Towards a European Public Health Service

The Corona pandemic has proven that we need a European health strategy. One step in this direction is the Franco-German initiative by President Emmanuel Macron and German Chancellor Angela Merkel.

by Claire Dhéret 


The Covid-19 crisis in Europe and beyond has exposed the structural weaknesses of our health systems, governments' inability to control health risks, and a lack of pan-European coordination to respond to a serious cross-border threat to its population’s health. Epidemics cannot be contained by borders, and the COVID-19 crisis has highlighted the need for a European public health system and improved cooperation between EU Member States.

At present, the pan-European public health service is very limited, because health has long been regarded as the domain of national governments. The EU's powers are restricted, as laid down in treaties. Essentially, they are limited to coordinating and supporting national governments. The low priority given to this issue by politicians is also reflected in the size of the European health budget: In the period between 2014 and 2020, a total of 449.4 million euros, or less than one percent of the total EU budget, was allocated to this sphere.

Nevertheless, as a result of the health crises that have hit Europe over the years, new instruments have been put in place, and it is reasonable to assume that the Corona crisis will play a decisive role in developing a pan-European strategy that will be more sophisticated, efficient and targeted than the previous ones. The instruments already in place include the European Centre for Disease Prevention and Control (established in 2004), which has an early warning system and contingency plan; the preparation of a legal framework for the event of serious transnational threats from diseases in 2013; an agreement on the group purchase of vaccines for Member States; and finally, the creation of an EU medical corps for emergency situations in 2016. Despite these existing facilities and measures, the COVID-19 crisis has shown how poorly Europe and its national health systems were prepared for a pandemic.

The pandemic has therefore sounded an alarm. It has reminded Europe of the pressing need for a European health strategy. This awareness is reflected in the  18 May 2020 Franco-German initiative of French President Emmanuel Macron and German Chancellor Angela Merkel, which underlines the need to strengthen European independence in health matters, in particular by creating capacity for the production of pharmaceutical and medical products at European level, by increasing the budget for research and development in the field of vaccines and treatments, and by creating common standards to ensure cross-border compatibility in the sector.

At the European level, this awareness has led to a re-examination of the proposed budget for the period 2021 to 2027 and the proposal of a European health package worth 750 billion euros. Health issues were given unprecedented importance in these proposals. The EU4Health programme linked to European health policy will now receive 9.4 billion euros. The aim is to promote health and stable health systems, prevent disease, support research and strengthen the EU's capacity to respond to health emergencies. In addition, investment in health will also be supported by other European funds.

However revolutionary these proposals may be, we must continue to reflect on how to make Europe better equipped to deal with health crises and how to respond in a coherent and effective manner to the failures of recent months.

To achieve this, there are various methods which would garner immediate or longer-term effects: 

First and foremost, the EU must equip itself with instruments that enable it to manage cross-border crises. We must think together at a European level to create strategic reserves of medical equipment and products that could be used in the areas most affected by a potential crisis.

Other considerations would include greater cooperation and mobility among health professionals who could travel to affected areas to respond to emergency situations, and a more coordinated approach to ensure equitable access to vaccines and medical treatment. This could include group purchasing by Member States.

Furthermore, in order to achieve this goal, we need to create more balanced, less strictly divided health systems that are not based primarily on hospital services. We need neighbourly care services with a multidisciplinary structure, in which health professionals can work together, complement each other and be able to provide real aftercare for their patients. The EU can help push for this goal. By focusing its tools and funding on these priorities and by encouraging the exchange of best practice, the EU can support this shifting approach.

Finally, the EU must take global leadership in tackling health crises. It must help to strengthen the structures for dealing with health issues globally, especially at a time when other world powers are threatening them. 

It is always important to learn lessons from a crisis. The one we are currently experiencing is, first of all, a health crisis, but we must not forget that it is also an economic and social crisis. It is now the responsibility of our leaders and governments to create a European public health system that will enable us to be better equipped to deal with future epidemics.

Translated by Caroline Härdter and Jess Smee


Claire Dhéret  manages the Social Europe and Well-being programme at the European Policy Center (EPC), an independent think tank in Brussels.