The EU, Covid-19 and the State of the Health (Dis)-Union

• In Event: COVID-19 and Disparities (Pre-Recorded)

Abstract

Covid-19 has brought under the spotlight the contradictions and limits of our societies and institutions. While the European social model may have proved an asset in the pandemic containment across many dimensions starting from public healthcare to advanced welfare and unemployment systems, the old continent has been especially hit by the inadequacy of European Union governance across two key areas for Covid-19 response: health and fiscal policies. The austerity paradigm directing fiscal approaches in the EU especially since the Great Recession has been long debated in the literature as having detrimental social effects, especially for weaker economies within the Union. Health has as well been at the forefront of the supranational squeeze on domestic spending within the EU, especially for countries in more precarious fiscal positions. At the same time, the health policy area remains in the near exclusive hands of the Member States, with a limited coordination role carved by the treaties for the supranational level. Such predicament has proved especially sub-optimal in the context of a naturally transnational challenge as Covid-19, with early cries for improved cooperation and coordination crashing against limited institutional capacity and decision-making power at the supranational level. Against this far from rosey background the paper investigates (i) how the governance framework has contributed to the (limited) preparedness of healthcare system especially in periphery regions leading to permaining heterogeneity in the domain across Member States and (ii) how such background has contributed to shape likewise heterogeneous and divergent outbreak and containment efforts (and outcome) across the EU Member States in (iii) deriving some insights in relation to the current debate on progress toward an Health Union concerning whether proposals overcome governance weaknesses and allow for effective joint coordination mitigating inequalities and equipping the Old Continent to better face transnational health challenges. In answering these interrogatives the paper takes a mixed methods approach. Starting from the analysis of the contribution of EU governance to (negative) trends in health spending and geographical heterogeneities in the matter, the paper quantitatively characterises Member States healthcare, demography and spatial characteristics at the onset of the pandemic uncovering linkages between outbreak severity, containment measures, vaccine roll-out and outcomes both in human and economic terms. In doing so the analysis combines information of all the mentioned dimension from secondary sources across Eurostat for pre-pandemic backgrounds, the European Center for Disease Prevention and Control (ECDC) and John Hopkins COVID-19 Data Repository for outbreak and vaccination data, the Oxford Covid-19 covid response tracker for enacted containment measures and European Commission estimates for current and post-pandemic economic outlooks. Considering a rich and multifaceted set of data, the analysis performs dimensionality reduction by way of Principal Component Analysis (PCA) to uncover the connection between input factors, outbreak dynamics and outcomes. At the same time, the analysis maps heterogeneity in where countries - and geographical subgroups - fit across the emerging components of the Covid-19 outbreaks and responses. In addition, heterogeneity in performance in vaccine roll-out - accounting for cross-country differences, for example, in outbreak severity and progression, allows to investigate how far the EU remains from converging away from health inequalities even within an area in which unprecedented effort and progress has been made in jointly tackling the battle against Covid-19. Against the backdrop of the findings, the analysis further distinguishes across the early phases of the pandemic and the later stages in considering descriptively whether heterogeneity has somewhat decreased and in which variables or subgroup of countries convergences emerges across subsequent waves. Qualitatively, the paper maps findings to the political context at the EU and national level to draw some insights on governance weaknesses and preconditions for improvement of convergement in health crisis-management and inequalities, putting forward a preliminary policy evaluation of proposed reforms in the context of the Health Union debate. From an EU affair perspective, the contribution furthers the assessment of heterogeneity, convergence prospect and governance reform in the health arena, making the case for further coordination at the supranational level. Beyond the old-continent, the paper allows to develop a rich understanding of pandemic dynamics against the backdrop of challenges that span beyond the level of governance onto which the vast majority of the decision-making and implementation falls, of partial relevance also for national federal contexts.

Authors

• Carlo Maria Palermo

• Matilde Ceron, University of Milan