A view of the Central European Initiative headquarters in Trieste, Italy.
A view of the Central European Initiative (CEI) headquarters in Trieste, Italy. Photo: courtesy of the authors.

A Regional Approach to Fighting COVID-19 in Central, Eastern and South-Eastern Europe

COVID-19 global health Europe

Reflecting on “the world after coronavirus,”1 historian Yuval Noah Harari highlighted the urgency to choose global solidarity over nationalist isolation to fight the COVID-19 pandemic. He states, “both the epidemic itself and the resulting economic crisis are global problems. They can be solved effectively only by global cooperation. […] Countries should be willing to share information openly and humbly seek advice and should be able to trust the data and the insights they receive.”  

Yet, at the time when this article was published in the Financial Times (March 2020), cooperation and trust seemed under threat: indeed, unilateral decisions of some European governments to close their borders were feeding Euroskeptic instincts, while a dangerous lack of solidarity was exacerbating political tensions and generating a new wave of criticism against multilateral solutions. 

To a certain extent, this was true also for the member countries of the Central European Initiative (CEI), the first intergovernmental forum for regional cooperation ever incepted in Europe, whose origins date back to the end of the Cold War. With a membership covering a large portion of Central, Eastern and South-Eastern Europe, the CEI reaches out and connects nine European Union members (Bulgaria, Croatia, Czech Republic, Hungary, Italy, Poland, Romania, Slovakia and Slovenia), five countries involved in the EU accession process (Albania, Bosnia and Herzegovina, Montenegro, North Macedonia and Serbia) and three Eastern neighbors (Belarus, Moldova and Ukraine).

As a large and well-rooted platform for policy dialogue, the CEI has taken up the challenge to encourage a “spirit of global cooperation and trust”— again Harari’s words — by promoting, in conjunction with the WHO Regional Office for Europe, a transnational science-policy interface comprising key health officials and experts, and aiming to facilitate knowledge circulation, data exchange, sharing of experiences and best practices, ultimately seeking to provide the CEI countries with a robust evidence base for their national policy making.

The establishment of this dedicated CEI-WHO Task Force (TF) was politically endorsed by the CEI Heads of Government (HoGs), who gathered in the midst of the European emergency for an extraordinary Virtual Summit on May 15, 2020. A Joint Statement2 was unanimously adopted, with a focus “on solidarity and cooperation of the CEI Member States in the face of the challenges posed by the novel coronavirus disease COVID-19.” While reiterating that “cooperation, confidence, and solidarity are the most efficient responses to this pandemic”, the CEI HoGs warned against “the proliferation of disinformation about the virus as well as hate speech.” Along these lines, they stressed “the importance of independent media and the free exchange of accurate and reliable information” as a measure to tackle “false or manipulated information on the spread of COVID-19.”

These topics looked even more pressing in smaller countries with fragile healthcare systems, such as those in the Western Balkans and Eastern Europe, certainly at a higher risk of suffering irreparable social and economic damage. The creation of a multilateral arena for an open exchange of information rooted in science and evidence-based country experience was, therefore, highly appreciated by the target countries. Moreover, one shall remark that this was not an isolated initiative; it rather fit into a more general CEI action in support of science diplomacy, a foreign policy tool not equally developed and exploited within its constituency.

The CEI has always attached great importance to the promotion of international science cooperation, benefitting from the location of its Executive Secretariat in Trieste, Italy, a city with a long tradition as a hub of science, research, and innovation, not to mention its geographical and cultural projection towards Central Europe and the Western Balkans. Over the last three decades, science, as an effective and recognized vector of soft power, has contributed to the CEI’s distinctive “bridging role.” It allows for supporting connections between, and interactions among, the countries of its “hybrid” membership, thus reinforcing the ties between the “ins” and the “outs” (for example, in and out of the EU; in and out of the North Atlantic Treaty Organization (NATO)). Scientific cooperation — supported at both institutional (meetings of ministers in charge of science and research) and operational level (seed funds to promote mobility of researchers, international conferences, capacity building, trainings, collaborative research, etc. — has always been a powerful tool at the CEI’s disposal to strengthen cohesion along the Eastern and South-Eastern borders of the EU, a priority pursued by the CEI through a combination of intergovernmental policy dialogue, result-oriented operations, and confidence-building measures.

