Part I: Understanding EU Global Health Policies

The 2010 Communication on the EU Role in Global Health focused on highlighting shared views on health topics that could unite Member States and the EU

The development of EU global health strategies involves the twin processes of recognizing how EU policies affect health, and then developing and implementing a vision and priorities for using those policy tools, including by determining where health fits in broader EU strategic conversations and goals.

While the EU had taken steps towards developing a shared voice and vision, such as the 2005 European Consensus on Development and recognition of the EU’s global health role in the 2007 Health Strategy, the first joint EU policy statements on global health took shape in the 2010 Council Conclusions paired with a Commission Communication enunciating the priorities and actions for implementation, including emphasis of EU goals and values, such as universal health access and human rights, as well as proposed steps towards strengthening coherence, such as through coordinating views in multilateral organizations and overseas aid (EUR-Lex, 2005; European Commission, 2007, 2010; Council of the European Union, 2010).

COVID-19 gave a new momentum to develop a stronger and more coherent global health strategy

While consensus on the usefulness of a new EU global health policy might reflect the achievements of the 2010 efforts and the many things that have changed since then, the COVID-19 pandemic has been a catalyst for reconsideration of the topic. Against the background of major advances in EU health policy overall (Greer & Jarman, 2021; Greer et al., 2022a; Brooks et al., 2023), Commissioners Stella Kyriakides (DG SANTE) and Jutta Urpilainen called for the development of a new EU Global Health Strategy, they explicitly referenced the harm caused by the COVID-19 pandemic, the extent to which the years since 2020 had seen success in meeting sustainable development goals (SDGs) go into reverse, and the health security issues evoked by their statement that “viruses know no borders”. They went on to specify the goals of an EU strategy:

“That is what our citizens and partners expect: robust action to secure their health – action rooted in the universal values of human rights, equity, solidarity and cooperation.

“We will act on the basis of a new and impactful Global Health Strategy as part of the Global Gateway: we must improve health systems so that they can more effectively prevent and respond to global health threats as well as tackle all infectious and non-communicable diseases. We must address inequalities and advance towards universal health coverage. We must have strong strategic health partnerships with other regions in the world. We must reinforce local health manufacturing capacities, in Africa and beyond. And we must put the One Health approach at the core of our action, recognizing the intrinsic connection between the health of people, animals, plants and their shared environment.”

(European Commission, 2022a, undated, a)

The new Global Health Strategy was launched in November 2022

The European Commission released its much-anticipated Global Health Strategy in November 2022 (European Commission, 2022b). This was the first strategic document released since the 2010 Commission Communication and Council Conclusions (2010) and the first EU Global Health Strategy. As an external dimension of the European Health Union (EHU), the Strategy continues the EHU’s mission to sustain health systems that function in a way that reflects the EU’s core political values including solidarity while also preventing potential future health disasters (European Commission, 2022b).

The 2022 EU Global Health Strategy lays out 20 Guiding Principles that aim to steer future global health initiatives (summarized in the Annex of this Policy Brief). Overall, future health initiatives are meant to encompass the core EU values considering health for all, including humans and ecosystems, that reflect the intertwined nature that is further being discussed in the EU space in 2023. The Strategy’s three overarching priorities are:

1. Delivering better health and well-being of people across the life course.
2. Strengthening health systems and advancing universal health coverage.
3. Preventing and combatting health threats, including pandemics, applying a One Health approach (European Commission, 2022b).

These principles mean enhancing the capacity and resilience of health systems through increasing workforce capacity and capability, keeping abreast of technology, and the integration of health policies across sectors. They also influence each other. For instance, the first principle focuses on tackling root causes of ill-health, specifically for women, girls and populations previously overlooked. This directly hits upon the first and second priorities.

The Strategy presents policy tools to achieve its goals. Global mechanisms of financing are repeatedly mentioned, as are pandemic preparedness mechanisms. Moving forward, global health actions will take the One Health approach, considering the role of health across sectors. The aim of this brief is to explore these relevant policy mechanisms and tools in light of the new Global Health Strategy, its priorities and guiding principles.

Box 1

Redesigning global health governance (a perspective by Ilona Kickbusch).

