On Friday in an intense plenary session, the European Parliament voted strongly in favour of a European Health Union and stronger cooperation in the area of health, to combat future threats to public health systems in a new EU public health strategy. 

The COVID-19 pandemic has been a harsh lesson and a stark eye-opener on various aspects, from business to education, work-life balance and health. 
The pandemic has placed public health systems around Europe under enormous strain – and by doing so, has revealed gaps in the way health emergencies are handled. 

While primary responsibility for public health and healthcare systems lies with individual member states, the EU has a critical role in improving health, preventing and managing diseases, mitigating sources of danger to human health and harmonising health strategies between member states. 

It is in this spirit that the gaps revealed by the coronavirus pandemic are aimed to be addressed. The European Parliament has consistently promoted the establishment of a coherent EU public health policy. An April 2020 resolution called for the European Centre for Disease Prevention and Control and the European Medicines Agency to be strengthened, as well as for the creation of a European health response mechanism, and on May 15, MEPs insisted on a new stand-alone European health programme.

The Commission has since presented a proposal for an EU4Health programme for 2021-2027 as part of the Next Generation EU recovery plan. 

Covering the period 2021-2027 and investing €9.4bn, this is the largest health programme ever in monetary terms. It will provide funding - to EU member states, health organisations and NGOs - to boost the EU’s preparedness for major cross-border health threats and strengthen health systems, so they can face epidemics and the long-term challenges these bring, while making medicines and medical devices available and affordable. According to the Commission’s proposal, it will work closely with the Member States to ensure that the support provided is based on national needs.

The need for the EU to have a stronger role in fighting the COVID-19 crisis and future challenges – as well as stronger cooperation between member states - is highlighted by public opinion. In a Eurobarometer survey on the expectations of European citizens in 21 member states, nearly seven out of 10 respondents said they wanted a stronger role for the EU in fighting this crisis, while almost six out of 10 respondents said they were dissatisfied with the solidarity shown between member states during the pandemic. 

On Wednesday, July 8, in a plenary debate with Health Commissioner Stella Kyriakides - preceding Friday’s resolution on the EU’s public health strategy post-COVID-19 - MEPs debated how to ensure health systems across Europe are better equipped and achieve greater coordination in facing future health threats, as no member state can deal with a pandemic such as COVID-19 alone. During the same debate, MEPs highlighted the need for the EU to have a stronger role in the area of health – and how this stronger role must include measures to tackle shortages of affordable medicines and protective equipment, as well as support to research. 

The resolution, put to the vote on Friday, was adopted by 526 votes to 105 and 50 abstentions. It sets out the principles of the EU’s future public health strategy post-COVID-19, including stronger cooperation to create a European Health Union, common minimum standards for quality healthcare, and a European Health Response Mechanism to be created rapidly to respond to all types of health crises through better coordination and management of the strategic reserve of medicines and medical equipment. The EP’s position also emphasizes that the upcoming EU pharmaceutical strategy must contain measures to make essential medicines more immediately available in Europe, and diversified supply chains need to be put in place to guarantee affordable access at all times.

The new dedicated €9.4 billion EU4Health Programme was also strongly welcomed and MEPs believe that long-term investments and commitments are needed. They request the establishment of a dedicated EU fund to improve hospital infrastructure and health services. On top of that, the European health agencies ECDC and EMA, as well as joint health research, must be strengthened.

MEPs also reiterated their call for affordable access for all people worldwide to future COVID-19 vaccines and treatments as soon as they are available, with joint EU procurement to be used more systematically to avoid competition between member states when public health is at stake.

For MEP David Casa (EPP), the EU has been criticised for its lack of coordinated response when the outbreak kicked off on the continent, especially at around March, but Europe is standing up to be counted now. 

“Back then, uncertainty was at a peak. Against a ticking clock and rising counters of bad news, national governments were faced with colossal choices to navigate through totally uncharted territory.

“Probably the single major downfall that the pandemic exposed within the European bloc was a lack of an initial coordinated response. Aside from bilateral gestures of solidarity, such as sending personal protective equipment across borders, or accepting to treat patients to relieve pressure off of national hospitals, member states were generally left to fend by themselves. 

“However this requires a very important qualification. The panic and knee-jerk ‘every man for himself’ reaction was not uniquely European: it was a universal response to an unprecedented and rapid threat that caught everyone off guard. Europe did well to recognise the severity of the threat early on and despite initial hesitation, the EU’s mechanisms and channels that were already in place before the pandemic were used in the best interests of citizens, and largely proved to work. 

“The pandemic has taught Europe that globalisation is more than just a buzzword. International cooperation has been essential to combatting the virus. But it has also delivered the realisation to Europe that essential medicines and virus-fighting equipment are not in a ready supply. Going forward, we cannot afford to be reliant on faraway lands for such vital, life-saving gear. 

