Stronger international rules and cooperation mechanisms on health are at the heart of the European Union’s new global health strategy, which was launched on Wednesday. 

The strategy is based on three priorities: ensuring that people stay well throughout their lives, strengthening health systems particularly by advancing universal health coverage, and applying a ‘One Health’ approach to preventing health threats.

“This is a strategy which is rooted in equity. It’s rooted in solidarity, in human rights and in partnership. But what really fuels it is our determination to strengthen good global governance,” said European Commissioner Stella Kyriakides.

Stressing that global health threats “know no borders”, Kyriakides called for “stronger international rules and cooperation mechanisms on health, including a legally binding pandemic agreement”.

Better detection of threats, more equitable access to vaccines and treatments, and more robust global governance to guarantee results.

Today we've adopted a new EU Global Health Strategy to improve global health security and deliver better health for all.#HealthUnion

— European Commission (@EU_Commission) November 30, 2022

The strategy – the first in 12 years – also means that the EU is “stepping up its leadership on global health”, said Commissioner Jutta Urpilainen.

Urpilainen said that the EU would “ramp up investments in health systems with innovative financial instruments”, including supporting the African Union to achieve its goal of producing 60% of the continent’s vaccines by 2040.

“COVID-19 really highlighted the deep challenge in medical manufacturing capacities and other supply chains, bottlenecks. Africa, for example, still imports 99% of its vaccines and 94% of its medicines,” said Urpilainen.

The EU wanted to fill any gaps in global health governance and financing through a “strong and responsive multilateral system” with the WHO at the core.

More power for EU?

However, the EU also indicates that it wants a more prominent seat at the decision-making table, based on its large investment in global health, and some sources have indicated that the EU might seek membership of the WHO itself.

“The main message of this strategy is that the EU intends to reassert its responsibility and deepen its leadership in the interest of the highest attainable standards of health,” the strategy states.

Pointing out that the EU and its member states contributed €53.7 billion to assist 140 countries during the COVID-19 pandemic, the strategy states that “the EU’s influence in shaping the agenda must match its financing support as a champion of global health”. 

Sandra Gallina, European Commission Director-General for Health and Food Safety, also stressed the need for “an international rulebook” because, without it, there had been a “cacophony” and “very, very rapid degradation of relations” during COVID-19.

“We want to have a pandemic treaty with antimicrobial resistance at the heart of it,” she stressed.

UHC contribution

A smiling World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus, while commending the EU’s strategy for being aligned with that of the WHO, revealed that the EU had just contributed €125 million to the WHO to promote universal health coverage. 

“Each of these challenges transcends borders, sectors, languages,
ethnicities and political divides. No single country or organization can deal with them in isolation. Which is why multilateralism is more important than ever”-@DrTedros pic.twitter.com/Ah7jpy2sFl

— World Health Organization (WHO) (@WHO) November 30, 2022

“This new strategy comes at a critical time as our world faces so many threats to health from the continuing COVID 19 pandemic, to the silent pandemics of non-communicable diseases and antimicrobial resistance, conflicts around the world, rising inequality and the existential crisis of climate change,” said Tedros.

“Each of these challenges transcends borders, sectors, language, ethnicities, and political divides. No single country or organisation can deal with them in isolation, which is why multilateralism is more important than ever. “

Dr Ayoade Alakija, chair of the African Union (AU) Africa Vaccine Delivery Alliance and the WHO’s Special Envoy for the ACT Accelerator, said that the EU’s strategy was important to address the “geopolitical schism” and reassert a “global” response.

Pointing to the fact that “global procurement didn’t work during the pandemic”, Alakija said that the influence of the global vaccine alliance, Gavi, was declining, and being replaced by other organisations like CEPI and FIND with ‘transformative leaders” that are cooperating with regions.

EU leaders travelled to Nigeria to consult with the African Union before finalising the strategy, which will now be fine-tuned by member states.

Lack of detail on climate change

But Alan Dangour, the Wellcome Trust’s director of climate and health, was critical of the lack of “clearly defined deliverables” about how to address climate change.

“So there are really, I’m afraid, substantial things that are potentially missing from this strategy, which is a much greater ability to plan for the future for something that we know is coming. This is physics. This is basic physics. And I would love there to be a substantially stronger agenda on climate change and the impact that climate change is having and will continue to have around the world.”

The WHO’s head of health emergencies, Dr Mike Ryan, welcomed that the document stated what needed to be done “because we need to move our communities from doom to do”.

However, Ryan stressed that “global solutions will not deliver what we need” in a health emergency.

“Epidemics, pandemics, begin and end in communities. Global health security emerges when you have strong national and local systems responsive to the needs of their communities, well prepared, agile, mobile, scalable, and able to serve.

“There are only two things we do in a public health crisis. We protect communities, and we provide safe, scalable, clinical treatment.”

Ryan warned that, in terms of climate change, the world needs to prepare for “multiple intertwined amplifying events” rather than a single event.

Meanwhile, Prof Peter Piot, the special advisor to the President of the European Commission, warned that Europe, in seeking to address its health workforce problems “should make sure that we are not making things worse for low and middle-income countries by recruiting staff from there. So we need to make sure that we honour international commitments at that level.”

What are the promises?

To address people’s well-being, the strategy undertakes to “prioritise addressing the economic, social and environmental root causes of health and disease – including poverty and discrimination, age, nutrition and healthy diets, social protection, education, care, water, sanitation and hygiene, occupational health – and other areas such as healthy ecosystems pollution or contact with chemicals and waste and threats to security of energy supply.”

It also aims to put the needs of women, girls and young people at the forefront of responses, and te EU will  “engage with partner countries to expand access to a basic package of health services covering prevention and care with particular focus on poor and marginalised populations through bilateral and regional programmes”.

The EU also plans to make digital health a pillar of its approach, undertaking to “leverage the potential of health data worldwide in line with the principles of the planned European Health Data Space and foster the use of new technologies including artificial intelligence to boost their potential to improve diagnosis and treatments worldwide”. 

Way forward

At this stage, the strategy is a draft that is not binding on member states. Radic Policar, the Czech deputy health minister, said that it will be presented to member states’ development ministers for further discussion.

However, Sweden assumes the presidency of the EU from the Czech Republic in 2023 and it will need to champion the strategy with members, a challenge that Anders Nordstrom, Sweden’s Ambassador for Global Health seems ready to do.

“During the Swedish EU Council presidency , starting on 1 January, member states will have the opportunity to address the strategy through council conclusions and we will do our utmost to support that process. And what will be important that is of course to see how we as, member states, together with EU institutions actually can support the implementation of this and also ensure that there is an effective monitoring and accountability,” said Nordstrom.