Helena Legido-Quigley
Good afternoon, everybody. Many thanks for joining the Chatham House event. Welcome, everybody. Thanks a lot for joining us today. As you know, today we’re going to discuss the – what can we expect from the EU, in terms of pandemics? We’ve got three great speakers, with very different experiences, but what they all have in common is that they’ve got vast experience on EU policy and working also at parliament level. Most European countries have been all affected by COVID-19 in a very bad way. We’ve got more than 160,000 deaths, and to – and we’ve seen the different approaches in terms of combatting the disease. But today, we’re not going to focus so much on the specific country responses, but more on what we’re going to expect from the European Union.
So, just to highlight a couple of things that the speakers are going to discuss is, are EU institutions limited in fulfilling these expectations that we were discussing before? What can we – what can the EU do to improve? And what should be the role of the EU in this type of crisis? And also, very importantly, what type of leadership can we expect? So, with these questions in mind, we’re going to move to the speakers. First is going to be Professor Martin McKee, then we’ll move to Jytte Guteland and then to Clive Needle. So, I’ve been asked to give very brief presentations on the speakers, so just to say I think most of you will know Professor Martin McKee. He’s a Professor on European public health, and he’s also the Director – Research Director of the European Observatory. So, I hand over to you, Martin, for your presentation.
Professor Martin McKee
Okay. Thank you very much. So, I want to take your minds back to March the 10th, when the European Council had a vide – held a video conference to discuss a joint European approach to combat COVID-19, and the Ministers there, the Heads of Government, identified four priorities.: limiting the spread of the virus, provision of medical equipment, promotion of research, and tackling the socioeconomic consequences. They also reiterated, as you would expect, the importance of strengthening solidarity, co-operation, and exchange of information between member states. So, what happened? Well, there was no doubt that there was a high-level political commitment from the EU, but what we have seen in the subsequent responses has suggested that there are a number of obstacles to developing a comprehensive response to infectious disease outbreaks in Europe.
The first issue is that member states have long guarded their responsibility for health services. They remain responsibility of the member states under the treaties, which provide the legal basis for EU action. Of course, as we know, there are provisions for acting in public health issues, but these are relatively limited, and what they focus on primarily, are serious cross border threats, that’s fine, but even in that, the EU must respect the autonomy of member states and operating their health systems.
What we also saw was the governments initially prioritised their own interests, even when it undermined solidarity with other countries. France, Germany, the Czech Republic, introduced limits on exports of PPE, face ma – face coverings, facemasks, and so on, despite severe shortages elsewhere. And this recalled similar measures that had been taken, following the swine flu epidemic in 2009, when several member states stockpiled vaccines and antivirals, declining to share them with other countries, and that experience led to a European legislative framework for joint procurement of equipment and medicines, when faced with cross-border threats to health, but that took quite some time to get going.
Third, there are existing co-ordination mechanisms, such as the Health Security Committee and the ECDC, the European Centre for Disease Prevention and Control, but despite being called European, they’re not truly European. They co-operate with the World Health Organization and with neighbouring countries, especially those that are candidates for membership, but the remit beyond the borders of the European economic area are relatively limited. Now, this is a problem because, to coin the old cliché, microorganisms do not respect national frontiers.
The ECDC also hosts a – the Early Warning and Response System, an online portal that connects the member states together, connecting the public health agencies, so allowing them to share information. But, again, countries beyond the EEA, such as Switzerland, don’t have full access, and obviously, this is going to be an enormous problem, although one that is clearly totally self-inflicted by the United Kingdom in the future. Even so, although the UK could participate in many of the early meetings, it did decide to socially isolate by not attending many of the meetings.
Now, Elias Mossialos, Michael Anderson and myself have argued in paper, in the British Medical Journal, that a number of changes are needed. The first thing is that, clearly, there’s no political appetite to revise the treaties, but there are some things that could be done, under the existing treaties, on an intergovernmental basis. For example, there is much more that could be done going beyond the joint procurement agreements, to ensure that there are supplies of personal protection – protective equipment, medicines, and so on.
Second, and an area where there has been progress, wealthier countries with strong health systems could do more to support those that are struggling, both because it’s in their own self-interest to prevent spread, but also, politically, importantly, to demonstrate European solidarity. Now, it has happened. Germany, for example, has taken patients from its neighbouring countries, from France and Italy in particular, but probably more could have been done.
And third, for a truly European response, the EU needs to proactively engage with countries that are not member states, which will mean trying to find ways in which they can link them into the Early Warning and Response System and the various other mechanisms. Now, this, of course, does require a quid pro quo from those countries. Switzerland has been struggling with tailoring its legislation, the United Kingdom will have to get a little bit more realistic than it has done so far, and recognise that this much vaunted sovereignty is fine, providing you don’t want any protection. But if you want to engage, you’re going to have to make some concessions, and, sadly, of course, we’re not seeing that at the minute, but I’m sure we’ll come back to that.
