How Norway missed the boat on Europe’s joint medical purchases

Tansy E. Hoskins

Covid-19 means almost all countries share the same medical needs. But it is easier to negotiate good prices and terms if you represent nearly 450 million customers than if you bargain on behalf of just under 5.4 million.

This is EU solidarity in action,’ said Ursula von der Leyen, President of the European Commission, last week. ‘It shows that being part of the Union pays off. This material should soon provide considerable relief in Italy, Spain and in 23 more member states.’

The 2009 swine flu pandemic exposed a dramatic lack of protective equipment throughout the EU. It was this experience which triggered the initiative of what in 2014 became the joint procurement agreement (JPA).

Norway: Buried for over two years

The Norwegian Government has enrolled Norway into the EU’s joint procurement scheme for medicines, medical supplies and protective equipment in the midst of the Coronavirus crisis. But Norway came just too late to take part in the supply of protective equipment and respirators, having sat on the issue since 2014.

Since Friday 20 March, Norway has been a member of the EU’s joint procurement agreement for medical countermeasures. But it enrolled three days too late for the Norwegian health care system to benefit from two major purchases: One of protective equipment, one of ventilators.

Norway is not an EU member, but it has access to the single market through the so called EEA agreement. When Norway joined the JPA on 20 March this year, the shortage of protective equipment in the Norwegian health system was acute. ‘We will be out of equipment in days or a week if a user gets infected. We have almost no masks, gloves, or hand sanitiser. We’re heading for a crisis!’ wrote a union representative in the Norwegian Nursing Association about the situation in the Oslo municipality, according to the newspaper VG.

For three weeks preceding March 20, bureaucrats at the Norwegian EU delegation in Brussels and in ministries in Oslo worked hard to get Norway into the EU’s common procurement scheme.

They did not start from scratch; they picked up a thread left by the authorities since 2017, when the EU determined that Norway could easily accede. This is evidenced by official documents seen by Investigate Europe.

Norway enrolled three days too late to benefit from two major purchases: One of protective equipment, one of ventilators

Norway’s first Coronavirus case was registered on Wednesday, February 26 2020. The following day, the EU delegation called the secretariat for the EU’s joint procurement of medical countermeasures, which is based in Luxembourg. In an email later that day, a Norwegian bureaucrat reminded her colleague that Norway had previously been in a dialogue with the EU Directorate for health to join the scheme.

‘Unfortunately, the process has been delayed on our part, but we are now ready to start the process again,’ the message from Norway said.

On Sunday, March 1, an assistant in the EU’s joint purchasing team responded that the secretariat would get back to Norway during the week.

Several days went by. On Friday, March 6, an impatient email was sent by a senior adviser in the Ministry of Health in Oslo: ‘With the current Coronavirus outbreak, it has become a priority’ to explore the possibility of joining the joint purchasing agreement, the email read. ‘Therefore I am writing to you to hear whether you have had the time to consider our questions and whether you will be able to get back to us within a short period of time?’ A few hours later, the procurement secretariat assured that they were definitely on the case and would get back as soon as possible.

On March 10, Health Minister Bent Høie mentioned the process when he presented the government’s measures on the Covid-19 pandemic in Parliament.

Ten days later, the authorities announced the Norwegian accession to the agreement on Twitter, with a picture of EU Ambassador Rolf Einar Fife sat at his Brussels desk in front of a Norwegian flag and an EU flag.

Why join?

‘We can now participate in joint procurement of, for example, personal protective equipment for health professionals who are now working with patients with suspected or confirmed Coronavirus infection,’ said Health Minister Bent Høie in a press release. JPA will make it possible to ensure that necessary equipment is available now and later – but does not prevent Norway from operating on its own in the market, Høie assured.

It is very important to be part of such an agreement now, explains Marianne H. Dragsten, partner in Vaar Advokat and a procurement specialist. Otherwise, she told Investigate Europe, Norway might soon be without important medicines, because Norway is a small player in the world and not at the front of the queue for vital medicines.

This is despite Norway having money to pay, she explains. It is much more profitable for drug manufacturers to have contracts with rich, populous countries like the US or Germany, to which they can supply large quantities, than to smaller countries. At least, Dragsten says, while there is a drug shortage and they have to choose who to sell to.

But Norway signed three days too late to be involved in two major EU purchases of infection control equipment and ventilators. Both were launched on March 17 and were open to countries that had signed the agreement by that date, an EU Commission spokesman told Investigate Europe. Norway is not, therefore, included in these purchases, says the spokesman. He adds that Norway is also “very welcome” as a party to the agreement for future procurement.