Council Conclusions

The 2022 Commission Global Health Strategy was followed in January by Council Conclusions on “EU Global Health Strategy: Better health for All in a changing world.” This follows a common pattern in which the Commission’s view are endorsed in somewhat amended form, by the Council. Council conclusions agreeing with a Commission are a powerful support for implementation of a strategy because they show that the member states are also committed to the agenda. Council conclusions are also worth reading in detail because they are formulated in careful diplomatic negotiations, so nuances of language and inclusion or exclusion of topics are important.

The January 2024 External Relations (RELEX) Council meeting endorsed the Commission’s Global Health Strategy and a shared commitment of the EU and its member states to a “leading role” in global health. It reaffirmed the Council’s commitment to the principles of “solidarity, humanity, equity, gender equality, and respect for human rights.” It further asserted that “The Council remains committed to policy coherence and a human-rights based approach and further acknowledges that EU contributions to global health go beyond the health sector, including in areas such as peace and security, agriculture, climate and environment, education, research and innovation, nutrition and food security, social protection, trade and water, sanitation and hygiene.”

It endorses the three priorities of the Commission strategy: “Deliver better health and well-being of people across the life-course; strengthen health systems and advance universal coverage (“equitable access to quality, accessible, acceptable and available health services including sexual and reproductive health care services”); prevent and combat health threats, including pandemics, applying a One Health approach.” The conclusions characterise the strategy as a “new paradigm that engages all relevant areas of external policy, with an important link to internal policies”.

It calls on the Commission, High Representative and member states to “apply the guiding principles and implement” by means including “concrete action to promote global health across relevant sectors…; strengthening capacity and enhancing coordination, including through informal cooperation, to boost the efficiency and impact of initiatives and actions, ensure that the EU and its member states are speaking with one voice in relevant international fora and intensifying dialogue and joint communication efforts at multilateral, regional and national level; taking a proactive and constructive role to strengthen multilateral cooperation by filling existing gaps in global governance and ensuring complementarity and coherence of action, and with a strengthened and more effective, accountable, and sustainably financed WHO at its core, noting that the EU seeking formal observer status at WHO could be addressed and decided upon in the relevant Council structures; expanding bilateral, regional, trans-regional and global partnerships…; regularly taking stock of progress and impact.” It finally commits to a broad range of partnerships inside and outside the EU and invites the Commission and EEAS to “develop a coherent EU global health diplomacy… augment global health capacity in key EU delegations… monitor and evaluate the implementation and impact of the Strategy.”

With the Member States reticent about pooling sovereignty, EU external action on health is based on voluntary coordination that draws on existing structures and tools

Historically, EU external action has not developed in the same way as the largely internal policy areas. From its inception, the EU had some strong competencies vis-à-vis the outside world. These grew out of its early missions as a Coal and Steel Community, and later a common market, and were focused on relevant trade policy issues. Over time, as the EU added competencies, specific Treaty clauses authorized action in fields such as international development aid and cooperation. Member States, nonetheless, were reluctant to create a EU foreign policy as such, and the history of EU action in external affairs took a different route, with a prominent role for voluntary coordination (Petiteville, 2003). Those familiar with EU health policy will recognize this pattern, in which EU policies made without regard to health affect health, and over time elicit efforts to refocus them on health and increase their coherence as health policies (Greer et al., 2022b). It can be seen in global as well as internal EU health policy.

Member States’ interest in retaining their freedom of action in international affairs has traditionally given EU foreign affairs an intergovernmental cast, with the Commission active within the realm of its competencies (e.g. trade) and a separate approach for foreign policy coordination, primarily via the European Union External Action Service (EEAS).

Many of the European Commission’s directorates contribute to global health as an extension of their internal roles

EU external affairs are primarily handled by the High Representative of the Union for Foreign Affairs and Security Policy (‘High Representative’) and the EEAS, the EU’s small diplomatic corps, which answers to the High Representative and is not part of the Commission (although supported by a Service Department for Foreign Policy Instruments (FPI) within the Commission). The Commission, nevertheless, has many of the key competencies as well as expertise and resources in the key areas of EU action, including health and coordinating between the EEAS, Commission, High Representative and member states is a major challenge and focus of EU external affairs.