But, also, we need to recognise that ECDC is a very small organisation. It’s got about 280 staff, a budget of about €60 million, and this is really tiny, so we need to have much, much more in place on that to help it to develop its capacity. Now, there are a lot of things that we can praise. The European Commission has produced a very detailed, a very valuable roadmap for relaxing the restrictions, and what we’re seeing is much more co-ordination in relaxing restrictions than we saw whenever they were being imposed. It’s said very clearly that no country should consider lifting restrictions, until it is certain that the disease is under control. A challenge for some of them, as it presupposes that the national authorities have accurate and timely information, and we’re sitting in the United Kingdom, a country that is abjectly failing to do that at the minute.
The importance of this information is absolutely crucial, because if we do not get the R number under one, clearly, we’re going to be having a second wave of infections. It’s going to be a challenge also in countries that have got weak laboratory capacity, and many of them are doing a lot to scale things up, but still much to be done. The Commission has stressed the importance of co-ordination, particularly in frontier areas, and we see that especially in those places where, for example, and this is one, Helena, you’re familiar with from our previous work, places, well, on the Irish border, but the city on the Italian Slovenian border, Gorizia and Nova Gorica, where the border goes down the centre of the main square, Valga Valka, between Estonia and Latvia, and many other examples of where communities are actually divided by a frontier. So, the Commission has – is working with governments to help them, to make sure that they co-ordinate. Now, of course, it cannot – the Commission, the European Union, cannot tell governments what to do, because health is their responsibility, but what it can do is to make sure that there is much more co-ordination and to support that process with its convening power.
So, to conclude, this is not going to be the last global pandemic. It is important that the European Union learns from this experience and takes action to improve its preparedness for – and planning for future infectious disease outbreaks. There are two things that I think need to be done now at a European level.
The first thing is that we desperately need to improve our data systems. When we look for information, we go to John Hopkins for their COVID tracker, and when we look for the impact on mortality, we go to the excellent resources provided by the Financial Times. Looking at all cause excess mortality, which is clearly the best measure that we can use. In the European Observatory, we’ve just published an analysis, looking at the different definitions of COVID deaths, and there are huge problems, as different countries have different definitions, but we only have those data from a small number of countries. We have to ask a very serious question of what has been going on in Eurostat, and what has been going on that they’ve not been able to get the data from National Statistical Offices. This is simply unacceptable.
Secondly, we need to look at strongly investing in the scope and the capacity of ECDC. It’s tiny compared to its equivalent in the United States. It needs a much stronger mandate, and working with member states, of course, but also picking up weaknesses where they exist, and surveyance, and preparedness, planning, scientific advice, and so on, but it will need a substantial increase in funding, and at that, I’ll pause.
Helena Legido-Quigley
Many thanks, Martin, for your presentation. So, you’ve reminded us of very important points, the funding for ECDC, also very important, the positive role of the European Commission, in terms of providing guidance, and in terms of relaxing restrictions, and many other points that we can discuss later in our question times. So, now we move to Jytte Guteland, who is going to give us a presentation more from the perspective of a Member of the European Parliament. Jytte is a Swedish Politician, and she’s also a Member of the Social Democrats, and she serves in the Committee of Environment, Public Health and Food Safety. She is also a Member of the European Council of Foreign Relations, and we’re really looking forward to hearing your perspective from a Member of Parliament. Over to you, Jytte. Many thanks.
Jytte Guteland
Thank you very much, Helena, and thank you, Chatham House, for letting me participate in this important discussion. I was also very – it was interesting to listen to Professor Martin McKee and hear the views from the expertise on what’s happening in Europe, and what we could learn. I’m a Member of the Environmental Committee, as Helena mentioned, and I’m – I work – the big part of my time is taking place in the discussions in the Environmental Committee, but I’m also in the Foreign Committee, AFET, so it’s also interesting to take part of the discussions on what’s happening outside of Europe and in relation to third countries.
I would like to start a little bit by talking about the COVID-19 crisis in Europe and some lessons, and then go to the geopolitical situation and more what we can do, in relation to foreign countries. In – if we look at the – what’s happened, I really share lots of that who’ve been said and presented by Professor McKee. I think there was, in the beginning of the crisis, very clear that we didn’t respond effectively together to this crisis, and then we had several member state who worked for national interests and they became negative to the EU as a whole, and they also didn’t help themselves by being very national in their way of acting. We suffered from medical equipment being stuck in different member states, and we need to learn how to avoid that in the future. The border were closed to important goods that was necessary to act in response to this crisis, and we must never let that happen again. We need to make sure that if we have an internal market, it needs to work during a crisis like this. If we have a second wave, we cannot let that happen again.
Another thing I want to emphasy is the situation for ECDC, who really worked hard and did the utmost to help and facilitate for the member states to understand what is happening, and also give their expertise advice, but it’s a very small agency, and that’s where I really want to accompany Professor McKee. I think we need to build the bigger agencies in the EU to respond to crisis, pandemia, like COVID-19, but also for the future. It is not sufficient for Europe, for EU, to have such a small agency on health level.
