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

EUROPEAN HEALTH UNION 97 a strict stay-at-home order for the population as the only alternative to control the pandemic. In a world as well-communicated as ours, restriction of movement has international implications, particularly in the EU, founded on freedom of movement for people, goods and capital. This led to the need to seek agreements on cross-border movement and to coordinate and cooperate on all meas- ures to control the pandemic. Mobility restrictions within the EU made it necessary to adopt agreements to (1) guarantee that diagnostic tests were correct and consistent, (2) coordinate impo- sition, exceptions to and raising of lockdown measures, following a common European road map, and (3) agree on cross-border cooperation measures for treating pa- tients and movement of health personnel. These and other related topics were constantly on the agenda for the Commission, the Committee of Health Ministers and the European Council during 2020. How- ever, their results were not always shared or respected such as when opening borders or restarting flights, re- flecting varying national interests and the internal pres- sure in the light of the (false) dilemma on whether to protect health or reactivate the economy. Strengthening the health sector The EU does not have direct health powers, which are the exclusive responsibility of the Member States, al- though their decisions on medicines and medical prod- ucts, professional qualifications, fiscal policy and public contracting have a great impact on the health systems. Covid-19 has demonstrated the importance of strength- ening the health sector and boosting its resilience. The EU has contributed with resources to strengthen Mem- ber States’ health services, both providing financial re- sources (2,700 million in April 2020) and facilitating availability of critical supplies such as protective equip- ment (PPE, Personal Protective Equipment), respirators, medicines and direct help. On the other hand, activat- ing the EU Civil protection mechanism, through the Emergency Support Instrument (ESI), made it possible to provide direct help during the critical months of the pandemic to countries in great difficulties such as Italy in April 2020, and contribute 60 million Euros to trans- porting vaccines. Scarcity of essential medical equipment to treat covid-19 sharply demonstrated the EU’s shortages and external dependency for vital medical supplies. Con- sequently, in the first weeks of the crisis, there were shortages, lack of organisation and individualist practic- es among Member States. Subsequently, measures were taken to alleviate this problem including (1) requirement of authorisation to export personal protective equip- ment: (PPE) outside the EU, (2) creation of a strategic storage system, the Strategic RescEU Stockpile of medi- cal equipment, such as ventilators and masks, (3) tempo- rary removal of tariffs and VAT for import of healthcare material into the EU, (4) making European standards for medical products available to manufacturers to increase their production, (5) approval in record time to postpone application of the Regulation on medical devices 4 for one year. In April 2020, the Joint Procurement Agreement was reactivated for medical products to respond to epidemics, created in 2014 5 to address severe cross-border threats, which could be activated with votes from four Member States and the Commission. On the other hand, the pandemic caused a shortage of certain medicines, and the EMA (European Medicines Agency) and the equivalent agencies in the Member States had to take steps to avoid shortages. For this task, the Commission created the EU Executive Steering Group on Shortages of Medicines Caused by Major Events. 6 4  European Commission. Medical Devices Regulation. https://ec.eu - ropa.eu/commission/presscorner/detail/en/ip_20_718 5  European Commission. Joint Procurement of medical countermeas- ures: ensuring proper preparedness. https://ec.europa.eu/health/secu- rity/preparedness_response_en 6  EMA. Availability of medicines during COVID-19 pandemic. https:// www.ema.europa.eu/en/human-regulatory/overview/public-health- threats/coronavirus-disease-covid-19/availability-medicines-dur- ing-covid-19-pandemic