This article is part of our special report 2014-2019: What Next for EU Healthcare.
SPECIAL REPORT: The Ebola crisis and immunisation campaigns in Africa have demonstrated the EU’s added value in addressing global health issues. But there is still potential to improve if EU countries were less “suspicious” of each other, health experts say.
“There is no longer a clear separation between what is domestic policy and what is foreign policy,” said Ilona Kickbusch, director of the global health programme at the Graduate Institute of International and Development Studies in Switzerland.
“There is an overlap which refers to issues that require collective action,” she told delegates at the European Health Forum Gastein (EHFG) on Wednesday (1 October).
A former professor at Yale university who now advises governments and international organisation, Kickbusch urged European institutions and the member states to “come together” saying “the EU needs to find out how it will impact the global health debate.”
According to Kickbusch, there is a global power shift going on, with changing alliances on human rights and gender equality, which requires stronger internal coordination among EU member states. When discussing global issues, the EU should have its own political climate in mind, she believes.
“There’s an increasingly political nature of the global health agenda over, for example, universal health coverage, equality and redistribution. We have a rise in nationalism which makes a global agenda more difficult,” the global health director said.
When it comes to the global health agenda, polio vaccines, for example, have become a political tool, Kickbusch said. “Things are happening that we never thought in a worst case scenario, such as health workers being attacked while distributing vaccines, in order for a political view to gain attention,” she continued.
‘Suspicious’ member states
Louise van Schaik, senior research fellow at the Clingendael Institute, said EU member states increasingly see the benefits of working with the European Commission or at the WHO, speaking with one voice.
But at the same time they tend to see health still mainly as a national issue and are afraid of losing authority, she said.
The WHO is the directing and coordinating authority for health within the United Nations system. It is among other things responsible for providing leadership on global health matters, articulating evidence-based policy options and providing technical support to countries.
“There is room for manoeuvre, but it is also a sensitive area for a lot of member states,” van Schaik said. “The process of EU coordination in external places such as the WHO… The member states see it as an added value, but they are also suspicious towards foreign affairs people taking care of health. There’s sometimes a hostile negotiation environment. They are worried because since the EU pays more to the budget, they also want their share of the power. They want to be more powerful and of course this also creates some kind of opposition. There is an aspect of fear.”
Lourdes Chamorro, who is in charge of WHO relations at the European External Action Service (EEAS), the EU’s foreign policy department, said internal tensions quickly disappear when EU countries speak together at the global level.
“At the global level, there are common values which unite us much more than our differences. Our values are much stronger when we discuss them with other countries such as China and Russia. We use our common values quite often to reach common positions and our differences are not so obvious when we speak at a global level than when we speak or discuss internally,” Chamorro said.
The EEAS spokesperson said positive steps were taken every time the EU moves away from internal coordination to focus on decisions on actions at the WHO.
“Member states have realised when it comes to the WHO that when we act together, we are strong. I think there’s a feeling of a collective EU team, an EU force, or EU mind,” Chamorro said.
‘TTIP of the iceberg’
Ongoing free-trade negotiations between the EU and the US – the Trans-Atlantic Trade and Investment Partnership (TTIP) – is one of the hottest issues when it comes to global health.
Signe Ratso, from the European Commission’s trade directorate (DG Trade), defended the benefits of TTIP for the health community.
“Benefits are jobs and growth that generate tax revenues which politicians can spend on the public health sector,” she said. “TTIP can also reduce costs of drugs as well as harmonise data requirements on medical devices.”
Ratso stressed that the health sector had to be protected in the EU-US trade talks, highlighting the Commission’s “unprecedented” dialogue with industry and NGOs on the matter.
“TTIP will not lower the level of protection. The precautionary principle is non-negotiable,” Ratso said.
Emma Woodford, interim secretary general at the European Public Health Alliance (EPHA), emphasised that TTIP has given the EU health community, a wake-up call regarding how trade impacts on health.
“There might be areas where TTIP can improve health, for example on harmonised clinical trials for people with rare diseases, but these are small areas. I’m still concerned about how TTIP will have an impact on public services,” Woodford said.
“TTIP is moving beyond general free-trade agreements and streamlining of tariffs. It’s the ‘TTIP of the iceberg’,” she added.