by Pauline Véron, Junior Policy Officer, European External Affairs Programme and Migration Programme at the European Centre for Development Policy Management
1. The first sentence of your report states that COVID-19 has not caused a fundamental change in the rules of the game when it comes to the EU’s limited role as a global health player. One year later, do you think it is still true? Why?
To some extent, yes. The COVID-19 pandemic continues to be a real test for the EU’s international leadership ambitions in the area of health. 1,5 years after the start of the pandemic, the world is still very much at risk of new variants as developed countries, including the EU and its member states, continue to hoard vaccines. About 73% of shots worldwide have been administered in high- and upper-middle-income countries. Only 0.8% of doses have been administered in low-income countries. Globally, 82 countries are at risk of missing the goal to inoculate 40% of their populations by the end of the year and an additional 550 million vaccine doses are needed to hit the target.
In this context, the announcement by European Commission President Ursula von der Leyen at the Special Session of the World Health Assembly in November 2021 that the EU plans to share at least 700 million COVID-19 vaccine doses by mid-2022 with lower- and middle-income countries (an increase from the prior target of 500 million doses) is positive, but it is too little, too late in view of the current health situation and needs. It is also a drop in the ocean compared to the excess doses the EU has reserved for itself.
One of the remarkable features of the response to the COVID-19 pandemic has been its multifaceted nature, as it put together a collective and comprehensive ‘Team Europe’ package, leveraged its research and innovation assets, and catalysed multilateral action. The EU political messages in favour of solidarity have been appropriate but concerns about the EU’s ability to follow up on its own ambitions were well placed. European countries themselves still struggle to find a balance between protecting their own citizens and ensuring a global fair response to the pandemic. Yet, it is also worth noting that the failure in global cooperation is of a much larger scale than just an EU deficiency.
The EU (as Team Europe, including EU institutions, Member States, EIB and EBRD) likes to present itself as a lead contributor to the COVAX Facility. Yet it is sometimes hard to find out how much fresh money has actually been allocated and to what exactly. The EU is also making big promises about supporting the manufacturing of vaccines in Africa, which is key, particularly for future pandemics. However, without clearly addressing the technology monopoly, the sole production of vaccines does not necessarily lead to better access for the continent right now. At the Special Session of the World Health Assembly in November 2021, European Council President Charles Michel said that we must apply boundless human ingenuity to ensure that in the next pandemic we have equitable access to vaccines and countermeasures to prevent the same inequality that we have seen in this pandemic. This is a bit, given that the EU had the capacity to support vaccine equity to a much greater extent during this pandemic.
Global health currently competes with many other priorities in the EU, including domestic priorities (green transition, economic recovery, digitalization, migration), despite the scale and urgency of the challenge. Ultimately, a greater EU role in global health will require more sustained and consistent political leadership from the EU and its member states.
2. How can France, during their Presidency of the European Council, reinforce the EU’s approach to Global Health? What are the possibilities? What would prevent France from doing it?
There are several opportunities and challenges facing the French EU Presidency as the COVID-19 pandemic continues to rage around the world. The next EU-AU summit will take place under the French Presidency on 17-18 February 2022, and it will be a key opportunity to show that the EU is serious about its global health commitments. The pandemic and the lack of a common agenda between European and African policy-makers delayed the summit, originally scheduled for 2020. In the Joint Communiqué from the Second African Union – European Union Foreign Affairs Ministerial Meeting in October 2021, ministers agreed to enhance cooperation on equitable access to vaccines and welcomed Team Europe’s commitment to increase doses sharing by the end of 2021. They also agreed to jointly strengthen further local manufacturing of vaccines in Africa as well as to support Africa’s response to the current pandemic and subsequent waves. Following up on these commitments will be key for the EU’s credibility in its partnership with Africa and the French Presidency of the EU will have a special responsibility in this regard.
