P9_TA(2020)0304

Programme for the Union's action in the field of health for the period 2021-2027 (‘EU4Health Programme’) ***I

Amendments adopted by the European Parliament on 13 November 2020 on the proposal for a regulation of the European Parliament and of the Council on the establishment of a Programme for the Union's action in the field of health –for the period 2021-2027 and repealing Regulation (EU) No 282/2014 (‘EU4Health Programme’) (COM(2020)0405 — C9-0152/2020 — 2020/0102(COD)) (1)

(Ordinary legislative procedure: first reading)

(2021/C 415/17)

Amendment 1

Proposal for a regulation

Recital 1 a (new)

Text proposed by the Commission Amendment (1 a) According to Article 8 of the Treaty on the Functioning of the European Union, in all its activities, the Union shall aim to eliminate inequalities, and to promote equality, between men and women, establishing the principle of gender mainstreaming.

Amendment 2

Proposal for a regulation

Recital 2

Text proposed by the Commission Amendment (2) In accordance with Articles 9 and 168 of the Treaty on the Functioning of the European Union (TFEU) and Article 35 of the Charter of Fundamental Rights of the European Union (the Charter), a high level of human health protection is to be ensured in the definition and implementation of all Union policies and activities. (2) In accordance with Articles 9 , 114, 168 and 191 of the Treaty on the Functioning of the European Union (TFEU) and Article 35 of the Charter of Fundamental Rights of the European Union (the Charter), a high level of human health protection is to be ensured in the definition and implementation of all Union policies and activities.

Amendment 3

Proposal for a regulation

Recital 3

Text proposed by the Commission Amendment (3) Article 168 TFEU provides that the Union is to complement and support national health policies, encourage cooperation between Member States and promote the coordination between their programmes, in full respect of the responsibilities of the Member States for the definition of their health policies and the organisation and delivery of health services and medical care. (3) Article168 TFEU provides that the Union is to complement and support national health policies, encourage cooperation between Member States , particularly in border regions, and promote the coordination between their programmes, in full respect of the responsibilities of each Member State to define their own health policy and to organise, deliver and manage health services and medical care.

Amendment 4

Proposal for a regulation

Recital 5

Text proposed by the Commission Amendment (5) On 11 March 2020 the World Health Organization (WHO) declared the novel coronavirus (COVID - 19 ) outbreak a global pandemic. That pandemic has caused an unprecedented worldwide health crisis with severe socio-economic consequences and human suffering. (5) On 11 March 2020 the World Health Organization (WHO) , due to an exponential increase of cases, declared COVID-19 (the disease resulting from the novel coronavirus SARS-CoV - 2 ) , and associated respiratory disease outbreak a global pandemic. The COVID-19 pandemic and more specifically the moderate to severe cases of the disease that need intermediate and intensive medical care pushed several health systems to breaking point within and outside of the Union, and caused an unprecedented worldwide health crisis with severe socio-economic consequences and human suffering , particularly affecting people with chronic conditions, causing both premature death and chronic conditions, and hitting the most vulnerable, patients, women, children, carers and the elderly the hardest . The severity of the crisis demonstrates also the importance of Union action and of adequately responding to threats deriving from infectious diseases, and in general of strengthening the Union's actions to complement national policies in the field of public health.

Amendment 5

Proposal for a regulation

Recital 5 a (new)

Text proposed by the Commission Amendment (5 a) Health care workers, which have been essential during the COVID-19 crisis, are predominantly women, and have been exposed to greater health risks during the crisis.

Amendment 6

Proposal for a regulation

Recital 5 b (new)

Text proposed by the Commission Amendment (5 b) Taking into account that the effects of diseases can be different between men and women, as it seems clear with Covid 19, which has a higher mortality rate in men, the Programme should study the causes of diseases’ behaviour in order to advance as regards pathology, treatment and cures.

Amendment 7

Proposal for a regulation

Recital 6

Text proposed by the Commission Amendment (6) While Member States are responsible for their health policies, they are expected to protect public health in a spirit of European solidarity (8). Experience from the ongoing COVID-19 crisis has demonstrated that there is a need for a further firm action at Union level to support cooperation and coordination among the Member States in order to improve the prevention and control of the spread of severe human diseases across borders, to combat other serious cross-border threats to health and to safeguard the health and well-being of people in the Union. (6) While Member States are responsible for their health policies, they are expected to protect public health in a spirit of European solidarity (8). Experience from the ongoing COVID-19 crisis has demonstrated that there is a need for a further firm action at Union level to support cooperation and coordination among the Member States , in particular between neighbouring border regions, as well as between authorities and relevant stakeholders. This cooperation should improve the preparedness, prevention and control of the spread of severe human infections and diseases across borders , to develop and make available products for the prevention and treatment of diseases , to combat other serious cross-border threats to health, and to safeguard and improve the health and well-being of all people in the Union. Preparedness is the key to improving resilience to future threats, and Member States, given their responsibility for the provision of healthcare, should carry out stress tests on their healthcare systems to identify weaknesses and verify that they are prepared for a possible future health crisis.

Amendment 8

Proposal for a regulation

Recital 6 a (new)

Text proposed by the Commission Amendment (6 a) While the Union's action in the field of health is limited, the Union should follow a coherent public health strategy in order to respond to existing epidemics taking into consideration regional and national specificities and have the capacity to face future worrying realities and health threats, such as pandemics and cross-border threats, including antimicrobial resistance, environmental health and the health impacts of the climate change. The Union should support Member States in reducing health inequalities and in achieving universal health coverage, including provision of sexual and reproductive health services, addressing healthcare associated infections, addressing the challenges of vulnerable groups, such as children, infant and maternal care, an ageing population, of chronic diseases, and disease prevention, in promoting a healthy lifestyle, prevention services and preparing their health systems for emerging technologies in order to fully benefit from the digital revolution while seeking synergies with other relevant Union programmes such as Horizon Europe, Digital Europe, the Connecting Europe Facility programme or the Union’s Space Programme.

Amendment 9

Proposal for a regulation

Recital 7

Text proposed by the Commission Amendment (7) It is therefore appropriate to establish a new Programme for the Union's action in the field of health, called EU4Health Programme (‘the Programme’) for the period 2021 -2027. In line with the goals of the Union action and its competences in the area of public health the Programme should place emphasis on actions in relation to which there are advantages and efficiency gains from collaboration and cooperation at Union level and actions with an impact on the internal market. (7) It is therefore appropriate to establish a new Programme for the Union's action in the field of public health, called EU4Health Programme (‘the Programme’) for the period 2021 -2027. In line with the goals of the Union action and its competences in the area of public health the Programme should place emphasis on actions in relation to which there are advantages and efficiency gains from collaboration at Union level as well as from cross-border cooperation at regional level and actions with an impact on the internal market. A holistic approach is needed to improve health outcomes, and EU policy-makers should ensure that the principle of ‘health in all policies’ is applied in all policy-making.

Amendment 10

Proposal for a regulation

Recital 10

Text proposed by the Commission Amendment (10) Due to the serious nature of cross-border health threats, the Programme should support coordinated public health measures at Union level to address different aspects of such threats. With a view to strengthen the capability in the Union to prepare for, respond to and manage health crisis the Programme should provide support to the actions taken in the framework of the mechanisms and structures established under Decision No 1082/2013/EU of the European Parliament and of the Council (10) and other relevant mechanisms and structures established at Union level. This could include strategic stockpiling of essential medical supplies or capacity building in crisis response, preventive measures related to vaccination and immunisation, strengthened surveillance programmes. In this context the Programme should foster Union-wide and cross-sectoral crisis prevention, preparedness, surveillance, management and response capacity of actors at the Union, national, regional and local level, including contingency planning and preparedness exercises, in keeping with the ‘One Health’ approach . It should facilitate the setting up of an integrated cross-cutting risk communication framework working in all phases of a health crisis — prevention, preparedness and response. (10) Due to the serious nature of cross-border health threats, the Programme should support coordinated public health measures at Union level , as well as between neighbouring regions to address different aspects of such threats. With a view to strengthen the capability in the Union to prepare for, respond to and manage any future health crises, the Programme should provide support to the actions taken in the framework of the mechanisms and structures established under Decision No 1082/2013/EU of the European Parliament and of the Council (10) and other relevant mechanisms and structures established at Union level. This could include capacity building in crisis response, preventive measures related to vaccination and immunisation, strengthened surveillance programmes , health information, and platforms to share best practices . In this context the Programme should foster Union-wide and cross-sectoral crisis prevention, preparedness, surveillance, management and response capacity of actors at the Union, national, regional and local level, including contingency planning and preparedness exercises, in keeping with the ‘One Health’ and ‘Health in all policies’ approaches . It should facilitate the setting up of an integrated cross-cutting risk communication framework working in all phases of a health crisis — prevention, preparedness and response.

