THE STATE OF THE EUROPEAN UNION REPORT. Europe in a period of transition

EUROPEAN HEALTH UNION 101 Reforms to boost the “European Health Union” “We cannot wait until the end of the pandemic to repair and prepare for the future. We will build the founda- tions of a stronger European Health Union in which 27 countries work together to detect, prepare and respond collectively” stated Ursula von der Leyen, president of the European Commission, at the World Health Summit on 25 October 2020. 29 This reflection is the basis for the proposals presented to the European Parliament by the Commission during the fourth quarter of 2020 to strengthen the health security system and prepare the EU to face crises.The discussion paper “Towards the Europe- an Health Union” 30 published by Fundación Alternativas, presents and analyses these initiatives presented by the Commission, which refer to three fields: 1. It improves EU coordination regarding cross-border health threats, strengthening the preparation and epidemiological surveillance, notification of data and regulation of declaring an emergency situation in the EU; 2. Strengthening the ECDC and the EMA, the two key agencies for the EU’s health, reviewing their current mandates; 3. Creation of a new EU agency (HERA) 31 for biomedi- cal preparedness, with five priorities: identifying virus variants, adapting the vaccines if necessary, running clinical tests, promoting express approval of vaccines and producing them on a large scale. Another central pillar of the “European Health Un- ion” is the Pharmaceutical Strategy for Europe. Presented in November 2020, it contained measures to “ensure 29  European Commission. European Health Union. https://ec.eu - ropa.eu/info/strategy/priorities-2019-2024/promoting-our-europe- an-way-life/european-health-union_es 30  Freire JM, Infante A. (2021). Hacia la Unión Europea de la Salud. (Towards a European Health Union.) Fundación Alternativas, Discussion paper. 109/2021 https://www.fundacionalternativas.org/public/storage/ opex_documentos_archivos/fbc69b319970c15331847917412d89e0.pdf 31  European Commission. European Health Emergency Preparedness and Response Authority (HERA). https://ec.europa.eu/info/law/bet- ter-regulation/have-your-say/initiatives/12870-European-Health-Emer- gency-Preparedness-and-Response-Authority-HERA-_en accessibility, availability and affordability of medicines. It supports diversified and secure supply chains, ensuring the EU’s open strategic autonomy in the world and pro- motes environmentally-sustainable pharmaceuticals.” 32 This set of initiatives constitutes the Commission’s response to the EU’s needs to provide effective instru- ments for the challenges of the covid-19 pandemic and to be better prepared for future pandemics. Summary and lessons learnt from the first year of the covid-19 pandemic in the EU. No Western country, not to mention the European Un- ion, was prepared to face a pandemic of the magnitude, severity and sheer infectiousness of covid-19. In the col- lective European imagination, this pandemic scenario belonged to a remote time in the past, or developing countries, despite the scientists (and recent health crises) warning us of the need to plan ahead for the next world pandemic. 33 The covid-19 health crisis has put all national health systems under a great deal of stress. It has also severely tried the governments and institutions of the EU and the Member States who have had to improvise initiatives to keep basic services running, to guarantee income for quarantined families, and to avoid an economic crisis with catastrophic consequences. Due to all this, both the health crisis and its consequent socioeconomic crisis, the existence of the EU has been crucially positive, plus the deployment of its institutions: Commission, Council, Par- liament, agencies such as the EMA, the ECDC and others. A counterfactual exercise is not required on what the covid-19 crisis would have been like if the EU did not ex- 32  European Commission. A European Health Union: A pharmaceuti- cal strategy for Europe. Information Sheet. 25/11/2020. https://ec.eu - ropa.eu/commission/presscorner/detail/es/fs_20_2201 Press release. 25/11/2020. https://ec.europa.eu/commission/presscorner/detail/es/ ip_20_2173 33  Ross,A. G. P., Crowe, S. M., & Tyndall, M.W. (2015). Planning for the Next Global Pandemic. International Journal of Infectious Diseases, 38, 89-94. https://doi.org/10.1016/j.ijid.2015.07.016