EVAL By / March 1, 2023

The EU’s health response to the COVID-19 pandemic: lessons for future cross-border health threats

This EPRS study on the EU’s Public health response to the COVID‑19 pandemic assesses the lessons learned from the pandemic, the current state of play, challenges, and opportunities for improvement to public health governance in the EU, and includes a series of recommendations to strengthen the EU’s resilience and preparedness for future cross-border health threats.

Written by Irmgard Anglmayer and Susanna Tenhunen.

COVID-19 was not the first epidemic, and it will not be the last of its kind. It is one of the most recent in a set of epidemics the World Health Organization (WHO) has designated Public Health Emergencies of International Concern (PHEIC) since 2009. Although experts had warned of the prospect of a pandemic, the sheer scale, suddenness, and serious social and economic consequences of COVID‑19 took the world by surprise. The outbreak provided a timely reminder of health as a public good. It also emphasised the need to prioritise preparedness and long-term prevention at all levels of governance, from local to global, and to ensure an effective response capacity.

From its outbreak, the COVID-19 pandemic cast unprecedented strain on European health systems and European solidarity. Looking back from today’s perspective, the common European response was a success story. Member States’ initial national containment measures and lock downs were limited and insufficient to stop the spread of the coronavirus. The early lessons from the pandemic show that cross-border challenges to health systems and economies, including supply chain problems, vaccine development and procurement and measures to sustain the economy, could no longer be overcome by Member States acting alone. Public health measures needed to be consistent, coherent, transparent and coordinated, to ensure maximal effectiveness.

This EPRS study on the EU’s Public health response to the COVID‑19 pandemic assesses the lessons learned from the pandemic, the current state of play, challenges, and opportunities for improvement to public health governance in the EU, and includes a series of recommendations to strengthen the EU’s resilience and preparedness for future cross-border health threats. It was drawn up at the request of the European Parliament’s Special Committee on the COVID‑19 pandemic: lessons learned and recommendations for the future (COVI).

The study covers five main areas (or ‘pillars’):

Integrated pillars 1 and 2 analyse the EU vaccines strategy and study its impact. In particular, they examine the role played by the European Medicines Agency (EMA) in activating the fast-track procedure to issue conditional marketing authorisation for COVID‑19 vaccines, which allowed timely and equitable access. In this context, the study also touches upon transparency issues at the different stages of vaccine research, development and manufacturing, authorisation and procurement.

The study gives an overview of national vaccination strategies in the 27 EU Member States and discusses some factors behind the differences in countries’ vaccination progress and coverage. The analysis on vaccine uptake builds on Vaccine Tracker data collected by the European Centre for Disease Prevention and Control (ECDC). A substantial variation is found between EU countries in terms of vaccine uptake, with a higher vaccine coverage rate in the older age groups. The study reveals that vaccine hesitancy, infodemic, and trust in public authorities are some of the pivotal elements underpinning the effectiveness of national vaccination programmes. In some Member States, initial reluctance turned into vaccination acceptance, while it remains relatively high in others.

Finally, pillars 1 and 2 discuss the scientific evidence regarding vaccine effectiveness, based on clinical trials and epidemiological studies. A correlation analysis shows a general negative relationship between COVID‑19 mortality rates/excess mortality rates and national vaccination progress. However, the fact that excess mortality rates were still high in 2022, suggests that vaccines need to be supplemented by other policies and tools to restore EU public health.

Pillar 3 discusses effectiveness, coherence, and the European added value of the EU’s public health response to COVID‑19. In this regard, it presents an early ex-post assessment of EU action. The study finds that after a slow start, the EU was very effective in mobilising a variety of resources in terms of public health, financial support and civil protection, to provide emergency support and long-term structural support within the EU. The European Health Union, the EU vaccines strategy, the joint procurement and deployment of vaccines and medical countermeasures, the ‘Green Lane’ approach, and the EU Digital COVID certificate to maintain the integrity of the single market are examples of successful common European action. In the global context, the COVID‑19 pandemic triggered a significant reversal in progress towards the United Nation’s Sustainable Development Goals (SDGs). Despite EU and other actors’ major contributions to global health, the COVID‑19 pandemic widened global inequities, one of the major issues being access to COVID‑19 vaccines worldwide.

Pillar 4 changes the focus from a backward-looking assessment of lessons learned to a forward-looking approach on how to further strengthen the EU’s prevention and preparedness for future cross-border health threats. The study looks at the extended mandates of the EU agencies ECDC and EMA, the state of health preparedness under the newly created Health Emergency Preparedness and Response Authority (HERA), the EU global health strategy, the future WHO pandemic treaty, and the rising challenges of antimicrobial resistance (AMR). Based on its findings, it reiterates that prevention and preparedness will need to be anchored in robust forms of international cooperation. This requires a ‘one health’ approach, together with a focus on the social and environmental determinants of ill health, and greater global cooperation.

Pillar 5 reviews the state of play of the EU’s competences in the public health domain, followed by key discussions on the citizen-driven proposals on public health presented at the Conference on the Future of Europe (CoFoE). It reviews Europe’s transition from a period of immediate emergency response to the COVID‑19 pandemic, to managing recovery and strengthening prevention. It concludes with reflections on the EU’s upgraded framework for serious cross-border health threats and summarises positions expressed in favour – as well as those with a more sceptical tone towards a potential Treaty change.

From a methodological point of view, the study builds on various complementary methods for data collection, including systematic desk research; a literature review of peer-reviewed scientific publications on vaccine effectiveness; a quantitative data collection of COVID‑19 vaccine roll-out in the 27 EU Member States; and interviews with key stakeholders involved in or affected by EU’s COVID‑19 response and crisis management.

Finally, drawing on the lessons from COVID-19, the study makes 12 recommendations to improve the EU’s prevention, preparedness and response to future cross-border health threats. The study was presented to the European Parliament’s COVI special committee on 28 February 2023. The web streaming of that event is available on the European Parliament website.

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