Revealed: how Italy's call for urgent help went ignored as coronavirus swept through Europe

It was a moment of chilling clarity. On 26 February, with the numbers of Italians known to be infected by coronavirus tripling every 48 hours, the country’s prime minister, Giuseppe Conte, appealed to fellow EU member states for help.

Daniel Boffey Celine Schoen, Ben Stockton and Laura Margottini 

3 hrs ago   15 July 2020

His hospitals were overwhelmed. Italian doctors and nurses had run out of the masks, gloves and aprons they needed to keep themselves safe, and medics were being forced to play God with the lives of the critically-ill due to an acute lack of ventilators.

An urgent message was passed from Rome to the European commission’s Berlaymont headquarters in Brussels. The specifications of Italy’s needs were uploaded into the EU’s Common Emergency Communication and Information System (CECIS).

But what happened next came as a shock. The distress call was met with silence.

“No member state responded to Italy’s request and to the commission’s call for help,” said Janez Lenarčič, the European commissioner responsible for crisis management. “Which meant that not only is Italy is not prepared … Nobody is prepared … The lack of response to the Italian request was not so much a lack of solidarity. It was a lack of equipment.”

Some 180,000 European citizens, across the European economic area and the UK, have died from coronavirus and 1.6 million have been infected since the disease crept on to the continent in December last year courtesy of a mystery patient zero.

The true number of deaths is almost certainly higher than so far recorded. The recent rise in infections in Serbia and the Balkans are cause for great concern. The continent is now on an unalterable course to the worst economic recession since the Great Depression of the 1930s, largely as a result of the lockdowns required to shield its many under-funded healthcare systems.

Leaders have been asked fundamental questions about the purpose of the European project when states fail to come to each other’s aid at the darkest times. This weekend the EU’s 27 heads of state and government will meet in Brussels for the first time in person for five months to try to plot a way forward.

Today, through both analysis of internal records and interviews with dozens of EU officials and experts in both Brussels and the bloc’s capitals, the Guardian and the Bureau of Investigative Journalism can tell the full story of how Europe emerged to be the WHO-designated “epicentre” of a global pandemic and what key lessons might be learned.

It is a story of well-meaning officials in Brussels speaking in urgent tones of an impending disaster to empty press conference rooms. Of increasingly desperate health ministers unable to convince their heads of government and finance ministries of the scale of what was coming and the imperative to act. Of governments belatedly recognising the speed at which the virus was spreading, only to rush into uncoordinated acts of protectionism in moments of ill-concealed panic. And of EU institutions and agencies in which central figures either lacked the experience or powers to get capitals to act together in the face of a disease with respect for neither borders nor the glacial pace of Brussels’ bureaucracy. It is the story of an EU caught ill-equipped and institutionally incapable of mounting an adequate response to the crisis that so swiftly engulfed it.

* * *

New year alert

It was as millions of Europeans prepared for their New Year’s Eve celebrations that officials in the Stockholm office of the EU public health agency, the European Centre for Disease Control and Prevention (ECDC), first received notice of a cluster of pneumonia cases in China of unknown origin.

Just 12 of the 27 member states, plus the UK, phoned in to the 17 January conference call

Established in 2005 in reaction to the Sars outbreak two years before, the ECDC offers scientific advice. It can do no more. Responsibility for health remains entirely with the national governments of the EU, and not in the European commission or its agencies. Despite its limitations, the ECDC’s job is to look to the full European horizon, and call the alarm whether capitals listen or not.

The agency gave its first threat assessment on 9 January, the body’s director Dr Andrea Ammon recalled. “At that time, the notion [was] most of the cases were linked to this live animal market [in the Chinese city of Wuhan]”, she told the Guardian. “Roughly two weeks later it turned out it is human to human transmission which of course changes what you need to do”.

The initial concern was how to keep the disease outside the EU’s borders. On 17 January a first coronavirus conference call was held by another EU body born out of previous health crises – but again lacking the powers retained by the national governments.

The European commission’s health security committee comprises health ministry representatives from each member state and has had responsibility for coordinating cross-border health threat responses in Europe since the H1N1 influenza outbreak of 2009.

But on 17 January, just 12 of the 27 member states, plus the UK, phoned in.