Joint procurement requires an initiative from at least four countries, he explains. He does not rule out that more orders may be initiated, but points out that the EU commission calls the procurement ‘successful’ so far, adding that he had no information on further plans for procurement.

It is much more profitable for drug manufacturers to have contracts with rich, populous countries like the US or Germany, to which they can supply large quantities, than to smaller countries

Examined and cleared in 2014

Why did Norway’s government not bring Norway into the agreement a long time ago?

The JPA has been around since 2014, and most EU countries have participated for several years. Back in 2014, the Norwegian government examined the law under which the agreement is based, to see if it ran contrary to the EEA agreement. It did not, they concluded: ‘The decision falls outside the four freedoms, but it is considered appropriate for Norway to include the act in the EEA agreement. The decision is considered relevant and acceptable.’

Since March 20, 2015 – five years before Norway joined the common shopping scheme – the law has been part of the EEA agreement.

Documents seen by Investigate Europe, show that the same employees of the Norwegian EU delegation and the Ministry of Health who went into action in late February this year, were in touch with the EU Directorate for Health from October 2016 to October 2017. The purpose was to get in place what was needed to make Norway a party to the purchase agreement.

Then it apparently stopped – for almost two and a half years. Until the Covid-19 pandemic invisibly came rolling. The question now is why?

The matter has been pending in Norway and several other countries that have acceded gradually, with the Covid-19 pandemic the agreement has been further actualised, says Junior Minister Anne Grethe Erlandsen in the Ministry of Health via email. She calls the agreement ‘a useful supplement’ to Norway’s independent purchase of vaccines and medical devices. The benefits of being able to participate in joint purchasing ‘have been made clear by the ongoing outbreak of Covid-19,’ Erlandsen writes.

A professional who knew the former process before it stopped, suggests that the long pause was due to “dawdling, and that the case has fallen between two chairs and been forgotten.”

There is much to learn from this pandemic, procurement specialist Marianne H. Dragsten points out: “You feel like you have plenty of time until something happens. In this situation, we discover many things that we should have been better prepared for,” she says.

Since Junior Minister Anne Grethe Erlandsen’s response last week, Investigate Europe has not received answers to repeated follow-up questions about whether Norway will benefit from the EU’s two major ongoing purchases from 17 March.

You feel like you have plenty of time until something happens

Poland and Sweden: In under the wire

EU members Sweden and Poland also had not enrolled in the joint purchasing agreement. But when the pandemic arrived, both acted faster than Norway and managed to be part of  the purchases.

Sweden signed the EU’s joint procurement agreement for medical countermeasures on February 28, and Poland followed suit on March 6. As a result, the Swedish government managed to become part of an order for masks that the EU launched on the day of the Swedish signature, February 28. It also will benefit from a large procurement of protective equipment dated March 17.

Poland chose to relinquish the protective equipment, but, like Sweden, is participating in an ongoing process to buy ventilators, which also launched on March 17.

The Swedish press release explained why the Swedes took the step right now. ‘With a possible larger outbreak of Covid-19 in Sweden, large amounts of personal protective equipment are needed for health professionals. Since international demand is very high at the same time, access to relevant material can cause problems for individual purchasers in Sweden. A nationally coordinated joint EU procurement gives Sweden greater chances of obtaining supplies when needed.’

“There has been no particular idea not to join. But it was a little more urgent now, when there was a specific purchase we wanted to be involved in,” Kim Brolin, at the Swedish Ministry of Social Affairs, told Investigate Europe.

Finland: has stocks but wants more

Finland has done well without being part of the EU’s joint procurement. This is due to its existing national stocks of protective gear. But now the Finish authorities believe they will need more in the future, says Kalle Tervo, senior adviser in the Ministry of Social Affairs and Health on why Finland has joined the JPA.  Tervo also state that the joining process did not take too long, and Finland believes that since not everyone else was included in the procurement that started March 17, that there will be new rounds of purchases.

The Prime Minister must not let Brexit ideology dictate his approach to Coronavirus.

UK: Brexit mentality

In the United Kingdom, Prime Minister Boris Johnson came under harsh criticism after his government failed to sign up for a joint procurement of equipment that the country desperately needs. The British have been part of the agreement until now and can participate independently of Brexit, an EU spokesman told Investigate Europe.

But the UK government has not expressed any interest in the JPA – and has been harshly criticised as a result. “The Coronavirus knows no borders. It is a pandemic. International  solidarity is crucial to protecting the UK,” stated Ed Davey, leader of the Liberal Democratic Party. “If working with the EU means  we can get access to more protective equipment, any sensible government  would jump at the chance. The PM must not let Brexit ideology dictate his approach to Coronavirus. People’s lives must come first.”

A previous version of this article was published with our Norwegian media partners.

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