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European Health Union 'should ensure that history will not repeat itself'

EU Reporter Correspondent

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COVID-19 has blatantly exposed all the cracks and fissures in the European health systems and shown the EU to be unprepared for dealing with major health emergencies. But the first building blocks of the future European Health Union, recently proposed by the Commission, look promising and may give the EU the right weapons to fight pandemics in the future.

The European Commission's proposals for building a stronger European Health Union (EHU), unveiled last November, aim to equip EU health care to manage any future health crises more effectively. This should go hand in hand with reinforcing public health systems in all member states, found a hearing held by the European Economic and Social Committee (EESC).

Topping the hearing's agenda were three proposals set out in the Commission Communication on Building a European Health Union. They refer to the regulation on serious cross-border threats to health and two regulations aiming to beef up the mandate of the EU's two key agencies in the field of public health: the European Centre for Disease Prevention and Control (ECDC) and the European Medicines Agency (EMA).

The EESC organized the event to collect input from representatives of European institutions, health professionals and civil society organizations for its forthcoming opinion analysing the Commission's proposals from civil society's point of view.

The participants agreed that the Commission's initiative was a step in the right direction.

"The pandemic has shown that the EU was not ready to protect its citizens. It exposed fractures in EU healthcare systems and in their architecture. We have seen the consequences of this, with thousands losing their lives, many becoming impoverished and inequality increasing," said the rapporteur for the EESC opinion, Ioannis Vardakastanis, who opened the hearing.

"European citizens want a consistent approach to healthcare. These proposals should lead to the creation of a new system, a new weapon in our arsenal, available both in the EU and in Member States, which will enable us to deal with the challenges and risks of future pandemics."

The proposals, presented at the hearing by Giraud Sylvain and Ingrid Keller from the Commission, include the establishment of an EU Health Task Force, training for healthcare staff and stipulating that an emergency can be declared at EU level rather than solely by the WHO, as is now the case.

There are plans to set up the Health Emergency Preparedness and Response Authority (HERA) to develop and procure biomedical and other solutions for better testing and contact tracing. The mandates of the ECDC and EMA will be extended, allowing them to recommend measures for outbreak control or to monitor and advise on the supply of medical devices in a crisis.

"We think we need more and better EU intervention. Our intention is not to return to business as usual after this or just carry on with where we are, but to invest in the knowledge gained and improve the EU's planning and preparedness for any future pandemics," Keller said.

ECDC Director Andrea Ammon said that they welcomed the strengthening of their role as they have been facing demands they could not meet due to the shortage of resources and the lack of a legal mandate.

The proposed EU Health Task Force, which will be set up within the ECDC, should help the agency to be better informed about the situation in countries inside and outside the EU.

"We are willing to take this forward. We have learnt one very crucial lesson: no country and no region can cope with a crisis of this scale on their own. We are so interconnected globally, we have to work together at global level: only then will we be safe altogether," said Ms Ammon.

EMA Director Emer Cooke was also pleased with the new roles and responsibilities given to her agency: "This extended mandate reflects several of the initiatives, structures and processes that we have ourselves put into train to respond to shortages of medicines, medical supplies and devices and to the crisis."

Nicolas Gonzalez Casares, European Parliament rapporteur for the EMA regulation, threw his support behind the Commission's proposal.

In his view, in the early days of the pandemic, uncoordinated measures by governments seeking to defeat the virus, such as internal border controls or closures, interrupted supply chains and cut off the flow of essential goods and services.

"Over the past months, we have seen how the agencies had to invent and create new structures for better coordination of response. This whole package aims to transform these lessons into a regulatory framework giving the Union the role that citizens have decided it should play," he said.

Room for improvement

Despite welcoming the Commission's efforts in this regard, the speakers had suggestions on how to improve what is on the table or expressed doubts over the effectiveness of some proposals.

Caroline Costongs, director at EuroHealthNet warned that a stronger ECDC and HERA will have little effect unless public health systems in Member States are strengthened as well. Building national and regional capacities should be a bottom-up process, with the involvement of local authorities.

She also pointed out that the EHU should structure the package around health inequality, with a stronger focus on psycho-social factors such as mental health, gender equality and digital health literacy.

"Our overarching concern is that proposals are mainly developed from a biomedical perspective, and do not do enough to incorporate psycho-social measures. The COVID-19 pandemic can be regarded as a "syndemic". This means that the severity of COVID-19 is magnified by existing non-communicable diseases, such as diabetes or obesity, and by existing forms of inequality," Ms Costongs said.