Wolfgang Philipp, the head of a small team within the commission’s health department in Luxembourg, chaired the meeting. He told those present that a few dozen people in Wuhan had been infected with a new strain of coronavirus.

With 300,000 people expected to travel to Europe from China that month, many to celebrate Chinese New Year on 25 January, the question was what to do about direct flights from Wuhan to London, Paris and Rome.

Screening all airport arrivals with symptom checkers and thermometers was believed to be largely ineffective in stopping the spread of the virus, an official from the ECDC told the committee. They instead recommended targeting passengers on the 12 weekly flights arriving in Europe from Wuhan.

The UK and France shared information about what they were doing at airports. But there was no update from the Italian government, one of the many absentees. The Italian representative hadn’t noticed the email inviting him to the meeting.

The committee had planned to release recommendations on border measures. But those who did attend couldn’t agree. It was an ominous sign of the difficulties the commission would face.

Although governments are required to inform the health security committee before implementing measures, unilateral action would repeatedly be taken in the subsequent weeks. The format and short duration of the meetings – typically only an hour with about 100 people attending – would also limit the communication and cooperation possible, sources said.

There would be frustration among attendees that some countries were not giving the committee the “weight that it deserves”. Its ability to coordinate effectively was questioned. “There was no time to catch up on events during the timespan of one week,” the source said. “Events happened at a tremendous speed.”

And at the helm of the commission was Ursula von der Leyen, just a few weeks into her job as commission president.

© Provided by The Guardian Ursula von der Leyen, European commission president who seemed unsure of the levers at her disposal. Photograph: John Thys/AFP/Getty Images

Distracted by Brexit

The pandemic was a crisis that could have been tailor-made for Von der Leyen, a medical doctor before embarking on a political career that would take her to the German defence ministry. She moved to the EU’s executive branch in December.

A significant intellect with steel, according to sources who worked with her during the crisis, but some within the system would come to wonder whether she might have done more in those first weeks. Her first steps were said by some to be tentative. She appeared unsure of the levers she had at her disposal.

“The commission should have taken a grip earlier,” said one EU official. “Von der Leyen is clever. But she is new to Brussels and relies on a couple of people from Berlin who also don’t have experience of the commission and what is possible. You don’t ask the member states if they want coordination, you just coordinate. Health is a national competence but you can push things.”

If it was a stuttering start by a Brussels novice, the seriousness of what was happening in China was at least understood early in some parts of the commission.

“We convened the first meeting of the so called crisis coordination committee on 28th of January,” Lenarčič said. “The commission did take this threat seriously. And we did not change course in our serious approach. Even when voices multiplied out there that ‘all this will just die out’. We even didn’t change the course when some others were toying with the concepts of herd immunity.”

A swift decision was taken by the commission to ban its staff from non-essential travel to China and a press conference was called for 29 January to communicate a clear message: get ready.

But if the alarm bells were sounding in Berlaymont, the media had other interests. The UK was about to leave the EU after 47 years of membership.

“We went to the press conference and the press room was almost empty,” recalled Lenarčič. “We called for preparedness – for all member states to take this seriously and prepare. There was a lot of echo because of the empty room. But we were still hoping that there would be some echo in the media next day. We didn’t find much of that because all the media attention in Brussels was, at that time, devoted to the last session of the European parliament plenary where the UK members participated.”

© Provided by The Guardian British MEPs mark the 29 January vote on Brexit, the same day the ECDC issued its coronavirus alarm. Photograph: Francisco Seco/AP

“So a lot of footage of people singing holding hands in the plenary,” Lenarčič said. “I understand that it was a historic moment, it was a sad moment it was emotional moment. But that all does not change the fact that we had something to say on that same day. And we said it, and not many people were interested.”

It was not only the newspapers and broadcasters failing to listen to the siren voices from the EU’s executive branch and agencies.

* * *

Threat underestimated

The ECDC in the same week advised governments to strengthen the capacities of their hospitals and, in particular, the intensive care units.

The urgency of the warning did not hit home in the capitals. “I think what turned out is that they underestimated, in my view, the speed of how this increase came”, said Ammon, a former head of department for Infectious Disease Epidemiology at the Robert Koch Institute in Berlin who took over the ECDC in 2017. “Because it is a different situation if you have to look for an increase in capacity of beds within two weeks or two days.”

