The Covid-19 crisis illustrates that globalisation entails health risks, and that the institutional design of public health systems is ill-suited for the scale of a pandemic, writes Joan Costa-Font. He argues that the inefficiency of the policies implemented by different EU member states highlights why a Europe-wide public health authority should now be a priority to counteract collective action problems among different member states. EU membership should be accompanied by a European ‘health citizenship’.

The Covid-19 crisis is not just the most important health crisis that higher income countries have suffered over the last century, but also one that comes with enormous consequences for the global economy. It illustrates more than ever that while globalisation can provide benefits via free trade and mobility, it also entails risks.

Although the exact consequences of the crisis are still to be determined, we already suspect that even under a best-case scenario they will be paradigm changing – and perhaps the tipping point desperately needed to address the challenges of globalisation.  A key lesson from the crisis should be that the collaboration and collective action required in Europe to meet these challenges cannot be achieved without transferring powers to a European public health authority.

Diverse responses

The way the world is organised has proven to be catastrophic for the management of this epidemic. In Europe, each country has reacted in a different way, perhaps revealing the distinct characters of national elites. Germany has managed to keep death rates low with heavy testing, but other European countries have been far slower to react, while some governments appear to have been less open about the situation they were facing and only reacted when the virus was at their doorstep. Some countries, such as Austria and Poland, have demonstrated nationalist instincts in their responses by closing down their borders. Meanwhile in Spain, the approach has included the centralisation of healthcare responsibilities following the declaration of a state of emergency, even though the relevant expertise is located at the regional level, and some Spanish regions that advocated for a lock down have remained open.

In contrast, In Italy, the regions of Veneto and Lombardy were early movers in setting up a quarantine and urging locals to stay home. In Lombardy, local health authorities established strong containment measures in the initial cluster by quarantining several towns in an attempt to slow transmission of the virus. In Germany, states have taken the lead in fighting the virus, while in the UK, Wales and Scotland have acted first by announcing policy measures such as school closures which were then followed by the whole country.

This being said, solutions must be built on cooperation and trust in existing institutions. Today, humanity faces an acute crisis not only due to Covid-19, but also due to a lack of public trust. To defeat an epidemic, people need to trust scientific experts, citizens need to trust public authorities, and countries need to trust each other.

Europe’s almost non-existent role

Public health was introduced as an express area of EU competence for the first time by the Maastricht Treaty and internal market regulation does constitute a significant constraint on health services. European health governance is a multilevel system very much like that of other federations. According to article 3 TEC, the European Community shall contribute to a “high level of health protection”. Although the right to health care is a ‘positive right’, the European Court of Justice has envisaged it as a ‘negative right’ linked with the principle of freedom and non-discrimination.

Stella Kyriakides, the European Commissioner for Health and Food Safety, Credit: CC-BY-4.0: © European Union 2019 – Source: EP

However, Europe reacted to the Covid-19 crisis fairly late. Only in the second week of March did the President of the European Commission propose that all non-essential travel to the EU should be suspended for 30 days. Alongside Europe’s failure to manage the migration crisis, it can be argued there is now a desperate need to reform the EU’s institutions to enable them to take more effective control over global crises in areas where national reactions are affected by collective action problems (i.e. countries only react when they face an immediate cost to themselves).

A European public health authority

Today, European citizenship is defined by a common European health card as much as a European passport. However, the European role in managing health crises has remained modest. The Covid-19 crisis highlights that public health (the management of global public risks) is an area where the EU should be more proactive. Given the nationalistic and even selfish policies implemented by various member states, the creation of a European wide public health authority must now be viewed as an urgent matter to consider as part of wider reforms. Being European should entail having a European health citizenship.

The help provided by the German state of Baden-Wuerttemberg to patients in the French region of Alsace is illustrative of the fact that health crises like Covid-19 are global in nature and require collaboration to be eradicated. However, this collaboration and collective action cannot be enforced without transferring health powers to the European level. This should be accompanied with recognition that local knowledge is fundamental to the management of health systems.

Crises like Covid-19 affect Europe in a different way from the rest of the world and there is a clear case for an authority that can ensure cooperative policy solutions across member states. If all European countries had implemented the same policy response that Germany put forward, Europe would likely have far fewer fatalities.

Although the delivery of health services is more efficient when it is decentralised (as preferences and needs are heterogeneous), global public health crises should be addressed centrally at the highest level possible, namely the EU’s institutions. We should remember this lesson during the next pandemic.

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Note: This article gives the views of the author, not the position of EUROPP – European Politics and Policy or the London School of Economics.


About the author

Joan Costa-Font – LSE
Joan Costa-Font is Associate Professor (Reader) in the LSE’s Department of Health Policy.

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