Amendment 11

Proposal for a regulation

Recital 11

Text proposed by the Commission Amendment (11) As in the time of health crisis emergency health technology assessment as well as clinical trials can contribute to the rapid development of medical countermeasures the Programme should provide support to facilitate such actions . The Commission has adopted a proposal (11) on Health Technology Assessment (HTA) to support cooperation on health technology assessment at Union level. (11) In the context of public health crises, Health Technology Assessment (HTA) and clinical trials can contribute to the rapid development , identification and availability of medical countermeasures. The Commission has adopted a proposal (11) on Health Technology Assessment (HTA) to support cooperation on health technology assessment at Union level. The Programme should provide support to facilitate such actions.

Amendment 12

Proposal for a regulation

Recital 12

Text proposed by the Commission Amendment (12) With a view to protect people in vulnerable situations, including those suffering from mental illnesses and chronic diseases, the Programme should also promote actions which address the collateral impacts of the health crisis on people belonging to such vulnerable groups. (12) With a view to protect people in vulnerable situations, including those suffering from mental illnesses , living with or most affected by communicable or non-communicable diseases and chronic diseases , such as obesity, cancer, diabetes, cardiovascular disease and neurological disorders , the Programme should also promote actions which address the collateral impacts of the health crisis on people belonging to such vulnerable groups. With a view to guaranteeing continued high standards of essential healthcare services, including prevention, the Programme should, in particular in times of crisis and pandemics, encourage a transition to accessible and affordable telemedicine, at-home administration of medication and implementation of preventative and self-care plans, where possible and appropriate, while ensuring that access to healthcare and prevention services is provided to chronic patients and patients at risk.

Amendment 13

Proposal for a regulation

Recital 13

Text proposed by the Commission Amendment (13) The COVID-19 crisis has highlighted many challenges in ensuring the supply of medicines, medical devices as well as personal protective equipment needed in the Union during the pandemics. The Programme therefore should provide support to actions which foster the production, procurement and management of crisis relevant products ensuring complementarity with other Union instruments. (13) The COVID-19 crisis has highlighted many challenges including the Union’s dependency on third countries in ensuring the supply of chemical raw and starting materials, active pharmaceutical ingredients, medicines, medical devices as well as personal protective equipment needed in the Union during the pandemics. The Programme therefore should provide support to actions which will increase the security of production, procurement, management and distribution of medicinal products and medical devices in the Union and reduce dependency on third countries by encouraging the diversification of supply chains, fostering the production in the Union and joint procurement and management of crisis relevant products ensuring complementarity with other Union instruments , to mitigate the risk of shortages, especially in periods of health crises .

Amendment 14

Proposal for a regulation

Recital 14

Text proposed by the Commission Amendment (14) In order to minimise the public health consequences of serious cross-border threats to health it should be possible for actions supported under the Programme to cover coordination of the activities which strengthen the interoperability and coherence of Member States’ health-systems through benchmarking, cooperation and exchange of best practices and ensure their capability to respond to health emergencies, that includes contingency planning, preparedness exercises and the upskilling of health care and public health staff and the establishment of mechanisms for the efficient monitoring and needs-driven distribution or allocation of goods and services needed in time of crisis. (14) In order to minimise the public health consequences of serious cross-border threats to health it should be possible for actions supported under the Programme to cover coordination of the activities which strengthen the interoperability and coherence of Member States’ health-systems through benchmarking, cooperation and exchange of best practices also via an increased number of joint actions and ensure their capability to respond to health emergencies, that includes contingency planning, preparedness exercises and the upskilling of health care and public health staff and the establishment of mechanisms for the efficient monitoring and needs-driven distribution or allocation of goods and services needed in time of crisis , which would be particularly beneficial in a cross-border context .

Amendment 15

Proposal for a regulation

Recital 14 a (new)

Text proposed by the Commission Amendment (14a) The establishment of a communication portal for the public would allow the Union to share validated information, send alerts to European citizens and fight against disinformation. It could include a wide range of information, prevention campaigns and youth education programs. This portal could also be used to promote, in cooperation with the European Centre for Disease Control (‘ECDC’), strong immunization coverage at European level.

Amendment 16

Proposal for a regulation

Recital 15

Text proposed by the Commission Amendment (15) Experience from the COVID-19 crisis has indicated that there is a general need for the support to structural transformation of and systemic reforms of health systems across the Union to improve their effectiveness, accessibility and resilience. In the context of such transformation and reforms, the Programme should promote, in synergy with the Digital Europe Programme, actions which advance digital transformation of health services and increase their interoperability, contribute to the increased capacity of health systems to foster disease prevention and health promotion, to provide new care models and to deliver integrated services, from the community and primary health care to the highly specialised services, based on people's needs and ensure an efficient public health workforce equipped with the right skills, including digital skills. The development of a European health data space would provide health care systems, researchers and public authorities with means to improve the availability and quality of healthcare. Given the fundamental right to access to preventive healthcare and medical treatment enshrined in Article 35 of the Charter of Fundamental Rights of the European Union and in view to the common values and principles in European Union Health Systems as set out in the Council Conclusions of 2 June 2006 (12) the Programme should support actions ensuring the universality and inclusivity of health care, meaning that no-one is barred access to health care, and those ensuring that patients’ rights,including on the privacy of their data, are duly respected. (15) Experience from the COVID-19 crisis has indicated that there is a general need for the support to structural transformation of and systemic reforms of health systems across the Union to improve their effectiveness, accessibility , sustainability and resilience. In the context of such transformation and reforms, the Programme should promote, in synergy with the Digital Europe Programme, actions which advance digital transformation of health services and increase their interoperability, contribute to the increased capacity of health systems to foster primordial, primary, secondary, tertiary and quaternary disease prevention and health promotion, to provide new outcome-based care models and to deliver integrated services, from the community and primary health care to the highly specialised services, based on people's needs enhancing citizens’ levels of health literacy and digital health literacy, and ensure an efficient public health workforce equipped with the right skills, including digital skills , regularly updated in the light of scientific and technological progress, as provided for in Directive 2005/36/EC of the European Parliament and of the Council (11a) . The synergy between the European Health Programme and the Digital Europe Programme should contribute to the implementation and expansion of e-health, reducing unnecessary travel and unmet healthcare needs . The development of a European health data space and of a European electronic health record would provide health care systems, researchers and public authorities with means to improve the accessibility, affordability, availability and quality of healthcare , increasing the amount of data available to patients and health workers, and thereby improving the quality of healthcare and the patient's freedom of movement around the Union . Given the fundamental right to access to preventive healthcare and medical treatment enshrined in Article 35 of the Charter of Fundamental Rights of the European Union and in view to the common values and principles in European Union Health Systems as set out in the Council Conclusions of 2 June 2006 (12) the Programme should support actions ensuring the universality and inclusivity of health care, meaning that no-one is barred access to health care, and those ensuring that patients’ rights, including on the privacy of their data, are duly respected. The Programme should support access to and sharing of personal health data, without prejudice to the application of GDPR and increase the digital skills of patients.

Amendment 17

Proposal for a regulation

Recital 15 a (new)

Text proposed by the Commission Amendment (15 a) Gender and sex sensitivity and knowledge need to be improved in the education of health care professionals, the research, diagnosis, treatment and impact of medicines and therapeutics to better understand and treat both sexes.

Amendment 18

Proposal for a regulation

Recital 15 b (new)

Text proposed by the Commission Amendment (15 b) Under Article 153 TFEU, the Union is to support and complement the activities of Member States concerning improvement of the working environment, and protection of workers' health, safety and working conditions. It is important to take account of the large amount of time that workers spend in their workplaces and the potential health risk they could be exposed to, such as health hazard substances and carcinogens and to repeated movements, leading to a high burden as regards incapacity and number of work days lost, which in turn has consequences for the individual, family and society. The Programme should also reflect the importance of occupational health and its impact on health workers and societies. The Commission should work with Member States to create new legislation to improve workers’ health conditions, improve their working conditions, the balance between work and life, promote wellbeing and better mental health, prevent early-retirement due to ill health and poor health management.