I also want to put some thoughts into also, the healthcare systems in our member states. They work really differently, and in a crisis like this, we need to make sure that we have a minimum level in Europe, and that we don’t come to a situation where some member state cannot help their citizens in a sufficient way. So I really believe that we also need to, in the EU, make sure that we put some effort to that and make sure that we have a minimum standard for the healthcare system to work when we have a pandemia like we had this time, and also, be prepared for a second wave of COVID-19.
That being said, I would also like to say a few words on the situation when – in our response and our responsibility to third countries. As you probably know, our new Commission has stated that this is a geopolitical commission, which is more necessary now than ever. The ambition is to be more proactive and strategic in the foreign policy, and I agree with the – with our High Representative, Josep Borrell’s thought, that the coronavirus pandemic has effectively destroyed some parts of the global governance model, and the EU should play a key role in rebuilding the international order. We saw that China, as well as Russia, made efforts in the Western Balkans to provide help, but also to brand themselves as allied with countries in the region.
A conclusion from this is that where EU leadership is lacking, and also where we see that the US leadership is lacking, and even worsening the international conflicts, we really must make sure that we reveal the EU to take a leadership, and it also – we also need to unite. We have a history of reforming and rebuilding after crisis. Let’s use that now, and I really hope that this will be the result of this terrible pandemic as well. I am hopeful, though, because EU response, in both international politics as well as global response, is characterised by co-operation, and I think it’s unlikely that we’ll see national interests prevail the way that it unfortunately did in the beginning of this crisis.
All over the world, people are losing sources of income now, and they are finding themselves unable to provide for themselves and their families. We see that people are starving, and we also see that this is something that is getting bigger, and we think also that we might have doubling the situation of people starving in the world after the pandemic, and it’s especially worrying also, for partner countries outside EU with fragile health systems. They will be really vulnerable now. And I believe the goal is to protect the EU citizens and to make people feel protected by the Union, and make sure that we can co-ordinate ourselves and make ourselves strong, both for that cause but also, in relation to third countries, and to take a leadership globally for health and for rebuilding the governance structure globally after the pandemia.
And I can close by one more concrete thing that I thought for long, but I think it’s necessary now, it is a good idea to push for majority votes in the EU Council, when it comes to very important issues in foreign policy. This is a good thing to do now, together with the leadership that EU needs to show. Thank you.
Helena Legido-Quigley
Thank you, Jytte, for your analysis. I thought it was very interesting and very frank when you were mentioning some of the limitations and some of the areas where the EU had a slow response and could have timed better. Very interesting also your point on the needs that we need to strengthen minimum standards for health systems across the European Union, and also very interesting your reflection on the need to reassess global governance, in terms of health, also, and your final comment, more concrete on the majority vote, very interesting contribution, also. So, now, before we go – we’ve got our final speaker, which is Clive Needle, and he was a former Politician in the UK. He was a Member of the EU Parliament in the 90s, and currently, he’s a Policy Advisor for EuroHealthNet, which is a non-profit that focuses on health equity in Europe. So, over to you, Clive.
Clive Needle
Thank you, Helena, and thank you very much, and I can avoid duplicating the excellent and very wise words of the two previous speakers. So, a couple of additional points, particularly from the view that EuroHealthNet, the organisation which I work with mostly, works across the European Union policies. The questions around what role the EU has played have already been well dealt with, and as the speakers have said, there’s been good and bad. Let’s face it, no-one was truly ready, and the EU needs to look very closely at itself, in terms of its systems, as Martin has set out very well.
We had heartbreaking calls from some of our members on the frontline in EU member states, such as Northern Italy, looking for resources, looking for medical professionals, etc., and actually, indicating that they were getting more help from countries outside of the European Union than they were initially from within, which is part of the questions around discontent of European citizens, and that sort of approach, “Do our systems have enough rapid response in place?”, is something we must take forward. Attempts at common approaches, in schools between Spain and Sweden, easing lockdown, the digital variations, which are still ahead of us in decisions about track and test and trace, for example, questions about data and safety, are very much live questions, which all need to be thought of, in terms of the approach towards these pandemics.
On the other hand, I wouldn’t want to dwell on the bad too much because great things have been done and great strides made. The leverage that has been exerted by the EU institutions, in terms of supporting work in states, the financial roles of the investment, and the central banks, the shifts around procurement and preparedness, looking at new innovations and bringing new partnerships in pharma and other markets is quite stunning, in terms of how fast things can move. And it’s important to look at how the governance can be adapted for these new paradigms to move forward in future.
What do member states most expect? Well, our members often want things like money, that’s the basic truth. They expect the European Union to provide the resources. We’ve had requests from states, they want things like translations funded, so they can actually understand what they can do, in terms of building partnerships, and learn below national levels. So, for example, citizen regions can actually interpret good practice and preparedness data. What member states don’t like is the comparability. They don’t like being told that they come way down charts and tables, they don’t like look – seeing inequalities being exposed in their countries. And that is often stifling, being able to get accurate and honest assessments of what can be done to go forward, and Martin made important points about improving honest, transparent use of data and those systems. But we need to also be asking what people want beyond member state governments, because those governments are often acting as a filter in both directions, in terms of implementing legislation, but also, not wanting people to know the good things. And this week, we’ve seen the President of the European Council have to introduce his own newsletter to get messages across, which are not being heard.
