In Switzerland, the product safety regulation of therapeutic products (medicinal products and medical devices), consumer healthcare products and new products/technologies is not contained in one comprehensive body of legislation but is spread over various statutes, ordinances and guidelines, and also includes international regimes. These regulations contain different, and partially disparate, requirements in particular for design and manufacture, market access, sales and post-marketing surveillance, as well as advertising and product claims. The authorities responsible for enforcement are also different, as are the administrative measures and sanctions available to them.
A product may generally only be categorised in one product group. Both from a public health as well as from a practical industry and healthcare-provider perspective, it is important that individual products are categorised correctly. Perhaps most fundamentally, the mandatory authorisation by a public authority for the marketing of medicinal and biocidal products in Switzerland – which demands significant scrutiny, time and expense – is not required for medical devices, foodstuffs, nutrition supplements or cosmetics. Also, an incorrect categorisation may have far-reaching consequences, including recalls and liability claims. Disclaimers generally do not have legal value if, at the same time, the product is marketed for another purpose.
Navigating the various product categories, their complex regulation and, on occasion, the subtle delimitation issues demands extensive practical industry experience as well as legal and regulatory expertise (see the rest of 1. Applicable Product Safety Regulatory Regimes and 2. Commercialisation and Product Life Cycle for further detail).
Medical Devices and Medical Instruments
According to Swiss nomenclature, medical devices are products, including instruments, apparatus, equipment, in vitro diagnostics, software, implants, reagents, materials and other goods or substances, that are intended, or claimed, to have a medical use and whose principal effect is not obtained with a medicinal product (Article 4 paragraph 1 lit b, Therapeutic Products Act (TPA)).
Product safety-related aspects of medical devices are mainly governed by the TPA, the Medical Devices Ordinance (MedDO), the Ordinance on In Vitro Diagnostic Medical Devices (IvDO), the Ordinance on Clinical Trials for Medical Devices (ClinO-MedD), and (in parts) the Ordinance on Integrity and Transparency in the Therapeutic Products Sector (OIT). Depending on the circumstances, sector-specific regulations may apply, in particular in the fields of research, transplantation and reproductive medicine.
Swiss medical devices law was recently completely revised with the entry into force, on 26 May 2021, of the totally revised MedDO and, on 26 May 2022, of the new IvDO, the revised parts of the TPA and the new ClinO-MedD. Thereby, Switzerland has improved the quality and safety of medical devices for patients in Switzerland, and it has adapted the main parts of its medical devices legislation to Regulation (EU) 2017/745 on medical devices (EU-MDR) and Regulation (EU) 2017/746 on in vitro diagnostic medical devices (EU-IVDR).
Personal Protective Equipment (PPE)
In line with EU law, PPE is defined as equipment, as well as interchangeable components and connection systems for such equipment, designed and manufactured to be worn or held by a person for protection against one or more risks to that person’s health or safety (Article 1 paragraph 3, Ordinance on the Safety of Personal Protective Equipment (OPPE); Article 3(1), Regulation (EU) 2016/425 on personal protective equipment (EU-PPE Regulation)).
Depending on whether it is intended for medical use (see 1.4 Borderline Products for further detail), PPE may qualify as a medical device and be subject to the respective regulation. To the extent it does not so qualify, its product safety-related aspects are governed by the OPPE, which implements pertinent parts from the EU-PPE legislation, or by the utility articles regulation (see 1.2 Healthcare Products) as well as the Product Safety Act and the related Ordinance (PSA, PSO; Article 1 paragraph 5, OPPE).
Pharmaceuticals (Medicinal Products) and Blood Products
According to Swiss nomenclature, medicinal products are products of chemical or biological origin which are intended, or claim, to have a medicinal effect on the human or animal organism, in particular in the diagnosis, prevention or treatment of diseases, injuries and disabilities. They include prescription as well as over-the-counter products. Blood and blood products are also considered medicinal products (Article 4 paragraph 1 lit a, TPA).
Product safety-related aspects of medicinal and blood products are mainly governed by the TPA, the Medicinal Products Licensing Ordinance (MPLO), the Ordinance on Medicinal Products (OMP), the Ordinance on the Requirements of Marketing Authorisation of Medicinal Products, the Ordinance on the Simplified Marketing Authorisation Procedures, the OIT, and the Ordinance on Advertising of Medicinal Products (OMPA). Complementary and herbal medicines are further regulated by the Ordinance on the Simplified Authorisation and the Notification Procedure for Complementary and Herbal Medicinal Products. Depending on the circumstances, sector-specific regulations may apply, in particular in the fields of research (Human Research Act and related ordinances), transplantation (Transplantation Act and related ordinances), reproductive medicine (Reproductive Medicines Act and related ordinances) and narcotics (Narcotics Act (NarcA) and related ordinances). Certain raw materials for medicinal products are also subject to Swiss chemicals law.
The increasing number of cosmetics, foodstuffs and nutrition supplements that have been put on the market in recent years and are advertised as having a positive effect on health because of their ingredients raises difficult questions of categorisation. Meanwhile, the regulatory approaches in Switzerland correspond, or are moving ever closer, to EU legislation.
Cosmetics
Cosmetic products generally qualify as utility articles (Article 5 lit b, Federal Act on Foodstuffs and Utility Articles (FSA)) and are defined, as under Regulation (EU) 1223/2009 on cosmetic products, as substances or mixtures intended to be placed in contact with external parts of the human body (epidermis, hair system, nails, lips and external genital organs) or with the teeth and the mucous membranes of the oral cavity with a view exclusively or mainly to cleaning them, perfuming them, changing their appearance, protecting them, keeping them in good condition or correcting body odours (Article 53 paragraph 1, Ordinance on Foodstuffs and Utility Articles (FUAO)).
Product safety-related aspects of cosmetics are mainly governed by the FSA, the FUAO and the Cosmetics Ordinance (CosO) which, in its Appendix 1, contains an exemplary list of products qualifying as cosmetics. Certain raw materials for cosmetics may also be subject to the Swiss chemicals and biocides regulation.
Food and Nutrition Supplements
Foodstuffs are all substances or products that are intended, or may reasonably be expected, to be consumed by humans in a processed, partly processed or unprocessed state (Article 4 paragraph 1, FSA).
Product safety-related aspects of foodstuffs and nutrition supplements are mainly governed by the FSA; the FUAO; the Food Additives Ordinance; the Novel Foods Ordinance; the Ordinance on Genetically Modified Foodstuffs; the Ordinance on Food of Plant Origin, Mushrooms and Table Salt; the Ordinance on the Addition of Vitamins, Minerals and Other Substances to Foods; the Ordinance on Foods for Persons with Special Nutritional Needs; the Ordinance on the Maximum Levels of Contaminants (ContO); and the Ordinance on Information about Foods (FoodIO). Certain raw materials for foodstuffs and nutrition supplements may also be subject to the Swiss chemicals and biocides regulation.
Biocides
Biocidal products are active substances and preparations that are not plant protection products and are designed to deter, render harmless, destroy or otherwise control harmful organisms, or prevent damage from being caused by harmful organisms (Article 4 paragraph 1 lit d, Chemicals Act (ChemA); Article 2 paragraph 1 lit a, Ordinance on Biocidal Products (OBP)). Biocides can be roughly divided into four main groups: disinfectants, protectants, pesticides and other biocidal products (antifouling products, embalming and taxidermy fluids, etc).
The Swiss regulation of product safety-related aspects of biocides is technically equivalent to Regulation (EU) 528/2012 concerning the making available on the market and use of biocidal products, and is mainly contained in the ChemA, the Chemicals Ordinance (ChemO) and the OBP.
Unlike therapeutic products and consumer healthcare products, the new products covered in this chapter are not governed by specific regulation in Switzerland. This makes their qualification, and regulatory governance, more complex and challenging.