Amendment 19

Proposal for a regulation

Recital 15 c (new)

Text proposed by the Commission Amendment (15c) The programme should facilitate the revision of the EU-OSHA’s mandate to promote healthy and safe workplaces across the Union and to support the Agency’s activities and analysis regarding occupational safety and health. The Commission should propose a new Union strategic framework on occupational safety and health for the period 2021 — 2027 and continue updating Directive 2004/37/EC of the European Parliament and of the Council (12a) . The programme should also support actions to facilitate people’s return to the workplace after long-term sick leave and to better include people who are chronically sick or have a disability in the workforce.

Amendment 20

Proposal for a regulation

Recital 16

Text proposed by the Commission Amendment (16) Keeping people healthy and active longer and empowering them to take an active role in managing their health will have positive effects on health, health inequalities, quality of life, productivity, competitiveness and inclusiveness, while reducing pressures on national budgets. The Commission has committed to help Member States to reach the sustainable development targets set in the ‘UN 2030 Agenda for Sustainable Development’ in particular Sustainable Development Goal 3 ‘Ensure healthy lives and promote well-being for all at all ages’ (13). The Programme therefore should contribute to the actions taken towards reaching these goals. (16) Health is an investment and the Programme should have this concept at its core. Keeping people healthy and active longer and empowering them to take an active role in managing their health , by improving their health literacy, will have positive effects on health, health inequalities , health inequities , quality of life, productivity, competitiveness and inclusiveness, while reducing pressures on national health systems and budgets . The Programme should also support action to reduce inequalities in the provision of healthcare, in rural and remote areas including in the outermost regions, for the purposes of achieving inclusive growth . The Commission has committed to help Member States to reach the sustainable development targets set in the ‘UN 2030 Agenda for Sustainable Development’ in particular Sustainable Development Goal 3 ‘Ensure healthy lives and promote well-being for all at all ages’ (13). The Programme therefore should contribute to the actions taken towards reaching the SDGs goals , and consequently improve the social determinants of health and enhance the health of the Union’s citizens .

Amendment 21

Proposal for a regulation

Recital 17

Text proposed by the Commission Amendment (17) Non-communicable diseases are a result of a combination of genetic, physiological, environmental and behavioural factors. Such non-communicable diseases as cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes, represent major causes of disability, ill-health, health-related retirement, and premature death in the Union, resulting in considerable social and economic impacts. To decrease the impact of non-communicable diseases on individuals and society in the Union and reach goal 3 of the Sustainable Development Goals, Target 3.4, to reduce premature mortality from non-communicable diseases by one third by 2030, it is key to provide an integrated response focusing on prevention across sectors and policy fields , combined with efforts to strengthen health systems. (17) Non-communicable diseases are a result of a combination of genetic and health determinants ( physiological, behavioural, and environmental) Such non-communicable diseases, as cardiovascular diseases, cancer, obesity, chronic respiratory diseases, diabetes, mental health illness and neurological disorders represent major causes of disability, ill-health, health-related retirement, and premature death in the Union, while non-communicable diseases were responsible for 87 % of Disability-Adjusted Life Years (DALYs) in the Union in 2017, resulting in considerable affective, social and economic impacts. To decrease the impact of non-communicable diseases on individuals and society in the Union and reach goal 3 of the Sustainable Development Goals, particularly but not exclusively Target 3.4, to reduce premature mortality from non-communicable diseases by one third by 2030, it is key to provide an integrated response focusing on health promotion and prevention across sectors , specialities and policy-fields, taking into account the interrelated nature of most non-communicable diseases , combined with efforts to strengthen health systems and the supply of appropriate medicines . , on strengthening the implementation of the WHO Framework Convention on Tobacco Control is crucial to achieving an effective, sustainable reduction in preventable non-communicable diseases. The Program should support actions aimed at integrating mental health into all areas, including in the workspace and in schools, and promote actions to combat depression and suicide and to implement integrative mental health care.

Amendment 22

Proposal for a regulation

Recital 18

Text proposed by the Commission Amendment (18) The Programme therefore should contribute to disease prevention throughout the lifetime of an individual and to health promotion by addressing health risk factors, such as the use of tobacco and related products and exposure to their emissions, the harmful use of alcohol, and the consumption of illicit drugs. The Programme should also contribute to the reduction of drugs-related health damage, unhealthy dietary habits and physical inactivity, and exposure to environmental pollution, and foster supportive environments for healthy lifestyles in order to complement Member States action in these areas. The Programme should also therefore contribute to the objectives of the European Green Deal, the Farm to Fork Strategy and the Biodiversity Strategy. (18) Health promotion and health prevention are vastly more cost-efficient than treatment, both in terms of money and of quality-adjusted life years, therefore the Programme should contribute to disease prevention throughout the lifetime of an individual and to health promotion by addressing determinants of health , such as the use of tobacco and related products and exposure to their emissions, the harmful use of alcohol, an unhealthy food environment, and the consumption of illicit drugs and psychoactive substances. To achieve the best health status possible, the Programme should tackle all health determinants. Health promotion, health protection and disease prevention throughout the lifetime of an individual should be at the core of the programme by addressing health and mental risk factors, such as the use of tobacco and related products and exposure to their emissions, the harmful use of alcohol, and the consumption of drugs and other addictive behaviours . The Programme should also contribute to the reduction of drugs-related health damage, obesity and unhealthy dietary habits, physical inactivity, and exposure to environmental pollution, and foster supportive environments for healthy lifestyles in order to complement Member States action in these areas. The Programme therefore should contribute to a high level of human health protection and prevention, throughout the entire lifetime of an individual, including through the promotion of physical activity, nutritional care and promotion of health education. The Programme should also strengthen and support the implementation of the Union’s health-related legislation, including in the area of environmental health, and foster the ‘Health in All Policies’ approach. The Programme should also contribute to the objectives of the European Green Deal, the Farm to Fork Strategy and the Biodiversity Strategy and the Chemicals strategy for sustainability .

Amendment 23

Proposal for a regulation

Recital 18 a (new)

Text proposed by the Commission Amendment (18a) The Programme should continue supporting actions in the area of reducing and preventing alcohol related harm in the perspective of a revised Union alcohol strategy. Protecting children from alcohol should be one of the Programme’s priorities.

Amendment 24

Proposal for a regulation

Recital 18 b (new)

Text proposed by the Commission Amendment (18 b) The burden of chronic diseases is still significant in the Union. Chronic diseases develop slowly, are long-lasting and often incurable. Chronic diseases are, in many cases, associated with more than one comorbidity, which makes them even more difficult to treat and manage. They have caused great human suffering and also placed an enormous burden on health systems. However, many chronic diseases, such as cardiovascular diseases and type 2 diabetes, could be prevented by healthy lifestyle choices, while other illnesses, for instance neurological diseases, can be managed to slow the onset if detected early, or helping patients feel their best and remain active for longer. The Union and the Member States can therefore greatly reduce the burden of Member States by working together to achieve a better and more effective management of diseases, and the Programme should support actions in this area. The Programme should support the development of specific European preventive and disease management guidelines in the area of both communicable and non-communicable diseases, such as cardiovascular diseases, neurodegenerative diseases, respiratory diseases and diabetes.

Amendment 25

Proposal for a regulation

Recital 19

Text proposed by the Commission Amendment (19) Cancer is the second leading cause of mortality in the Member States after cardiovascular diseases. It is also one of non-communicable diseases that share common risk factors and the prevention and control of which would benefit the majority of citizens. In 2020 the Commission announced the ‘Europe’s Beating Cancer Plan’ which would cover the entire cycle of the disease starting from prevention and early diagnosis to treatment and quality of life of patients and survivors . The measures should benefit from the Programme and from Horizon Europe’s Mission on Cancer. (19) Cancer is the second leading cause of mortality in the Member States after cardiovascular diseases. Cancer is caused by many factors and therefore requires a new prevention paradigm that addresses individual health determinants (genetic, lifestyle) and wider (populations) determinants related to occupational, environmental and social exposure factors. It is also one of non-communicable diseases that share common risk factors with others and the prevention and control of which would benefit the majority of citizens . Poor nutrition, physical inactivity, obesity, tobacco and alcohol are risk factors common to other chronic diseases, such as cardiovascular diseases, and therefore cancer prevention programmes should be implemented within the context of an integrated chronic disease prevention programme . In 2020 the Commission announced the ‘Europe’s Beating Cancer Plan’ which would cover every key stage of the disease: prevention, diagnosis, treatment , life as a cancer survivor, reinsertion and palliative care and pain management. The programme should promote actions to complement the ‘Europe’s Beating Cancer Plan’ and thus improve cancer patients' quality of life. The measures should benefit from the Programme and from Horizon Europe’s Mission on Cancer in particular by initiatives which support the mid- and long-term goals of the Plan, and address cancer’s common risk factors and synergies with other major non-communicable diseases .

