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Coronavirus lays bare central Europe’s shortage of doctors

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When Imre Varju graduated from Hungary’s Semmelweis University in 2011 and qualified as a medical doctor, his starting salary would have been the equivalent of about €300 a month, a pittance after six years of study. Dr Varju chose to pursue a PhD, while almost half his classmates emigrated, mostly to Germany and Austria.

“They are now only a 10-hour car drive or a two-hour plane ride away, and they can earn up to eight times as much . . . with a huge difference in the quality of life they can have for themselves,” said Dr Varju, now a lecturer at Semmelweis.

As a second wave of the coronavirus pandemic sweeps through central Europe many in the region fear that the lack of medical staff — the result of years of underfunding and emigration — will add to pressure on already strained health services.

Milan Kubek, head of the Czech Medical Chamber, last week appealed to Czech doctors working abroad to return home to help the country cope with a surge in cases. Meanwhile, Hungary has approved a significant pay increase for doctors.

Staffing problems could be even more critical than equipment shortages. In the first months of the pandemic, the Hungarian government ordered 16,000 ventilators, said Peter Almos, vice-president of the Hungarian Chamber of Doctors. However, with only 2,000 intensive care unit doctors and the same number of nurses, it does not have enough staff to operate them.

The Czech Medical Chamber says the number of infected medical workers could rise from 5,500 to 40,000 within a month © Gabriel Kuchta/Getty

“Ventilators you can buy easily with money, but doctors you can’t,” he said.

For decades, medical staff have been leaving central Europe in droves, an exodus made easier after 2004 when ten central and eastern Europe countries joined the EU. In Hungary for instance, about 1,200 new doctors qualify each year. But 900 emigrated in 2018, the most recent year for which there are statistics. 

In Slovakia, according to President Zuzana Caputova, the shortages have been compounded by the fact that many of the country’s doctors are in an age range that makes them vulnerable to Covid-19 themselves.

The Czech Republic has similar problems. Mr Kubek said on Thursday that, on current trends, the number of infected medical workers could rise from 5,500 to 40,000 within a month.

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“That would be a disaster that would really mean a collapse for healthcare,” he told the Czech website IDNES.CZ.

But Mr Almos said the problem in Hungary was that doctors in their 40s and 50s, who had the most experience and could train their colleagues, were missing. “They leave the country and don’t come back,” he said. Those left behind are newly qualified and older doctors.

Many of those emigrating complain about the low salaries and poor working conditions at home. 

“At the moment resident doctors make €3 per hour after taxes, or €6 as a specialist,” said Mr Almos. “If you work in Tesco [in Hungary] as a cashier you can earn more.”

According to Eurostat data, Poland has the lowest number of practising physicians per capita in the EU, with 238 per 100,000 inhabitants, while Romania has 304, Hungary 338 and Slovakia 352. By way of comparison, Austria has 524 and Germany 431.

Filip, an anaesthetist who moved from Poland to the German city of Dortmund with his wife, who is also a doctor, said they decided to make the switch after working in a German hospital during their studies.

Poland has the lowest number of practising physicians per capita in the EU, with 238 per 100,000 inhabitants © Omar Marques/Getty

“The more time we spent in hospitals [in Poland] the more we saw how badly they functioned, how unhappy doctors were. Then we did a three-months Erasmus internship in a German hospital and we saw how big the difference was, most of all in the organisation of work. [In Germany] the doctor deals with medical procedures, much less with bureaucracy and paperwork,” he said.

Romania has lost one-third of its home-trained doctors, according to the OECD. Clotilde Armand, a French-born Romanian MEP, said the emigration was a loss for medical services but also a lost investment — on average, it costs €100,000 to train a doctor in the region. Ms Armand calls for a Medical Works Compensation Fund into which countries that heavily recruit medical professionals could pay.

“In eastern Europe everybody wants free circulation of people — they suffered so much [under the closed borders of communism],” she said.

“But we as responsible politicians have to understand the economics behind it.” 

Hungary is trying to remedy the shortage with pay increases. The country’s parliament adopted a law raising doctors’ salaries by as much as 120 per cent, the biggest increase since 1990. 

Clotilde Armand: ‘In eastern Europe everybody wants free circulation of people  . . .  but we as responsible politicians have to understand the economics behind it’ © Robert Ghement/EPA-EFE

The new salaries, which will put wages at about half of what an equivalent doctor in Austria would earn, were approved alongside other reforms, including a ban on accepting extra cash from patients.

Mr Almos said the rise was in line with his organisation’s demands, but he warned that some of the other conditions in the law could worsen the brain drain. Many doctors hold down multiple jobs to support themselves, and a new condition would require approval to do so — even in an unrelated field — from a government body. By far the most worrisome was a contentious clause legalising mandatory relocation to any hospital in Hungary for up to two years.

