There are lessons to be learned from the EU’s responses to the Covid-19 crisis. The pandemic reveals the absolute need for further cooperation in the EU if the member states are to manage these types of health crises effectively. Importantly, the crisis has shown that the social and economic costs of not being able to react – or reacting too late – can be enormous for the EU and its member states.
What is clear is that Covid-19 is unlikely to be the last of this type of health challenge to EU countries and its citizens. Antimicrobial resistance – AMR – is increasingly seen a problem that will become one of the biggest challenges for global and European public health during the next twenty to thirty years. Like Covid-19, AMR, knows no borders. Resistant bacteria move across countries along with people, animals and goods.
It is estimated that AMR causes around 33,000 deaths per year in the EU, and global AMR deaths are estimated to reach 10 million deaths per year by 2050. More people are expected to die due to AMR in 2050 than due to cancer.
In humans, antimicrobials – like antibiotics – are being used to combat various types of bacterial infections (e.g., pneumonia) and for prophylactic purposes in connection with surgery (e.g., heart transplants or hip replacement surgery). In the veterinary sector, antimicrobials are used to combat or prevent bacterial infections among livestock animals (pigs, cattle, chickens, etc.), and even among our pets. Use of antimicrobials is an integral part of modern human medicine and modern livestock production.
Approximately one-third of the consumption of antimicrobials in the EU is used within the human sector, while two-thirds is used in the veterinarian sector. However, every time antimicrobials are used to combat bacterial infections, the bacteria tends to become more resistant. Today, most bacterial infections can still be treated with antimicrobials, but in the near future, there is good reason to believe that we will be facing ‘superbugs’ for which antimicrobials will have no effect.
Over the past decade, the EU has taken a number of steps to combat AMR at the global and European level. In many ways, the EU is taking the lead in this effort, collaborating with UN organizations like the World Health Organization (WHO). The European Commission has launched two actions plans to combat antimicrobial resistance within the EU countries. The first Action Plan was launched in 2011, and the second in 2017. Both action plans contain a number of initiatives that can help ameliorate the AMR threat.
The basic aim of these initiatives has been to reduce overall consumption of antimicrobials in the EU. These include a proposal to increase testing of patients before they are given antimicrobials, increased antimicrobials stewardship systems at hospitals, and limiting the use of antimicrobials in livestock production. There is a close correlation between the level of antimicrobial use and the level of AMR. Countries with high levels of antimicrobial use, such as Italy, have high levels of AMR, while countries with low levels of use of antimicrobials, such as Denmark, also have low levels of AMR. Reducing overuse of antimicrobials is therefore a central goal in the EU Commission’s action plans.
A major challenge to the development of a common EU AMR policy is that health policy is primarily an area of national competence. The national control over health policy is explicitly stated in the Treaty of the Functioning of the European Union (Art. 168 No. 7 TFEU). This national competence has also been the case for EU policies aimed at reducing the risk of developing AMR.
Consequently, the Commission is prevented from initiating regulation on antimicrobial use unless there is clear support from the member states. The Commission has thus based a number of their initiatives in the AMR action plans on ‘soft law’. Hence, instead of laws and directives, they use ‘recommendations’ and ‘methods of open coordination’ as the regulatory instrument for reducing overuse of antimicrobials among, for example, physicians or pig farmers. Binding legislation such as EU ‘regulations’ or ‘directives’ are seldom used in the AMR context, unless these can be directly related to the single market. From the Commission’s perspective, the use of soft law within the field of AMR can be seen as a strategic way of dealing with the lack of EU competence in this policy field in situations where there is a clear need for transnational initiatives.
The action plans to combat AMR launched by the Commission have definitely increased focus on AMR problems among the EU member states. Most member states have developed their own plans for how to reduce the use (and overuse) of antimicrobials at national level.
Yet, the overall consumption of antimicrobials in the EU remains high. One explanation for continued overuse of antimicrobials is probably that the EU actions plans are rather new, and that a number of member states until now have not been so active in the combat against AMR. Another reason could be that the use of soft law reduces the effects of the EU initiatives. Member states might feel a normative pressure to act in line with the Commission’s recommendations, but at the end of the day, they decide for themselves whether they wish to follow the recommendations. In that respect, pressure is on the member states as they have the main responsibility for reducing the consumption of antimicrobials.