Amendment 26

Proposal for a regulation

Recital 20

Text proposed by the Commission Amendment (20) The Programme will work in synergy and complementarity with other EU policies, programmes and funds such as actions implemented under the Digital Europe Programme, Horizon Europe, rescEU reserve under the Union Civil Protection Mechanism, Emergency Support Instrument, European Social Fund+ (ESF+, including as regards synergies on better protecting the health and safety of millions of workers in the EU), including the Employment and Social Innovation Strand (EaSI), the InvestEU fund, Single Market Programme, European Regional Development Fund (ERDF), Recovery and Resilience Facility including the Reform Delivery Tool, Erasmus, European Solidarity Corps, Support to mitigate Unemployment Risks in an Emergency (SURE), and EU external action instruments, such as the Neighbourhood, Development and International Cooperation Instrument and the Instrument for Pre-accession Assistance III. Where appropriate, common rules will be established in view of ensuring consistency and complementarity between funds, while making sure that specificities of these policies are respected, and in view of aligning with the strategic requirements of these policies, programmes and funds, such as the enabling conditions under ERDF and ESF+. (20) The Programme will work in synergy and complementarity with other EU policies, programmes and funds such as actions implemented under the Digital Europe Programme, Horizon Europe, rescEU reserve under the Union Civil Protection Mechanism, Emergency Support Instrument, European Social Fund+ (ESF+, including as regards synergies on better protecting the health and safety of millions of workers in the EU), including the Employment and Social Innovation Strand (EaSI), the InvestEU fund, Single Market Programme, European Regional Development Fund (ERDF), including Interreg, Recovery and Resilience Facility including the Reform Delivery Tool, Erasmus, European Solidarity Corps, Support to mitigate Unemployment Risks in an Emergency (SURE), and EU external action instruments, such as the Neighbourhood, Development and International Cooperation Instrument and the Instrument for Pre-accession Assistance III. Where appropriate, common rules will be established in view of ensuring consistency and complementarity between funds, avoiding any overlap or duplication of financing, while making sure that specificities of these policies are respected, and in view of aligning with the strategic requirements of these policies, programmes and funds, such as the enabling conditions under ERDF and ESF+.

Amendment 249

Proposal for a regulation

Recital 20 a (new)

Text proposed by the Commission Amendment (20a) The Programme should contribute to the establishment of a reserve of health crisis relevant products, such as essential medicines, vaccines and medical devices, in synergy and complementarity with rescEU, the Emergency Support Instrument, the Resilience Instrument and with other Union policies, programmes and funds.

Amendment 27

Proposal for a regulation

Recital 21

Text proposed by the Commission Amendment (21) In accordance with Article 114 TFEU, a high level of health protection should be ensured in the legislation adopted by the Union for the establishment and the functioning of the internal market. On the basis of Article 114 TFEU and point (c) of Article 168(4) TFEU, a considerable body of Union acquis was developed which guarantees the high standards of quality and safety for medicinal products and medical devices. Given the rising healthcare demand, Member States’ healthcare systems face challenges in the availability and affordability of medicines and medical devices. To ensure a better public health protection as well as the safety and empowerment of patients in the Union, it is essential that patients and health systems have access to high quality healthcare products and can fully benefit from them. (21) In accordance with Article 114 TFEU, a high level of health protection should be ensured in the legislation adopted by the Union for the establishment and the functioning of the internal market. On the basis of Article 114 TFEU and point (c) of Article 168(4) TFEU, a considerable body of Union acquis was developed which guarantees the high standards of quality and safety for medicinal products and medical devices. Given the rising healthcare demand, Member States’ healthcare systems face challenges in the availability and affordability of medicines and medical devices. To ensure a better public health protection as well as the safety and empowerment of patients in the Union, it is essential that patients and health systems have access to sustainable, efficient, equitable, affordable and high quality healthcare products , including in a cross-border context, and can fully benefit from them , based on transparent, consistent, patient-oriented medical information .

Amendment 28

Proposal for a regulation

Recital 22

Text proposed by the Commission Amendment (22) The Programme should therefore support actions to monitor shortages of medicines, medical devices and other healthcare products and to ensure greater availability and affordability of those products while limiting the dependency of their supply chains on third countries. In particular, in order to address unmet medical needs, the Programme should provide support to clinical trials so as to speed up the development, authorisation and access to innovative and effective medicines, promote incentives to develop such medicinal products as antimicrobials and foster the digitial transformation of healthcare products and platforms for monitoring and collecting information on medicines. (22) The Programme should support the development of a European monitoring, reporting and notification system for shortages of medicines, medical devices , vaccines, diagnostic tools, and other healthcare products , to avoid fragmentation of the single market and to ensure greater availability and affordability of those products while limiting the dependency of their supply chains on third countries. The Programme should, therefore encourage the production of medicinal products and medical devices within the Union. In particular, in order to address unmet medical needs, the Programme should provide support to clinical and real world evidence generation to enable the development, authorisation , evaluation of and access to effective medicines , including generics and biosimilars, medical devices, and treatment, promote research and the development of new medicinal products, with particular attention to be given to antimicrobials and vaccines to tackle AMR and vaccine-preventable diseases , promote incentives to boost the production capacity for antimicrobials , personalized treatment and vaccination, and foster the digital transformation of healthcare products and platforms for monitoring and collecting information on medicines. The Programme should also strengthen decision-making on medicines by enabling access to and analysis of real-world healthcare data by regulators and health technology assessments (‘HTA’), bodies. The Programme should also help to ensure best use of research results and facilitate the uptake, scaling-up and deployment of health innovation in healthcare systems and clinical practice.

Amendment 29

Proposal for a regulation

Recital 22 a (new)

Text proposed by the Commission Amendment (22 a) A harmonised definition should be laid down at Union level for the terms ‘shortage’, ‘tension’, ‘supply disruptions’, ‘stock-out’ and ‘overstocking’. The Commission should work towards developing such harmonised definitions in close cooperation with the Member States and all the relevant stakeholders, including patient organisations. Moreover, the Commission should, in particular, reinforce the definition of ‘shortage’ proposed by the European Medicines Agency (EMA) and the Heads of Medicines Agencies (HMA) joint Task Force in 2019.

Amendment 30

Proposal for a regulation

Recital 23

Text proposed by the Commission Amendment (23) As the optimal use of medicines and antimicrobials in particular yields benefits for individuals and health systems, the Programme should promote their prudent and efficient use. In line with the European One Health Action Plan against Antimicrobial Resistance (14), adopted in June 2017 following the request from Member States, and given the experience with the bacterial secondary infections related to COVID 19 , it is essential that the Programme supports actions aimed at the prudent use of antimicrobials in humans, animals and crops, in the framework of an integrated policy on patient safety and prevention of medical errors. (23) As the optimal use of medicines and antimicrobials in particular yields benefits for individuals and health systems, the Programme should promote their prudent and efficient use. In line with the European One Health Action Plan against Antimicrobial Resistance (14), adopted in June 2017 following the request from Member States, and given that infections and sepsis caused by antibiotic-resistant bacteria are responsible for a high number of deaths in the Union , it is essential that the Programme supports actions aimed at the prudent use of antimicrobials in humans, animals and crops, and actions including the use of non-antibiotic integrative treatments, in the framework of an integrated policy on patient safety and prevention of medical errors. The Programme should support the monitoring and surveillance programmes on the usage of antimicrobials and AMR, and the support to the implementation of local, regional and national plans to fight against AMR, supported by evidence-based strategies and the sharing of good practices within the Union.

Amendment 31

Proposal for a regulation

Recital 24

Text proposed by the Commission Amendment (24) Since environmental pollution caused by human and veterinary pharmaceutical substances is an emerging environmental problem that can impact on public health, the Programme should foster measures to strengthen the assessment and appropriate management of environmental risks associated with the production, use and disposal of medicinal products, in line with the European Union Strategic Approach to Pharmaceuticals in the Environment (15). (24) Since the pollution caused by human and veterinary pharmaceutical substances is an emerging environmental problem that can impact on public health, the Programme should foster measures to strengthen the assessment and appropriate management of environmental risks associated with the production, use and disposal of medicinal products, in line with the European Union Strategic Approach to Pharmaceuticals in the Environment (15).

