Not because you can, but because you have to
The final weeks of 2021 were dominated by the cross-border nature of COVID-19 and its control. While the Netherlands entered the festive season in full lockdown, full closures remained largely absent in Germany and Belgium. This leads to so-called border effects, where, like a waterbed, people divert to neighbouring countries to enjoy the hospitality industry and shops there. In response, the heads of government of the Netherlands, Flanders and North Rhine-Westphalia called for people not to go to neighbouring countries if they don’t have to.[1] This call is not new, but has been made repeatedly over the past small two years of COVID-19. So too in 2020 just before the holidays. An ultimate emergency measure was the Belgian border closure, after the opposite scenario took place with many Belgian residents coming to recreate in the Netherlands.
ITEM analyses show how cross-border cooperation fell and falls short during COVID-19, to the detriment of the border region where border commuting is a day-to-day phenomenon. Indeed, in the border region, measures taken at the national level clash and create friction.
Boostertourism
“GGD: Don’t get booster shot abroad” headlined NOS,[2] following several reports of Dutch ‘booster tourism’ in Germany. The GGD’s call to vaccinate in the Netherlands fits into the overall national reflex during the crisis. This is remarkable in a cross-border crisis, where there is a common goal: to have as many people as possible fully vaccinated as quickly as possible. All the more remarkable is the call in light of the fact that COVID-19 vaccination is precisely what is now aligned at the European level. In addition to procurement, a European Regulation regulates that all those vaccinated in the EU by an authorised vaccine can obtain an EU Corona certificate (EU Digital COVID-19 Certificate). This Regulation also stipulates that the Member State in which the last vaccine was administered is obliged to issue a certificate. Now that this is regulated on a European level through a Regulation, such a certificate is also valid throughout Europe. By law, this applies to travel (the ‘international’ QR code), member states can also choose to use the European corona pass for access to sectors, according to the 3G or 2G rule. The Netherlands, Belgium and Germany, for example, have done this.
Of course, it would be good if it became possible for a German booster could also be registered in the Dutch Corona Check app, also for an overview of vaccination coverage. On the contrary, this requires even more cross-border cooperation. With a common goal, GGD cooperation with the German counterpart fits better than a national reflex. Wouldn ‘t it benefit the booster campaign if , for instance for residents of borderregions ‘ to cooperate with their eastern neighbours, now that they are apparently open to it? For residents of South Limburg, Aachen may be closer than many available higher vaccination sites. It is these innovative solutions in and for the border region that do justice to the passage by GGD GHOR (the umbrella branch organisation of the GGD’s): ‘each region as capacity demands, with its own innovative and creative ways of implementation, to fulfil the required scaling-up as soon as possible ‘.[3]
Three handicaps
Despite COVID-19 proving the need for cross-border cooperation, its absence is mostly painfully visible. “National decision-making has not sufficiently taken into account those parts of our country in which there are integrated societies across the border in several respects,” said King’s Commissioner Han Polman.[4] A study on cross-border crisis management in the Meuse-Rhine Euregion shows that during COVID-19, cooperation across borders was rather hampered at the regional level by national steering, for example with regard to cooperation between ICU departments and patient exchange.[5] Why does a cross-border crisis fail to be adequately dealt with across borders? It can be argued from ITEM’s analyses that this can be explained by three major handicaps.[6]
First, the European handicap. There is a lack of more far-reaching European harmonisation in the field of health and infectious diseases, unlike, say, animal disease. More European harmonisation creates more room for cross-border cooperation for regions at the border. There are too few instruments at European level to combat health risks in a more coordinated way, now that healthcare is a national competence. The European Commission is often looked at and pointed at, but they are little to blame if their powers are simply lacking. The coordinated approach around vaccinations and evidence is an important milestone in this light; it has prevented member states from becoming competitors of each other. Following on from this, why would it not be possible to also achieve more structured cooperation on patient dissemination in the future? Here, border regions could be important frontrunners if agreements are reached at European level. After all, when it comes to financial support measures, it has previously proved possible to come up with an unprecedented European approach. Prof Luuk van Middelaar recently described in the Guardian how the common “recovery fund”, another evidence of far-reaching cooperation, breaks a “taboo” and how important that is for the cohesion of the European Union.[7] Strangely enough, there is little discussion about the benefits of a more far-reaching “Health Union”, especially in the Netherlands too.