“If the law would state that you can be ordered in case of medical emergency, that’s one thing . . . but it seems that the chronic shortage of doctors would be treated this way, which is unacceptable and doctors will leave,” said Mr Almos.

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Greece sets tone for Europe’s summer travel

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Kalimera and welcome to Europe Express. Tourists from the UK, Germany and other countries started arriving on Greek islands over the weekend, after Athens lifted all restrictions for Covid-19 negative or vaccinated travellers (Russian vaccine included), no matter where they come from. We will look at how this early experiment is shaping up and what difference the EU’s “green certificate”, expected to be rolled out next month, will make.

We will also explore how Finland got back on track towards giving its formal assent to the EU’s recovery fund borrowing, after a four-day filibuster that included the recitation of fairy tales and Bible excerpts. 

But first, news from Brussels, which is working with African capitals and EU member states to boost vaccine manufacturing capacity in Africa. Ursula von der Leyen, European Commission president, is expected to lay out her plans to support the effort at a global health summit she is co-hosting in Rome on Friday, European officials said.

Before then, France’s president Emmanuel Macron will tomorrow host several African leaders at a summit in Paris to discuss the economic fallout from Covid-19, including the burden on public finances.

This article is an on-site version of our Europe Express newsletter. Sign up here to get the newsletter sent straight to your inbox every weekday morning

Summer travel

While the EU is ironing out the details of a digital platform aimed at simplifying travel this summer, countries including Greece and Portugal already have national systems up and running, write Eleni Varvitsioti in Athens and Valentina Pop in Brussels.

Greece was among the first EU countries to formally welcome foreign visitors last week, as it seeks to double the revenues of its tourism industry, a vital sector that has been heavily hit since the pandemic brought travelling to a halt.

Tourists arriving in Greece no longer have to quarantine if they provide proof that they have been fully vaccinated (including with Russia’s vaccine), a negative Covid-19 test or documentation that shows they have recovered from the virus. 

Since the EU-wide digital green certificate (nothing to do with energy consumption on appliances) that will incorporate national systems is not ready yet, individual member states are putting their own systems in place. 

What is the EU’s digital green certificate?

  • Digital proof valid in all EU countries that a person has tested negative, was vaccinated or has recovered from Covid-19

  • Format is a QR code in the national language and in English

EU affairs ministers last week gave their green light to the scheme, but final details are still being ironed out, with some countries taking part in pilot trials aiming to have the final system set up by the end of June. 

Meanwhile, negotiators from the European parliament, commission and member states are seeking to thrash out a deal on the final details of the certificates. Last week, one of the sticking points was the parliament’s insistence that Covid-19 tests should be free to avoid adding hundreds of euros to the cost of family vacations. The price of a Covid-19 test ranges from zero in France to about €200 in Finland.

Visitors arriving in Greece have to declare their contact information and final destination in electronic form so they can be traced if needed. 

“Greece has an internal green pass operational already and will be there from day one, June 1, participating in this important European achievement,” tourism minister Harry Theoharis told Europe Express.

Over the past weekend, the number of arrivals at Greece’s 14 regional and national airports was 23,455, according to the Ministry of Tourism, showing signs that the country’s most profitable industry is gearing for a comeback. 

Last year, the number of visitors to Greece was down roughly 80 per cent to 7.4m, from a record 34m in 2019. Greece’s finance ministry is hoping to reach about half its pre-pandemic tourism revenues in order to keep the country’s budget on track. 

Given how important tourism is for a swath of European economies, other capitals will be watching early experiments in re-opening very intently.

Chart du jour: All flights lead to Greece

Chart showing that passenger demand for summer travel to Europe has yet to return

Greece has been the only summer destination in Europe attracting more flights than in previous years — at least of British tourists. Some southern European countries are rethinking their tourism strategies (Find out why).

FI, for filibuster

Finland’s parliamentarians last week made some headway dispelling rumours that theirs is not a talkative population, writes Valentina Pop.

For four days, members of the Eurosceptic Finns party not only voiced their opposition to taking on any common debt with other EU nations, but they also filled speaking time by reading out fairy tales, hymns and Bible passages.

It was a classic filibuster move, even if the procedural manoeuvre is not as common in Europe as it is in the US Senate. “This is a once in a decade kind of thing,” said Johanna Vuorelma, a political scientist at Tampere University. Previous filibusters occurred in the 1990s in the run-up to Finland’s EU membership and in the early 2010s around bailouts in the eurozone financial crisis. 