Mobile Health (mHealth)
As defined by the WHO and the Swiss Competence and Co-ordination Centre of the Confederation and the Cantons (eHealth Suisse), mHealth describes the technical requirements for the use of health data from portable medical devices and other wearables for the electronic patient record (EPR). mHealth is a component of eHealth, which covers all electronic means that are used in the health sector to improve processes and network those involved, including telemedicine.
mHealth devices that act directly in or on the human body, or that are used in vitro for the examination of specimens derived from the human body, are generally qualified as (in vitro diagnostic) medical devices. The same applies to software that is part of such an mHealth device. Standalone software (eg, medical apps) installed on devices that are not themselves (in vitro diagnostic) medical devices, such as mobile phones, tablets and PCs, may – in line with European legal practice – qualify as a (in vitro diagnostic) medical device if the manufacturer specifically intends the software to be used for a medical or diagnostic purpose, in particular for diagnosing, preventing, monitoring, treating or providing information on conditions, diseases, injuries or disabilities (Article 3 paragraph 1, MedDO; Article 3 paragraph 1, IvDO).
mHealth is not a defined legal category. To the extent an mHealth item is qualified as a medical device, the respective regulations apply (see 1.1 Medical Devices). Otherwise, the PSA and PSO may apply. Other issues of relevance in connection with mHealth concern data protection, in particular sensitive personal health data, “big data” and EPRs that are governed by federal and cantonal legislation, including the Federal Act on Data Protection and the related Ordinance as well as the Federal Act on the Electronic Patient Record and related ordinances.
Products Containing Cannabidiol (CBD)
CBD is an important cannabinoid that occurs in large quantities in the cannabis plant but that, unlike THC (tetrahydrocannabinol), does not produce a comparable psychoactive effect and, hence, is not subject to the NarcA.
The range of CBD-containing products is extensive and includes raw materials such as cannabis buds or powder with a high CBD content, extracts in the form of oils or pastes, ready-to-use products such as capsules, food supplements, liquids for e-cigarettes, tobacco substitutes, scented oils, and chewing gums or ointments, some of which are offered as care products.
Product safety-related aspects of CBD are governed by a number of different regulations, depending the respective categorisation, which has to be undertaken on a case-by-case basis taking into account all relevant factors, including composition, intended use, dosage, etc. Whoever places the product on the market is required to provide information on the intended use – eg, as a medicinal product or medical device (see in particular TPA, MedDO), as a foodstuff, a cosmetic or utility article (see in particular FSA, FUAO, ContO, FoodIO), as a tobacco substitute (see Tobacco Ordinance), or as a chemical (see in particular ChemO).
Medical Devices and Medicinal Products
The intended use of a therapeutic product, taking into account the entire circumstances of the individual case, must be the medical effect or use on the human organism, in particular in the diagnosis, prevention or treatment of diseases, injuries and disabilities (BGer 6B_979/2009). Such intended use can be objective (where, by its very nature, the product can be used exclusively for medicinal purposes) or subjective (due to the purpose a manufacturer or distributor gives to the product in connection with its designation and promotion, whereby the focus should not be on the promotion alone; BGer 2A.565/2000, E. 4b/cc; BGer 6B_600/2020 E. 5.2 et seq).
Drawing the line between medical devices and medicinal products can be difficult. The decisive factor is not a product’s material composition but whether its intended main effect in or on the human body is caused by pharmacological, immunological or metabolic means, in which case the product qualifies as a medicinal product. By contrast, the typical main effects of a medical device are mechanical, physical or physico-chemical (BVGE C-2093/2006, E. 3.5).
PPE and Medical Devices
Equipment intended primarily for self-protection, and not for a medical effect or use on the human organism, is generally considered to constitute PPE that is governed by the OPPE, and not a medical device. Depending on its use, however, it is possible that the same PPE in parallel qualifies as a medical device and is in so far governed by the medical devices regulation.
For example, face filtering pieces (FFP), in particular FFP2/FFP3-masks, are qualified as PPE, while surgical masks that, when used correctly, primarily protect the patients from infection are considered medical devices subject to the MedDO. Meanwhile, textile and other DIY-masks that, at best, offer a certain degree of third-party protection are considered utility articles and are subject to the FSA and PSA/PSO.
Cosmetics, Therapeutic Products and Biocides
Utility articles, including cosmetics, and therapeutic products are mutually exclusive categories (Article 2 paragraph 4 lit d and Article 4 paragraph 3, FSA). There is no unregulated space between these two categories (BGer 6B_979/2009).
Substances or preparations that are intended to be ingested, inhaled, injected or implanted in the human body cannot be considered cosmetic products from the outset (Article 53 paragraph 2, FUAO). Where the distinction is less obvious, a product has to be categorised on the basis of an overall and objectified evaluation, considering its predominant purpose according to the perception of the market. The presence of a medicinal claim does not automatically make a product a medicinal product (BGer 2C_413/2015).
Products that have a primarily biocidal function are in principle subject to the OBP. This includes, for example, disinfectants. Where biocidal materials or active substances are added to cosmetic products, such products are generally subject to cosmetics regulation as long as the biocidal function is only secondary to a primary cosmetic function (eg, added biocidal preservatives) or the biocidal function is inherent in the cosmetic function (Article 1a paragraph 3 lit a, OBP; Article 46, FUAO). Where a clear categorisation is difficult, the same distinction criteria as for cosmetics and medicinal products are deemed to apply.
When distinguishing therapeutic products from biocidal products, both the manufacturer’s intended purpose as well as the impressions of consumers are to be taken into account (BVGer C-900/2007, E. 6.3.3).
Medical Products and Food
Medicinal products and foodstuffs are mutually exclusive categories. There is no unregulated space between these two categories (BGer 6B_979/2009).
The key circumstances for the purpose of distinction include product composition, pharmacological effects including adverse reactions (Article 7 paragraph 1, FSA) and the intended use as perceived by the average consumer. The impression that the average consumer has in terms of intended use depends on a variety of circumstances, including the presentation of the product, form of administration and distribution channels. From the perspective of intended use, the question to be asked with reference to the nature of the foodstuff is to what extent a product contributes to the development or maintenance of the human body. If a product also has curative properties, these need to be qualified; the more the primary purpose is nutrition, the more the product is a foodstuff (BGer 2A.565/2000 E. 4 b) cc)).
Medical Devices and PPE
Any natural or juridical person who manufactures or fully refurbishes a (in vitro diagnostic) medical device or has a device designed, manufactured or fully refurbished, and markets that device under its name or trade mark in Switzerland is considered a manufacturer (Article 4 paragraph 1 lit f, MedDO; Article 4 paragraph 1 lit e, IvDO).
Manufacturers of (in vitro diagnostic) medical devices do not require a prior licence from a public authority. Instead, they must guarantee that their devices, including as regards mHealth, meet the general safety and performance requirements set out in Annex I EU-MDR/EU-IVDR when they are placed on the market or are put into service in Switzerland, taking into account their intended purpose. If such requirements are specified by designated technical standards, common specifications or prescriptions of the pharmacopoeia, compliance with these requirements is presumed as long as the product conforms to those standards, specifications or regulations. Obligations regarding the quality and risk management systems are governed by Article 10 EU-MDR/EU-IVDR (Articles 6, 46, 50, MedDO; Articles 6, 39, 43, IvDO).
If the manufacturer is not established within Switzerland, its devices may only be placed on the market if it has appointed an authorised representative in Switzerland that is responsible for the formal and safety-related aspects (Article 51, MedDO; Article 44, IvDO; Article 11, EU-MDR/EU-IVDR).
If PPE qualifies as a medical device, its manufacture is governed by the respective regulation. Otherwise, when placing PPE on the market in Switzerland, manufacturers have to ensure that it has been designed and manufactured in accordance with the essential health and safety requirements in Annex II EU-PPE Regulation (Article 4 paragraph 1 lit a, OPPE).
Medicinal Products
Manufacturing means all stages in the manufacture of a therapeutic product, from the acquisition of the precursors and the processing to the packaging, storage and delivery of the end products, including quality controls and batch releases (Article 4 paragraph 1 lit c, TPA).
The manufacture of medicinal products in Switzerland requires a prior licence issued by the Swiss Agency for Therapeutic Products (Swissmedic). Such a licence is generally granted if the applicant proves that the necessary technical and operational conditions are fulfilled, and that an appropriate system of quality assurance, in particular with respect to Good Manufacturing Practice (GMP) compliance, exists (Articles 5 et seq, TPA; Articles 3 et seq and Annex 1, MPLO).
