By Dr Martha Theodorou
You have described the COVID-19 crisis as the greatest public health crisis in living memory, which has revealed Europe’s strengths as well as its weaknesses. What were the successes of the European Commission’s handling of the pandemic within the health sector, and what could have been done better?
Faced with this unprecedented health crisis that has shaken humanity to its core, the extent of the tragedy could have been much greater had the European Union (EU) and its Member States not acted with the speed and determination that they did in order to protect human lives and the livelihoods of their citizens. The European Commission used all the means at its disposal to tackle the pandemic and its economic repercussions. Unprecedented decisions have been taken at incredible speed under the exceptional circumstances we are still living through. In the area of public health, the EU, collectively, achieved what no Member State could have achieved alone. We have invested in innovative medicines and vaccines; we have negotiated the advance purchase of vaccines with manufacturers who are very close to developing the first vaccine. At the outset of the pandemic, there was no funding and no global framework for a vaccine against COVID-19. It was at that very moment that the EU stepped up to take a leading role in the global response to the virus. In cooperation with civil society, the G20 group, the World Health Organization and other European and international organisations, players and partners, we managed, through our immense efforts, to unite more than 40 countries in order to raise 16 billion euro in funding for research into vaccines, tests and treatments for the whole world. The EU joined the global COVAX facility, contributing 500 million euro to ensure that safe vaccines will be made available not only to those who can afford them but to everyone without exception. Guidelines on diagnostic testing methodologies and the free movement of healthcare professionals, medical devices and protective equipment, along with voluntary contact tracing applications, made sure that best practices were scaled up. We worked with European industry to increase the production of protective masks, gloves, tests and ventilators. Our Civil Protection Mechanism allowed doctors to travel between Member States and provide medical care to patients in places where health systems had come under extreme pressure, while at present we are seeing an increase in patients being transported from countries whose systems are coming under pressure to a worrying degree. We also stepped in regarding third countries in order to prevent a shortage in medicines caused by the relevant export restrictions they had put in place.
With the ‘green lanes’ system, the Commission preserved the integrity of the Single Market, when long queues of freight vehicles started forming at the EU’s internal borders, to ensure the swift transportation of basic goods.
Regarding the second part of your question, about what could have been done better, the answer lies in what we are now proposing: the European Health Union programme, which, I would say, is of historic significance to our future as European citizens.
What is the central focus of the European Commission’s Communication about building a European Health Union?
Now is precisely the time to lay down solid foundations for the future of Europe’s health. The current framework for cooperation in the health sector has completed its cycle. The European Health Union is here to fulfil that role now, allowing us to address common health threats collectively. Emergency situations should be dealt with at European level, jointly. The same should apply to the measures that will be taken. Fragmentation undermines our strength us all, both individually and collectively, and leaves us vulnerable to cross-border threats to public health. For this reason, we are advocating collective management. It will make us stronger and therefore better at tackling such threats. United we are always stronger.
And what are you proposing specifically, in order for us to move towards this Union?
Our proposals focus on revamping the existing legal framework for serious cross-border threats to health, as well as stepping up the crisis preparedness and response role of key EU bodies, namely the European Centre for Disease Prevention and Control (ECDC) and the European Medicines Agency (EMA). Our preparedness will be further boosted through a health and pandemic crisis plan as well as through recommendations for the adoption of plans at national level. The preparation of national plans will be supported by the ECDC and other EU agencies. The plans will be audited and stress-tested by the Commission and EU institutions. A strengthened, integrated surveillance system will be created at EU level, using artificial intelligence and other advanced technological means. At the same time, Member States will be required to step up their reporting of health system indicators (e.g. availability of hospital beds, capacity of specialised treatment and intensive care , number of medically trained staff etc.). The declaration of an emergency situation at EU level would trigger increased coordination and allow for the development, stockpiling and procurement of crisis relevant products. Finally, we have announced the main elements of the future Health Emergency Response Authority (HERA), to be proposed by the end of 2021. Such a structure will be an important new element in supporting a better EU-level response to cross-border health threats.
In the recent compromise reached by the European Parliament on the long-term EU budget, MEPs managed to convince the Council to triple the budget for the EU4Health programme to 5.14 billion euro. Will the objective of ensuring that the EU retains its status as the place with the highest level of healthcare services in the world be achieved by this sum?
This is certainly a crucial step in achieving the objective you mentioned. The EU4Health programme will strengthen Member States’ health systems while supporting innovation and guiding us towards integrated digital healthcare. It will implement targeted programmes such as Europe's Beating Cancer Plan, the Pharmaceutical Strategy for Europe, etc.
