By Claudia Mantovan
With the current COVID-19 crisis, the ability of the European Union (EU) to effectively face public health emergencies is being questioned once again. In the context of the pandemic, there is need for coordination and solidarity and one of the EU’s tools to try to achieve that is the Joint Procurement Agreement (JPA) for medical equipment, medicines and vaccines. But is it effective to face public health emergencies? In this blogpost it will be argued that the JPA might be an advantageous tool to coordinate a united response of EU’s Member States (MS) and to help counter global health threats such as the pandemic we are witnessing at the moment.
According to Article 168 of the Consolidated version of the Treaty on the Functioning of the European Union (TFEU), the EU does not have much to say in regards to Public Health. Indeed, each Member State is in charge of organising and managing its own national health system. The EU comes into play exclusively under serious “cross-border threats to health” and has a main role of coordination between the Member States (Consolidated version of the Treaty on the Functioning of the European Union: Article 168). Following the experience of the H1N1 influenza pandemic of 2009, where Member States competed with each other to obtain limited medical resources, a joint procurement legislation was introduced on the basis of Article 168(5) TFEU by Decision 1082/2013/EU. This aimed at ensuring a better management of cross-border public health crises and to resolve problems related to price, liability, availability and confidentiality. Consequently, in 2014 the Commission adopted a Joint Procurement Agreement. This agreement concluded between the Commission and the participating MS sets the procedures and processes of procurement, as well as the allocation policy. The overall procedure is organised by the European Commission, which is responsible for it (Azzopardi-Muscat et al., 2017: 44; Beetsma et al., 2021: 254; McEvoy et al., 2020: 853-855).
In fact, a pooled procurement of medical countermeasures is a way of raising equity among countries by increasing competition between suppliers and thus reducing prices. This way, all countries are on the same level regardless of their size or level of economic development. In fact, this helps smaller countries enhancing their buying power (Beetsma et al., 2021: 254; Huff-Rousselle, 2012: 1574; McEvoy et al., 2020: 856-857). As a matter of fact, it has been witnessed that after the introduction of the JPA, all EU MS with a population of less than 5 millions had already signed the agreement after only a few months since its introduction (Azzopardi-Muscat et al., 2017: 44-45). In times of a pandemic that knows no borders, the JPA is thus a significant way to speed up the process of attaining herd immunity, or to quickly contain the spread of the disease.
Furthermore, this tool can help to cope with medicine shortages that routinely occur in multiple EU MS and in countries suffering financial and economic crises (Azzopardi-Muscat et al., 2017: 45, Baute et al., 2021: 2). Securing a common pool of drugs and medical supplies, in the event of a cross-border health threat, prompt and fair allocation of supplies to countries in emergency situations can be performed. Drawing on past examples of joint procurements in other regions of the world, we can witness improvements in the timing of the procurement process, a simplification of administrative procedures, a cut in the expenses and the enhancement of supply chain management (Azzopardi-Muscat et al., 2017: 49-50; Huff-Rousselle, 2012: 1575-1576).
Although the voluntary basis of the agreement and its flexibility can be viewed as the Achilles’ heel of this tool, it is in fact an attractive feature to MS, especially larger ones. Being able to decide whether or not to participate to it, withdrawal at any time and the possibility to additionally carry out on the side their own negotiations with the suppliers are all attractive features. As a joint procurement can be made if at least four countries want it, smaller MS can still cooperate even if other bigger MS are not interested, which is very positive. Furthermore, other MS can still join the agreement in a second time and the reach of the agreement can grow progressively (Azzopardi-Muscat et al., 2017: 49-53).
Finally, the JPA additionally offers an opportunity to pool expertise and skills by creating possibilities of exchange of information and networking between experts, driving to a better control and management of common health emergencies (Azzopardi-Muscat et al., 2017: 54; McEvoy et al., 2020: 857-858). This has also shown to positively influence the sustainability of pooled procurement agreements (Azzopardi-Muscat et al., 2017: 50).
In conclusion, the EU’s JPA could be considered as an essential tool to help cope with public health emergencies based on a number of reasons. As cross-border health threats such as pandemics require collaboration and solidarity to be countered, the JPA offers a way to enhance cooperation between European states and solve issues related to individual procurements. Finally, by strengthening collaboration between MS in the public health sphere, we could imagine that the JPA may eventually even drive to additional Europeanisation of health policy, as Azzopardi-Muscat et al. suggest.
Azzopardi-Muscat et al. (2017), “The European Union Joint Procurement Agreement for cross-border health threats: what is the potential for this new mechanism of health system collaboration?”, Health Economics, Policy and Law, 12(1), pp. 43–59.
Baute S., De Ruijter A. (2021), “EU health solidarity in times of crisis: explaining public preferences towards EU risk pooling for medicines”, Journal of European Public Policy, pp.1-23.
Beetsma R. et al. (2021), “Public support for European cooperation in the procurement, stockpiling and distribution of medicines”, The European Journal of Public Health, 31(2), pp. 253–258.
Bogaert P. et al. (2015), “A Qualitative Approach to a Better Understanding of the Problems Underlying Drug Shortages, as Viewed from Belgian, French and the European Union’s Perspectives”, PLoS ONE 10(5), pp. 1-20.
Consolidated version of the Treaty on the Functioning of the European Union, https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=celex%3A12012E%2FTXT, (25 October 2021).
European Commission (2014), “Joint Procurement Agreement to procure medical countermeasures”, European Commission, Brussels.
European Union (2013), “Decision No 1082/2013/EU of the European Parliament and of the Council of 22 October 2013 on serious cross-border threats to health and repealing Decision no 2119/98/EC. 293 sess”, Official Journal of the European Union, L 293: 1–14.
Huff-Rousselle M. (2012), “The logical underpinnings and benefits of pooled pharmaceutical procurement: a pragmatic role for our public institutions?”, Social Science & Medicine, 75(9), pp. 1572–1580.
McEvoy E., Ferri D. (2020), “The Role of the Joint Procurement Agreement during the COVID-19 Pandemic: Assessing Its Usefulness and Discussing Its Potential to Support a European Health Union”, European Journal of Risk Regulation, 11(4), pp. 851–863.