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 R&D, and coordinating efforts in multilateral forums.
“We consider this an act of modern piracy,” steamed Berlin’s interior minister, Andreas Geisel, in April 2020. “Even in times of global crisis, there should be no wild west methods.” Geisel had just learned that 200,000 protective masks intended for Berlin’s police force had effectively disappeared. They had not been stolen by brigands off the coast of Somalia but rather ‘diverted’ in Bangkok by corporate fiat. The US company that made them had been prohibited from exporting medical products by an emergency law invoked by President Donald Trump. Even as Geisel fumed that US actions did not comply with international rules, Trump put the matter rather starkly: “We need these items immediately for domestic use. We have to have them.”

Crises tell us a lot about ourselves and the world we live in. The coronavirus crisis has taught us that the health system is an element of security as much as the defence industry or telecoms infrastructure. The absence of health security threatens the ability of societies to function, economies to prosper, and nations to compete in geopolitical competition. Health emergencies can also erode democracy and human rights at home, perhaps permanently, as we have already seen during the current crisis.

Health security, like many other areas of international life, is both cooperative and competitive. We live in a world of interconnections – people, goods, information, and of course microbes flow across borders with ever-increasing speed and quantity. These flows create enormous benefits, but, as the 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.

Populations expect their governments to protect the nation against the downsides of globalisation. They want, in other words, their governments to retain strategic sovereignty, to be able to retain their capacity to act, and to control their nation’s destiny. As recent events have shown, the ability to nurture and protect an effective health system – one that can withstand pandemics and other crises – is a key element of strategic sovereignty.

Achieving strategic sovereignty in the health area is no simple task. There is no option for ‘health autarky’ in the modern world. States clearly need effective international cooperation to tackle their health problems. To staff and equip their health systems, they need access to global labour markets and supply chains. To treat diseases, they need medicines and information from foreign sources and international organisations. To achieve progress in treatment and prevention, they need to work collaboratively in transnational research networks.

But states also compete in the health arena, sometimes quite viciously. They seek to capture key technologies and intellectual property, they try to attract key medical staff, and, particularly in times of emergency, they struggle over scarce resources such as vaccines and protective equipment. They also use health issues as wedges in larger geopolitical competitions, by, for example, using their control over supply chains to extract geopolitical concessions.

Managing cooperation amid geopolitical competition is a fundamental challenge for health security. For European Union member states, cooperation at the European level is a key part of the solution. If member states are to retain their ability to provide effective health security to their populations, they will need effective cooperation with their European partners, both through the EU and other mechanisms.

Of course, healthcare is and should remain largely a national competence. Healthcare systems across Europe vary dramatically, reflecting different historical experiences and cultural preferences. Some are centralised, some are federal, some are local, some are administered by social insurance companies, some countries have a private healthcare industry, others limit healthcare to the public sector. These often-fundamental differences make cooperation, and certainly convergence, in Europe difficult.

But, as in other areas, protecting European strategic sovereignty in health does not require a centralised solution. It just requires European-level efforts that can serve as a forum for cooperation and setting standards, act as a force multiplier for national efforts, and ensure much-needed European solidarity. European populations agree. According to a 2017 Eurobarometer Survey, 60 per cent of Europeans support greater EU engagement in health issues. Forthcoming ECFR surveys show that policy professionals in every member state overwhelmingly support a greater EU role on health policy, except in Poland, Hungary, and the Czech Republic.

This paper seeks to lay out a concept of European health sovereignty and to 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.

Towards this end, the first section maps out the key constituent elements of health sovereignty. The next two sections seek to understand the geopolitical and European context for health sovereignty, with a focus on what other powers are doing and how European states differ in their approaches. The final section of the paper makes recommendations for how, through the EU and other mechanisms, member states can work together to promote policies that better protect health sovereignty.