A letter to EU commissioner for International Partnerships: EU's long-term response to health threats

The European Union must play a key role in ensuring adequate emergency funding to respond to the current urgent health needs and support the adaptation of health services in fragile countries. As the battle continues, and acknowledging the efforts for a coordinated response, the EU's emergency response must be accompanied by a rights-based approach, solidarity within and outside Europe, and long-term strategic investments that improve global health system resilience. For the EU's response to be effective, it must be founded on EU values and international commitments, especially the SDG concept of leaving no one behind. We understand that the crisis presents pressing economic challenges, which is why  we warmly welcome the EU's recent proposal to host an international online pledging event to ensure adequate funding to develop and deploy a vaccine against COVID-19.

We have come a long way since the 2014 Ebola outbreak in West Africa, and many of the lessons learned are crucial to tackling the COVID-19 crisis. That response underlined the importance of strong and resilient health systems in preparing for, and responding to, public health emergencies. Investing in the development of new treatments and vaccines and stockpiling those life-saving essential medical tools as quickly as possible was critical. Thanks to the efforts of partners like Gavi, CEPI (the Coalition for Epidemic Preparedness Innovation), the EU and the World Health Organisation (WHO), an Ebola vaccine was available for emergency use during the 2019 DRC outbreak, which helped prevent the spread of the disease. Gavi and the EU are again supporting partners like CEPI in their work developing a vaccine for COVID-19. When a vaccine is available, Gavi is uniquely positioned to ensure it is made available in the poorest countries and to the most marginalised and vulnerable children, families and communities. The  EU should consider further strategic investments in global health partners, including CEPI, Gavi and WHO, who will be at the centre of a successful, global response to COVID-19 and future outbreaks.

Building EU policy to support health systems in fragile, crisis-affected, and least developed contexts

The current crisis showcases just how important health systems are for our societies and economies. In partner countries where health systems are weak, the impact of COVID-19 could be catastrophic, particularly for those in fragile settings and for the most marginalised and vulnerable such as women, girls, older persons, persons with disabilities and refugees. With this in mind, we were pleased to see references to upgrading health system strengthening (HSS), combating disease outbreaks, and Universal Health Coverage (UHC), reflected in the joint communication towards a comprehensive strategy with Africa. Jobs and growth for the people of Africa are crucial, but too often health and nutrition are overlooked. Simply put, people must be healthy to work and children must be healthy to learn. Investing in stronger, more resilient health systems which provide UHC can prevent human and economic disasters and is far less expensive than financing costly emergency responses.

Yet the proposal for a new partnership with Africa could be more ambitious on health: we recommend a sixth partnership - an EU-Africa Health Partnership - focused on health system strengthening and building partnerships across the region. All future health programming, including in partner countries beyond Africa, should take an equity and gender-sensitive approach, include preparation for sudden changes, and empower frontline health workers.

Investing in WASH and nutrition

Investments in health system strengthening must go hand in hand with water, sanitation and hygiene (WASH) and nutrition. The spread of COVID-19 reinforces the importance of WASH, with WHO's advice reiterating that practising good hand and food hygiene is a key defence against infection and the spread   of illness. Good nutrition is also an essential protective factor against viruses like COVID-19. Immediate results can be achieved by marrying the delivery of vaccines and health system strengthening with nutrition interventions and hygiene promotion.

Better R&D to prevent outbreaks

The global response to COVID-19 exposes flaws in the current market and profit-driven model of biomedical research and development (R&D). As was the case after the Ebola crisis, outbreaks lead to a scale up in research investments, but as soon as those outbreaks fade away, funding for R&D on diseases that do not provide market incentives evaporates. If more investments had been made in vaccine platform technology and vaccine candidates for known strains of the coronavirus family, this could have saved time in the development of a vaccine for the current outbreak. Governments and public funders have a responsibility to proactively fund neglected disease R&D, regardless of the profit-margins for pharmaceutical companies. Through its external action, the EU can complement R&D efforts by investing in research and laboratory capacity building in low- and middle-income countries and in regulatory system strengthening to ensure new health tools can rapidly reach the markets and those who need them.

EU leadership in global health

Finally, while the EU is a global health champion, it lacks a modern vision for global health. The existing EU policy framework pre-dates Ebola, COVID-19, Agenda 2030, the Sustainable Development Goals, the Paris Agreement, the Global Action Plan on SDG 3, the Astana Declaration, and the UN Political Declaration on UHC. To have a more sustainable and long-term response to today's current health crises, the EU should:

• Consider further strategic investment in global health partners, such as CEPI, Gavi, and WHO, who are leading in the global response to the COVID-19 crisis.
• Ensure that the Neighbourhood Development and International Cooperation
• Instrument (NDICI) increases and aligns EU support to help build suitable, resilient, and comprehensive health and WASH services and increase public financing for health.
• Increase R&D funding for neglected diseases and epidemics in EU Research Framework Programmes (including the future programme Horizon Europe) and attach provisions to EU public funding to ensure affordability, accessibility, availability and effi ciency throughout all stages of R&D.
• Adopt a sixth EU-Africa partnership on health system strengthening which integrates WASH and nutrition.
• Develop a European Global Health Strategy in partnership with a range of stakeholders, including civil society, and an accompanying action plan for implementation that maximises the EU's multifaceted role in global health and as a principled responder to health crises.