Yes, we have failed. This was the short answer to the central question posed during a recent European Health Forum Gastein webinar to discuss the European Health Union Initiative (EHUI) – a campaign for a European Health Union (EHU) – which supports the vision of a European Health Union for concerted action on health threats. The European Health Union Initiative looks beyond covid-19 and addresses longer-term and more comprehensive issues such as environmental sustainability and ensuring the most vulnerable populations are heard and protected.
Anita Simonds, President of the European Respiratory Society, pointed to some obvious failures in Europe’s response to covid-19, including delays in the procurement of personal protective equipment (PPE), respiratory devices, medicines, and now vaccines; ongoing disputes around coordination of national lockdowns; and unilateral decisions about border closures. She also highlighted positive examples of joint work, including several multi-centre pan-European trials that have helped to understand which treatments for covid-19 do or do not work. Could we have done better, if European collaboration had been prioritised over nationalistic actions?
The first concrete steps towards building a European Health Union and enabling more effective cross-border collaboration on health were taken last autumn. In November 2020, the European Commission put forward a number of different legislative proposals including reinforcement of the roles of the European Medicines Agency (EMA) and the European Centre for Disease Prevention and Control (ECDC), and the establishment of a new European agency for advanced biomedical research and development.
These are important steps, but essentially reactive ones which fall short of addressing the major systemic issues exposed and exacerbated by the covid-19 syndemic. Richard Horton has rightly called the COVID-19 crisis a “syndemic”, as socio-economic factors as well as biological preconditions need to be taken into consideration when designing responses to the ongoing multifaceted crisis. To have a meaningful and long-lasting impact, new or reinforced actions should not only go beyond biomedical solutions, but also transcend health policy to address socio-economic, environmental, and commercial determinants of health. We must provide the conditions in which our societies can thrive and become more resilient to adverse situations.
“The [European] Union’s aim is to promote peace, its values and the wellbeing of its peoples,” said WHO Special Envoy for the European region Vytenis Andriukaitis, citing Article 2 of the Treaty of Lisbon. He underlined that there is no wellbeing without health and that the EU has a moral responsibility to ensure all its citizens enjoy an equal right to health. He shared the recent findings of a Eurobarometer survey showing that Europeans consistently prioritise health and support a greater role for the EU on health matters.
The EU undoubtedly has the potential to do more to support its member states to improve health. However, as highlighted by Urska Erklavec, Ministry of Health, Republic of Slovenia, member states have multiple concerns about embracing a European Health Union, including extra administrative burdens, allocation of resources, and overall questions about how the agenda will be set and how the EU could compel member states to act. Arguably a clear message that member states are not ready to devolve more powers to the EU on health was exemplified by the fact that in the middle of the syndemic, national governments wanted to commit only EUR 2 billion (out of the EUR 9 billion proposed by the EC) to fund the EU4Health Programme (2021 – 2027). The EU4Health Programme is a financial instrument of the EU to help member states to deliver on urgent health priorities.
Could the upcoming Conference on the Future of Europe (CFE) help realise the vision of a European Health Union? The conference, which runs from 9 May 2021 until spring 2022, will give European citizens the chance to have a say on policies that matter to them. Crucially, the European institutions have agreed to jointly follow up on the concrete ideas proposed by citizens, explained Mattia de’ Grassi, Member of the Cabinet of Dubravka Šuica, European Commission Vice President for Democracy and Demography. Fully participatory approaches are clearly necessary, but many of those involved in the EHUI, including Vytenis Andriukaitis, believe that only changes to the Treaty of Lisbon, to expand the remit of EU responsibilities in the field of health, will enable the EU to ensure better citizen protection and wellbeing.
There are others who argue that much can be done by better using existing frameworks. Tamara Hervey, Jean Monnet Professor of European Union Law at the University of Sheffield, noted that using existing competencies fully could help achieve the goals set out in the Treaty. For example, a more “humanised” union could be brought to life through mechanisms like the EU’s annual cycle of economic and social policy coordination “the European Semester process” or implementation of the European Pillar of Social Rights, a (non-binding) commitment among member states to address social challenges and guarantee social rights.
In the near future it will most likely be the existing mechanisms at the EU level that are used to deliver on the vision of “one health”. At this stage it may be too early to speak of a fully-functioning European Health Union, as there are simply too many nuances and issues that national governments would like to have clarified. However, over the next year the CFE presents an opportunity for citizens and civil society to make their voices heard, and demands for the EU to include health in all its policies are likely to create further momentum. In parallel, the covid-19 syndemic continues to mobilise us to rethink our socio-economic and health systems, and for meaningful cross sector action to improve health.
A full recording of the webinar is available to watch here.
This opinion piece was written by Lina Papartyte, Project Coordinator at EuroHealthNet and member of the Young Forum Gastein. The opinion piece was published online in the BMJ Opinion on 9 April 2021.