EU Solidarity and Policy in Fighting Infectious Diseases: State of Play, Obstacles, Citizen Preferences and Ways Forward

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The Amsterdam Centre for European Studies SSRN Research Paper 2020/06 EU solidarity and policy in fighting infectious diseases: state of play obstacles citizen preferences ways forward Anniek de Ruijter Roel Beetsma Brian Burgoon Francesco Nicoli Frank Vandenbroucke 1 We thank Rita Baeten Hendrik Vos Jonathan Zeitlin helpful comments on an earlier version this paper we also Hannah van Kolfschooten putting together a preliminary overview the instruments are grateful to providing funding research This work is licensed under Creative Commons Attribution 4 0 International License © Beetsma* Burgoon** Nicoli*** Vandenbroucke**** 2020 Faculty Law University Studies; deruijter@uva nl *MN Chair Pension Economics School Amsterdam; Netspar; CEPR; CESifo; Fiscal Board; r m w j beetsma@uva **Faculty Social Sciences b burgoon@uva *** Ghent f nicoli@uva **** Professor i g vandenbroucke@uva www aces uva Abstract In confront role traditionally plays domain health with urgent need collective action triggered by corona virus pandemic face such crisis argue that joint procurement stockpiling allocation medical countermeasures key component true besides maintaining integrity Single Market present first results survey experiment taken before current citizens’ attitudes towards centralizing at level policies combat diseases which indicates considerable support conclude more robust framework substantial centralization warranted Keywords Covid-19 medicines Union JEL Codes: I10 I18 Introduction Since few weeks world has been throes outbreak COVID-19 At moment writing there have over 950 000 confirmed cases almost 50 deaths worldwide Healthcare systems completely overburdened while economic implications devastating Vaccines number one counter measure stop future outbreaks save human life And yet development dissemination just vaccines generally where political fights can be fiercest US government tried secure rights access EU-based vaccine developers through its legal financial power – flouting global regarding measures against Among other moves it reportedly sought buy companies based Germany building dossier expected centrally authorized June or July year Apparently prevented completion sale now working come up general strategy solution address kind challenge promote pooling resources risk incident might not last attempt any country party go alone thus disregard broader sense organizing societal counter-measure wider serious disease instance terms However focuses narrower aspect solidarity: within healthcare what best options regard medicinal counter-measures diseases? addresses question backdrop analysis informed public discuss ‘EU solidarity’ means Solidarity well-known principle national care guiding distribution rationalization goods involved recognized EU’s constellation although always tension between domestic internal market principles Second outline manner promises organize pandemics promise could from Treaty changes Lisbon amendments new regulation adopted after 2009 Swine Flu outbreak; nevertheless competences remain relatively limited even way proved difficult given significant hesitations Member States Third empirically report among representative sample 400 Dutch citizens (yielding 2400 judged packages) surveyed explores should respect conclusions emerging these three steps clear: good social arguments likely meaningful procuring allocating eliminates inefficiency associated excess demand supply co-existing various parts More importantly allows massive firepower instantly targeted wherever starts if well-organized ex ante secures credible commitments all cooperation needed post when hits 1. 1.1 Health law pertains area our shared risks opportunities related mortality 2 linked commitment help those do know exactly whom helping donation blood often cited as how context suffering driving force & Policy: Expansion Power Public Care (Oxford Press 2019) ‘The Impediment Laws’ Values Constitutional Setting EU’ TK Hervey Calum Alasdair Young Louise Bishop (eds) Handbook Policy (Edward Elgar 2017) Tamara K Jean V McHale Law: Themes Implications (Cambridge 2015) organization 3 Particularly emergency people keen out widely seen acceptable than self-help multifaceted bioethics long history;5 used particularly (as opposed care/medical care) justify interferences quarantines mandatory examinations vaccinations e enforcement authorities necessary understood 6 When comes resource forms value: here justifies mechanisms insurance redistribution planning rationing ensure services protect part welfare system 7 implementation notion equal preventive well ‘universal access’ 8 Universal each granted specific basket ensuring universal entails most ‘Implicit solidarity’: Catherine Waldby Robert Mitchell Tissue Economies: Blood Organs Cell Lines Late Capitalism (Duke 2006) 128 see Titmuss Richard Gift Relationship (Reissue): From Human (Policy 2018) A M Farrell ‘Is Still Good? Examining Politics Regulation Safety Union’ (2006) 14 Medical Review 155 Philipp Genschel Anton Hemerijck ‘Solidarity Europe’ (2018) 01 EUI Brief 5 Rob Houtepen Ruud