The Directorates General (DGs) that are involved in global health policy are a mixture of those largely specializing in external affairs and those that contribute to global health as an extension of their internal roles. The list of DGs with a strong external face and relevance for global health due to their internal activities starts with DG SANTE (health), but includes many other DGs due to the strong external effects of many EU internal policies, such as DG GROW (Internal Market, Industry, Entrepreneurship and SMEs), DG JUST (Justice and Consumers), DG AGRI (Agriculture and Rural Development, responsible for the Common Agricultural Policy), DG CLIMA (Climate Action), DG ENV (Environment) and the new Health Emergency Preparedness and Response Authority (HERA), which is currently organized as a Commission Service whose work is closely interlinked with that of DG SANTE within the Commission. The European Health Data Space is formally part of DG SANTE and, once operational, will be internally focused. However, EU data legislation is globally influential and likely to serve as a model for doing business in the global market. The 2022 Global Health Strategy further highlights the role of the EU Commission’s plan in extending the current internal roles outwards, connecting DGs cross-sectorally in pursuit of global health goals. Ultimately, the EU is so important in the world that, like other major economies, its domestic decisions all have global health implications, and a Strategy could recognize almost any of its competencies’ relevance to global health.

Box 2

The European Health Union: Internal action with cross-border implications.

DGs that focus on external affairs and are especially relevant to global health include: DG INTPA (Institutional Partnerships), DG ECHO (Civil Protection and Humanitarian Aid Operations), DG NEAR (Neighbourhood and Enlargement), DG AGRI (Agriculture) and DG TRADE (Trade). DG NEAR is the leading DG for accession candidate states and those that are part of the Neighbourhood Policy area. DG INTPA’s remit is responsible for the EU’s international partnership and development policy, including the European Consensus on Development. DG ECHO’s remit is primarily international and its origins were in that area, but its role in Civil Protection (e.g. the RescEU programme) has given it a profile internally in recent years (for further information on EU instruments in these policy areas refer to the section on ‘Official development assistance and humanitarian aid’). DG TRADE implements the powerful, exclusive or mixed, EU competencies in international trade (see the section on ‘Trade in services and goods’).

Agencies such as the ECDC, EMA and EFSA play a major role in formulating international standards that may have global influence

Most EU agencies have limited remits in technical areas as well as limited executive authority. This can paradoxically contribute to their ability to produce evidence, guidelines and standards that are well regarded and influential worldwide: because it is clear that they are more technical and less political, governments and experts can trust them. Trust must be earned, but it is easier for agencies to earn it if they have clear objectives and technical focuses. In health, the ECDC and the EMA gained worldwide visibility for their role in the COVID-19 pandemic. At the same time, agencies like the European Food Safety Authority (EFSA) work to promote food safety as well as to prevent zoonotic health threats and those that might spread through food contamination (Bronzwaer et al., 2021). The EU role in formulating shared international standards, often in technical but important areas, is hard to overestimate, and agencies are often a key part of that global influence.

EU actors, such as the EIB and the European Court of Justice, have powerful effects on global health action

The High Representative and the Commission, along with the heads of government in the European Council, are at the centre of most conversation about EU global policy, and of this brief. It is nonetheless worth noting that the EU has a number of actors with powerful external effects.

Some of these are indirect, as with the European Court of Justice (ECJ)’s exchanges with other high courts, which diffuse European legal concepts and doctrines. Others are quite direct, as with the financial and monetary policy operations of the European Central Bank (ECB), which often coordinates with other central banks, or the loaning of various European and other European multilateral banks, which can affect the resources and policy orientations of debtor countries. While some of these organizations, such as the European Investment Bank (EIB) and the European Bank for Reconstruction and Development (EBRD), are very low profile, their actions are part of the EU’s effect on global health.

In recent years, the role of such banks has become increasingly important, along with philanthropic actors and private sector funding, for development and international cooperation funding mechanisms. While they are often independent – the ECB in particular enjoys a treaty base that deliberately limits its accountability to member states or the public – there is a measure of pragmatic information exchange and perhaps coordination. Coordinating with these actors is also part of the High Representative’s responsibilities as well as being part of the EU’s overall coordinating machinery headquartered in the Council and Commission secretariats.

More information on the EU’s political and financial cycles, as well as the structures, legislative provisions and instruments of relevance to its health and global health policies can be found in the European Observatory’s book ‘Everything you always wanted to know about European Union health policies but were afraid to ask’ (Greer et al., 2022b) and the policy brief ‘European support for improving health and care systems’ (Fahy, Mauer & Panteli, 2021).