In more recent times, the CEI has undergone a shift of perspective from pure support to international science cooperation to a broader vision of science diplomacy. Therefore, a deeper investigation into science diplomacy and its potential benefits for its member countries has represented a logical step, also taking into account that, until now, this large part of Europe had not been fully involved in the growing discourse on science diplomacy. At the end of 2019, the CEI Ministers in charge of Science and Research mandated the organization to explore this concept further, as well as to promote networking activities and design capacity-building actions and trainings dedicated to early-career scientists and diplomats.3 Member states have gradually become aware of the fact that the CEI can contribute to the three dimensions of science diplomacy identified in the taxonomy proposed by the Royal Society and the American Association for the Advancement of Science (AAAS) in their seminal policy report “New frontiers in science diplomacy”.4 As a diplomatic body, the most obvious direction goes towards supporting “diplomacy for science” from a regional/multilateral perspective; yet, while the domain of “science in diplomacy” can be addressed through the promotion of collaborative research networks — on scientific topics interlinked with the foreign policy objectives of member states — also the “science for diplomacy” dimension is to be explored, taking into account that the CEI area is not immune from geopolitical tensions (potential or underway) that can be softened by means of cross-border and transnational scientific collaborations.

As a first step towards implementing such a broader vision, researchers at the University of Trieste collaborated with the CEI-Executive Secretariat to write a report entitled “Science Diplomacy in CEI Member States.”5 This first attempt to map the science diplomacy landscape in Central, Eastern and South-Eastern Europe proved to be very useful for understanding prospects, opportunities, and barriers related to science diplomacy across the CEI region. While a widespread interest in this foreign policy tool has clearly emerged from this research, it has also highlighted a tendency towards fragmentation between the structures involved in foreign policy and those involved in international science cooperation. Thus, supporting the establishment of science-policy interfaces at both the national and international level shall be seen as a rather common need in CEI countries.

Within this framework, and taking into account its intergovernmental nature, the CEI could only make an attempt to fill in this gap by launching a transnational science-policy mechanism. This mechanism aims to map the development of the epidemic and to reach a shared understanding of the crisis, as well as to identify critical implementation, capacity, and resource gaps in dealing with COVID-19 control, both within countries and in terms of between-country coordination and cooperation. Anticipating potential adverse consequences within a heterogeneous setting and then promoting coherent interventions has been challenging and possible only by relying on scientific inputs provided by experts. Indeed, the possibility of effectively incorporating scientific expertise to inform and strengthen international policy decision-making appears to be essential to counter the current and future global crises.

Going back to the Royal Society/AAAS framework, the CEI-WHO Task Force represents an attempt to combine the dimensions of “diplomacy for science” — with the CEI diplomatic network laying the foundations for scientific and technical consultations at transnational level — and “science in diplomacy,”— which aims to consolidate the practice of scientific advice to decision makers throughout the CEI constituency. Moreover, if we look at the pragmatic conceptualization of science diplomacy proposed by Gluckman, Turekian, Grimes and Kishi6 — and consider the global outreach of COVID-19 — the type of cooperation pursued in the context of the TF falls into the category of science diplomacy actions “primarily designed to meet global needs and challenges.” At the same time, since many COVID-19-related issues are cross-border by nature, we can say that the scope of the TF also relates to the group of actions “designed to address cross-border interests.” On the contrary, no connections seem to exist between the TF and the last category identified by the above-mentioned authors — “actions designed to directly advance a country’s national needs”— as the TF has been promoting a shared response to a common threat rather than favoring specific national interests.

Since its enactment, the TF has held intensive bi-weekly activities. Fifteen virtual meetings have been organized in all, with an overall participation of sixteen countries and forty key health officials and experts. An Agreed Summary of Conclusions was elaborated after each meeting, thus providing CEI governments with a concise yet solid and up-to-date knowledge base.

To ensure an extensive and inclusive perspective, the TF has expressed, right from the very beginning, the need to widen the discussion beyond purely health-related issues. Therefore, it has covered a broad array of topics. This was also due to the fact that its activities had been launched during the beginning of the “transition” phase in several CEI member states. While the first debate addressed the topic of “mobility” — a concept tackled in its broadest sense (e.g. including mobility of persons, opening of the borders, mobility for job or medical reasons) — the TF has stimulated transnational debates on all key factors at the heart of a successful transition, such as robust governance mechanisms, strong data analytics, digital solutions, and effective communications against disinformation.

Overall, three sets of key challenges can be identified:

1) The improvement of healthcare systems for fostering social cohesion and encouraging economic rebirth.