“Considering the situation in Europe compared to other developed states, we have managed not to compromise on fundamental values while faring relatively well. Cases are no longer spiralling uncontrollably. We regret each death caused as a tragedy, and the future remains uncertain. But if Europe wasn’t on the ball immediately, it has certainly stood up now, and is arguably way more prepared to combat the rest of the pandemic than it was a few months ago.”

For MEP Miriam Dalli (S&D), COVID-19 has underscored the fact that the European Union is not well equipped to deal with a health emergency of the magnitude that we experienced. 

“This was mainly due to different systems in different member states, the lack of coordination that existed across the board between all them particularly in the initial weeks, as well as the dependency on third countries for many medicinal and medical products. 

“At the start of the pandemic, the S&D group set up a task force to address the impact of COVID-19 across the EU. We focused on the impact on different sectors to make sure that we use the lessons learnt from this pandemic to rebuild a stronger Union-wide healthcare system. 

“As a member of this task force, I highlighted the lack of access to medication, during the pandemic but not only. I wanted to make sure that in the aftermath of COVID-19 we realise how important it is to always ensure access to medicines, particularly when it comes to patients with rare diseases. The crisis has shown that we need a European health framework that ensures that all people have fair access to medical products irrespective of geographical location, socio-economic status, the illness that they suffer from or their age. 

“To achieve this, member states must have a level playing field via transparency and a coordinated joint procurement when negotiating medicinal prices with the industry. 

“Unlike a number of other member states, Malta has a strong healthcare system that, together with other containment measures, helped the country be successful in keeping the pandemic under control. However, we had to push the Commission to ensure a fair system of distribution should a COVID-19 vaccine be made available. This is one example where, cooperation and a joint procurement system would benefit all Member States and avoid creating any unfair competition for prices of medicine, accessibility and distribution amongst the different countries. 

“We must become less dependent on third countries and this can be done via an updated EU strategy to address obstacles in the pharmaceutical supply chain and to attract back manufacturing sectors for raw materials that previously moved out of the EU.”

MEP Alfred Sant explained how the EU does not have a single market in public or private healthcare. 

“Measures in the sector could have only been taken when they had a direct bearing on the economic and commercial management of the single market. For the rest, it was mainly a question of coordinating certain areas of health policy.

“The pandemic has exposed the vulnerability of this approach given the free movement of labour as part of the single market plus the free movement of people as part of Schengen.

“Preliminary reactions to the pandemic were national in scope and threatened to unravel the economic and social underpinnings of the single market, by way among others of export bans on needed medical materials and a rush to secure supplies of them worldwide.

“Overall there is now a three-pronged approach to cope with the public health challenge: a common EU set-up to meet with the short to medium term needs for procurement of medical supplies, especially anti-Covid vaccines when/if they come on stream; better and deeper ongoing coordination long term of public health policies between national health authorities; and an understanding that public health issues should become a leading plank of economic management policies in the Union as a whole, with a pledge – explicit or implicit – to eliminate the damage that austerity policies in the past decade have inflicted on public health systems by freezing them out of needed funds.

“If well run, this approach should give positive results. It is in the interests of all member states that it should do so. On such a point there appears to be full consensus.”

MEP Alex Agius Saliba said that now is the time to act together. 

“The COVID-19 pandemic has put European health systems under enormous strain, revealing gaps in the way the EU and its member states deal with public health emergencies. Today, we are experiencing the worst emergency in terms of health, economic and social consequences,” he said.

“This strategy is the first step towards effective prevention, more and better research to have effective medicines and treatments, and vaccine accessible to all.

“With this Health Strategy, we can renew our commitments to the well-being of EU citizens and to all health professionals in order to guarantee them more protection, better working conditions and response capabilities in case of health emergencies.

“COVID-19 has also tremendously affected the lives of persons with disabilities. Besides, due to the pandemic, many persons with disabilities were left without appropriate healthcare and access to medicines. Many support and care services were not available due to the lockdown, and some confinement measures did not take into consideration the needs of persons with disabilities and their families. This cannot happen again! We have to ensure that the most vulnerable citizens of our society should have the same rights and protection, always, and especially during health emergencies.

“I believe that in order to achieve the right results and meet our commitments stressed in the health strategy, there should be a stronger coordination between member states. Now we have the right opportunity to protect and strengthen our health systems against future threats.”

Parliament has called on the Commission – as the EU body that has the right of initiative - to propose without further delay a new Strategic Framework for Health and Safety. 

Meantime, in the coming weeks, Parliament and the governments of EU countries will negotiate the Commission’s EU4Health proposal as part of the agreement on the EU's next long-term budget. The programme is expected to be launched as of January 1, 2021, with its main priorities focusing on the protection of people from serious cross-border health threats, improved availability of medicines and stronger health systems.

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