COMMUNICATION FROM THE COMMISSION TO THE EUROPEAN PARLIAMENT, THE COUNCIL, THE EUROPEAN ECONOMIC AND SOCIAL COMMITTEE AND THE COMMITTEE OF THE REGIONS COVID-19 - Sustaining EU Preparedness and Response: Looking ahead
Date: 2022-04-27
Institutions: Directorate-General for Health and Food Safety, European Commission
Subjects: clinical trial, coronavirus disease, disease surveillance, epidemic, health certificate, health control, medical device, security of supply, travel, vaccination, vaccine

EN 

  EN 

   EUROPEAN COMMISSION  Brussels, 27.4.2022  COM(2022) 190 final  COMMUNICATION FROM THE COMMISSION TO THE EUROPEAN PARLIAMENT, THE COUNCIL, THE EUROPEAN ECONOMIC AND SOCIAL COMMITTEE AND THE COMMITTEE OF THE REGIONS COVID-19 - Sustaining EU Preparedness and Response: Looking ahead  
 
 
1.  INTRODUCTION 

The global COVID-19 pandemic is not over. Vigilance and preparedness remain essential.  

While varying case numbers are observed across Europe, increases are not leading to severe disease 
or  death  as  often  as  before.  The  currently  dominant  Omicron  variant  is  less  severe  than  previous 
variants.  Population  immunity  against  the  virus,  whether  natural  or  through  vaccination,  has  also 
significantly improved.  

The past two years have shown that the summer months are likely to see lower incidence rates. The 
pressure from the pandemic is thus likely to fall in the coming months. This creates a much-needed 
window to  prepare for possible future  pandemic surges. We need to  act  fast and together  to  fully 
use this opportunity to prepare for this autumn and winter and beyond. 

Infections  are  still  in  the  millions  worldwide.  Many  people  around  the  world  are  in  lockdowns. 
Many  are  still  suffering  or  dying  from  COVID-19.  Waning  immunity  against  infection,  and 
possible winter seasonality all increase the likeliness that new variants of SARS-CoV-2 – the virus 
that causes COVID-19 – will emerge and spread.  

With this in mind, several Member States have started to implement new approaches to manage the 
on-going COVID-19 pandemic towards a sustainable and resilient recovery.  

While Member States are implementing new approaches towards managing the ongoing pandemic, 
fragmented preparedness and response strategies are likely to undermine the benefits that EU-wide 
coordination of health security measures has brought so far. The EU Vaccines Strategy has ensured 
access to enough safe and effective vaccines for all. The WHO and the European Centre for Disease 
Prevention  and  Control  (ECDC)  estimated  that  COVID-19  vaccines  have  saved  nearly  half  a 
million lives across Europe1 and substantially prevented serious illness.  

By  working  together,  the  EU  has  also  kept  its  single  market  operational,  minimised  travel 
restrictions  and  mobilised  manufacturing  capacity  of  critical  products  when  supply  chains  were 
disrupted  –  thanks  to  the  relentless  work  of  people  at  the  frontline.  In  this  new  phase  of  the 
pandemic, coordination will be, once more, essential. 

This  Communication  puts  forward  an  approach  for  the  management  the  pandemic  in  the  coming 
months,  moving  from  emergency  to  a  more  sustainable  mode.  It  invites  Member  States  to  take 
actions before the autumn, building on the successful EU-wide coordination for health preparedness 
and  response.  The  common  aim  should  be  to  protect  public  health  while  keeping  society  and 
economy open and resilient. 

2.  THE CURRENT CONTEXT AND CHALLENGES  

When  it  comes  to  vaccination,  two  elements  give  rise  to  concerns  ahead  of  autumn:  plateauing 
and/or  suboptimal  vaccination  coverage  in  several  EU  Member  States;  and  lower  vaccine 
effectiveness among individuals who have not yet received a booster dose. Over 90 million eligible 
people  in  the  EU/EEA2  are  still  unvaccinated,  including  approximately  9  million  aged  60  and 
above, thereby increasing the risk of mortality and emergence of new variants. In addition, there are 
large  differences  in  vaccination  coverage  rates  across  EU/EEA  Member  States.  In  some,  almost 
85 % of the total population has received a full primary vaccination course; in others, the figure is 

1  
vaccination. 
2  

https://www.ecdc.europa.eu/en/news-events/who-ecdc-nearly-half-million-lives-saved-covid-19-

This number includes all individuals eligible for vaccination, excluding children younger than 5 years.  

1 

 
                                                           
less  than  50 %.  Secondly,  the  percentage  of  adults  over  18  in  the  EU/EEA  who  have  received  a 
booster has started to plateau, currently at around 64%3.   

While the pandemic’s future course is difficult to predict, one thing is certain: COVID-19 is here to 
stay.  The  virus  will  continue  to  evolve  and  the  emergence  of  new  variants  is  highly  likely.  Our 
response must be to maintain high levels of readiness for COVID-19 outbreaks and the emergence 
of new virus variants, and to step up vaccination coverage, with targeted efforts to reach those who 
are still unvaccinated. 

Countries have been adapting their testing strategies, e.g. by focusing testing on severe cases and on 
people with risk factors for severe disease. With these changes, their coverage of tested people is 
likely  to  decrease  in  Member  States.  This  will  also  make  interpreting  epidemiological  data  more 
challenging.  It  is  therefore  essential  that  new  testing  strategies  are  designed  so  that  they  ensure 
representativeness and therefore provide useful indications on the epidemiological trend.  

These efforts have wider importance as health and economic prosperity are intertwined. The global 
economic loss due to  the pandemic  has  been  estimated at  EUR 12.25 trillion  by the  International 
Monetary  Fund4.  Unprecedented  economic  and  budgetary  measures  were  able  to  substantially 
cushion  the  economic  and  social  impact.  Health  security  preparedness  and  resilient  health  and 
social  protection  systems  are  an  investment  in  growth,  stability  and  economic  resilience,  as  has 
become evident once again in recent weeks, with China experiencing dramatic case increases and 
reintroducing  stringent  measures  reminiscent  of  the  very  early  days  of  the  pandemic.  Tens  of 
millions of people in China were placed under strict lockdowns in early April 2022. Early evidence 
shows an impact on logistics and warehousing, as well as some key suppliers pausing production, 
for example in  the  electronics sector. Situations like  the current  one in  China,  could  heighten  the 
risk of adverse impacts on the global economy and global value chains – and the supply of strategic 
products from China on which the EU depends5. Therefore, supply chain resilience must remain a 
priority. 

Over  the  past  two  years,  we  have  witnessed  the  crucial  role  of  resilient  supply  chains  in  our 
response to the pandemic. By monitoring the supply chains of critical input materials for vaccines, 
supporting  the  expansion  of  EU  production  capacity  and  working  closely  with  international 
partners, the Commission’s Task Force for industrial scale-up of vaccine production has addressed 
supply  chain  bottlenecks  and  supported  the  unprecedented  ramp-up  of  production  capacity.  As 
bottlenecks can continue to appear, continuing this work remains crucial. 