The past months have shown that, principally in countries with weaker social protection, the current healthcare system is exposed to contingencies and is, therefore, in need of reform to ensure quicker and more flexible responses, especially to the most vulnerable groups (mental health, disabilities, chronic diseases, the elderly, etc.). The very high mortality rate, the extreme isolation suffered by residents and workers in nursing homes and long-term care facilities has deeply impacted the public opinion—with distressing reports indicating neglect or mistreatment--and has brought about the urgent need, shared by TF members, to elaborate specific guidelines for the management of these structures, thus defining joint procedures for ethical and technically correct treatments.7

2) The need for helping all countries develop an intersectoral approach.

This aspect has clearly emerged as soon as the TF focused on the reopening of schools, a multi-faceted topic including elements related to health, social, education, and transport sectors. Against the complexity of these challenges, a decisive question was raised by Dorit Nitzan, Regional Emergency Director at WHO Europe, at a recent meeting of the TF: will we ever be ready for a pandemic? In her view, responsible leadership and public trust are crucial to answer this question, while governance models (at national, transnational, and global levels) and social values should be supported by consistent, timely, and transparent messaging, driven by scientific evidence—also in order to prevent and mitigate the infodemic.8

3)  Effective information and citizens’ empowerment.

The general consensus is that easing dissemination of health information across borders, through political and diplomatic channels, should be a priority concern for countries wishing a better and quicker recovery. Improving risk communication and strengthening community engagement, while enhancing trust in the public, are, therefore, some of the required measures governments will have to design to be fully prepared—during this transition phase and in the future.

To help find solutions to these complicated and interlinked challenges, an inclusive science diplomacy action can play a decisive role by facilitating knowledge exchange and circulation among countries with noticeable differences such as those encompassed in the CEI membership. The TF activities have highlighted the importance to explain to decision and policy makers why it is necessary to invest now for a better future. In this regard, science diplomacy — aiming to increase openness, transparency, and international collaboration — could be the most viable solution. For example, sharing international good policies and practices to link research and scientific evidence to health and care services, in order to better train healthcare professionals and empower citizens, could be one of many actions to reinforce preparedness: it would demonstrate that benefits of science-policy collaborations go well beyond times of crisis.

The TF has already achieved positive results to the benefit of the participating countries. One successful outcome has been a better compliance with WHO guidelines and directives. Moreover, the TF has managed to create a coherent and efficient framework helping countries deal with specific deficiencies in a quick manner. This has already occurred for instance when accurate information on antigen rapid tests for SARS-CoV-2 was provided by the TF to those countries that were validating their testing strategy. Or when the TF proved to be able to inspire different joint initiatives leading to the development and implementation of training modules tailored to the needs of specific targets, such as front-line healthcare workers.

In the following months, countries are likely to face additional challenges, such as a shortage of healthcare workers, widespread digital and health illiteracy, and an inadequacy of the current assessment tools and indicators. These are just some of the most pressing issues that, together with the management of potential new waves of infections, will affect the socio-economic recovery process. 

Things are moving fast, thus remaining flexible is crucial. Nevertheless, one lesson can already be drawn from the experience of the CEI-WHO Task Force: the pandemic and its development have shown how essential acting from a regional cooperative perspective is. Whereas the crisis is global, the impact of the virus has proved to occur within “clusters,” and any restriction/containment measure finds its effectiveness diminished if not adequately supported on a local/regional basis. This aspect confirms the need for flexibility and rapidity of response as soon as the situation changes, as well as the necessity to sustain all efforts geared towards effective transnational cooperation. In this regard, the Ministers of Foreign Affairs (MFAs) of the CEI member states, who gathered online on September 24, 2020, adopted a Communiqué.9 While underlining the “CEI’s efforts in providing timely and efficient responses aiming to mitigate devastating health and socio-economic consequences of the COVID-19 pandemic,” it conveys further political momentum to the work of the CEI-WHO TF. More specifically, the CEI MFAs mandated the TF to continue its work with the goal of “strengthening the preparedness and response capacity of health and social care systems and overall health governance capacity,” while reaffirming “the importance of strong multilateral cooperation [...], using the recovery phase as an opportunity for a better future for our societies, empowering the CEI as an important forum of regional cooperation.”