So, institutions are limited, but I want to finish, if I might, Helena, on some positive suggestions and recommendations, perhaps go a little bit wider than the excellent ones which I fully support, which we’ve already heard. We need to look at the fundamental causes, not just the symptoms of this. Systematic inequalities, which we’ve seen exposed in the UK this week, regarding people from ethic and other minorities, we need to look at sustainable and safe food systems and the real causes. We need to look at over-globalisation and the impacts of travel, and that feeds very much into the Climate Emergency and the Green Deal transformations. These things can’t be taken separately, and we need to look at the digital revolutions that are affecting and impacting on people’s lives, and the EU has fundamental roles to play in all of that.
EU citizens have rights. Martin rightly talked about the treaties, which give collective rights to governments to organise, but we also have the European Pillar of Social Rights, a right to preventive and curative care. Citizens might well be demanding, on the streets, that that actually happens, as a result of this, so how is the EU going to respond to that? We’ve had great initiatives from Finland and elsewhere around the economics and wellbeing, using new indicators to match that data that has been spoken about. We’ve got a new approach to the European Semester of economic governance, which is all about strengthening health systems and strengthening the way that investments will take place in member states, and using the huge new funds that are now being invested in the newly proposed multiannual financial framework and its investment programmes, including a new standalone health programme, which wasn’t anticipated a very short time ago, but offers new opportunities.
Some of that should go towards strengthening National Agencies, as Martin mentioned. The Dutch National Agency, RIVM, has become much more prominent in looking at things like its Foresight studies, in looking at things like health equity and environmental impact assessments, which should be become fundamental to the governance, and the global health. Martin mentioned the strength of ECDC, but also the European Commission Directorate, Sante, is way under-resourced to be able to deal with the cancers, as well as the global pandemics. Many more things like that can be done, and we can think about strengthening the governance.
Lastly, Jytte mentioned the importance of the geopolitical role, which has been stated, and EU leaders have been quick to actually engage with African countries and the African Union and to signal new approaches. But, let’s be honest, if we look at the mission letters for those Commissioners about what they would actually do, we have an excellent new Finnish Commissioner for building partnerships in the development sphere, doesn’t mention health. Talks about good things like gender equity, great, let’s build on that, but I think we need to look anew at those mission letters and what should be the responsibility of rebuilding that new global architecture, rebuilding the missions that we have.
The global health strategy looks to me as if it hasn’t been properly updated since 2010, thought about in 2016, badly needs relooking at again for the new circumstances, particularly in terms of the SDGs and working with UN organisations where Mr Trump might not want to strengthen ‘em, but the EU very much can strengthen the WHO, and look at partnership examples, for example that we have on the Tobacco Framework Convention, to see if new models can work to use and strengthen the EU role. So, there’s a lot to look forward to, a lot to discuss, and thank you very much for the opportunity to provoke some of that.
Helena Legido-Quigley
Many thanks, Clive, for your contributions. Very useful, the solutions that you proposed there at the end. I think there seems to be some agreement on the need, from the three speakers, to improve data. I think some of the questions might relate to that, and to reflect on how can we do that, because there has been a bit of a debate, within countries, why can we not compare, for example, mortality data? There has been a huge debate in Spain. Also, very important, Clive, what you’ve mentioned on systematic inequalities. We’ve already seen evidence that COVID doesn’t affect everybody the same. We’ve got evidence from the UK, from Spain, and in areas with more poverty, there has been higher mortality. And then I think this debate with – that you’ve mentioned, Jytte and Clive also, on the idea of EU leadership and the need to reassess governance at the global level. So, I think on those notes, I’m going to move to questions, and I think I’ve got one here – that I’m going to start with a simple one, well, a short question, but a bit complex, and I’ll hand over to you. So, the question, by Peter Shellinck mentions “How is the pandemic affecting US European relations?” As I said, short, but complex to answer. So, who wants to go first?
Jytte Guteland
Yes, I think it is affecting the US-EU relations. It is a very difficult situation in the relations, even before, as you know, and you’re probably very well aware, the leadership with the President in the US is not very stable, and to be very diplomatic in how to frame it, and the leadership from there seemed to be more the blame game than to really have effective result for US, but also globally. We’ve also seen a very weak response from US when it come to the climate policy and the – also, how US withdraws from the World Health Organization, and other international agreements, is really worrying.
I believe EU needs to continue to push, have a dialogue, try to involve the US, try to be the mature, adult voice in the relation, fill its shoes globally, really try to also connect to all the different states. There are – I mean, the President is not speaking for the whole of US, as we see in the climate discussion. We know that we have a progressive alliance of states in US, who has another way of working, and not to undermine the official federal state, but at least to make sure that we have different dialogues going on. I think that will be really important also, in relation to the World Health Organization, because we need the US to help and we need the US to be a partner, and we cannot ignore them, so we need to try to involve them.