Meanwhile, the virus was continuing to quietly seed. On 30 January, two Chinese tourists in Rome tested positive for coronavirus. The Italian government immediately banned all flights to and from China and sought a meeting of EU health ministers to push for stricter entry screening measures across Europe.

But the meeting took three weeks to organise. The Croatian government, responsible for convening it as holder of the rolling EU council presidency, had become embroiled in a financial scandal during which the prime minister, Andrej Plenković, had been forced to fire his health minister, Milan Kujundžić. By the time health ministers did finally meet on 13 February, pockets of cases were sprouting.

The response to the coronavirus threat had been “prompt and effective” declared the new Croatian minister of health, chairing the council meeting.

But an internal ECDC report dated the day after the meeting gave a rather different account, listing a litany of things that were still unknown about the virus and its risks to Europe. The “preparedness status in different member states” was “uncertain”, it read.

* * *

Mask stocks destroyed

The stark reality was that in the months and years before coronavirus arrived in Europe, stocks of personal protective equipment (PPE) had dwindled. Emergency supplies of masks had expired, been destroyed and never replaced. Pandemic preparedness plans were out of date.

“Several European countries had a strategic stock of masks that were outdated … Most of them were just destroyed,” said one scientific adviser.

France held 1.7bn protective masks in 2011, but now had only 117m. Between January and March this year it incinerated 1.5m. In 2017, Belgium ordered the destruction of 38m masks and they were never replaced.

No one, it appeared, had a hold on what was out there. Up until 23 February, flights carrying donations of PPE were leaving Europe for China in the hope of containing the virus there. But the unpalatable truth was that Europe itself was exposed.

“My colleague [the health commissioner] Stella Kyriakides was asking for data all along,” said Lenarčič, a former Slovenian ambassador to the EU. “They started early on and and according to my information they never received the full data that would allow the commission to have a fully clear picture about the stockpiles of equipment and capacities of intensive care units. And in many cases it transpired that the member states themselves did not have a clear picture of their capacity of this sort.”

© Provided by The Guardian Trucks queuing at the German-Polish border on 18 March 2020, after both countries unilaterally imposed checks despite a Brussels plea for unity Photograph: Odd Andersen/AFP via Getty Images

Red-hot anger

By the weekend of 29 February and 1 March, more than 2,000 people were infected in Europe. In Italy, 35 people had died. Von der Leyen decided to put herself at the forefront of the crisis.

She informed Lenarčič that the scale of the crisis required a coronavirus crisis response team of commissioners covering everything from health to the economy and borders.

The new team was presented to the public on the Monday. As Von der Leyen walked to the lectern to the click of camera shutters she gestured to the commissioners. “Come on” she was heard to say.

Yet within hours, Europeans witnessed one of the biggest failings of the entire pandemic. Now each in full-blown crisis mode, European countries individually acted to impose restrictions on the export of key medical supplies to neighbours.

On 3 March, France’s president, Emmanuel Macron, announced that he was requisitioning “all stocks and the production of protective masks”. The next day, the German government banned the export of PPE.

A total of 15 member states placed restrictions on the movement of equipment or drugs within the EU during the outbreak. Trucks of masks, gloves and protective gowns were stopped at some borders. European leaders accused each other of undermining EU solidarity and the single market.

PPE shipments destined for EU countries that arrived in ports in Germany and France were “very simply stolen”, said a source. The Belgian and Dutch governments meanwhile were buying up the ingredients to make key drugs and delivering them to hospitals to be produced on-site.

With a limited supply of these ingredients in Europe, the move hamstrung efforts by the pharmaceutical industry to increase the manufacture of medicines needed to treat the most severe coronavirus cases.

© Provided by The Guardian European commissioner for crisis management Janez Lenarčič Photograph: Julien Warnand/EPA

By the time European health ministers attended a second council meeting on 6 March, the health commissioner Stella Kyriakides, flanked by Lenarcic and Thierry Breton, commissioner for the internal market, felt the need to stress the importance of European unity. “I ask you all today to commit to us all working together, openly and transparently, in a spirit of solidarity to ensure a coherent political response,” Kyriakides said.

