As Europe plans its response to the neurological disease burden, a fundamental measurement gap is being overlooked — and the cost of ignoring it is being felt.

A briefing requested earlier this year by the European Parliament’s Committee on Public Health (SANT) put it plainly: neurological diseases are one of Europe’s most urgent and rapidly expanding health, social and economic challenges. Published in February 2026, it calls for a coordinated European plan linking prevention, early diagnosis, research and innovation.¹ But before Europe considers what that plan should look like, a foundational question demands attention: are we measuring the right things?

Multiple sclerosis (MS), a chronic, progressive disease of the central nervous system that disrupts communication between the brain and the body, offers a revealing case study. Consider a woman in her mid-30s, working, raising a family, managing what her neurologist calls “stable” MS. She has not slept properly in years, her memory has been slipping and she is cutting her hours at work. Her last clinical note reads: “No change.” On paper, she is stable, but in reality she is anything but.

Her story is not unusual. According to research commissioned by Sanofi^*, the gap between what health systems measure and what people with MS experience may be costing individuals, families and economies more than we realize.³

The stakes for Europe

Over 3 million people globally live with MS and Europe has the highest prevalence, at 133 per 100,000 people.^2,3 The condition strikes primarily during prime working years, meaning hundreds of thousands of people are navigating a progressive, unpredictable disease at precisely the point when inadequate support is felt most acutely.³

That support begins with measurement. And right now, the tools used to assess MS in clinical practice do not fully capture what people with the disease experience.³

The consequences extend far beyond the clinic: 82 percent of people with severe MS rely on unpaid family caregiving, yet this burden rarely appears in standard health data or policy design.³ When the full impact of disease is not measured, health systems can underestimate need, delay support, and overlook the wider effects on work, welfare and family life.³

The measurement gap

The Expanded Disability Status Scale (EDSS), the primary tool used to measure MS disability, was developed in 1983 to assess walking ability. We now know that MS affects far more than mobility. Fatigue affects 94 percent of people with MS, while 75 percent report cognitive difficulties, but both are absent in the EDSS assessment.³ In a field where clinical consensus is rare, seven in ten neurologists agree: a more comprehensive approach is needed.³

Growing recognition of smouldering neuroinflammation has made the need for new methods of quantifying MS progression increasingly urgent. This slow, chronic disease activity can persist even when a patient appears clinically stable, with effects that are subtle, cumulative and easy to miss until significant damage has already occurred.⁴

This is why Sanofi initiated the development of the Smouldering Associated Worsening (SAW) Index⁺. The SAW Index Study — led by an international steering committee of leading MS clinicians, researchers and patient advocates — is due to complete in 2027. Based on hundreds of hours of in-depth qualitative research with people with MS, the goal of the SAW Index is to provide neurologists with a comprehensive measurement framework that bridges the gap between lived experience and what clinical tools are currently able to detect.

According to the European Multiple Sclerosis Platform, people with MS experience an average of 14 symptoms within the first five years of diagnosis, with fatigue, sensory problems, sleep disturbances, cognitive impairment and balance problems among the most common.⁵ These are precisely the experiences the SAW Index is designed to surface, replacing static labels like “moderately affected” with measurement metrics grounded in the experience and words of people with MS.

The cost of this gap

These aspects of MS can be challenging to quantify and are associated with substantial societal and economic burdens. Lifetime productivity loss per person with MS ranges from €394,000 in France to €668,000 in Germany.³ The cost profile shifts significantly as the disease progresses: in mild MS, direct healthcare costs dominate; in severe MS, indirect costs become the primary driver.³ Indeed, lost wages, absenteeism, early retirement, disability payments and the growing burden on unpaid carers outweigh medical costs in many countries, placing growing long-term pressure on social insurance and disability systems.³

Early identification of progression could change that trajectory, extending years of employment, preserving household income, and reducing long-term dependence on disability and social benefits.^3,6 That is a cost-avoidance opportunity current measurement frameworks are missing.

Progress in motion

There is no single fix, but there is momentum.