Setting the ‘right’ EU global health priorities depends on matching intended goals with real or realistic policy options

Determining which policy tools are to be part of a strategic EU approach is a process based on first understanding the priorities and goals of the strategy. For some purposes, the right tools might be in trade policy, for others, ODA, while in other cases the right tools might be a blend from across different policy areas. The EU Global Health Strategy of 2022 covers the work of DG SANTE and DG INTPA, but European policy tools that affect and can be used to shape global health stretch far beyond their activities.

Understanding EU global health and prioritizing actions requires triangulating between the tools (what the EU can do) and the goals (what are the intentions of EU action above and beyond what is already being done?). The Global Health Strategy will contribute to shaping Europe’s place in the world, but only if it matches goals with real or realistic policy tools.

Determining the goals that the EU is to pursue in health is a political process that must balance a variety of interests

The EU and its Member States face many problems to which global health action is relevant, and different actors place varying weights on them. Determining the goals that the EU is to pursue in health is a political process that must balance a variety of interests.

Interests to be found in any international strategy can include the ambition to tackle emerging challenges such as pandemics and to implement effective One Health approaches to curb future health threats. Others may be related to navigating various geopolitical climates, to building support for a particular international order (such as one with a strong role for international law and human rights), advancing health and human development as a goal in its own right, or promoting internal economic growth or economic development abroad. These different goals tend to map onto both particular policy tools (for example, trade policy is historically driven by domestic economic concerns) and policy constituencies.

An EU Global Health Strategy, just as any other EU strategy, demarcates a set of linked policy tools and sets out the priorities that should affect their use. Although reconciling different interests and priorities is a challenging process, the Global Health Strategy identifies the scope of global health goals, alludes to some of the relevant tools, and guides their use in shaping global health policy.

Box 3

Global health goals moving forward (a perspective by Ilona Kickbusch).

There is a broad range of EU instruments that can be used to impact health globally

There are many tools the EU uses that affect health and can be part of a successful and powerful global health strategy. To capture this complex set of policies, we categorized EU tools relevant to global health. The categories were kept sufficiently abstract and mutually exclusive to allow assigning the instruments for EU action for global health. The categories were designed in support of the discussion of the EU Global Health Strategy. The intention is to produce a clear picture of what is already done by the EU on global health as well as where the new Global Health Strategy may guide the EU’s actions in future. This lends itself to discussing policy consistency and synergies between different instruments. The categories were therefore designed irrespective of the EU policies stipulated in the Treaty and also irrespective of the remit of the different Directorates General.

The main results are presented in Part II of this brief. Ownership of the instruments can be looked up in the detailed tables in the annex. EU instruments were systematically researched and mapped through: 1) literature search; 2) analysis of the websites of different DGs; and 3) expert advice and consultation. The research team was composed to reflect technical competence matching the main categories. We are also grateful to our external reviewers for helping us to close gaps and identify inaccuracies.

EU global health tools can be grouped into four types: policy, funding, information and technical support

We divided tools used by the EU in global health into four main areas based on the principal content and form of the support provided. The four categories are policy, funding, information and technical assistance. These categories had been previously developed and used by Fahy et al. to classify instruments relevant to the EU’s internal health action and policies in the policy brief on ‘European support for improving health and care systems’, although with slightly different meanings and implications (Fahy, Mauer & Panteli, 2021).

For the purpose of this brief, policy refers to wide-reaching EU actions, such as tariff decisions, that influence global health by shaping what the EU does internally or supports in international forums. Policy decisions might not directly involve big sums of money but can have dramatic effects. For example, the EU single voice in multilateral organizations can shape what they do, and trade preferences can have enormous consequences for exporters to the EU.

Funding refers to direct EU expenditure and financial support. The EU is one of the larger players in ODA and global health, and even to simply note its large ODA expenditure is to understate its external financial impact. EU instruments based primarily on funding involve EU financial support of particular partners in pursuit of particular goals.

Information is an often underestimated tool of influence and one in which the EU is strikingly strong among major global actors. It involves providing and circulating information, guidelines and technical knowledge, often coupled with the development of networks of experts, provision of advice and training. Countries with limited resources and close relationships with the EU, in particular, will often appreciate and be influenced by such engagement.

Technical assistance, finally, refers to targeted support such as that provided by the civil protection mechanism (which includes a mechanism, the European Medical Corps, for sending emergency medical staff to the sites of disasters) as well as assistance on issues such as accession (for pre-accession states) or trade capacity building.

