31.03.2025. (Caucasian Journal) Healthcare, a subject of a pressing public concern, has been underrepresented in the Caucasian Journal. Today, we address this by interviewing Jeffrey LAZARUS, Professor of Global Health at the Barcelona Institute for Global Health (ISGlobal) and the Graduate School of Public Health and Health Policy, City University of New York (CUNY SPH), whose career bridges Europe and North America.
As Georgia navigates its European aspirations, we discuss the potential benefits of various healthcare systems and what joining the EU could mean for the health and well-being of the Georgian people.
▶ ქართულად: The Georgian version is here.
Alexander KAFFKA, editor-in-chief of Caucasian Journal: Dear Jeff [if I may], welcome to Caucasian Journal and thank you for your attention to our readers. If you were the main decision-maker responsible for the healthcare sector in an EU candidate country like Georgia, what future strategy would you choose? Would you adopt an existing model from another EU country, combine several models, or create a new one from scratch?
Jeffrey LAZARUS: My main message would be to focus on having a strong primary care system with a gatekeeper system of general practitioners or family doctors and then a strong network of specialists. General practitioners should be in the community, easy to access, and - something the EU is not so good at - there should also be easier telehealth like video access for consultation, so one does not always have to go to an office to see their primary care provider.
Some EU healthcare systems, like Sweden, have a relatively low fee to see a primary care physician.
I think there should be no fees. Primary care should be free for the user. As soon as a fee is introduced, we usually see that individuals with the lowest financial resources tend to avoid visiting the clinic and only go when they have a more serious condition or rely on emergency rooms, which should not be used as a replacement for primary care.
AK: I know that you are familiar with Georgia and have visited Tbilisi professionally. Could you share a bit about your professional interests and what connects you to this region?
JL: I have been to Georgia on several occasions as a member of the technical advisory group for Georgia's viral hepatitis elimination programme, which is a truly fantastic effort. I spent 11 years at the World Health Organization, three years at the Global Fund to fight AIDS, tuberculosis, and malaria, and helped set up the WHO Collaborating Center on viral hepatitis and HIV. During that time, I met many Georgian health experts.
I work all over the world, with a base in Spain and New York, where I'm a professor at a university and at a research institute. I've seen many different healthcare systems, and I try to share what works best. While I was at the WHO in Europe, I had the opportunity to visit Georgia, Armenia, Russia, Ukraine, and to learn about the transition from the “Semashko system” [named after Academician Nikolai Semashko, creator of the state-funded Soviet healthcare model - CJ] to more modern healthcare that recognizes the importance of primary and community care, and people-centered health systems.
AK: You are working in Spain, which is known for having some of Europe's most affordable healthcare. I recall being surprised by the low cost of prescriptions at a Spanish pharmacy. Could you share your insights on the Spanish model?
JL: In Spain, medicine for the consumer is relatively low cost, and it is quite common to receive generic drugs. It's a priority of the system to provide the lowest cost medicines to their population. So, unlike in the United States, the healthcare model is not driven by profit or expensive medications, hospital beds, and operations.
My own experience with the Spanish system is that it is very easy to see your primary care doctor. It can take a bit longer to see a specialist, but the care is excellent. The hospital I work at is ranked in the top 25 in the world, and many hospitals are providing world-class care. The primary care system is effective, and they have a strong network of pharmacies, which seem to be everywhere, and people often buy their toothbrush and suntan lotion there, as well as their medications. By having that network, you're speaking to a healthcare provider on more occasions than, for example, in the U.S., where pharmacies are also selling food, and it's unlikely you'll engage with an actual pharmacist.
Across the EU, the ethos is that everyone receives the care free of charge, and that seems to be working quite well. EU citizens can receive excellent and affordable, usually free, healthcare in any of the EU member states.
AK: Is it true that, unlike many other sectors, healthcare across the EU remains remarkably unstandardized? If there are significant disparities in healthcare costs, medication prices, and medical insurance coverage between member states, how is this inequality being tackled?