ter Meulen ‘New Types Welfare State’ (2000) Analysis 329 There some discussion explanatory weight arrengements sharing burdens large scale Barbara Prainsack Alena Buyx Solidarity: Reflections Emerging Concept Bioethics (Nuffield Council 2011); Angus Dawson Marcel Verweij ‘Solidarity: Moral Need Clarification’ (2012) Ethics 1; ‘Understanding (With Little Help Your Friends) Response Verweij’ 206 But uses interstate relations carries less Lawrence O Gostin Lindsay F Wiley Thomas R Frieden Duty Restraint (3 edition California 2016); Howard Brody Eric N Avery ‘Medicine’s Treat Pandemic Illness: Vulnerability’ (2009) 39 Hastings Center Report 40 (2011) Biomedicine Beyond 7; Daniels Just Health: Meeting Needs Fairly 2008); Chris James William Savedoff ‘Risk Pooling Redistribution Care: An Emperical Attitudes toward Solidarity’ [2010] World (2010) Background No De (n 7) matter choices; choices democratic legitimacy entail age limits certain prevention programmes cancer mean experimental treatments alternative (social) benefits package networks choice particular providers achieved ‘budget model’ only provided constraints budgets inevitable waiting lists intricate politics economics 9 Indeed value reality protections ground very different Out-of-pocket costs Eastern Countries Greece vary 23 50% payments going down 12 15% Western Scandinavian 10 These health-system public- divergences well-documented organized largely State Medicines make about 25 percent average 11 across 1.2 Despite differences throughout Article TFEU outlines: WHO Europe ‘Strengthening Collaboration Improving Access Region EUR/RC67/11 67th Session Budapest Hungary -14 September 2017’ See quick Country Profiles Commission: https://ec europa eu/health/state/country_profiles_en Also Eurostat facts figures eu/eurostat/statistics- explained/index php/Health_in_the_European_Union_%E2%80%93_facts_and_figures OECD ‘Pharmaceutical spending (2018)’ ‘Council Conclusions Strengthening Balance Pharmaceutical Systems Its (17 2016)’ Department Price Scheme Eleventh Parliament February 2012 available October repealing 2119/98/EC [2013] 293/1 ‘Joint Procure Countermeasures’ applies (antivirals vaccines) (infusion pumps needles) ‘other goods’ mitigate treat laboratory tests diagnostic tools decontamination masks personal protective equipment 42 procedure contracting parties (Member decide join Commission) meet conditions affect constitute cause distortion competition; impact budget participating 43 detailed practical arrangements evaluation requests participation award contract applicable competent court hearing disputes 44 Importantly tender criteria governing amounts receive exact amount ordered may slower accordance 45 request derogation 46 faster donate acquired 47 ‘urgency’ joined Steering Committee ‘Medical procured Agreement’ SANCO C3 eu/health/sites/health/files/preparedness_response/docs/jpa_note_scope_en 43Article 5(3) 165(2) Financial 17(1) JPA 17(2) Each sets own distributive 48 representing half population 49 company Seqirus currently preparing procedures diphtheria anti-toxin Tuberculin BCG Personal Protective Equipment organising low example centralising effect done 51 processes 52 ministries contact emergencies indicated initiatives procurements eye respirators ventilators EMA investigating availability investigational therapeutics 53 ‘rescEU’ Belgium Croatia Cyprus Estonia France Ireland Malta Netherlands Portugal Slovakia Slovenia Spain ‘MEMO28/03/2019 Framework Contracts Vaccines’ eu/health/sites/health/files/preparedness_response/docs/ev_20190328_memo_e n press release 29-03-2020 eu/commission/presscorner/detail/en/MEX_19_1891 launched four calls supplies (gloves surgical gowns) (personal respiratory equipment) (laboratory testing kits) (https://ec eu/info/live-work-travel-eu/health/coronavirus-response/public-health_en) ‘DG Summary 11th meeting Coronavirusdisease (COVID-19) (13 2020)’ Another route heading proper regime mandates 54 established depends willingness forces strengthened centralize capacities 55 funds pre-committed co-financed disposal efforts respond creates possibility operating parallel infrastructure 56 Here assume because implementing decisions “rescEU” contribute doubtful All needs mindful diverse realities purchasing powers absence intergovernmental nature inevitably bureaucratic manage generating speed delicate along process: think priority (e vaccine) cannot answer large-scale larger 192/53 (EU) 2019/420 amending 1313/2013/EU (OJ 77I 1–15) Par structure deployment urgency free-riding 2.3. export limitation crucial importance Communication published recently 57 coordinating actions scarce ‘channeled most’ 58 Thus vehicles whenever movements communicated 59 essential task mediated One restrictions exist prevent firms tendered started hoarding limiting suppliers’ interfere getting sees interrupting chains vital whole potentially prohibited reiterates exports Legally Central Bank (March 2020) Investment Eurogroup Coordinated response COM(2020) 112 page Serious Threats Repealing 5-11-2013)’ supra note solid reason want restrict authority proportionate non-discriminatory proportionality nature: [The be] appropriate achieve [health] adequate preventing occurrence aggravation shortages individual iteration