EU health policy in the aftermath of COVID-19: neofunctionalism and crisis-driven integration

In March 2020, the COVID-19 pandemic shook the European Union (EU). The EU responded to the multifaceted challenge with an integrative leap forward. Member States substantially increased their investment in existing health policy tools such as civil protection and financing for health initiatives. There was innovation in EU law, where a process of redefining public health began, and in strategies for vaccines and pharmaceuticals, where the EU took on a direct and significant role in medicines procurement for the first time. We use the framework of neofunctionalism to analyse developments in health policy during the pandemic to further understand the dynamics of integration and, in particular, to understand why EU Member States opted for further integration in response to the pandemic. As neofunctionalism might predict, Member States solved problems born of integration with more integration: preserving the internal market, insuring against disasters, preventing border closures and enhancing EU power in vaccine development and procurement. Reflecting decades of entrepreneurs who had created various mechanisms, they primarily built on pre-existing, if often weak, structures and enhanced EU governance more than competences. [ FROM AUTHOR] Copyright of Journal of European Public Policy is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

More Competences than You Knew? The Web of Health Competence for European Union Action in Response to the COVID-19 Outbreak

Encourage, support, coordinate, resource The Union enjoys significant powers to encourage, support and coordinate cooperation between the Member States in the area of public health, in general,6 and in the context of natural disasters.7 Specific competence norms support, for example, cooperation between Member States in cross-border healthcare,8 in biomedical and other research9 and in civil protection.10 The Union has already lawfully taken binding decisions that coordinate actions of the Member States in epidemiological surveillance, and has done so since the 1990s.11 The Union has power (eg through coordination decisions taken within the Health Security Committee12) to encourage Member State cooperation in adopting passenger screening measures, requiring the temperature of passengers to be taken before boarding a flight.13 The Member States took coordinating measures of that nature as an intergovernmental act in 2009 during the swine flu epidemic. The Union also enjoys significant powers to deploy its own (admittedly relatively limited) resources, such as through its structural funding.14 The Union has competence to fund collaborative research15 into vaccines, treatments, new medical equipment and devices;epidemiological research into the spread of COVID-19;behavioural research into effective disease containment strategies;and social science research into the social, economic, political, legal and cultural consequences of COVID-19. Since 2007, the Union has had competence, under the “solidarity clause”,16 if its Member States so desire,17 to pool resources under a Civil Protection Mechanism. Since March 2019, the Civil Protection Mechanism has been strengthened by “rescEU”, in an attempt to centralise Union capacities,18 permitting the Union to use its internal funds, pre-committed national funds and Union-co-financed Member States’ capacities at the disposal of Union efforts to respond to a major emergency. The limits of Union harmonisation The Union does not have competence to adopt measures that have as their primary objective the “harmonisation” of national definitions of health policy;or the organisation and delivery of health services and medical care, including management of health services and medical care and the allocation of resources;25 or of national public health laws on tobacco or the abuse of alcohol.26 But these constraints on Union competence do not mean “that harmonising measures … cannot have any impact on the protection of human health”.27 The Union may lawfully adopt measures that have the effect of improving health, so long as those measures remove obstacles to trade or remove appreciable distortions of competition.28 Union internal market measures must protect and promote public health,29 and where new scientific evidence comes to light, the Union must update existing harmonised measures.30 Thus, the Union may, for example, amend its packaging laws to contain COVID-19 spread through hard surfaces31 and protect consumer health.32 The Union also has competence to protect the environment,33 and so could, for instance, adopt the World Health Organization (WHO) technical standards on water, sanitation, hygiene and waste management for COVID-1934 in Union law.

EU health solidarity in times of crisis: explaining public preferences towards EU risk pooling for medicines

The COVID-19 outbreak in Europe has brought attention to EU health policy as a focal point for solidarity, particularly as it concerns access to medicines. Against the backdrop of policy proposals for EU joint procurement of medicines, this article expands our understanding of public opinion towards this particular aspect of European integration. Drawing on data from a conjoint experiment in five EU countries, the study investigates the extent to which citizens’ preferences concerning alternative policy designs for EU joint procurement of medicines are either structured along a pro-EU versus anti-EU or ideological divide, or are crisis driven by the perceived COVID-19 threat. The analysis reveals that individual preferences over the design of EU risk pooling for medicines are most strongly explained by Euroscepticism, while egalitarian ideology plays only a modest role. How citizens’ perceived threat of COVID-19 affects their preferences for this form of EU risk pooling is dependent on the national context. [ABSTRACT FROM AUTHOR] Copyright of Journal of European Public Policy is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Towards more comprehensive health law and policy research.

In this comment, and drawing on the papers in the special issue, we ask: what are the core questions for the future of research into health law and policy, and European health law and policy more specifically? We first sketch the general functions and values of health law and policy. We then outline how these functions and values are affected by globalisation and Europeanisation, on the one hand, and technological change and digitalisation, on the other. In light of these developments we carve out some questions for future research and the implications of this agenda for the academic community that is working on European health law and policy.

Public support for European cooperation in the procurement, stockpiling and distribution of medicines.

BACKGROUND: The COVID-19 outbreak has heightened ongoing political debate about the international joint procurement of medicines and medical countermeasures. The European Union (EU) has developed what remains largely contractual and decentralized international procurement cooperation. The corona crisis has broadened and deepened public debate on such cooperation, in particular on the scope of cooperation, solidarity in the allocation of such cooperation, and delegation of cooperative decision-making. Crucial to political debate about these issues are public attitudes that constrain and undergird international cooperation. METHODS: Our survey includes a randomized survey experiment (conjoint analysis) on a representative sample in five European countries in March 2020, informed by legal and policy debate on medical cooperation. Respondents choose and rate policy packages containing randomized mixes of policy attributes with respect to the scope of medicines covered, the solidarity in conferring priority access and the level of delegation. RESULTS: In all country populations surveyed, the experiment reveals considerable popular support for European cooperation. Significant majorities preferred cooperation packages with greater rather than less scope of medicines regulated; with priority given to most in-need countries; and with delegation to EU-level rather than national expertise. CONCLUSION: Joint procurement raises delicate questions with regard to its scope, the inclusion of cross-border solidarity and the delegation of decision-making, that explain reluctance toward joint procurement among political decision-makers. This research shows that there is considerable public support across different countries in favor of centralization, i.e. a large scope and solidarity in the allocation and delegation of decision-making.