The Joint Communiqué also mentioned the need to conclude discussions on how the WTO can support the ramping up of manufacturing, the equitable distribution of COVID-19 related health products and the transfer of technologies. In June of 2021, French President Emmanuel Macron declared that intellectual property rights should “never be an obstacle to accessing vaccines” for the COVID-19 response; however, France continues to support the EU Commission’s position blocking the proposed WTO temporary IP waiver, which would facilitate knowledge transfer for the equitable distribution of vaccine manufacturing and medical tools to address the COVID-19 crisis. During its Presidency, France could strengthen the EU’s approach to global health and make the EU’s commitment to global vaccine access as a public good a reality by working towards ending the EU’s opposition to the TRIPS waiver at the WTO. This would show that France and the EU more broadly are serious about global health equity.
While France does benefit from a certain diplomatic capital that might help with gathering support for its initiatives, it will also face several challenges during its Presidency that might prevent it from strengthening the EU’s role in this field. First of all, the country will be holding a presidential election in April 2022 which will take much of the political energy and might thus affect its EU agenda. Secondly, the EU’s political agenda – including the French Presidency agenda – is currently filled with other priorities, including the green and digital transitions and socio-economic issues, which might push health down the agenda despite the urgency of the situation. Thirdly, if the health situation continues to deteriorate over the coming months, the challenge for France will be to ensure that domestic EU action on health does not undermine international action and solidarity. Finally, the challenges that European Centre for Development Policy Management (ECDPM) previously identified in its analysis have not gone away: lack of coherence and coordination within Europe, EU’s limited health competences, divergent interests and views of EU member states – all tend to still hamper stronger collaboration across the EU institutions and with member states, despite some new initiatives to solve these issues.
3. France wants to mobilize Team Europe to strengthen health systems in LMiC. Do you think it is a good signal? What are your concrete recommendations on how it should be done?
This is a very positive and important signal, given that the pandemic has revealed the challenges posed by weak investments in healthcare systems around the world. There has been limited indication so far that health would feature strongly in the programming of the NDICI – Global Europe or in Team Europe Initiatives. This is because other priorities, particularly the green transition, have taken most of the spotlight. Even as part of the Team Europe response to COVID-19, most funds have been mobilised to tackle the social and economic consequences of the pandemic, much less to strengthen health and water and sanitation systems.
Beyond manufacturing and access to vaccines, it will key to mobilise Team Europe to ensure that LMICs have adequate health systems in place to mount effective vaccination campaigns but also to withstand future crises. Attention should be paid to universal health coverage, access to quality health services to cope with outbreaks of diseases, and safe drinking water and sanitation services.
Mobilisation of Team Europe’s players (member states, EIB, EBRD, European development agencies) is a welcome step in this endeavour. Indeed, the main asset of this approach is the pooling of financial resources but also of member states’ respective expertise and comparative advantages for transformative impact. Pooling resources and speaking with one voice also provide the EU with a stronger leverage in political/policy dialogue with partner countries. Yet it is also worth noting that the extent to which Team Europe promotes more coordination than other initiatives (such as joint programming, or ‘working better together’) have in the past still remains unclear.
It will be key to monitor this French initiative, in terms of how much funding is allocated and from which sources. Besides, it might be useful to link the strengthening of health systems with other strategic priorities, such as digitalisation (which some member states are already doing, for instance in the area of e-health). These are two important priorities for African partners, for example, and such an approach might thus garner increased support and have a more transformative impact. Indeed, an important aspect of such an initiative will be to ensure that this goes beyond a donor-driven and Eurocentric approach (which Team Europe has been criticised for) and that it also fosters ownership and consultations with partner countries’ authorities and local stakeholders to ensure that the support is aligned to country needs and priorities. Coordinated support at country, regional and global level will also be key.
Ultimately, France will already partly succeed if it manages to convince its Team Europe partners and fellow member states that the strengthening of health systems in LMICs is a key shared priority that requires sufficient additional resources and investment. Socioeconomic recovery will be very high on the agenda in 2022 and beyond, both in Europe and in partner countries. Yet long-term and inclusive recovery, sustainable growth and job creation will not be possible without strengthened investments in health systems. If the EU wishes to play a bigger role in global health, it will have to upscale its support for health systems as a whole, as opposed to simply producing a narrow emergency response to future outbreaks.