While the COVID-19 emergency continues to evolve globally, the TF intends to expand its action to address emerging challenges, where competition between and among countries is threatening the effective implementation of common regional approaches. Access to vaccines — with the phenomenon called “vaccine nationalism”10 — represents a clear example of how international relations could be hindered rapidly when critical situations occur, and it highlights the need for an inclusive strategic response across the globe. In this regard, the CEI-WHO Task Force could act as a bridge between the EU— whose vaccines strategy11 is based on agreements signed by the European Commission with producers to facilitate access and distribution to all member states—and the non-EU countries included in the CEI membership. The involvement of WHO/Europe could help address health inequalities, bolster the resilience of health systems, and strengthen cooperation,12 with the ultimate goal to support equitable access to affordable COVID-19 vaccines for all CEI member states.13

As a firm supporter of science diplomacy, the CEI will thus try to strengthen the activity of the TF as a flexible multilateral framework where interactions among scientists, diplomats, and policy makers can be facilitated, and transnational collaborations nurtured, thus contributing to achieve that spirit of solidarity and cooperation that we badly need to overcome the crisis and win the battle over the COVID-19 disease.


  1. Yuval Noah Harari, “The World After Coronavirus,” Financial Times, March 20, 2020, https://www.ft.com/content/19d90308-6858-11ea-a3c9-1fe6fedcca75.
  2. Central European Initiative, Heads of Government Adopt Joint Statement on Solidarity and Cooperation in Response to COVID-19,  https://www.cei.int/news/8844/cei-heads-of-government-adopt-joint-statement-on-solidarity-and-cooperation-in-response-to-covid-19.
  3. These political orientations have been summarized in the “Trieste Declaration on Science”, unanimously adopted by the CEI Ministers in charge of Science and Research on 13 December 2019, which is available at https://www.cei.int/news/8689/ministerial-meeting-on-science-research-trieste-declaration-adopted.
  4. Royal Society/AAAS, New Frontiers in Science Diplomacy (London: Royal Society, 2010), https://royalsociety.org/topics-policy/publications/2010/new-frontiers-science-diplomacy.
  5. Central European Initiative, Science Diplomacy in CEI Member States, https://www.cei.int/publications.
  6. Vaughan Turekian, Peter D. Gluckman, Terou Kishi, and Robin W. Grimes,  “Science Diplomacy: A Pragmatic Perspective from the Inside,” Science & Diplomacy 6, 4 (December 2017).
  7. All efforts and research studies about the relation between population and access to care/treatment take on the greatest importance: the ratio of hospitalization and day-care centers and home-care services has never been more relevant. 
  8. In the Joint statement by WHO, UN, UNICEF, UNDP, UNESCO, UNAIDS, ITU, UN Global Pulse, and IFRC, “Managing the COVID-19 Infodemic: Promoting Healthy Behaviours and Mitigating the Harm from Misinformation and Disinformation” (September 23, 2020), an infodemic is defined as “an overabundance of information, both online and offline. It includes deliberate attempts to disseminate wrong information to undermine the public health response and advance alternative agendas of groups or individuals,” see https://www.who.int/news/item/23-09-2020-managing-the-covid-19-infodemic-promoting-healthy-behaviours-and-mitigating-the-harm-from-misinformation-and-disinformation
  9. Central European Initiative, “CEI’s Ministers of Foreign Affairs Discuss Transition to ‘New Normal’ with Multilateralism as Cornerstone of Cooperation,”  https://www.cei.int/news/8903/cei-ministers-of-foreign-affairs-discuss-transition-to-new-normal-with-multilateralism-as.
  10. Jeremy Farrar, “Let’s Get Real. No Vaccine Will Work as if by Magic, Returning Us to ‘Normal,’” The Guardian, September 6, 2020, https://www.theguardian.com/commentisfree/2020/sep/06/lets-get-real-no-vaccine-will-work-as-if-by-magic-returning-us-to-normal
  11. European Commission, Coronavirus Vaccines Strategyhttps://ec.europa.eu/info/live-work-travel-eu/coronavirus-response/public-health/coronavirus-vaccines-strategy_en.
  12. World Health Organization, “Joint Statement—A Deeper and Result-oriented Partnership for Health in Europe,” https://www.euro.who.int/en/media-centre/sections/statements/2020/joint-statement-a-deeper-and-result-oriented-partnership-for-health-in-europe.
  13. It is worth mentioning that, as of the end of 2020, the TF work plan for 2021 is under discussion and yet to be finalized with the consensus of all CEI member states. 
Diplomacy for Science Mechanisms Regional Integration and Trade