Cross-border cooperation during a cross-border pandemic

"GGD: Don't get a booster abroad" was the headline of the NOS.[2] It comes after several reports about Dutch 'booster tourism' in Germany. The GGD's call to vaccinate in the Netherlands fits the general national attitude during the crisis. This is remarkable in a cross-border crisis, where countries share a common goal: to have as many people fully vaccinated, as quickly as possible. The call is even more remarkable since COVID-19 vaccination has been coordinated at the European level. In addition to the common purchase of vaccinations, a European Regulation stipulates that all people who are vaccinated with a vaccine officially recognised in the EU, can receive an EU Digital COVID-19 Certificate. This Regulation also states that the member state in which the last vaccine was administered is obliged to issue a certificate. Now that this is regulated at a European level by means of this Regulation, such a certificate is valid throughout Europe. By law, this applies to travel (the 'international' QR code), and next to that, Member States can also choose to use the European corona pass for access to other sectors, in line with the 3G or 2G rule. The Netherlands, Belgium and Germany, for example, have implemented these rules.

Of course, it would be good if it was possible to register a German booster in the Dutch Corona Check app - also to get an overview of the vaccination rate in the country. This requires even more cross-border cooperation. With a shared goal, cooperation between the GGD and its German counterpart would fit the crisis more than a purely national reflex. Wouldn't it benefit the booster campaign and the inhabitants of border regions, if, for example, there would be cooperation with the eastern neighbours, now that they are evidently open to it? For residents of South Limburg, Aachen may be closer than many available northern locations to get a vaccination. It are these innovative solutions in, and for, the border region, that do justice to the statement by GGD GHOR (the umbrella branch organisation of the GGDs) itself: 'each region, depending on its capacity, will implement its own innovative and creative ways, to meet the required upscaling as quickly as possible'.[3]

Three handicaps

Even though COVID-19 proves the necessity of cross-border cooperation, the absence of the latter is often painfully visible. "In national decision-making, those parts of our country where integrated societies across the border exist in several respects, have not been sufficiently taken into account", says King's Commissioner Han Polman.[4] A study of cross-border crisis management in the Meuse-Rhine Euroregion shows that cross-border cooperation at the regional level during COVID-19 was rather hampered by national guidance, for example regarding cooperation between IC-departments and the exchange of patients.[5] Why is it not possible to adequately fight a cross-border crisis? From the analyses by ITEM, three major hindrances can be identified to explain this.[6]

Firstly, the European handicap. There is a lack of greater European harmonisation in the field of health and infectious diseases, as opposed to, for example, animal diseases. More European harmonisation gives border regions more scope for cross-border cooperation. There are too few instruments at the European level to combat health risks in a more coordinated way, because the fact remains that health care is a national competence, and the Member States themselves have the final say on it. The European Commission is often looked at for solutions, and the finger is often pointed at them, but they can hardly be to blame if their powers are lacking. In this light, the coordinated approach to vaccinations and certificates is an important milestone that has prevented Member States from becoming competitors. In line with this, why should it not be possible in the future to also achieve a more structured cooperation around patient distribution? Here, border regions could be important frontrunners if agreements are made at European level. After all, it has previously proved possible to come up with an unprecedented European approach, as can be seen in the area of financial support measures. Prof. Luuk van Middelaar recently described, in the Guardian,  how important the common "recovery fund" broke a "taboo" and how important that was for the cohesion of the European Union.[7] Strangely enough, there is little debate, especially in the Netherlands, on the benefits of a far-reaching "Health Union".

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 the lack of competences, solidarity with neighbouring countries seems even more important. In border regions, cooperation should then be based not so much on European rules, but on good agreements between governments at different levels. However, this is not, or not sufficiently, the case. There are few, if any, cross-border agreements regarding a cross-border health crisis, surprisingly enough not even within the Benelux Union. Therefore, the lack of sufficient agreements for working together across borders lies at the root of this second problem. As a result, ad-hoc actions were improvised. Examples are the joint appeals by the heads of government as shown before, 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 went beyond attempts to solve, instead of coming up with an approach to prevent these problematic situations from happening in the first place. Again, innovative ideas such as the possibilities of coordinated cross-border patient distribution or the harmonisation of vaccination strategies are not even discussed at the national level, where decisions are made and strategies are formed. Although there is goodwill and ideas at the local level, they have not sufficiently reached the national decision-making process.

Lastly, there is the third handicap, at the local and regional level. All involved parties, stakeholders, and actors in the Euroregion were guided by national crisis management strategies, as is the case with the booster vaccinations. The role in cross-border crisis management has also been taken over by national/regional and federal authorities, placing the Euregional players in a ‘reactive’ role. Willing regional actors are thus not in a position to take action themselves. Regional cross-border cooperation is therefore hampered. The regional handicap is aggravated by the complexity on the administrative level, where, in contrast to the operational level, local administrators do not always know how to find their counterpart on the other side of the border for information exchange and coordination. This was evident at least for the Euregio Meuse-Rhine in the case of, for example, the chairmen of crisis teams, according to research by ITEM within the framework of PANDEMRIC.[8] It underlines the importance of structural consultation and understanding of (crisis) organisation structures across the border. In the future, new cross-border crisis teams could play a role, whereby the challenge is to bring the right partners together due to the differences in national competences.

To Conclude

Three handicaps, at the European, national, and local levels, explain the lack of cooperation in the (cross-border) fight against the COVID-19 crisis. After almost two years of a pandemic, national attitudes are again present during the booster campaign. A bitter conclusion is that the existing cross-border governance system on the three levels described is not robust enough for this crisis. The way forward should be without national blinders, to effectively remove the three hindrances, and gain a better understanding of cross-border solidarity and cohesion. European policy, such as a European Health Union, structural cooperation and agreements at bilateral and/or multilateral level under the roof of the Benelux Union, as well as better connections between government levels and crisis teams across the border, are important preconditions to achieve this.

So, let's not aim for 'booster tourism' in Aachen, but for booster cooperation with Aachen