Opinion

Health at the Future of Europe Conference: Lessons from the COVID-19 pandemic

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In the framework of the Conference for the Future of Europe, which will address issues such as institutional reform, starting with the election of the President of the European Commission, migration, the rule of law and citizen participation, health will play a major role, especially after the blow dealt to us by the pandemic.

Europe, in its position among the countries with the highest standard of living, has shown itself to be unprepared for a situation such as the one that unfolded in February 2020, which has demonstrated our weaknesses in an irrefutable and particularly cruel way.

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Most EU countries have health systems that have proven to be effective, as shown by indicators such as life expectancy at birth. This is where Spanish healthcare is at the forefront of Europe, because at least until before the pandemic, our life expectancy at birth was the second highest in the world, behind only Japan, and the overall Spanish healthcare system, according to the Bloomberg Global Health Index, was at the top of all countries in the world in 2019. The universality of more than 98% of the Spanish healthcare system could make it the model to follow.

However, within the framework of the European Union, we should have a homogeneous healthcare system in all members, both in terms of the portfolio of services and especially in terms of efficiency, quality and safety, to ensure excellent results and user satisfaction.

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The implementation of the European Health Insurance Card, which ensures emergency healthcare for all Europeans in all EU countries, has been a major milestone, but it is still limited by differences in the financing of each healthcare system, for example, when there are changes of residence. Ideally, all EU citizens would have the right to receive all types of health care in all EU countries. 

It is up to the legislators to determine how these differences in funding between members and the safe demands for care from citizens in countries other than their own would be compensated for.

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The COVID-19 pandemic has demonstrated the total lack of preparedness for such a situation. But, above all, it has demonstrated the absence of a common response by all the countries of the Union. Two obvious questions arise. First, how could we have responded better, and second, what lessons can we learn from the situation we have experienced?

I will try to answer both questions together.

In a pandemic situation, there are two priority actions. First, controlling the transmission of the infectious agent. And secondly, to ensure the best possible health care for infected individuals, avoiding hospital and primary health care collapses, and thus reducing the number of deaths or serious sequelae.

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In terms of controlling the transmission of infection, the first thing to do is to know as soon as possible which agent is responsible. In this respect, the results in the case of the COVID-19 pandemic have been spectacular. When cases had only been identified in China, we already knew that it was a SARS virus, which is transmitted by air and possibly by contact with contaminated surfaces, although this means is now in question, and that it is an infection with a very high lethality, although much lower than that of other viruses such as the Ebola virus. From this point on, it can be said that the mistakes began, first of all, of the potential experts, of their respective governments and of the supranational health organisations. When the World Health Organisation declared an international pandemic, the reaction should have been much quicker. It is fair to recognise that at that time no one was aware of what was to come, but we have learnt that it was not acted upon with sufficient diligence and without an idea of a united attitude.La UE puede emitir deuda desde hoy para financiar el Fondo de Recuperación

The European Union should have unified criteria and acted jointly. The availability and compulsory nature of individual protective equipment, which was essential for health workers in the initial stages of the pandemic, depended on each individual state. The measures of containment, restriction of movement, border closures and health controls, the only ones effective in slowing down the spread of the disease, would have been much more effective in a minimally coordinated European Union.

The appearance of vaccines, an exceptional event from a scientific point of view due to the speed of their development, was not accompanied by manufacturing and distribution measures in keeping with the Union's supposed industrial and economic power. Once again, individual interests, not of the countries themselves but of each of their respective governments, prevailed over the Community interest. It was more than obvious that it was not going to be possible to have the necessary number of vaccines to immunise a sufficient percentage of the population with the necessary speed. And yet the population continued to be knowingly misled. And as if this were not enough, doubts about the safety of vaccines have been made public based solely on exceptional, unverified facts, and on the basis of these, decisions have been taken that have only served to delay the administration of the available vaccines. These are the reasons why it is taking so long to get out of the situation of maximum gravity.

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Nor was there consensus from the outset on how to treat infected patients. Once again, the particular interests of governments and states prevailed over the general interest of saving as many lives as possible. It took too long for minimally effective treatments to become available, and sometimes ineffective and even harmful treatments have been used in disregard of responsible international bodies such as the World Health Organisation or the European Medicines Agency.

The lessons learned from this pandemic are so simple that those responsible should be ashamed of not having acted otherwise. A truly united European Union should always act jointly, swiftly, with actions based on scientific evidence and by calling on sufficiently informed people to take decisions, but especially in situations such as the present one in which the lives of many of our citizens will depend on these decisions.

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Another extremely important point is that of information. The differences between the members of the Union have also been reflected in the information provided to citizens. Information has not been prompt, but the most worrying thing is that it has often not been truthful. I cite as mere examples the need for protective measures, the real number of infected people and deaths, the availability and safety of vaccines. If the magnitude of the drama was not enough to worry the population, the information, often partial and in some cases clearly erroneous, only served to increase the levels of anxiety and distress. Accurate and unified information throughout the Union would have been of great help.

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The COVID-19 pandemic has highlighted the lack of health unity in the European Union. Let us draw conclusions that will be useful for health care as a whole in order to avoid differences in results and therefore in the efficiency of the respective health systems.

I do not wish to sound utopian, let alone visionary, but I believe that the real European Union will not depend solely on economic union, the disappearance of borders or the supposed agreements on external relations. Unity in health care is a goal that should be a priority. Designing health systems with similar financing, not forgetting the fair and as uniform as possible remuneration of health workers, would achieve a more efficient and fairer health system for all citizens. Developing a truly effective European Medicines Agency and collaboration in biomedical research, its development and innovation, providing the necessary means to put us on a par with countries such as the United States or China, will determine the place that Europe will occupy in the coming decades.

Antonio González, doctor and head of the Internal Medicine Department, Hospital Vall d'Hebron (Barcelona).