Germany assumed the Presidency of the Council of the European Union from 1 July, but in quite different circumstances from what was originally foreseen, with the response to tackling COVID-19, and its health, economic and social consequences being the defining issue of the next six months. The European Parliament has consistently promoted the establishment of a coherent EU public health policy, and has just adopted, with an overwhelming majority, a resolution on the EU’s public health strategy post-COVID-19. Members of the European Parliament are demanding far stronger cooperation in the area of health to create a European Health Union, to include common minimum standards for quality healthcare, based on urgently needed stress tests of Member States’ healthcare systems to identify weaknesses and verify that they are prepared for a possible resurgence of COVID-19. At the same time, topics of great importance for the future of Europe will also preoccupy the Presidency: for example, the next multi-annual financial framework, climate protection, digital transformation, the rule of law and Europe’s role in the world.
‘Together for Europe’s Recovery’ – the German Presidency Programme
The trio presidency programme (which also looks forward to the Portuguese and Slovenian Presidencies beginning in January and July 2021 respectively) has placed health high on the agenda, in line with the key recommendations of the recovery roadmap.
“In order to boost the economic and social recuperation of all EU member states, we will work during Germany’s Council Presidency on a joint recovery plan and financial framework for the years ahead. Together, we want to emerge strengthened from this crisis. That means focusing firmly on the future. Climate change mitigation, digital sovereignty and Europe’s responsibility in the world are therefore key focuses of our Presidency.” says German Chancellor Angela Merkel in the ‘Together for Europe’s recovery’ German Presidency programme.
As regards the health portfolio, digitization, Big Data and artificial intelligence will certainly high on the agenda according to Jens Spahn, German Health Minister, the chair of the Health Council. and the future negotiations about the Health Technology assessment will be worth watching out for as a measure for assessing the presidency’s performance on health.
What does the German EU Presidency mean for the future of health policy in the EU?
As well as finalising the legislative process to establish the new EU4Health programme, the underlying strategic question, however, is the future role and competences the EU will or will not be provided with in the area of health.
A big challenge of the ‘coronavirus’ presidency will be to draw the lessons learned from the pandemic and steer the strategic discussion in a way which could result in a new power sharing arrangement between national capitals and Brussels. The future of health is a political question, too but heavyweight politicians and state personalities are all calling for EU action. Everyone agrees that “more should be done,” but how this is developed in practice from simply better preparedness and coordination to an eventual health Union. The European People’s Party (EPP) is asking for more EU health but with moderation, while the stance of the second largest group, the Socialist and Democrats (S&D) is different, asking: “It is time to set up a European Health Union. If not now, when?”
The German presidency is cautiously ambitious in this area: openly calling for more power and resources for the European Centre for Disease Prevention and Control so that Europe can be better prepared for the next pandemics as well as more action in the area of crisis management – but not significantly more powers in other areas.
The way counts as much as the goal: there will be a process: a vibrant civil society and the Conference on the Future of Europe. The process will be inclusive, including public health civil society, too.
EPHA has recently formulated recommendations to the EU4Health programme proposal and will be ready to contribute to the debate on the future of health in Europe together with its members. Its ‘Europe, let’s do more on health!’ (EU4Health) campaign, launched in 2017, co-led by the European Patients Forum (EPF) and today involving 24 European health alliances and patients associations. The EU4Health civil society alliance members outlined their vision for more health in the EU and are also be ready to engage in that process.
Below we break down the implications for public health over the next few months in other key policy areas:
A New Pharmaceutical Strategy
Germany is expected to lead the EU recovery, with the experiences of COVID-19 bearing heavily on the proposed new EU pharmaceutical strategy: “..we want to discuss concrete measures within the framework of our Council Presidency (…) on how to prevent supply bottlenecks for pharmaceuticals in the EU, secure supply chains and avoid dependencies in the production of active ingredients”. The programme also stressed that it is “essential” to strengthen the global competitiveness of the pharmaceutical sector and “ensure access to innovative medicines”.
Foreign Minister Heiko Maas has called for closer collaboration, such as the joint procurement and production of life-saving medical goods, while keeping supply chains open and improving civil protection. On the next EU budget, Germany wants to invest in areas including research, climate protection, technological and crisis-proof health, and social systems. He added that strengthening the United Nations and the “underfunded” World Health Organization (WHO), especially in the development and distribution of tests and vaccines, is “one of the best investments in the fight against the pandemic.”
