Failing and innovating: from the Covid pandemic to the European Health Union
"We cannot wait for the end of the pandemic to repair the damage and think about the future. We will lay the foundations for a stronger European Health Union, in which 27 countries can work together to identify threats, prepare and initiate a collective response."
-Ursula von der Leyen, President of the European Commission, during her speech at the World Health Summit (25 October 2020)
What we have just experienced was, in all probability, the strangest holiday season that living generations have ever seen. No crowded shops, dinners or toasts with friends and only a handful of loved-ones with whom we could each spend the holidays. Face masks and hand sanitiser could be seen as far as the eye could see to make sure you do your part and don't endanger yourself and others.
A common destiny
The Covid-19 pandemic has highlighted a profound fragility, forcing citizens of all countries to experience the same chaotic, uncertain situation. An experience that, following seventy years of peace, growth and economic well-being, was far from expected. Europe, which showed itself as broken up, powerless and at the mercy of national selfishness in the early stages of the pandemic, has since celebrated V-Day for the administration of the first doses of the vaccine, developed by BioNTech and Pfizer, and authorized by the European Medicines Agency (EMA) on December 21st. It was a much-needed moment of unity and a success for the President of the EU Commission, Ursula Von der Leyen. If it is indeed true that every crisis lays the foundations for a new development, the Coronavirus could be the triggering event that will launch Europe toward the fulfillment of an ancient project.
An old story
The proposal for a European Health Union is not new. In fact, it dates back to the dawn of political unity in Europe in the 1950s. The subject was dear to Robert Schuman, one of the founding fathers of the Union, who dreamed of a European health community, which was known to experts at the time as the "white pool" – so named to complement the "black pool", which was the European Coal and Steel Community (ECSC), and the "green pool", the Common Agricultural Policy (CAP). This third community was to be founded on the harmonization of public health policies, the unification of health insurance legislation, the introduction of pan-European funding programs and the construction of assistance centers and laboratories to promote joint research. An ambitious proposal that ended up being shelved.
The current state of affairs
Broadly speaking, the functioning of the European Union is based on the cardinal principles of subsidiarity, proportionality and attribution of competences. These serve to ensure that decisions are made at the level as close as possible to the citizen (as most effective) and to outline the perimeters on issues in terms of priority for action by Regions, States and the Union. Health policy is a shared competence between the Member States and the Union, as defined by art. 168 of the Treaty on the Functioning of the EU (TFEU): while individual countries define and provide their own national health services and medical assistance, the EU seeks to integrate national policies through a health strategy. This continental health strategy sets the goals of preventing disease by promoting healthy lifestyles, facilitating access to better and safer healthcare, contributing to innovative, efficient and sustainable health systems, addressing cross-border threats, and keeping people healthy by taking advantage of new technologies and practices. In short, and as stated in Article 6 of the TFEU, the Union can coordinate or support actions, which are the responsibility of the Member States, with the aim of protecting and improving human health.
And in fact ...
As we all know, the EU’s response to the Coronavirus health crisis has been slow and fragmented. Member States acted selfishly, with one such example being the German ban on exports of personal safety equipment (PPE), which was then lifted following the Commission's threat to take legal action. There has been a "free movement of patients'', introduced more as a gesture of solidarity amongst Member States than as an organized response, but it was introduced nonetheless. Masks were supplied to 25 countries and we witnessed the creation of a common reserve of medical equipment at European level, known as the rescEU reserve. Then came the vaccine strategy which was presented in June, complete with contracts and investments to accelerate research and grab the doses necessary to cover the entire population of the EU. These steps were vital so as to avoid competition between Member States and ensure a fair supply of vaccines for all.
On November 11th
The most important step was taken on November 11th, with the presentation of the communication Building a European Health Union: Strengthening the EU's resilience to cross-border health threats that will kick-start the process of building the European Health Union. Based on the lessons learned from the crisis, this strategy contains new proposals to strengthen the health security framework and strengthen the crisis preparedness and response roles of the main EU agencies. Specific reference is made to the European Center for Disease Prevention and Control (ECDC) and the European Medicines Agency (EMA), whose weaknesses have been highlighted by the ongoing crisis. Together with the communication, which roadmaps the coming years, the Commission has published three proposals for regulations concerning both agencies and also cross-border threats to health.
The first, concerning serious cross-border threats to health, focuses on three axes:
Strengthening preparedness thanks to the elaboration of a plan and several recommendations to prepare for health crises and pandemics, to be adopted at national level. The elaboration of the plans would be supported by the ECDC and other EU agencies, and will be subjected to checks and stress tests by the Commission and the agencies;
Strengthen surveillance through the creation of an integrated and enhanced surveillance system at EU level, through the use of artificial intelligence and other advanced technological means;
Improve data communication by Member States, which will have to enhance the communication of health systems indicators (e.g. availability of hospital beds, availability of places for specialized care and intensive care, quantity of qualified medical staff, etc.).
The second regulation concerns the ECDC which, in recent months, has only been able to issue technical guidelines, without being able to provide analysis of the data collected. The intention is to strengthen the mandate in terms of: epidemiological surveillance; response preparation and planning; communication of information and controls; development of non-binding recommendations and options for risk management; ability to mobilize and dispatch a health task force of the EU to support local response in Member States; establish a network of EU reference laboratories; and establish a network for substances of human origin.
The third concerns the EMA, whose mandate is to be expanded by: focusing on monitoring and mitigating the risk of shortages of essential medicines and medical devices; scientific advice on medicines potentially capable of treating, preventing or diagnosing diseases at the core of crises; the coordination of studies to monitor the efficacy and safety of vaccines; and coordination of clinical trials.
What would Schuman say?
Obviously, we cannot be sure. What’s clear is that we are still far from a real "white pool" as envisaged by one of the EU’s founding fathers, but we can say that we are becoming more and more aware of the need to make his dream a reality. Despite the exchange of information and the support of Member States' actions, greater integration and timeliness of response to the health crisis triggered by Covid-19 was needed. This is indisputable and has generated an impulse towards a path of innovation. Solidarity has been a source of inspiration: as the pandemic progressed, Member States have moved from unilateral measures, such as export restrictions or the reintroduction of internal border controls, to mutual support, as they recognised that this is the right way to go. The EU must continue down this path towards further unity as we drag ourselves out of the ever-worsening mess created by the pandemic.