Public health and joint, coordinated preparedness and response capacity must remain at the top of 
the  EU  agenda  if  we  are  to  future  proof  our  economic  growth  path  in  the  age  of  pandemics.  In 
addition,  the  quality  and  resilience  of  healthcare  systems  must  be  improved,  in  particular  in  least 
developed regions, where the mortality due to COVID 19 has been higher than in more developed 
regions,  as  indicated  in  the  8th  Cohesion  report6.  Cohesion  funds  are  available  to  national 
authorities for that purpose. Over the 2014-2020 period, a significant part of ESF financing went to 

3  
ECDC,  COVID-19 
tracker.html#age-group-tab. 
4   
2022.  
5  
equipment. 
6  
final. 

vaccine 

tracker, 

https://qap.ecdc.europa.eu/public/extensions/COVID-19/vaccine-

https://www.imf.org/en/Publications/WEO/Issues/2022/01/25/world-economic-outlook-update-january-

E.g.  active pharmaceutical ingredients  (APIs), IT components,  critical raw  materials and personal protective 

Commission Communication on the 8th Cohesion Report: Cohesion in Europe towards 2050, COM(2022) 34 

2 

 
                                                           
support health and social services and the healthcare facilities constructed or improved so far with 
the support of the ERDF provided an improved service for 53.3 million people. 

Russia’s military aggression against Ukraine will put additional pressures on Member States’ health 
systems over the coming months. Many of the millions forced to flee Ukraine are vulnerable and in 
need of  emergency care,  in  particular of mental  health support,  treatment of chronic diseases and 
routine  healthcare  such  as  childhood  vaccination.  Refugees  and  displaced  persons  need  access  to 
healthcare,  including  vaccinations  against  COVID-19  as  well  as,  mental  health  and  psychosocial 
support.  

The Emergency Response Coordination Centre has coordinated a wide array of actions in Ukraine 
and  its  neighbours  to  address  the  health  emergencies  resulting  from  the  war7.  For  example,  the 
Commission has set up a dedicated European solidarity mechanism through which Member States 
can  request  support  to  transfer  patients  in  need  of  specialised  hospital  treatment  and  care. 
Operational  recommendations  from  the  ECDC8  also  guide  EU  Member  States  and  healthcare 
professionals  in  preventing  and  controlling  infectious  diseases  in  these  situations,  so  that  routine 
vaccination programmes for displaced persons, as well as vaccination against COVID-19 and other 
diseases can continue. 

The  Commission  is  also  closely  assessing  possible  future  health  threats  and  the  availability  and 
accessibility  of  medical  countermeasures  to  address  the  specific  health  needs  that  the  Russian 
invasion  and  on-going  war  in  Ukraine  has  created.  Increasing  the  number  of  vaccinated  people, 
including among refugees, will help ease pressure on our healthcare systems. This, in turn, will free 
up space for helping injured, chronically ill or psychologically traumatised refugees fleeing the war. 

3.  REMAINING VIGILANT  

In light of these ongoing challenges, the future course of the COVID-19 pandemic and its burden 
on society in the coming years will depend on the decisions we take now.  

Member States should make use of this period to strengthen their surveillance, healthcare systems, 
and  overall  pandemic  preparedness.  Meanwhile,  researchers  and  vaccine  manufacturers  should 
prioritise  the  development  of  universal,  variant-proof  vaccines  that  offer  longer  term  protection 
against  infection.  Also,  the  development  of  COVID-19  therapeutics,  particularly  targeted  for 
immunocompromised patients who are over-represented in intensive care units, and the continued 
need for improving access to COVID-19 vaccines and therapeutics  globally are areas that require 
our attention.  

(i) 

Increasing the uptake of COVID-19 vaccines 

Vaccination strategies 

The  EU  Vaccines  Strategy  has  secured  a  wide  portfolio  of  COVID-19  vaccines  and  access  to 
vaccines for all. Currently, in the context of the Omicron variant, the focus should be on increasing 
the  roll  out  of  booster  doses,  especially  for  the  most  vulnerable  groups.  We  still  see  large 
differences  in  vaccination  coverage  rates  across  Member  States:  while  some  have  reached  high 

Commission Communication: Welcoming those fleeing war in Ukraine: Readying Europe to meet the needs, 

https://www.ecdc.europa.eu/sites/default/files/documents/prevention-control-infectious-diseases-russia-

7  
COM(2022) 131 final. 
8  
aggression.pdf. 

3 

 
                                                           
rates, others are significantly lagging behind9. Closing vaccination gaps among adults, both within 
and between Member States, should remain the priority.   

Cumulative vaccine uptake among people aged 18+ years, week 13 2022 
EU/EEA values based on pooled data from 30 countries reporting 
At least one dose administered and with available population data for the target group 

Cumulative uptake of at least one vaccine dose   

Cumulative uptake of the primary course   

 Cumulative uptake of a booster/additional dose 

In  a  joint  statement  published  by  the  ECDC  and  the  European  Medicines  Agency  (EMA)  on  6 
April10, the EU agencies state that, based on the latest evidence available, a fourth dose of mRNA 
vaccines to immunocompromised individuals continues to be recommended. Due to the fragility of 
the very elderly (adults above 80 years of age), their lower immune response to vaccination and the 
higher risk of severe COVID-19, a second booster dose could also be administered to this group at 
least 4 months after the last jab and taking into account the local epidemiological situation.  

Concerning children and youth, there are now several COVID-19 vaccines approved at EU level for 
use in  adolescents  (12-17  years old) and children (5-11  years old). Overall, vaccination  uptake in 
adolescents  in  the  European  Union  is  high  (e.g.  more  than  71 %  of  the  15-17  years  old  have 
received a full primary vaccination course), but is stagnating at low levels among younger children 
(e.g. less than 15 % of the 5 to 9 years old have received a full primary vaccination course). While 
closing  vaccination  gaps  among  adults  remains  the  priority,  EU  Member  States  should  consider 
strengthening their efforts to increase vaccination coverage rates among younger children.  

ECDC, 

9  
overviews.ecdc.europa.eu/vaccination.html. 
10  

country 

overview 

https://www.ecdc.europa.eu/en/news-events/ema-ecdc-statement-fourth-covid-vaccine-dose. 

report, 

vaccination, 

https://covid19-country-

4 

 
 
 
 
                                                           
Our current vaccine portfolio11, and the access it offers to adapted vaccines where necessary in the 
future,  offers  Member  States  a  range  of  possible  options  when  it  comes  to  future  vaccination 
strategies.  Member  States  should  be  ready  to  roll  out  additional  doses  of  vaccines  ahead  of  the 
upcoming autumn/winter season. This will need to take into account emerging evidence of waning 
protection  conferred  from  vaccines  and  natural  infection,  the  epidemiological  situation  and  the 
emergence of new variants, as well as the development of new vaccines and their effect on infection 
and further transmission. Moreover, important public health questions will need to be answered, for 
example  for  determining  the  best  vaccine  combinations  and  how  to  best  integrate  the  next 
generation  vaccines  in  the  vaccination  schedules.  The  vaccination  campaigns  for  the  upcoming 
autumn  and  winter  period  also  need  to  consider  the  co-circulation  of  COVID-19  and  seasonal 
influenza.  

KEY ACTIONS FOR MEMBER STATES 

  Strengthen  efforts  to  increase  the  uptake  or  completion  of  the  primary  course  among  the 
unvaccinated  or  partially  vaccinated  including  by  continuously  monitoring  and  analysing 
vaccine hesitancy to overcome it.  
Increase efforts on the uptake of booster doses by all eligible adults, starting from three months 
after the primary course. 

 

  Before the beginning of the 2022-2023 school year, consider strategies to increase vaccination 
coverage rates among  younger children, e.g. by working with paediatricians and other health 
professionals who are trusted sources of information for many parents.  

  Ensure a fourth dose for immunocompromised individuals and consider a second booster dose 

for individuals above 80 years of age, taking into account the local epidemiological situation.  

  Prepare  COVID-19  vaccination  strategies  for  the  upcoming  autumn/winter  season,  and 

 

incorporate, as of 2023, COVID-19 vaccination into national vaccination programmes. 
Increase awareness  of the annual  seasonal  influenza vaccination campaigns  and  ensure swift 
scaling-up of vaccination campaigns among the most vulnerable.  