Foodstuffs and Utility Articles (Including Cosmetics)
In application of the principle of self-control, Swiss manufacturers of foodstuffs and utility articles, including cosmetics, must ensure that the statutory requirements are complied with, in particular with respect to safety, hygiene and protection of consumers from deception (Articles 1, 7, 10, 15, 26, FSA; Articles 8 et seq and 45 et seq, FUAO; Article 3 paragraph 1, CosO).
Biocides
Manufacturers that place biocidal products on the market in Switzerland are responsible for ensuring that they do not endanger life or health. In particular, they shall assess and classify biocides according to their properties as well as packaging and labelling them in accordance with the type of hazard concerned, whereby they must obey certain specifications on test methods, Good Laboratory Practice (GLP), assessment and classification criteria, as well as packaging and labelling requirements (Article 5, ChemA).
Environment and Biosafety
The manufacture of medicinal products can affect the environment in a number of ways. In response to increasing concerns about environmental risks caused by pharmaceuticals, a risk assessment is carried out before a marketing authorisation is granted for a new active pharmaceutical ingredient (API) (Article 81 paragraphs 2 and 3, OMP).
A number of regulations protect employees, the public and the environment against serious harm or damage resulting from major accidents in connection with the handling of genetically modified, pathogenic or alien organisms in contained systems, such as laboratories and production units (Ordinance on Handling Organisms in Contained Systems; Ordinance on Protection against Major Accidents; Ordinance on Protection of Employees from Dangerous Micro-organisms).
Corporate Social Responsibility (CSR)
The Swiss Confederation understands CSR to be a contribution to sustainable development made by companies, and it expects companies based or operating in Switzerland to take responsibility for all activities they perform here or abroad in accordance with internationally recognised CSR standards and guidelines. On 15 January 2020, the Federal Council adopted a revised CSR Action Plan 2020–23. Apart from a company’s own liability and its liability for unlawfully caused damage through auxiliaries (Article 55, Code of Obligations (CO)), no extended corporate liability exists for the conduct of third parties.
However, two amendments to the CO (Articles 964bis et seq) entered into force on 1 January 2022: Similar to Directive 2014/95/EU regarding disclosure of non-financial and diversity information by certain large undertakings and groups, they introduce transparency obligations on large Swiss companies to report on the risks of their business activities, and respective measures relating to the environment, social and employee matters, human rights and the fight against corruption. Furthermore, similar to Regulation (EU) 2017/821 laying down supply chain due diligence obligations for EU importers of tin, tantalum and tungsten, their ores, and gold originating from conflict-affected and high-risk areas, they require companies with risks in the areas of child labour and so-called conflict minerals to comply with special and far-reaching due diligence obligations. The new requirements will apply for the first time in the fiscal year 2023.
COVID-19
In light of the experiences during the COVID-19 pandemic, and in line with the respective OECD initiative, the State Secretariat for Economic Affairs (SECO) encourages active supply chain management to address vulnerabilities in the supply chain and to support contingency planning in order to manage disruptions.
Compulsory Licensing
Applicants may bring action before Swiss courts for a compulsory non-exclusive licence for the manufacture of patent-protected pharmaceutical products and for their export to a country that has insufficient or no production capacity of its own in the pharmaceutical sector and which requires these products to combat public health problems, in particular those related to epidemics (Article 40d paragraph 1, Patents Act). However, no such licence has been granted to date in the pharmaceutical products area.
Therapeutic Products and PPE
Generally, advertising aimed at healthcare professionals (HCPs) is allowed for medicinal products authorised for marketing in Switzerland and for (in vitro diagnostic) medical devices. Such advertisements are limited, respectively, to the authorised indications and use of the medicinal product and the product information of the medical device (Article 5 paragraph 1, OMPA; Article 69 paragraph 1, MedDO; Article 62 paragraph 1, IvDO).
In contrast, advertising of therapeutic products aimed at the general public is restricted. Such advertising is prohibited for prescription medicinal products, for medicinal products that are often misused, that can lead to habituation or addiction, that contain narcotic or psychotropic substances, or that may not, on account of their composition and their intended use, be used without the intervention of a doctor for the necessary diagnosis, prescription or treatment, as well as for medicinal products that are reimbursed by health insurance companies (Article 32 paragraph 2, TPA; Article 65 paragraph 2 and Article 68 paragraph 1 lit d, Health Insurance Ordinance), whereas advertising for over-the-counter medicinal products is allowed with certain limitations (Article 31 paragraph 1 lit b, TPA; Articles 14 et seq, OMPA). Advertising for medical devices aimed at the general public is prohibited only for (in vitro diagnostic) medical devices intended exclusively for use by professionals (Article 69 paragraph 3, MedDO; Article 62 paragraph 3, IvDO).
To prevent false expectations about the quality, efficacy, composition or safety of a therapeutic product, consumers are to be protected against misleading information (Article 1 paragraph 2 lit a, TPA). Swissmedic rejects an application for marketing authorisation of a medicinal product, inter alia, if the product name or the design of the container or packaging material is contrary to public policy or morals, is misleading or is likely to cause confusion (Article 9 paragraph 4, OMP). Provisions to protect HCPs and consumers from misleading advertising of therapeutic products are contained in the OMPA (eg, Articles 5 and 22) and in Article 69 paragraph 2 of the MedDO and Article 62 paragraph 2 of the IvDO. In the broader context of advertising, it should also be recalled that, on 1 January 2020, revised rules on integrity and transparency, including the OIT, came into force that mainly focus on medicinal products.
Apart from information and instruction obligations according to the OPPE and the EU-PPE Regulation, advertising and product claims for PPE that is not qualified as a medical device are governed by the Federal Act on Unfair Competition, which is generally applicable to advertising in Switzerland.
Foodstuffs and Utility Articles (Including Cosmetics)
Foodstuffs, consumer articles and cosmetics must ensure the protection of consumers against deception, imitation and confusion. The presentation, labelling and packaging of such products must correspond to the facts and may not mislead consumers (Articles 18 et seq, FSA; BGE 144 II 386 E. 4.2.2).
Prohibited are, in particular, information on effects or properties of foodstuffs which, according to the current state of scientific knowledge, they do not possess or which are not sufficiently scientifically proven; claims that foodstuffs contain properties of preventing, treating or curing a human disease or suggesting that such properties exist; as well as claims of any kind that give foodstuffs the appearance of medicinal products (Article 12, FUAO). Health claims relating to foodstuffs are permitted if they are explicitly provided for in Annexes 13 and 14 of the FoodIO or are approved by the Federal Food Safety and Veterinary Office (FSVO).
With respect to cosmetics in particular, advertising claims are only permitted if they fulfil six common criteria, which are also contained in Regulation (EU) 655/2013 laying down common criteria for the justification of claims used in relation to cosmetic products, namely, legal compliance, truthfulness, evidential support, honesty, fairness and informed decision-making (Article 10 and Annex 6, CosO). Finally, references to curative, soothing or preventive effects (eg, medicinal or therapeutic properties, disinfecting or anti-inflammatory effects) are prohibited, except for scientifically substantiated cavity-preventing and other preventive properties of dental and oral care products (Article 47 paragraphs 3 and 4, FUAO).
Biocides
Only authorised biocides may be advertised, and no misleading information shall be given in respect of the risks to human or animal health, the environment or their efficacy. In any case, claims such as “low-risk biocidal product”, “non-toxic”, “harmless”, “natural”, “environmentally friendly” or “animal friendly” must not be made (Article 38 paragraph 1 and Article 50, OBP).
Medicinal Products and Biocides
Medicinal and biocidal products may in principle only be placed on the market in Switzerland if they are authorised.
Unless an exemption (Article 9 paragraph 2, TPA) or a case of early and managed access applies, such as in connection with compassionate use (Article 9b paragraph 1, TPA) or off-label and unlicensed use (Article 20, TPA), medicinal products can obtain a marketing authorisation from Swissmedic for Switzerland if the applicants prove that the product is of high quality, safe and effective, if they hold a licence to manufacture (see 2.1 Design and Manufacture), import or conduct wholesale trade, and have a registered address or office in Switzerland (Article 10, TPA). Pre-marketing, (serious) adverse events and suspected unexpected serious adverse reactions in clinical trials of medicinal products have to be documented and reported to Swissmedic and the responsible ethics committee, depending on their severity (Articles 39 et seq, Clinical Trials Ordinance).