At the same time, the lessons learned from the pandemic have led to our proposal for a European Health Union, as I mentioned, which will allow us to strengthen the foundations of the health sector in Europe and will equip us to adequately deal with similar health crises in the future.
Within the EU Vaccines Strategy, the European Commission negotiated Advance Purchase Agreements with vaccine production companies on behalf of EU Member States. It also recently approved the contract with the BioNTech-Pfizer partnership. Bearing in mind that vaccine development is a complex and costly process, how close would you say we are to the distribution of a safe, effective, universally accessible vaccine against COVID-19?
We negotiated together with and on behalf of Member States with the vaccine production companies and we reached the advance purchase agreements to give all countries, regardless of their size, direct access to a safe vaccine once it is ready to distribute. As regards the timeframe, this is still uncertain. The production and delivery of the candidate vaccines will depend on various factors, the primary one being their safety and effectiveness. There are encouraging signs pointing to the first vaccine possibly becoming available towards the end of this year or at the start of the coming year. Member States will therefore need to be ready for the vaccines, from an operational point of view. I have said this on numerous occasions. It is not the vaccines that save lives but the vaccinations. While the vaccine is the solution for exiting the crisis, this is not going to happen overnight. It is vital that we continue to respect safety measures in order to protect ourselves, our loved ones and the general public.
You mentioned Europe's participation and contribution in ensuring the vaccine reaches countries that cannot afford it.
The funding in question amounting to 500 million euro, with guarantees that Europe has pledged to the COVAX facility, makes the EU one of the facility's major sponsors. Of all the lessons we have learned over the past year, the most important one is that solidarity yields results. COVAX is an example of this. With this additional contribution, we are close to meeting the target of funding the purchase of 2 billion vaccines for the most vulnerable populations in 92 low and middle-income countries. However, additional support will be required next year to produce and distribute a safe and effective vaccine across the world as soon as it becomes available. We do not intend to relax our efforts, but nor are we prepared to take shortcuts when it comes to the safety of the vaccine.
How are you going to deal with the reluctance to vaccinate and the distrust of the vaccine's safety, which we are seeing in the Member States of the EU?
Combatting coronavirus misinformation and disinformation saves lives. The European Commission is developing all the necessary tools and is funding initiatives to tackle disinformation. All European institutions are engaged in a joint effort to combat disinformation. We work closely with online platforms, encouraging them to promote authoritative sources, not to feature content that is fact-checked as false or misleading and to take down illegal content or content that may harm individuals or our societies. The Commission has created a dedicated coronavirus response website providing real time information on the virus and the EU's response. A dedicated disinformation section features regular rebuttals – in all EU languages – of fake news and disinformation. Meanwhile, we are also working with our partners around the world using established channels such as the rapid alert system. A special section will soon be set up to facilitate the sharing of coronavirus-related communication materials between EU institutions and Member States. The EU will also increase support and assistance to civil society actors and independent media in third countries, including neighbouring countries.
The European Union relies increasingly on third countries for the import of medicines and their active ingredients. The pandemic highlighted the need for the direct supply of safe and affordable medicines for patients. In this context, how will the Pharmaceutical Strategy for Europe support the European pharmaceutical industry in being innovative and pioneering on a global level?
This strategy is being framed in the midst of the COVID-19 pandemic, as part of the EU4Health programme and the Horizon Europe programme for research and innovation. One of its goals is to ensure Europe's supply of safe and affordable medicines to cover patients’ needs, as well as to support the European pharmaceutical industry, ensuring that it continues to be innovative and that it remains at the forefront, not just on a European level but on a global level too. We will strive as far as possible to gain more autonomy in this sector. We will soon be ready to announce this Strategy, which is going to bring many changes in relation to the medicines issue.
Europe's Beating Cancer Plan aims to support EU Member States in improving cancer control and care. Could you describe the Strategy's main pillars?