The German Presidency with the forthcoming Council Conclusions on COVID-19 will need to address the issue of access and affordability of COVD-19-related medicinal products (treatments and vaccines). EPHA has already highlighted concerns and outlined nine recommendations on how the EU and Member States should approach the procurement of new treatments seen as vital for tackling COVID-19.
It will also have to take stock of the sizable public contribution to the drug development process and ensure transparency and public interest conditionalities are attached to this significant and multi-layered public support into the biomedical R&D – civil society has already outlined measures which should be put in place to guarantee affordability, accessibility and transparency when it comes to the ACT Accelerator, in which the EU is a significant investor. Last but not least, the Presidency should make progress on the revision of the orphan and paediatric legislation in light of the upcoming publication of the Commission staff working document on the evaluation of those pieces of legislation.
Antimicrobial Resistance (AMR)
One of the most urgent cross-border health threats is AMR. The numbers are striking:
- 33000 deaths AMR is annually responsible for in Europe,
- 5 billion € yearly healthcare costs and productivity losses due to AMR in Europe,
- 10 million deaths per year worldwide by 2050 if no action on AMR is taken
- 24 million people who could be pushed into extreme poverty by 2030 by AMR.
As such, the European Centre for Disease Prevention and Control is responsible for coordinating the EU’s response, so when discussions begin about increasing its competences and resources, AMR should also be consideredl. Highlighted by German MEP Peter Liese, the European Parliament is calling for concrete legislative proposals to reduce the use of antibiotics (in humans and animals) and incentives for the development of new antibiotics.
EPHA will contribute to these processes aiming at keeping AMR high on the political agenda, providing secretariat support, together with Healthcare Without Harm Europe, to the MEP Interest Group on AMR. Likewise, the European Stakeholder Network on AMR, also coordinated by EPHA, will continue to build bridges between science, practical experience, civil society and decision makers to tackle AMR.
Climate Sustainability, Clean Air and Mobility
The Trio Programme will prioritise “safe, innovative and connective transport, including promotion of alternative sustainable fuels and drivetrains”. The Trio will also “look forward to the Strategy for sustainable and smart mobility”.
Commentators had already criticised the first draft programme of Germany’s EU Presidency for containing mainly empty words on the European Green Deal. There are no new goals, with actions on hydrogen being the only area not already prescribed by the Commission’s work programme. According to the final programme for “A sustainable Europe”, Germany wants to press ahead with the creation of the necessary markets and infrastructures for hydrogen within the EU during its six months in charge.
Climate sustainability and energy policy remain on the agenda of the German presidency. As the programme says, ‘The German Presidency will ensure that, as the Union deals with the pandemic, the objectives of Europe’s Green Deal are upheld and the Union that emerges after the pandemic will be more competitive, greener and more sustainable.’
However, such a high ambition and delivery can only be achieved if respective public health entry points are explored. A new EPHA briefing looks at the intersections between climate and public health policy and the opportunities to harvest public health benefits in various areas of the European Green Deal. While various files are listed related to the climate, including the climate law, the elephant in the room is definitely the car industry: how to ensure a competitive and zero and low emission european industry shifting from the internal combustion engine to electricity? The EU Strategy for a Sustainable and Smart Mobility will be issued during the German Presidency will be a vital opportunity to ensure lower health and climate harmful emissions emerging from the transport sector. The German Presidency, as an honest broker will have the Herculean task to put aside any national interest and act for the common interest of the Union and its people.
Digital Health
The Presidency wishes to accelerate progress on the digital transformation of society and expand Europe’s digital sovereignty by being both forward-looking and protecting common values. This is relevant for public health where artificial intelligence and data-driven solutions are quickly gaining ground. Another focus will be on developing digital skills and competences across sectors. A common understanding of greater digital sovereignty, including secure data infrastructures, will be sought, not least as a result of the COVID-19 pandemic, underpinned by common norms..
Encouragingly, there will be a big focus on protecting European values and fundamental rights in this context, with a commitment to the “responsible and human-centric” development and use of AI, with the common good as a guiding principle especially in healthcare.
The Presidency also wishes to advance the discussion launched by the European Data Strategy on rules and guidelines for the governance of common European data spaces, as well as the debate about datasets for digital services. Health data are particularly important in the post-crisis context and a goal is to improve pan-European access to and the exchange of health-related data. A “transparent European healthcare data space” shall provide legal security and Council conclusions are expected to set in motion efforts to draft a code of conduct for the use of healthcare data, taking into account data protection, data sovereignty and consumer protection law. This also entails establishing the legal conditions for ensuring that personal devices feature secure storage options or standardised secure elements.
