Public Policy Dynamics Spain #9

by RPP colleagues

Health and Politics in Spain

Total COVID-19 cases:3,559,222
14-day total COVID-19 cases per 100,000:171
14-day change:-27
Total COVID-19 deaths:78,726
14-day rise:1,230
  • The Spanish Government has submitted the Stability Programme 2021-2024 and the Recovery Plan to the European Commission, containing structural reforms and investments to be made in the coming years. The main opposition party (People's Party) has won the regional elections in Madrid, and political tension is now shifting to other regions.
  • Health policy priorities for the coming years have been set out in the strategic lines of the Recovery Plan. The Government has underlined its intention to strengthen the capacities of the health system through increased investment in primary care, the improvement of health equipment and technology, and the reform of the public health system to ensure greater equity between regions.
  • The incidence curve in Spain continues to fall. However, the situation in hospitals remains at a high-risk level and the number of deaths recorded each day still exceeds 100. Meanwhile, 5,696,827 people have already received the full course of vaccination.


  • On 30 April the Spanish Government submitted the National Reforms Plan 2021 and the Stability Programme 2021-2024 to the EU Commission, complying with the given deadlines. The former explains the priorities developed in the national Recovery and Resilience Plan, which includes a series of reforms and investments to be financed with EU Recovery funds (also sent for the European Commission’s assessment). The latter refers to the economic framework for next years, according to available macroeconomic indicators; the expectations on health developments; and the impact of the national Recovery and Resilience Plan. As such, an economic growth trend is expected by the Government, eliciting the V-shaped recovery from the economic downturn due to the economic standstill in 2020.

  • On 4 May snap elections were held in Madrid, resulting in the victory of the right-wing People’s Party with 44.73% of the votes (65 seats, just 4 short of an absolute majority). Therefore, the incumbent regional president, Isabel Díaz Ayuso, can renew her post for the next two years (until the end of the regular election cycle, which remains unaltered due to the snap elections) and will form a government in the coming days, likely with the support of far-right party Vox. These elections have taken place in a general context of political tension, amid strong criticism and confrontation between the regional and national governments. The results have been a blow for left-wing parties, as the socialist party (PSOE) lost 13 seats, obtaining even fewer votes than MasMadrid (a former split of Unidas Podemos), resulting in unprecedented internal tensions for the socialists of Madrid.

  • At the same time, leader of Unidas Podemos (far-left party and junior coalition partner of the Spanish Government) and former Spanish vice-prime minister Pablo Iglesias announced his retirement from politics in view of the negative results. Ciudadanos, the liberal party and former junior coalition member of the Madrid government, did not make it through the minimum threshold and obtained no representation at all in one of its strongholds, leading to an uncertain future of the party at national level. However, some former members of Ciudadanos might be integrated into the next regional Government, as the regional President has expressed a willingness to form a strong centre-right bloc government that will pave the way for the party’s national policy and will likely shape party politics in Spain for the years to come.



  • Health policy is included as a strategic line of the Spanish Recovery and Resilience Plan. The allocation, together with science policies, amounts to €4.94bn (7.1% of total funds) and is articulated under the framework “Promotion of science and innovation and strengthening of the capabilities of the National Health System”. The plan includes a national Strategy for Artificial Intelligence (€0.5bn), an Institutional reform and capacity-building in the national science, technology and innovation system (€3.38bn), and renewal and expansion of the capabilities of the National Health System (€1.5bn). The latter component is shown to be particularly important in the future policies of the Ministry of Health, whose head has stressed in recent weeks that the promotion of primary care, health cohesion policies to improve equity between regions, and investment in high-tech equipment will be priorities in the coming months. At the same time, a reform of the regulation of medicines and health products is expected, accompanied by other developments in the field such as the announced biosimilars plan (to be approved in the next weeks).

  • The aforementioned elections in Madrid have also brought new developments in regional health policy that could be extended to other territories. According to the party’s manifestos, the new government will likely aim to promote an innovative and highly qualified healthcare system with more resources for primary care, the strengthening of home care and innovative public procurement. It is also worth noting the intention of increasing the effectiveness of resources, to reduce surgical waiting lists through the Safe Surgery Programme and a personalised post-surgery follow-up using new technologies, as well as the incorporation of state-of-the-art equipment in hospitals.



  • The infections rate in Spain continues to fall and stands at 202 cases per 100,000 inhabitants in the last 14 days. However, the situation in hospitals remains at a high-risk level, with a high occupancy of ICUs by Covid-19 patients, and the number of deaths recorded each day still exceeds one hundred. Meanwhile, vaccination is progressing well, after a record number of vaccines were administered on 29 April, with more than 500,000 shots given.

  • The state of emergency in force since November 2020 comes to an end on Sunday 9 May, meaning that restriction measures imposed to curb the pandemic will no longer be binding. This situation has been met with some negative reactions from regional governments, which find themselves without a clear legal framework for the enactment of further restrictions. Thus, there is a widespread concern about a surge in infections due to potentially increased social contacts and the end of curfews and perimetral lockdowns. The opposition parties in Congress criticised the Government for “neglecting their duties” as no specific legislation has been passed to allow a clear framework for further restrictions. Separately, the Government has approved the seventh extension of the limitation of flights from Brazil and South Africa.


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