Intended for healthcare professionals


High hopes for Europe's new Health Emergency and Response Authority

BMJ 2022; 376 doi: (Published 17 January 2022) Cite this as: BMJ 2022;376:o127
  1. Miriam Reiss, researcher
  1. Health Economics & Health Policy Department of the Institute for Advanced Studies in Vienna

Will the creation of a new EU body to tackle cross-border health threats guarantee the bloc will mount a better and more coordinated response to the next pandemic?

At the onset of the covid-19 pandemic, the European Union (EU) did not present itself from its best and most unified side. Uncoordinated border closures, export bans on medical supplies, and a lack of cross-border contact tracing were just some examples of the failures to find a common response to a threat that did not stop at borders.1

As we approach the second anniversary of the coronavirus outbreak, there is no doubt that there is a need for better coordination and cooperation in health policy at the EU level, at least when it comes to cross-border threats like communicable disease outbreaks.2 It’s with this in mind that the European Commission launched a package of measures aimed at reinforcing the EU’s health crisis preparedness and moving towards a “European Health Union.” It includes strengthening the mandate of both the European Centre for Disease Prevention and Control (ECDC) and the European Medicines Agency (EMA). At the core of the new package is the creation of a new authority, the Health Emergency Preparedness and Response Authority (HERA).3

The announcement of this new authority has provoked controversy, which was also in evidence at a session of the European Health Forum Gastein in September 2021, organised by the European Commission Directorate-General for Health and Food Safety (DG Santé), on The future of health threats preparedness.4

Pierre Delsaux, deputy director-general of DG Santé, opened the session with a passionate appeal for a European Health Union that would prepare and respond together to health threats and improve the resilience of Europe’s health systems. He then gave an outline of the main role the new authority will play. This includes horizon scanning to anticipate health threats of different types, identification of potential countermeasures, support of research and development, ensuring sufficient production capacity of health technologies, and arrangements for stockpiling and distribution of medical supplies and equipment. To this end, HERA is assigned a budget of six billion Euros for the first six years, in addition to funds for other EU programmes directed at health security. The vision Delsaux painted was that, rather than duplicating work already done by ECDC and EMA, HERA would act in synergy with them by drawing on their experience and expertise. Representatives of Member States on the panel (Mojca Gobec, Head of the Public Health Sector in the Slovenian Ministry of Health, and Antoine Schwoerer, Head of International Cooperation at the Crisis Response Team of the French Ministry of Solidarity and Health), however, sounded more cautious. While they signalled their support for the establishment of the new authority, they pointed out that strong involvement of national institutions in HERA’s activities as well as more clarity with respect to HERA’s competences and financing would be required.

Arguably the key question here is whether there really is a need for an additional authority at EU level or if it would be more efficient to facilitate cooperation among, and strengthen the position of, existing ones. It can be argued that creating a new authority only makes sense when this authority is assigned sufficient competences and funds to generate added value in the EU’s joint health policy.

Critics of the Commission’s proposal claim that the way HERA is currently designed, it will be toothless and merely serve to institutionalise decisions and actions already undertaken by the Commission during the current pandemic.5 It would appear that the current proposals for how HERA will work have been “downgraded” from an initial, more ambitious proposal (e.g., HERA being an administrative unit within the Commission rather than a standalone agency) as a result of Member States’ reservations against a powerful institution that might siphon off what are seen as national competences.6 For example, Member States resisted a proposal to have their pandemic preparedness audited on EU level. Furthermore, there is criticism that the Parliament is being cut out of negotiations around HERA and that its structure lacks transparency and accountability, especially considering its ample budget.7

Other views are more optimistic, stressing that the Commission’s European Health Union package, and the creation of HERA in particular, is a first step in an evolution towards better European coordination in health policy—an area that so far has essentially been entirely within the hands of national governments.6

It’s early days for HERA as it only became fully operational in early 2022. But it is clear from the current debate that it has a job on its hands to prove its value in meeting the challenges it will undoubtedly face. Eight It will have to collaborate closely with existing EU agencies and Member State authorities, avoiding duplication of effort and ensure it makes use of valuable experiences gathered by these throughout the pandemic. Beyond that, it should seek exchange with international organisations (such as the World Health Organisation (WHO) or the Coalition for Epidemic Preparedness Innovations (CEPI)) and non-EU national agencies to facilitate global preparedness. Furthermore, when developing strategies to fight future health emergencies, it will have to anticipate that these emergencies might look significantly different from a respiratory virus pandemic. Hence, strategies need to be adaptive to a broad spectrum of threats, including antimicrobial resistance and health consequences of the climate crisis.

If HERA can live up to these demanding requirements, it could become a crucial player in a coordinated and effective response to future health threats. The next threat may be just around the corner, and when it becomes imminent, the EU cannot afford to face it as poorly prepared and disunited as it initially faced the coronavirus pandemic.


  • Competing interests: MR is a member of the Young Forum Gastein.

  • Provenance and peer review: not commissioned, not peer reviewed