Helena Legido-Quigley
Many thanks, Jytte. Martin, you want to say something? Yeah, Martin?
Professor Martin McKee
Yeah, sure. Yeah, I’m on mute. I think it’s an extremely difficult – a very, very serious time, and I think what we’re going to see, I think, in a way, man – I mean, I speak for myself, but I think for many others outside, we’re hoping for a particular result in November. But what is really worrying is the situation that could arise if Trump is defeated in November and then he has that time, in the rest of November, December, early January. And the worry is that you have somebody who is so irrational, so detached from reality, so completely narcissistic, that you have almost an acting out of the final bit of the Ring Cycle, Götterdämmerung, the Twilight of the Gods, because he seems to be determined not just to bring the United States down by fermenting racial hatred, and also allowing COVID to run wild, but to bring down the rest of the world by defunding the World Health Organization with his undermining of the climate change agenda.
So, I think the challenge is really going to come for the rest of the world. I mean, it will be coming from two sides, the progressive alliance and states that Jytte has just mentioned, where we’re already seeing that, and in the COVID response, we’re seeing that groupings of states are coming together, in the East Coast to West Coast and the Midwest, to fill the gap that has been left by the absence of the federal – of anything sensible from the federal government. But also, I think internationally, if the international community struggles with – you know, it’s not – I mean, we have plenty of experience of dealing with failed states, be it Yemen or Somalia or wherever, but the challenge arises whenever you have a failed state that is nuclear-armed, which is one of the wor – probably the world’s only remaining superpower, and then, of course, we haven’t mentioned Brazil, but there’s a challenge there that gets into the whole international world order. How do you deal with that, and particularly whenever you have, you know, the US having a veto on the Security Council, and so on?
I think there’s really very great danger, particularly potentially in that period between November and January, whenever this man has really nothing to lose. And I think what is then going to depend is whether those around him, and we’re already seeing that with the military saying – the US military saying, “Actually, we’re not going to do some of the things you’re asking us,” but are we going to – are the checks and balances, which have really been eroded in the US constitutional system, are they going to be strong enough to deal with somebody who is just so detached from reality as that, and I really worry.
Helena Legido-Quigley
Clive, would you like to add anything?
Clive Needle
Yeah, I can be very brief, I don’t need to duplicate. I don’t disagree with what I’m hearing, but let – again, let’s try and, sort of, think and there’s one or two positive things. Many organisations and agencies have multilateral links with the United States, and, very shortly, I’m sure, Martin will be involved in the World Public Health Conference. The way that the Center for Disease Control has been attacked and cut back in the States is worrying, but we have opportunities there, and EuroHealthNet will be trying to engage on a range of different activities, where we can go across borders because we have these new ways of connecting now. We have new communities of interest and new dynamics that are emerging, powerful cities, for example, who have taken all sorts of new approaches and can link with our friends in the States, new technologies, new connections.
And I’d like to come back finally and quickly to the leverage issue. The EU has huge powers for good and sustainability and global health for its trade and aid provisions, and already, the Commissioners are looking at extending that. And particularly looking at the leverage to factor in things like private public partnerships across the world, looking at global inequalities, looking at that preparedness, and building new ways of doing things, so that the old dinosaurs no longer are the only voices that dominate. But, yes, of course, we can’t ignore the threats that are coming, which obviously offer huge barriers, but I believe they can be overcome.
Helena Legido-Quigley
Many thanks, Clive. So, moving now from within the European Union, very interesting question by Frini Chance, she mentions, “Will this half crisis further deepen the divide between the European North and South?” Very important. “In the aftermath of the crisis, should we expect a more regional approach to combatting the aftermath of the crisis and reviving the economy? Comments on that. Jytte, you want to start?
Jytte Guteland
Competition and also involved in politics. Before I was a professional Politician, I always believed that we can choose or destiny, and, of course, there are crisis that we need to handle always in the world that will come. But, as human beings, we can always work together to overcome crisis and also, make choices on how we would like to live, and I really believe that I would like my kids to live in Europe and the EU that is together, and I would like us to fight global challenges together. I would like us to overcome difficulties from North to South, and I believe that we are many in Europe who feels the same, and still feels the same, and maybe after this pandemic, even is stronger in our belief that we need to overcome the difficulties that we had in the beginning of this crisis, but also, the crisis that we had before that was weakening Europe.
I don’t want us to go in a two-level Europe. I would like us to go together, and I don’t want the North and the South, the East or the West, to not come together. I think we can have periods of time where we have really difficult economically to understand each other, to help each other, to do the right thing together. We will also have difficulties because of our history and because we have a different level of advanced healthcare systems or societies who are different from our history. But I really believe that, as the European Union is coming along, we will also have more and more shared history, and we will also be more similar in handling some things, so the things that were difficult before might be easier in the future.
