Eastern European Nationalism to Find a Fertile Ground in COVID-19 Pandemic
COVID-19 will overwhelm resource-poor eastern EU health systems. In the aftermath, ramped up nationalism and erosion of democracy are a strong possibility. To avert this, the public needs EU leadership and guidance.
By Veronica Anghel, PhD, Fulbright Fellow, The Europe Center, Stanford University; Associate Fellow SAIS — Johns Hopkins University
Central-East European (CEE) authorities are more reactive than proactive on COVID-19 management and have devised an ad hoc patchwork of measures. States rely on drastic ‘stay-at-home’ strategies to curb excessive demand on health systems. The public is not a participant in decision making, parliaments are mostly bypassed and restrictive measures are enforced without much concern for individual freedoms. Politically, COVID-19 is not creating new attitudes but amplifying existing ones. It offers national-populists a fertile environment for centralized decision-making and adopting measures incompatible with normal democratic practices.
These are not unique elements to the new post-communist EU members. However, given previous attitudes on restrictive interpretations of the rule of law in countries such as Poland and Hungary, there is a risk that temporary limits on individual freedoms will be used not just to deal with the health crisis. They also damage citizens’ avenues of participation in decision-making. A further strengthening of ruling parties’ grip on state resource allocation is to be expected, along with limitations on the rights of the media and individuals, including the freedom of movement of medical personnel. The crisis will highlight weaknesses in medical systems and put pressure on poorer countries to try to reverse these trends.
Under-financed Health Systems
Compared with older EU member states, CEE countries have dysfunctional and under-financed health systems and lack the necessary medical staff and supplies to withstand the emergency now facing the whole world.
Following EU accession, the freedom to seek work led to a flow of highly skilled workers from east to west. Doctors and nurses moved more than any other such group. Combined with less healthcare expenditure in the Eastern EU on average, this resulted in fragile health systems, particularly in Romania, Bulgaria, Hungary and the Baltic states.
Sign up for the FSI newsletter to receive stories like this directly to your inbox
OECD and European Commission statistics show annual increases of health spending per capita in all EU countries. However, eastern member states have yet to converge with EU standards. According to the World Health Organization (WHO), there are shortages of health professionals in the largest CEE countries, Poland and Romania. The emigration of Polish nurses and physicians has made these shortages more acute. The WHO estimates the ratio of physicians to 1,000 inhabitants in 2016 at 2.4, compared with an EU average of 3.6. The number of practicing nurses is also low: 5.2 per 1,000 in 2016, compared with 8.4 for the EU. Poor working conditions and low salaries are among the main reasons given for leaving Eastern Europe.
Romania has the most understaffed and least-resourced healthcare system. Expenditure per capita is three times lower than the EU average, and the lowest in the EU. Whereas EU countries spend on average about 10% of GDP on health, in Romania, although its expenditure has grown more or less constantly, it had still only reached 5% of GDP by 2019. Measures to increase doctors’ pay in 2019 have yet to reverse the trend of medical professionals leaving the country. According to healthcare officials, 14,000 doctors left Romania between 2009 and 2015, for such better- paying countries as France, the United Kingdom and Germany — half of Romania’s registered doctors. The trend has continued to grow since then, with another 10,000 registering to practice outside the country between 2016 and 2018. Medical assistants and pharmacists are leaving in even greater numbers.
More than 5,000 doctors left Bulgaria during 2008–18 to work in other EU countries. As in the case of Romania, most leave straight out of university and do not return. The Baltic States and Hungary are the other countries most hit by the migration of physicians and medical assistants.
Medical equipment
Besides depleted human resources, lack of funding also results in low stocks of necessary materials. CEE governments are struggling to scramble protective gear for medical staff.
Dealing with the initial wave of coronavirus patients without proper protective kit has removed many healthcare professionals into quarantine. In Romania, tens of medical professionals have resigned from fear of working with COVID19 patients without protective gear.