The Covid-19 crisis has laid bare the interdependence of the EU member states when it comes to vulnerability to different types of transnational health challenges. Both Covid-19 and in the long term the risk of AMR have put pressure on the member states in order to accept a higher degree of EU policy development in relation to health policy.
This blog post draws on Carsten Strøby Jensen, ‘While We Are Waiting for the Superbug: Constitutional Asymmetry and EU Governmental Policies to Combat Antimicrobial Resistance,’ published in JCMS.
Carsten Strøby Jensen is an associate professor at the Department of Sociology, University of Copenhagen. His work has mainly focused on political sociology, labour market and processes of EU integration. Recently he has increasing worked with different societal aspect of the consequences of antimicrobial resistance.
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She wrote:
‘We’re ending free movement to open Britain up to the world. It will ensure people can come to our country based on what they have to offer, not where they come from.’
Her Tweet is an insult to all EU citizens who came to Britain specifically to work and who offer so much to our country.
And that represents most of them.
Because most EU citizens in this country are in gainful employment, doing jobs that we simply don’t have enough Britons to do, and who make a massive NET contribution to our Treasury and our economy.
Your Tweet, Ms Patel, demeans and diminishes them.
Those EU citizens came here because of what they could offer, and they offer so many skills that our country needs.
And yes, it was easier for them to come here because of where they are from. Because it makes sense – economically, environmentally and geographically – to have free movement between neighbouring countries.
Does ending free movement with Europe really ‘open Britain up to the world’?
No.You are not opening up Britain ‘to the world’. You are simply applying the same rules to EU citizens that have always applied to non-EU citizens.
You are putting up new barriers to Europe, whilst keeping the same old barriers to all other continents.
With your crass Tweet, you are saying to EU citizens:
‘We don’t like where you’re from, and we don’t appreciate what you offer.’
What a slap in the face to the hard-working EU citizens offering so much to hospitals and care homes in service to the country and our citizens, especially at this time, in the middle of a pandemic.
Without EU citizens working in all sectors, trades, professions and industries right across the UK, our country would be poorer and not nearly so enriched.
Do you really know what you are doing to Britain? Or understand the divisiveness of your words and actions?
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Yes, we’re getting our country back (really?) but instead, we’re losing our continent, or at least, easy access to it.
Among some of the key points for travel throughout the EU, Switzerland, Norway, Iceland or Liechtenstein from 1 January 2021:
You may be refused entry if your passport only has 6 months left
The guarantee of free mobile phone roaming ends
Your EHIC health card is only valid until 31 December 2020
Use separate lanes from EU/EEA arrivals when queuing
Visa requirements for long stays, business travel, work or study
Your pet passport will no longer be valid
Extra documents to drive
Customs declarations for business goods
Of course, this is just the tip of the iceberg. More restrictions are likely, especially – as anticipated – we don’t get a deal this year covering our new relationship with the EU.
Brexit means ending free movement between us and our continent.
Oh, how the people of the former Communist countries would have cherished ‘free movement’ instead of being trapped behind their Iron Curtain. Oh, how Winston Churchill would have been amazed – shocked – that the people of Britain would volunteer to end easy access to the European mainland.It was he who wrote to his foreign secretary, Anthony Eden, on 21 October 1942, after the first British victory of the Second World War at El Alamein:
‘Hard as it is to say now.. I look forward to a United States of Europe, in which the barriers between the nations will be greatly minimised and unrestricted travel will be possible.’
And it was he who said in his famous speech on 5 March 1946 at Westminster College, Fulton, Missouri:
“The safety of the world requires a new unity in Europe, from which no nation should be permanently outcast.”
And yet, it’s Britain that is maximising the barriers between European nations and restricting travel. And yet, it’s Britain that is shunning unity in Europe by making ourselves a permanent outcast. What have we done?
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It’s almost as if the British government wants a no-deal, even though the non-binding ‘political statement’ of the Withdrawal Agreement, approved by the UK Parliament, called on both sides to achieve:
“a free trade area…underpinned by a level playing field”
Both sides are far away from achieving a ‘level playing field’ – with Britain insisting on retaining some EU benefits, with the EU saying you can’t pick and choose, or enjoy EU benefits without agreeing to our rules.
