A survey of experts on personalized medicine landscape in European Union and China

Our survey showed that PM is being considered as a relevant issue within the R&I policy and funding landscape in China and the EU. The health research agenda has been reported as disease-focused, that is, national health research priorities have been related to major health problems, such as cancer, chronic diseases or neurodegenerative disease.

Investing in PM research deemed imperative, in both countries, to better understand the molecular mechanisms of diseases, as well as to identify and validate biomarkers. Greater agreement emerged on where policies have the greatest impact, financing and bringing innovation to market being the most relevant. Although China was considered as the second largest spender on R&D globally as of 2020 [12], lack of funding was indicated as the main obstacle for targeted research [13]. A recent study by Wang et al. [14] reported that the Chinese government funding is mainly associated with enhancement of measurable and recognizable scientific output, whereas EU is more likely to fund projects with social impact, that might not directly be transferable to scientific output [15]. The experts considered that partnerships between funding organizations, government, pharmaceutical industry and academic institutions have the potential to facilitate funding programs or activities. It has been widely discussed that the main barriers to PM financing are reimbursement through traditional payment models [15], not specific to PM and a strong link between public and private stakeholders, as well as industry and academia [16]. In China, it is more likely performance based funding for immediate high publication output, whereas EU plays a crucial role in supporting priorities of internal EU market development [14].

The indicated priorities differed across countries, posing challenges to present to the authorities the benefits that PM research represents for the health system. It depends, also, on the level of discordance between research prioritization at national or international agenda. The latter, alongside with lack of harmonization of legal and ethical guidelines are considered by the experts as the main barriers to financing research in PM [17, 18]. Healthcare systems have fragmented legislations and PM policies and programmes vary significantly among countries. Currently, neither China, nor the EC have adopted any decision for cross-border sharing of data, technical resources, or biological material. for optimal cooperation. Data transfer within and outside EU is regulated by the GDPR, whereas within and outside China by the PIPL, with stringent requirements on security controls and data localization [19]. Given that the regulations in place do not consider all the specificities of personalized interventions, it emerges as fundamental need to update or develop the current regulations and harmonize legislation.

European experts focused on translational medicine and innovation, while the Chinese experts pointed out the importance of workforce training and patient involvement. Big data and ICT solutions were a key shared theme, fostered in both countries by significant investments and dedicated policies [19]. The great interest in big data and ICT solutions could be leveraged as a driver for European policies to improve healthcare quality through the rapid and effective implementation of new technologies; similarly, Chinese research institutions could gain new perspectives from the focus on patient and citizen engagement conducted in the EU. Leveraging each other’s experiences and expertise could lay the foundation for new collaborations, creating a virtuous circle of exchange of ideas, knowledge, and best practices [6, 20]. In line with this, our survey emphasized that Sino-European collaborations need to be strengthened, based on mutual partnerships, at both scientific and policy level [21]. To maximize the mutual synergies, existing networks and collaborations should be taken advantage of, given that since the Science and Technology Cooperation Agreement in 1998, EU and China have established a long-term scientific, research and innovation cooperation [22, 23]. In fact, in the EU’s FP7 funding programme (2007–2013), China was the third most important international partner country. In 2015, the Chinese Government and the EU agreed to set up a Co-Funding Mechanism for research and innovation, that could pave the way towards a closer collaboration, further been renewed for the period 2018–2020, to support joint projects between European and Chinese universities, research institutions and companies [23]. Through multilateral activities, EU and China could learn from each other’s experiences and practices on how to tackle certain challenges and share stories of success. However, according to a recent article, the current level of collaborations is suboptimal [24]. Therefore, further actions are needed to facilitate and strengthen such synergies or to launch new ones.

According to our results, policymakers do not fully understand the meaning and exact implications of PM in health systems. The social and ethical consequences of PM implementation have not been fully evaluated, which is why the principles of ELSI, also across-borders, need to be further studied by research and applied by all stakeholders [21]. Within this context, experts raised concerns regarding the cooperation on standardization and research ethics, particularly in China, when refereeing to the adoption of novel technologies. Recently, ethical practices in research have been included in the political agenda in China, where on January 2019, MoST and Ministry of Finance published a joint document urging research institutions and scientists to strengthen ethics regulation and establish regulatory committees [25].

These results should be interpreted in the light of some limitations and strengths. Our sample size might not be representative of all the experts working in PM- related activities, although we conducted an extensive search in identifying them. Therefore, the respondents’ activities were mainly focused in certain domains of PM, thus their interpretation was not general, but domain-driven, being probably subjective. However, to our knowledge, this was the first survey aiming to understand PM scenario, both in China and the EU, in a comprehensive way.

To conclude, specific long term policy measures or strategies focused on PM are required to achieve sustainable development. A continuous and sustainable cooperation between the EU and China, that takes into account the main drivers of change, as well as the relative uncertainties, is fundamental to support networking between European and Chinese policy makers, scientists, programme owners and funders.