More than any other year, 2020 has reminded us of the importance of health for all European citizens. This year has highlighted the importance of robust health systems. It has highlighted the importance of understanding each disease and how vital cooperation is. Europe's Beating Cancer Plan is aimed precisely at ensuring better prevention, diagnosis and treatment of cancer, a better quality of life for those who have experienced cancer or who live with the disease. This Plan is of personal importance to me and to Commission President Ursula von der Leyen. Since the programme was launched we have been in contact with and listened to numerous stakeholders in order to make sure we have a complete understanding of all aspects and that all voices have been heard: Policymakers in EU Member States, scientists specialising in health issues and cancer, patient and citizen groups. Their contribution is essential and crucial in shaping the Plan based on a holistic approach. This ensures that the proposed actions for every stage of the disease put the patient at the centre. Despite the huge blow dealt to us by the pandemic, we are working towards the implementation of the Plan, which we will be announcing in the coming weeks. Through the Horizon 2020 programme, the Commission has also funded research into new innovative technologies for cancer prevention, as well as treatments, for example in the area of paediatric cancer. Meanwhile, we are also developing an e-health digital service infrastructure that will make it possible for healthcare providers to exchange patient summaries. Digital health and care opens up the possibility of offering innovative solutions. It can improve access to and the quality of healthcare. We are planning a new Knowledge Centre for cancer, which will coordinate and align the technical and scientific aspects of the Commission's cancer-related actions. All of these choices offer a unique opportunity for us to step up the fight against cancer. However, it is vital that all 27 Member States redouble their efforts to achieve this. With the new proposed EU4Health programme, which I referred to earlier, the Commission is ready to provide financial support to Member States to implement actions within the framework of the Beating Cancer Plan. Again, I would like to stress that the keyword here is cooperation.
The digital transformation of the health and care sector is a major challenge. Is the EU on track in relation to this process?
The European Health Data Space will be a crucial component of a strong European Health Union. Data saves lives – this has become clear to all of us during the pandemic. The European Health Data Space will allow access to health data under a trusted governance and clear rules and support the free movement of digital health services. By 2025, patients from all Member States should be able to share their data with healthcare professionals of their choice when travelling abroad. Together we can empower millions of citizens to digitally boost their access to healthcare. The set of proposals adopted by the Commission to strengthen the EU's crisis preparedness and response, taking the first steps towards a European Health Union, also pave the way for the participation of the European Medicines Agency (EMA) and the European Centre for Disease Prevention and Control (ECDC) in the future European Health Data Space infrastructure, along with research institutes, public health bodies, and data licensing authorities in the Member States.
The Farm to Fork Strategy, together with the Biodiversity Strategy, is at the core of the European Green Deal. How will the implementation of the Strategy, which will cover every link in the food chain, from production to consumption, guarantee a healthier and more sustainable European food system?
Our Strategy will indeed cover all stages in the food chain while promoting the protection of the environment and animal welfare through specific actions. We are living in a world where around one third of the food produced globally goes to waste, while 690 million people are suffering from hunger. Every item of food that is needlessly thrown away amounts to unjustifiable waste, not least because it could be used to feed hungry people. Food production uses precious resources such as water, energy and raw materials, as well as human resources and care. Food losses and waste generate 4.4 gigatons of greenhouse gas emissions each year. That represents 8% of global emissions. Not only does food waste put pressure on our planet, it is quite simply unjustifiable from an ethical point of view. Food waste is something that concerns us all directly. We need to take decisive action jointly in order to tackle this problem. This means that we need to re-examine how we produce, process, trade and consume food.
How can we make the best use of the potential of innovation and technology and develop targeted practical solutions to avoid food waste?
In cooperation with stakeholders, we can develop new business models across the entire food supply chain that will allow us to avoid surplus production while using precious resources in the most efficient way. Momentum is currently on our side: the pandemic has reminded many people of the close link between health, ecosystems, supply chains, consumption patterns and the limits of our planet. We need to change our consumption patterns and contribute to the promotion of healthy and sustainable foods for a global population that is expected to rise to 10 billion people by 2050. Our planet cannot sustain our current practices and habits whilst simultaneously providing food for 10 billion people. Reducing food losses and waste is an integral part of this Strategy, which proposes that legally binding goals be set to cut food waste across the whole of the EU by 2023. The use of pesticides in agriculture contributes to soil, water and air pollution. The Commission will take steps to reduce the use of and risks posed by chemical pesticides by 50% over the next decade. We will take steps to reduce losses in nutrient value by at least 50% whilst helping prevent a deterioration in soil fertility. We have set targets to reduce the use of fertilisers by at least 20%. Concerning antimicrobial resistance, which is linked to the use of antimicrobials in animal and human health, we will reduce sales of antimicrobial substances used in animal husbandry and aquaculture by 50% within the EU. We will provide bespoke support for the development of organic farming in the EU by setting the target of 25% of all agricultural land being farmed organically. Creating an environment in which the choice of healthy and sustainable foods should be an affordable option for consumers. Food labelling is going to play an important role in this. In cooperation with third countries and international players, we also support a worldwide movement for the creation of sustainable food systems. Our goal is a healthy planet for healthy citizens.