(ii) 

Surveillance and intelligence gathering through testing and sequencing 

Integrated surveillance systems 

The objective of surveillance  should  no longer be based on  the identification and reporting of all 
cases, but rather on obtaining reliable estimates of the intensity of community transmission, of the 
impact of severe disease and on vaccine effectiveness.  

The  ECDC,  along  with  the  WHO,  concur  that  there  is  a  need  to  build  on  existing  surveillance 
systems  for  seasonal  influenza  and  other  respiratory  infections  in  order  to  achieve  these  goals. 
Member States should develop  strategies for re-establishing sentinel  primary  care-  and secondary 
care-based  surveillance  systems12  for  acute  respiratory  infections,  taking  advantage  of  the 
digitalisation  of  health  information.  This  should  be  complemented  with  strengthening  other 
monitoring systems such as wastewater surveillance of SARS-CoV-2 and beyond (e.g. poliovirus, 
influenza viruses or antimicrobial resistance). 

Currently, there are three different vaccine technologies available. With the Valneva vaccine, the EU will soon 

11  
be able to offer its citizens a fourth vaccine technology. 
12  
Sentinel  surveillance  is  the  "monitoring  of  rate  of  occurrence  of  specific  diseases/conditions  through  a 
voluntary network of doctors, laboratories and public health departments with a view to assess the stability or change 
in health levels of a population. 

5 

 
                                                           
There is also a continued need for ensuring that sufficient samples are collected for the monitoring 
of  virus  strains  to  detect  new  variants.  The  Commission  will  support  such  efforts  through  the 
EU4Health  programme  and  its  Health  Emergency  Preparedness  and  Response  Authority  (HERA) 
and  in  collaboration  with  the  ECDC.  These  efforts  should  ensure  that  all  sequences  are  shared 
through open access platforms, such as the European COVID-19 data portal13, to allow for a good 
understanding of the SARS-CoV-2 variants that circulate in Europe.  

This will help identify high impact priority threats and potential gaps regarding the availability and 
accessibility of relevant medical countermeasures. 

KEY ACTIONS FOR MEMBER STATES 

  Put  in  place,  as  soon  as  possible,  integrated  year-round  surveillance  systems  for  acute 
respiratory  illnesses  (integrating  surveillance  of  COVID-19,  influenza  and  other  respiratory 
viruses)  that  are  sustainable,  representative  and  based  on  common  criteria  for  case 
identification  and  testing  strategies  in  the  EU  as  well  as  connect  general  practitioners, 
hospitals, laboratories  

  Agree, with ECDC support, on common criteria for case identification and testing strategies in 

the EU.  

  Continue  to  collect  and  share  with  the  ECDC  reliable  and  timely  data  from  integrated 
surveillance  systems14  as  well  as  from  population-based  surveillance  systems  to  monitor 
COVID-19 hospitalisations and deaths.  

  Use  of  complementary  surveillance  systems,  such  as  wastewater  monitoring,  to  detect 
COVID-19 surges. Make full use of EU financial support to put in place or reinforce SARS-
CoV-2 systematic surveillance in wastewaters. 

EU INITIATIVES AND ACTIONS 

  The  ECDC  will  guide  the  transition  from  comprehensive  EU/EEA  COVID-19  emergency 
surveillance  to  routine  integrated,  sustainable,  representative  surveillance  systems  for  acute 
respiratory  illnesses  and  severe  acute  respiratory  illnesses  (integrating  COVID-19,  influenza 
and other respiratory viruses). 

  The European expert  group on SARS-CoV-2 variants will  continue to  provide advice  on the 

development and potential use of vaccines adapted to new emerging variants.  

  HERA  will  develop,  during  2022-2023,  a  state-of-the-art  IT  system,  generating  actionable 
insights for decision-making in respect of medical countermeasures during both preparedness 
and crisis phase, complementing existing systems already in place.   

  HERA,  in  collaboration  with  the  ECDC,  will  strengthen  the  existing  ECDC  SARS-CoV-2 
network  of  laboratories  to  conduct  studies  on  the  characterisation  of  emerging  variants,  and 
their impact on the effectiveness of vaccines and therapeutics. 

  HERA,  in  collaboration  with  the  ECDC  and  international  partners,  will  identify  high  impact 
threats  and  address  gaps  regarding  the  availability  and  accessibility  of  relevant  medical 
countermeasures 

  The  Commission  will  support  Member  States,  with  up  to  EUR  20  million,  through  the 
EU4Health programme in setting up integrated and coordinated surveillance systems under the 
One Health approach for cross-border pathogens15. 

13  
14  
respiratory infections) integrated surveillance systems.  

COVID-19 Data Portal: https://www.covid19dataportal.org/. 
Such  as  from  SARI  (severe  acute  respiratory  infections),  ILI  (influenza-like  infections),  or  ARI  (acute 

6 

 
 
                                                           
Testing and whole-genome sequencing 

Targeted  diagnostic  testing  should  be  put  in  place.  Priority  groups  for  targeted  testing  should 
include, for example, people in outbreak settings for containment or mitigation purposes, people at 
risk  for  developing  severe  COVID-19  and  that  need  therapeutics,  and  people  who  are  in  regular 
contact  with  vulnerable  populations,  such  as  healthcare  workers  in  acute  and  long-term  care 
settings.  

Rapid antigen tests are being used by Member States as a way of further strengthening countries’ 
overall testing capacity, particularly in case of limited PCR test capacities or where clinical needs 
require faster testing turnaround times. In this context, the EU Health Security Committee set up a 
dedicated  technical  working  group  to  regularly  review  and  update  an  EU  common  list  of  rapid 
antigen tests16 meeting specific performance criteria for SARS-CoV-2 detection.  

KEY ACTIONS FOR MEMBER STATES 

  Have sufficient testing and contact-tracing capacities in place, and plan for scaling up national 

testing strategies, when needed.  

  Ensure readiness for rapid response in case of national or local outbreaks with barometer-type 

policy responses17. 

  Continue  capacity  building  for  laboratory  sequencing  and  virus  characterisation  services, 
including  data  reporting  on  open  access  platforms,  and  ensuring  uninterrupted  viral 
surveillance. 

  Conduct periodical reviews of laboratory safety standards based on the lessons learnt from the 

COVID-19 experiences, informing necessary revision, and strengthening biosafety standards. 

  Continue strategic testing linked to representative and targeted genomic sequencing (following 

the ECDC guidance18), to be able to monitor for the emergence and spread of variants. 

(iii)  Public health preparedness and response measures  

Preparedness planning 

Evidence  shows  that  non-pharmaceutical  interventions,  such  as  mask-wearing,  ventilation  and 
physical distancing, are effective in slowing down the spread of COVID-19, if implemented early 
and comprehensively and accepted by society. Member States should have plans in place to swiftly 
and  effectively  reintroduce  such  interventions  if  the  national  or  local  epidemiological  situation 
requires so, with the goal of protecting vulnerable groups and settings such as hospitals and long-
term  care  facilities.  Further  synergies  should  be  developed  with  occupational  safety  and  health 
strategies to protect workers and  ensure business continuity.19 Clear plans should also be in place 

Technical  working  group  on  COVID-19  diagnostic  tests,  https://ec.europa.eu/health/health-security-and-

15  
For  example:  “Direct  grants  to  Member  States’  authorities:  setting  up  a  coordinated  surveillance  system 
under the One Health approach for cross-border pathogens that threaten the Union” (CP-g-22-04.01); “Joint Action on 
Strengthened  International  Health  Regulations  and  Preparedness  in  the  EU  (SHARP)”:  https://sharpja.eu/;  and  the 
Integrate Surveillance Joint Action.  
16  
infectious-diseases/crisis-management/covid-19-diagnostic-tests_en. 
17  
providing a framework for tuning COVID-19 response measures. 
18  
https://www.ecdc.europa.eu/en/publications-data/guidance-representative-and-targeted-genomic-sars-cov-2-
monitoring. 
19 Increasing preparedness for any potential future health crises is one of the three key cross-cutting objectives set up 
in the EU Strategic Framework for health and safety at work 2021-2027, COM(2021) 323 final. 

