On track for a “true” European Health Union?

In response to the COVID-19 pandemic, the European Commission has taken initial steps towards forming a European Health Union. Many public health representatives believe that further-reaching measures should follow.

Text: Dietmar Schobel

In February 2020 the wave of COVID-19 infections reached Europe. Like almost all nations around the world, the Member States of the European Union were completely unprepared for the effects. They instinctively reacted with protectionist policies, closing national borders and banning exports of medical devices and PPE. In Italy, the first European country to become swamped by the virus, and where the effects of the pandemic were especially severe, supplies of respirators and protective clothing were flown in from China. At the same time, the response in the European Union (EU) was neither collaborative nor coordinated.

Portrait of Ursula von der Leyen attending the Weekly meeting of the von der Leyen Commission, 11_11_2020 - Among other items, they discussed the European Health Union
Ursula von der Leyen, Photo European Union, 2020, Etienne Ansotte

This changed as the COVID-19 pandemic progressed, however. Vaccines have been researched and purchased as a collective. Debts have been taken out jointly for the first time in the history of the EU, and the Recovery and Resilience Facility (RRF) has been set up to help deal with the consequences of the pandemic. This has also led to health being catapulted straight to the very top of the political agenda. “For me, it is crystal clear – we need to build a stronger European Health Union,” said newly elected President of the EU Commission Ursula von der Leyen in September 2020, in her first annual State of the Union Address before the European Parliament in Strasbourg.

For me, it is crystal clear – we need to build a stronger European Health Union.


Being better prepared

Making better provisions for future crises and being in a better position to respond are also at the heart of the concept presented by the European Commission for a European Health Union. Since then, several initiatives from this concept have already been implemented to some extent, or are at least in an early stage of development. The mandates of the existing EU health authorities have been bolstered, for instance – the European Medical Agency (EMA) as the EU central authorising body, and also the European Centre for Disease Prevention and Control (ECDC).

For example, in future the EMA will not just evaluate the safety of medicines, but also give recommendations on pharmaceuticals for treating diseases that have caused a health crisis. In addition, it will monitor sufficient quantities of potentially critical pharmaceuticals and medical devices. One of the future responsibilities of the ECDC will be to regularly examine the pandemic preparedness plans at national and EU levels, and also ensure state-of-the-art surveillance of disease outbreaks in Europe at all times. From now on, the authority will also supply the Member States with recommendations for outbreak control.

HERA launched as key pillar

Portrait of Pierre Delsaux, Deputy Director-General of the Directorate-General for Health and Food Safety of the European Commission
Pierre Delsaux, Photo: European Commission

In particular, the Health Emergency Preparedness and Response Authority (HERA) was established in autumn 2021. With a budget of one billion euros per year until 2027, or even more in an acute health crisis, the aim of the new authority is to contribute towards preparing the European Union for future health crises in the best possible way. “One of our current projects is making certain that manufacturing capacities are reserved by pharmaceutical companies for the European Union. In emergencies these capacities would be used by us to produce vaccines or other vital medicines at short notice,” explains HERA Director General Pierre Delsaux. Consequently, at the end of April 2022 the EU FAB call asked pharmaceutical companies to submit tenders for the provision of manufacturing capacities for the EU, with a budget of 160 million euros. Negotiations are expected to be concluded by the autumn.

As soon as we notice the practical benefits of the steps already taken, it will be easier to progress.


HERA will also handle the overall coordination of contacts with the industry, deal with the joint procurement of medical devices, and in acute health crises function as a coordinator and adopt a leading role at European level. Infectious diseases are just one of the potential threats. In July the new authority presented a list of the top three health hazards requiring EU-level coordination of measures: These are

* firstly – pathogens with high pandemic potential

* secondly – chemical, biological, radiological and nuclear threats

* and thirdly – threats resulting from antimicrobial resistance.

The pharmaceutical strategy is another pillar of the European Commission’s concept for a European Health Union. EU pharmaceutical legislation will be modernised to support innovations and also make medicines more affordable and supply chains more resilient. In addition, “Europe’s Beating Cancer Plan” presented by the European Commission intends to improve cancer screening, and also increase the quality of life for cancer patients and survivors, their families and carers.

Does the health union already exist?

So have these initiatives already formed the European Health Union? Or will a “true” European Health Union require more extensive projects for implementing and financing healthcare in “normal” times, i.e. when there are no cross-border health threats? As we all know, this is currently handled by each nation individually.

István Ujhelyi, Photo: private

“To create a European Health Union that is actually worthy of the name, it is crucial that it contributes to reducing the gross disparities between the quality and patient safety indicators of healthcare systems. So that a European citizen who needs treatment in an Eastern European hospital, for example, does not have less chance of recovery or even survival than their Western counterparts,” comments István Ujhelyi, a Hungarian member of the EU Parliament. Ujhelyi examined the prerequisites for a health union long before the outbreak of COVID-19 in Europe, and he adds that in his home country, for example, the probability of catching a hospital-acquired or in extreme cases even fatal infection is three times higher than in Germany. He supports minimum quality standards in the EU that must be met in the public healthcare systems of all Member States in future – even if this seems difficult to achieve at present. (The full “Healthy Europe” interview with István Ujhelyi on the European Health Union can be accessed here).

It is crucial to reduce the gross disparities between European countries.


A different economic system

Milka Sokolović, Director General of the European Public Health Alliance, as the umbrella organisation for around 80 national and European non-governmental associations on public health, goes a step further. On the one hand, she demands structured forms of participation for patients and EU citizens, with long-term financing. And on the other hand, in her view the focus should not just be on caring for sick people, but also on all other areas of life that influence health – ranging from the economic system and social services through to the environment.

Portrait of Milka Sokolović, Director-General of the European Public Health Alliance
Milka Sokolović, Photo: EPHA

“As a result of the pandemic, climate change, the war in Ukraine, we find ourselves in the eye of the hurricane,” comments Milka Sokolović: “All these crises affect our health, independently and jointly, and tackling them requires a next level of boldness. We need the same courage when it comes to developing a ‘true’ European Health Union. It takes a systemic effort across sectors to accomplish it, and it takes outstanding political leadership. Especially as the economic system needs to change fundamentally. We must move away from an economy that is exclusively oriented on maximising profit, and reach a system that aims to achieve the greatest possible well-being for its citizens.”

We must move away from an economy that is exclusively oriented on maximising profit.


The goals that define the vision of a European Health Union are therefore crucial to deciding if we are gradually getting closer, or if the process has perhaps even been completed. Depending on what is required, the path to be trodden remains potentially arduous. Director General of HERA Pierre Delsaux takes a pragmatic approach: “As soon as we notice the practical benefits of the steps already taken towards a European Health Union, it will be easier to progress.”