BRUSSELS — It’s officially August, which means the last Eurocrats are heading out of town to their favorite summer retreats, and most of Brussels is “out of office.”
But a few commissioners have the questionable honor of being on the summer roster, staying behind as the person on duty should an emergency arise. Former Commission chief Jean-Claude Juncker introduced the system in 2017 to show that the EU never sleeps, and his successor Ursula von der Leyen continued it. A rota is set up at the start of each five-year Commission term and covers all holiday periods, with each commissioner holding down the fort for 13 days. Von der Leyen and top EU diplomat Josep Borrell are exempt.
The official job description for the commissioners on duty recalls the theme of “Designated Survivor.” The assigned commissioner will be in charge if there’s an unexpected crisis and will maintain the “continuity of the Commission’s core tasks,” a Commission spokesperson said, adding that these include “coordination, decision-making processes and communication.”
But in practice, not much decision-making goes on in Brussels in August. “They’ll be sitting in the Berlaymont watching the rain from their windows,” said a Commission official who was granted anonymity to discuss internal matters.
Environment CommissionerVirginijus Sinkevičius (who at 32 is the youngest member of von der Leyen’s team) holds the keys to the Berlaymont this week following agriculture chief Janusz Wojciechowski, who was on duty last week.
Health Commissioner Stella Kyriakides will have to tear herself away from the beaches of Cyprus from August 5-11; then home affairs boss Ylva Johanssontakes the reins from August 12-18; and finally Equality Commissioner Helena Dalli will wrap up the roster for August 19-27.
Commissioners also rely on a core of officials from the EU executive’s key units, including the secretariat-general, legal service, communication department and spokesperson’s service. Everyone else is expected back in town for the next College of Commissioners meeting, scheduled for September 6.
Despite Brussels’ best efforts to preserve the sanctity of summer holidays, sometimes the outside world does come knocking — as the commissioners know all too well. Wojciechowski, Dalli and Johansson were on duty during the summer of 2021, when the Belarus migration emergency and the Taliban takeover of Afghanistan set EU capitals into motion.
When you’re feeling under the weather, the last thing you want to do is trek from pharmacy to pharmacy searching for basic medicines like cough syrup and antibiotics. Yet many people across Europe — faced with a particularly harsh winter bug season— are having to do just that.
Since late 2022, EU countries have been reporting serious problems trying to source certain important drugs, with a majority now experiencing shortages. So just how bad is the situation and, crucially, what’s being done about it? POLITICO walks you through the main points.
How bad are the shortages?
In a survey of groups representing pharmacies in 29 European countries, including EU members as well as Turkey, Kosovo, Norway and North Macedonia, almost a quarter of countries reported more than 600 drugs in short supply, and 20 percent reported 200-300 drug shortages. Three-quarters of the countries said shortages were worse this winter than a year ago. Groups in four countries said that shortages had been linked to deaths.
It’s a portrait backed by data from regulators. Belgian authorities report nearly 300 medicines in short supply. In Germany that number is 408, while in Austria more than 600 medicines can’t be bought in pharmacies at the moment. Italy’s list is even longer — with over 3,000 drugs included, though many are different formulations of the same medicine.
Which medicines are affected?
Antibiotics — particularly amoxicillin, which is used to treat respiratory infections — are in short supply. Other classes of drugs, including cough syrup, children’s paracetamol, and blood pressure medicine, are also scarce.
Why is this happening?
It’s a mix of increased demand and reduced supply.
Seasonal infections — influenza and respiratory syncytial virus (RSV)first and foremost — started early and are stronger than usual. There’s also an unusual outbreak of throat disease Strep A in children. Experts think the unusually high level of disease activity is linked to weaker immune systems that are no longer familiar with the soup of germs surrounding us in daily life, due to lockdowns. This difficult winter, after a couple of quiet years (with the exception of COVID-19), caught drugmakers unprepared.
Inflation and the energy crisis have also been weighing on pharmaceutical companies, affecting supply.
Last year, Centrient Pharmaceuticals, a Dutch producer of active pharmaceutical ingredients, said its plant was producing a quarter lessoutput than in 2021 due to high energy costs. In December, InnoGenerics, another manufacturer from the Netherlands, was bailed out by the government after declaring bankruptcy to keep its factory open.