These  are  pre-defined,  predictable  policy  responses  implemented  based  on  epidemiological  thresholds, 

SARS-CoV-2  monitoring, 

representative 

Guidance 

targeted 

genomic 

ECDC, 

and 

for 

7 

 
                                                                                                                                                                                                
managing educational settings should a new variant emerge, not only to limit further transmission 
among younger age groups and further transmission to vulnerable populations, but also to limit the 
closure of schools and their impact on the education and well-being of children. 

Indoor  ventilation  is  an  area  where  further  efforts  are  required.  SARS-CoV-2  transmission 
principally  occurs  in  indoor  settings,  especially  when  ventilation  is  poor.  The  use  of  devices 
equipped with high quality filters20 should be considered by Member States, particularly in schools, 
high-risk and occupational settings. 

KEY ACTIONS FOR MEMBER STATES 

  Review, ahead of autumn 2022, the effectiveness, cost-effectiveness, and social acceptability 
of non-pharmaceutical interventions implemented to date and prepare to contingency plans to 
reintroduce  public  health  measures  if  needed  to  limit  the  impact  of  new  variants  of  SARS-
CoV-2. 
Improve or maintain national healthcare system’s capacity for coping with increasing numbers 
of  cases  of  COVID-19  and/or  seasonal  influenza,  including  hospital/ICU  capacity  and 
adequate supplies of personal protective equipment, vaccines and therapeutics.  

 

  Publish  updated  recommendations  for  the  use  of  face  masks  in  specific  settings  to  protect 
people vulnerable to severe COVID-19, such as the older persons and people with underlying 
medical conditions. 

  Quickly increase  air  quality indoors with  appropriate ventilation,  particularly  in  those spaces 

that many people visit, reside or work in, such as healthcare facilities and schools. 

  Strengthen coordination between public health and occupational safety and health authorities, 
including  drawing  up  preparedness  plans  for  future  health  crises  in  national  occupational 
safety and health strategies. 

  Optimise and invest in infection prevention and control practices in both acute and long-term 
healthcare  settings,  e.g.  by  ensuring  the  availability  of  sufficient  and  appropriately  trained 
human resources and of materials, such as personal protective equipment. 

Intra-EU and international travel measures  

The  EU  Digital  COVID  Certificate  has  been  a  success  in  providing  citizens  with  a  tool  that  is 
accepted  and  trusted  across  the  EU.  It  has  prevented  the  emergence  of  a  fragmented  system  of 
multiple national certificates. The EU Digital COVID Certificate system is sufficiently flexible to 
be adapted, if necessary, to possible future developments and new scientific evidence. 

Some Member States have also, based on national laws, used the EU Digital COVID Certificate at 
domestic level as a way to contain the spread of COVID-19, for example by requiring persons to 
hold a certificate to access cultural events, public transport and places of work. In addition, 37 non-
EU countries and territories have joined the EU Digital COVID Certificate system and several more 
countries have signalled their interest or started the procedure to join, making it a global standard. 

The EU Digital COVID Certificate system has proved to be key to the economic recovery, cultural 
and social exchange also beyond the EU borders.  

20  
For  example,  standalone  air-cleaning  devices  equipped  with  either  HEPA  (high-efficiency  particulate 
absorbing)  filters  or  filters  with  comparable  efficacy  and  of  ultraviolet  germicidal  irradiation  (UVGI),  devices  in  the 
ducts of heating, ventilation, and air conditioning systems or placed sufficiently high in rooms (upper-room UVGI). 

8 

 
                                                           
 As  noted  in  Council  Recommendation  (EU)  2022/10721,  any  free  movement  restrictions  put  in 
place  in  response  to  the  pandemic,  should,  in  accordance  with  the  principle  of  necessity  and 
proportionality, be lifted as soon as the epidemiological situation allows. As a result, many Member 
States no longer require intra-EU travellers to present COVID-19 certificates or impose other travel 
restrictions. The Commission encourages other Member States, in particular those that lift  similar 
domestic  public  health  measures,  to  lift  such  travel  restrictions  where  there  is  no  public  health 
necessity.  

The EU Digital COVID Certificate  was introduced as a temporary measure initially for one  year. 
However, as it cannot be excluded that Member States consider it necessary to reintroduce it over 
the course of the coming year, the Commission adopted a proposal to extend the validity of the EU 
Digital COVID Certificate Regulation until 30 June 202322. The proposal seeks to ensure that the 
well-established system remains available should the epidemiological situation require its use.  

Furthermore,  in  the  context  of  travel  from  third  countries,  in  June  2020,  the  Council  adopted  a 
coordinated approach to travel to the EU23, which has since then been amended three times. The last 
amendment,  adopted  on  22  February  2022,  provides  that  Member  States  should  lift  temporary 
restriction on non-essential travel to the EU for persons vaccinated with an EU- or WHO-approved 
vaccine and for persons who have recovered from COVID-19 prior to travelling to the EU. The EU 
Digital COVID certificates and COVID-19 certificates issued by third countries which are deemed 
equivalent  to  EU  Digital  COVID  certificates,  should  be  used  as  the  primary  means  of  proving 
testing and vaccination, and as the only means to prove recovery, given that they can be securely 
verified.  

Finally,  efforts  to  strengthen  Member  States’  contact  tracing  capabilities  regarding  cross-border 
passengers should be further strengthened, where necessary and proportionate. The results from the 
streamlining  of  digital  Passenger  Locator  Forms,  from  promoting  the  uptake  of  the  EU  digital 
template and application and from enabling the effective exchange passenger data among Member 
States encourage further simplification and improvements.  

KEY ACTIONS FOR MEMBER STATES AND EUROPEAN PARLIAMENT 

  Lift  the  requirement  for  travellers  to  present  EU  Digital  COVID  Certificates  as  soon  as  the 
epidemiological situation allows, and in particular when lifting similar domestic measures.   
  Ensure the adoption of the Commission proposal  to extend the application of the EU Digital 

COVID Certificate Regulation. 

  Lift the restrictions for travel within and into the EU, as soon as the epidemiological situation 

 

at allows and, in particular, when lifting similar domestic measures. 
Join the Passenger Locator Form exchange platform, which will greatly facilitate work in case 
contact-tracing of cross-border passengers becomes a priority again should the epidemiological 
situation  require  its  use.  For  this  purpose,  adopt  digital  versions,  preferably  the  EU  digital 
Passenger Locator Form template and application. 

Council Recommendation (EU) 2022/107 of 25 January 2022 on a coordinated approach to facilitate safe free 

21  
movement during the COVID-19 pandemic and replacing Recommendation (EU) 2020/1475 (OJ L 18, 27.1.2022, p. 
110). 
22  
23  
the EU and the possible lifting of such restriction. 

https://ec.europa.eu/commission/presscorner/detail/en/ip_22_744. 
On the basis of Council Recommendation 2020/912 on the temporary  restriction on non-essential travel to 

9 

 
                                                           
(iv)  COVID-19 vaccines, therapeutics and clinical trials 

COVID-19 vaccines  

A  second  generation  of  vaccines  will  become  progressively  available,  offering  additional  and 
possible  more  effective  options,  including  broader,  more  robust,  and  longer-lasting  or  better 
protection  against  infection  or  transmission.  The  Commission,  working  through  HERA,  and  the 
European  Medicines  Agency,  in  conjunction  with  the  EU’s  international  partners,  including  the 
Coalition for Epidemic Preparedness Innovations, will continue working with vaccine developers to 
ensure  a  coordinated  approach  for  second  generation  vaccines,  meeting  the  needs  of  Member 
States.  Moreover,  at  present,  there  are  a  number  of  vaccine  developers  working  on  combined 
vaccines  against  COVID-19  and  seasonal  influenza.  If  successful,  such  vaccines  could  prove  a 
powerful tool for Member States.  