A second handicap is at the national level, where there is a lack of coordination between neighbouring countries. Since European cooperation in healthcare as described is very limited due to competences, solidarity with neighbouring countries seems all the more important. In border regions, cooperation should then not so much be through European rules, but on the basis of good agreements between governments at different levels. However, this is not to little the case. There are few to no cross-border agreements regarding a cross-border health crisis, surprisingly not even in the context of the Benelux Union. Consequently, the lack of proper agreements to cooperate across borders is at the root of this second handicap. As a result, ad hoc cross-border actions had to be improvised. Examples include the joint appeals by government leaders or the ad hoc agreements on the transport of Dutch patients to German Intensive Care Units. Especially the latter shows, that there is no structural cooperation. It never got beyond attempts to cure, not to a joint approach to prevention. Again, innovative ideas such as the possibilities of coordinated cross-border patient dissemination or harmonisation of vaccination strategies are not even discussed at the national level, where decisions are made and strategies formed. Although benevolence and ideas exist at local, decentralised levels, these have not managed to reach national decision-making sufficiently.
Finally, there is the third handicap at the local and regional level. All involved parties, stakeholders and actors in the Euroregion were driven by national crisis management strategies, as also with regard to booster vaccinations. The role in cross-border crisis management has also been taken over by national/regional and federal authorities, placing Euroregional players in a ‘reactive’ role. Benevolent regional actors are thus not in a position to take action themselves. Regional cross-border cooperation is thus hampered. The regional handicap is compounded at the complexity on the administrative level, where, in contrast to the operational level, local administrators did not always know how to find their counterpart on the other side of the border for information and coordination. This was evident at least for the Meuse-Rhine Euroregion with, for example, crisis team chairmen, ITEM research as part of PANDEMRIC[8] shows. It endorses the importance of structural consultation and knowledge of (crisis) organisational structures across the border. New cross-border crisis teams could play a role in the future, with the challenge being to bring the right partners together because of differences in national competences.
In conclusion
Three handicaps, at European, national and local levels, explain the lack of cooperation for the good of the (cross-border) response to the COVID-19 crisis. After just under two years of a pandemic, national reflexes also take place again in the booster campaign. A bitter conclusion is that the existing cross-border governance system at the three levels described is not robust enough for this crisis. The way forward would benefit from stripping away the national blinders, effectively removing the three handicaps and coming to a better understanding of cross-border solidarity and cohesion. Here, European policies, such as around a ‘European Health Union’, structural cooperation and agreements bilaterally and/or multilaterally under the roof of the Benelux Union, and better links between government layers and crisis teams across borders are important preconditions.
Thus, on to not ‘booster tourism’ in Aachen but booster cooperation with Aachen.
Referentions
[1]https://www.rijksoverheid.nl/documenten/diplomatieke-verklaringen/2021/12/23/gezamenlijke-verklaring-van-nederland-en-noordrijn-westfalen-over-beperken-van-contacten
[2]https://nos.nl/artikel/2411076-boostertoeristen-in-duitsland-in-nederland-duurt-het-te-lang
[3]https://ggdghor.nl/actueel-bericht/18-plus-boosterprik/
[4]‘Grensregio’s en besluitvorming over Covid-19’, Han Polman, in Essaybundel voor Ministerie Justitie & Veiligheid
[5]ITEM Grenseffectenrapportages 2020 en 2021.
[6]As presented in the Essay Collection for Ministry of Justice & Security, ‘Crisis management with a triple handicap’ by Martin Unfried m.m.v. Pim Mertens
[7]‘Faced with Covid, Europe’s citizens demanded an EU response – and got it’, Luuk van Middelaar, The Guardian, 29.12. 2021, https://www.theguardian.com/world/commentisfree/2021/dec/29/covid-europe-citizens-eu-response-pandemic-european-health
[8]Buiskool, Lakerveld, Unfried (2021). Covid-19 Crisis-management in the Euroregion Meuse- Rhine. Maastricht: ITEM. Onderzoek in het kader van het INTERREG EMR project PANDEMRIC (EMR177).