The Finnish parliament debated the EU recovery plan for four days © AP

In Finland, the “own resources” decision needed to fuel the EU’s €800bn recovery plan already has a higher hurdle to pass than in most countries. A previous attempt by the Finns party-led opposition to thwart the initiative was successful in imposing a two-thirds threshold for the actual vote. 

But if the vote goes ahead as planned tomorrow, pundits including Vuorelma expect it to pass — even though some members of the ruling coalition have indicated they may oppose it. Passage would be met with considerable relief in Brussels, which has anxiously watched the progress of national votes on its unprecedented recovery fund borrowing powers.

A more consequential delay was averted last week when the chamber’s vice-chair from the Finns party, Juho Eerola, was sidelined. He had admitted that he could have used procedural quirks to delay the own resources vote until autumn — which would have created a massive problem for the bloc.

“It showed that they are willing to go quite far, this is a strong ideological position for them,” Vuorelma said. With municipal elections in June and the Finns party having polled first in the weeks prior to this debate, the filibuster may have also had tactical intentions. “It certainly raised their profile, even if some party members resented the move,” she said. 

Two things to watch today

  1. European parliament resumes its plenary session

  2. European affairs ministers hold an informal council

. . . and later this week

  1. France hosts a number of African leaders for a summit on Tuesday, and on Friday, Italy and the European Commission host a Global Health Summit in Rome

  2. EU finance ministers meet in Lisbon on Friday and Saturday for informal talks

Notable, Quotable

  • The EU and US are expected to announce a temporary truce on Monday in their dispute over Trump-era steel and aluminium tariffs. The deal would mean the EU would shelve plans to boost tariffs on certain US products next month, giving the sides space to negotiate a settlement to the metals dispute. (Bloomberg)

  • Italy’s digital transition minister tells FT Rome correspondent Miles Johnson why he wants to roll out a nationwide digital platform for public services as part of the €248bn recovery plan designed to reignite the eurozone’s third-largest economy.

  • Marine Le Pen is allegedly at the core of a fraudulent scheme funnelling EU funds from the European parliament, according to a French police report seen by Journal du Dimanche.

  • The UK is not very keen on Joe Biden’s global minimum corporate tax proposal, arguing that a digital tax should come first. (Read more here)

  • The Polish government has put forward a plan, in part funded by the EU, to boost health spending and cut income tax.

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Today’s Europe Express team: sam.fleming@ft.com, eleni.varvitsioti@ft.com, valentina.pop@ft.com. Follow us on Twitter: @Sam1Fleming, @Elbarbie, @valentinapop





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Bullying Russia yearns to be treated as a great power

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The writer is the author of ‘Putin’s Russia’ and a member of the Liberal Mission Foundation

At their Conference on the Future of Europe, which opened on May 9, EU leaders invited citizens to “join the debate” on the path ahead. In Washington, President Joe Biden has called for “togetherness” as he announces ambitious plans to transform the US economy and society. For the west, the way to deal with crises is to build images of a better, shared future.

By contrast, Russia is turning to the past in its search for unity. At a Red Square military parade, also held on May 9, President Vladimir Putin asserted that the Soviet people had fought “alone” on their road to victory over fascism in the second world war. In this way, he confirmed that Russia and the west are on opposite trajectories.

Putin’s emphasis on his nation’s past achievements could secure stability in Russia for a while. His rule benefits from the fact that the Kremlin today faces no serious internal or foreign threats. Why, then, is Putin acting like some geopolitical Alfred Hitchcock and creating suspense in international relations, forcing western leaders to play “who blinks first”?

As Russia’s chief decision maker, Putin’s personal moods obviously matter. However, more important is the logic of the Russian system of power, with its demand for recognition on the world stage of the nation’s great power status. According to this logic, Russia cannot be ignored and must be a member of the global concert of powers. It believes macho bullying is the entry ticket to the concert.

Despite the crackdown on domestic dissent and the anti-western rhetoric of state propaganda, the Kremlin’s policies are aimed at preventing Russia from turning into a sealed-off fortress. For in order to be a great power, Russia has to sit at the same table as its peers. To satisfy its global aspirations and conform with the logic of its domestic power arrangements, Russia has to be simultaneously with the west and against it.

In a sense, Putin is getting what he wants. Biden has suggested holding a US-Russian summit, and EU leaders are trying to keep open lines of dialogue with Moscow despite low levels of mutual trust. However, if western governments hope to find a modus vivendi with Russia, they may be disappointed.

For the price that the Kremlin is willing to pay for the risks its policies are incurring is higher than the costs that the west is ready to impose on Russia for causing disruption. In effect, the west is pursuing a dual-track policy towards Russia of containment and co-operation. In recent times, however, this policy has run into the problem that co-operation stalls every time the west feels a need to deter Russia. If they want their approach to work, western countries will have to do a better job of compartmentalising the two tracks.

