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The European Union Joint Procurement Agreement for cross-border health threats: what is the potential for this new mechanism of health system collaboration?

  • Natasha Azzopardi-Muscat (a1) (a2), Peter Schroder-Bäck (a1) and Helmut Brand (a1)


The Joint Procurement Agreement (JPA) is an innovative instrument for multi-country procurement of medical countermeasures against cross-border health threats. This paper aims to assess its potential performance. A literature review was conducted to identify key features of successful joint procurement programmes. Documentary analysis and a key informants’ interview were carried out to analyse the European Union (EU) JPA. Ownership, equity, transparency, stable central financing, standardisation, flexibility and gradual development were identified as important prerequisites for successful establishment of multi-country joint procurement programmes in the literature while security of supply, favourable prices, reduction of operational costs and administrative burden and creation of professional expert networks were identified as desirable outcomes. The EU JPA appears to fulfil the criteria of ownership, transparency, equity, flexibility and gradual development. Standardisation is only partly fulfilled and central EU level financing is not provided. Security of supply is an important outcome for all EU Member States (MS). Price savings, reduction in administrative burden and creation of professional networks may be particularly attractive for the smaller MS. The JPA has the potential to increase health system collaboration and efficiency at EU level provided that the incentives for sustained commitment of larger MS are sufficiently attractive.


Corresponding author

*Correspondence to: Dr Natasha Azzopardi-Muscat, Department of Health Services Management, Faculty of Health Sciences, University of Malta c/o Mater Dei Hospital, MSD 2090 Msida, Malta. Email:


