Green European Journal: Healthcare professionals were celebrated as heroes in 2020. How can we go beyond applause to protect public health and the healthcare sector?

Petra De Sutter: The “how” questions are the most difficult because everyone agrees that this crisis has been a wake-up call for health systems in the EU. As always in a crisis, it’s the public sector that has to come forward and find the solution. Applauding healthcare professionals is not sufficient; structural reforms and increased health spending are needed. The austerity policies that drove us towards liberalisation, privatisation, and higher cost efficiency in the healthcare sector were always dangerous because they left European countries with no surplus capacity for crisis management. Across Europe, every political party now understands the need for greater investment in public healthcare.

Applauding healthcare professionals is not sufficient; structural reforms and increased health spending are needed.

It’s not only about intensive care capacity; more investment in mental health and prevention also needs to be taken away from this crisis. Isolation and lockdown have caused serious mental health issues. Depression and anxiety peaked during the first wave and the same risks happening again. Then, if you look at how the crisis evolved and how the virus spread, it is clear that stronger preventative healthcare saves in the treatment department. Prevention goes far beyond the healthcare sector. It concerns the environmental risks and pollution, food quality, and trade policies, and safety at work, to name just a few areas. An important way to support the healthcare sector is by taking a “health in all policies” approach so that the health impacts are taken into account across all areas.

Will this new consensus around ending austerity in the health sector outlast the crisis?

That’s the million-dollar question. Some political groups may want to return to business as usual once the crisis has been handled. However, public sentiment is strong.

Even before the crisis, polling from across Europe showed that over 70 per cent of EU citizens consider health to be a priority and want the EU to do more.[1]

What’s more, the measures put in place now will not just be temporary, they will lead to structural changes. At the European level, solidarity between member states and their health systems needs to be deepened. Healthcare is of course a member state competence so it will be a struggle. But moments of crisis are typically the time when the European Union takes steps forward and crises like Covid-19 know no borders.

What would greater European cooperation on health entail?

A full European-level healthcare policy probably would not work as it touches on too many areas such as social security and financing. European countries have different systems with different levels of privatisation, so it might not even be desirable and it’s not realistic either. But what the European Union can do is incorporate measures that improve health across areas in which it does have power: food and agriculture, trade, and employment for example.

Where it can act directly on health matters, such as in crisis management, the EU should go beyond recommendations to take more binding action. The European Centre for Disease Prevention and Control has a mandate for crisis management and preparedness as an EU agency and it should be strengthened, with greater powers to coordinate border closures and emergency stocks of medicines and equipment. One Green proposal is the creation of an EU Health Force that would be part of Europe’s civil protection systems. Doctors and nurses in hospitals across Europe could be trained and prepared for mobilisation in case of a local crisis or outbreak.

What about cooperation on medicines and medical equipment?

Europe’s dependence on essential medicines produced elsewhere in the world has been exposed during this crisis. Paracetamol is produced in China, packaged in India, and then shipped to the EU. Imagine a crisis where borders were really closed and access was cut off. So some relocalisation is needed and should be organised at the European level. The European Union also has competence over the development and marketing of pharmaceuticals and vaccines. During the Covid-19 crisis, some member states began to negotiate directly with pharmaceutical companies to pre-order vaccines. Of course, the industry likes to negotiate with multiple countries. Fortunately, the European Commission has since taken over and the result will be much better terms for the development and production of vaccines. If we want to ensure affordability and access for countries in the rest of the world, the European level is essential.

The crisis raises questions as to how we produce and market pharmaceuticals more generally. The power of the pharmaceutical industry is tremendous. They both negotiate prices to their benefit and concentrate on the most profitable drugs. They’re not interested in orphan or low-cost drugs. The public sector, including at the European level, should consider taking the initiative and investing in public labs for research and development. There is also an argument for decoupling the development and the marketing of drugs. The public sector could guide where development needs to happen and then work with the market to organise research and marketing. The pharmaceutical market is not like other markets because first, as a patient, you don’t choose your sickness and, second, in the end, everything is paid for by either public money or insurance.

The pandemic has triggered a social crisis but it is also very much an environmental crisis. How can Greens make sure that its root causes aren’t lost in the push for economic recovery?

