Five years after the Covid-19 pandemic exposed the weaknesses of Europe’s health and social care systems, have policymakers truly learned from the crisis?
While some steps have been taken to improve preparedness, such as improving coordination of disease centres as well as response mechanisms, the most important lesson has been overlooked: Europe’s resilience depends on strong, well-funded public health and care services with qualified staff.
Yet instead of strengthening these systems, many governments are prioritising deregulation and competitiveness, risking the same vulnerabilities that left Europe unprepared in the first place.
Indeed, the EU’s current trajectory — marked by budget cuts and market-driven policies — risks deepening inequalities, worsening workforce shortages, and leaving Europe unprepared for future health emergencies.
The political shift away from public investment ignores the lessons of the pandemic and undermines the fundamental right to healthcare. Without renewed commitments to funding, regulation, and public sector protections, Europe risks repeating past failures and exposing its citizens to preventable harm.
Over two million people in the European region died due to the pandemic, including many health and social care workers. Many continue to suffer from post-Covid conditions such as long Covid or stress-related problems like depression, burnout, and PTSD. Research on the crisis’s impact on healthcare workers and trade unions' responses has documented these ongoing struggles.
More than three years after the peak of the pandemic, the WHO declared on 5 May 2023 that Covid-19 no longer qualified as a global emergency.
However, its devastating effects persist — continuing to strain healthcare systems and the broader public service sector. Cuts to the public sector, or in some cases chronic underinvestment, combined with privatisation, left health and social services unprepared for the pandemic.
For too long before the pandemic, policymakers viewed care as a commodity rather than a fundamental right and a long-term investment in economic and social well-being. Institutions such as the ILO and WHO have consistently emphasised the need for sustained public investment in care services.
Although the initial applause for health workers led to some policy proposals — such as those outlined in the WHO-Europe Bucharest Declaration and the OECD Health Ministers’ Declaration, as well as EU4Health projects addressing nursing shortages — implementation remains inconsistent. Addressing workforce shortages at both the EU and national levels is now a pressing issue, with the WHO projecting a shortfall of 4.1 million healthcare workers in the EU by 2030.
Efforts to address workforce shortages must prioritise retention as well as recruitment. Improving retention starts with better working conditions. While collective bargaining and strikes have led to wage increases, other key aspects of working conditions — such as reducing overtime, improving work-life balance, and strengthening occupational safety and health (OSH) regulations — require urgent attention.
The EU has the legal competence to improve OSH legislation, yet the European Commission has yet to present an initiative for a dedicated directive on psychosocial risk factors, as proposed by European trade unions and supported by the European Parliament. This directive could address factors such as excessive workloads and workplace violence, which have both increased since the pandemic. Additionally, EPSU argues that a dedicated OSH directive could help prevent staff shortages in the healthcare sector.
The pandemic also highlighted the sector's reliance on overtime, a trend with serious health consequences. Eurofound’s 2022 report on overtime in Europe notes that long working hours increase the risk of physical and mental health issues. The health sector ranks lowest in Europe in terms of flexible working arrangements, with fewer than 20 percent of workers reporting the ability to take time off for personal or family matters. Addressing this issue is especially crucial in a female-dominated sector such as healthcare, where improving flexibility and work-life balance would yield significant benefits.
Improving working conditions must go hand-in-hand with increased public service funding, particularly in health and social care. While European governments and the European Commission initially recognised the need for investment, implementation has lagged behind. The political narrative has shifted from making Europe more resilient to future pandemics to introducing austerity measures, including healthcare budget cuts aimed at reducing national deficits.
These austerity measures could lead to reduced access to healthcare professionals and hospital services, particularly in rural areas (medical deserts), or even recruitment freezes across the public sector, as seen in Romania.
The commission’s recently presented work programme makes it clear that health is no longer a top priority.
Instead, it focuses on deregulation and competitiveness, as outlined in the Competitiveness Compass — a policy approach at odds with the urgent need to strengthen healthcare systems. Health and social care should not be treated as competitive industries — Europe should not and cannot "compete" with other regions when it comes to healthcare.
In times of pandemics or other health emergencies, international collaboration — from sharing healthcare workers to exchanging patents and medical products — is essential. This is why the WHO has been working on the Pandemic Treaty. Health is not a commodity, and a profit-driven private sector approach will inevitably lead to fragmentation, reduced service quality, and worse outcomes for low-income populations.
Rather than deregulation being pushed in the name of ‘competitiveness’, the health and social care sector needs clear guidelines to ensure equal access to quality care, the availability of qualified personnel, and access to essential medicines and medical devices. While bureaucracy can be streamlined through digital solutions, key procedures must be maintained to guarantee high-quality care. Instead of focusing on competition, Europe must work together — both regionally and globally — to ensure universal access to quality healthcare.
Care must also be central to European preparedness for future emergencies, including pandemics, climate-related disasters, and conflicts.
Yet, the recent Niinistö report, Safer Together – Strengthening Europe’s Civilian and Military Preparedness and Readiness, barely mentions healthcare, underscoring the sector’s continued marginalisation in future planning.
Five years after the pandemic began, it is more critical than ever to protect a rights-based approach to healthcare and prevent its politicisation — particularly against far-right misinformation and attacks. From Covid-19 vaccine conspiracy theories to proposals by the US and Argentina to withdraw from the WHO, we are witnessing growing attacks on public health institutions, experts, and trade unions.
Universal access to quality healthcare is a fundamental right that only a strong, well-funded public sector can guarantee. To uphold this right and ensure that access to care remains equitable, healthcare systems must be shielded from austerity-driven policies, deregulation, and far-right ideologies.
Adam Rogalewski is policy officer for health and social services in the European Federation of Public Service Unions, having worked for the British public-services union Unison, the Swiss general union Unia and the Polish federation of trade unions, OPZZ.
Adam Rogalewski is policy officer for health and social services in the European Federation of Public Service Unions, having worked for the British public-services union Unison, the Swiss general union Unia and the Polish federation of trade unions, OPZZ.