Amendment 32

Proposal for a regulation

Recital 25

Text proposed by the Commission Amendment (25) The Union health legislation has an immediate impact on public health, the lives of citizens, the efficiency and resilience of the health systems and the good functioning of the internal market. The regulatory framework for medical products and technologies (medicinal products, medical devices and substances of human origin), as well as for tobacco legislation, patients’ rights in cross-border healthcare and serious cross-border threats to health is essential to health protection in the Union. The Programme therefore should support the development, implementation and enforcement of Union health legislation and provide high quality, comparable and reliable data to underpin policymaking and monitoring. (25) The Union health legislation has an immediate impact on public health and safety , the lives of citizens, the efficiency and resilience of the health systems and the good functioning of the internal market. The regulatory framework for medical products and technologies (medicinal products, medical devices and substances of human origin), as well as for tobacco legislation, patients’ rights in cross-border healthcare and serious cross-border threats to health is essential to health protection in the Union. The Programme therefore should support the development, implementation and enforcement of Union health legislation and , in conjunction with key partners such as EMA and ECDC, provide high quality , unbiased , comparable and reliable data , including real-world healthcare data collected locally across Europe, through a well-defined homogeneous methodology, to underpin policymaking and monitoring , set targets and develop tools to measure progress .

Amendment 33

Proposal for a regulation

Recital 26

Text proposed by the Commission Amendment (26) Cross-border cooperation in the provision of healthcare to patients moving between Member States, collaboration on health technology assessments (HTA), and European Reference Networks (ERNs) are examples of areas where integrated work among Member States has shown to have strong added value and great potential to increase the efficiency of health systems and thus health in general. The Programme should therefore support activities to enable such integrated and coordinated work , which also serves to foster the implementation of high-impact practices that are aimed at distributing in the most effective way the available resources to the concerned population and areas so as to maximise their impact. (26) Cross-border cooperation in the provision of healthcare to patients moving between Member States or living in border regions , collaboration on health technology assessments (HTA), and European Reference Networks (ERNs) are examples of areas where integrated work among Member States has shown to have strong added value and great potential to increase the efficiency of health systems and thus health in general. The Programme should therefore be aimed at ensuring that such integrated and coordinated work is developed and implemented to its full potential in areas such as HTA and ERNs. That work would serve to foster the implementation of high-impact practices that are aimed at distributing in the most effective way the available resources to the relevant groups of the population and areas so as to maximise their impact.

Amendment 34

Proposal for a regulation

Recital 26 a (new)

Text proposed by the Commission Amendment (26 a) Solidarity and unity are principles of the Union and the programme should ensure that the Union has a coherent approach to combating cross-border health-threats. In order to respond to public health threats, the Programme should under Article 168 TFEU support the creation of a European Health Response Mechanism, coordinated by the ECDC and led by the Commissioner for Health and the Commissioner for Crisis Management, fully articulated with the other EU health agencies. This Mechanism with its own medical resources under a strengthened Union Civil Protection Mechanism should be prepared with a pandemic emergency plan, in order to have a coordinated response and the capacity to rapidly scale up the response to future health crises, based on standardised information.

Amendment 35

Proposal for a regulation

Recital 27

Text proposed by the Commission Amendment (27) The ERNs, established pursuant to Directive 2011/24/EU of the European Parliament and the Council (16) are virtual networks involving healthcare providers across Europe. They aim to facilitate discussion on complex or rare diseases and conditions that require highly specialised treatment, and concentrated knowledge and resources. As the Networks can improve the access to diagnosis and the provision of high-quality healthcare to patients with rare conditions and can be focal points for medical training and research and dissemination of information, the Programme should contribute to the upscaling of networking through the ERNs, and other transnational networks. It should consider the extension of ERNs beyond rare diseases to communicable and non-communicable diseases such as cancer. (27) The ERNs, established pursuant to Directive 2011/24/EU of the European Parliament and the Council (16) are virtual networks involving healthcare providers across Europe. They aim to facilitate discussion on complex or rare diseases and conditions that require highly specialised treatment, and concentrated knowledge and resources. ERNs are a ground-breaking platform that represents a unique opportunity and which, based on the innovative use and sharing of knowledge and health data across borders, aims to improve diagnosis and care for people living with a rare or complex disease. The Programme should, therefore, provide adequate funding to support the coordination and collaborative activities of both existing and future ERNs through grants or other instruments that are fit for purpose. It should increase upscale current funding to ensure that ERNs fulfil the objectives set out in their mission. As the Networks can improve the access to diagnosis and the provision of high-quality healthcare to patients with rare conditions and can be focal points for medical training and research and dissemination of information, the Programme should also contribute to the upscaling of networking through the ERNs, and other transnational networks. It should consider reinforcing ERNs, supporting the creation of new ERNs to cover infectious diseases , complex pregnancies and rare and complex mental health diseases. The reinforcement of ERNs can play a key role in supporting the adoption of a common newly developed screening framework at Union level, starting from disease selection criteria and mechanisms, with the aim of overcoming existing inequalities in terms of screening coverage across Member States. The Programme should also consider the development of excellence networks in the field of communicable and non-communicable diseases , including cancer and paediatric cancer, cardiovascular disease, chronic respiratory disease, diabetes, mental health conditions, neurodegenerative diseases and other major chronic diseases, and in the field of health crisis management .

Amendment 36

Proposal for a regulation

Recital 27 a (new)

Text proposed by the Commission Amendment (27 a) The ERNs face significant challenges as regards ensuring they are financially sustainable and are able to operate effectively within and across national healthcare systems, as highlighted by the European Court of Auditors, in their ‘Special report no 07/2019: EU actions for cross-border healthcare’ (16a) .

Amendment 37

Proposal for a regulation

Recital 30

Text proposed by the Commission Amendment (30) In order to optimise the added value and impact from investments funded wholly or in part through the budget of the Union, synergies should be sought in particular between the Programme for the Union's action in the field of health and other Union programmes, including those under shared-management. To maximise those synergies, key enabling mechanisms should be ensured, including cumulative funding in an action from the Programme for the Union's action in the field of health and another Union programme, as long as such cumulative funding does not exceed the total eligible costs of the action. For that purpose, this Regulation should set out appropriate rules, in particular on the possibility to declare the same cost or expenditure on a pro-rata basis to Programme for the Union's action in the field of health and another Union programme. (30) In order to optimise the added value and impact from investments funded wholly or in part through the budget of the Union, synergies should be sought in particular between the Programme for the Union's action in the field of health and other Union programmes, including those under shared-management , in particular the Interreg programme, which already addresses cross-border cooperation in the field of health and helps to facilitate the cross-border mobility of patients and health professionals, and to develop access to high quality healthcare through the use of common equipment, shared services and joint facilities in cross-border areas . To maximise those synergies , and avoid duplications , key enabling mechanisms should be ensured, including cumulative funding in an action from the Programme for the Union's action in the field of health and another Union programme, as long as such cumulative funding does not exceed the total eligible costs of the action. For that purpose, this Regulation should set out appropriate rules, in particular on the possibility to declare the same cost or expenditure on a pro-rata basis to Programme for the Union's action in the field of health and another Union programme , guaranteeing detailed and transparent reporting .

Amendment 38

Proposal for a regulation

Recital 31

Text proposed by the Commission Amendment (31) Given the specific nature of the objectives and actions covered by the Programme, the respective competent authorities of the Member States are best placed in some cases to implement the related activities. Those authorities, designated by the Member States themselves, should therefore be considered to be identified beneficiaries for the purpose of Article 195 of the Financial Regulation and the grants be awarded to such authorities without prior publication of calls for proposals. (31) Given the specific nature of the objectives and actions covered by the Programme, the respective competent authorities of the Member States are best placed in some cases to implement the related activities. Those authorities, designated by the Member States themselves, should therefore be considered to be identified beneficiaries for the purpose of Article 195 of the Financial Regulation and the grants be awarded to such authorities without prior publication of calls for proposals. Investments from the Programme should be implemented in close cooperation with Member States especially in areas falling under national competences.

