Although it has great potential, HERA - the EU's new body for fighting future health emergencies across borders – falls short on transparency and ambition. With few checks and balances in place for its work, there are doubts as to whether HERA will be able to fulfil its public health mission, rather than giving a predominant role to the pharmaceutical industry
The European Economic and Social Committee (EESC) praised the European Commission's swift creation and set up of HERA, the new EU authority tasked with countering cross-border health threats and coordinating the production, procurement and distribution of medicines and medical supplies that may be used in the event of a potential public health emergency.
At the same time, the EESC expressed its concerns over a number of issues it sees as a potential barrier to HERA serving as an authority that puts public health and the interests of vulnerable groups at the core of public health policies and measures that the EU and its Member States may take to prevent or respond to health crises spilling over borders.
These include inadequate transparency or independence, the absence of democratic oversight of HERA's future work and the promotion of the interests of the pharmaceutical industry.
The civil society body listed its concerns in the opinion adopted at its plenary session in February, stressing that the Commission should address these in order to make sure that the new authority truly serves the public interest.
Our opinion considers the potential and gaps of HERA in specific sections, looking at HERA's institutional and operational framework, its mandate and operational arrangements. We looked to see whether this new authority has been effectively designed to protect EU citizens against cross-border threats, said rapporteur Ioannis Vardakastanis.
The EESC's main objection is the potential lack of public scrutiny of HERA's work which can happen due to the very limited role given to the European Parliament, regional authorities, health insurance bodies and civil society organisations, including patient organisations and trade unions of health sector workers.
The Parliament only has a simple vote on the budget and an observer role on HERA's board; the EESC also noted that the Parliament was not consulted or involved before or during HERA's establishment.
Unlike the pharmaceutical industry, which will have its say in HERA through a Joint Industrial Cooperation Forum (a subgroup of the Advisory Forum), civil society organisations have not been allocated any role in the HERA Board or the Health Crisis Board. This is why the EESC recommends establishing an Advisory Forum subgroup that would include patients and public health organisations, health sector trade unions and non-commercial research institutions. The EESC and the Committee of the Regions should also have a seat in this subgroup which would be on an equal footing with its industrial counterpart.
We recognise the importance of industry in tackling health emergencies but we are concerned that the current structure of HERA could fail to ensure that public health and the interests of vulnerable groups are at the core of the EU's preparedness and response capacity, instead favouring industrial policy, said Mr Vardakastanis, stressing that democratic scrutiny was essential for the development of public health policies.
Other EESC objections referred to HERA being insufficiently independent, unambitious or lacking transparency and openness in its current set-up.
In the EESC's view, as an agency established as a structure under the remit of the Commission, HERA appears to be primarily a technical authority lacking the strategic and forward looking component needed to address cross-border threats.
Furthermore, HERA's current mandate fails to ensure equity during preparedness and crisis response times, making it unambitious. For example, no commitment was made to ensure the collection of better disaggregated data on vulnerable groups or to ensure non-discrimination and equality in the distribution of medical supplies and medicines.
Another major concern is the insufficient transparency of HERA's decision-making process and the lack of full transparency with regard to the funds allocated and spent by and through HERA. According to the EESC, civil society should be involved in the oversight of HERA's financial aspects.
HERA could also play a role in ensuring better coordination of communication campaigns related to prevention and response to cross-border health crises, specifically targeting the most at risk people and vulnerable groups.
There is also a danger that there might be some overlap between HERA's mission and the work of other bodies including the EMA and ECDC, the civil society body concluded in the opinion.