Unless an exemption applies (Article 3 paragraph 3 lit b and c, OBP), biocides may only be placed on the market, or be used professionally or commercially, in Switzerland if they are authorised by the Notification Authority for Chemicals of the Federal Office for the Environment (FOEN), the Federal Office of Public Health (FOPH) and SECO, and are appropriately labelled (Article 3 paragraph 1, OBP). Biocides authorised in the EU may be authorised in Switzerland by means of recognition procedures (Article 3 paragraph 3 lit a, OBP). Certain biocides may not be authorised for use by the general public (Article 11d, OBP).
Medical Devices and PPE
In contrast to medicinal products and biocides, and unless an exemption applies, there is no prior authorisation by a public authority for (in vitro diagnostic) medical devices (including mHealth) and PPE in Switzerland. Instead, anyone who is domiciled in Switzerland and places a device on the market here, or puts a device into service without placing it on the market, must undertake a prior assessment of the conformity of that device with the general safety and performance requirements. The conformity assessment procedure is based on Articles 52&54/48 and Annexes IX-XI of the EU-MDR/EU-IVDR (Articles 21 et seq, MedDO; Articles 17 et seq, IvDO). If successful, the manufacturer issues, and continuously updates, a declaration of conformity and thereby assumes responsibility for ensuring the compliance of the device (Article 29, MedDO; Article 25, IvDO; Annex IV, EU-MDR/EU-IVDR). Devices placed on the Swiss market, or made available in Switzerland, must bear a respective conformity (MD or CE) marking (Article 13 and Annex 5, MedDO; Article 12 and Annex 4, IvDO; Annex V, EU-MDR/EU-IVDR). Pre-marketing, (serious) adverse events in clinical trials of medical devices have to be documented and reported to Swissmedic and the responsible ethics committee, depending on their severity (Articles 32 et seq, ClinO-MedD).
The regulation of PPE that is not qualified as a medical device equally follows the principle of self-control by the persons placing the product on the market. They must be able to prove, if necessary with the assistance of a conformity assessment body, that their products comply with the essential health and safety requirements (declaration of conformity; Article 3 paragraph 2, OPPE; Articles 14, 15 and 19 and Annexes I–IX, EU-PPE Regulation) or, where no such requirements have been specified, that they have been manufactured according to the current state of knowledge and technology (Article 3 paragraph 2, PSA). There is no requirement in Switzerland to attach a CE marking (Article 3 paragraph 3, OPPE).
Foodstuffs and Utility Products (Including Cosmetics)
Foodstuffs and utility articles, including cosmetic products, sold in Switzerland do not require an authorisation from the cantonal or federal authorities. Nonetheless, in application of the principle of self-control, anyone who places such products on the market in Switzerland must ensure that the statutory requirements are complied with, in particular with respect to safety, hygiene and protection of consumers from deception (Articles 1, 7, 10, 15 and 26, FSA; Articles 8 et seq and 45 et seq, FUAO; Article 3 paragraph 1, CosO). Official inspection does not imply an exemption from the obligation to carry out self-supervision (Article 26, FSA).
For certain foodstuffs, however, there are either positive lists (eg, the exhaustive list of permissible vitamins and minerals in Annex 1 of the Food Additives Ordinance), negative lists (eg, the list of impermissible plants or parts or preparations thereof in Annex 1 of the Ordinance on Food of Plant Origin, Mushrooms and Table Salt) or prior authorisation requirements (eg, for novel foods; Article 15 et seq, FUAO; Novel Foods Ordinance).
International Regulatory Harmonisation and Mutual Recognition
While most of the Swiss regulation on medical devices, consumer healthcare products and mHealth has been, and is continuously being, harmonised with EU, and (in parts) international, regulatory standards, Switzerland is not part of the EU and, hence, international commerce to and from the country is subject to the Swiss customs regime and certain barriers to trade.
To address the latter, Switzerland and the EU entered into an Agreement on Mutual Recognition in Relation to Conformity Assessments (MRA). The MRA ensures that, for the products and areas covered by the agreement (including PPE, GMP inspections, manufacturing licences and batch releases for medicinal products, biocides and GLP), Swiss manufacturers and conformity assessment bodies have, to the greatest extent possible, the same access to the EU market as their EU or EEA competitors.
With respect to medical devices, however, the EU and Switzerland have to date found no agreement to update Chapter 4 of the MRA on medical devices, as would be necessary to ensure the continued compatibility of the Swiss medical devices regulation in light of the recent amendments to the EU regulatory framework. As of 26 May 2021, therefore, the EU has been treating Switzerland as a third country as regards medical devices. The effect is that Swiss companies now face more demanding requirements when seeking to export medical devices to the EU, including the requirements to appoint an authorised representative, depending on the risk class of the device to present a certificate issued by an EU conformity assessment body, and to comply with the EU requirements on registration and labelling of products (see 5.2 Legislative Reform for further detail).
In the novel foods sector, applicants regularly submit a novel foods application in the EU and not in Switzerland, given the superior geographic range of the European novel foods authorisation and its automatic dynamic recognition in Switzerland (Annex to Novel Foods Ordinance).
International Product Liability
Upon entry into an international market, Swiss manufacturers of medical devices, consumer healthcare and mHealth products become exposed to international product liability litigation (see also 4.2 Product Liability).
Generally, a claim can be brought before Swiss courts if the defendant resides in Switzerland, regardless of where the claimant resides. Irrespective of this, if a product liability claim is based on tort or the Product Liability Act (PLA), the claim may be brought in Switzerland if the defective or faulty product was manufactured, or if the damage occurred, in Switzerland (Articles 129 et seq, Private International Law Act (PILA); Article 5(3), Convention on jurisdiction and the recognition and enforcement of judgments in civil and commercial matters between Switzerland and the Member States of the EU (LugC)). Claims based on contract can be brought in Switzerland if the product causing the loss was delivered to Switzerland, if the defendant is a consumer and resides in Switzerland, or if the parties contractually agreed on Swiss jurisdiction (Articles 5, 113 et seq, PILA; Articles 5(1), 15 et seq and 23, LugC).
In proceedings initiated by a foreign party, the defendant may request that the plaintiff provides security for party costs (Article 11b, PILA; Article 99 paragraph 1 lit a, Civil Procedure Code (CPC)).
Therapeutic Products and PPE
Marketing authorisation applicants for medicinal products as well as (in vitro diagnostic) medical device (including mHealth) manufacturers must have a post-market surveillance system (pharmacovigilance and materiovigilance plans, respectively) in place (Article 11 paragraph 2 lit a No 5, TPA; Article 56, MedDO; Article 49, IvDO).
Marketing authorisation holders for medicinal products with a new API or a biosimilar must periodically and automatically file periodic safety update reports (PSURs) with Swissmedic on the safety and risk-benefit ratio for four years after authorisation (Article 60, OMP). Depending on the classification of a (in vitro diagnostic) medical device, its manufacturer has similar trend report, periodic summary report and PSUR obligations to the designated body involved in the conformity assessment (Articles 59 et seq, MedDO; Articles 52 et seq, IvDO).
As for incident notification requirements, manufacturers of medicinal products, distributors of ready-to-use medicinal products and HCPs must notify Swissmedic of adverse events, adverse drug reactions and quality defects. Such notifications are voluntary for consumers, patients, their organisations, and interested third parties (Article 59, TPA). Serious adverse reactions should be reported within 15 days of diagnosis, and non-serious reactions within 60 days. Similarly, anyone placing (in vitro diagnostic) medical devices on the Swiss market as a manufacturer must report to Swissmedic all serious incidents that occur, as well as field safety corrective actions that are undertaken in Switzerland (Article 66, MedDO; Article 59, IvDO). In response, Swissmedic may take all administrative measures it considers necessary, including publishing recommendations and prohibiting the distribution and dispensing of therapeutic products, and ordering recalls (Article 66, TPA).