Maybe I’m sounding a bit like a Philosophian more than a Politician right now, but I believe it’s important also, to emphasy the importance of working together and that I see that things that were difficult before, maybe from some countries, when we had the enlargement last time, will be easier in the future because we become more similar, and the crash that we might feel in the beginning might easen up. I think, after this pandemic, there are some guilt towards southern part of Europe, Italy is one good example. We need to show that we are sorry that they didn’t get all the help they needed in the beginning, and some others, too. I know that from a Swedish perspective, we also have medicine and equipment that didn’t come to Sweden that we wanted, but we don’t need the blame game. We can say we’re sorry, but we should also try to make sure that the Politicians work towards a system who is better and can deal with the next wave or the next pandemia, but always with the goal to keep together, and that’s better than be divided.
Helena Legido-Quigley
Many thanks, Jytte. Especially coming from Spain, I really appreciate your words on what you’ve said. Martin, Clive, do you want to add any points?
Clive Needle
Thank you, very briefly, yes. Well, I mean, EuroHealthNet exists as an organisation to try and build that co-operation and sharing, and what we – I mean, we had a major meeting yesterday. We had over 60 bodies, from 26 countries taking part, who very much wanted to cooperate. So, there are instruments that we are able to advise them that can be used, but I have to say, I’m wondering if part of the problem isn’t the state model, the government model. The – this morning, I was reading Council conclusions on demographic changes, which, quite frankly, were not good enough. They’re superficial. They did not sufficiently take into account whole new changes in the way that people are living and moving, migration trends and impacts in all directions, and the pressures that that means on communities and societies. And just a brief reference to healthy aging and a brief reference to long-term care and the impact doesn’t begin to address the sort of pressures that are faced by people in reality on the ground, so it’s not surprising that people react to that.
There are really important new instruments around, changes to cohesion policies, the transition funds, as part of the Green New Deal, which can be vital in giving people that sense of community and sense of fairness, and a shared ownership. And I wonder if some of the pressures are not going to express themselves, as Martin will know very well, in the United Kingdom, the country that we both know best, in terms of the pressures to pull away from the traditional nation state model to more devolved models, which we can see happening across many countries, and we see increasingly dynamic powers come from cities and come from subnational regions, and that’s where we see a lot of innovation pressures coming from. So, I think there are going to be all sorts of dynamic demographic changes, and we need to understand and react to them much faster and much better.
Helena Legido-Quigley
Thank you, Clive. Martin?
Professor Martin McKee
Yeah, I agree with you there, actually, and I think it’s been quite interesting. If you look at the situation in Italy, for example, where you do have a high level of regional autonomy, and the Italia – if we look at a measure of effectiveness in controlling the pandemic, as taking it as keeping the excess all cause mortality below 50%. Well, they actually did confine those problem regions to a few in the North, and they really did – were able to restrict the spread, in the rest of the country, with actually very low rates in the South, and that even when you got further below Emilia-Romagna. So, I think – and also in France and in Spain, again, the epidem – the pandemic has not been generalised, whereas, in the United Kingdom, with a highly centralised response, and even though we’ve got four devolved nations now taking on much more autonomy in their decision-making, but initially, very much driven by London, you actually have seen a much more generalised pandemic, and maybe a bit in the South West a bit spared.
So, I think that we’re going to recognise that the regions of Europe everywhere need to take on a much greater role. I think within the United Kingdom, I know we’re not primarily talking about that, but I think that this is going to have a profound impact. Clearly, we’ve got other things going on, but I think we’re now seeing on bo – and from Northern Ireland, obviously, both sides of the community there recognising that maybe they’ve got more com – in common with each other than they do, and with the rest of the island, than they do have with England.
And also, I think the very visible sense that Nicola Sturgeon, the First Minister of Scotland, has been in control, I mean, we can criticise some aspects of the Scottish response, but she has certainly given a very clear impression of knowing what she’s talking about that has not been apparent in London, so I think that is going to be a stimulus. And in the same way that pandemics throughout history have led to political change, we have the Black Death of 1348, which contributed to the peasants’ revolts, contributed to the reformation, and there are many examples of the changes that have been brought about. I think we’re going to see some profound political changes as a response to this, and particularly in the United States we’ve talked about, but in Europe, too.
Helena Legido-Quigley
Thank you, Martin. So, continuing with the politics, we have a question from Lara Holman, and she refers to Clive’s comment on the global health strategy. So, as Clive pointed out, the global health strategy has not really been updated since 2010, and overall, it has not strongly positioned itself as a global health actor in the past. “Will the changes, shaping the EU as a stronger global health actor, be sustainable and long-term or will this drop, once the epidemic is no longer dominating the news and everyday life? And Lara already mentions, already now, we are seeing the discussions and focusing on the economy and it’s being framed as an economic crisis, rather than a public health crisis.” Do you want to respond, Clive, as it’s referring directly to you?
Clive Needle
Thank you. Yeah, well, thank you, Lara, very good question. I think you have asked a very important question about the sustainability of this approach, and this is where I would say that we very much need to make sure that this is linked into the Sustainable Development Goal approach through to at least 2030 and beyond. The European Commission, I know, wants to integrate the approaches together, but I think there are gaps and blind spots in its programme, and hopefully, Jytte and the colleagues in the European Parliament can add a great deal of strength to this. I think they have a vital role in being the voice directly of citizens, but also, their scrutinising role, and in pointing out where there are gaps. We haven’t had an update of the European approach on health inequalities either, since around about the same time.