MS care has advanced significantly in recent decades: diagnosis is happening earlier, treatment options have expanded and the focus is shifting from relapse control alone to slowing long-term disability progression.⁷ Furthermore, there is growing recognition of the importance of cognition, mental health, rehabilitation and the day-to-day realities that shape whether people living with MS can remain independent and active.⁸

The challenge now is to ensure policy keeps pace with that progress, and better measurement is part of the answer. If Europe wants health spending to deliver lasting value, it should see these improvements not as costs to be managed, but as investments in independence, participation, productivity and more sustainable health systems.

Time to act

The European Parliament’s SANT Committee has called for a fully funded European neurological health plan — one with the scale and ambition of Europe’s Beating Cancer Plan, aligning health, research and societal action in a unified framework.¹ MS offers a clear and immediate test case for what that ambition looks like in practice.

But ambitious plans require accurate data. If Europe is serious about a coordinated response to neurological disease, getting measurement right is not a secondary concern; it is the foundation on which everything else depends.

The people living with MS across the continent cannot wait for the tools that measure their disease to catch up with the science that understands it. Neither should policymakers.

^*Research commissioned by Sanofi. All editorial control retained by Economist Impact.
⁺Sanofi initiated and funds the SAW Index Study.

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References

1. European Parliament. Strengthening Brain Health: Policy Recommendations to Tackle the Rising Burden of Neurological Diseases. Available at: https://www.europarl.europa.eu/telastatic/cmsdata/302850/Briefing_Strengthening%20Brain%20Health_EN.pdf. Accessed: September 2026
2. MS International Federation. MS Atlas. Available at: https://atlasofms.org/map/global/epidemiology/number-of-people-with-ms. Accessed: September 2026
3. Economist Impact. Measuring what matters: Bridging the gap between disability impact and economic burden in multiple sclerosis. Available at: https://impact.economist.com/health-society/measuring-what-matters. Accessed: September 2026
4. Scalfari, A, et al. (2024) Smouldering-Associated Worsening in Multiple Sclerosis: An International Consensus Statement on Definition, Biology, Clinical Implications, and Future Directions. Ann Neurol 2024;00:1. DOI: 10.1002/ana.27034.
5. European Multiple Sclerosis Platform. (n.d.). Impact of multiple sclerosis symptoms (IMSS) [Fact sheet]. Accessed: October 2026
6. Cicely Dudley, Victoria Donnaloja and Karen Steadman. A guide for Health Care Professionals to have Conversations on Work with People with Multiple Sclerosis. Available at: https://emsp.org/wp-content/uploads/2017/02/Ready-for-Work-Employment-Guide.pdf. Accessed: September 2026
7. Montague T, Drummond J, Ng K, Parratt J. Advancements in multiple sclerosis. Intern Med J. 2025 Jun;55(6):895-904. DOI: 10.1111/imj.70023.
8. Giovannoni G, et al. MS care: integrating advanced therapies and holistic management. Front Neurol. 2024 Jan 30;14:1286122. doi: 10.3389/fneur.2023    

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Disclaimer

POLITICAL ADVERTISEMENT

• The sponsor is Sanofi.
• The political advertisement is linked to driving action in how neurological disease is measured in the EU (using MS as a case study) and driving action around the briefing requested by the SANT committee aimed at strengthening brain health (Policy Recommendations to Tackle the Rising Burden of Neurological Diseases).

More information here.

BRUSSELS — EU countries must “do their job” to prevent travelers from being stuck in airport queues over Christmas, Migration Commissioner Magnus Brunner told POLITICO, as he singled out Brussels Airport for the way it has handled the new Entry/Exit System.

In an interview, Brunner defended the bloc’s digital border system and blamed its problems on national authorities and airports.

“Member states had enough time to prepare themselves for this system. They agreed on the system,” Brunner said. “It’s a security issue. It has to work … it’s up to the member states to do their job.”

EU countries began rolling out the Entry/Exit System, which records the fingerprints and facial images of non-EU visitors to the Schengen area, a year ago. It has been fully operational at all external Schengen border crossings since April.

But it has led to long waits at many airports — particularly over the summer, when some countries switched it off during peak periods. Delays persist at some airports, including at Brussels Zaventem, where travelers were forced to wait in lines for up to five hours last month.

