“Health is not everything, but without health, everything is nothing,” said German philosopher Arthur Schopenhauer, in an aphorism that might serve as the defining mantra for Europe and the world in the age of the COVID-19 pandemic. The Coronavirus crisis is, as we know, the greatest global public health emergency in a century and threatens to get worse. Economies are reeling. The crisis has exacerbated poverty and inequality - not least in health. Healthcare professionals have emerged as more indispensable than ever, yet remain extremely vulnerable. Public finances are being stretched further than during the financial crisis of a decade ago.
These challenges come on top of those that Europe already faced pre-pandemic. Healthcare systems devour increasing amounts of funds as demand grows exponentially, raising questions of sustainable affordability; lagging investments in IT in health, and the twin scourges of non-communicable diseases such as cancer and (arguably, the greatest potential killer of them all) antimicrobial resistance. So, Europe has to act swiftly and decisively to tackle these immense challenges if it is to survive. In addition, it has the chance to show global leadership in how it tackles these, as others retreat to their national fortresses. Here, one must commend the initiative shown by the European Union, not least by Commission President Ursula von der Leyen, as we heard all too clearly in her State of the EU speech on 16 September.
“Healthcare systems devour increasing amounts of funds as demand grows exponentially, raising questions of sustainable affordability”
We're talking about the role the EU has played in supporting the swift development of safe, effective and high-quality novel vaccines that will be accessible and affordable for all EU citizens. The EU27 can play a powerful role in the market, not simply as purchaser of billions of doses but also in ensuring that poorer countries are not left behind when it comes to vaccines. The EU is exercising a very clear mandate of global solidarity when it comes to schemes such as COVAX Facility or ATC Accelerator, for which the EU is the single largest donor.
But solidarity must begin at home. Partnerships are key: we have to work not only with national governments and regulators but also with multinational pharma companies, to ensure that Europeans can enjoy safe, effective, high-quality medicines and treatments as equals. This is why I support President von der Leyen's ambitious plans for an EU Health Union or, at the very least, a much greater, more proactive role in health and health crisis management such as through the European Centre for Disease Prevention and Control (ECDC) or the European Medicines Agency (EMA).
The pandemic has exposed how economic nationalism in health - whether hoarding PPE or vaccines for your own folk alone - is, in the end, self-defeating. Viruses know no borders. What’s more, the ripple effects of a public health/economic emergency in one country can turn into a tsunami sweeping over an entire currency zone or political community built on shared values and interests. It is shameful how Member States exercised travel restrictions or warnings within the Union.
Of course, national authorities have always been responsible for the health of their country's populace and will continue to do so but cross-border threats do require joint efforts to prepare for and manage common health threats. How extensive EU competences in healthcare should be is an area that we might usefully discuss at this year's European Health Forum Gastein (EHFG). As with more money and beefed-up powers for EU agencies such as EMA, ECDC or, indeed, President von der Leyen's proposed European BARDA to drive biomedical innovation. How far should national governments be prepared to go in ceding health sovereignty to Europe in the form of the EU? And what scope is there for the reshoring of APIs and other medical products from, say, China and other parts of Asia, back to Europe?
“The pandemic has exposed how economic nationalism in health - whether hoarding PPE or vaccines for your own folk alone - is, in the end, self-defeating”
Similarly, I see scope for the widest discussion of future funding of health. Of course, as Mark Pearson of the OECD recently stressed, healthcare systems can be hugely wasteful but nobody can be in any doubt that they must be sustained. However, new, perhaps innovative and/or radical, ways of financing them must be sought. So, let's talk about this in Gastein without pretending to come up with definitive solutions. Or indeed frightening patients and taxpayers.
“A virus, a thousand times smaller than a grain of sand, exposed how delicate life can be and it laid bare the strains on our health systems and the limits of a model that values wealth above wellbeing” is how President von der Leyen described it. Let's get to work and see if we can help make that good.