And we don’t want to get too bogged down in looking back in reports, we want dynamic approaches, we have the Sustainable Development Goals. The EU is committed to actually implementing them across the 17 goals, and they’re universal in all the countries of Europe, as well as their global commitments. So, yes, I do have worries that this will be short-lived, and that there could be a return to normal service, unless we are vigilant and diligent, and we really press the case. There are tremendous ideas that I’m seeing coming from think tanks, tremendous new voices being heard and people say, “We can do things differently,” and I believe that the sort of initiatives that we’ve spoken about can be taken forward. But we’re going to have to work extremely hard to put our voices forward and make sure that people who would want to revert to the bad old ways don’t win the arguments.
Helena Legido-Quigley
Many thanks, Clive. I think I’m going to move onto some of the other questions because we’ve got quite a lot, and we’ve only got ten minutes left. So, one on research, we’re moving to research. So, Peter Schellinck, “What more is being done to support research into the coronavirus, which includes benefitting those outside the EU?” So, any initiatives on research, maybe Jytte wants to mention that or – yes?
Jytte Guteland
Yeah, we put a lot of emphasy on that in the Environmental Committee, that we need more on the research, and we also need to make sure that the vaccine is developed. But also, when its developed, that it will be accessible for people and that we don’t see that it becomes too share – too pricy for people to take the vaccine, and we would like to see that, of course, globally. And we don’t want to have this system where there’s also a limitation to some countries, so we have pushed the European Commission to have a strategy for this, and to make sure that we have prepared both to put in the money, but also, to make sure that the citizens don’t lose when the vaccine is developed.
And we also put some emphasy on the procurement procedure and we would like to have medicines in Europe for people, not only – today we see that we don’t have control over the whole chain, and we also see there’s some medicines who are rare, it’s really expensive and it’s very difficult for some member states to have access for them. And this is something where we would like to – the Commission to put into its pharmaceutical strategy this fall, when it’s presented. We would like to see some action here on how to make sure that we can have access for medicines, also the rare medicines, for the whole of Europe. So, we work both with vaccine programmes and the money for it, the founding, but also, with how to work with other medicines necessary, to help people who are sick.
And then, one last thing, on the last question, I will not be long, but I would like to say that we would like Europe to be more of a health union and work more on that, but I’m really, really also aware that when the camera is off, it might not be the same activity. I’ve seen it on climate, and I really would like both climate and health to be driving visions for Europe on how we develop further.
Helena Legido-Quigley
Thank you, Jytte. I saw that Clive was nodding, do you want to add something, or…?
Clive Needle
No, I think you’ve made the point very clearly. I mean, driving the research forward is going to be absolutely crucial. It’s – the thing is, I’ve heard people say – in fact, I’ve heard colleagues of Jytte in the European Parliament say recently, “Part of the driving goal has been competition, and we need to be much more, in terms of looking at co-operation, what is for good?” And I think there has been that understanding, and it’s part of the same answer, that we need to have that vigilance to make sure that the missions of the EU research programmes, the fairness, in terms of making sure that less developed nations have equal access to the newest technologies, the newest developments and innovations, can happen. Martin’s done a tremendous amount of work over the years with colleagues at the London School and elsewhere, on important research projects. We need to be much better at actually taking up that learning. He’s part of an investment panel, translating the learnings of science into sustainable delivery and implementation, and the gap is far too big at the moment, and there is much to be done on bridging that gap to make it a truly effective research union, for the reasons that we’ve said several times.
Helena Legido-Quigley
Thank you. Martin, to finish off with the research and data, do you mind commenting on that, and also, on the data aspect, what can we do? And one final issue on the mortality data, I see you’ve written a paper on it, do you mind clarifying us what would be advisable, at European level, to do on that?
Professor Martin McKee
Sure. Well, I might sound like a broken record to some of my colleagues in the Commission, because I’ve been going on about this for such a long time. It really does seem remarkable, when we look at the wealth of data that the United States has collected by the CDC in particular, ongoing surveys that allow you to do – and just to give you an example, my colleague, Jacob Bor, at Harvard, was able to take existing routine data and show, using it, that there was a marked deterioration in mental health, mental wellbeing, among African Americans living in states where a Police Officer had shot an unarmed Black person, and they had the data because it was regularly being undertaken, and it was at sufficiently large numbers, and he was able to show that that didn’t – there wasn’t a deterioration, if the person who’d been shot had been armed.
It was a really outstanding example of how we can interrogate data, if we are collecting it in a consistent way, and they are doing that in the United States. We’re nowhere near that. We don’t have consistent mortality data. I mean, we have in terms of the content, and there are issues of coding, but in terms of the timeliness, we’ve got major delays in getting data from a number of countries. And then, when we go beyond that, a lot of work has been done in the European health inform – interview surveys and health examination surveys, but nothing like enough, and it’s far, far less than we’ve – we see in the United States. So, you know, we just need to get our act together, so we actually have those data. We’ve got the survey of income and living conditions, but it’s very limited, in terms of the health questions.