High-filtration N95 masks, intensive care beds and ventilators are being rationed to those patients who will benefit the most. Like most West European countries, eastern member states are looking for more real-time polymerase chain reaction (PCR) test units and COVID-19 testing kits. PCR is the most commonly used test for diagnosing coronavirus because it is highly accurate, but it is not a sustainable strategy in the long run. PCR testing is limited, time-consuming and expensive for under-resourced health systems. As most PCR units in CEE are small, they can only process about 40–45 tests per day. Numbers of trained professionals are required to work in shifts to produce results. Doctors who know how to operate with this technology are scarce. Protocols are currently being imagined to train new staff on how to work with this technology. Fighting time and resource scarcity, Romania is one of the first countries in the world to sign a contract to equip 20 hospitals with a new technology that is cheaper and can deliver results in 45 minutes. Designed by US company Bioneer and recently been given FDA approval, it still awaits EU approval. Other European countries are likely to follow suit should this test prove its accuracy.
Dealing with COVID-19 cases
Technology and human resources are reflected in the number of reported cases. As of April 3, the Czech Republic was in the lead in COVID-19 testing relative to population, with 67,281 reported tests administered and 4,091 confirmed cases. Poland had tested 61,000 people and reported 3,266 positive cases. In Hungary, 15,401 people were tested and 585 cases confirmed. In Romania, 3,183 people tested positive out of 28,483 administered tests. The overall numbers of cases in CEE are still small compared to the hotspots of Italy and Spain, but an increase is expected in the coming weeks.
The lack of prepared procedures to deal with epidemics and the pervasiveness of informality through direct payments to medical staff present CEE with further challenges. In normal times, socioeconomic inequalities translate into selective access to healthcare, favouring those with access to private treatment or who are well connected. Such practices dictate access to medical care and testing also in times of crisis. Private hospitals have ramped up their testing capabilities, but offer them at a cost. In normal times, out of pocket households’ irregular payments are the second-largest source of finance for public healthcare. During the pandemic, hospitals are turning to corporate, industrial and private sources of finance for urgently needed equipment. Universities and research centers are not prioritized as a source of innovation, as they are traditionally underfinanced. High-complexity labs are rare.
Political aftermath
Governments will be judged on how well they handle the pandemic — CEE countries are no different. The public will get behind restrictive measures as long as governments can present them as resolving the crisis. In the long run, many leaders will downplay the role of experts, resort to nationalism and target external ‘enemies’.
Many European states are using national borders to protect their citizens from contact with foreigners often blamed for introducing infection. In CEE, the COVID-19 pandemic offers a new platform for national-populists and Eurosceptics to stress the importance of borders, capitalise on public fear and confusion, and move more powers to the centre. In Hungary, these are the migrants. In Romania, the travelling diaspora is increasingly blamed for having brought the virus from Italy.
Despite their fewer cases, some CEE states immediately closed borders to foreigners, including EU citizens — although many West European states did much the same. The rhetoric employed by national -populists has been problematic. CEE states have also been among the first to declare states of emergency, giving governments the ability to suspend laws, although again, they were not alone in the EU in this regard.
Hungarian Prime Minister Viktor Orban has gone furthest, blaming foreigners and migrants for the emergence and spread of the virus. Ruling Fidesz pushed through parliament laws limiting freedom of expression, under the guise of stopping the spread of misinformation, or of information that alarms the public or interferes with the government’s mission to protect. Such measures leave great scope for interpretation. As of March 30, the Hungarian Parliament gave the prime minister the possibility to rule by decree and no longer entertain legislative debates. This is in line with the previous pattern of behavior from Fidesz leaders. As with the 2009 economic crisis, they nurture the same belief in the need to centralize decision making for fast action. In doing this, they have the support of the public. Parties opposed to the government have asked for a three-month limit on the new emergency provisions. PM Viktor Orban has argued that this is not enough, as Hungary could be in worse shape then.
The European People’s Party (EPP), the European political family of which Fidesz is a suspended member, asked for justifications of such extreme measures. In a letter of reply, PM Orban used the same argument for the need for fast decision making.
In Bulgaria, Prime Minister Boyko Borisov obtained parliamentary support for a bill amending the penal code to punish spreading false information with heavy fines and prison terms. President Rumen Radev vetoed the bill, saying it attacked “the last vestiges of free speech” and could be used against “any inconvenient free thinking”. The bill can still pass the parliament in second vote without the president’s approval.