To the extent that PPE is not qualified as a medical device, manufacturers or distributors must monitor such PPE and notify the competent control body (the Swiss National Accident Insurance Fund (SUVA), the Swiss Council for Accident Prevention (BFU) or the organisations designated by the Federal Department of Economic Affairs, Education and Research (EAER)) if it poses a risk to the safety or health of users (Article 6, OPPE; Article 8 paragraph 5, PSA; Article 19 et seq, PSO). If it is necessary to protect the safety or health, warnings may be issued, further marketing or export may be prohibited, or the PPE may be recalled (Article 10, PSA).
Foodstuffs and Utility Articles (Including Cosmetics)
Where the responsible person identifies, or has reason to believe, that foodstuffs, utility articles or cosmetics that are imported, produced, processed, handled, dispensed or distributed by the respective company have endangered or may endanger health they shall immediately inform the competent cantonal enforcement authority where the foodstuffs or utility articles are no longer under the direct control of the company. The authority may take the necessary measures, including withdrawal from the market and recall (Article 84 paragraph 1, FUAO).
Biocides
The competent authority (see 2.4 Marketing and Sales) must be informed without delay if new findings emerge relating to a biocidal product or if significant changes occur with regard to essential points such as properties or intended use (Article 17, ChemA). The authority may take the necessary measures, including recall, seizure and destruction (Article 42 paragraph 3, ChemA).
On the federal level in Switzerland, the main relevant authorities for therapeutic products are Swissmedic and the FOPH. Cantonal authorities carry out enforcement tasks that are either assigned to them by the TPA or that are not expressly assigned to the federal government (Articles 69 et seq and 82 et seq, TPA). To the extent that PPE is not qualified as a medical device, the competent control authorities are SUVA, BFU and the organisations designated by EAER (Articles 20 et seq, PSO).
The enforcement of the foodstuffs and utility articles (including cosmetics) regulation in Switzerland is decentralised and carried out by the cantons, unless the federal government, in particular the FSVO, is responsible (Article 47 paragraph 1 and Articles 38 et seq, FSA).
The biocides regulation is enforced by a series of federal and cantonal authorities including, depending on the respective field of application, FOPH, FOEN, SECO and FSVO (Articles 50a et seq, OBP).
The regulatory authorities referenced in 3.1 Regulatory Authorities generally have the power to conduct inspections and take all administrative measures necessary to enforce the respective regulation (eg, Article 58 paragraph 1 and Articles 66 et seq, TPA; Article 10, PSA; Articles 19 et seq, PSO; Articles 30 et seq and 34 et seq, FSA).
Where applicable, the prosecution of criminal offences is a matter for the cantons, except where the respective regulation provides otherwise (eg, Articles 86 et seq, TPA; Articles 49 et seq, ChemA).
Therapeutic Products and PPE
For therapeutic products and PPE qualified as a medical device, the penalties for product safety offences under the TPA range from felonies to misdemeanours and contraventions. For felonies, the penalty is a sentence with custody of up to ten years, potentially combined with a monetary penalty, or (merely) a monetary penalty (Article 86 paragraph 2, TPA), while for misdemeanours the penalty is a custodial sentence of up to three years or a monetary penalty (Article 86 paragraph 1, TPA). For contraventions, the penalty is a fine (Article 87 paragraph 1, TPA). For PPE that does not qualify as a medical device, the maximum penalty for product safety offences under the PSA is custody of up to three years or a monetary penalty. Unlawful pecuniary advantages may be confiscated (Articles 16 et seq, PSA).
The Federal Supreme Court (FSC) has discussed the application of the aforementioned penalties, inter alia, in the following cases.
Foodstuffs and Utility Articles (Including Cosmetics)
For foodstuffs and utility articles, including cosmetics, the penalties for product safety offences under the FSA range from felonies to misdemeanours and contraventions. For felonies, the penalty is custody of up to five years or a monetary penalty (Article 63 paragraph 2, FSA), while for misdemeanours the penalty is a custodial sentence of up to three years or a monetary penalty (Article 63 paragraph 1, FSA). For contraventions, the penalty is a fine not exceeding CHF40,000 (Article 64 paragraph 1, FSA).
In BGE 127 IV 178, the FSC applied the penalty provisions of the FSA to a person who was accused of having sold mushrooms that contain active substances which are harmful to health.
Biocides
For biocides, the ChemA provides for penalties for product safety offences that amount, at most, to custody of up to five years, with a monetary penalty of up to CHF500,000 or with a fine up to CHF20,000 (Articles 49 et seq, ChemA).
The FSC has not yet had the opportunity to rule on these product safety offences in connection with biocides.
Product liability suits in respect of therapeutic products, PPE, foodstuffs and utility articles, including cosmetics, as well as biocides may be based on (i) the PLA, (ii) contract law, (iii) tort law, or (iv) statutory provisions applicable to specific industries.
First, if a product causes damage because it did not provide the safety which could reasonably be expected, a claim can generally be brought against the product’s manufacturer, importer or supplier as, based on the PLA, they are strictly liable for personal injuries. Compensation of damage to property is limited pursuant to the PLA. The injured person cannot claim compensation (i) for damage on commercially used property, (ii) for damage on the faulty product itself, or (iii) for property damage below CHF900. Since the PLA is neither a complete nor an exclusive cause of action, an injured person may raise additional claims based on alternative legal grounds (Article 11 paragraph 2, PLA).
Second, if a contractual relation exists between the injured person and the supplier, a defective product can also give rise to a claim for breach of contract. The CO contains general contractual liability provisions (Articles 97 et seq, CO) and special contractual liability provisions, such as in the case of sales contracts (Articles 197 et seq, CO). While contractual liability is generally fault-based, in sales contracts the seller is strictly liable for direct losses caused to the buyer (Article 208 paragraph 2, CO).
Third, tort law provides for fault-based liability claims. Hence, if a person unlawfully caused damage to another person, the person causing the damage is liable pursuant to Article 41 of the CO. In practice, tort liability is often derived from the principal’s liability (Article 55, CO). According to this specific provision, the principal – usually an employer – is liable for the unlawfully caused damage by its employees or ancillary staff in the performance of their work. An exemption from liability for the principal is only possible if they can prove that they took the necessary due care to avoid any damage. In practice, however, the FSC set the bar extremely high for the acceptance of such a defence. As a result, the principal’s liability amounts to that of strict liability. In order to be held liable under tort law, damage must, inter alia, be caused unlawfully – ie, in violation of absolutely protected legal interests (life, physical integrity, property) or of a statutory obligation, the purpose of which is to prevent damage of the very kind suffered. Hence, the breach of a statutory obligation can impose tort liability if such statutory obligation was introduced to prevent the damage suffered.
In addition to these general product liability claims, the Epidemics Act (EpA) provides a special ground for liability claims for vaccines, which has been of particular relevance since the beginning of the COVID-19 vaccination campaign in 2021. Anyone who is harmed by an officially ordered or officially recommended vaccination is entitled to compensation (Article 64, EpA; see 5.3 Impact of COVID-19 for further details).
Technical advancements to therapeutic products, PPE, foodstuffs and utility articles, including cosmetics, as well as biocides in medical devices and consumer health products have so far not had a recognisable impact in case law on the application of product liability laws to these products. However, if such products are faulty, a lower standard applies to the burden of proof: Generally, the standard for proving the existence of an alleged fact that needs to be met by the person who derives rights from such facts, ie, the plaintiff, is “full evidence”. However, with regard to the burden of proving causation, the FSC has lowered the claimant’s burden of proof and held that the involvement of a faulty product in an accident is already a significant indicator of the causal link. Moreover, where the causation can only be proven indirectly and by circumstantial evidence, the applicable standard of proof is not “full evidence” but the lower standard of “preponderant probability” (BGE 133 III 81). Nevertheless, the burden of proving causation still poses a high bar for product liability claims, as a recent judgment of the FSC indicates (BGer 4A_635/2020).
In principle, a Swiss jurisdiction is required for a lawsuit in Switzerland. Generally, a claim can be brought before Swiss courts if the defendant resides in Switzerland, regardless of where the claimant resides. There are a number of different provisions based on which foreign defendants may be sued in Switzerland.
If a product liability case is based on tort or the PLA, the claim can be brought in Switzerland if the defective or faulty product was manufactured there or if the damage occurred in Switzerland. If the claim is based on contract law, the foreign defendant can be sued in Switzerland if the product causing the loss was delivered to Switzerland, if the defendant is a consumer and resides in Switzerland, or if the parties contractually agreed on Swiss jurisdiction.