Helena Legido-Quigley
Thank you, Martin. A quick comment here maybe for Clive to reflect on, if you don’t mind, from Ali Guba. “One of the socioeconomic consequences of COVID is the poor prioritisation of sexual and reproductive health services and rights. Please do not forget sex, as there is anxiety about the restriction on contraceptive services, contraceptive supplies and services to tackle intimate partner violence.” I thought maybe, Clive, you can mention, since your work on your non-profit.
Clive Needle
Yeah, absolutely. I mean, there are huge concerns, and we’re part of some joint actions amongst member states that, you know, up until, when Martin was speaking about, you know, everything changed from earlier in the year, and a lot was being done on building the services, and a lot has been paused. There is a lot of concern about the way that the services have been delivered and the future economic impacts on how people will be able to get the protection. So, absolutely across sexual and reproductive health, but also, we need to mention mental health, there are a whole load of other services, regarding workplace health, where there’s an immediate focus on making sure you’re physical distancing, but taking into account the normal threats, we do not provide sufficient protection for people, employees.
Now, we have a lot of knowledge about this. We did a huge amount of work with WHO and the European Union, in the wake of the financial crisis just a few years ago, and yet, that wasn’t taken forward. So, the problems became huge, they were delayed, and service providers, health systems, delayed the worst impacts of cut. But they’ve been savagely slashed, and the amount of money from public health in health systems’ budgets nationally, in terms of providing preventive and promotioned services, around about 3% on average, is not insufficient for us to have sustainable health systems. We need to have this reorientation. We need to use the research, the work of Michael Marmer and others, as Martin says, using properly disaggregated data, to find out those most in need, where the best investments can be placed, and how we can make sure that we do not break this down into siloes, but we actually fund the services that people need, on the basis of sustainability and equity and good health going forward. So it’s very important, Ali, thank you very much for raising that point.
Helena Legido-Quigley
Thank you, Clive. Moving onto Daniel Lopez-Acuña, and maybe this one’s for Jytte, because it talks about the nation states. Yes, so, “A European system and a global system, WHO, still based in a concept of nation state sovereignty does not work for the purpose of health security and for preparing and responding to a pandemic.” Any comments on that, Jytte? Or Martin, if you want to, or Clive?
Jytte Guteland
Yes, very brief. I would like to mention that I think, and I know also, that many colleagues in European Parliament thinks that we needs to be stronger, when it comes to health on the European level. In my political group, we actually talk about the health union, and it is about many things, both make sure that we work in the EU, with better measures together, more coherent, and have a minimum level of healthcare in our member state. Make sure that we have stronger agencies. Make sure that we have better procurement measure, also, the stockpiling, and make sure that we don’t build borders, when we need to help each other. There are many things that we would like to emphasy for the future.
And then, in relation to third countries, I really believe that we need to be also adapting and changing our strategy and put health in – as a priority, and there could be a seminar of its own on that, because what we see globally now is really scary. And I believe that there is both the health aspect and also the socioeconomic health aspect from this pandemia that really makes it necessary too, for the upcoming years, to be more updated and put the health question in as one of the priority in our global measures. Thank you.
Helena Legido-Quigley
Thank you. Any other comments from Martin or Clive? Yes, Clive?
Clive Needle
Yeah, I see time is up. So just very briefly, in the reorganised World Health Assembly recently, we had a seminar that was really helpful over the Global Health Promotion Alliance, which was particularly focusing on the need to address commercial determinants of health, which arguably, is one of the causes behind the current crisis we have. I think this means that we need new dynamics and new ways of looking that move away from some of the sterility that we’ve had. WHO is a potentially great force for good. The new Director in Europe, Hans Kluge, has great ideas about new partnerships and new approaches, for example, using the Healthy Cities Network to develop new dynamics, using its Venice office on investment, with its health equity status approaches, which completely revitalised the way that things have been done, moving away from stayed approaches, and actually bringing in much more partnerships with citizens and communities, with National Parliament, with the European Parliament, so that Jytte and Co can get involved with the work that’s being done, and, crucially, focusing on new partnerships. There is a new way that it can be done. I think we should see this as an opportunity to strengthen WHO.
Helena Legido-Quigley
Many thanks, and I’m aware of time, it’s already two minutes past three. I’m – I’ve tried to go through most of the questions, but there are a few left, so apologies for that. In the interest of time, I want to thank everybody for your questions, for your time, and I also especially want to thank Martin, Clive and Jytte for your excellent contributions. I hope you found it useful, and I think the three of you, you’re all on Twitter, I’m myself on Twitter, so if you want to follow-up there with us, you can also do it through Twitter, and Chatham House, I think they will provide also, some type of dissemination for this event. So, again, thanks a lot for your time, and goodbye to everybody. Bye.