Global health tools can also be grouped by policy area: trade in goods and services; public investment and fiscal instruments; ODA and humanitarian aid; solidarity, voice and multilateralism; research and training partnerships

Defining the boundaries of global public health might seem to be a largely academic enterprise, but it is one with political stakes. If global public health includes policies on preventing AMR, then food and agricultural policy internal and external to the EU become part of global health policy. If the health workforce is part of global health policy, then education, training and free movement become part of global health policy. In delineating the EU’s Global Health Strategy, therefore, it is helpful to think in terms of policy areas and evaluate the extent to which they can contribute to any particular goal.

The policy areas we defined include public investment and fiscal interests, in which the EU supports mobilization of investment. This can involve: both public and private investment, which is assembled by risk-sharing mechanisms or other forms of incentive; ODA and humanitarian aid, which refers to direct assistance to governments and non-governmental organizations (NGOs) for response to major shocks as well as development in third countries, including the direct neighbourhood and accession candidate countries; solidarity, voice and multilateralism, which refers to the EU’s participation in and role in shaping the global health governance environment, which involves both coordination in decision making and financial support; and finally, research and training partnerships, which shape and support global networks of health research and workforce (see Box 4 for a short summary of the policy areas). Sections in Part II discuss the primary instruments identified in each of these policy areas and classified according to type, as well as potential strategies for maximizing the EU’s role in global health. These policy categories are not exhaustive, but serve to cover a vast proportion of the EU instruments relevant to global health, as well as to demonstrate the added value in mapping available tools and what they do to support the implementation of the Global Health Strategy priorities.

Box 4

Main policy areas analysed.

Figure 1

Mapping EU global health actions through the lens of policy tools and areas.

Policy problems differ depending on the geographical area, but geographical categorization does not necessarily support coherence

Places are crucial in global health. Issues, stakes, priorities and problems all differ from country to country. The EU has a dense conceptual and legal framework for, in particular, countries in the region around it. This framework of accession candidates, European Economic Area (EEA) members, neighbourhood states and other categories has a history that separates them from ‘global health’ issues. It is not, however, at all clear that this framework accurately reflects EU problems, priorities or tools, or how separating out these different categories creates policy coherence or enables prioritization. In addition, the EU engages multilaterally with many other actors beyond the national level. In this regard, the WHO and the UN, with their headquarters in Geneva and New York respectively, represent focal points for collaboration and coordination of global health initiatives (Hosli, 2022).

The region around Europe is a place in which health and other policies affect Europe, and European policies can have particularly dramatic health effects

The area around Europe contains a very diverse set of countries which have varying health statuses, political relations with the EU, and health or economic impact on the EU. Perhaps reflecting these challenges, the EU subdivides the countries around it fairly precisely. These countries exist in a somewhat ambivalent relationship to EU ‘global’ strategies, partly because of the depth and complexity of exchanges and partly because of the institutional organization of the EU. Nonetheless, the region around Europe is both a place in which health and other policies affect Europe, and where European policies can have particularly dramatic health effects. The EU’s 27 Member States, for example, make up half of the 53 Member States of the WHO European Region. A coordinated EU voice in the Regional Committee can make the EU extremely influential in that body.

The EEA is at bottom a system for connecting the EU with a set of three countries: Iceland, Liechtenstein and Norway. These are not EU Members but are very tightly integrated into the EU. Along with Switzerland, they are Members of the European Free Trade Association (EFTA). EFTA maintains its own institutions, including a court. Switzerland, which is important in global health for a number of public and commercial reasons, belongs to EFTA but not the EEA, preferring to manage relations with the EU outside the EFTA–EU relationship through bilateral agreements with the EU.

The rest of this section discusses the countries around the EU in the terminology of the EU. In most cases, the problems with these older clusters of countries are apparent; accession countries, for example, include countries as different as Türkiye and Ukraine, the United Kingdom is in an unstable category of its own (Greer & Laible, 2020; Fahy et al., 2022), and almost nothing – and certainly not relations with the EU – unites the designated neighbourhood states. It is not clear that these frameworks are helpful or always much used in organizing EU relations, but the countries matter enormously for health in the world and for the EU’s action on health.

