. FISCHER

Gvozden Srećko FLEGO

Bernard FOURNIER

Hans FRANKEN

Martin FRONC

Sir Roger GALE

Karl GARÐARSSON

Pavol GOGA

Mustafa Sait GÖNEN

Sylvie GOY-CHAVENT

Fred de GRAAF/ Tuur Elzinga

François GROSDIDIER/Damien Abad

Dzhema GROZDANOVA

Mehmet Kasim GÜLPINAR/ Ali Şahin

Gergely GULYÁS/Mónika Bartos

Jonas GUNNARSSON

Márton GYÖNGYÖSI

Sabir HAJIYEV

Alfred HEER/ Maximilian Reimann

Martin HENRIKSEN

Françoise HETTO-GAASCH

Oleksii HONCHARENKO/Vladyslav Golub

Jim HOOD/David Crausby

Anette HÜBINGER

Andrej HUNKO

Ali HUSEYNLI/Sahiba Gafarova

Rafael HUSEYNOV

Ekmeleddin Mehmet İHSANOĞLU

Florin IORDACHE/Daniel Florea

Gedimnas JAKAVONIS

Tedo JAPARIDZE/Zviad Kvatchantiradze

Michael Aastrup JENSEN

Mogens JENSEN

Aleksandar JOVIČIĆ/Dejan Kovačević

Anne KALMARI

Mustafa KARADAYI/Hamid Hamid

Marietta KARAMANLI/Marie-Christine Dalloz

Niklas KARLSSON/Eva-Lena Jansson

Bogdan KLICH/Helena Hatka

Manana KOBAKHIDZE

Haluk KOÇ/Metin Lütfü Baydar

Željko KOMŠIĆ

Ksenija KORENJAK KRAMAR

Alev KORUN/Andreas Schieder

Rom KOSTŘICA/Gabriela Pecková

Elvira KOVÁCS

Tiny KOX

Borjana KRIŠTO

Eerik-Niiles KROSS

Marek KRZĄKAŁA/Killion Munyama

Ertuğrul KÜRKÇÜ

Athina KYRIAKIDOU/Stella Kyriakides

Serhiy LABAZIUK/Ihor Huz

Inese LAIZĀNE

Olof LAVESSON

Pierre-Yves LE BORGN’

Jean-Yves LE DÉAUT

Valentina LESKAJ

Terry LEYDEN

Inese LĪBIŅA-EGNERE

George LOUKAIDES

Yuliya L’OVOCHKINA

Philippe MAHOUX

Thierry MARIANI

Soňa MARKOVÁ/Pavel Holík

Milica MARKOVIĆ

Meritxell MATEU PI

Ana MATO

Frano MATUŠIĆ

Liliane MAURY PASQUIER

Evangelos MEIMARAKIS/Liana Kanelli

Attila MESTERHÁZY

Jean-Claude MIGNON

Olivia MITCHELL

João Bosco MOTA AMARAL

Arkadiusz MULARCZYK

Oľga NACHTMANNOVÁ

Hermine NAGHDALYAN/Naira Karapetyan

Andrei NEGUTA

Miroslav NENUTIL

Baroness Emma NICHOLSON

Michele NICOLETTI

Aleksandar NIKOLOSKI

Julia OBERMEIER

Marija OBRADOVIĆ

Judith OEHRI

Carina OHLSSON/Lotta Johnsson Fornarve

Joseph O’REILLY

Maciej ORZECHOWSKI/Michal Stuligrosz

José Ignacio PALACIOS

Liliana PALIHOVICI

Judith PALLARÉS CORTÉS

Ganira PASHAYEVA/Sevinj Fataliyeva

Florin Costin PÂSLARU

Waldemar PAWLAK/Jan Rzymełka

Gabino PUCHE

Kerstin RADOMSKI

Mailis REPS/Andres Herkel

François ROCHEBLOINE

René ROUQUET

Rovshan RZAYEV/Fazil Mustafa

Milena SANTERINI

Nadiia SAVCHENKO/ Sergiy Vlasenko

Deborah SCHEMBRI/Joseph Sammut

Stefan SCHENNACH

Ingjerd SCHOU

Frank SCHWABE

Urs SCHWALLER/Luc Recordon

Predrag SEKULIĆ

Ömer SELVİ/Suat Önal

Senad ŠEPIĆ

Samad SEYIDOV

Jim SHERIDAN

Bernd SIEBERT/Thomas Feist

Valeri SIMEONOV/Kancho Filipov

Andrej ŠIRCELJ

Serhiy SOBOLEV

Olena SOTNYK

Lorella STEFANELLI/Gerardo Giovagnoli

Yanaki STOILOV/Valeri Jablianov

Karin STRENZ

Damien THIÉRY/Dirk Van Der Maelen

Lord John E. TOMLINSON

Goran TUPONJA

Ahmet Kutalmiş TÜRKEŞ/Süreyya Sadi Bilgiç

Dana VÁHALOVÁ

Petrit VASILI

Imre VEJKEY/Rózsa Hoffmann

Stefaan VERCAMER

Nikolaj VILLUMSEN

Vladimir VORONIN

Viktor VOVK

Klaas de VRIES

Nataša VUČKOVIĆ

Draginja VUKSANOVIĆ/Snežana Jonica

Piotr WACH

Karl-Georg WELLMANN/Johann Wadephul

Katrin WERNER

Morten WOLD

Gisela WURM

Maciej WYDRZYŃSKI

Leonid YEMETS/Pavlo Unguryan

Tobias ZECH

Kristýna ZELIENKOVÁ

Marie-Jo ZIMMERMANN

Naira ZOHRABYAN