In order to bring a claim before a Swiss court, such claim needs to meet the following further requirements (Articles 59 and 209, CPC):
In general, Swiss law follows the “loser pays” rule – ie, the prevailing party may recover its legal costs (attorneys’ fees and expenses) from the unsuccessful party (Article 106 paragraph 1, CPC). However, party costs are awarded on the basis of statutory tariffs that mainly depend on the amount in dispute. In most cases, the compensation awarded covers only part of the actual costs incurred. The unsuccessful party has to bear the court fees and other incidental expenses as well as its own legal costs.
Throughout the proceedings, the parties are free to settle at any time. If an agreement can be reached, the legal costs incurred up to that point are distributed at the discretion of the court. Generally, each party has to bear its own costs, and the court costs are split equally.
Before the court takes on a case, it may demand an advance payment from the claimant up to the amount of the presumed court costs (Article 98, CPC). The defendant may request that the plaintiff shall provide security for the defendant’s attorneys’ fees if the plaintiff is not domiciled in Switzerland.
The mechanisms that are available in respect of product-related contentious matters depend on the acting authority that sets the cause of a complaint or appeal. In principle, a distinction must be made between federal and cantonal authorities.
Decisions by federal regulatory bodies, such as Swissmedic, can be appealed to the Federal Administrative Court (Article 31, Federal Administrative Court Act; Article 5, Administrative Procedure Act). The Federal Administrative Court’s decision can be further appealed to the FSC (Article 75 paragraph 1, Federal Supreme Court Act (FSCA)).
Decisions by cantonal regulatory bodies, such as cantonal ethics committees, can be appealed to a cantonal administrative court. The cantonal administrative court’s decision can be further appealed to the cantonal court of appeal or, depending on the canton, directly to the FSC (eg, in Basel according to Section 29 of the Constitutional and Administrative Jurisdiction Act of the Canton of Basel-Stadt; Article 75 paragraph 1, FSCA).
If a regulatory body conducts an inquiry, replies to a request or issues a preliminary assessment, but does so without issuing an official decision, such act cannot by itself be appealed. However, each concerned party may request an official decision in order to receive a valid object of appeal (for federal regulatory bodies see Article 25a of the Administrative Procedure Act).
To date, no class action system exists in Switzerland. A group action right is available to certain associations to protect the interest of a specific group of individuals. However, this group action right is limited to non-monetary claims, such as cease-and-desist orders and declarations of unlawful conduct (Article 89, CPC). Because monetary group action claims are, to date, not allowed, group actions are practically irrelevant for liability claims.
There are, however, alternative instruments for collective redress, such as the simple rejoinder pursuant to Article 71 of the CPC. According to this provision, two or more claimants whose rights or duties result from similar circumstances or legal grounds may jointly appear as plaintiffs, or be sued as joint defendants, provided that the same type of procedure is applicable.
In 2018, against the background of respective EU developments, Swiss lawmakers suggested the introduction of a collective redress system. After controversial discussions on the introduction of such a collective redress system, the Parliament decided in June 2022 not to respond to a new proposal from 2021, but instead to ask for further clarifications. The Swiss Parliament is expected to resume discussions on the matter in the second quarter of 2023 at the earliest.
In principle, a mandatory conciliation proceeding must be pursued before a claim can be filed with the court (Article 197, CPC). If the amount in dispute is higher than CHF100,000, the parties can agree to waive the conciliation proceedings (Article 199 paragraph 1, CPC). Moreover, the claimant can unilaterally forgo conciliation if the defendant’s registered office or domicile is abroad or if the defendant’s residence is unknown (Article 199 paragraph 2, CPC). No conciliation proceeding takes place if the case must be filed with a special commercial court (Article 6, CPC).
Pursuant to Article 213 of the CPC, the parties can also jointly decide to replace the conciliation proceeding by a mediation. In practice, the parties rarely make use of this possibility.
As mentioned in 4.7 ADR Mechanisms, prior to bringing a claim, the claimant must normally initiate conciliation proceedings (Article 197, CPC). Alternatively, such conciliation proceedings can be replaced by a mediation. Hence, a conciliation proceeding or a mediation is a necessary prerequisite for a lawsuit and will be followed by such lawsuit if no amicable settlement is reached.
The public prosecutor’s office is responsible for prosecuting product safety offences. Hence, it is not in the hands of civil litigants whether product safety issues are prosecuted. If, in order to settle a case, litigants apply pressure by threatening to report product safety offences to the prosecutor, such conduct might qualify as coercion (Article 181, Criminal Code) and result in a separate criminal proceeding.
The criminal justice authorities are obliged to report to the competent authority all offences that they have ascertained in the course of their official activities or that have been reported to them, unless they are themselves responsible for prosecution. The confederation and the cantons may introduce such a duty to report offences for members of other authorities (Article 302, Criminal Procedure Code).
If a criminal proceeding is initiated first, such proceeding can be combined with a product liability claim, as harmed persons may assert their civil claims as private plaintiffs by way of adhesion to criminal proceedings.
For the policy developments relating to CSR, the environment and sustainability see 2.2 Corporate Social Responsibility, the Environment and Sustainability.
For details on the current legislative reform projects see 5.2 Legislative Reform.
In view of societal, technological, political and economic developments, as well as regulatory advances in the EU, Swiss therapeutic products regulation is continuously being updated.
Medical Devices
In the course of aligning Swiss medical devices regulation with the new EU-MDR and EU-IVDR, the MRA also needs to be updated in order to ensure mutual market access, co-ordinated market surveillance, information sharing between authorities, and the mutual recognition of certificates of conformity. The EU Commission is making the updating of the MRA subject to progress on the EU-CH Institutional Framework Agreement (InstA). However, on 26 May 2021, the Swiss Federal Council decided not to sign the Agreement, bringing the negotiations on the draft InstA to a close.
In order to mitigate the negative effects from this decision, the Federal Council, on 26 May 2021, approved amendments to the completely revised MedDO that was enacted on the same day. These amendments are also reflected in the new IvDO of 26 May 2022. Inter alia, the amendments allow unilateral access to medical devices certified in the EU and set lengthy transitional periods of – in many cases – over one year for the appointment of an authorised representative, thereby alleviating supply problems in Switzerland. Manufacturers, importers and authorised representatives must register with Swissmedic and obtain a unique identification number (Swiss Single Registration Number, CHRN), which is to enable continued market surveillance and compensate for Swissmedic being denied access to the central European database for medical devices (EUDAMED 3) and to the EU working groups on the joint surveillance of new medical devices.
Subject to the outstanding updating of the MRA, this for the moment completes the revision of the Swiss medical devices legislation.
Medicinal Products
In the course of the continued implementation of the Medicrime Convention, provisions are being drafted and discussed that should improve patient protection and fight forgery of medicinal products through a voluntary placing of safety features on product packaging. It is yet to be determined when these provisions will enter into force.
In connection with COVID-19 vaccinations, as indicated in 4.2 Product Liability, the EpA provides a special compensation scheme according to which anyone who is harmed by an officially ordered or officially recommended vaccination is entitled to damages, and also to moral compensation of maximum CHF70,000 if the severity of the impairment justifies it (Articles 64 et seq, EpA). However, the Swiss State only grants compensation if the damage cannot be covered otherwise with reasonable efforts – eg, by the vaccine manufacturer. While this compensation scheme existed already prior to the COVID-19 pandemic, it has attracted greater attention since.
Henric Petri-Strasse 35
P.O. Box 257
4010 Basel
Switzerland
+41 58 200 30 00
+41 58 200 30 11
info@kellerhals-carrard.ch www.kellerhals-carrard.chThird Country Status of Switzerland – Its Impact on the Medtech Industry
Third country status of Switzerland
Since 2001, Switzerland has regulated medical devices in the same way as the EU. The former EU Directives on classical medical devices (93/42/EEC), on active implantable medical devices (90/385/EEC) and on in vitro diagnostic medical devices (98/79/EC) were fully incorporated into Swiss law, and Switzerland was integrated in the EU market surveillance system and the EU internal market for medical devices. As a result, there was a practically barrier-free market between the EU and Switzerland with regard to medical devices.
