The emergence of post-Westphalian health governance during the Covid-19 pandemic: the European Health Union

Abstract

The response to the Covid-19 pandemic in 2020–21 was dominated by the Westphalian primacy of national territory and sovereignty, significantly worsening and prolonging this crisis. Global platforms for cross-border coordination and cooperation were constrained by national self-interest. Arguably, the lack of a worldwide supranational (or post-Westphalian) authority in health governance is one important structural reason for the fragmented, chaotic, and ineffective response to Covid-19. The failure of Westphalian governance responses to the pandemic provides a unique opportunity for post-Westphalian governance structures to be established and contribute to reforming international pandemic preparedness. While this is unlikely to happen soon at the global level, a comprehensive framework is emerging at the European Union level in the form of a European Health Union. Through a combined conceptualisation of supranational governance and the securitisation process of international health crises, Covid-19 has opened the door to post-Westphalian health governance coordinated by the European Commission.