Amendment 39

Proposal for a regulation

Recital 31 a (new)

Text proposed by the Commission Amendment (31 a) In order to ensure that each of these objectives is implemented at Union level, the Commission should increase the budget and should submit a proposal to strengthen the mandates of the ECDC and of EMA, which are already pursuing some of the EU4Health objectives at their level, and should have a greater role in the implementation of the Programme.

Amendment 40

Proposal for a regulation

Recital 33

Text proposed by the Commission Amendment (33) Given the common agreed values of solidarity towards equitable and universal coverage of quality health services as a basis for the Union’s policies in this area and that the Union has a central role to play in accelerating progress on global health challenges (19), the Programme should support the Union’s contribution to international and global health initiatives with a view to improve health, address inequalities and increase protection against global health threats. (33) Given the common agreed values of solidarity towards accessible, equitable and universal coverage of quality health services , including in a cross-border context, as a basis for the Union’s policies in this area and that the Union has a central role to play in accelerating progress on global health challenges (19), the Programme should support the Union’s contribution to international and global health initiatives with a view to improve health, address inequalities and increase protection against global health threats.

Amendment 41

Proposal for a regulation

Recital 34

Text proposed by the Commission Amendment (34) In order to maximise the effectiveness and efficiency of actions at Union and international level, cooperation should be developed with relevant international organisations such as the United Nations and its specialised agencies, in particular the WHO, the World Bank, as well as with the Council of Europe and the Organisation for Economic Co-operation and Development (OECD) to implement the Programme. Pursuant to Article 94 of Council Decision 2013/755/EU (20), persons and entities established in Overseas Countries and Territories (OCTs) are eligible for funding subject to the rules and objectives of the Programme and possible arrangements applicable to the Member State to which the relevant OCTs are linked. (34) In order to maximise the effectiveness and efficiency of actions at Union and international level, cooperation should be developed with the Member States and with relevant international organisations such as the United Nations and its specialised agencies, in particular the WHO, the World Bank, as well as with the Council of Europe and the Organisation for Economic Co-operation and Development (OECD) to implement the Programme. Pursuant to Article 94 of Council Decision 2013/755/EU (20), persons and entities established in Overseas Countries and Territories (OCTs) are eligible for funding subject to the rules and objectives of the Programme and possible arrangements applicable to the Member State to which the relevant OCTs are linked.

Amendment 42

Proposal for a regulation

Recital 34 a (new)

Text proposed by the Commission Amendment (34 a) The programme should guarantee that there is strong involvement of civil society, in particular patients' associations, and academics, in particular healthcare professionals' societies, to ensure a balanced representation and participation in achieving public health goals. European health organisations should contribute to the implementation and the evaluation of the programme.

Amendment 43

Proposal for a regulation

Recital 34 b (new)

Text proposed by the Commission Amendment (34 b) To achieve a coherent implementation of the actions included in the Programme, a EU4Health Steering Group should be established.

Amendment 44

Proposal for a regulation

Recital 39 a (new)

Text proposed by the Commission Amendment (39a) According to the WHO, climate change affects the social and environmental determinants of health, including clean air, safe drinking water, sufficient food and secure shelter, and that 250 000 additional deaths, from malnutrition, malaria, diarrhoea and heat stress, are expected every year between 2030 and 2050, with extreme high air temperatures contributing directly to deaths particularly amongst the elderly and vulnerable individuals. Through flood, heatwaves, drought and fires, climate change has a considerable impact on human health, including under nutrition, cardiovascular and respiratory diseases, and vector-borne infections.

Amendment 45

Proposal for a regulation

Recital 40

Text proposed by the Commission Amendment (40) Reflecting the importance of tackling climate change in line with the Union's commitments to implement the Paris Agreement and the United Nations Sustainable Development Goals, this Programme will contribute to mainstream climate action in the Union's policies and to the achievement of an overall target of 25 % of the EU budget expenditures supporting climate objectives. Relevant actions will be identified during the Programme's preparation and implementation, and reassessed in the context of its mid-term evaluation. (40) Reflecting the importance of tackling climate change in line with the Union's commitments to implement the Paris Agreement and the United Nations Sustainable Development Goals, this Programme will contribute to mainstream climate action in the Union's policies and to the achievement of an overall target of 30 % of the EU budget expenditures supporting climate objectives. Relevant actions will be identified during the Programme's preparation and implementation, and reassessed in the context of its mid-term evaluation.

Amendment 46

Proposal for a regulation

Recital 40 a (new)

Text proposed by the Commission Amendment (40 a) Recognising the importance of achieving gender equality, this Programme should contribute to mainstream gender equality in the Union's policies. It should use gender mainstreaming and gender budgeting tools to ensure that health crises are responded to in a gender- sensitive and transformative manner and that women’s and girls’ specific health needs are addressed during and in the aftermath of a health crisis.

Amendment 47

Proposal for a regulation

Recital 43

Text proposed by the Commission Amendment (43) Given the nature and potential scale of cross-border threats to human health, the objective of protecting people in the Union from such threats and to increase crisis prevention and preparedness cannot be sufficiently achieved by the Member States acting alone. In accordance with the principle of subsidiarity as set out in Article 5 of the Treaty on the European Union, action at Union level can also be taken to support Member States’ efforts in the pursuit of a high level of protection of public health, to improve the availability and affordability in the Union of medicines, medical devices and other crisis relevant products, to support innovation and to support integrated and coordinated work and implementation of best practices among Member States, and to address inequalities in access to health throughout the EU in a manner that creates efficiency gains and value-added impacts that could not be generated by action taken at national level while respecting the Member States’ competence and responsibility in the areas covered by the Programme. In accordance with the principle of proportionality, as set out in that Article, this Regulation does not go beyond what is necessary in order to achieve those objectives. (43) Given the nature and potential scale of cross-border threats to human health, the objective of protecting people in the Union from such threats and to increase crisis prevention and preparedness cannot be sufficiently achieved by the Member States acting alone. In accordance with the principle of subsidiarity as set out in Article 5 of the Treaty on the European Union, action at Union level should also be taken to support Member States’ efforts in the pursuit of a high level of protection of public health, to improve the availability , sustainability, acceptability, accessibility, safety and affordability in the Union of medicines, medical devices and other health crisis relevant products and services , to support innovation and to support integrated and coordinated work and implementation of best practices among Member States and among their regions, , and to address inequalities and inequities in access to health throughout the EU in a manner that creates efficiency gains and value-added impacts that could not be generated by action taken at national level while respecting the Member States’ competence and responsibility in the areas covered by the Programme. In accordance with the principle of proportionality, as set out in that Article, this Regulation does not go beyond what is necessary in order to achieve those objectives.

Amendment 49

Proposal for a regulation

Article 2 — paragraph 1 — point 3

Text proposed by the Commission Amendment 3) ‘health crisis’ means any crisis or serious incident arising from a threat of human, animal, plant, food or environment origin, having a health dimension and which requires urgent action by authorities; (3) ‘health crisis’ means any crisis or serious incident arising from a threat of human, animal, plant, food, chemical, biological, radiological , nuclear , environmental or unknown origin, having a health dimension and which requires urgent action by authorities;

Amendment 50

Proposal for a regulation

Article 2 — paragraph 1 — point 4

Text proposed by the Commission Amendment (4) ‘crisis relevant products’ means products and substances necessary, in the context of a health crisis, to prevent, diagnose or treat a disease and its consequences, included but not limited to: medicinal products — including vaccines — and their intermediates, active pharmaceutical ingredients and raw materials; medical devices; hospital and medical equipment (such as ventilators, protective clothing and equipment, diagnostic materials and tools); personal protective equipment; disinfectants and their intermediary products and raw materials necessary for their production); (4) ‘crisis relevant products’ means products , tools and substances necessary, in the context of a health crisis, to prevent, diagnose or treat a disease and its consequences, and for the monitoring and the epidemiological surveillance of diseases and infections , including but not limited to: medicinal products — including vaccines — and their intermediates, active pharmaceutical ingredients and raw materials; medical devices; hospital and medical equipment (such as ventilators, protective clothing and equipment, diagnostic materials and tools); personal protective equipment; disinfectants and their intermediary products and raw materials necessary for their production);

Amendment 48

Proposal for a regulation

Article 2 — paragraph 1 — point 5

Text proposed by the Commission Amendment (5) ‘One Health approach’ means an approach which recognises that human and animal health are interconnected , that diseases may be transmitted from humans to animals and vice versa and must therefore be tackled in both, and that the environment links humans and animals ; (5) ‘One Health approach’ means an approach which recognises the interconnection between the human, animal and environmental spheres , that diseases may be transmitted from one pillar to another and must therefore be tackled in a holistic approach ;