Any  regulatory  flexibilities  and  simplifications  needed  for  the  next  generation  and  universal 
vaccines  against  COVID-19,  will  be  addressed  by  the  Commission  and  EMA  by  building  on  the 
changes  that  were  already  made  to  the  regulatory  framework24  as  well  as  on  existing  guidance 
documents.25  

The success of the EU Strategy for COVID-19 vaccines has led to a stable and predictable supply 
of  vaccines,  which  combined  with  plateauing  vaccination  rates,  has  accumulated  unused  doses. 
Therefore, the focus of the Commission and the Member States  has now shifted towards working 
closely with manufacturers to align supply and demand in the most optimal way.  

EU INITIATIVES AND ACTIONS 

  Develop  a  strategy  for  the  next  generation  COVID-19  vaccines  encouraging  coordination 

between public health actors, experts and researchers in this regard.  

  Support  projects  on  the  development  of  the  next  generation  of  vaccines  in  the  frame  of 

 

Horizon Europe work programme 2022.26 
Identify promising candidates for the next generation of COVID-19 vaccines and mobilise all 
available instruments to support their development. 

  Promote research on new vaccine formulations and investment in world class infrastructures. 
  Continue  working  with  vaccine  developers  and  international  partners  to  address  the 

accumulation of unused vaccine doses. 

COVID-19 therapeutics  
The EU Strategy on COVID-19 therapeutics27 aims to build a broad portfolio of safe and effective 
COVID-19  therapeutics.  It  covers  the  full  lifecycle  of  medicines  from  research,  development, 
selection of promising candidates, fast regulatory approval, manufacturing and deployment to final 
use. To date, eight COVID-19 therapeutics of different categories have been authorised addressing 
different stages and severity of the disease, which are suitable for application either at home or in 
hospital.  

24  
Commission Delegated Regulation (EU) 2021/756 of 24 March 2021 amending Regulation (EC) No 1234/2008 
concerning the examination of variations to the terms of marketing authorisations for medicinal products for human 
use and veterinary medicinal products, OJ L 162, 10.5.2021, p. 1–3. 
25  
26  
hlth-2022-disease-06-03-two-stage. 
27  

https://ec.europa.eu/health/system/files/2021-09/guidance_regulatory_covid19_en_0.pdf. 
https://ec.europa.eu/info/funding-tenders/opportunities/portal/screen/opportunities/topic-details/horizon-

Commission Communication: EU Strategy on COVID-19 therapeutics, COM(2021) 355 final/2. 

10 

 
                                                           
The  Commission  is  supporting  Member  States  to  have  access  to  therapeutics  and  has  concluded 
four Framework Contracts that have ensured the availability of therapeutics in a number of Member 
States.  

The Commission is also prioritising work on new therapeutics, including through the expert group 
on COVID-19 therapeutics, a subgroup of the European expert group on SARS-CoV-2 variants. It 
will  continue  its  work  on  horizon-scanning  for  promising  therapeutics,  in  close  conjunction  with 
Member States, to identify those that potentially offer the most benefits to patients.  

New  therapeutics  should  preferably  be  easier  to  store  and  administer.  This  could  be  particularly 
important for use in low-income countries and thus bring benefits to addressing COVID-19 at the 
global  level.  In  parallel  to  work  on  new  therapeutics,  surveillance  of  viral  resistance  (e.g.  to 
monoclonal  antibodies  or  antiviral  drugs)  is  necessary  to  choose  appropriate  therapies  and  to 
monitor the spread of resistant virus in the population.  Surveillance of the potential emergence of 
antiviral resistance is thus critical during the COVID-19 pandemic. 

EU INITIATIVES AND ACTIONS 

  Work with Member States to identify priorities for further Joint Procurements for therapeutics 

and strengthen the integration with established national and EU processes.  

  Further  enable  the  coordinated  assessment  of  new  therapeutic  compounds  in  large-scale 

European adaptive platform trials, through the joint access advisory mechanism. 

  Foster research and development for COVID-19 therapeutics. HERA will explore possibilities 

to support projects targeting the development of antivirals. 

Clinical trials 

Due to the increasing need of developing new vaccines and therapeutics, clinical trials have become 
more important than ever. Large, multi-national clinical trials are regarded as the best approach to 
generate  adequate  clinical  evidence  in  the  shortest  time  for  regulatory  decisions.  The  COVID-19 
pandemic has shown that there is a need for a faster and more robust procedure for a coordinated 
approval  of  multi-national  clinical  trials  by  Member  States  to  avoid  fragmentation,  when  small, 
mono-national trials are competing for the same resources and patient populations.  

To enable large-scale multi-national trials for COVID-19 in Europe, addressing the specific public 
health  needs  of  our  continent,  two  European  clinical  trial  networks  have  been  established  under 
Horizon  2020:  one  for  therapeutics  and  one  for  vaccines.  In  addition,  the  joint  access  advisory 
mechanism  supports  an  efficient  use  of  resources  between  the  trials  and  avoids  duplication  of 
efforts. The vaccine trial network includes public health focused vaccine trials in the elderly, in the 
general adult population and in children28. Moreover, in January 2022, the European Commission, 
EMA, and the Heads of Medicines Agency launched ACT EU bringing together clinical research 
stakeholders to enable bigger, faster and better clinical trials29. 

The swift approval of large-scale clinical trials in the EU is also part of the EU Strategy on COVID-
19  therapeutics,  and  a  joint  action30  was  launched  to  implement  the  fast-tracked  assessment  and 
approval of multinational trials for COVID-19 therapeutics. Moreover, the competence of the EMA 

28  
29  
30  
and-expedited-assessment-clinical-trials-covid-19-therapeutics_en. 

EU-COVAT-1 AGED, EU-COVAT-2 BOOSTAVAC and EU-COVPT-1 CoVacc 
https://ec.europa.eu/health/system/files/2022-01/medicinal_accelerating-clinical-trials-eu_en.pdf. 
Kick  off  meeting,  3  February  2022:  https://ec.europa.eu/health/events/joint-action-support-coordinated-

11 

 
                                                           
emergency task force was extended to include support for cooperation between sponsors to enable 
large-scale platform trials in public health emergencies.  

As global actors, European regulators are contributors to the ongoing revision of the  guideline on 
Good Clinical Practice of the  International Council for Harmonisation of Technical Requirements 
for  Pharmaceuticals  for  Human  Use  and  support  the  work  within  the  International  Coalition  of 
Medicines Regulatory Authorities to facilitate the international acceptability of large-scale platform 
trials to address health emergencies31.  

EU INITIATIVES AND ACTIONS 

  Strengthen the national capacity in EU/EEA countries to undertake research and contribute to 
multi-country  clinical  trials  during  a  crisis;  priority  should  be  given  to  the  timely 
implementation of European multi-state trials. 

  Monitor  the  full  and  timely  implementation  of  the  Clinical  Trials  Regulation  with  the 

development and regular publication of Key Performance Indicators. 

