The multi-dimensional crisis that hit Europe as a result of the COVID-19 pandemic has triggered discussions about the EU’s role in the field of public health. Strengthening of existing legal framework and agencies is already in place, as is the establishment of the new Health Emergency Preparedness and Response Authority (HERA). Under the ambition to establish a so-called European Health Union, the Commission is also pushing forward in new areas such as exchange of health data and the EU’s external role in global health.

While the proposals for a European Health Union have so far mainly been analyzed as a case of closer integration, the underlying logic of their substance has been little discussed. Drawing on critical perspectives in IR and security studies, this paper leaves the integration discussion aside and sets out to examine the reforms against the particular way in which health policy has previsouly been “securitized” at EU-level. Do the reforms enable a new direction for EU health policy, beyond the narrow focus on “health security” as in pandemic preparedness and response? Will there be space for broader perspectives such as mainstreaming of health (“health in all policies”), universal health coverage and the links between health and climate change? The paper draws on open-source material from the Commission and the relevant agencies, as well as interviews with key EU civil servants.

In essence, the EU's role in matters of health policy has always been complementary to that of the Member States. According to the Treaties, its powers were primarily intended to coordinate Member State action by fostering cooperation and formulating recommendations. However, Article 168 of the Treaty of the European Union, which states that "[a] high level of human health protection shall be ensured in all Union policies and activities," created the conditions for a more decisive intervention from other public policy areas to regulate health policy issues such as European citizens' right to healthcare when moving within the EU, authorization of medicines and medical devices on the EU internal market, and management of serious public health threats.

During the pandemic, new mechanisms for coordinating Member States' health policies were established and tested for effectiveness. They enabled actors from various administrative units to provide a coordinated response - the European Commission was put in a position to act as a broker in identifying the best solutions, other supranational bodies were entrusted with critical tasks related to the unprecedented health crisis.

Experimentalist architectures in EU decision-making have been a recurrent feature of EU governance (Zeitlin 2016). They have been characterized by decentralized, intergovernmental decision-making, allowing the EU to intervene in areas of public policy not expressly mentioned in the Treaties or in which the EU's position was relatively weak. Consequently, supranational institutions, particularly the European Commission, have been able to expand their authority in this manner.

Drawing on an expanding literature on experimentalist governance, this contribution aims to highlight how the position of supranational institutions, in particular the European Commission, has changed with regard to public health decisions.

Solidarity, in the sense of universal access to healthcare, is considered to provide a point of convergence for European Union (EU) Member State healthcare systems (Hervey 2011) and to have potential as a distinctly European principle of medical ethics (Frischhut and Werner-Felmayer 2020). Despite this notable recognition, solidarity appears elusive, even destined to remain fragmented across disciplines and interpretations. For instance, attempts to map solidarity have focused primarily on the wider biomedical context (Prainsack and Buyx 2018), on elucidating a status as an EU law concept (Biondi et al. 2018), and on the historical, theological and philosophical interpretations (Stjernø 2005).

This paper considers four dimensions with a view to mapping solidarity in European healthcare, mindful not only of the various aforementioned disciplinary perspectives, but also of healthcare system type, complicating further the EU-national dynamic in healthcare.

Firstly, the role solidarity plays in the context of accessing healthcare by reference to how it features within the EU internal market provisions. This enables consideration not only of concerns about free movement of patients having potentially corrosive effects on commitments to solidarity within national healthcare systems, but also the extent of comprehensive sickness insurance within definitions of EU(-level) citizenship.

Secondly, the ways in which solidarity might be deemed to underpin healthcare provision, by reference to notably EU competition policy, where solidarity defines the exception mechanisms. Questions raised in this area include the existence of different solidarities, and whether solidarity is determined at national or EU level.

Thirdly, the relevance of solidarity in shaping access to pharmaceuticals, by reference to EU activity in this area. The global nature of the pharmaceutical industry provides a different perspective which prompts questions about solidarity being understood at a global, as well as the EU and national levels.

Finally, EU and national responses to COVID-19 have underscored the importance of solidarity in European healthcare. While these responses inevitably draw on the other dimensions, there is also scope to consider how fiscal policy responses to the pandemic might frame solidarity, and whether this may prove to have implications for overarching fiscal narratives – as happened with austerity policies following the 2008-9 economic downturn. The extent to which solidarity may yet play a decisive role in further developing pandemic response initiatives such as the European Health Union and the EU pharmaceutical policy remain to be seen.