How Belgium can tackle the pharmaceutical "tragedy of the commons" and help shape Europe's healthcare future 

Looking at this situation through the lens of research from Vlerick's Healthcare Management Centre, it seems the current balance may be tipping too far towards short-term cost containment – creating what the centre's founder and director, Professor Walter Van Dyck, calls "the tragedy of the commons". 

In a recent policy paper – Beyond the tragedy of the commons: A strategic framework for Belgian pharmaceutical policy reform – Professor Van Dyck and his colleague Paola Argiolas issue a warning. The way medicines are priced and reimbursed across Europe could unintentionally be weakening incentives for innovation, delaying patient access to new treatments and threatening Europe's long-term competitiveness in life sciences. 

A Europe-wide challenge 

Across Europe, governments have developed sophisticated mechanisms to keep medicine costs under control. They negotiate prices, assess the value of new therapies and often benchmark prices against those in other countries. 

These approaches have helped make healthcare more affordable. But they also create a challenge. When multiple countries focus on securing the lowest possible prices, the cumulative impact can reduce the revenues that pharmaceutical companies use to fund research and development. 

This is where the concept of the "tragedy of the commons" comes into play. Individual countries may benefit from pushing prices down. But if all countries use the same tactics, the incentive for pharmaceutical companies to invest in the next generation of medicines may weaken. And with recent industrial and pharmaceutical pricing policy developments in the United States and increasing R&D pressure from China, the debate about pricing and innovation is now more urgent than ever. 

Why Belgium matters 

While this challenge affects all of Europe, Belgium provides an especially interesting example of how these dynamics play out. 

The country is recognised as one of Europe's strongest performers in pharmaceutical research and development, with a thriving life sciences ecosystem and a strong track record in clinical research. However, at the same time, Belgian patients can face delays in accessing innovative medicines. And compared with many European neighbours, the country makes relatively limited use of generic medicines. 

According to the policy paper, this means Belgium may be missing opportunities to generate savings that could be reinvested into innovative therapies. 

The authors argue that Belgium has an opportunity to rethink how medicines are funded, priced and accessed throughout their lifecycle – creating a model that could strengthen both innovation and affordability. 

Four recommendations for Belgium 

Building on their previous research on international pricing and best practices across Europe, the policy paper outlines four recommendations for reshaping Belgium's approach to pharmaceutical policy – reforms that could also offer valuable lessons for healthcare systems across Europe. 

1. Reform the clawback system 

The first recommendation is to reform the current clawback system, where pharmaceutical companies repay spending that exceeds agreed budgets. The authors argue for a more balanced, multi-year approach that shares risk more fairly and takes greater account of the factors driving spending increases. 

2. Make better use of lower-cost medicines 

The second recommendation focuses on generics and biosimilars. One of the paper's key messages is that Belgium should make better use of lower-cost alternatives after patents expire. This, say the authors, would boost competition in mature markets and generate savings that could be reinvested in innovative medicines – improving both affordability and access. 

3. Accelerate access to innovative treatments 

The third proposal is inspired by Germany's "day-one access" model, which gives patients access to new drugs as soon as they are approved. Under the model, pricing and value assessments continue to be negotiated after launch. The authors argue that a Belgian version of this approach could help patients gain faster access to new therapies while effectiveness and value continue to be monitored. 

4. Position Belgium as a European pioneer 

The fourth and most ambitious proposal looks beyond Belgium's borders. The paper suggests exploring a European fund to help finance advanced treatments, such as cell and gene therapies, which often carry high upfront costs. By pooling financial risk across countries, this fund could improve patient access and support continued investment in innovation. 

This is not a challenge that can be solved by a single country. Healthcare systems across Europe are grappling with rising costs, ageing populations and increasing demand for innovative therapies. At the same time, the continent faces growing competition from the United States and Asia in the race to develop next-generation medical breakthroughs. 

For Professor Van Dyck, the solution is not to indiscriminately spend more. Instead, it is about using existing resources more strategically. 

Belgium leading by example 

The message of the policy paper is ultimately one of balance. If Europe wants to remain a leader in healthcare innovation, it must find ways to reward breakthrough research while making sure that patients receive timely access to treatment. 

The four reforms outlined in the policy paper are designed for Belgium. Yet the questions they address extend far beyond its borders.

This health policy research was funded with the support from Novartis NV. Scientific and technical data, errors or omissions, expressed viewpoints and policy recommendations are the sole responsibility of the authors.