  Support  the  coordinated  and  harmonised  conduct  and  regulatory  oversight  of  the  EU-funded 

 

 

COVID-19 therapeutic platform trials under the Clinical Trials Regulation. 
Implement  the  ACT-EU  initiative  strengthening  clinical  trials  that  deliver  evidence  for 
decision-making,  including  on  vaccines  and  therapeutics  for  public  health  crises  and 
pandemics. 
Implement  the  EU4Health  Joint  Action  for  fast-tracked  approval  of  COVID-19  therapeutic 
trials  and  the  development  of  a  harmonised  procedure  for  expedited  and  coordinated 
assessment of clinical trial applications between Member States in case of future emergencies. 

(v) 

Resilient supply chains throughout the pandemic 

While  vaccine  production  capacity  currently  meets  demand,  vigilance  remains  needed  for  supply 
chain bottlenecks, not only for vaccines, but also for other medical countermeasures and their input 
materials.  Collaboration  with  global  partners  continues,  such  as  through  the  Joint  EU-U.S. 
Taskforce on COVID Manufacturing and Supply Chains.  

Moreover, in order to maintain a part of the newly created production capacity in the EU for future 
health  emergencies,  the  Commission  has  announced  today  the  launch  of  EU  FAB,  a  network  of 
ever-warm  production  capacity  for  vaccines.32  The  Commission  is  launching  the  procurement 
procedure to ensure that sufficient and agile manufacturing capacities for different vaccine types are 
kept operational and can be readily activated in times of crisis. 

Beyond the health industrial ecosystem, further vigilance is also needed on the impact of the next 
phases of the pandemic on supply challenges in other industrial ecosystems, for instance due to the 
impact  of  local  lockdowns  or  staff  shortages  on  logistics.  Close  collaboration  with  stakeholders 
across industrial ecosystems remains important. 

The COVID-19 pandemic has also highlighted broader challenges for the Single Market in case of 
unforeseen  demand  or  supply  shocks.  Enhanced  information-sharing  and  better  communication 
channels could have made for better management of the emergency response in specific sectors of 
strategic  importance.  These  aspects,  amongst  others,  will  be  further  assessed  in  the  impact 
assessment  of  the  Commission’s  forthcoming  proposal  on  the  Single  Market  Emergency 
Instrument. 

31  
32  
https://ted.europa.eu/udl?uri=TED:NOTICE:467537-2021:TEXT:EN:HTML&src=0. 

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00061-5/fulltext. 
See 

information 

published 

notice 

prior 

the 

on 

17 

September 

2021: 

12 

 
                                                           
EU INITIATIVES AND ACTIONS 

  Continued  industry  outreach  on  the  impact  of  pandemic  measures  around  the  world  on  the 

availability of critical materials. 

  Launch EU FAB, a network of ever-warm single and/or multi-technology production facilities 

in Europe for the production of vaccines. 

  Continue  supply  chain  monitoring  for  critical  medical  countermeasures  and  their  input 
materials,  notably in  collaboration with  global partners, including through the Joint EU-U.S. 
Taskforce on COVID Manufacturing and Supply Chains. 

(vi)  Addressing mis- and disinformation  

The pandemic has been  exploited by foreign  actors to  feed off and deepen insecurities,  fears and 
genuine  concerns  of  citizens  for  their  own  advantage.  Such  information  manipulation  and 
interference,  including  disinformation,  has  threatened  the  effective  response  to  the  pandemic  and 
undermined  public  trust  in  the  institutions  dealing  with  the  COVID-19  pandemic.  For  more  than 
two  years,  the  Commission  and  the  High  Representative  have  been  supporting  Member  States  to 
promote  trust-worthy  content,  identify  and  respond  to  information  gaps,  engage  in  countering 
information manipulation and interference activities, and attempts by state and non-state actors to 
exploit the crisis and put citizens’ lives at risk.  

In  response  to  the  massive  spread  of  false  and/or  misleading  information  in  an  unintentional 
manner, the EU and Member States have stepped up their communications efforts to provide timely 
and  factual  information  about  the  pandemic  and  the  measures  taken.  The  EU  has  increased  its 
cooperation, both within the EU Institutions and in particular with EU Member States, stakeholders 
from  civil  society  and  industry  through  the  Rapid  Alert  System  (RAS),  to  share  information, 
analysis  and  best-practices  on  how  to  strategically  communicate  and  raise  resilience  against 
pandemic-related information manipulation as well as cooperate in the framework of the EU’s Code 
of  Practice.  The  European  Union  has  also  published  a  Joint  Communication  on  COVID-19 
Disinformation33. Due to the global scale and impact of information manipulation and interference 
in the context of the pandemic, the EU has also closely worked together with international partners, 
in particular the G7 Rapid Response Mechanism, to share insights into such activity and exchange 
on response options. 

KEY ACTIONS FOR MEMBER STATES 

  Ensure  a  continued,  consistent  and  repeated  messaging  to  reduce  mis-  and  disinformation 
surrounding  COVID-19,  supported  in  particular  by  a  monitoring  of  the  information 
environment and trends to react and share accordingly.  

  Prepare  clear  messages  on  balanced  non-pharmaceutical  interventions,  the  need  for 

vaccination, and the possible re-introduction of measures based on the best available science.  

  Put in place specific community engagement arrangements, for better understanding concerns 
and  risk  perception.  Consider  behavioural  insight  studies,  especially  for  understanding  the 
acceptance of vaccines – against COVID-19 as well as influenza – to be able to optimise their 
uptake.  

  Prepare  communication  strategies  for  possible  up-coming  needs  of  additional  doses  of 

COVID-19 vaccines with new or modified vaccines. 

  Keep  sharing  analysis  and  assessments  of  foreign  information  manipulation  and  interference 

related to the pandemic via the EU’s Rapid Alert System. 

33  

Joint Communication:  Tackling COVID-19 disinformation - Getting the facts right, JOIN/2020/8 final. 

13 

 
                                                           
EU INITIATIVES AND ACTIONS 

  The Commission and the High Representative will continue to build on the actions listed in the 
Joint  Communication  on  COVID-19  disinformation  and  the  European  Democracy  Action 
Plan34  to  increase  resilience  to  mis-  and  disinformation  in  the  longer  term.  This  includes 
facilitating  the  exchange  of  coronavirus-related  communication  materials  between  EU 
institutions  and  Member  States35,  as  well  as  monitoring,  analysing  and  swiftly  reacting  to 
threats to public health.  

  Through the strengthened Code of Practice on Disinformation36 the Commission will enhance 

cooperation with online platforms and support European fact checkers. 

  The  Commission  is  supporting  research  for  understanding  how  misinformation  and 
information manipulation that may impact vaccine uptake. The need for further research will 
be assessed.  

(vii)  Global dimension: solidarity and governance  

The  EU,  its  Member  States  and  financial  institutions,  acting  as  Team  Europe,  have  been  at  the 
forefront of the global response to COVID-19 pooling resources and expertise.  

The EU has led the way in global solidarity as the world’s largest exporter of COVID-19 vaccines, 
with over 2.1 billion finished doses exported to 166 countries by March 2022, about two-thirds of 
its  overall  manufacturing  to  date,  starting  from  the  very  early  stages  of  the  pandemic.  An  export 
authorisation  mechanism,  in  the  meantime  replaced  by  a  monitoring  mechanism,  has  ensured 
transparency  of  vaccines  exported  and  compliance  by  manufacturers  with  their  obligations  in  the 
Purchase Agreements signed with the EU, which included commitments to make vaccines available 
internationally for ending the global pandemic.   