JL: Across the EU, healthcare is very unstandardized. Even within a country like Spain, which has 17 autonomous communities, there are 17 healthcare systems, 17 commissioners of health, and even electronic medical records don't travel well from one region to another. As soon as you move between European countries, your care might be covered through the EU health insurance, but the prices will be very different in Denmark compared to Spain, for example. The waitlists and even what exactly is covered will be different.
AK: Is there something like a core set of medical services that every EU citizen can receive free of charge?
JL: I'm not sure that there's a core set of services that every citizen is entitled to because healthcare is really devolved to the member states, but across the EU, the ethos is that everyone receives the care they need free of charge. And that seems to be working quite well. Obviously, there are issues around undocumented migrants, people traveling among countries and then wanting to receive their services in a different country than in their home country. But overall, EU citizens can receive excellent and affordable, usually free, healthcare in any of the EU member states.
The message from the new U.S. administration is that health really is not a priority... So, the outlook in the U.S. is not very positive at all.
AK: Your transatlantic experience gives you a unique perspective on comparing European and North American healthcare. With the new US administration, what changes might we see in US healthcare?
JL: There are big changes afoot in the United States. With the new administration, we've seen a reduction in grants from the National Institute of Health (NIH). That's affecting hospitals and university research centers, so we're seeing hiring freezes. Some of these changes will be seen rather quickly, and some will take months or years to be seen.
The message from the new U.S. administration is that health really is not a priority - both abroad (where they've been reducing the activities of USAID) or at home with the Centers for Disease Control and Prevention (CDC) and the NIH facing major human resources and budget cuts.
We have a new Secretary of Health, RFK Jr., who has questioned vaccination. That's fueling the vaccine hesitancy movement. So, the outlook in the U.S. is not very positive at all.
AK: Do you foresee any ripple effects from changes in US healthcare that could impact Europe?
JL: The ripple effects from the U.S. are many; for example, the role of the NIH, which has been really the world's leader in health research funding. If there are continued delays, that will have an impact. It will also mean European research will have increased importance, but there are European researchers who rely on NIH funds and partnerships in the U.S. And if enough doubt is cast over vaccination, that may also have an effect in Europe, although I think the European population and leaders are better educated on the importance of getting all of the recommended vaccinations.
AK: Global healthcare is a vast topic, but I'd like to touch briefly on the WHO. What are your thoughts on the WHO's effectiveness and its future prospects?
JL: I worked for 11 years at the World Health Organization's regional office for Europe, and it's a fantastic organization. I'm biased, but I know WHO from the inside. The normative standards, guidance and policies, action plans, and strategies that it developed are unparalleled. It's overseen the elimination of smallpox and the near elimination of polio. The list is almost endless on where WHO has excelled as the organization that can bring together the world on health issues.
But I think WHO could become more efficient and effective. Their response to COVID-19 could have been much better. They could have recognized airborne transmission earlier and developed a global strategy. There should be term limits on how long staff can stay there.
Overall, the WHO budget is not very big globally. For that kind of budget, it's really remarkable what they're able to achieve. With the US and, I think, Argentina leaving WHO, it's a big blow. If they do leave, they also leave a conversation and collaboration that's incredibly important as we respond to current and future health issues.
AK: As a university professor, you work with young people daily. Could EU accession open doors for Georgian medical students to study at top European medical schools, ultimately improving healthcare quality in Georgia?
JL: My understanding is that EU accession for a country like Georgia would open the door for more Georgians at European medical schools.
Actually, when I was at WHO, the head of WHO was from Georgia, and one of the heads of our health systems program was from Georgia. Some of the top experts I knew in health were all from Georgia. So we also have to make sure that Georgians spend some time in their home country, but they're certainly very welcome and well-respected in the global health networks.
AK: Thank you very much!
Read the Georgian language version here.
This article was produced with the financial support of the EU and the German Marshall Fund of the United States (GMF). Its contents are the sole responsibility of the Caucasian Journal and do not necessarily reflect the views of GMF.
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