Saving Lives Through Participatory Democracy

Vytenis Povilas Andriukaitis


Ladies and Gentlemen, members of the Council of the Participatory Democracy,

The COVID-19 pandemic revealed limits of preparedness to mitigate negative impact of health emergencies on people health, on economic growth, employment, fiscal balances, international trade, free movement of people.

The EU is now at crossroads to respond to health, economic and social crisis. It can choose to continue doing business as usual with some improvements of todays’ tools or it can take on more responsibility by strengthening the Treaties in the field of health at the EU level.

How can we, drawing lessons from the current crisis, create a resilient EU that can move forward with confidence and vitality, keeping in mind peoples’ health, wellbeing and quality of life?

Each health crisis, as with BSE, SARS, Ebola – has added a health policy layer and created new institutions. So, in the face of this crisis, we need to take forward new EU competences in the field of health, as well as the other areas of EU policy with impact on health. Both directions of the reform should form an important part of the forthcoming Conference on the Future of Europe to be held next year.

Let us be clear: the challenge is not to make the EU i.e. BRUSSELS responsible for all matters in health but to find the right form of integration and cooperation for the EU and its member states to act more effectively together in health in both “normal” and pandemic times.

The fact that a term “A European health Union (EHU) was coined in spring 2020 and a few months later catapulted to the rank of the official EU policy. In her first annual State of the European Union address, European Commission President Ursula von der Leyen said the coronavirus pandemic had underlined the need for closer cooperation in health.

“For me, it is crystal clear – we need to build a stronger European Health Union”, she said.

And for me is also crystal clear, that a Europe where all people are as healthy as they can be throughout their lives is possible. If we are thinking about participatory democracy and citizens led debates about our Future of Europe, we all can agree, that to be as healthy as possible as long as possible is the main human right.

In all European Nations life and health is one of the most important pillars of wellbeing. Value of health is the cultural backbone of our civilization.

From the very beginning, the European project was about saving lives. When the French foreign minister Robert Schuman delivered his famous Declaration on 9 May 1950, he was outspoken about the importance of eliminating war in Europe. 70 years of peaceful development of the continent is proof that his project for peace, for saving lives, works.

For many years Eurobarometer indicates also clear preference of European citizens to do more for health and Europeans are demanding more pan-European actions for health.

Unfortunately, until recently, development goals such as saving lives, promoting good health and longevity were out of the radar of big European policy.  For decades health-related matters were considered by the EU almost exclusively as business of Member States or quasi markets. Until COVID-19, health remained a minor topic in the European Treaties, the European Semester or the EU Budget. The “EU does not take action” prevails” unless it is more effective than action taken at national, regional at local level” – this is how in usual everyday practice subsidiarity principle and role of the EU in health is interpreted.

The SARS-CoV-2 pandemic has shaken Europe. The experience of the pandemic has shed light on the weaknesses of existing mechanisms for collaboration among Member States and with the European institutions. The Pandemic triggered strong public health response on national and the EU levels as well as inspired rethinking of the role health plays in European politics.

During the European Health Forum Gastein 2020 the change of political sentiments was nicely described: “Health has been the Cinderella of public policymaking for a long time, nobody would listen, and we never got to go to the ball. Now we are the equivalent of the princess at the ball and everyone wants to dance with us”.

To many Europeans, including patients, healthcare practitioners and progressive societal leaders it is crystal clear that health is a big issue, and we have to seize this window of opportunity to ensure strong public action to transform the cooperation at the EU level.

Apart of being the EU as a block that only cares about single market, monetary, banking or fiscal union, the EU should evolve as the Union were lives and health of all residents matters.

Following the idea about possibility to build the European health Union, we elaborated the Manifesto. It is a reflection on the role health currently plays as well as a call to look to the future after the pandemic will be over, a call to consider the health as a rightful partner of a European ball after a bell tower watch will strike a midnight.

The success of the Cinderella will not stop with the end of pandemic but the path EHU is going to be developed is not designed jet.