Recent data from the Netherlands show that the 20% of the population at the lower end of the social gradient are three times more likely to die from COVID-19 than the 20% at the highest end.

"This kind of data will be emerging in other Member States too. The EHU package should respond to this injustice," she warned.

Zoltan Massay Kosubek from theEuropean Public Health Alliance (EPHA) said that the ECDC's mandate should be further extended to include non-communicable diseases, while HERA should have a clear public health mission. EPHA was in favour of a Health in All Policies (HiAP) approach that seeks to mainstream health into all relevant policy processes.

The time for applause is over

Annabel Seebohm from the Standing Committee of European Doctors (CPME) emphasised the need to review the legislation and policies on the working conditions of the health workforce, as the current proposals only address this point indirectly. The terms of employment of health professionals should be safe and lawful, including in emergency situations.

For Jan Willem Goudriaan from the European Federation of Public Services Union (EPSU), "a strong EHU depends on the people delivering it." However, many workers often feel their work is not appreciated enough. They need professional recognition and better pay and working conditions.

"The time when healthcare workers could live on the applause is over," he said. He warned against the budget cuts in the health sector and against the introduction of for-profit services, which will not improve healthcare or give everyone access to it.

"Public health is a public good, not a commodity you can sell to the highest bidder, Mr Goudriaan said.

Marta Branca from theEuropean Hospital and Healthcare Employers' Association (HOSPEEM) saw the recent crisis as an alarm bell and a wake-up call to recognise the health sector as an area for investment and not just for budget cuts.

"The economy of a country is healthy when its population is healthy. Let's hope the member states will invest in health care. It is a vicious circle," she said, adding that HOSPEEM would like to see more information on stress tests, auditing procedures and indicators which will show the preparedness of national healthcare plans for crisis response.

According to HOSPEEM, healthcare management should remain a member state competence, given the diversity of systems linked to culture and history.

The need to include local and regional authorities in the national and EU plans on health matters was highlighted by the three rapporteurs on the EHU from the Committee of the Regions (CoR) - Roberto Ciambetti, Birgitta Sacrédeus and Olgierd Geblewicz.

Background

Primary competence for health protection and health-care systems lies with the member states. The EU can support and complement national policies. 

The new European Health Union should ensure that all EU countries prepare and respond together to health crises. It should also improve the resilience of Europe's health systems. 

The EESC's opinion on the EHU will be adopted in April.

Climate change

Big business seeks unified, market-based approaches ahead of climate summit

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Corporate executives and investors say they want world leaders at next week’s climate summit to embrace a unified and market-based approach to slashing their carbon emissions, write Ross Kerber and Simon Jessop.

The request reflects the business world’s growing acceptance that the world needs to sharply reduce global greenhouse gas emissions, as well as its fear that doing so too quickly could lead governments to set heavy-handed or fragmented rules that choke international trade and hurt profits.

The United States is hoping to reclaim its leadership in combating climate change when it hosts the 22-23 April Leaders Summit on Climate.

Key to that effort will be pledging to cut US emissions by at least half by 2030, as well as securing agreements from allies to do the same.

“Climate change is a global problem, and what companies are looking to avoid is a fragmented approach where the US, China and the EU each does its own thing, and you wind up with a myriad of different methodologies,” said Tim Adams, chief executive of the Institute of International Finance, a Washington-based trade association.

He said he hopes U.S. President Joe Biden and the 40 other world leaders invited to the virtual summit will move toward adopting common, private-sector solutions to reaching their climate goals, such as setting up new carbon markets, or funding technologies like carbon-capture systems.

Private investors have increasingly been supportive of ambitious climate action, pouring record amounts of cash into funds that pick investments using environmental and social criteria.

That in turn has helped shift the rhetoric of industries that once minimized the risks of climate change.

The American Petroleum Institute, which represents oil companies, for example, said last month it supported steps to reduce emissions such as putting a price on carbon and accelerating the development of carbon capture and other technologies.

API Senior Vice President Frank Macchiarola said that in developing a new U.S. carbon cutting target, the United States should balance environmental goals with maintaining U.S. competitiveness.

“Over the long-term, the world is going to demand more energy, not less, and any target should reflect that reality and account for the significant technological advancements that will be required to accelerate the pace of emissions reductions,” Macchiarola said.

Labor groups like the AFL-CIO, the largest federation of U.S. labor unions, meanwhile, back steps to protect U.S. jobs like taxing goods made in countries that have less onerous emissions regulations.

