In a Europe without borders, a virus spreads more easily than elsewhere. Although the EU has acknowledged this fact on several occasions, member states do not want to relinquish their sovereignty in the field of public health. The EU agency established after SARS is but a shadow of its American counterpart.
On Saturday 14 March, inhabitants of the Zeeuws-Vlaanderen region of the Netherlands witnessed at first hand what can happen if each EU country adopts its own coronavirus policy. People who were no longer able to visit bars and restaurants in Belgium flocked to Dutch border towns such as Sluis which, according to the local newspaper Provinciale Zeeuwse Courant, was ‘swarming’ with Belgians.
On Sunday, Dutch Public Health Minister Bruno Bruins ordered a lockdown of all bars and restaurants. He explained at a press conference that ‘café tourism’ from Belgium to the Netherlands was the motive behind this measure.
The next day, the public safety body Veiligheidsregio Zeeland called on the Dutch Cabinet to liaise more closely with Belgium. ‘We must prevent incidents such as these from happening again,’ said Rob van der Zwaag, mayor of the town Veere.
In an email, a spokesman for the Belgian Federal Crisis Centre told Follow the Money that his organisation was in daily contact with its Dutch counterpart and the two countries’ embassies. But he did not clearly state whether Belgium had given the Netherlands prior notice of its decision to close the bars, which was announced on March 12.
That same weekend, an editorial in the Dutch paper de Volkskrant highlighted the major European differences in approach. ‘How come Spain puts entire municipalities in quarantine, and the Netherlands doesn’t? How come the Czech Republic suspends almost all incoming air traffic, including that from other EU nations, and most other countries don’t? Why are only one hundred people allowed to congregate in the Netherlands, whereas the number is five hundred in Sweden and one thousand in Germany?’
The EU harmonises rules in so many policy areas that the Volkskrant commentator apparently expected member states to coordinate their pandemic measures properly: ‘What is worrying is the total lack of European coordination that came so clearly to light this week.’
This is not the first time that the outbreak of a contagious disease has led to calls for ‘more Europe’. However, the answer has been the same every time: member states may want to share more information, but Brussels must not be allowed to interfere with their sovereignty in the field of public health.
By their own choice
If you think that the European Union isn’t doing enough against the coronavirus, you should be aware that member states themselves made this decision. The Dutch MEP Sophie in ’t Veld recently said in the newspaper Algemeen Dagblad: ‘The member states refuse to do this, and that’s where the buck stops. So why isn’t Europe doing anything? Well, because you didn’t want it to.’
A borderless Europe allows free movement of people, and also free movement of viruses
The EU can take action only if the member states have decided to share powers in a specified policy area. According to Helmut Brand, professor of European public health at Maastricht University, ‘Europe can only be as strong as its member states allow it to be. The member states have made it clear that they want to retain their power in the field of health and social security.’
However, the coronavirus does not take any notice of the EU legal framework. A borderless Europe allows the free movement of people, and also free movement of viruses.
Previous outbreaks of contagious diseases led to calls for a European response. In 2003-2004, following the SARS coronavirus outbreak, the EU decided to establish a European Centre for Disease Prevention and Control (ECDC). The European Commission’s 2003 proposal, and Dutch parliamentary letters, stressed the link with SARS.
‘Migration and tourism allowed the SARS virus to spread from a small village in China to Europe, North and South America and Asia in just a few weeks,’ the proposal stated. ‘Rapid action is particularly important in the European Union. Products and people can move freely across member states, and internal border controls have been abolished.’ The Commission thus recognised that open borders increase the EU’s susceptibility to the spread of infectious diseases.
The ECDC was supposed to become the successor to a cooperative network between member states that has existed since 1998. ‘SARS has created the momentum to improve the relatively informal cooperation between member states by establishing a European counterpart to the American Center for Disease Control,’ wrote Minister of Social Affairs and Employment Aart Jan de Geus on November 21, 2003, on behalf of Health Minister Hans Hoogervorst. A month later, Hoogervorst wrote that the SARS outbreak was a ‘wake-up call’ for the Netherlands: ‘It’s important that it will become an independent centre with the best specialists in the field of infectious disease control.’