In Romania, the Parliament voted the state of emergency unanimously on March 19. Since then, President Klaus Iohannis and the executive make all the decisions regarding restrictions of individual freedoms. President Klaus Iohannis has gone as far as suggesting Romanians abroad should not return to their own country for the duration of the health crisis, so as not to spread the virus any further. In this case, nationalism has excluded the numerous diaspora, despite the fact that it can usually be relied upon to vote for the president’s centre-right party. The foreign ministry is nevertheless arranging flights to bring home Romanian nationals stranded abroad as seasonal workers. According to a controversial statement from Romanian PM Ludovic Orban, such efforts should only be limited to Romanians who are lawfully working abroad.
In Poland, Prime Minister Mateusz Morawiecki declared at a press conference on March 13 that most cases of COVID-19 were imported by foreigners or Poles returning from abroad. The underlying message is that nations would not be in crisis if there were less freedom of movement. This is in line with previous anti-migration and nationalist agendas. So far, Poland has refrained from any further tightening of the executive’s grip on democracy. However, given its history of challenging the rule of law, Law and Justice is likely to curb a critical press at least.
So far, signs of solidarity or collaboration between CEE countries have been lacking in dealing with the COVID-19 pandemic.
Disinformation running rampant
With more people spending time online, disinformation and misinformation are ever more widespread, sowing confusion and mistrust of the authorities and experts. Russian-led outlets and alternative blogs are spreading fears of global economic collapse, as well as suspicions that the pandemic is faked. Their interest is not in making any one story stick, but in increasing social divisions and confusion.
Online communities are magnifying rumors about the need to make ‘a run to the bank’ in the face of impending global economic collapse. The government slow to address the public’s growing economic concerns. As in previous cases in Hungary and Bulgaria, the authorities are answering the spread of misinformation punitively.
In a bid to stop panic, the Romanian government has even forbidden county prefects to inform the public how COVID-19 is spreading regionally, starting March 21. This is likely to backfire, as the public will then resort to alternative sources of information and rumor. Hungary and Romania are the only two European states to adopt this strategy.
In the early stages of the pandemic, the lack of trust in authorities in such countries as Romania and Bulgaria has led citizens to doubt the seriousness of the crisis and downplay their individual responsibility in tackling it. By the time the authorities were announcing total lockdowns and the use of the army to enforce institutionalised quarantines, people were disregarding recommendations to stay at home. An exponential increase in the number of those infected is likely. However, ‘quarantine-fatigue’ is also likely to kick in soon, with citizens increasingly flouting the rules.
Conclusion
The pandemic numbers will expand more quickly as a consequence of tests becoming more available, delayed isolation strategies in some countries and citizens seeking to evade quarantine rules. The healthcare infrastructure will be overwhelmed by the severely ill and government resources will be over-stretched. Medical equipment and interventions will need to be rationed, with doctors and nurses already falling ill or being quarantined for lack of protective gear.
As it began, so the pandemic will end — gradually. Restrictive measures could remain in place after the peak of the crisis. The population is not protesting against repression now, but their attitudes will depend on how governments handle the crisis.
Most CEE governments are likely to suspend local or national elections, at least for the next six months. The exception is Poland, which expects to hold the May presidential election, although the main opposition is not campaigning because it would violate social distancing and will probably boycott the vote altogether.
Nativist national attitudes will be accentuated by new fears of ‘the foreigner’. As previous studies have shown, if poorly managed, the economic shock felt in the aftermath of the crisis will contribute to a spike in extremist and populist attitudes.
The next EU budget may take into account the latest revelation of less affluent members’ structural weaknesses. However, EU solidarity is already stretched. The current pandemic is likely to create new tensions between east and west at a moment when Eastern countries need strong countermeasures to nationalist rhetoric and isolationist policies.
An earlier version of the analysis was published by Oxford Analytica. © Oxford Analytica 2020. All rights reserved. No duplication or transmission is permitted without the written consent of Oxford Analytica