Owing to various incidents and scandals in relation to medical devices, doubts were raised about the quality of the EU surveillance system put in place for medical devices. In order to improve the safety of medical devices, the EU passed the Medical Device Regulation (MDR) and the In Vitro Diagnostic Medical Device Regulation (IVDR). Both regulations, which replaced the previous Directives mentioned above, entered into force in 2017. To ensure continuing equivalence with the EU, Switzerland adapted its national legislation for medical devices to the MDR and the IVDR. In particular, a new Medical Devices Ordinance (MedDO) and a new Ordinance on In Vitro Diagnostics (IvDO) were adopted.
To maintain the free trade of medical devices between the EU and Switzerland, an update of the mutual recognition of conformity assessments (MRA) was also necessary. However, the EU made the conclusion of the update of the MRA dependent on the conclusion of an institutional framework agreement with Switzerland (InstA), which had no direct relation to the regulation of medical devices. On 26 May 2021, the Swiss Federal Council terminated the negotiations with the EU because of substantial differences on key aspects of InstA. Since this date, the EU has considered Switzerland a “third country” with regard to medical devices.
As a result, Swiss medtech companies have to overcome higher hurdles to be permitted to continue selling their medical devices in the EU/EEA region. In parallel, there are increased requirements for medtech companies from EU/EEA states to introduce their medical devices on the Swiss market. This article provides an overview of the most relevant changes and consequences, and shows that the rift between the EU and Switzerland might open new opportunities for the medtech industry outside the EU/EEA states.
Impact on the medtech industry in Switzerland
Designation of an EU-REP and corresponding labelling requirement
Owing to Switzerland's “third country” status, the European Commission is of the opinion that Swiss manufacturers – as required for other non-EU manufacturers of medical devices – must mandate a competent EU representative (EU-REP) and label their medical devices with the relevant information about the EU-REP as of 26 May 2021 in order to continue selling their medical devices in EU/EEA states. The EU-REP acts as representative of the Swiss manufacturer vis-à-vis the European authorities and is jointly liable with the Swiss manufacturer for defective medical devices. The new obligation to appoint an EU-REP and the corresponding labelling requirements give rise to considerable additional costs. According to industry estimates, the initial transition has cost the Swiss medtech industry CHF114 million with expected annual recurring costs of around CHF75 million.
Several legal experts are of the opinion that the European Commission has violated EU and WTO law and that the EU and its member states must recognise existing registrations of Swiss manufacturers and of Swiss authorised representatives in Switzerland. They are of the view that the European Commission may not require the appointment of an additional EU-REP. However, as long as this view is not confirmed by courts, Swiss manufacturers are forced to comply with these additional requirements. Alternatively, they risk that their medical devices will not be permitted to enter the EU/EEA market. Rather, they will already be intercepted and confiscated at customs.
Validity loss of SQS certificates
Another consequence affects the so-called “notified bodies” of Swiss manufacturers. A notified body is an organisation designated by an EU member state or by other countries under specific agreements to assess the conformity of medical devices before being placed on the market. These bodies are entitled to carry out tasks related to conformity assessment procedures set out in the applicable legislation. Since November 2017, such conformity assessment bodies have been able to apply for designation as notified bodies under the MDR and the IVDR. The European Commission publishes a list of such notified bodies.
The European Commission is of the opinion that, due to the “third country” status of Switzerland and the absence of an update to the MRA, the certificates issued by Swiss notified bodies – including certificates issued under the former EU Directives prior to the entry into force of the MDR and IVDR – are no longer valid in the EU. This has the effect that the only remaining notified body in Switzerland, the Swiss Association for Quality Management Systems (SQS), has lost a significant business sector. More serious consequences, however, arise for Swiss manufacturers that have certified their medical devices at the SQS. Since 26 May 2021, their SQS certificates are no longer valid and they are no longer able to place their medical devices verified with SQS certificates on the EU/EEA market, unless they get them recertified by a European notified body.
Several legal experts consider this view of the European Commission to be unlawful and are of the opinion that EU member states must continue to permit sales of all medical devices with a valid certificate issued by a Swiss notified body prior to 26 May 2021 and may not require an EU certificate as a condition for import. A few Swiss manufacturers with SQS certificates have therefore filed a claim with the competent EU court. This is currently still pending.
Germany, which is an important export country for the Swiss medtech industry, has also objected to the view of the European Commission and decided that SQS certificates notified under the former EU Directives will continue to be valid in Germany until the deadlines set out in the MDR expire. Swiss manufacturers may therefore continue to sell their medical devices with SQS certificates in Germany, but not in other EU/EEA states. However, the European Commission announced that it considers this arrangement between Switzerland and Germany to contradict EU law. Therefore, it seems that the last word in this matter has not yet been spoken.
Refused EUDAMED access
EUDAMED is the IT system established by the MDR and the IVDR aimed at improving transparency and co-ordination of information regarding medical devices available on the EU market. It is structured around six interconnected modules and a public website. However, presently only three modules are available (“Actors registration”, “UDI/Devices Registration” and “Notified Bodies and Certificates”). The remaining modules (“Clinical Investigation & Performance Studies”, “Vigilance and Post-Market Surveillance” and “Market Surveillance”) are still under development and will only be released when the entire EUDAMED is fully functional.
Owing to Switzerland's “third country” status, the European Commission has refused Swissmedic, the Swiss medical enforcement authority, access to EUDAMED. Switzerland is thus denied participation in this key element of the MDR and IVDR structure, which is intended, in particular, to enhance joint market surveillance. This decision by the European Commission is also considered unlawful by several legal experts. They are of the opinion that the EU and its member state authorities must grant Swiss authorities access to EUDAMED.
At present, the denial of access to EUDAMED is still of limited consequence to Switzerland with regard to market surveillance, as the relevant module is not yet accessible. Moreover, Switzerland is still a member of the Medicrime Convention, which was concluded by member states of the Council of Europe and other states. This convention provides for a comprehensive exchange of information and joint co-operation between its member states regarding the fight against counterfeiting of medicinal products and medical devices and similar offences that threaten public health.
Consequences
Irrespective of the question of whether the action of the European Commission is lawful or not, the Swiss medtech industry has lost its previously barrier-free access to the EU/EEA market. This loss is undoubtedly serious. However, since the EU already made it clear at the end of 2018 that it would neither conclude new bilateral agreements with Switzerland nor update existing ones without the conclusion of InstA, the majority of Swiss medtech companies had already prepared for the prospect of a “third country” scenario at an early stage in order to continue exporting their medical devices to EU/EEA markets.
Nevertheless, the Swiss medtech industry is concerned about the possible loss of its international appeal owing to its “third country” status. Switzerland risks losing its competitive edge compared to EU countries owing to the perceived bureaucracy associated with its “third country” status. Naturally, the objective of the Swiss medtech industry is to continually strengthen its international attractiveness. With an export share of over 70%, a portion of 16.4% of Switzerland's positive trade balance, more than 63,000 employees in the sector and the most patents per inhabitant across Europe, the medtech industry is of great economic importance in Switzerland.
Impact on the medtech industry of EU/EEA states
Maintaining Market Access
Despite Switzerland's “third country” status, Swiss medical device legislation still largely adopts the rules of the MDR and the IVDR. Switzerland continues to recognise the European Conformity Markings as well as the certificates issued by notified bodies based in EU/EEA states, even though the EU reciprocally no longer recognises the certificates of the only existing Swiss notified body (SQS). Medtech companies from EU/EEA countries are therefore still permitted to distribute their medical devices certified in the EU in Switzerland. Since 26 May 2021, however, they no longer benefit from the almost barrier-free market access to Switzerland, but rather have to meet more stringent requirements, as the following sections will illustrate.
Designation of an CH-REP and corresponding labelling requirements
As a result of the non-updated MRA, Switzerland requires that manufacturers from EU/EEA countries mandate a Swiss authorised representative (CH-REP) – whose rights and obligations are comparable to those of an EU-REP – and label their medical devices with the relevant information about the CH-REP within certain legal transitional periods, in order to continue placing their medical devices in Switzerland. These additional requirements are associated with considerable costs. It is therefore expected that many manufacturers from EU/EEA states will not be willing to take on this additional effort for the relatively small Swiss market.