AFL-CIO spokesman Tim Schlittner said the group hopes the summit will produce “a clear signal that carbon border adjustments are on the table to protect energy-intensive sectors”.

Industry wish lists

Automakers, whose vehicles make up a big chunk of global emissions, are under pressure to phase out petroleum-fueled internal combustion engines. Industry leaders General Motors Co and Volkswagen have already declared ambitious plans to move toward selling only electric vehicles.

But to ease the transition to electric vehicles, US and European automakers say they want subsidies to expand charging infrastructure and encourage sales.

The National Mining Association, the US industry trade group for miners, said it supports carbon capture technology to reduce the industry’s climate footprint. It also wants leaders to understand that lithium, copper and other metals are needed to manufacture electric vehicles.

“We hope that the summit brings new attention to the mineral supply chains that underpin the deployment of advanced energy technologies, such as electric vehicles,” said Ashley Burke, the NMA’s spokeswoman.

The agriculture industry, meanwhile, is looking for market-based programs to help it cut its emissions, which stack up to around 25% of the global total.

Industry giants such as Bayer AG and Cargill Inc have launched programs encouraging farming techniques that keep carbon in the soil.

Biden’s Department of Agriculture is looking to expand such programs, and has suggested creating a “carbon bank” that could pay farmers for carbon capture on their farms.

For their part, money managers and banks want policymakers to help standardize accounting rules for how companies report environmental and other sustainability-related risks, something that could help them avoid laggards on climate change.

“Our industry has an important role to play in supporting companies’ transition to a more sustainable future, but to do so it is vital we have clear and consistent data on the climate-related risks faced by companies,” said Chris Cummings, CEO of the Investment Association in London.

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Brexit

UK asks for more time to respond to EU Brexit legal action: RTE TV

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Britain has asked for more time to respond to legal action taken by the European Union over its unilateral decision to ease requirements of the Northern Ireland Protocol, Ireland’s RTE television reported on Wednesday (14 April), writes Conor Humphries.

“The request came in two letters from the UK’s chief Brexit minister David Frost,” RTE correspondent Tony Connelly said in a Twitter post.

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EU

Team Europe increased Official Development Assistance to €66.8 billion as the world's leading donor in 2020

EU Reporter Correspondent

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The EU and its 27 member states have significantly increased their Official Development Assistance (ODA) for partner countries to €66.8 billion in 2020. This is a 15% increase in nominal terms and equivalent to 0.50% of collective Gross National Income (GNI), up from 0.41% in 2019, according to preliminary figures published today by the Organization for Economic Co-operation and Development's Development Assistance Committee (OECD-DAC). The EU and its member states thereby confirm their position as the world's leading donor, providing 46% of global assistance from the EU and other DAC donors, and have taken a major leap forward towards meeting the commitment to provide at least 0.7% of collective GNI as ODA by 2030.

International Partnerships Commissioner Jutta Urpilainen said: “Team Europe has significantly increased its contribution of Official Development Assistance compared to last year. This is crucial at a time when so many people in our partner countries face significant health, economic and social challenges linked to the COVID-19 crisis. The latest figures show that 10 years ahead of the due date to deliver on our commitment to provide 0.7% of our collective GNI as ODA, we are more determined than ever to achieve this target.”

Overall, 17 Member States increased their ODA in nominal terms in 2020 compared to 2019, with the strongest nominal increases coming from Germany (+€3.310bn), France (+€1.499bn) and Sweden (+€921 million), and further increases coming from Austria, Belgium, Bulgaria, Croatia, Cyprus, Denmark, Finland, Hungary, Latvia, Malta, Poland, Romania, Slovakia and Slovenia. The EU institutions' ODA (meaning the European Commission and the EIB) increased by €3.7bn (27%) overall in 2020 in nominal terms. 15 member states improved their ODA relative to their GNI by at least 0.01 percentage points: Austria, Belgium, Bulgaria, Croatia, Denmark, Finland, France, Germany, Hungary, Latvia, Malta, Romania, Slovakia, Spain and Sweden. In Cyprus and Greece, ODA as a share of GNI decreased by at least 0.01 percentage points.

