Cooperation on Global Health—the View from Europe
This article is a part of Agenda 2021, an edited series where experts provide ideas for strengthening U.S.-India and Europe-India cooperation in five different policy areas. It is part of GMF’s India Trilateral Forum, conducted in partnership with the Swedish Ministry for Foreign Affairs and the Observer Research Foundation.
The beginning of the coronavirus crisis unveiled the very limited capacities of the European Union when it comes to health. To be fair, health is not (yet) one of its competencies: The responsibility in this field lies with member states. At the same time, this was the first time that the EU was hit by a pandemic, and European governments and citizens made their expectations clear of the EU being the most appropriate platform to find a solution for the continent and globally.
Though in its initial phase, the pandemic affected member states on different scales and to different extents, almost all were confounded by their heavy reliance on goods and services from third countries. This reliance undermined the EU’s capacity to respond autonomously. It also demonstrated that the nexus between the internal and external responsibilities on health is growing and cannot be detangled. This entails for the EU to promote healthcare standards for its citizens, to develop schemes making patient and healthcare-personnel mobility a reality, to prioritize investment in research and innovation in health, and to adopt a significantly more important role on the international stage. The EU has a responsibility to coordinate with global health institutions and to develop a vision for global health governance. It should pursue a values-based strategy and use its economic might to enshrine higher health standards in multilateral trade and environmental agreements.
The coronavirus crisis has provided an opportunity for European governments and private-sector actors in health to review and adjust their value chains for greater health sovereignty. In fact, increasing the supply security of critical health goods could go hand in hand with a general review of supply chains that aims to increase protection from economic coercion more broadly. The EU needs to assess products according to how critical they may be in a health crisis. In this regard, the European Council on Foreign Relations has suggested to bracket products according to four key actions:
- Reshoring for products where the EU finds full (or quasi-full) supply-chain redistribution necessary for health sovereignty.
- Nearshoring for products whose supply chains should operate in the EU periphery, such as in the Balkans or North Africa.
- Diversification for products whose critical components must have a minimum number of diverse suppliers, or for which certain countries may be excluded or supply from countries is conditional on certain guarantees.
- Addressing chokepoint vulnerabilities for products where supply chains either rely on single suppliers (because it is a highly trusted third country) or where they must (because components cannot be found elsewhere).
The European pharmaceutical industry should take this opportunity to expand to new markets. For example, shifting manufacturing to additional countries and diversifying to limit disruptions and shortages. One option already discussed by experts is for health companies to be “obliged through a kind of quota to include suppliers in their tenders who obtain their active ingredients from the EU instead of from abroad.”
In asserting its health sovereignty, the EU will have to make difficult choices about whom it wants to partner with. One obvious option is India, which is already a major partner in supplying medicine and developing research. India has also joined the EU in the fight for multilateralism and this could expand European engagement in the Indo-Pacific. In light of increasing China-U.S. tensions, the EU and like-minded Asian countries could find a common path forward.
The coronavirus crisis has seen convergence between the European and Indian agendas on global health cooperation. The latest EU-India Summit communiqué mentions bolstering their cooperation to respond to global health emergencies, improving preparedness, and developing synergies especially in the production of pharmaceuticals and vaccines as well as in research and development.
The latest EU-India Summit communiqué mentions bolstering their cooperation to respond to global health emergencies, improving preparedness, and developing synergies especially in the production of pharmaceuticals and vaccines as well as in research and development.
Given India’s extensive capacity to produce non-mRNA coronavirus vaccines, it could be a destination of choice for the EU to mass-produce these. The EU and India could reach an agreement that Johnson & Johnson and Sanofi-GSK, which both have plants in India, increase their manufacturing capacities there. Part of these could be used in the COVAX initiative for ensuring the equitable access to the vaccine to all, especially in the developing world.
As the proposed investigation into the source and propagation of the coronavirus has left the World Health Organization (WHO) in a deadlock and subjected a few countries, including in Europe and in the Indo-Pacific, to economic coercion, the EU will have to initiate important reforms of the global health multilateral system. With Italy presiding over the G20 and the United Kingdom presiding over the G7 this year, European countries are in a position to promote multilateralism through existing institutions and ad hoc coalitions. They can do so on several levels.
First, the EU can convene ad hoc global initiatives such as the Access to Covid-19 Tools pledge conference and position itself as the convening platform for state and non-state actors, such as the WHO, the G7, the G20, foundations, and the pharmaceutical industry. European Commission President Ursula von der Leyen pledged in her State of the Union speech last September to build a European health union and to strengthen the EU’s crisis preparedness and management. Such proposals could be put forward at the Global Health Summit in Italy in May.
The EU could also unblock multilateral institutions by avoiding getting caught in any Sino-U.S. confrontation in these institutions and by determining which partners it wants to work primarily with, such as India. The EU should engage actively in the WHO, with the appropriate financial conditions and coordination support to bolster more traditional international health governance.
Finally, the EU should push to reform the global system to respond to health emergencies. It should insist on the implementation of verification mechanisms and improvements to early-warning and response capabilities—especially, as the world is still managing the impact of the coronavirus pandemic and needs at the same time to prepare for the next crisis. The EU, alongside like-minded partners, should bolster coordination with international financial institutions, multilateral funds, and member states. It should also ensure an equitable access to vaccines to all, possibly by encouraging research partnerships, with India among others, that enable the indigenous production development and manufacture of vaccines.
Tara Varma is the head of the Paris office of the European Council on Foreign Relations. She follows French foreign and European policies, and is particularly interested in European and Asian security issues.