Considering the fact that manufacturers from EU/EEA countries did not need a CH-REP to place their medical devices on the Swiss market until 26 May 2021, the question seems justified as to why this should now be necessary. In view of potential supply shortages, Swiss industry associations have already called on the Swiss Federal Council in March 2021 to ensure that no unnecessary import barriers are created by Swiss legislation. However, as noted above, their intervention was without success.
Obligation to register medical devices and economic operators
Until the MRA is updated, Swissmedic is unable to register economic operators domiciled in Switzerland via EUDAMED. To mitigate the consequences of this loss and to continue to ensure market surveillance in Switzerland, manufacturers, authorised representatives and importers domiciled in Switzerland are required to register once with Swissmedic to market their medical devices in Switzerland. Economic operators have to register within three months of placing their first medical device on the Swiss market. At present, the registration obligation only applies to economic operators domiciled in Switzerland. A precise date by which registration must take place for all medical devices and economic operators has not yet been announced. This additional registration requirement, which results from Switzerland's “third country” status, also constitutes an import hurdle for foreign medtech companies in distributing their medical devices in Switzerland.
Consequences
Owing to Switzerland's “third country” status, manufacturers from EU/EEA countries that had previously profited from barrier-free market access to Switzerland must overcome increased hurdles in order to sell their medical devices in Switzerland. It is expected that many EU/EEA manufacturers will be reluctant to comply with these additional measures solely to access the relatively small Swiss market. The Swiss healthcare sector is therefore concerned that there will not be enough medical devices available to supply the Swiss population in the future. Forecasts suggest that around one out of eight medical devices will, in future, no longer be available in Switzerland.
This worry is justified because Switzerland could face supply shortages regardless of its “third country” status. This is because the EU/EEA countries are also concerned about supply shortages as a result of the different legal situation related to the MDR and the IVDR. The MDR and the IVDR, for example, require stricter review processes for notified bodies. As a result, there are currently far fewer notified bodies than under the previous regime. This will most likely lead to delays in certification of medical devices. Another reason for possible supply shortages in the EU and Switzerland is that the MDR and the IVDR provide for various upgrades in the classification of medical devices, which means that medical devices have to meet higher requirements and therefore could either come onto the market with some delay or be prevented from being placed on the market, because certain manufacturers might reduce their product portfolio as a result of the higher classifications.
Impact on the medtech industry outside EU/EFTA states
No direct market access
Medical devices thathave not been certified by a notified body recognised by the EU do not have free access to the Swiss market. In principle, it is therefore not possible for medical devices that have been certified in the USA or Australia, for example, to be placed on the Swiss market without an additional European conformity assessment, regardless of the possibility that these countries impose comparable or even higher safety requirements on medical devices.
Switzerland's “third country” status does not affect this regulatory system. However, owing to the rift between the EU and Switzerland, the question arises as to whether Switzerland should also recognise certifications from countries outside the EU/EEA. This idea is not totally new in the global context. There are different states that recognise certifications from different regulatory systems. For example, the Australian authority, the Therapeutic Goods Administration (TGA), not only accepts European certifications, but also accepts certificates from the USA, Canada and Japan, as well as certificates issued under the Medical Device Single Audit Program (MDSAP).
Political Intervention
Swiss politicians have recognised that, in view of the imminent supply shortages of medical devices, Switzerland should not only continue its negotiations with the EU but should also consider options for action outside the EU. A motion submitted in 2020 by the Council of States member Damian Müller pursues this approach. With this motion, the Swiss Federal Council was requested to adapt the Swiss legislation in such a way that medical devices from non-European regulatory systems could also be placed on the Swiss market. This motion emphasised that it is not guaranteed that the Swiss population will be supplied with sufficient medical devices in the future and that it is therefore irresponsible to rely exclusively on EU certification to satisfy national demand.
The Swiss Federal Council commented on this motion on 2 September 2020, at the time still expecting that the MRA between the EU and Switzerland would be updated. It stated that recognition of certificates from regulatory systems outside the EU had to be assessed with care.
In May 2020, National Council member Albert Rösti submitted a similar motion. He also requested that Switzerland should recognise certificates of non-European notified bodies, in particular, the certificates of the United States Food and Drug Administration (FDA). He emphasised that his motion had become even more urgent as Switzerland had been classified as a “third country” by the EU.
At present, it is uncertain whether these two motions, which have already overcome several political hurdles, will be implemented by the government. In order to limit supply shortages and to strengthen the attractiveness of Switzerland as a target market, the adoption of these motions would be beneficial. This would not only be advantageous to Switzerland, but would also provide new opportunities to medtech companies outside the EU/EEA territory, which might profit from easier market access to Switzerland in the future.
Increased importance of exemptions
Without a change in legislation, there is no way that medical devices which have been certified outside of the EU/EEA countries can be imported into Switzerland. This is only possible by means of an exceptional authorisation by Swissmedic.
Article 22 paragraph 1 MedDO provides for such an exemption. According to this provision, Swissmedic may, upon reasoned application, grant an exemption for the distribution of a specific medical device even if it has not undergone the relevant conformity assessment procedure if its use is in the interest of public health or patient safety. An exemption according to Article 22 paragraph 1 MedDO may be granted, for example, for medical devices that have been certified by a notified body outside the EU/EEA territory.
Another exemption is established in Article 23 paragraph 1 of the COVID-19 Ordinance 3. According to this provision, Swissmedic may authorise the placing on the market and use of medical devices that have not undergone the relevant conformity assessment procedure, provided their use for preventing and combating COVID-19 in Switzerland is in the interests of public health. This exemption is only expected to be available until the end 2022, unless the COVID-19 Ordinance 3 is extended again.
Owing to the predicted supply shortages, it is expected that these exemptions will gain more importance in practice and that Swissmedic will increasingly issue such exemptions for medical devices with non-European certifications and relax its hitherto restrictive practice. This might open up opportunities for foreign manufacturers who have certified their medical devices outside the EU.
Consequences
The rift between Switzerland and the EU/EEA and the “third country” status of Switzerland have, in principle, no direct impact on medtech companies outside the EU/EEA. They still do not have free market access to Switzerland unless they get their medical devices certified by a notified body within the EU/EEA territory. However, owing to the strained relationship with the EU, Switzerland may be forced to examine alternative supply options outside the EU/EEA countries. The political impasse between the EU and Switzerland might therefore become an opportunity for the medtech industry in non-European countries with comparable or even higher safety standards to introduce medical devices into the attractive Swiss market. Switzerland has one of the best healthcare systems worldwide and spends over EUR8,300 per capita on healthcare per annum. The majority of European countries spend less than half of that amount. The Swiss market therefore offers considerable economic potential despite its relatively small size.
Summary
After Switzerland's designation as a “third country” by the EU, the Swiss medtech industry is faced with two existential challenges. On the one hand, it must ensure the sustainable supply of medical devices to the Swiss population. On the other hand, it must maintain the competitiveness and innovative strength of Switzerland in the global medical market.
Both challenges could be overcome if the EU and Switzerland were to agree on an update of the MRA. At present, however, the positions of the EU and Switzerland seem increasingly irreconcilable. Therefore, it is presently uncertain how the relationship between the EU and Switzerland will develop. What is clear, however, is that the EU is by far Switzerland's most important trading partner. One in every three jobs in the Swiss medtech industry depends on orders from the EU. Therefore, it is crucial, not only for the Swiss medtech industry but also for other fields of industry, that Switzerland puts its relations with the EU back on a solid foundation.
A parallel way to tackle the challenges facing the Swiss medtech industry would be for Switzerland to extend its focus to countries outside the EU/EEA with comparable regulatory systems in the medical device sector. In the short term, this can be done by granting more exemptions for medical devices with non-European certificates. In the longer term, a change in the Swiss legislation might come into force, whereby non-European certificates would also be recognised in Switzerland. The current challenges might therefore offer new opportunities for the medtech companies from non-European countries (eg, from Canada, Australia, Singapore and the USA), which might benefit from easier access to the affluent and attractive Swiss market in the future.
Despite the expected easing of access requirements, importing medical devices into the lucrative Swiss market is still heavily regulated. Should any questions arise as to business opportunities, do not hesitate to contact the Health and Medical Law team at Prager Dreifuss.
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