The sheer diversity of neighbourhood countries, territories and areas means that there needs to be a multitude of tools to be effective

The EU Neighbourhood Policy is not a geographical expression, but rather a concrete policy vehicle originally developed to manage and strengthen relations with neighbouring states, territories and areas. To the south, that means Algeria, Egypt, Israel, Jordan, Lebanon, Libya, Morocco, occupied Palestinian territory, including East Jerusalem, the Syrian Arab Republic and Tunisia. To the east, neighbourhood policy states are Armenia, Azerbaijan, Belarus, Georgia, and Moldova. The sheer diversity of neighbourhood countries and territories means that one policy could hardly be relevant for all of them. In many cases, major political events have led to their relations with the EU becoming essentially bilateral, conducted outside any particular framework (Israel and Libya, for example) or essentially frozen (Belarus, the Syrian Arab Republic).

The Russian Federation is not a neighbourhood policy state and while there have been efforts to forge cooperative relations in health, EU cooperation with the Russian Federation was stifled by Russian restrictions on civil society and health cooperation initiatives had largely ceased by 2022. EU relations with the Russian Federation are likely to remain difficult due to the repercussions of the Russian Federation’s war on Ukraine.

Accession states receive financial and technical assistance as well as information from the EU to support them in the implementation of the acquis communautaire

Candidacy to EU accession is a particular status that follows application by the state in question and acceptance of that application by the Council. Once a state is a candidate for accession, negotiations begin on a wide variety of substantive chapters of the EU acquis communautaire, the body of EU law which every state must accept and implement in order to join the EU. In this they can receive financial and technical assistance as well as information from the EU. Not all candidates are equally enthusiastic about their EU applications or the domestic policies needed to advance, while EU Member States are not all equally enthusiastic about all the candidates’ applications. The result is that a number of significant EU relationships are with countries that are clearly not on a rapid path to accession but are still technically candidates and dealt with as such. Current accession candidates are Albania, Moldova, Montenegro, the Republic of North Macedonia, Serbia, Türkiye and, since June 2022, Ukraine. The southeast European candidates could join the EU, in principle, within a few years. Türkiye’s application is frozen and there seems to be little political will on either side to advance it. EU relations with Türkiye on major issues, such as refugees, take place outside the accession framework. Ukraine’s candidate status, recent and awarded to a country defending its territorial integrity in a war, was politically momentous but the numerous technical details of accession, many of which touch on health, are just starting to be discussed.

The EU should use its global voice for health

International partnerships based on co-ownership and co-responsibility are recentred in the Global Health Strategy. The Global Gateway would develop multilateral partnerships with countries that have similar global aims. Countries including the United States, United Kingdom, Japan and Canada have all been specifically identified, with partnerships between agencies such as the ECDC and American Centers for Disease Control (CDC) or African Union aiming to build resilient health systems and governance to prevent outbreaks.

The EU Global Health Strategy addresses strains to health systems in neighbouring Ukraine and Moldova, as well as candidate countries. The Strategy specifies not only the need for ongoing European health system support, but also the need to extend health system aid through continuous partnerships.

Global health action is used for and affected by geopolitical goals

The world outside the immediate environs of the EU is obviously diverse and complex, ranging from small states highly dependent on European aid to a range of great powers with varying patterns of cooperation and rivalry. Some noteworthy clusters of countries include great powers, which range from longstanding allies and partners such as the United States, Japan, United Kingdom and Canada, to powers such as Brazil, China, and India, whose relations with the EU are still in flux. The policy tools that are relevant in direct relations with them will vary considerably based on their gross domestic product (GDP) and the nature of their interactions with the EU; trade policy, for example, is a major feature of EU interactions with the United States, United Kingdom, Japan and Canada, and is a powerful tool to shape relations with them. Their goals can also lead them into direct competition with the EU as well as complementary relations. We see this, for example, in the history of Brazil’s efforts to build a domestic research-based pharmaceutical industry and consequent tensions with the EU, and within Brazil and the EU over IP and access to medicines issues (Massard da Fonseca & Moraes de Achcar, 2022).

Geopolitical competition in health is often filtered through relations with third countries. ‘Vaccine diplomacy’ in 2020 and 2021 was a notable example (Jarman et al, 2024). Most countries with access to COVID-19 vaccines, including EU Member States, used vaccines as diplomatic tools with which to build relations with particular governments and acquire prestige in other countries.

Box 5

Moving from Health in All Policies to Health for All Policies.