By Joanna Hosa and Tara Varma, ECFR
The EU is now the obvious platform for strategic health planning – but it still has work to ensure greater trust and solidarity in the face of future health crises
Faced with relative vaccine scarcity due to production issues, more EU countries are turning to the Russian vaccine Sputnik: Hungary was the first purchaser and has now been joined by Slovakia. Several others, including Germany and Italy, are planning to produce it on their own territory.
In an ideal world, none of this would pose a problem. The virus is a global threat that demands global solutions – so goes the mantra. But the reality is that vaccines have turned political, and the Russian authorities deliberately politicised Sputnik from the start – its very name is designed to remind the world of the glories of the space race. And the rush to import and even produce Sputnik in the EU could actually undermine the extent to which Europeans will accept it as a viable option. While the European Union now plays a central role in health policy, what it does next could prove critical to both getting Europeans vaccinated and securing trust in that process.
Europe’s battle for health sovereignty
Health policy is not part of the EU’s competencies, which is one of the reasons it was slow to act at the beginning of the pandemic. But, faced with the unprecedented health crisis, the EU assumed a greater role than it had ever known before in advocating a global health agenda. Soon enough, there emerged striking differences between member states’ national health systems along with sometimes antagonistic views between member states on the need to Europeanise health policy. In the end, the European Commission took the lead in trying to coordinate actions – if not policies – when it came to patient mobility, ad hoc solidarity in cross-border regions, or exchange of scarce medical equipment, among other things.
At the EU level, health is now a core element of European security, alongside the defence or critical infrastructure sectors. But it is an area in which the EU lacked strategic autonomy – and to obtain this the EU acted on several levels: creating common strategic stocks, diversifying and reshoring supply chains, strengthening investment protection in innovative companies, investing in research and development, and coordinating efforts in multilateral forums. In short, it needed to limit its dependency on third countries, especially those it increasingly considered to be geopolitical rivals. Acting in that spirit, the European Commission also took the lead on the joint procurement of vaccines. A year into the pandemic, the rollout is much slower than expected, and EU member states are again eager to criticise Brussels for not delivering. They have started pursuing their own strategies, undermining the common EU approach.
Last August, Russia was the first country in the world to register a covid-19 vaccine for domestic use. Russian state propaganda went into overdrive, even though the actual vaccination programme only started in December. Announcing the vaccine even before trials were finished, while data was still questionable – and combined with an aggressive PR campaign and mixed messages about who the vaccine could help – all seem to have harmed trust in Russia’s vaccine. The latest polls from Russian opinion polling organisation Levada Center show that only around 2 per cent of Russians are against vaccines in principle, but 62 per cent are not prepared to take Sputnik. This figure has been steadily rising despite recent data showing the vaccine is highly effective and despite endorsement by international scientists.
And, even though it has control over the production and export of a vaccine, Russia has so far delivered only 5.28 jabs per 100 citizens, compared with 109.66 in Israel, 38.39 in the United Kingdom, and the EU average of 11.42. In a very secretive manner – with no photo op or particular information – it was revealed that Vladimir Putin had a vaccine only on 23 March 2021 – and it is not even clear if he took Sputnik or not. Meanwhile, Russia has been actively trying to sell its vaccine to as many countries as possible, all the while denying that it seeks to gain political influence, and accusing others of politicising the issue. While the EU is waiting for the European Medicines Agency (EMA) to examine the vaccine, the commission’s president has stated that Russia should explain why it is not vaccinating its own citizens.
Effective vaccine or a threat?
Notwithstanding any controversies, and faced with delays from Western producers, Hungary and Slovakia have now purchased the Russian vaccine, a scandal that led to a change in government in Slovakia. In the past few days, Austria also made known its willingness to purchase the Russian vaccine. These decisions are controversial because Sputnik has not yet secured approval from the EMA. More broadly, side-deals beyond the EU scheme harm European solidarity. There are also worries about how Russia could use its vaccine leverage to further undermine this solidarity as the EU more broadly continues to struggle to agree a common policy on Russia.
Trust is critical
While vaccinating people is a race against time, public trust in vaccines is also critical. And this trust is fragile, as seen with AstraZeneca. Even before (disproven) suspicions were aroused that there was a relationship with blood clots, statements by public figures and authorities in France and Germany had caused EU citizens to be wary of having this specific shot. This was even though this vaccine was developed by Oxford University, had secured EMA authorisation, and continued to receive endorsement and statements that it is safe and effective. But, as vaccinations are not obligatory, some people are choosing to wait for another option when it becomes available. The AstraZeneca saga does not bode well for people’s acceptance of Sputnik. Given how long it took to obtain reliable scientific information about the Russian vaccine, what could cooperation and information exchange with Russian vaccine providers and authorities look like in the future if and when doubts appear around side-effects or Sputnik’s efficacy when it comes to new variants?
To create this trust, Sputnik should receive EMA authorisation for use in the EU before any country buys it. Hungary’s and Slovakia’s moves have unfortunately undermined this, but public authorities can still play a role by talking about the scientific data that underpin the authorisation, should Sputnik be given it. Buying Russian vaccines for the sake of buying vaccines will not necessarily help the vaccination programmes in the EU.
For the future, the EU should invest in more facilities and manufacturing chains to produce its own vaccine. Covid-19 is likely to stay, and scientists warn that this will not be the last pandemic. Vaccines are the best hope and solution for such crises, and vaccine factories will belong to critical infrastructure. Reshoring part of the pharmaceutical manufacturing industry to the EU is one of the tools at the disposal of this geopolitical commission. It will have to decide which countries or regions it would nearshore to for products whose supply chains could operate in the European periphery such as the Balkans or North Africa. Diversification is also needed. Vaccines depends on critical components from diverse suppliers, and the more options the EU has, the better. The EU could decide to only work with certain partners, as well as make vaccine production with some countries conditional on certain guarantees. Decisions around protecting and expanding the EU’s pharmaceutical supply chains are fully part of its efforts to strengthen its strategic autonomy in health.
A year ago, the EU had no competency in health. It has come a long way since then – though this remains informal: for health to become part of EU competencies, a treaty change would be required. But the EU is now the obvious platform for decisions on vaccines, strategic medical stocks, and research. It has received criticism for its rollout of the vaccine, and in the future will require greater transparency and open communication on its health policy: availability of vaccines to the European population; a more precise calendar on how the rollout of the 27 vaccination campaigns will lead to the 70 per cent of the European population vaccination goal that the commission has set for itself; and a clearer mapping of the public and private partners the EU is prioritising in the framework of its health strategic planning. Improving the EU’s health autonomy will be an ongoing experiment, but it is one worth pursuing. The alternative is the sauve qui peut approach seen at the beginning of the pandemic – which did not really save anyone.