Until March 2020 and the emergence of the COVID-19 pandemic in Europe, the concepts of ‘sovereignty’ and ‘strategic autonomy’, used at European level, often referred to a French specificity developed during the Cold War with the aim of independence from the two blocs.
Now, and it must be welcome, these concepts finally go beyond French borders and international relations stricto sensu. Unable to produce sufficient surgical masks, to equip hospitals with ventilators, or to treat adequately some patients due to a lack of medicines, Member States have understood that the concept of ‘strategic autonomy’ applies to all of them, and should be extended to the health sector.
The difficulty? Defining health as a strategic area to ensure a robust pharmaceutical supply chain in Europe has three concrete implications, which are in strong opposition to some European dogma:
1. Competition rules must be put into question when the most vital interests of States — such as the health of their population — are at stake;
2. The European Union must become a political power capable of proposing levers to respond to the challenges and threats to its vital interests;
3. Member States must be able to set aside their own competences when it comes to improving cooperation to defend these vital interests.
Let us not be naive, in strategic sectors, the other powers of the world — Russia, China, the United States — do not focus on the principles of free competition. State aids support innovation and research, private companies and the development of their supply chains.
At European level, the same must be done: if it is a matter of protecting the pharmaceutical industry or encouraging a company to set up or maintain its business in Europe, Member States should be allowed to intervene by means of fiscal or financial incentives.
In particular, the COVID-19 pandemic has demonstrated that security of supply must be a priority criterion as prices in attribution of tenders. It should be a key criterion in order to better diversify sources of supply, and thus reduce the dependence of certain products on certain industries and/or geographical areas.
The launch of Important Projects of Common European Interest (IPCEI) is a step in the right direction. Since, January 1st 2022 it allows Member States to circumvent State aid rules in order to address market failures.
The European Union must also assert itself as a political power capable of offering structural solutions to Member States when its strategic interests are at stake.
Two of them appear to be fundamental: the stockpiling of medicinal products and medical devices of public health and strategic interest as wells as the creation of non-profit pharmaceutical establishments of general interest.
As regards strategic stocks, the European Commission announced their creation in March 2020. Once fully operational, they will have to cope with possible tensions on supply chains. In parallel, some old medicines are no longer produced, because they are not profitable enough even though they remain essential for public health. The establishment of pharmaceutical establishments should be considered to produce such medicinal products of strategic and health interest and to ensure their security of supply in any event and at all costs.
The Commission will present its “Market Emergency Instrument” next March. Let us hope that this new regulation will be ambitious, and will respond efficiently and rapidly to existing disruptions in supply chains and possible future shortages.
These two measures will not be able to achieve their objectives without further cooperation between Member States and European integration in health matters.
The joint procurement of COVID-19 vaccines is a resounding success demonstrating the added value of European cooperation. There are now more citizens vaccinated in Europe than anywhere else in the world.
Even better, Europe has become a true vaccine factory, becoming the world’s largest exporter, able to send half of its production abroad, a sine qua non condition for ending the pandemic.
Finally, while more cooperation between Member States is needed, there is also a need to strengthen public-private partnerships. Increasing European research capacities is crucial: let us believe in the innovative power of the Old Continent!
Thus, ensuring a robust and safe supply chain for pharmaceuticals in Europe requires broadening the concept of strategic autonomy to the health sector. This enlargement has implications which some will consider to be totally opposed to the fundamental principles of the functioning of the European Union. I call on them not to be afraid to break taboos in order to grant citizens better performing health systems, better equipped to withstand competitive pressures, and better able to anticipate and respond to possible future health threats!