Yes, the country voted for Brexit – albeit by the slimmest of margins, and with only a minority of the electorate voting for Leave(Just 37% of the UK electorate voted for Leave – in all other mature democracies across the world that hold referendums on key issues, that would not have been enough for Leave to have won. A super majority endorsement of at least 50% of the entire electorate, and often at least 60%, would have been required before a big change could go ahead.)
Yes, Leave was on the ballot paper, and Leave won.But when did Britain vote for a No-Deal Brexit?
We’ve never been given any say on what type of Brexit we’ll get – and still we don’t know what Brexit we might get.
That’s like saying to the estate agent,
‘We agree to sell the house. But we’ll leave it up to you what our next home will be.’
The current transition period runs until 31 December 2020, during which time the UK continues to follow EU rules.
After that? We don’t know.
The government responded bluntly last month to an online petition requesting a Brexit transition extension:
“The transition period ends on 31 December 2020, as enshrined in UK law. The Prime Minister has made clear he has no intention of changing this. We remain fully committed to negotiations with the EU.”
As reported by The Week magazine:
‘The EU wants the UK to agree to follow its rules on fair and open competition so British companies given tariff-free access to the EU market can’t undercut their European competition.
‘The EU has warned that the UK won’t be allowed a “high-quality” market unless it signs up to EU social and environmental standards.’
If a deal can’t be agreed with the EU, then the UK will default to World Trade Organization (WTO) terms from 1 January 2021.
Every WTO member has a list of tariffs and quotas that they apply to other countries.
As The Week outlined in stark terms:
‘That means the UK would be hit by big taxes when it tried to sell products to the EU market. The bloc’s average WTO tariffs are 11.1% for agricultural goods, 15.7% for animal products and 35.4% for dairy. ‘British car makers would be hit with a 10% tariff on exports to the bloc, which could amount to €5.7bn per year. That would increase the average price of a British car sold in the EU by €3,000. ‘Currently, trade between the UK and EU is tariff-free. But the Confederation of British Industry (CBI) predicts that no-deal would mean that 90% of the UK’s goods exports to the EU would be subjected to tariffs. ‘WTO “most favoured nation” (MFN) rules mean that the UK couldn’t lower its tariffs for any specific country or bloc, such as the EU, without agreeing a trade deal.’The EU is the UK’s biggest export and import market by far – almost half of ALL our exports go to the EU and just over half of ALL our imports come from the EU.
Even the UK government, in it’s ‘secret’ but leaked Yellowhammer report last year, detailed how a no-deal Brexit would be catastrophic for the UK, including delays at ports and food and medicine shortages.
And that’s before the government knew anything about the Covid-19 pandemic, which is sending the UK into recession, with unemployment predicted to spiral.
Back in the day, before the referendum campaign, when the Conservative government was pro-Remain, they presented the three main Brexit alternatives – all of which, said the government then, would cause damage to Britain.
① THE NORWAY OPTION – means Britain would leave the EU but still have free and frictionless access to the EU Single Market, by far Britain’s most important and lucrative export and import market. But this option would mean Britain continuing to pay the EU and obey its rules – including free movement of people – without any say in them.
② THE CANADA OPTION means Britain would have tariff free trade with the EU, but not the highly cherished and valuable frictionless trade. And there would only be limited access for our services sector, which makes up almost 80% of our economy.
③ THE WTO OPTION (often referred to as ‘no-deal’) means relying on World Trade Organisation rules. But that would mean new tariffs and complicated, costly procedures on UK trade with the EU, hurting British consumers, businesses and employment. It would also suddenly and catastrophically end all EU membership benefits, affecting all our daily lives.
None of these options were presented as choices in the referendum that voters could opt for. The only option was for Remain, or an undefined Leave.
Before the referendum, Jacob Rees-Mogg proposed a second referendum if Leave won. He said in 2011, when he was campaigning for a new referendum on Brexit:
‘We could have two referendums. As it happens, it might make more sense to have the second referendum after the renegotiation is completed.’
It makes sense now to give people a vote on the type of Brexit we want. Of course, the Tories won’t give us that.
But do remember that when, early next year, the country is likely to be in the middle of two catastrophes: Covid-19, and a no-deal Brexit.
One on top of the other will cause us deep pain.
Given a choice, wouldn’t you vote to avoid the second pain, since unlike Covid-19, it is entirely avoidable?
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