“Some member states are a bit behind,” Brunner acknowledged. “We have some challenges, like Zaventem for instance, in Belgium, but also in other member states. And they have to do their job. They agreed on the new system, and now it’s up to the member states to do their job.” 

Brunner also said the Commission had offered support from border agency Frontex and funding to help countries implement the system, adding that he was “very confident” the problems would be ironed out before the next holiday rush.

Belgian Interior Minister Bernard Quintin pushed back at Brunner’s criticism, with a spokesperson saying his responsibility was to ensure there were enough police officers to staff the infrastructure provided by Brussels Airport Company.

The police have “been fully staffing the 12 positions at arrivals,” the spokesperson said, but the airport can process only 500 to 600 non-Schengen passengers an hour, compared with nearly 3,500 who may arrive between 6 a.m. and 10 a.m. on busy days. The airport’s infrastructure “cannot cope” with that demand, the spokesperson said, and the company must “make significant changes.”

Brussels Airport did not directly address the criticism from Brunner or Quintin, instead saying in a statement that “all parties involved” were working to fix the delays, including testing new e-gates and pre-registration kiosks, and training more police. “The need for additional infrastructure is also being assessed,” the statement said.

The Entry/Exit System has logged almost 230 million entries and exits across roughly 1,500 border points, Brunner said. Authorities have refused entry to about 80,000 people, including 2,000 considered security threats because of links to activity such as terrorism or organized crime.

“So you see, it actually works. And it pays off,” the Austrian commissioner said.

“This is the most modern border management system in the world,” he added. “We have the comparison to the U.S., to Canada, to others, and they’re all jealous.”

Ceuta stress test

As the EU’s migration commissioner, Brunner also faced another major test over the summer, when tens of thousands of people crossed from Morocco into Spain’s North African exclave of Ceuta.

The crisis remains an ongoing challenge for Spain and the EU.

Madrid initially said almost all those who crossed from Morocco had returned within days. But thousands remained in Ceuta. More than 3,000 people were living at Trampolín beach when authorities cleared an encampment last week; more than 1,200 then chose to return voluntarily to Morocco rather than go through the asylum-screening process, according to local authorities.

Images of thousands of people swimming toward Ceuta and overwhelming the area quickly became political ammunition, with far-right politicians campaigning for tougher migration policies — turning the crisis into a potent election issue and putting pressure on Prime Minister Pedro Sánchez.

Brunner described Ceuta as a warning that the EU needs to be better prepared for sudden arrivals. He recently proposed a plan for cooperation with partner countries, stronger external borders, early-warning systems, and action against smuggling networks. Migration will be a key topic of conversation at this week’s EU leaders’ summit in Brussels.

Among the Commission’s plans to tackle migration is a proposal to strengthen Frontex that would see it have a reinforced standing corps of officers able to be deployed more quickly, a bigger role in returning people to non-EU countries, closer cooperation with partner countries and more capacity to monitor the EU’s borders. The Commission has also proposed giving the agency a role in monitoring social media to help spot emerging migration movements.

Brunner said the reforms would not mean countries would be forced to host Frontex operations if they did not want them. The plan envisages EU support during border emergencies, but member countries remain responsible for their own external borders.

Greece and other countries want the EU to be able to suspend asylum applications during a large influx and Brunner said he is “definitely going ahead” with an emergency response framework, as requested by Commission President Ursula von der Leyen. EU leaders will discuss “concrete steps” at this week’s leaders’ summit.

The goal is to make the EU “more flexible” and “more agile” if events like Ceuta occur, where “mass movements are actually engineered and weaponized” against the bloc, he said.

Brussels also wants to help partner countries protect their borders to reduce irregular arrivals into Europe. To that end, Brunner on Monday begins a trip to Bangladesh and Pakistan, seeking to strengthen cooperation on migration with the two countries, he said.

“We want to help them to protect their borders,” Brunner stated, adding that the EU could support Bangladesh “via Frontex, for instance.”

This story has been updated with statements from Interior Minister Bernard Quintin’s office and Brussels Airport.