Yet just a few days later Germany unilaterally closed its borders, bringing the continent to a halt, with footage of 50km (31 miles) traffic queues on the German-Polish border dominating the news. The divisions of old Europe appeared to be back.

“It is not a problem to close the border but you have to talk to your neighbour on the other side of it and some didn’t,” said Lenarčič. “That was wrong and created a lot of problems. First it hampered the flow of goods which is dangerous not only for the functioning of the single market but also for the Covid response because some of those goods are essential like medical equipment, not to talk about food.”

There was red-hot anger in the commission’s headquarters. “The commission acted forcefully and immediately in order to persuade all those member states that indulged in such selfish measures,” Lenarčič said.

To placate those claiming that there were “people running around Europe with big bags of cash buying everything they could at any price”, the commission agreed to an export authorisation scheme to control what equipment left the bloc, Lenarčič said. But it had been a sobering moment for those with faith in the union. “Things were not done properly.”

* * *

No PPE on the market

It was a scenario surely unimaginable even just a few weeks earlier. From 9 March, starting with Italy, and ending on 23 March when Boris Johnson finally followed suit, Europe’s governments shut down their economies one-by-one. Only Sweden went its own way.

For some, it was all too late. “If Italy could have done it 10 or 14 days before it would have been better. The ministry of health wanted to do that but it took time to convince the government,” prof Walter Ricciardi, a senior adviser to the Italian health ministry said. “But they [the other member states] had the Italian experience and they didn’t follow it … It was very difficult for ministers of health to convince ministries of finance and prime ministers that this was a serious situation”

We only had ventilators when our acute situation was over

On 12 March, Von der Leyen’s experts told her the outbreak in Europe couldn’t be stopped. Next day, the head of the World Health Organization declared that Europe was now the “epicentre” of the global pandemic.

For the commission, the overriding imperative was to source equipment. Ricciardi, however, recalls his deep disappointment with what then unfolded. “At the time we had desperate need of PPE and ventilators and it was almost impossible to find it on the market,” Ricciardi recalled. “So our call was distribution of what was present in Europe and joint procurement. But it took two months to do that. Not for lack of willingness of the European commission but the process was so slow and bureaucratic. We only had ventilators when our acute situation was over.”

The commission had first raised the idea of joint procurement of PPE, of becoming “one big buyer”, in mid-January, but had been faced with a lack of interest from the member states. It was not until 5 February that it was decided to launch a formal assessment of what PPE member states might need.

It then took two weeks, and a number of missed deadlines, for governments to hand over the information. By then global stocks had been severely depleted and the member states, waking up to their predicament, were individually contacting Chinese manufacturers, creating further competition in the market place.

By Thursday 12 March, the scheme hadn’t secured a manufacturer. A notice was posted to the EU’s contract database of the failure. It would take two weeks to find one. The first delivery of masks under the scheme was on 8 June.

The commission had to take the initiative as it became apparent that the joint procurement scheme was proving ineffective. Emergency legislation was rushed through to allow the commission to build a central stockpile through a scheme called RescEU.

* * *

‘When Italy asked, nobody could help’

While member states would be responsible for procuring the supplies, the commission would manage their distribution and cover most of the costs. Hundreds of thousands of masks have been distributed so far to the pandemic hotspots. And looking to the future, Lenarčič believes this is the model to follow as leaders come together in Brussels on Friday to discuss their seven-year budget and plans for a one-off recovery fund.

“In the latest commission budget proposal the funding for health goes from €400m to €9bn,” he said. “The whole logic is give the commission the means to support member states more. Because when Italy asked for help, nobody could give help. We also couldn’t help Italy.” The commission wants to buy equipment for the stockpile rather than rely on the generosity of member states. It wants to expand the type of equipment to cover potential chemical, biological or nuclear crises. “I see one very clear lesson,” Lenarčič said. “There is a wish of an overwhelming majority of the European public to have more Europe on issues like this.”

Ricciardi agrees. He also believes the ECDC should be a decision-making body not just advisory at times of crisis, and that the commission has to be given its head when coordination is vital. “The member states must learn that we need to prepare for this new normality – this will only be the first of a series of events,” he said. “We will have it in the future. The patterns of behaviour, trade and tourism, are changing around the world. And if we don’t realise this we are going to be seriously disappointed.”

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