Commissioner Stella Kyriakides wrote to Greece’s health minister asking him to take into consideration the effects of bans on third countries | Stephanie Lecocq/EPA-EFE
The result, according to Sandoz, one of the largest producers on the European generics market, is an especially “tight supply situation.” A spokesperson told POLITICO that other culprits include scarcity of raw materials and manufacturing capacity constraints.They added that Sandoz is able to meet demand at the moment, but is “facing challenges.”
How are governments reacting?
Some countries are slamming the brakes on exports to protect domestic supplies. In November, Greece’s drugs regulator expanded the list of medicine whose resale to other countries — known as parallel trade — is banned. Romania has temporarily stopped exports of certain antibiotics and kids’ painkillers. Earlier in January, Belgium published a decree that allows the authorities to halt exports in case of a crisis.
These freezes can have knock-on effects. A letter from European Health Commissioner Stella Kyriakides addressed to Greece’s Health Minister Thanos Plevris asked him to take into consideration the effects of bans on third countries. “Member States must refrain from taking national measures that could affect the EU internal market and prevent access to medicines for those in need in other Member States,” wrote Kyriakides.
Germany’s government is considering changing the law to ease procurement requirements, which currently force health insurers to buy medicines where they are cheapest, concentrating the supply into the hands of a few of the most price-competitive producers. The new law would have buyers purchase medicines from multiple suppliers, including more expensive ones, to make supply more reliable. The Netherlands recently introduced a law requiring vendors to keep six weeks of stockpiles to bridge shortages, and in Sweden the government is proposing similar rules.
At a more granular level, a committee led by the EU’s drugs regulator, the European Medicines Agency (EMA), has recommended that rules be loosened to allow pharmacies to dispense pills or medicine doses individually, among other measures. In Germany, the president of the German Medical Association went so far as to call for the creation of informal “flea markets” for medicines, where people could give their unused drugs to patients who needed them. And in France and Germany, pharmacists have started producing their own medicines — though this is unlikely to make a big difference, given the extent of the shortfall.
Can the EU fix it?
In theory, the EU should be more ready thanever to tackle a bloc-wide crisis. It has recently upgraded its legislation to deal with health threats, including a lack of pharmaceuticals. The EMA has been given expanded powers to monitor drug shortages. And a whole new body, the Health Emergency Preparedness and Response Authority (HERA) has been set up, with the power to go on the market and purchase drugs for the entire bloc.
But not everyone agrees that it’s that bad yet.
Last Thursday, the EMA decided not to ask the Commission to declare the amoxycillin shortage a “major event” — an official label that would have triggered some (limited) EU-wide action— saying that current measures are improving the situation.
A European Medicines Agency’s working group on shortages could decide on Thursday whether to recommend that the Commission declares the drug shortages a“major event” — an official label that would trigger some (limited) EU-wide action. An EMA steering group for shortages would have the power to request data on drug stocks of the drugs and production capacity from suppliers, and issue recommendations on how to mitigate shortages.
At an appearance before the European Parliament’s health committee, the Commission’s top health official, Sandra Gallina, said she wanted to “dismiss a bit the idea that there is a huge shortage,” and said that alternative medications are available to use.
And others believe the situation will get better with time. “I think it will sort itself out, but that depends on the peak of infections,” said Adrian van den Hoven, director general of generics medicines lobby Medicines for Europe. “If we have reached the peak, supply will catch up quickly. If not, probably not a good scenario.”
Helen Collis and Sarah-Taïssir Bencharif contributed reporting.
Three years into the COVID-19 crisis, which upended lives across the globe and led the EU to promise to work better together when the next health crisis emerged, countries have once again been involved in a political tug-of-war.
China’s decision to lift its zero-COVID policy has led to a surge in cases that has alarmed the world. But early attempts at a joint EU response were dashed when Italy announced its own border control measures on arrivals from China.
While the EU is now inching toward a coordinated approach on travel measures for arrivals from China — including pre-departure testing, masks on flights and testing wastewater for possible new variants — and is set to hold a meeting of its crisis response body on Wednesday, it comes after countries one-by-one announced unilateral measures for travelers arriving from China.
“It is disappointing to me that — despite three years of pandemic — there still is not a coordinated EU united response,” said Marion Koopmans, head of the Erasmus MC’s department of viroscience.
So why did European unity fall at the first hurdle? Here’s what you need to know.
What measures are in place for arrivals from China?
