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Upholding the World Health Organization. Next Steps for the EU

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Upholding the World Health Organization. Next Steps for the EU NO. 47 OCTOBER 2020 Introduction Upholding the World Health Organization Next Steps for the EU Susan Bergner, Remco van de Pas, Louise van Schaik and Maike Voss Before the COVID-19 pandemic, the European Union (EU) was neither a strong pro- moter of global health nor a strong supporter of the World Health Organization (WHO). The Global Health Council Conclusions from 2010 were never comprehensively implemented and quickly forgotten. With the pandemic greatly affecting EU member states, the EU is increasingly interested in upholding multilateral cooperation in the global health field. Therefore, the EU should aim for an upgrading of the EU’s status in WHO, the establishment of a global health unit in the European External Action Service (EEAS), and an overhaul of the formal relationship between the European Commission and WHO. The pandemic discloses the discrepancy The Union’s global health policy-making between the EU advocating for global access lacked visibility in recent decades, although to a COVID-19 vaccine while at the same the EU is traditionally a promoter of effec- time safeguarding its own access to it. Its tive multilateralism. With its Council Con- refusal to alter patent laws that serve to clusions on global health, adopted in 2010, protect the commercial and innovation in- the EU committed itself to stronger global terests of pharmaceutical companies based health governance – including support- in EU countries can equally be questioned ing WHO and the United Nations (UN) sys- on grounds of global solidarity. A revamped tem – focusing on Universal Health Cover- global health strategy is needed to over- age, strengthening health systems, as well come such issues and make the EU a reli- as recognising the need for a “Health in All able and capable partner on global health Policies” approach, including in the EU’s that gives WHO a central role. external actions. However, the Conclusions never received the strong backing of health, development, and foreign ministries of EU Global Health Policy Undervalued member states, as the EU was primarily seen as a development actor rather than a As public health policy-making remains strategic agent in global health. Thus, EU mainly a national competence under Euro- member states decided in an incoherent pean legislation, the EU can coordinate and way on how large a budget that they and complement the policies of member states. the European Commission would make available for international health priorities, enhance Europe’s capacity to respond to initiatives, and institutions such as WHO. cross-border threats. Before the COVID-19 pandemic, global Unfortunately, it is not clear if EU mem- health was not a priority on the European ber states also support these ambitions. A political agenda, and both the health and proposal for the EU health budget (2021– international development cooperation 2027) to be increased to 25 times its current mandate was reclaimed by EU member size was largely undone by member states states; with some exceptions being issues deciding to reduce the overall amount of the in fashion, such as anti-microbial resist- EU budget. A strong European investment ance and digital health. in health systems and monitoring would have made global EU efforts in supporting the resilience of health systems and crisis COVID-19: The EU’s Wake-up Call preparedness more credible. Budgetary lines to Global Health? for global health policies for international cooperation have not been introduced or The EU has been struggling to respond to bolstered yet, which makes the future financ- the COVID-19 pandemic, as member states ing of ambitious EU global health policies primarily followed a national response at in the upcoming EU budget challenging. the beginning. European and international The Commission and EU member states cooperation were initially placed on the were more united in February 2020, when back burner with the introduction of ex- they decided to uphold the international port restrictions on protective equipment health order by activating financial support such as masks and gloves. Aside from the for WHO early on. During the pandemic, reluctance of member states to cooperate, WHO has moved to the centre of infor- the lack of resources and authority of the mation provision regarding the spread of European Centre for Disease Prevention the disease and the required public health and Control (ECDC) has hampered a har- responses. After harshly attacking WHO monised, evidence-based approach with- and accusing the organisation of being in Europe, and it has impeded the ECDC too China-friendly, the US administration from proactively engaging in global health announced in July 2020 that it would be policies. pulling out of WHO. There are now in- Gradually, a more “Europeanised” effort creased expectations for the EU to fill finan- is now evolving to shore up the effective- cial as well as leadership gaps. EU