Amendment 51

Proposal for a regulation

Article 2 — paragraph 1 — point 9

Text proposed by the Commission Amendment (9) ‘serious cross-border threat to health’ means a life- threatening or otherwise serious hazard to health of biological, chemical, environmental or unknown origin which spreads or entails a significant risk of spreading across the national borders of Member States, and which may necessitate coordination at Union level in order to ensure a high level of human health protection; (9) ‘serious cross-border threat to health’ means a life- threatening or otherwise serious hazard to health of biological, chemical, radiological, nuclear, environmental or unknown origin which spreads or entails a significant risk of spreading across the national borders of Member States, and which may necessitate coordination at Union level in order to ensure a high level of human health protection;

Amendment 52

Proposal for a regulation

Article 2 — paragraph 1 — point 9 a (new)

Text proposed by the Commission Amendment (9a) ‘ Health in all policies’ means an approach to the development, implementation and review of public policies, regardless of the sector, whereby the health implications of decisions are taken into account, and which seeks to achieve synergies, and to avoid harmful health impacts being caused by such policies, in order to improve the health of the population and health equity;

Amendment 53

Proposal for a regulation

Article 2 — paragraph 1– point 9 b (new)

Text proposed by the Commission Amendment (9b) ‘Health determinants’ means a range of factors, such as behaviour- related, biological, socio-economic and environmental factors, that influence the health status of a person;

Amendment 54

Proposal for a regulation

Article 3 — paragraph 1 — introductory part

Text proposed by the Commission Amendment The Programme shall pursue the following general objectives, in keeping with the ‘One Health’ approach where relevant: The Programme shall pursue the following general objectives, in keeping with the ‘Health in all policies’ approach where applicable , and with the ‘One Health’ approach:

Amendment 55

Proposal for a regulation

Article 3 — paragraph 1 — point 1

Text proposed by the Commission Amendment 1) protect people in the Union from serious cross-border threats to health; (1) improve and foster health in the Union , by supporting health promotion and disease prevention, reducing health inequalities and ensuring equal and full access to health;

Amendment 56

Proposal for a regulation

Article 3 — paragraph 1 — point 1 a (new)

Text proposed by the Commission Amendment (1a) protect people in the Union from any serious cross-border threats to health; support the development and implementation of better preparedness and coordination within and between Member States as regards health emergencies;

Amendment 57

Proposal for a regulation

Article 3 — paragraph 1 — point 2

Text proposed by the Commission Amendment (2) improve the availability in the Union of medicines, medical devices and other crisis relevant products, contribute to their affordability, and support innovation; (2) supporting existing and future Union legislation and policies, in order to, inter alia, restore pharmaceutical independence and address shortages, improve the availability , accessibility and affordability of health care and services in the Union , and support research and innovation as well as development in health and healthcare without duplicating efforts under other programmes, including Horizon Europe ;

Amendment 58

Proposal for a regulation

Article 3 — paragraph 1 — point 3

Text proposed by the Commission Amendment (3) strengthen health systems and the healthcare workforce, including by digital transformation and by increased integrated and coordinated work among the Member States, sustained implementation of best practice and data sharing, to increase the general level of public health. (3) strengthen health systems and their sustainability, as well as the healthcare workforce, including by digital transformation and by increased integrated and coordinated work among the Member States, including at national, regional and local level, by sustained implementation of best practices, and by sharing of comparable and interoperable data, with the aim of increasing the general level of public health , health literacy and make health systems more resilient and responsive .

Amendment 59

Proposal for a regulation

Article 4 — paragraph 1 — introductory part

Text proposed by the Commission Amendment The general objectives referred to in Article 3 shall be pursued through the following specific objectives, in keeping with the ‘One Health’ approach where relevant: The general objectives referred to in Article 3 shall be pursued through the following specific objectives, in keeping with the ‘Health in all policies’ approach where applicable , and with the ‘One Health’ approach:

Amendment 226

Proposal for a regulation

Article 4 — paragraph 1 — point 1

Text proposed by the Commission Amendment (1) strengthen the capability of the Union for prevention, preparedness and response to serious cross-border threats to health, and the management of health crises, including through coordination, provision and deployment of emergency health care capacity, data gathering and surveillance; (1) strengthen the capability of the Union for prevention, preparedness and rapid response to serious cross-border threats to health, and the management of health crises, including through coordination, provision and deployment of emergency health care capacity, data gathering and surveillance , the coordination of stress testing of national healthcare systems and the development of quality healthcare standards ;

Amendment 250

Proposal for a regulation

Article 4 — paragraph 1 — point 2

Text proposed by the Commission Amendment (2) ensure the availability in the Union of reserves or stockpiles of crisis relevant products, and a reserve of medical, healthcare and support staff to be mobilised in case of a crisis; (2) In synergy with other Union instruments, programmes and funds, support actions to allow medical, healthcare and support staff to be mobilised in case of a crisis , such as staff of the European Medical Corps, including by improving the staff's training and updating their knowledge, and support action to contribute to the availability in the Union, during a crisis, of health crisis relevant products such as essential medicines, vaccines and medical devices ;

Amendment 62

Proposal for a regulation

Article 4 — paragraph 1 — point 3

Text proposed by the Commission Amendment (3) support actions to ensure appropriate availability, accessibility and affordability of crisis relevant products and other necessary health supplies; (3) strengthen the European Medicines Market, to ensure in a sustainable manner the availability, accessibility and affordability of medicinal products , e-health solutions, medical devices and other necessary health related supplies and crisis relevant medical products ;

Amendment 222

Proposal for a regulation

Article 4 — paragraph 1 — point 4

Text proposed by the Commission Amendment (4) strengthen the effectiveness, accessibility, sustainability and resilience of health systems, including by supporting digital transformation, the uptake of digital tools and services, systemic reforms, implementation of new care models and universal health coverage, and address inequalities in health; (4) strengthen the effectiveness, accessibility, sustainability and resilience of health systems, including by supporting digital transformation, including the creation and implementation of a European Health Data Space systemic reforms, implementation of new care models , enhance the equal and timely access to quality, sustainable, affordable, person-centred, outcome-based healthcare and related care services, the achievement of universal health coverage, encompassing access to sexual and reproductive health and rights, and reduce inequalities and inequities in health;

Amendment 64

Proposal for a regulation

Article 4 — paragraph 1 — point 4 a (new)

Text proposed by the Commission Amendment (4a) strengthen the Union’s innovation to ensure the development and uptake of the next generation of medicines, vaccines and medical devices to meet increasing healthcare challenges and expectations that arise;

Amendment 65

Proposal for a regulation

Article 4 — paragraph 1 — point 5

Text proposed by the Commission Amendment (5) support actions aimed at strengthening health system’s ability to foster disease prevention and health promotion, patient rights and cross-border healthcare , and promote the excellence of medical and healthcare professionals ; (5) support actions aimed at strengthening health system’s ability to foster disease prevention , screening and early diagnosis, and implement health promotion , address health determinants, improve health literacy , patient rights and safety and cross-border healthcare;

Amendment 245

Proposal for a regulation

Article 4 — paragraph 1 — point 6

Text proposed by the Commission Amendment (6) support action for the surveillance, prevention, diagnosis and treatment and care of non-communicable diseases, and notably of cancer; (6) support action for the surveillance, prevention, diagnosis and treatment and care of non-communicable diseases, the early diagnosis of neurodegenerative disorders and other brain diseases, and notably of cancer;

Amendment 66

Proposal for a regulation

Article 4 — paragraph 1 — point 6 a (new)

Text proposed by the Commission Amendment (6a) strengthen the Union fight against cancer in synergy with the Europe’s Beating Cancer Plan, including by supporting actions for the surveillance, prevention, early diagnosis and treatment and care of cancer, including paediatric cancer, and by supporting the establishment of the European Cancer Institute;

Amendment 67

Proposal for a regulation

Article 4 — paragraph 1 — point 6 b (new)

Text proposed by the Commission Amendment (6b) strengthen the fight against communicable diseases and health threats;

Amendment 68

Proposal for a regulation

Article 4 — paragraph 1 — point 6 c (new)

Text proposed by the Commission Amendment (6c) address vaccine hesitancy, and support action for the elimination of vaccine preventable diseases, including cancers;

