Firstly, let us pay tribute to the 75,000 people who have died and been laid to rest during social distancing, to the carers working tirelessly behind the scenes and those looking for solutions – all of them Europeans!
The major epidemics, including the infamous Black Death in the 14th century, are engraved in Europe’s collective memory. Some of them have had a greater influence on the course of history than certain wars. But it is now more than a century since our continent has seen such a devastating virus, the ‘Spanish flu’ of 1918-19: 2.3 million dead in Western Europe, maybe as many as 100 million worldwide.
The ‘Founding Fathers of Europe’ may have wanted to keep future generations safe from war, but they didn’t give much thought to keeping them safe from pandemics, which they probably thought were unlikely. All the same, the ‘health question’ would knock several times on the door of the euro sphere, starting with a key element in the common agriculture policy: the healthiness of the food we eat. The most memorable case is the ‘mad cow disease’ crisis (1996), which took more than 200 human victims, seriously afflicted the meat industry and discredited various services of the European Commission.
The institutional system – and particularly its agents in charge of external relations and development policy – could not have been unaware of the deadliness of the viruses that have ravaged Africa (Ebola, since 2013) and Asia: bird flu (1956-58), Hong Kong flu (1968-70), severe acute respiratory syndrome (SARS, 2002-2003) – to say nothing of AIDS.
The Europe of Health remains entirely inter-governmental, other than through the CAP, consumer protection and research policy. A ‘Public Health’ section appeared in the Maastricht Treaty (1993), with a single, extremely general article making provision for ‘coordination’ between member states, but it included a reference to ‘major health scourges’. This article was bulked out considerably by the Lisbon Treaty (art. 168 TFEU), which confirms that each member state is responsible for defining its own health policy and for organising and delivering it. The EU takes only a supporting role, through the open method of coordination and, in certain very specific cases, by legislative means under co-decision, but ‘excluding any harmonisation of the laws and regulations of the member states’.
No doubt inspired by the SARS epidemic, however, the authors of the constitutional treaty made provision for possible harmonisation measures, to make it easier to tackle serious cross-border threats to health. This treaty was voted down by the French and Dutch citizens; then, when the Lisbon Treaty was being negotiated, this option was removed by request of the Danish government. A step backwards, in other words. The interdict on any harmonisation would, moreover, make a reappearance in article 196 TFEU with specific reference to civil protection, which covers such things as natural and human-origin disasters within the EU.
It is nonetheless worth noting that there is an EU multi-annual action plan in the field of health, with a budget of some €63 million under the general 2020 budget (chapter 17 03). This plan has four specific objectives, one of which is to ‘protect citizens against serious cross-border threats to health’: defining and developing coherent methods to prepare for health emergency situations and coordination in these situations, and to support implementation of these.
This same ‘Public Health’ chapter pays for the European Centre for Disease Prevention and Control (ECDC) (57 million euros), the European Food Safety Authority (105 million), the European Medicines Agency (34 million) and swathes of pilot projects, just one of which, which was funded until 2018, concerned a prospective study for the development of policies on rare diseases...
Notwithstanding these tools to complement and support national policies, and despite useful statistics on public health spending provided by Eurostat, which reveals in particular major disparities between member states (which spend from 2.7% to 8.3% of GDP), one is forced to conclude that the ‘hospital of Europe’ does not yet exist. The panoramic analytical instruments at our disposal, including those for vocational training (via Cedefop), education (via Eurydice), through the integrative structures of the world of agriculture, fishing and research, do not have their equivalent in the European healthcare universe. In addition to the structural handicap of the wide range of differing resources available to healthcare establishments, the share of the GDP of the EU of 27 being spent on health has declined over the period from 2009 to 2016 (from 7.3% to 7%, a level at which it has remained stable since), a fact not unrelated to austerity policy. And on top of this, Europe’s dependence on Asia for medicines and health supplies has rocketed over the last decade.
It is against this backdrop that what can only be described as coronavirus’s ambush of Europe, which will become its greatest victim, is playing out. (To be continued).
Renaud Denuit