The EU's strengths and weaknesses at COVID-19

On 18 March 2020 the British Medical Journal expressed the weaknesses in the European response to outbreaks, indicating the need for Member States to work together. The European Council on 10 March identified four priorities: limiting the spread of the virus, providing medical equipment, promoting research and addressing the socio-economic consequences; and also reiterating the strengthening of solidarity, cooperation and information exchange between Member States. 

Pre-existing agreements allow for action in the face of serious cross-border health threats, but the exercise of national sovereignty has not facilitated optimal action, even undermining solidarity by introducing border closures and even limits on exports of health products and medical equipment, even to countries with significant needs. This is not the first time this has happened (2009, H1N1 influenza pandemic).

Initially the European Commission's responses were partial, and this may have fuelled disintegrative approaches and nationalist sentiments, over and above those of belonging to the Union. This was corrected over time during 2020, with the creation of the strategic reserve (RescEU), the ReOpenEU web platform for traveller information and funds for therapeutic and epidemiological research. Also with the recovery plan for Europe with a Multiannual Financial Framework and the NextEUGeneration programme for economic recovery.

The European Parliament extended the EU Solidarity Fund to take action in multiple areas, and postponed the need for new requirements for medical devices to avoid stock-outs; proposal on clinical trials; supplies of medicines; and numerous economic and financial proposals.

In the European Council, efforts were coordinated mainly for the post-pandemic scenario with good results, although initial opposition between the Franco-German axis and other member countries, more in the direction of loans rather than grants. This has meant clearly necessary borrowing. 

Incomplete joint governance to sustain optimal action in the face of a very serious cross-border health threat is defined by the conviction of the European Commission itself and the member states, with national sovereignties being stingily preserved. This problem requires an urgent response, as the only way to respond is with cross-border actions that go beyond national ones, which also make collective supranational action impossible, unless sovereignty is ceded to a European Union health authority that leads the way. Another example is the permissiveness with regard to the competitiveness of vaccination projects, in pursuit of increasing commercial production rather than population needs. Suffice it to say that only 4% of the world's global population (USA) has 14 times more vaccines than the entire African continent combined.

Insufficient responses in anticipating pandemic warning signs, the absence of clearly predefined thresholds in the pandemic control strategy for the de-escalation of restrictions, and the delay in the strategy for carrying out diagnostic tests and supplying medical equipment and personal protective equipment, all contribute to the continuation of infections.

Vaccine policy regarding the management of vaccine procurement, which was not entirely transparent, and the communication strategy on vaccine safety went against the precautionary principle, which ensured the need to continue vaccinating given the very rare occurrence of adverse effects. The decisions have been confusing, contradictory, and late. Only a European health authority should have decided on the safety of vaccines, which has led to a prevailing opinion among European citizens that some vaccines are safer than others. The slow pace of vaccinations also leads to differences of up to 14% between countries.

For an efficient response, the European Union should have public health competencies in a single body with sufficient legal capacity, an effective health policy approach, avoiding the lack of coordination of preventive measures, especially non-pharmacological ones. This has disconcerted European citizens and discouraged them from following up, with a consequent increase in the transmission of the virus. 

The leadership needed to articulate mechanisms to make patents more flexible. This has already been done with antiretroviral treatments for AIDS. So that the production of vaccines and the consequent delays in vaccination are multiplied.

It is clear that whether the EU's leading generation sees it or not, COVID-19 will not be the last pandemic. The European Union must take note, because the creation of the ECDC has not been sufficient; and health intelligence, specifically epidemic intelligence, has not produced an appetising result. Experience teaches us that what is not working in normal circumstances will hardly work in abnormal situations, let alone in disaster scenarios. Nor has human creativity in the use of technological advances been our forte. One example is the use of robotics to reduce the risks for healthcare workers in treating infectious patients, as well as artificial intelligence for epidemic diagnosis and modelling. And the need for real-time disease reporting systems for immediate decision making through a health alert coordination centre that would do so in real time when necessary on the basis of threshold indicators, which would then be corroborated by the European Health Authority.

Julián Domínguez, head of Preventive Medicine at the University Hospital of Ceuta