Here’s a brief rundown of a fast-moving situation. Most countries have announced some form of testing, with Italy testing travelers arriving from China and isolating those that are positive. Spain is testing and carrying out temperature checks, and from Tuesday, imposing COVID certificates, and France requires negative tests before traveling from China, masks on planes and PCR tests on arrival for all passengers.
Sweden became the latest EU country to announce plans to implement restrictions, saying Tuesday that it was “preparing to introduce travel restrictions requiring a negative COVID-19 test for entry to Sweden from China.”
Across the Channel, the U.K. announced Friday it would require a negative test before travel and would also be taking samples from arrivals.
Belgium, however, has taken a different tack, testing the wastewater from planes twice a week and sequencing the samples to search for new variants.
All this could change on Wednesday, however, with the EU’s crisis response body meeting to discuss (finally) a coordinated response.
A Chinese traveler leaves the arrival hall of Rome Fiumicino airport on December 29, 2022 after being tested for COVID-19 | Filippo Monteforte/AFP via Getty Images
Why the different responses?
There are multiple factors at play — bitter experience, fear of new variants, concerns about China’s secrecy, and good old economics.
Italy, the first to strike out alone, has said its rules will ensure “surveillance and identification of any variants of the virus in order to protect the Italian population.” This decision seems to be driven by the psychology that Italy was hit incredibly hard by COVID-19 in 2020, said Elizabeth Kuiper, associate director and head of the social Europe and well-being program at the European Policy Centre think tank.
France has justified its decision by saying the government has taken “health control measures in order to ensure the protection of the French population.” As well as testing, they will also be sequencing positive test results to screen for new variants, according to the prime minister, Elisabeth Borne, potentially belying a mistrust of information coming out of China.
Over in the U.K., the government has no qualms about saying its decision is due to the “lack of comprehensive health information shared by China.” The health ministry said that if there is an improvement in the sharing of information and greater transparency “then temporary measures will be reviewed.”
Others have held back. For Austria, which has so far resisted pressure from countries like Italy to coalesce around bloc-wide travel measures, any restriction on China arrivals would be a massive blow. The Austrian government has said that China’s reopening “heralds the return of the most important Asian source market for the coming tourism seasons.”
This is “a clear example of how countries are trying to balance the economic consequences of COVID and public health concerns,” said Kuiper.
Didn’t EU countries agree to work together?
One of Europe’s key lessons from the pandemic was supposed to have been to respond collectively to health threats. It was so important to countries that the EU Health Union was established. But the disagreements over China show that the “default to knee-jerk national responses hasn’t entirely gone away,” said Paul Belcher, consultant in European public health and adviser to the European Public Health Alliance.
This disorderly response has raised questions over whether EU coordination has taken the right form. A central part of the EU Health Union is the Health Emergency Preparedness and Response Authority (HERA), which was established precisely to enable Europe to respond quickly and appropriately during a health crisis. But it sits within the European Commission rather than independently — which has tied its hands somewhat, argued the European Policy Centre’s Kuiper.
“If HERA would have been an independent agency, they could have taken a stronger EU position concerning the need for travel restrictions for passengers coming from China,” Kuiper said. Without this leadership, countries have taken measures based on national motivations, she said.
Can we believe Chinese data?
WHO chief Tedros Adhanom Ghebreyesus said that in order to make a comprehensive risk assessment of the situation on the ground the WHO “needs more detailed information” | Fabrice Coffrini/AFP via Getty Images
Concerns about China’s transparency on COVID-19 are nothing new but as the country opens its borders, even the World Health Organization, which usually declines to point the finger at specific countries, has called for more information.
WHO chief Tedros Adhanom Ghebreyesus has said that in order to make a comprehensive risk assessment of the situation on the ground the WHO “needs more detailed information.”
What China is doing is sharing genetic sequence data on the international database GISAID, “which is laudable,” said David Heymann, professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine. “But they are not sharing the epidemiological data that will help understand the transmissibility and virulence that goes along with each sequence information and thus leaving a gap in our understanding,” he said.
Meanwhile, China isn’t pleased with the global response. “Some countries have implemented entry restrictions targeting only Chinese travelers. This has no scientific basis, and some practices are unacceptable,” a spokesperson said.
What does the science say?
“There is no scientific consensus on what to do, whether it makes sense to test everyone at arrival or not,” said Steven Van Gucht, head of the scientific service of viral diseases at the Belgian national institute for public and animal health. “The current discussion is a mixture of the scientific debate, but it’s also political.”