member ness of Europe’s public health response states such as Germany and France have within the EU as well as in its multilateral already stepped in, with the former pledg- commitments to bolster global health. Euro- ing an unprecedented €500 million to WHO pean governments have started to realise for 2020. France has committed an addi- that a joint approach is necessary to recover tional €50 million to WHO as well as a €90 from the pandemic and the socio-economic million commitment towards founding a crises that will follow. In her State of the new WHO Academy. Union address, Commission President Ursula von der Leyen called for a European Health Union. She announced plans to bolster the Formal EU and WHO Cooperation ECDC and the European Medicines Agency. An expansion of EU competence in the field The relationship between WHO and the EU of health is to be discussed in the Confer- is based on an exchange of letters dating ence on the Future of Europe, which the back to 1972. The EU–WHO cooperation European Commission will organise in 2021. is modelled on the work done by WHO and She also announced the establishment of a the EU on the global, regional, and national European Biomedical Advanced Research levels. Firstly, the EU and WHO Headquar- and Development Authority (EU BARDA) to ters in Geneva interact through designated SWP Comment 47 October 2020 2 Figure 1 staff in the EU delegation and via Senior Of- regional economic integration organisa- ficial Meetings. Both are mostly concerned tions. with global issues. Secondly, the European Despite various levels and areas of co- Commission as well as the ECDC have a prac- operation and the EU’s observer status in tical partnership with the WHO Regional WHO’s governing bodies, the EU and WHO Office for Europe (WHO EURO) in Copen- partnership still feels shaky and less clari- hagen, which is primarily focused on topics fied than it is for other partnerships between concerning the European region. Thirdly, EU and UN institutions. The EU has, for the EU cooperates through its delegations instance, pushed for an enhanced observer with WHO country offices at the national status within the UN General Assembly level worldwide. (UNGA) that gives the Union, among others, The coordination among EU member the right to speak early in the debate of states on WHO matters has been prepared the UNGA and to be invited to the general by the EU delegation in Geneva since 2010. debate. Furthermore, WHO is primarily Despite some initial questions on legitima- considered a development organisation for cy and trust, it is now clearly in the driving public health standard-setting outside the seat to bring across a common EU position EU. The COVID-19 pandemic may change between European countries on key issues. this misconception for the better, since all It is backed by the European Commissions’ countries are dependent on WHO recom- Directorate-General for Health and Food mendations, followed by many – but not Safety (DG SANTE) and the EEAS. However, all – EU member states. the EU only has an observer status, as only The political support and increased joint nation-states can join WHO. This prevents action could strategically strengthen EU– the Union from fully participating in WHO WHO cooperation at all levels by building governing body meetings. Hitherto, the EU on existing collaboration and partnership has not made any attempts to change this. models (Figure 1). Three aspects are critical However, with the current global climate in the EU’s web of relations with WHO. of retreat from multilateralism, there might Firstly, the European Commission does not be a window of opportunity for the EU to have formal partnerships with regional upgrade its status as well as that of other WHO offices aside from WHO EURO, which SWP Comment 47 October 2020 3 could enable the EU to engage in global platform for global coordination on inter- health diplomacy within and outside the national health priorities. European region. Secondly, the cooperation The EU pledging conferences are an with WHO EURO seems to be primarily example of “fast multilateralism”, but focused on European issues, which is un- their focus is only on the development of derstandable. However, the next program- vaccines, therapeutics, and diagnostics for matic partnership between WHO EURO and one infectious pandemic disease, leaving the European Commission might therefore other pressing health challenges neglected. focus on global priorities that are equally Questions remain as to how more structural important to both parties, such as projects investment in and with WHO can be created about the environment and health, gender to sustain global health multilateralism equity, and the commercial determinants and create a sustainable impact on people’s of health. Thirdly, collaborative efforts health. between EU delegations with WHO country Secondly, in the first ever virtual World offices could be made more visible, coordi- Health Assembly (WHA) – the highest nated, and harmonised through shared learn- decision-making forum of WHO’s member ing and training sessions.
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