Globally, 2024 has already been hailed as “the ultimate election year” as citizens in over 60 countries are heading to the polls, including in the US. This year, Europe will see several parliamentary elections but also – of course – the elections to the European Parliament (EP). The latter will take place in the EU member states between 6 and 9 June and will be followed by the appointment of a new political leadership of the European Commission.
In other words, as the new year begins, the current term of the EP and the Commission is soon coming to an end – a time to take stock and gaze forward to the upcoming political cycle. While the 2019-2024 term has implied exceptional steps for the EU’s role in health against the backdrop of the COVID-19 pandemic – including advance purchase agreements of vaccines, and the so-called European Health Union, accompanied by an unprecedented, tenfold budgetary increase for the EU health program – many questions remain. As stated in a report by the European Policy Centre, defining the European Health Union for the new, 2024-2029 political cycle will be crucial to avoid the interlinkages between health and other policy areas being overlooked, as the lessons from the pandemic seem further and further away.
While one should be careful with fortunetelling, it is thus worth contemplating how the elections and change in EU leadership in 2024 may (or may not) condition the future of European health policy.
To start with, while citizens often rate health policy highly as an area where they would like to see a stronger EU (during the Conference on the Future of Europe, citizens called for health and healthcare to be included among the shared competencies between the EU and member states), it is unlikely that health policy will feature greatly in the electoral campaigns. While COVID-19 brought about exceptional momentum for EU health policy, other issues including security, the cost-of-living, migration as well as climate change, are now arguably enjoying a much greater salience for both citizens and politicians. In addition, research generally confirms that EP elections are “second order” elections, as voters still largely vote along national lines and on national concerns.
Still, many predict that the upcoming elections to the EP may become the most contentious so far, and many hope that turnout may rise like last time in 2019. Predictions regarding the outcome are, however, that the longstanding power sharing between the center-right European People’s Party (EPP), as well as the center-left Alliance of Socialists and Democrats (S&D) and centrist Renew Group, may change due to the expected rise in support for far-right parties of the European Conservatives and Reformists (ECR) and the Identity and Democracy (ID) groups. This could impact the EP’s role so far, which has generally been as a keen supporter of deeper European integration in general and policies such as consumer rights, health and environmental protection in particular.
In addition, following the EP elections, the EU’s top leadership positions will also be up for new nominations. While the appointment of the president of the European Commission is not a direct result of the elections, the heads of state and government propose a candidate to the European Parliament, taking into account the results of the elections, and the European Parliament then elects the Commission president. The chosen candidate has to negotiate with the political groups in the EP, in order to secure backing from a majority of its members. Once the President of the Commission is confirmed by the Parliament, his or her designated Commissioners, including the one with the health portfolio, will need the green light following hearings in the relevant EP committee. If all goes well, a new College of Commissioners can be confirmed in the EP plenary and be in office by late autumn 2024.
The concessions of the Commission president to the EP will naturally depend on the relative strength of the party groups in the new EP. Currently, the slogans run by the ECR group headed by Italian Prime Minister, Giorgia Meloni, include “Doing less, but better” as well as “Cooperation yes, superstate no”. Yet, MEPs such as Joanna Kopcińska (ECR, PL) have actively supported the EU’s initiatives on non-communicable diseases and the extension of the ECDC mandate, including as rapporteur. It is clear, however, that any strong stance on EU health policy, in any direction, will not be a priority of far-right parties in negotiations with the new Commission.
Rather, much is likely to depend on who becomes the new president of the European Commission – if Ursula von der Leyen is allowed a second term, there is of course a greater likelihood of continuity. A medical doctor by training and known for her strong leadership during the pandemic, as well as her statements in favour of making health a shared EU and member state competence, she is likely to defend the health portfolio against unfavorable splits and to propose an ambitious mission letter to the new commissioner. That of the incumbent Stella Kyriakides, produced before the pandemic in 2019, included flagship initiatives such as the European Health Data Space and the EU Beating Cancer Plan. The new commissioner who is allocated the health portfolio will also have some influence.
Others that will want to have a say over the new Commission’s political line on health are the civil servants, in particular the Director General of DG SANTE (Health and Food Safety) and her advisors. During the Commission’s Global Health Policy Forum in November 2023 the incumbent, Sandra Gallina, mentioned areas that will be at the top of her list: more focus on One Health (i.e. the interlinkages between animal, human and environmental health) as well as intersections between climate and health policy, and health in all policies more broadly. Such a “greening” of the European Health Union was also something supported by citizens in the Conference on the Future of Europe and has been highlighted as a necessary next step by policy experts and think tanks. In general, the strengthening of preparedness as well as strategic autonomy to reduce vulnerabilities in the health sector are also likely to be safe topics for further deepening.
Whether these ideas will survive in the process of appointing the new Commission and the fleshing out of its new political priorities remains to be seen. In any case, 2024 promises to be an interesting year for European democracy and policy making. Ultimately, public debates about the future direction of the Union, possibly facing a new historic enlargement and related institutional and policy choices in the near future, can hopefully contribute to higher voter turnout and ultimately, democratic legitimacy of the Union.