Team Europe has committed close to EUR 6 billion to the ACT-A Accelerator, of which over EUR 
4 billion to COVAX, the vaccine pillar, in grants and loans for vaccines purchase for low and lower 
middle-income  countries.  The  COVAX  Humanitarian  Buffer  that  aims  to  enable  vaccination  in 
fragile contexts and difficult-to-reach areas has been supported with EUR 10 million so far. The EU 
has pledged at least 700 million doses of COVID-19 vaccines for donations to partner countries, of 
which  over  474  million  have  already  been  shared.  Moreover,  it  has  made  its  EU  Strategy  on 
COVID-19 therapeutics is scalable for the benefit of COVID-19 patients globally. More generally, 
Team Europe has mobilised over EUR 46 billion to support partner countries  in facing the health 
and socio-economic impact of the pandemic. 

With a large supply of vaccines available, the challenge is shifting from providing high numbers of 
doses  to  administer  these  and  help  countries  address  their  specific  challenges  in  doing  so.  Team 
Europe has so far mobilised EUR 1 billion37 to this end. The Vaccine Support Package presented at 
the  African  Union-European  Union  Summit  (AU-EU  Summit)  in  February  2022  covers  supply, 
ancillary  material,  and  delivery  support.  It  will  be  adapted  in  response  to  countries’  specific  and 
changing  needs.  The  EU  calls  for  enhanced  coordination  of  international  efforts  to  strengthen 

Commission Communication on the European democracy action plan, COM/2020/790 final. 
Through the internal Network Against Disinformation and the Rapid Alert System (RAS). 
Commission  Communication,  European  Commission  Guidance  on  Strengthening  the  Code  of  Practice  on 

34  
35  
36  
Disinformation, COM/2021/262 final. 
37  

https://ec.europa.eu/commission/presscorner/detail/en/fs_22_870. 

14 

 
 
                                                           
countries’  capacity  for  effective  use  and  administration  of  vaccines,  such  as  through  the  Global 
Action Plan and its Lines of Efforts.  

In  parallel,  the  EU  is  following  up  on  the  conclusions  from  the  AU-EU  Summit  together  with 
African  partners,  including  on  the  implementation  of  the  Team  Europe  initiatives  to  boost  the 
manufacturing  of  vaccines,  medicines  and  health  technologies  in  Africa  (MAV+)  and  to  further 
strengthen  health  systems  and  regulatory  frameworks.  The  Commission  will  further  enhance 
collaboration  with  the  Africa  Centres  for  Disease  Control  and  Prevention  (Africa  CDC)  and  the 
African Medicines Agency (AMA), particularly aiming to further increase African health systems’ 
resilience and promote regional cooperation, also in other regions of the world.  

Work will continue across the Western Balkans and Eastern Partnership countries to strengthen the 
capacity  of  health  systems  to  deal  with  local  outbreaks  of  COVID-19  as  well  as  other 
communicable diseases. 

The  experience  with  the  COVID-19  pandemic  has  highlighted  the  need  for  reforms  to  the  global 
health architecture and for the international community to respond to future pandemics collectively, 
effectively and immediately. Following the EU’s advocacy, for a new legally binding international 
instrument  on  pandemic  prevention,  preparedness  and  response38,  negotiations  have  now  started. 
Such  an instrument  should  be a  game  changer for the  global health framework by  addressing the 
gaps exposed by the COVID-19 pandemic.  

This  goes  hand  in  hand  with  the  need  to  ensure  better  compliance  and  implementation  of  the 
International  Health  Regulations,  and  to  strengthen  the  WHO  including  though  sustainable  and 
adequate financing to deliver on its mandate. 

In  continuing  its  leading  role  to  improve  the  global  health  landscape,  the  EU  will  pursue 
multilateral efforts. The COVID-19 Summit convened on 12 May by the United States will be an 
occasion  to  enhance  global  cooperation.  Furthermore,  building  on  the  Global  Health  Summit  on 
May  2021,  the  Commission  will  convene  the  first  Global  Health  Policy  Forum  with  civil  society 
organisations in the next months. 

In  addition,  through  the  WTO,  the  EU  is  seeking  to  reinforce  the  resilience  of  global  trade  in 
essential  products  by  encouraging  its  trade  partners  to  undertake  commitments  to  restrain  from 
export  restrictions of essential  goods,  ensure  greater transparency of trade measures and facilitate 
trade  in  time  of  crisis.  The  EU  is  also  actively  working  to  reach  an  agreement  on  the  role  of 
intellectual  property  as  part  of  a  comprehensive  trade  and  health  approach  by  the  12th  WTO 
Ministerial Conference. 

EU INITIATIVES AND ACTIONS 

  The EU will continue to pursue, in coordination with international partners, its leading role in 
the  global  response  to  COVID-19,  adapting  its  efforts  to  the  evolving  context  –  notably  by 
providing  a  further  comprehensive  vaccine  support  package  to  Africa  based  on  supply, 
ancillary material and delivery support. 

  Team  Europe  will  continue  to  support  access  to  adequate  healthcare  for  all  populations  and 
stronger health systems in partner countries in all regions to detect, treat and prevent diseases, 
and respond to the current and future epidemics and pandemics, notably through strengthened 
local pharmaceutical production and through a One Health approach. The EU will invest over 

38    

https://www.who.int/news-room/commentaries/detail/op-ed---covid-19-shows-why-united-action-is-

needed-for-more-robust-international-health-architecture. 

15 

 
                                                           
EUR  1  billion  to  strengthen  health  systems  and  at  least  EUR  1  billion  to  support  local 
manufacturing of health products in Africa. 

  The EU will continue supporting the Western Balkans and the Eastern Partnership and African 
countries  in  strengthening  their  health  systems,  including  targeted  service  delivery,  primary 
and secondary care, health workforce and health information systems, and a basic package of 
essential  services  to  withstand  shocks,  to  enable  early  warning  of  disease  outbreaks  and  to 
prevent anti-microbial resistance.  

  The  EU  will  continue  to  encourage  its  partners  in  the  Western  Balkans  to  join  the  activities 
under  the  EU4Health  programme,  to  be  signatories  to  the  EU  Joint  Procurement  Agreement 
(which  should  also  be  opened  to  DCFTA  countries  39  in  the  Eastern  partnership),  and, 
alongside Ukraine (and other DCFTA countries) to be able to participate in the Health Security 
Committee as observers. 

  The  EU  will  support  and  drive  multilateral  efforts  to  learn  the  lessons  from  the  current 
pandemic  by  improving  global  health  strategies,  the  global  health  architecture  and  the 
International Health Regulations.  

  The EU will engage with trade partners in the run-up to the 12th Ministerial Conference of the 
World Trade Organisation to ensure the continuing availability of necessary materials through 
open supply chains and trade and to actively support work in the WTO on the response to the 
pandemic, including on intellectual property aspects. 

4.  MEASURES TO BE TAKEN IN THE MEDIUM AND LONG TERM 

COVID-19  has  created  long-term  challenges  that  the  EU  needs  to  address  in  order  to  be  better 
equipped to sustainably address health threats posed by infectious diseases. Building on the shorter-
term actions set out in the previous chapter, opportunities exist to further enhance, by taking a One 
Health  approach,  pandemic  preparedness  and  strengthen  coordination  in  responses  between 
Member States as well as at the global level. 

Furthermore, the Commission will continue supporting additional preparedness measures under the 
Union  Civil  Protection  Mechanism  further  developing  its  rescEU  strategic  reserve  of  medical 
equipment. 

It  is  important  to  ensure  an  alignment  between  COVID-19  recovery  measures  and  long-term 
climate, environmental and social goals, to build back better. 

