An interview with Ilona Kickbusch, global health expert and EHFG Vice-President, about the European Health Union and the role of the European Union in global health policy.
Interview: Dietmar Schobel
HEALTHY EUROPE
“ReArming Europe” and “competitiveness” are the topics that are currently dominating the political agenda in the European Union. Health seems to have been sidelined again. Professor Kickbusch, in 2020 during the COVID-19 pandemic EU Commission President Ursula von der Leyen awakened hopes when she called for a “stronger European health union”. Have these hopes been disappointed?
Ilona Kickbusch: It depends what was expected of the European Health Union. If it was about national health policy expertise being shared with the EU and significantly reducing differences in healthcare between the Member States, then hopes will probably have been disappointed. Healthcare remains the area where European states place the greatest importance on organisation and regulation as national entities. Naturally, this is because health is something that has a direct effect on their citizens and it is pivotal to them. And so the people who take national health decisions want to keep control of them. However, there have been highly important developments in efforts to establish a stronger European health union in relation to cross-border health threats.
HEALTHY EUROPE
So was the COVID-19 pandemic a game changer for EU health policy after all?
Ilona Kickbusch: Well, the European Union is at least far more resilient today than in 2020. Back then, numerous Member States closed their borders unilaterally and without any kind of coordination, and they also placed export restrictions on medical items as well as travel bans. Today, the relevant legislation has made it inconceivable for EU states to attempt to fight cross-border health threats like the infectious disease caused by the SARS-CoV-2 virus by going it alone. Besides that, existing EU institutions in the health sector have been awarded greater importance, and new ones have been set up.
Health is an important factor in foreign policy and geopolitics.
ILONA KICKBUSCH, GLOBAL HEALTH EXPERT
HEALTHY EUROPE
Can you give some examples?
Ilona Kickbusch: The European Centre for Disease Prevention and Control (ECDC) and the European Medicines Agency (EMA) have been given additional authority. In 2021 the Health Emergency Preparedness and Response Authority (HERA) was set up as a new institution to enable good coordination between EU Member States in their response to future cross-border health crises right from the outset. On top of that, numerous other activities and initiatives continue to be pursued by the European Union in the health sector, such as the joint procurement of vaccinations, medicine and medical devices, as well as Europe’s Beating Cancer Plan for improved prevention, diagnosis and therapy of cancer, and also the European Health Data Space, through to the EU Pharmaceutical Strategy. The latter aims to secure access to affordable and high-quality medicine for all patients, to strengthen the competitiveness of the pharmaceutical industry in Europe, and to increase the security of supplies.
HEALTHY EUROPE
In November 2022 the EU Commission published a global health strategy. At the same time, we are currently experiencing a new era in geopolitics. Instead of a rule-based international order, it seems that we are increasingly returning to the law of the jungle, where the strongest has the upper hand. What role can and should the European Union play in connection with this in the area of global health?
Ilona Kickbusch: Health is an important factor in foreign policy and geopolitics. New world powers recognised this long ago. For example, China constructed the building for the Africa CDC – the Africa Centers for Disease Control and Prevention – which opened in 2023 in the Ethiopian capital Addis Abeba. India supplies pharmaceutical active ingredients to many countries of the world, including Africa, and has its pick of international partners. In Europe, it is only individual countries such as France and Denmark that have understood the global dimension of health issues and adjusted their foreign policy accordingly. And so, EU Member States have a lot of catching up to do here, as does the European Union as a whole.
HEALTHY EUROPE
Since Donald Trump returned to power, in many cases the USA has partially or completely ceased to donate foreign aid and support global organisations such as the WHO. Would this be an opportunity for the EU to close the resultant funding shortfall?
Ilona Kickbusch: At present, the European Union cannot afford that financially, and it shouldn’t be the focus of its action for global health either. In the recent past, from a geopolitical perspective we have not just seen a shifting balance of strength between the major powers USA, China and Russia, and also the EU and India. The situation in many so-called emerging economies or developing nations has changed as well. One example here is Indonesia, which has agreed to give 30 million US dollars to the Global Alliance for Vaccines and Immunisation (GAVI) between 2026 and 2030. And many African countries have experienced significant development in recent years. They are unwilling to continue being dependent on other countries or states whose representatives they no longer trust. It is here that opportunities can be taken by the European Union. Many of its Member States have a strong health economy and the expertise for advising and accompanying other countries in setting up their own health institutions and their own health economy, and also overall a health system built on solidarity. In order to be able to exploit this potential, Europeans need to change their way of thinking – and naturally also display the right negotiating skills.
HEALTHY EUROPE
Health is influenced far more by factors outside the health system than by health systems themselves – for example, by environmental conditions or unhealthy diets. What could or should the EU do about this on a global level?
Ilona Kickbusch: The European Union is the second largest participant in world trade, after China. Its rules and corresponding bi- and multilateral agreements enable the EU to make a considerable contribution here, to control the supply of healthier goods on a global level, and also to make production healthier, with a greater social impact and with fairer wages. This is known as the “Brussels effect” – and its effects on health should not be underestimated.
Ilona Kickbusch (born 1948 in Munich) worked for the World Health Organization (WHO) from 1981 to 1998. She masterminded the WHO Ottawa Charter for Health Promotion that was passed in 1986, and since 2008 she has managed the Global Health Programme at the Graduate Institute in Geneva.