The ECDC was formally established on April 21, 2004, with a mandate to ‘to identify, assess and communicate current and emerging threats to human health from communicable diseases’. However, the founding regulation stressed that the centre was not given ‘any regulatory powers’.
Its choice of name was therefore partly bravado. The ECDC is not a fully-fledged European counterpart of the CDC in the United States, as described in De Geus’ letter of 2003. The CDC has many more tasks, many more staff, and a larger budget. It employs approximately 10,000 people, while the ECDC’s Stockholm headquarters has 180 full-time workers. That number is already lower than seven years ago, when it had to cut 18 jobs as part of an EU-wide cutback.
Fewer staff, more stress
This has operational implications, the ECDC has been warning in its work programmes. Last January, it reiterated that staff feel ‘overwhelmed’ by their workload, stating in its annual programme that ‘prioritisation of activities is crucial to avoid increased stress levels among staff’.
That month, the organisation also published two employee satisfaction surveys, from 2017 and 2019. The proportion of dissatisfied employees was found to have risen slightly. In 2017, 67 percent said they agreed that the ECDC was a great place to work; last year 64 percent agreed and 15 percent disagreed. Also, the proportion of respondents who would recommend the ECDC as an employer fell from 52 percent in 2017 to 48 percent in 2019.
The ECDC’s headquarters in Stockholm. Image: European Union
The ECDC has to make do with an annual budget of around €58 million, a pittance compared to the CDC's $7.3 billion. Even compared to the Dutch National Institute for Public Health and the Environment (RIVM), which has about €350 million a year at its disposal, it is not much. On the other hand, the ECDC has fewer responsibilities.
The budgets for EU agencies like the ECDC are determined every seven years, in negotiations on the so-called multi-annual budget of the EU. This year is the last of the current period: the next one runs from 2021 to 2027. These negotiations started with a Commission proposal in May 2018 containing the broad outlines of the budget; how much each agency should receive has not been made public.
Internal figures from the European Commission, seen by Follow the Money, show that the Commission wanted to reduce the ECDC’s budget slightly, from €400 million to €397 million, every seven years.
A spokesperson stated that the Commission based its proposals for agency budgets at the time on a ‘requirements assessment’ and the implications of Brexit. However, since the coronavirus outbreak, it has decided to amend its proposal. ‘Just as the world looks very different now from a few weeks ago, so should our budget,’ Commission president Ursula von der Leyen commented in an opinion piece.
For this year, the Commission wants to make more funding available for the ECDC. Because the EU cannot borrow money, it has to cut back elsewhere. The Commission proposes increasing the ECDC’s budget by €3.6 million this year, by cutting back on animal welfare programmes. The member states and the European Parliament have yet to agree to this. A spokesperson for the Croatian EU presidency expected the procedure to be finalised during a plenary session of the European Parliament on 16 and 17 April.
Not equally relevant for every member state
The increase in the ECDC budget is a reflex that Professor Helmut Brand has observed before. Before joining Maastricht University in 2007, he headed the Institute for Public Health in the German state of North Rhine-Westphalia . During crises, politicians want to act decisively, he says, so they increase the budgets of existing bodies.
If member states don’t want to expand the tasks of the ECDC, what’s the money for?
But Brandt has doubts about the effectiveness of more money without more powers. ‘If member states don’t want to expand the tasks of the ECDC, what’s the money for?’
The centre’s main role during the coronavirus crisis is to collect and disseminate information. For example, it is an important source for RIVM guidelines for municipal health services and hospitals, and also keeps track of infections throughout Europe. However, the ECDC is at the end of the information chain, dependent on reports from member states. Brand believes that it would be better to invest on a local level in order to speed up the reporting of new illnesses and deaths.
The ECDC does its job very well, according to Brand’s Maastricht university colleague Timo Clemens, a lecturer and PhD researcher on the EU’s influence on healthcare. ‘It’s quite efficient, and has a high output considering its limited budget,’ he says. This is mainly because the ECDC also has the knowledge of seconded staff from national healthcare institutions at its disposal. Yet the centre is not equally relevant to every member state.