The Covid-19 outbreak happened because of the risk of zoonotic spread that our relationship with ecosystems brings. Experts have already warned that other diseases like Covid-19 will emerge in future, particularly if the destruction of wild animal habitats continues. The task for Greens is keeping this message high on the agenda. The World Health Organization has incorporated this narrative in its analysis of the Covid-19 crisis. Its director Tedros Adhanom has talked about how the pandemic reminds us of the “intimate and delicate relationship between people and planet.” It almost sounds like a Green talking. The next step is making sure this link is just as recognised by governments and European institutions. The EU’s commitment to protecting biodiversity in 30 per cent of all ecosystems by 2030 needs to be backed up by investment and action. Links between biodiversity loss and the origins of this crisis, as well as those between air pollution and vulnerability to Covid-19, show that the environment, climate change, and health cannot be separated. If we want to think about resilience and avoiding future pandemics, such issues have to be addressed as one.

Is there a sense in which the implications of the health crisis go much deeper than climate warming? It’s not just about energy systems; Covid-19 has touched every aspect of how we live our lives.

It might sound strange to say but climate change is insipient. It goes very slowly and people cannot see its immediate effects. Of course, you’d need to have had your head buried in the sand to have missed the changes in the world’s weather systems. But still, we’re talking about events that take around 10, 15, even 30 years to become visible. Climate change is abstract and often it’s been the next generation’s problem. The pandemic, on the other hand, has been so disruptive; it brought everything to a standstill in a way that we couldn’t have imagined a year ago. It was something out of science fiction, but it happened. When the change is so radical – for society, for companies, for industry, everyone – it’s the moment to orient the recovery in a new direction.

When the change is so radical […] it’s the moment to orient the recovery in a new direction.

Will we see that kind of break?

The forces, mainly on the extreme right, that want to return to business as usual and stick to a fossil fuel economy are now in the minority. Across other political groups, in most EU countries (though not all), and even in the European Commission, this crisis is understood as a moment to build a future based on climate neutrality and digitalisation. Green proposals and ideas for recovery and resilience put forward during the crisis went on to shape the EU’s recovery package. Because when you rebuild an economy, you don’t think on a two or three-year timeline but look 20 or 30 years ahead. The ambitions and the timeline for the climate and the energy transitions are clear and they provide the direction to take.

What risks threaten these prospects for a green recovery?

The European Green Deal of course sounds great and ambitious but plans always sound nice on paper. The Greens have always taken a constructive but critical attitude while waiting to see what it means in practice. Coherence is the plan’s Achilles heel. The progress made through a biodiversity strategy and green investment can be completely undermined with agricultural reforms that don’t mandate the pesticide cuts you say you need and a trade policy that allows standards to be undercut.

Because when you rebuild an economy, you don’t think on a two or three-year timeline but look 20 or 30 years ahead

Another real question is how the recovery money will be used. EU countries are meant to invest in the green and digital transitions but how rigid will the oversight be? Will the focus be on a purely economic recovery rather than its ecological and social aspects? Social issues, health, and education have never played a major role in the European semester. On the contrary, EU countries were often encouraged to reduce public investment and, in the past, the European Commission even asked member states to privatise parts of their healthcare systems to save money. Let’s hope nothing similar will return and the investment goes where it should.

Belgium’s two Green parties entered government in October 2020 and Greens are in power in many other cities, regions, and countries around Europe. Does leaving opposition to govern in a crisis require some adjustment?

After only a short time in government, we are still getting used to it and many people in our party remain in opposition mode. When you make a deal to enter government, it becomes your programme even if it’s not your manifesto. The Belgian coalition agreement has many green elements and we held the pen for climate, energy, and mobility. Some other parts didn’t come from our programme but that’s what being part of a governing majority means. It takes a mindset shift after almost 20 years in opposition. In Belgium, the Greens are now in power at the federal level and in the regions of Brussels and Wallonia. In Ghent, a city close to my heart, they have been in power for six years. People see the effects on their quality of life and appreciate that Greens are not only dreamers. Moving from theory and opposition to making change happen is important.