Few countries have covered themselves with glory in the battle against Covid-19. Western Europe, currently the center of the pandemic, has had its share of poor preparation, planning, and coordination. It been hit hard: Italy has more than 120,000 cases and more than 15,000 dead — the highest number in the world. Spain is not far behind with more than 12,000 deaths.
The difference between the crisis in Europe and elsewhere is that Italy and Spain are parts of the European Union, the world’s largest experiment in political integration. And in this pandemic, it doesn’t appear to be living up to its ideals: A union that speaks often of solidarity between peoples initially saw little solidarity. A union often reproached for technocracy showed none of it. A union built on the freedom of movement of people and goods has become a chaotic continent of closed borders and export bans.
Even though European Union institutions quickly moved to undo member countries’ selfish restrictions on movement, much of the damage had been done, and Italians welcomed donations of medical supplies from China before they got them from Germany. Some may say that this proves that the European Union itself is failing its citizens. That idea might be especially attractive in countries like Italy and Spain that have yet to recover from the eurozone crisis and European-mandated austerity.
So when it comes to public health, how did European Union get it so wrong? And what can be done to make sure a similar disaster is averted in the future?
The truth is that when it comes to public health, the Union has done what its member nations wanted it to do: not much. For years, European governments have kept Brussels out of health care and public health whenever possible. They have resisted everything from shared standards of care to electronic health records to allowing patients free access to the health care systems of other countries. Under the bloc’s constitutional treaties, action on public health is meant to be optional and driven by member states, and health care is a member state responsibility. A disease in animals can be met with forceful E.U. action, but it can’t if it becomes a human health problem.
That led Europe to where it is today, unprepared for a crisis that is crossing borders.
The coronavirus pandemic has laid bare the importance of Europe-wide public health and therefore the importance of an E.U. public health policy that lives up to the challenge. If the Union cannot manage fundamental threats to its citizens’ health — or help members that cannot on their own — then its overall contribution to its citizens’ life might be questioned.
Here’s what it should look like. First, the European Union needs to fund and build the capacity to test for diseases — starting, of course, with the coronavirus — and share the information across member nations. There is a strong chance that there will be graduated lockdowns of different parts of the world over the next 18 months, with restrictions tighter in places with more infections and loosened elsewhere. That would offer a way out of an unsustainable continentwide lockdown and closed borders, but it would depend on credible information, quickly shared.
That kind of crucial information sharing is unlikely under the current set up: Europe’s executive branch, the European Commission, is constrained by laws that limit its power and it has no specific budget for health security. The European Center for Disease Control and Prevention has only around 300 employees and is primarily a hub for sharing expertise.
More professional staff, financial resources, research technology, and obligations for reporting to the Commission and E.C.D.C. could support members as they build up their public health infrastructure. This would be beneficial in smaller and poorer member states that have limited resources for testing or monitoring of population health. It would also be an asset to larger countries, which might not invest in expertise on all the diverse public health threats that exist. It would also continue to be helpful after Covid-19, when we have to confront other frightening public health issues, like the declining effectiveness of antibiotics.
The second prescription is to build on European joint procurement of vaccines and equipment. Much of the struggle right now is getting adequate supplies of equipment like masks to the right places. The pandemic is likely to finally end when there is a vaccine; the risk is that getting adequate supplies of a vaccine will not be easy or harmonious.
The European Union has a secret weapon here: its size. With 446 million people, it is the world’s largest market for many drugs and medical devices. Since the H1N1 pandemic of 2009, E.U. member states have increasingly worked together to negotiate and purchase vaccines and medicines.
That’s the good news. But it could be done faster and better. Negotiating a price together is hard enough, since some governments have more sympathy for the pharmaceutical companies than others. But even negotiating a price is not the same as buying enough and allocating it according to need. A transparent and reliable mechanism to purchase medicines and devices together and allocate them by need would be a major E.U. contribution to health. That is sure to be especially critical in the coming months once a coronavirus vaccine is developed. A bidding war over scarce vaccines is one individual European countries might often lose, but the Union as a whole, with its immense market, cannot lose.
Finally, the member countries need to use the bloc to get their act together when it comes to disaster responses. RescEU, the European Union’s organization for crisis response at home and abroad, is a year old. It is set up to look for win-win solutions, like pairing countries with spare firefighting capacity and countries with unexpected wildfires. It is not set up to manage continentwide crises like this pandemic. Nor does it really have its own resources. It relies on member states deciding, case by case, to help out. Only late last month did RescEU start developing stockpiles of key resources like masks, ventilators, vaccines and laboratory equipment for handling a pandemic.
The European Union should allocate actual resources to RescEU: above all money that can be quickly released, but also dedicated stockpiles, staff and equipment for key risks.
None of this will be easy. Member nations of all political affiliations have resisted E.U. intervention in health care and most public health policy. Driving down prices through joint procurement will be resisted by influential pharmaceutical lobbies, especially in countries like France and Germany. Politicians will resist allocating vital supplies by need rather than nationality. Even within decentralized countries, Spain and Italy as much as the United States, politicians will fight for their own jurisdictions and credit. Big and rich countries will see less value in cooperation than smaller and poorer ones. It is always easy to underfund stockpiles when there is no crisis.
But European integration is too far along for it to be avoided. Europe’s economies are tightly woven together. They can no more be isolated for a year than their individual citizens can be. The European Union institutions will have to lead the members out of their shared public health crisis. That will require measures enable the member states to take joint action.
These changes will help the European Union deal with its problems right now, so that its economies and societies can exit their medically-induced coma, and in the future, because threats to health like Covid-19 will not go away. Europe is only as safe as the least safe place in it, and that is why governments and citizens need to ensure the E.U. can make all of Europe safe.
Scott L. Greer (@scottlgreer) is a professor of health management and policy, global public health and political science at the University of Michigan.
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