Looking  ahead,  the  ECDC  has  provided  an  analysis  on  qualitative  long-term  scenarios  that 
demonstrate  a  wide  range  of  possible  outcomes,  as  shown  below.  In  mid-April  2022,  the  recent 
resurgence  observed  in  Europe  appeared  to  be  slowing  down.  This,  combined  with  signs  that  the 
sustained  transmission  recently  observed  among  older  populations  may  not  translate  into  rates  of 
severe disease as significant as those seen earlier, results in a current situation that lies between ‘a 
diminished threat’, and ‘regular reinfections’ scenarios. It will have to be seen which scenario will 
hold in the long-term. 

Five possible phases: Long-term scenarios for the development of the COVID-19 pandemic 

A diminished threat 

Regular 
reinfections 

Barely manageable 
winters 

 COVID-19 

hospitalisations and 
mortality has 
become and 

 New immune-

evading variants 
continue to emerge, 
driving frequent 

 The virus outpaces 
vaccines and our 
immune system’s 
protection against 

Unmanageable 
winters 

 There is sufficient 

waning of immunity 
and viral evolution 
to regularly lead to 

A new pandemic 

 Under this scenario, 
the persistent threat 
of emergence of 
novel pandemic 

39  
European Union, and Georgia, Moldova, and Ukraine respectively. 

The Deep and Comprehensive Free Trade Areas (DCFTA) are three free trade areas established between the 

16 

 
 
 
 
 
 
 
 
 
 
                                                           
remains very low. 

 COVID-19 is 

deemed across the 
EU/EEA to be 
routinely 
manageable. 

reinfections.  
 Although COVID-19 
mortality remains 
relatively low, 
waning immunity is 
apparent and there 
are non-negligible 
rates of 
hospitalisations and 
mortality among at-
risk populations.  

infection and 
onward 
transmission. 
 SARS-CoV-2 

variants emerge 
with higher intrinsic 
severity, combined 
with waning 
immunity.  
 A declining 

willingness among 
the population to 
take additional 
vaccine doses also 
contributes to 
significant winter-
time strains on 
healthcare systems. 

hospitalisation rates 
among the general 
population that 
exceed healthcare 
system capacities. 
 Such circumstances 

would require 
stricter population-
level NPIs, but these 
are highly unpopular 
and poorly adhered 
to, and thus 
mandatory 
measures have been 
effectively 
abandoned.  
 General vaccination 
fatigue.  

strains is eventually 
realised.  
 Return to ‘flattening 

the curve’ 
approaches for 
buying time to 
introduce revised 
vaccine.  
 The (re)imposition 

of stringent 
restrictions in an 
already pandemic-
fatigued population 
would require 
careful assessment.  

Tackling wider health impacts of the pandemic, including “long COVID”  

The complex, direct and indirect health impacts of the COVID-19 pandemic are so far only partly 
understood.  Reaching  a  full  understanding  of  such  health  impacts  will  require  further  data 
collection  and  analysis  in  the  coming  years.  Moreover,  the  magnitude  of  the  public  health, 
economic and social issues related to people suffering from post-COVID-19 condition, also referred 
to as “long-COVID”, needs to be understood.  

It  will  be  important  to  increase  the  focus  on  healthcare  system  resilience  adaptability  in  terms  of 
financial and human resources, as well as allocated goods for healthcare delivery. Additionally, to 
better enable planning of healthcare need, we must improve our understanding of excess mortality 
and  morbidity  levels  observed  during  the  pandemic,  which  will  also  relate  to  backlogs  in  non-
COVID  care.  Similarly,  more  efforts  should  be  made  at  all  levels  to  tackle  conditions  that  have 
shown to increase the risk of severe outcomes from COVID-19 such as obesity and diabetes.   

In parallel, the burden of the pandemic on mental health has increased, as reflected in a significant 
rise  of  reported  anxiety  and  depressive  disorders  in  most  European  countries.  Available  data 
suggest that the impact of the COVID-19 pandemic on people’s mental health has been especially 
marked in  children40 and  young people, women, and vulnerable  groups such as  older people, and 
people with underlying health conditions or disabilities41.  

The Commission launched in February 2022 a call for proposals for projects to support the mental 
health of vulnerable children and  young  people42, each  to  be funded  with  a EUR 4 million grant, 
and also contributing to the European Year of Youth. On 4 May, the 2021 EU Health Award will 
reward  community-based  initiatives  alleviating  the  mental  health  impact  of  COVID-19.  Up  to 
EUR 750 000  is  available  to  help  roll  out  two  practices  tackling  mental  health  challenges  during 
COVID-19.  

Speeding up digitalisation in health  

The  COVID-19  pandemic  has  clearly  demonstrated  the  importance  of  digital  services  and  has 
triggered  a  huge  acceleration  in  the  uptake  of  digital  tools,  including  for  public  health  and  in 

40  
UNICEF’s 2021 report on ‘The State of the World's Children’ was dedicated to mental health. It warned that 
children and young people may feel the negative impact of the pandemic on their mental health for many years to 
come: https://www.unicef.org/media/108121/file/SOWC-2021-Europe-regional-brief.pdf. 
41  
2022.  https://apps.who.int/iris/handle/10665/352189. 
42  

WHO, 2022, Mental health and COVID-19: early evidence of the pandemic’s impact: scientific brief, 2 March 

EU4H-2022-PJ-03: DP-g-22-07.01/03 Call for proposals on promoting mental health. 

17 

 
 
                                                           
healthcare services43. Making digitalised systems within and outside Europe interoperable will also 
be instrumental for linking inter-regional and global surveillance and response as well as enhancing 
their  efficiency.  The  Commission’s  upcoming  legislative  proposal  on  a  European  Health  Data 
Space will aim to harness the power and potential of health data and for the benefit of patients, to 
increase the resilience of health systems and their capacity to respond quickly to health threats.   

5.  CONCLUSION 

The  COVID-19  pandemic  has  had  a  multitude  of  wide-ranging  impacts  on  public  health,  on  our 
health systems, our economies, and our entire way of life. How we approach the next phase in the 
pandemic could prove to be a turning point.  

The relaxation of non-pharmaceutical interventions offers great relief, in particular for citizens and 
health  systems,  but  also  for  economic  operators  recovering  from  the  devastating  impacts  of  the 
pandemic.  Yet  continued  efforts  are  pivotal.  The  pandemic  is  still  with  us  and  future  surges  are 
likely. Effective preparedness and response should be viewed as a continuous process, and should 
be accompanied by ongoing evaluations of policies, plans and procedures based on lessons learned 
in order to be as effective as possible.  

We can and must do more to identify and act on those lessons, so that we improve our public health 
preparedness  and  response  to  future  pandemics  and  health  crises.  To  succeed,  we  need  to  jointly 
address the gaps in our public health and healthcare systems and make sure that they are resilient 
enough to face future health threats, while recognising the importance of the One Health approach 
and of coordination across sectors in making the EU better prepared for emergencies. If we invest 
in  these  areas  now,  we  also  invest  in  the  future  as  we  may  be  able  to  curb  impact  of  future 
outbreaks or pandemics.  

Vaccination, natural immunity and a coordinated EU approach offer us a window of opportunity to 
act to better prepare Europe for the different scenarios to come. The swift adoption of all European 
Health Union proposals will further strengthen the EU’s capacity to prevent, prepare and respond to 
health crises. This vigilance can pave the way for stronger health security at European and global 
level. Let’s seize that opportunity and act while the window is still open.    

43  
Such  as  electronic  health  records,  telehealth,  e-prescriptions  and  digital  health  applications.  Moreover, 
digital  platforms  and  apps  have  been  used  for  COVID-19  monitoring  and  surveillance,  contact  tracing,  vaccination 
programmes, and for issuing and verifying COVID-19 certification. 

18