In response to the coronavirus pandemic, the EU, its member states, and the European financial institutions, together with the European Investment Bank and the European Bank for Reconstruction and Development, have combined their financial resources as Team Europe, mobilising over €40bn in support to partner countries in 2020. 65% of this amount was already disbursed in 2020 in support of the immediate humanitarian needs; health, water, sanitation and nutrition systems, as well as tackling the social and economic consequences of the pandemic. The unprecedented nature of the COVID-19 crisis has put a huge stress on public finances and debt sustainability of many developing countries, affecting their ability to achieve the Sustainable Development Goals. This is why, in May 2020, President von der Leyen called for a Global Recovery Initiative, linking debt relief and investment to the SDGs to promote a green, digital, just and resilient recovery. The Global Recovery Initiative is about shifting to policy choices supporting green and digital transitions, social inclusiveness and human development while enhancing debt sustainability in partner countries.

ODA is one of the sources of financing to deliver on the SDGs, although more transparency is needed on all sources of finance for sustainable development. As an important step in that direction, data on Total Official Support for Sustainable Development (TOSSD) has been collected and published for the first time, increasing transparency on all officially-supported resources for the SDGs, including South-South co-operation, support to global public goods such as vaccine research and climate mitigation as well as private finance mobilized by official interventions.

Background

The data published today is based on preliminary information reported by the EU Member States to the OECD pending detailed final data to be published by OECD by early 2022. EU collective ODA consists of the total ODA spending of EU member states and the ODA of the EU institutions not attributed to individual member states or the UK (notably own resources of the European Investment Bank and, for the first time in 2020, special macro-financial assistance loans on a grant equivalent basis).

Despite its withdrawal from the European Union taking effect on 1 February 2020, the United Kingdom still contributed funding in the form of ODA to the EU budget and the European Development Fund in 2020. This is included in the EU institutions' ODA. However, in order to avoid double-counting between the ODA reported as EU collective ODA and the ODA reported by the United Kingdom itself, the United Kingdom's contribution to EU institutions is not included in what is reported as EU collective ODA.

Four EU member states already exceeded the 0.7% target of ODA as a share of GNI in 2020: Sweden (1.14%), Luxembourg (1.02%), Denmark (0.73%) and Germany (0.73%).

When highlighting the member states which increased or decreased their ODA as a share of GNI, only cases where the change amounts to at least 0.01 percentage points (based on exact rather than rounded values) are taken into account, while member states for which the change is smaller than 0.01 percentage points in either direction are considered to have kept their ODA as a share of GNI stable.

The EU and its member states thereby perform significantly above the average of non-EU DAC donors in terms of their ODA as a share of GNI, standing at 0.50% compared to 0.26% by the aggregate of all non-EU DAC donors.

In May 2015, the European Council reaffirmed its commitment to increase collective ODA to 0.7% of EU collective GNI by 2030. Since 2015, on a flow basis, ODA by the EU and its current 27 member states has grown by 37% (€18.7bn) in nominal terms while the ODA/GNI ratio has increased by 0.1 percentage points. The year 2020 marks a turn in the previous trend of declining ODA since the 2016 climax when the EU and its then 28 member states' ODA reached 0.52% of GNI. This turn is due partly to an absolute increase in collective ODA in nominal terms, and partly to an absolute decrease in collective GNI in nominal terms. The EU is also committed to give collectively between 0.15% and 0.20% of the EU GNI in the short term to Least Developed Countries (LDCs) and 0.20% by 2030. Since 2015, on a flow basis, ODA by the EU and its current 27 member states to LDCs has grown by 34% (€3.5bn) in nominal terms to reach €13.8bn (0.10% of GNI) in 2019, and the ODA to LDCs/GNI ratio has increased by 0.01 percentage points. Moreover, compared to 2018, the EU and its then 28 member states increased their aggregate ODA to Africa by 3.6% in nominal terms to €25.9bn in 2019. Data on ODA to LDCs, Africa and other specific recipients for 2020 are expected by early 2022.

Scaling up sustainable finance and private sector engagement in partner countries is essential, coupled with reforms to enhance business climates, as meeting the challenges of the Global Recovery Initiative cannot be achieved by ODA alone. The EU has been instrumental in bringing together aid, investment, trade, domestic resource mobilisation and policies designed to unlock the full potential of all financial flows. The European Fund for Sustainable Development guarantee in particular has played a key role in unlocking additional finance for partner countries. Over the last year alone, the EU signed €1.55bn worth of financial guarantees with our partner financial institutions, leveraging over €17bn of investments – also helping to ensure that recovery from the pandemic is green, digital, just and resilient.

More information

Q&A on preliminary figures on 2020 Official Development Assistance for the EU and its member states 

Annex Preliminary Figures on 2020 Official Development Assistance, Tables and Graphs for the EU and its member states

Commission's publication of figures on the global COVID-19 response

OECD press release

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