The European Parliament is undertaking an extremely important task of examining how the European Union has dealt with the response to the ongoing COVID-19 pandemic. We know that its impact on almost every aspect of our lives and livelihoods has been and often continues to be undeniably large. In undertaking this work, the new special committee will have to deal with quite a challenge, the conclusions of which should help all of us to strengthen EU’s crisis prevention, preparedness and response to emergencies that will inevitably come.
The pandemic and the European response have left their mark on a number of issues, such as health inequalities and the impact on non-communicable diseases, including on mental health, vaccine equity and access to medicines, the well-being of healthcare professionals, and the rapid development of digital health. Examining lessons learned and formulating recommendations for the future, public health understood in its broadest sense must be seriously considered in the committee’s work, to ensure that we are all able to build back better.
Health Inequalities
The pandemic laid bare large inequalities between different groups in Europe. Although the virus does not discriminate, the health and socio-economic impacts do. Vulnerable people have been, and still are, disproportionally at risk of being exposed to the virus because of their living conditions, more likely to suffer serious illness because of poorer health status and/or worse access to health care, and disproportionally impacted by containment measures, either preventing them from working or worsening their working conditions. Particularly groups who avoid out-of-pocket expenses despite the health care needs, or socially excluded people are at higher risk, including homeless people, elderly people (especially those living alone), migrants and undocumented workers without health coverage or proof of identity, and Roma and Travellers. Especially among the Roma large issues were laid bare such as comparatively high vaccine hesitancy, exclusion from online learning due to the large digital gap, and disproportionate negative effect on mental health.
Vaccine Equity
The COVID-19 pandemic has painfully exposed and deepened many pre-existing social and health inequalities in the European Union, directly affecting the lives of many vulnerable communities. Existing social and healthcare barriers have also made it difficult for many groups to access COVID-19 vaccines. Reasons were the lack of tailored information campaigns, geographic and infrastructure bottlenecks, and administrative difficulties coupled with low political commitment to pandemic mitigation. Rightly included in the committee’s mandate, the notion that “nobody is safe until everybody is safe” should be also applied within the EU to address inequities in essential countermeasures distribution.
Non-Communicable Diseases
NCDs are one of the 21st century’s foremost threats to health and well-being. The COVID pandemic has only further emphasized that preventing NCDs should be a main priority for national governments and the European Union. Despite the fact many NCDs are to a significant degree preventable, we are facing epidemic levels of chronic diseases that undermine people’s well-being, healthcare systems, and Europe’s economic and social prosperity. Pre-existing health conditions, such as diabetes, cardiovascular diseases, chronic respiratory illnesses, chronic kidney and liver conditions, and exposure to unhealthy living conditions, such as polluted air, have been widely associated with worsened health effects from COVID-19. NCDs also tend to disproportionally affect people from more vulnerable populations, thereby increasing the (health) inequalities gap in Europe. As rightly addressed in the mandate of the new committee, the pandemic has caused enormous disruptions in the health care needed to treat many NCDs. Numerous countries reported a considerable degree of disruption of NCD services, including significant difficulties in mental health care. The pandemic has disrupted or halted critical mental health services with the increasing demand for support clearly on the horizon.
Access to Medicines
COVID-19 has become a turning point for pharmaceutical policy and for access to medicines in the EU. During the pandemic, many systemic issues and pressing challenges came to light and paved the way for medicine shortages, unequal access to medical countermeasures on a global scale, and loss of trust fueling vaccine hesitancy. The European vaccines strategy’s Advance Purchase Agreements mechanisms have been used by the EU to procure vaccines for COVID-19. Unfortunately, the secrecy surrounding the negotiations made it impossible for the process to be publicly scrutinized, resulting in loud calls for improvements in preparation for future challenges. While negotiating with the private sector (e.g., pharmaceutical companies) and mobilizing investments to split the risk of producing the necessary technologies (while decreasing liabilities of the private actors), public authorities must act prudently and be guided primarily by the public interest and health of all. To be better prepared for future health emergencies, the EU needs to take steps to guarantee transparency and a fair return on this substantial and multifaceted public support by attaching public interest conditionalities. The EU’s first opportunity is HERA, which is now operational. One of the main challenges ahead is tackling antimicrobial resistance (AMR). The full effect of COVID-19 on AMR is yet unknown , however, given the potential gravity of AMR on health provision and patient outcomes, policy recommendations should ensure the inclusion of AMR prevention and control measures under a One Health approach. Antimicrobial resistance is often referred to as the ‘silent pandemic’ and is regarded as a global health threat by prominent health bodies. The interplay of COVID-19 and AMR has already shown direct and indirect impacts, including cases of antibiotic misuse and overuse, low human resources threatening infection prevention and control practices, and discontinuity of care of already immunocompromised NCD patients.
Healthcare Workers
The strain that this pandemic placed on the health sector and particularly upon health workers has been widely felt throughout Europe. Unfortunately, this came at a time when many health systems are already struggling with significant staffing shortages from factors such as too much pressure, negative workplace culture and poor pay relative to responsibilities. This also exists within a ‘brain drain’ of health workers migrating from lower to higher income countries, both within Europe and globally. Improving both the working environment and staff value – including better pay, collaboration in management, decision-making, health and wellbeing support, and continual professional development, must be at the forefront of policy recommendations, to ensure the health sector is better placed to manage future pandemics.
Digital Health
COVID-19 has rapidly accelerated the pace of digitalization across the EU, making digital tools tangible for many people. Services and tools that have become more common include telemedicine and telehealth services, as well as mobile health applications and wearable devices for personal health data management, remote monitoring, and direct communication between healthcare providers and patients. However, it is important to note that those who are at higher risk for COVID-19 are the least likely to use and therefore benefit from digital health tools. eHealth has also played an important role in the surveillance and management of COVID-19 with the development and rollout of specialized national-level contact tracing applications as well as EU-wide interoperable Digital COVID certificates. At times, there have been challenges in promoting the use of these health tools (notably the COVID-19 contact tracking apps) due to concerns over data privacy and a lack of trust in governments. Therefore, these digital solutions must be designed ethically and transparently, and their purpose must be clearly and unambiguously communicated to the public, with a clear analysis of the impact they may have on citizens’ fundamental rights.
Way Forward
Once again, the European Parliament has undertaken the important task of examining Europe’s response to the COVID-19 pandemic. The conclusions of this work, which we will see in approximately a year, must be developed together with civil society and public health organizations. For the European Union to be able to strengthen its crisis prevention, preparedness and response to emergencies, drive health equity and improve policy coherence, this special committee must actively and transparently involve independent experts in its work. It is these actors, often on the ground, who support the people in the fight against the pandemic and have the experience and knowledge that will allow us to draw conclusions for the future. It will also strengthen accountability and the necessary trust of citizens.