These flows create enormous benefits but, as the covid-19 pandemic demonstrates, they also create societal vulnerabilities and expose us to risk. States can limit these flows but only at enormous cost to their economies, their culture, and their people. In the face of these vulnerabilities, populations expect their governments to be able to protect them and their health. They want, in other words, their governments to retain health sovereignty.

In a new policy brief, ECFR experts Jonathan Hackenbroich, Jeremy Shapiro and Tara Varma lay out a concept of European health sovereignty and propose some European-level efforts that can increase the capacity of EU member states to protect their populations in the face of increased competition over health issues.

Key findings of the report include:

• The coronavirus affected EU member states in different ways and to different extents, but almost all found that their public health relied, more than they understood, on goods or services from third countries. This reliance undermined Europe’s capacity to respond autonomously.
   
• The EU bodies coordinating the response and providing an early warning system were slow to act, and requests for aid from EU member states went unheeded – creating feelings of abandonment among the worst-hit countries.
   
• Europe must improve its early warning systems, supply chain resilience, medical research and development, and cyber security and technology, to act decisively in future public health emergencies.
   
• Europe can build greater health security by creating common strategic stocks, diversifying and reshoring supply chains, strengthening investment protection in innovative companies, investing in research and development, and coordinating efforts in multilateral forums.

The border closures and intra-European disputes at the beginning of the crisis demonstrated how intricate European relations can be at the local, national, and continental level. But it also eventually demonstrated that the EU has the necessary tools – material and financial – at its disposal to play a key role in building European health sovereignty.

• The pandemic dramatically affected the capacity of the single market to function. The EU could help avoid this through a few preparation and crisis management efforts. These include: strengthening the EU civil protection mechanism, creating common strategic stocks of emergency health equipment, mapping European healthcare infrastructure and dependencies, and investing in scenario planning and forecasting for future crises.
   
• Europeans should also now amend the framework of investment screening regulations so that it covers more areas, such as health. In some countries, the healthcare sector is not clearly covered by investment protection law but is only mentioned on the margins.
   
• A solution could be to identify more parts of the healthcare sector in which foreign takeovers have to be reported to European governments for review, while avoiding any over-broadening of prohibition criteria.
   
• The crisis now provides an opportunity to review and adjust European supply chains for greater health sovereignty. It is Europe’s openness that assures its innovation capacity and determines whether Europeans will still be producing the pharmaceuticals of the future.
   
• The EU can and should endorse new responsibilities on the multilateral stage. Europeans can promote ad hoc global initiatives, such as the Access to Covid-19 Tools pledge conference organised by the European Commission in May 2020, and position itself as the convening platform for state and non-state actors, such as the World Health Organisation, the G7, the G20, foundations, and the pharmaceutical industry.

An appendix includes perspectives on health sovereignty, and expectations on the European and multilateral levels, from six key EU capitals (Berlin, Madrid, Paris, Rome, Sofia, and Warsaw).

Europe’s role in global health will be discussed at the ECFR annual conference today at 5:30 pm (CEST). The panellists include Jens Spahn, Federal Minister of Health, Germany; and Mark Suzman, CEO, Bill & Melinda Gates Foundation. The discussion is chaired by Gunilla Carlsson, Former Deputy Executive Director of UNAIDS and Former Minister for International Development Cooperation of Sweden.

Follow the live stream here.

About the authors:

Jonathan Hackenbroich is a policy fellow for economic statecraft and the head of ECFR’s Task Force for Protecting Europe from Economic Coercion. His work for ECFR’s European Power programme focuses on economic coercion and geo-economics, especially sanctions policy.

Jeremy Shapiro is research director at the European Council on Foreign Relations. Previously, he was a fellow in foreign policy at the Brookings Institution in Washington, where he edited the “Order from Chaos” blog. He previously served in the US State Department as a member of the policy planning staff and was a senior adviser in the Bureau of European and Eurasian Affairs.

Tara Varma is a policy fellow and head of the Paris office of the European Council on Foreign Relations, where she works on French foreign policy and European and Asian security developments.