Food systems and Non-communicable disease prevention
While the European Green Deal, and especially climate policy, is set to be a central issue for the presidency, the role of food systems in this agenda does not seem to have been clearly defined. Food systems are responsible for around 30% of anthropogenic greenhouse gas (GHG) emissions and are major drivers of global deforestation and biodiversity loss.
The presidency priorities do make a link between biodiversity and human health and reference the importance of “safe” and “affordable” food. The adoption of the Common Agricultural Policy is seen as a priority, but no mention is made of the more comprehensive, and potentially transformative, approach embodied by the EU Farm to Fork Strategy. Likewise, the UN World Food Systems Summit, scheduled for 2021, is mentioned, but only as part of the international cooperation agenda. This leaves some room for concern whether the presidency’s priorities will not be driven by a ‘business as usual’ approach to food policy challenges, which scientific opinion no longer sees as a viable option.
Similarly, while the COVID crisis has made health a central pillar of the priorities, the approach, as far as can be judged, seems primarily focused on containing and overcoming the direct threats by focusing on the role of the Health Security Committee and the European Centre for Disease Prevention and Control. It accords little reflection to dealing with the factors that amplify the pandemic’s impacts, such as non-communicable diseases (NCDs) and obesity, as key pre-existing conditions responsible for increased severity of illness and mortality. In fact, NCDs are not mentioned at all in the programme and only one passing reference is made to the implementation of Europe’s Beating Cancer Plan.
International Trade
The role of international trade is at crossroads. The European Commission has just announced a new Trade Policy Review, to help formulate the direction of EU trade policy for the medium-term in an ever more challenging global environment and build on lessons learned from the crisis. The results of this reflection and consultation process taking place in the coming months will feed into a communication to be issued towards the end of the year.
With the dissolution of the EU Trade advisory group, it is more challenging for the European public health community to highlight public health concerns in the area of international trade. EPHA will continue to advocate that trade is for health, and not health for trade! Our advocacy on EU international trade policy aims to protect and promote public health, to ensure policy coherence between trade and public health and to guarantee policy and regulatory space for governments and the EU. During the German EU Presidency, progress can be expected with various trade agreements (USA, China, New Zealand and Australia and Mercosur) as well as the multilateral discussions on a new form of arbitration – the Multilateral Investment Court System).
The EPHA suggestions for an EU model chapter in Free Trade agreements as well as its risk register how to protect health in future agreements remain EPHA’s position in engaging on the topic
Health Inequalities
The COVID19 pandemic has exacerbated existing inequalities experienced by vulnerable groups such as the homeless, migrants or those living in severe poverty. Not only have they been amongst those most affected by the socio-economic impact of COVID19, but they are amongst those who will continue to experience its long-term effects. The German Presidency has to increase its efforts to mitigate the rise in levels of poverty in Member States, which will only widen existing health inequalities and the barriers to accessing quality healthcare they already face.
The German Presidency has the responsibility to drive EU priorities towards health equity and social justice, including mechanisms and instruments ensuring health protection of the most vulnerable, including Roma, migrants, refugees and isolated minors as those are most heavily impacted by the crisis in many European countries. As the Presidency begins the implementation of the European Pillar of Social Rights, expectations are high concerning stronger guarantees for health protection, prevention, decent housing conditions and equal opportunities for all. The post-2020 EU Roma Strategy is also due to be unveiled later this year – having consistently called for health to be put at its heart – we await its publication with interest. In addition, the German Presidency will play a strategic role in reshaping the European migration policy through its proposal for an European Migration Pact that can provide a common position and define the responsibility of Member States for mitigating the impact of the crisis on refugees and migrants.
Child protection becomes a top priority for the German Presidency which is a significant step in providing stronger guarantees for child rights and their promotion across the world. Improving child’s protection against exploration, sexual abuse, human trafficking and recruitment in armed conflicts is an important achievement for the European Union and its foreign policy, however, more expectations are raised when it comes to children from vulnerable groups and the level of inequalities they face across Europe. The crisis has had severe consequences for children’s access to healthcare and prevention; decent housing and accommodation, social and educational services leaving many Roma, migrant children, children with disabilities and isolated minors with lower opportunities to break the cycle of poverty, exclusion and social inequalities.