‘If you look at Germany, with its 80 million inhabitants: that country already has all the experts it needs,’ says Brand. member states like Bulgaria and Romania benefit much more from the centre. According to Brand, it has raised the level of knowledge in smaller and poorer member states over the past decade, and we are now much better informed about what is going on in Europe.
One size fits all?
The ECDC has no mandate to take specific action during epidemics. Perhaps that’s a good thing. ‘I don't think European citizens would accept that. How would you feel if, all of a sudden, Swedish speaking people wearing ECDC jackets visited your city and asked who you’ve been in contact with?’, Brand says. There are major differences between EU member states, both geographically and in terms of national character. The borders of an island such as Malta or Cyprus are much easier to close than Germany’s frontiers with nine other countries. According to Brand: ‘One size fits all doesn’t work.'
The EU’s public health ministers do consult, through video conferencing, and so do their subordinates on the Health Security Committee. But they don’t make joint decisions. The spokesperson of the Belgian National Crisis Centre says that each country places ‘different emphases’ when taking measures, ‘regardless of the desire to coordinate national responses’.
Pro-European federalists often look longingly towards the situation in the United States, with its highly centralised agencies. But there are also big differences within the US, and the fifty states have a great deal of freedom to shape policy as they see fit.
However, despite the creation of the ECDC, the call for more European coordination in the wake of disease outbreaks has become urgent. For example, in December 2011, the European Commission published a document in which officials described the problems in addressing serious cross-border health threats at EU level. This was two years after Europe was hit by the H1N1 pandemic, with member states competing for scarce vaccines.
Without coordination at EU level, the document stated, member states can take their own, sometimes contradictory measures in the event of a public health crisis, for example with regards to closing borders, quarantining, or providing travel advice. ‘The result will be crisis management at EU level that is ineffective and inefficient; public trust in national authorities and in those EU institutions with public health responsibilities will be undermined and, lastly, there may be important repercussions on other EU policies (free movement of persons and products, energy, transport).’
The Commission document appeared as an annex to a proposal for new arrangements on a streamlined response to any new pandemic. It proposed giving member states power to take European measures if national ones did not work. This was not accepted by the member states. When the Decision on Serious Cross-Border Threats to Health was published as legislation in 2013, it was a watered-down version of the already cautious Commission proposal.
In December 2011, the Commission proposed new rules on serious cross-border threats to health, in the form of a so-called Decision of the European Parliament and the Council. This was intended to ensure that member states would coordinate their measures more effectively in the event of a pandemic, for example. If individual states’ measures were not sufficient, the Commission should be able to intervene. The national governments, whose approval was required, didn’t really want the latter to be the case.
Dutch Health Minister Edith Schippers wrote in a parliamentary letter in March 2012: ‘The starting point for the Netherlands is that public health is [and remains] a national responsibility, even in times of crisis management (...), and that the EU’s action is complementary to it.’
A comparison between the Commission’s 2011 proposal and the Decision, ultimately published in the EU’s Official Journal in 2013, shows how member states have watered down the legal texts.
For example, the European Commission proposed: ‘Effectively responding to serious cross-border threats to health at national level requires consultation among member states, in conjunction with the Commission, with a view to coordinating national responses and necessitates exchange of information.’
After the Council had heavily revised it, the text became: ‘Effectively responding to serious cross-border threats to health at national level could require consultation among member states, in conjunction with the Commission, with a view to coordinating national responses and could necessitate exchange of information’.
Other sentences were also made more non-committal. At the same time, references to ‘Member State needs and circumstances’ were added, as well as phrases such as: ‘The member states have a responsibility to manage public health crises at national level.’
Some articles were even deleted altogether, such as a proposal to allow the Commission to adopt temporary EU-wide measures if national action was not sufficient. Health ministers decided that they did not want to give the Commission ‘the possibility to take common temporary public health measures.’
The Decision requires member states to inform one another before taking any measures, but also allows countries to deviate from it. ‘If a member state intends to adopt public health measures to combat a serious cross-border threat to health, it shall, before adopting those measures, inform and consult the other member states and the Commission of the nature, purpose and scope of those measures, unless there is such an urgent need to protect public health that measures must be adopted immediately.’
Belgium only has to refer to those last seventeen words to defend its failure to inform the Netherlands about the sudden closure of bars and restaurants.