As the number of cases of coronavirus in the UK passed 51, the Prime Minister, Boris Johnson, addressed the nation from 10 Downing Street. He set out some fairly gloomy possibilities.
The coronavirus could mean that up to a fifth of workers will be off work at the same time. People may be expected to stay at home, avoiding workplaces and anywhere else that people congregate in large numbers. Non-urgent hospital appointments could be delayed and the emergency services will only respond to the most serious problems.
If the incidence of infection continues to grow, the police may be required to maintain public order and the military may be called in to support the NHS and emergency services. All this is occurring just as UK has left the EU.
The emergence of the latest coronavirus, now named 2019-nCoV, began with reports by health authorities in Wuhan, China on 31 December 2019, of a cluster of cases of pneumonia. Its subsequent spread to every continent (except Antarctica) serves as a reminder, if one is needed, that viruses and bacteria do not respect national boundaries.
Closer to home, a woman who travelled by plane from northern Italy, via Dublin, to Belfast was confirmed as the first case in Northern Ireland. Passengers sitting close to her on the flight were contacted, by now dispersed across the island of Ireland.
The permeability of borders – particularly along the UK’s only land border with the EU – highlights the necessity of cross-border cooperation and coordination when faced with an outbreak. Yet, incredibly, the UK government effectively plans to self-isolate from the EU-wide Early Warning and Response System (EWRS), a critical link in the UK’s preparedness and response to the coronavirus.
Coronavirus perfectly reveals one of the key flaws in the UK government’s stance on its future relationship with the EU. It is determined to ‘take back control’ of its affairs, even when this necessitates its withdrawal from tried and tested systems necessary for its own security, such as the EU’s highly interlinked health security regime.
As we have argued elsewhere, it is vital that the UK government revises its stance in negotiations on the future relationship with the EU so as to avoid erecting artificial barriers to pan-European cooperation that place the British people at risk, as well as others across Europe as a whole.
Why do we need the EU for health security?
At the global level the response to the coronavirus, and other major outbreaks of infectious diseases, are based on the International Health Regulations (IHR) and coordinated by the World Health Organisation (WHO). The EU regime for communicable disease control is coordinated by the European Centre for Disease Prevention and Control (ECDC), which is based in Stockholm.
The WHO and ECDC work closely together in EU-wide planning and response to health threats. Any health risk that poses a serious threat, and has spread across national borders, is notified via the EWRS. The ECDC collates data on such risks into its regular reports (such as the one on coronavirus).
What sets the EU system apart is that it is quick: more information is shared, because the rules in data protection are the same in all the participating countries; the definitions for disease are harmonised; and tracing contacts – and so potentially getting ahead of outbreaks – can be done EU wide through the system.
There is also a interrelated emergency mechanism for the approval of pandemic medicines by the European Commission through the European Medicines Agency (EMA), which moved from London and has been based in Amsterdam since March 2019.
There is even the possibility for the joint public procurement of medical countermeasures. All decisions and information are discussed in close contact between the EU member states’ health ministries and the Commission, in the Health Security Committee.
Since the UK left the EU, it no longer has any say in the EU’s decision-making processes, but continues to participate in the health security system, although only until the end of the transition period on 31 December 2020. The UK is no longer part of the EMA and cannot opt into the joint procurement arrangements.
Consequently, the UK does not have the same level of access to medical countermeasures as it did before it left the EU. That includes access to the bulk buying, along with a large group of member states, of vaccines that are crucial to limiting the spread of the coronavirus, and medicines to treat those infected.
Moreover, manufacturers of these vaccines are likely to prioritise obtaining market authorisation in the EU over the UK’s far smaller market.
Self-isolation and non-alignment
It is believed that the decision of the UK government to effectively self-isolate from health security information-sharing mechanisms was opposed by the Department of Health and Social Care, but 10 Downing Street intervened.
Regardless, the decision emphasises – perhaps quite accidentally – the implications of its wider negotiating position with the EU. This is to pursue non-alignment with EU single market rules, and to avoid oversight of the future relationship with the EU by the European Court of Justice.
Non-alignment means that the UK will anyway be unable to participate in the exchange of much of the data required for effective surveillance and certain aspects of response coordination, as well as authorisation and procurement of vaccines and medical countermeasures.
Of course, some will argue that it is in everyone’s interests to find a solution. This is true, but the solution must be consistent with the EU’s Treaties.
As Switzerland’s experience shows, this is not so easy: Switzerland is not only outside the EU, it is also outside the single market, although it participates in key areas through a series of agreements instead of automatically adopting single market rules.
Consequently, Switzerland is excluded from many elements of the EU’s health protection regime. Coronavirus has led the Swiss government to ask the EU to give it temporary access to the health security system, but its place outside the single market means it is unlikely to be given permanent access.
The EU health security system cooperates with other countries, including Iceland, Liechtenstein, and Norway, which along with the EU form the European Economic Area (EEA). These countries also participate in the EU’s health protection regime, as they are members of the single market, and work closely with the ECDC.
Countries near the borders of the EEA are not involved in the deeper cooperation of EU mechanisms, but have instead to rely on the framework of the WHO to facilitate limited involvement in some EU health security activities. Further afield, the ECDC cooperates with the USA, Israel, and the epicentre of the coronavirus outbreak, China.
Nevertheless, there is far more limited cooperation between the EU health security regimes and these other countries, especially in the key areas of data exchange, vaccine and medicines authorisations, and joint procurement of vaccines and other medical countermeasures.
Access to information is the minimum for UK and European health security
Barriers to cross-border cooperation and coordination are the consequence of political decisions. For the time being, until the end of the transition period, the UK is able to access the health security system and ensure timely and rapid communication and coordination between UK public health authorities and their EU-based counterparts.
The position of the UK government on health security communication and information via the EU system has potentially dire implications for the ability of the UK to respond to future outbreaks like the coronavirus, or indeed a whole host of other threats.
UK participation in the EU health security system is also in the interests of the EU itself – and, indeed, wider health security, since closer cooperation is required, not looser arrangements. The EU’s negotiating team is actually mandated to ensure a high level of health protection in its negotiations with the UK. But the UK’s position makes it likely that there are limits to what the EU will be able to agree with the UK.
Boris Johnson’s speech might seem to some to further evidence how the UK is ‘taking back control’. Yet, what control there is for now is based upon EU-wide health security communication, information and response mechanisms.
Future access to these mechanisms seems to have been cut off by the UK government. This has happened just at the time when the overwhelming weight of evidence suggests the mechanisms could not be more necessary to manage and control current and future cross-border public health threats.
The approach of the UK government ignores the reality faced by this country, and others, as they struggle to maintain health security.
By Mark Flear, Reader in Law at Queen’s University Belfast, Anniek de Ruijter, associate professor at Amsterdam Law School and Martin McKee, professor of European Public Health at the London School of Hygiene & Tropical Medicine. This article was originally published by the Telegraph.
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