European Health Union should ensure that history will not repeat itself

COVID-19 has blatantly exposed all the cracks and fissures in the European health systems and shown the EU to be unprepared for dealing with major health emergencies. But the first building blocks of the future European Health Union, recently proposed by the Commission, look promising and may give the EU the right weapons to fight pandemics in the future

The European Commission's proposals for building a stronger European Health Union (EHU), unveiled last November, aim to equip EU healthcare to manage any future health crises more effectively. This should go hand in hand with reinforcing public health systems in all Member States, found a hearing held by the European Economic and Social Committee (EESC).

Topping the hearing's agenda were three proposals set out in the Commission Communication on Building a European Health Union. They refer to the regulation on serious cross-border threats to health and two regulations aiming to beef up the mandate of the EU's two key agencies in the field of public health: the European Centre for Disease Prevention and Control (ECDC) and the European Medicines Agency (EMA).

The EESC organised the event to collect input from representatives of European institutions, health professionals and civil society organisations for its forthcoming opinion analysing the Commission's proposals from civil society's point of view.

The participants agreed that the Commission's initiative was a step in the right direction.

The pandemic has shown that the EU was not ready to protect its citizens. It exposed fractures in EU healthcare systems and in their architecture. We have seen the consequences of this, with thousands losing their lives, many becoming impoverished and inequality increasing, said the rapporteur for the EESC opinion, Ioannis Vardakastanis, who opened the hearing.European citizens want a consistent approach to healthcare. These proposals should lead to the creation of a new system, a new weapon in our arsenal, available both in the EU and in Member States, which will enable us to deal with the challenges and risks of future pandemics.

The proposals, presented at the hearing by Giraud Sylvain and Ingrid Keller from the Commission, include the establishment of an EU Health Task Force, training for healthcare staff and stipulating that an emergency can be declared at EU level rather than solely by the WHO, as is now the case.

There are plans to set up the Health Emergency Preparedness and Response Authority (HERA) to develop and procure biomedical and other solutions for better testing and contact tracing. The mandates of the ECDC and EMA will be extended, allowing them to recommend measures for outbreak control or to monitor and advise on the supply of medical devices in a crisis.

We think we need more and better EU intervention. Our intention is not to return to business as usual after this or just carry on with where we are, but to invest in the knowledge gained and improve the EU's planning and preparedness for any future pandemics, Ms Keller said.

ECDC director Andrea Ammon said that they welcomed the strengthening of their role as they have been facing demands they could not meet due to the shortage of resources and the lack of a legal mandate.

The proposed EU Health Task Force, which will be set up within the ECDC, should help the agency to be better informed about the situation in countries inside and outside the EU.

We are willing to take this forward. We have learnt one very crucial lesson: no country and no region can cope with a crisis of this scale on their own. We are so interconnected globally, we have to work together at global level: only then will we be safe altogether, said Ms Ammon.

EMA director Emer Cooke was also pleased with the new roles and responsibilities given to her agency: This extended mandate reflects several of the initiatives, structures and processes that we have ourselves put into train to respond to shortages of medicines, medical supplies and devices and to the crisis.

Nicolas Gonzalez Casares, European Parliament rapporteur for the EMA regulation, threw his support behind the Commission's proposal.

In his view, in the early days of the pandemic, uncoordinated measures by governments seeking to defeat the virus, such as internal border controls or closures, interrupted supply chains and cut off the flow of essential goods and services.

 Over the past months, we have seen how the agencies had to invent and create new structures for better coordination of response. This whole package aims to transform these lessons into a regulatory framework giving the Union the role that citizens have decided it should play, he said.



Despite welcoming the Commission's efforts in this regard, the speakers had suggestions on how to improve what is on the table or expressed doubts over the effectiveness of some proposals.

Caroline Costongs, Director at EuroHealthNet warned that a stronger ECDC and HERA will have little effect unless public health systems in Member States are strengthened as well. Building national and regional capacities should be a bottom-up process, with the involvement of local authorities.

She also pointed out that the EHU should structure the package around health inequality, with a stronger focus on psycho-social factors such as mental health, gender equality and digital health literacy.

Our overarching concern is that proposals are mainly developed from a biomedical perspective, and do not do enough to incorporate psycho-social measures. The COVID-19 pandemic can be regarded as a syndemic. This means that the severity of COVID-19 is magnified by existing non-communicable diseases, such as diabetes or obesity, and by existing forms of inequality, Ms Costongs said.

Recent data from the Netherlands show that the 20% of the population at the lower end of the social gradient are three times more likely to die from COVID-19 than the 20% at the highest end.

This kind of data will be emerging in other Member States too. The EHU package should respond to this injustice, she warned.

Zoltan Massay Kosubek from the European Public Health Alliance (EPHA) said that the ECDC's mandate should be further extended to include non-communicable diseases, while HERA should have a clear public health mission. EPHA was in favour of a Health in All Policies (HiAP) approach that seeks to mainstream health into all relevant policy processes.



Annabel Seebohm from the Standing Committee of European Doctors (CPME) emphasised the need to review the legislation and policies on the working conditions of the health workforce, as the current proposals only address this point indirectly. The terms of employment of health professionals should be safe and lawful, including in emergency situations.

For Jan Willem Goudriaan from the European Federation of Public Services Union (EPSU), a strong EHU depends on the people delivering it. However, many workers often feel their work is not appreciated enough. They need professional recognition and better pay and working conditions.

The time when healthcare workers could live on the applause is over, he said. He warned against the budget cuts in the health sector and against the introduction of for-profit services, which will not improve healthcare or give everyone access to it.

Public health is a public good, not a commodity you can sell to the highest bidder, Mr Goudriaan said.

Marta Branca from the European Hospital and Healthcare Employers' Association (HOSPEEM) saw the recent crisis as an alarm bell and a wake-up call to recognise the health sector as an area for investment and not just for budget cuts.

The economy of a country is healthy when its population is healthy. Let's hope the Member States will invest in healthcare. It is a vicious circle, she said, adding that HOSPEEM would like to see more information on stress tests, auditing procedures and indicators which will show the preparedness of national healthcare plans for crisis response.

According to HOSPEEM, healthcare management should remain a Member State competence, given the diversity of systems linked to culture and history.

The need to include local and regional authorities in the national and EU plans on health matters was highlighted by the three rapporteurs on the EHU from the Committee of the Regions (CoR) - Roberto Ciambetti, Birgitta Sacrédeus and Olgierd Geblewicz.



Primary competence for health protection and healthcare systems lies with the Member States. The EU can support and complement national policies. 

The new European Health Union should ensure that all EU countries prepare and respond together to health crises. It should also improve the resilience of Europe's health systems. 

The EESC's opinion on the EHU will be adopted in April.