One of the major concerns is that new variants could emerge from China. Some scientists say this is unlikely as China is behind the curve on new variants. “Because China’s variants have been and gone in the rest of the world, the threat of these viruses coming back out of China and causing waves is pretty unlikely,” said virologist Tom Peacock of Imperial College, London. Initial sequencing out of Italy has indicated that there were no new COVID variants among Chinese visitors.
Koopmans said that — based on what has been shared so far — the variants circulating in China are not so different from what’s being seen in other parts of the world, but “there are no reasons to assume they are ‘less fit.’”
However, if a new variant did emerge, it’s unlikely travel restrictions would completelystop the spread. For Koopmans, travel restrictions “in the past have shown they are not very effective at delaying transmission of variants.”
One way of quickly spotting the arrival of new variants without targeting individual passengers is to test wastewater from toilets on airplanes or at airports, something that European Health Commissioner Stella Kyriakides has called for — and which is on the table for Wednesday’s meeting.
It didn’t take long for EU countries to abandon the biggest lesson of the pandemic.
The principle of collective response to health threats, which underpins the European Union’s so-called Health Union, was ignored at the first sign of trouble.
All it took was a surge in COVID cases in China for several EU countries to go their own way and implement travel measures that the bloc’s scientific experts have criticized as “unjustified.”
With China abandoning its zero-COVID policy, countries such as the U.S. and Japan have tightened border controls for travelers from China. Italy was the first EU country to act, imposing mandatory testing for travelers arriving from China, leaving the EU to scramble to get ahead of another disjointed bloc-wide response that marked some of the early days of the COVID-19 pandemic.
A meeting of the EU Security Committee on Thursday resulted in countries deciding to not take any joint measures on travel, with the Commission tweeting that “coordination of national responses to serious cross border threats to health is crucial.” But that hasn’t stopped Spain from imposing its own measures, with the health ministry announcing Friday that travelers arriving from China need to be fully vaccinated or have a negative test.
The fear from countries like Italy, the U.S., Japan and now Spain is that China could be a breeding ground for new variants. But the current scientific opinion is that this is unlikely, given that China is way behind the curve when it comes to variants and those that are present in China won’t be able to compete with the strains circulating outside the country.
But that’s not stopping an EU political spat from kicking off.
With Italian Prime Minister Giorgia Meloni urging the EU to take joint action, acknowledging that action by Italy alone “may not be completely effective unless it is taken by the whole EU,” she’s being joined by prominent EU parliamentarians. The head of the European Parliament’s center-right bloc, the European People’s Party’s Manfred Weber, has called for bloc-wide mandatory testing for travelers from China.
Knee-jerk responses
There are echoes of earlier national differences on COVID policies, “with more competition rather than coordination about what to do,” said Paul Belcher, consultant in European public health and adviser to the European Public Health Alliance. But Belcher said this was finally overcome with joint approaches on things such as vaccines and new EU structures that made decision-making processes easier.
These included the new EU Health Union, which is meant to ensure better health security coordination when a crisis hits. The underpinning principle? Prepare and respond collectively.
Now, the disagreements over China “show that this default to knee-jerk national responses hasn’t entirely gone away,” said Belcher.
EU countries aren’t done with discussing the issue. POLITICO’s Brussels Playbook reports that the Council’s so-called integrated political crisis response mechanism — the EU’s defacto crisis forum — will take place next week.
Patients in the lobby of the Chongqing No. 5 People’s Hospital in Chongqing | Noel Celis/AFP via Getty Images
European Health Commissioner Stella Kyriakides also indicated to health ministers in a letter sent Thursday evening that the situation was “evolving.” She said that countries should assess their national practices regarding genomic surveillance of the virus — and to scale up capacity if needed — plus implement wastewater surveillance, including sewage water from airports.
“If a new variant of the SARS-CoV2 virus appears — be it in China or in the EU — we must detect it early in order to be prepared to react fast,” Kyriakides said in the letter seen by POLITICO. Guidance from the Commission is also on its way.
Where Kyriakides did express concern was with the lack of reliable epidemiological data coming out of China. The health commissioner has also reached out to her Chinese counterparts and offered public health expertise including variant-adapted EU vaccine donation.
China’s secrecy is also a concern raised by World Health Organization Director General Tedros Adhanom Ghebreyesus, who has called for “more detailed information” from China.
“In the absence of comprehensive information from #China, it is understandable that countries around the world are acting in ways that they believe may protect their populations,” he tweeted.
