Time for a European Health Union
The Coronavirus crisis has shown up many shortcomings in Europe’s healthcare systems, which is why we need a better, more coordinated approach, argues César Luena.
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The Coronavirus pandemic has placed healthcare systems under unprecedented pressure, exposing vast deficiencies in the healthcare systems of many European countries following years of underfunding and cuts. The crisis has also highlighted the fragility of multilateral institutions and global collaboration and has demonstrated the need to review European competencies in public health. No country alone can face a crisis like the current one in this globalised world in which we live.
The need for global coordination and collaboration through health diplomacy becomes essential if we are to prosper in the near future. In the early phases of the pandemic, some countries were tempted to engage in export restrictions to protect domestic supplies of medicines and medical devices. This contributed to slowing down the crisis response at its most critical stage. Even if some of the supply problems have been solved, others persist.
Furthermore, there are still some countries and regions that face shortages of both Personal protective equipment (PPE) and medical equipment such as ventilators. Differences in the numbers of diagnostic tests (PCR) performed per million of habitants, and inaccuracies in the counting of deaths, are preventing the gathering of significant statistics at EU level, which are essential in understanding how the pandemic is progressing and the efficacy of the measures being taken.
Most Member States do not have the capacity to produce sufficient essential medical equipment and active products to face this pandemic. They depend on imports from third countries such as China, India and the USA. On this basis, the EU has established a mechanism of joint procurement for medical equipment that should be strengthened for procuring new medicines and medical devices. This reinforced mechanism would secure more equitable access, an improved security of supply and more balanced prices.
"The Coronavirus crisis has highlighted the fragility of multilateral institutions and global collaboration and has demonstrated the need to review European competencies in public health"
It will be of utmost importance when a vaccine and/or new treatments for COVID-19 are ready in the market to make them available to all citizens. We need stronger leadership from the EU in the form of a European Health Union. We need to reinforce our health systems and ensure they can withstand health emergencies. For this reason, it is essential to perform stress tests on national health systems to verify their capacity to face such high-pressure scenarios.
Based on the findings, the European Commission should propose a Directive on minimum standards in healthcare using parameters such as hospital beds per head, numbers of doctors and nurses per head, availability of critical care capacities, level of health expenditure and access and affordability of healthcare for all, including vulnerable populations. Even if Member States are usually reluctant to share their health competencies with the EU, this new Directive could build on a minimum permitted level of health coverage.
Moreover, many countries, especially the southern and eastern Member States, have suffered from decades of brain-drain of highly specialised workers such as doctors and scientists. Many of them are looking for better working conditions and social recognition, leaving their home countries short of specialised workforce. It would be desirable to offer these highly trained workers equal opportunities across Europe. In parallel, we have witnessed that the current preparedness plans, which are very influenza-focused, have proved ineffective for COVID-19.
We therefore need new pandemic preparedness plans, updated and adapted to the new characteristics of this and future potential pandemics, including solid communication strategies to avoid misinformation and fight fake news. In the 21st century, we have seen an increase in the frequency of zoonotic disease outbreaks (those transmitted from animals to humans), such as SARS in 2003, H1N1 in 2009 and Ebola in 2014.
This is no coincidence; environmental destruction from deforestation and habitat loss; increasing contact between wild animals and humans; cultural practices such as eating exotic wildlife as well as intensive farming - which increases antibiotic dependence - are among the root causes of this. In other words, the current pandemic was somehow predictable and could have therefore been prevented.
"We need stronger leadership from the EU in the form of a European Health Union. We need to reinforce our health systems and ensure they can withstand health emergencies"
Thus, any new prevention measures put in place in future should consider the interconnectivity of environmental health with animal and human health, as well as a component for biodiversity protection. There is currently a decrease in the number of new COVID-19 cases and the death toll, in part due to the confinement measures, but also because doctors and medical staff are now better prepared and have more experience treating the disease.
However, we are still at the start of this crisis; if we want to recover from it, we need to become a more resilient society, one that leaves no one behind and puts environmental health at the centre of our economic growth. Our way towards the relaxation of lockdown measures and reactivation of our economies should not translate into ‘business-as-usual’; we must be ready as a community for a ‘new kind of normal’.
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