There are important differences with the cold war era of Soviet-western confrontation. In those decades, the Soviet Union unintentionally consolidated western unity by behaving in ways that strengthened the west’s commitment to principles of liberal democracy and the rule of law. Nowadays, post-Soviet Russia undermines the west by mimicking its liberal principles and getting “inside” western societies through its political and economic elites, business operations and powerful lobbying machines.

Partly for these reasons, the west finds it hard to set clearly defined “price tags” for what it deems unacceptable Russian behaviour. The Kremlin’s recent military build-up on Ukraine’s borders was evidently no red line for the EU. Yet to accommodate Moscow simply encourages its assertiveness.

Nevertheless, a bitter irony may lie in store for Russia. Putin’s international bullying beefs up his image as a strong leader at home. Yet the Kremlin’s continual testing of western patience serves to undermine Russia in more subtle ways.

After the Soviet Union’s collapse, Moscow learnt to use the west as an economic and technological resource. The Russian elite made the west its home. But to preserve the west as a resource, Russia needs the trust of western partners. Instead, the Kremlin’s Hitchcock-style games of suspense provoke western suspicions and an instinct to fall back on deterrence.

There is a potential trap for the west, too. Its dual-track policy helps Russia’s power structures, as they have evolved under Putin, to limp on. The Kremlin and its agencies engage in international behaviour that the west finds disagreeable. But the west can hardly try to undermine them without running the risk that Russia would plunge into instability. Is the west really prepared for the huge uncertainties of a world in which the existing power structures in Moscow unravel before any domestic alternative is available to take their place?



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PiS unveils ‘Polish Deal’ to lift economy

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Poland’s conservative-nationalist government has set out plans to boost health spending and cut income tax, as part of a sweeping programme designed to bolster the economy in the wake of the pandemic.

The so-called Polish Deal, which will include support for housebuyers, pensioners and families, as well as tax cuts for low and middle-earners, is widely regarded as an effort by the ruling Law and Justice party (PiS) to set out its stall ahead of parliamentary elections due at the latest in 2023.

Like most countries in the EU, Poland has been ravaged by Covid-19, with the pandemic claiming more than 70,000 lives and tipping the economy into recession for the first time in three decades.

Prime minister Mateusz Morawiecki said the Polish Deal — which will be buttressed by loans and grants from the EU’s recovery fund — was a chance to fulfil Poles’ dreams of catching up with richer countries in western Europe, as well as to expand the country’s middle class.

“We have a huge opportunity in front of us,” he said. “[In the past] we always had to worry about freedom from external oppression. But today, we can care about the freedom to decide about the rules of social and economic growth on our own sovereign Polish conditions.”

As part of the changes announced on Saturday, PiS and its two smaller allies plan to boost spending on the underfunded health system, parts of which have been overwhelmed by the pandemic, from 5 per cent of GDP in 2020 to more than 7 per cent in 2030.

The tax system will also be rejigged. The income-tax-free allowance will rise to 30,000 zloty, and the threshold at which Poles start paying the higher 32 per cent rate of tax will rise from 85,000 to 120,000 zloty per year.

Mortgage rules will also be revamped and guarantees will be provided to make it easier for the young to buy property, while the rules around building permits will be relaxed. There will also be further benefits for families with young children, and pensioners, as well as a programme of investments that PiS claimed would create 500,000 new jobs.

Morawiecki and his fellow speakers at the congress of the ruling camp gave few details on financing for the tax cuts.

Jaroslaw Gowin, deputy prime minister and head of Agreement, one of PiS’s two junior coalition partners, conceded richer Poles would have to pay more taxes, but did not go into detail. He also said the state budget would be hit.

Poland’s finance minister Tadeusz Koscinski told the FT that the tax cuts would partly be funded by faster growth. However, he added that the fiscal shortfall would also be partly covered by higher social security payments from workers and business, resulting from changes that would push more workers from self-employment to full employment contracts, and from the removal of a cap on social security payments for the self-employed.

Koscinski said the annual net cost to the state budget of the tax cuts would be about 7bn zloty. He added that there would be a further 3bn zloty in subsidies to co-finance investments by local governments that had lost revenue as a result of the tax changes.

Adam Czerniak, an economist at Polityka Insight, said the government’s assumptions about faster growth helping to cover the cost of the government’s plans were “optimistic, but I think they can happen”.

However, he expressed concern that the changes around housing — which include state guarantees on home loans for young borrowers — could cause a booming market to overheat.

“Guarantees on down payments are very risky at this point in the business cycle in the housing market,” he said.



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