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Bailes, A. J. K. and Thorhallsson, B. (2013), ‘Instrumentalizing the European Union in small state strategies’, Journal of European Integration, 35(2): 99115.
Bogaert, P., Bochenek, T., Prokop, A. and Pilc, A. (2015), ‘A qualitative approach to a better understanding of the problems underlying drug shortages, as viewed from Belgian, French and the European Union’s perspectives’, PLoS ONE 10(5): e0125691.
Clemens, T., Michelsen, K. and Brand, H. (2014), ‘Supporting health systems in Europe: added value of EU actions?’, Health Economics, Policy, and Law, 9(1): 4969.
Commission Officials Health Threats Unit (2014), ‘Development of the Joint Procurement Agreement’.
Council of the European Union (2010), ‘Council conclusions on lessons learned from the A/H1N1 pandemic - Health Security in the European Union’, 13 September.
Council of the European Union (2014a), ‘Council conclusions on Ebola Foreign Affairs Council Meeting Luxembourg’, Council of the European Union, 20 October, Brussels.
Council of the European Union (2014b), ‘Council conclusions on lessons learned from the A/H1N1 pandemic – Health Security in the European Union’, Council of the European Union, 13 September 2010, Brussels.
Creswell, J. W. (2012), Qualitative Inquiry and Research Design: Choosing Among Five Approaches, Thousand Oaks, London and New Delhi: Sage publications.
DeRoeck, D. (2003), ‘Group procurement of vaccines for Central/Eastern Europe and newly independent states: feasibility, issues, and options final report’,;jsessionid=A9BC92FB7D13AD02B483EC49F2065449?doi= [5 December 2003].
DeRoeck, D., Bawazir, S. A., Carrasco, P., Kaddar, M., Brooks, A., Fitzsimmons, J. and Andrus, J. (2006), ‘Regional group purchasing of vaccines: review of the Pan-American Health Organization EPI revolving fund and the Gulf Cooperation Council group purchasing program’, The International Journal of Health Planning and Management, 21(1): 2343.
European Commission (2010), ‘Commission Staff Working Document on lessons learnt from the H1N1 pandemic and on health security in the European Union’, European Commission, SEC 1440 final, Brussels.
European Commission (2014a), ‘Communication from the commission on effective, accessible and resilient health systems’, European Commission, 215 final, Brussels.
European Commission (2014b), ‘Explanatory note on the joint procurement initiative’, [2 December 2015].
European Commission (2014c), ‘Public health: joint purchasing of vaccines and medicines becomes a reality in the EU’, [7 December 2014].
European Commission (2014d), ‘Joint Procurement Agreement to procure medical countermeasures’, European Commission, Brussels.
European Commission (2015a), ‘Joint Procurement Agreement – list of EU countries’, [15 January 2015].
European Commission (2015b), ‘Joint Procurement Agreement – list of EU countries’, The Joint Procurement Agreement for medical countermeasures Agenda item AOBa Pharmaceutical Committee 17 March, European Commission, Brussels PHARM 685.
European Union (2011), ‘Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare. Public Law L 88’, Official Journal of the European Union, L 88: 45.
European Union (2013), ‘Decision No 1082/2013/EU of the European Parliament and of the Council of 22 October 2013 on serious cross-border threats to health and repealing Decision no 2119/98/EC. 293 sess’, Official Journal of the European Union, L 293: 114.
Fierlbeck, K. and Herder, M. (2015), ‘Evidence and Policy in Pharmaceutical Regulation: The Promise of, and Barriers to, a System of Adaptive Licensing’, Paper presented at International Conference on Public Policy, Milan, Italy, 1–4 July.
Flick, U. (2014) (ed.), ‘Chapter 22 using documents as data’, An Introduction to Qualitative Research, 5th edn, London, Thousand Oaks California, New Delhi and Singapore: Sage, 352362.
Gessner, B. D., Duclos, P., DeRoeck, D. and Nelson, E. A. S. (2010), ‘Informing decision makers: experience and process of 15 national immunization technical advisory groups’, Vaccine, 28: A1A5.
Greer, S. L. (2014), ‘The three faces of European Union health policy: policy, markets, and austerity’, Policy and Society, 33(1): 1324.
Greer, S. L. and Matzke, M. (2012), ‘Bacteria without borders: communicable disease politics in Europe’, Journal of Health Politics, Policy and Law, 37(6): 887914.
Hervey, T. (2015), ‘Reflecting on “supporting health systems in Europe: added value of EU actions?”Health Economics, Policy and Law, 10(4): 485489.
High Level Pharmaceutical Forum 2005–2008 (2008), ‘Final conclusions and recommendations of the High Level Pharmaceutical Forum’, 2 October, Brussels.
Huff-Rousselle, M. (2012), ‘The logical underpinnings and benefits of pooled pharmaceutical procurement: a pragmatic role for our public institutions?’, Social Science & Medicine, 75(9): 15721580.
Huff-Rousselle, M. and Burnett, F. (1996), ‘Cost containment through pharmaceutical procurement: a Caribbean case study’, The International Journal of Health Planning and Management, 11(2): 135157.
Jarman, H. and Greer, S. L. (2014), ‘Economic and fiscal governance: the hardening of European soft law’, Social Science Research Network [27 February 2014].
Juncker, J.-C. (2014), ‘Mission letter to Vytenis P. Andriukaitis Commissioner for health and food safety’, European Commission [2 December 2014.
Karamanoli, E. (2012), ‘Greece’s financial crisis dries up drug supply’, Lancet (London, England), 379(9813): 302.
Lam, E., McCarthy, A. and Brennan, M. (2015), ‘Vaccine-preventable diseases in humanitarian emergencies among refugee and internally-displaced populations’, Human Vaccines & Immunotherapeutics, 11(11): 26272636.
Martens, K. and Wolf, K. D. (2009), European Integration and the Governance of Higher Education and Research, Netherlands: Springer.
Martin, R. and Conseil, A. (2012), ‘Public health policy and law for pandemic influenza: a case for European harmonization?Journal of Health Politics, Policy and Law, 37(6): 10911110.
Matusewicz, W., Godman, B., Pedersen, H. B., Fürst, J., Gulbinovič, J., Mack, A., Selke, G., Timoney, A., Warmińska, E. and Malmström, R. E. (2015), ‘Improving the managed introduction of new medicines: sharing experiences to aid authorities across Europe’, Expert Review of Pharmacoeconomics & Outcomes Research, 15(5): 755758.
Ozierański, P., McKee, M. and King, L. (2012), ‘Pharmaceutical lobbying under post-communism: universal or country-specific methods of securing state drug reimbursement in Poland?’, Health Economics, Policy and Law, 7(2): 175195.
Radaelli, C. M. and Pasquier, R. (2007), ‘Conceptual issues’, in P. Graziano and M. P. Vink (eds), Europeanization: New Research Agendas, Basingstoke: Palgrave Macmillan, 3545.
Reuters/Francois Lenoir (2015), Belgium, Netherlands plan joint purchase of rare disease drugs, [23 June 2016].
Rosamond, B. (2000), ‘Neofunctionalism’, Theories of European Integration, Palgrave Basingstoke, 57.
Rosenkotter, N., Clemens, T., Sorensen, K. and Brand, H. (2013), ‘Twentieth anniversary of the European Union health mandate: taking stock of perceived achievements, failures and missed opportunities – a qualitative study’, BMC Public Health, 13: 1074.
Sorensen, K., Clemens, T. and Rosenkotter, N. (2013), ‘The EU’s heath mandate after 20 years: the glass is half full’, European Journal of Public Health, 23(6): 906907.
Thorhallsson, B. (2000), The Role of Small States in the European Union, England: Ashgate.
Versluis, E., Van Keulen, M. and Stephenson, P. (2010), Analyzing the European Union Policy Process, Basingstoke and New York: Palgrave Macmillan.
Vollaard, H. and Martinsen, D. S. (2014), ‘Bounded rationality in transposition processes: the case of the European patients’ rights directive’, West European Politics, 37(4): 711731.
Wafula, F., Agweyu, A. and Macintyre, K. (2013), ‘Regional and temporal trends in malaria commodity costs: an analysis of global fund data for 79 countries’, Malaria Journal, 12: 466.
Wafula, F., Agweyu, A. and Macintyre, K. (2014a), ‘Trends in procurement costs for HIV commodities: a 7-year retrospective analysis of global fund data across 125 countries’, Journal of Acquired Immune Deficiency Syndromes (1999), 65(4): e134e139.
Wafula, F., Marwa, C. and McCoy, D. (2014b), ‘Implementing global fund programs: a survey of opinions and experiences of the principal recipients across 69 countries’, Globalization and Health, 10: 15.
Walt, G., Shiffman, J., Schneider, H., Murray, S. F., Brugha, R. and Gilson, L. (2008), ‘“Doing” health policy analysis: methodological and conceptual reflections and challenges’, Health Policy and Planning, 23(5): 308317.
World Health Organisation Regional Office for Europe (2015), Access to New Medicines in Europe: Technical Review of Policy Initiatives and Opportunities for Collaboration and Research, Copenhagen: World Health Organisation.


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