I would like to highlight some suggested features of the future European Health Union:

  1. The role of health policy in the European Treaties will be reconsidered and strengthened. The objectives to keep in mind are: more proactive and preventive health, more solidarity in public health activities in Europe, more cooperation to build resilient health care and cure systems. No longer will laws with important consequences for health be adopted as part of the EU’s market building objectives.
  2. There will be sufficient capacity to safeguard EU solidarity, as when there are shortages of medical supplies simultaneously facing Member States. The EU will be empowered in some areas to ensure centralized distribution of emergency medicines, orphan drugs or medicines for rare cancer treatment and supplies based on medical needs.
  3. Cross border healthcare directive is not enough. We need the EU to share responsibility in “care and cure” in the areas of rare cancers and rare diseases while preserving subsidiarity as a core principle. We need the European health insurance Fund to cover rare disease and to assure that the pledge “no one left behind” is reality in Europe. None of the European countries alone is capable to assure universal health coverage for all up to 30 million EU patients suffering from rare diseases. The European Union can do it.

Different scenarios can be envisaged to develop EHU. If we will follow today’s existing constraints and legal limits, enshrined in the Treaties and coping only with COVID19, the two scenarios can be envisaged to develop weak or quasi EHU:

a) scenario ”a” – measures to make progress in health concentrate on what can be done with existing legal, financial, procedural and managerial instruments, upgrading already functioning institutions, and improved implementation of already agreed policies.

b) scenario “b” – fine tuning of existing instruments of health policy in parallel to the development of secondary legislation and establishment of new institutions that can create added value for European health. The scenario does not foresee amendments to the European Treaties.

But if we are looking into the Future of Europe and are thinking about stronger role of the EU in health and if the political will of European citizens is decisive to build strong European health Union, than we need to go to the third scenario:

c) scenario “c”– where the status of health policyin the European Treaties is strengthened, with provisions for a European Health Union incorporated into the Treaty on European Union and amending the Treaty on the Functioning of the EU, giving the European Union some competence in health policy in very concrete areas, while preserving the principle of subsidiarity as a core.

The Manifesto is calling European Leaders to consider a scenario “c” the most ambitious one.  By opting for scenario “a” or “b” Europeans would restrict the benefits they would obtain from deeper cooperation on health. The Manifesto encourages an inclusion of The European Health Union into the agenda of the Conference on the Future of Europe.

The Counsel of Health Ministers (2.12.20220) presented moderate support to the development of EHU according to the path similar to scenario “a” with some elements of scenario “b”.  This is a step forward in comparison to the political trajectory that prevailed just one year ago and a background to hope for even a stronger evolution of European health policy in the future.

Currently health is absent from main articles of the Treaty on the European Union (TEU) and appears only on Article 6 of the Treaty on the Functioning of the EU. (TFEU). In Article 6 of the TFEU you can find “The Union shall have competence to carry out action to support, coordinate or supplement the actions of Member States”. This is the main restrictive regulation which don’t allow to have more stronger EHU.

First of all we need a more “healthier” face of an article 3 of TEU. Let us amend a part 3 of article 3 which starts with “The Union shall…” by one sentence:


‘Article 3



3. The Union shall establish an internal market. It shall work for the sustainable development of Europe based on balanced economic growth and price stability, a highly competitive social market economy, aiming at full employment and social progress, and a high level of protection and improvement of the quality of the environment. It shall promote scientific and technological advance. It shall promote universal health coverage by establishing a health union.”…

And then let us amend part 2 of article 4 of the TFEU specifying point k) of paragraph 2 of article 4 of TFEU about shared competence between EU and MS in the area of health.

Maybe some of us would prefer slow development but without being ambitious there is a risk to miss a window of opportunity of evolving the EU beyond internal market, beyond a narrow today paradigm that does nit fit of the 21st century.

The citizens-led Conference on the Future of Europe should be very ambitious to take over Europe.

The former European Commission president Jacques Delors lack of solidarity in response to pandemic described as a mortal danger to the EU.

But lack of solidarity in health is also a mortal danger. Let us be inspired by this insight and let us be brave building strong and genuine EHU.