novel addition instrument assumes usual interpretation integrative (and sovereignty domain) traded-off According outright proportionate; aimed reach suit Clearly juncto never serve Rather discriminatory allowed according regulate medicine severely undermined disrupt runs bans EU- wide arrangement chain let based’ scrutinizing whether fall infringement scare politicians having control stockpiles Commission’s creating pressure taskforce involves looking markets hence able leverage mere urgently 3. What medicines? exploring consider paucity well- questions designs unfamiliarity risk-pooling tendency express opinions matters socially desirable expressing thinking To shed light conducted original pilot project fiscal administered prior broadly respondents yielding packages Our explored purchases accessibility portion so-called conjoint asking judge pairings combined features hypothetical answers being were: (1) Do prefer range financially beneficial? (Possible answers: medicines; medicines); (2) lends pooled country’s contribution instead stanch epidemic spread? contribution; prioritizing spread); (3) EU-level national-level experts? experts; experts) issue judgment asked entire exhibiting combination choose randomly combine random (from dimension) approach evokes honest undesirable revealed evidence period reveals focus two basic patterns gave plurality opposition Figure below strongly garners cent ‘only’ (32 indifferent) significantly demographic sub-groups (younger versus older respondents; educated women) sign tentative command 1: Percent Respondents Supporting medicine-procurement perhaps interestingly showed showing predicted preference dimension inference dots capture prediction dark lines side depict interval 95% confidence Where entirety right vertical left likely) EU-procurement feature 2: Predicted Preference Features Change probability supporting (relative alternative) shows preferred indifferent agencies administer programmes: Focusing third ‘WHO ADMINISTERS?’ weakly administration baseline) statistically difference (note crosses line) tend covers swath medicines: focusing ‘FOR WHICH MEDICINES?’ includes coverage narrow Finally gives contagion: second ‘PRIORITY ACCESS’ 23% contagion traced contributions without Obviously overinterpret outcomes framing Moreover place described frame midst respondents’ shaped Given shortcomings decentralized become obvious centralized fallen Hence interpret experiment’s qualified view traction 4. suggestions effective potential guide degree ‘protectionism’ thrust CJEU opposite: considers breach words witnessing clash claims prerogatives’ ‘pan-European approach’ Across differ history culture ‘subsidiarity principle’ deviations carry inefficiencies exacerbate inequalities: ignores varying impacts spillovers yields end bad everyone If argument accepted give prove tangible Therefore initiative (which size volume) coincide suffice say steering unfettered empowered real safe words: today ‘negative’ (‘Don’t block your borders!’) ‘positive’ (together cooperative effort) legacy policy- makers domestic-centered equilibrium reluctance follow coupled pool transfer redistributive 61 suggests misguided Not better exists protected provisions; opinion poll majority prepared share quite remarkable skeptical European-level stabilization 62 plausible willing leaders paying lack pan- competing acquire imposing outcome suboptimal allocated circumstances infringements little short catastrophic tries itself hastening tragedy commons done? embedded efficient truly Regional Office “Challenges (2010)”; int/health_financing/documents/pooling/en/ similar vein Jaime Espin ‘WHO-Europe How Can Voluntary Improve Technologies Europe?’ sceptical though expressed (senior) servants Heijdra Aarden Hanson Dijk (2018 30) stable EMU require VoxEU legally possibilities unsolidary behavior 63 certainly becomes Funding levying separate proportion GDP demography elderly excluded relative effects weighed benefits? advantage off threatening negotiate lower prices Secondly managed longer co-exist Thirdly greater target emerge consequences responsible stock avoids deviate securing Costa-Font (2020) Europe’s failure ‘health citizenship’ argues favour socialeurope eu/europes- failure-to-address-covid-19-shows-the-need-for-a-european-health-citizenship His mainly governments differing responses hard motivate optimal Breaking away self-defeating reduces chances quell once 64 Ideally missed ‘ex ante’ solutions unthinkable normal times ‘Crises hit consumer excellent speeding ’65 debt ESM ex-post design requires centrally-controlled guidance expertise instructions Prevention Control easier laid emerges obviously unknown stages namely concentration victims containment swing define determine minimization lost casualties Ethical considerations determining Risk-sharing dealing step drastic lockdown local economy mostly borne containing enjoyed uneven cost-benefit trade-off distinguished maker 65 114 levels reluctant take Having compensate equalize return” doubt learned tragic hesitation making scientific ethical executive parliament hold account accountability parliaments delegation execution exerted analogous Eurozone monetary “technocratic experts” President ECB appears regularly hearings