Amendment 69

Proposal for a regulation

Article 4 — paragraph 1 — point 7

Text proposed by the Commission Amendment (7) foster and support the prudent and efficient use of medicines, and in particular of antimicrobials, and more environmentally friendly production and disposal of medicines and medical devices; (7) foster and support the informed, prudent and efficient use of medicines, and in particular of antimicrobials, the development of medicines that are intrinsically less harmful for the environment, more environmentally friendly production of medicines and environmentally sound disposal of medicinal products and medical devices;

Amendment 70

Proposal for a regulation

Article 4 — paragraph 1 — point 8

Text proposed by the Commission Amendment (8) support the development, implementation and enforcement of Union health legislation and provide high-quality, comparable and reliable data to underpin policy making and monitoring, and promote the use of health impact assessments of relevant policies; (8) support the development, implementation and enforcement and, when necessary, the revision, of Union health legislation, and provide high-quality, comparable, and reliable, data to underpin policy making and monitoring , support the delivery of care and respond to unmet medical needs , and promote the use of health impact assessments of other relevant Union policies;

Amendments 246 and 71

Proposal for a regulation

Article 4 — paragraph 1 — point 9

Text proposed by the Commission Amendment (9) support integrated work among Member States, and in particular their health systems, including the implementation of high-impact prevention practices, and scaling up networking through the European Reference Networks and other transnational networks; (9) support integrated work among Member States, and in particular their health systems, including the implementation of high-impact prevention practices, support the identification of health technologies that are required to undergo a Union assessment, and strengthening and scaling up networking through the ERNs, develop and implement excellence networks for high prevalence communicable and non-communicable diseases and other transnational networks , including the Orphanet network, in full synergy with Horizon Europe and its Missions and Partnerships, and aim to to increase the coverage of patients and the response to diseases, and health problems, in greater numbers ;

Amendment 223

Proposal for a regulation

Article 4 — paragraph 1 — point 10

Text proposed by the Commission Amendment (10) support the Union’s contribution to international and global health initiatives. (10) support the Union’s contribution to international and global health commitments and initiatives , including access to sexual and reproductive health and rights .

Amendment 73

Proposal for a regulation

Article 5 — paragraph 1

Text proposed by the Commission Amendment 1. The financial envelope for the implementation of the Programme for the period 2021-27 shall be EUR 1 946 614 000 in current prices. 1. The financial envelope for the implementation of the Programme for the period 2021-27 shall be EUR 10 398 000 000 in current prices (EUR 9 370 000 000 in constant prices) .

Amendment 74

Proposal for a regulation

Article 5 — paragraph 2

Text proposed by the Commission Amendment 2. The amount referred to in paragraph 1 may be used for technical and administrative assistance for the implementation of the Programme, such as preparatory, monitoring, control, audit and evaluation activities including corporate information technology systems. 2. The amount referred to in paragraph 1 may be also used for technical and administrative assistance for the implementation of the Programme, such as preparatory, monitoring, control, audit and evaluation activities including corporate information technology systems. The administrative expenses related to indirect actions shall not exceed 5 % of the total amount under the Programme.

Amendment 75

Proposal for a regulation

Article 6

Text proposed by the Commission Amendment Article 6 deleted Resources from the European Union Recovery Instrument Measures referred to in Article 2 of Regulation [European Union Recovery Instrument] shall be implemented under the Programme through an amount of up to EUR 8 451 000 000 in current prices referred to in point (iii) of Article 3(2)(a) of that Regulation, subject to its Article 5(4) and (8). These amounts shall constitute external assigned revenue in accordance with Article 21(5) of Regulation (EU, Euratom) 2018/1046.

Amendment 76

Proposal for a regulation

Article 7 — paragraph 1 — point 1 a (new)

Text proposed by the Commission Amendment (1 a) The contributions of all associated countries shall be included in the relevant parts of the Programme. The Commission shall report to the Council and the Parliament during the annual budgetary procedure the total budget of each part of the Programme, identifying each of the associated countries, individual contributions and their financial balance.

Amendment 77

Proposal for a regulation

Article 8 — paragraph 1

Text proposed by the Commission Amendment 1. The Programme shall be implemented in direct management in accordance with Regulation (EU, Euratom) 2018/1046 or in indirect management with the bodies referred to in Article 62(1) (c) of Regulation (EU, Euratom) 2018/1046. 1. The Programme shall be implemented in direct management in accordance with Regulation (EU, Euratom) 2018/1046 or in indirect management with the bodies referred to in Article 62(1) (c) of Regulation (EU, Euratom) 2018/1046 , to ensure there is no overlap or duplication with other funding programmes at the Union level .

Amendment 78

Proposal for a regulation

Article 8 — paragraph 2

Text proposed by the Commission Amendment 2. The Programme may provide funding in any of the forms laid down in Regulation (EU, Euratom) 2018/1046, in particular grants, prizes and procurement. 2. The Programme may provide funding in any of the forms laid down in Regulation (EU, Euratom) 2018/1046, in particular grants, prizes and procurement. The Commission shall seek to achieve effective and balanced geographical coverage across the Union, including by supporting Member States to increase the quality of the projects through capacity building.

Amendment 79

Proposal for a regulation

Article 8 — paragraph 4 a (new)

Text proposed by the Commission Amendment 4 a. The Commission shall facilitate the consistent implementation of the Programme while seeking maximal administrative simplification. The Commission and the Member States shall, commensurate to their respective responsibilities, foster synergies and ensure effective coordination between the Programme and the other Union programmes and funds. For that purpose, they shall: (a) ensure that there is complementarity, synergy, coherence and consistency among different instruments at Union, national and, where appropriate, regional levels, in particular in relation to measures financed by Union funds, both in the planning phase and during implementation; (b) optimise coordination mechanisms to avoid duplication of effort; (c) ensure that close cooperation exists between those responsible for implementation at Union, national and, where appropriate, regional levels to deliver coherent and streamlined support actions under the instrument.

Amendment 80

Proposal for a regulation

Article 8 — paragraph 4 b (new)

Text proposed by the Commission Amendment 4b. The Commission shall develop cooperation with relevant international organisations such as the United Nations and its specialised agencies, in particular the World Health Organisation (WHO), as well as with the Council of Europe and the Organisation for Economic Co-operation and Development (OECD) when implementing the Programme, in order to maximise the effectiveness and efficiency of actions at Union and international level.

Amendment 81

Proposal for a regulation

Article 8 — paragraph 4 c (new)

Text proposed by the Commission Amendment 4c. The Commission shall consult the health authorities of the Member States in the Steering Group on Health Promotion, Disease Prevention and Management of Non-Communicable Diseases or in other relevant Commission expert groups as well as stakeholders, in particular professional bodies in the health sector and NGOs active in the field, at all stages of the implementation of the Programme .

Amendment 82

Proposal for a regulation

Article 9 a (new)

Text proposed by the Commission Amendment Article 9a Award criteria The award criteria shall be defined in the work programmes referred to in Article 18 and in the calls for proposals taking into account, to the extent applicable, the following elements: (a) consistency with the specific objectives provided for in Article 4; (b) contribution to the accessibility and affordability of the health system; (c) cross-border dimension; (d) contribution to digital transformation; (e) social impact (benefits and costs); (f) consistency with the provisions of Annex 1; (g) contribution to the prevention of diseases and notably of cancer; (h) contribution to access to medicine; (i) maturity of the action in the project development; (j) soundness of the implementation plan proposed.

Amendment 83

Proposal for a regulation

Article 12 — paragraph 3 a (new)

Text proposed by the Commission Amendment A reliable and efficient mechanism shall be created in order to avoid any duplication of funding and to ensure synergies between the different Union programmes and policies that are pursuing health objectives. All data on funding operations and actions financed under different Union programmes and funds shall be centralised under this mechanism. It shall follow the principles of transparency and accountability and shall allow better monitoring and evaluation of actions pursuing health objectives.

Amendment 84

Proposal for a regulation

Article 14 — paragraph 1 — point b

Text proposed by the Commission Amendment (b) any legal entity created under Union law or any international organisation; (b) any legal entity created under Union law or any relevant international organisation such as public authorities, public sector bodies, health establishments, research institutes, universities and higher education establishments, patient associations ;

Amendment 85

Proposal for a regulation

Article 14 — paragraph 3

Text proposed by the Commission Amendment 3. Legal entities established in a third country which is not associated to the Programme should in principle bear the cost of their participation. 3. Legal entities established in a third country which is not associated to the Programme should bear the cost of their participation.

Amendment 86

Proposal for a regulation

Article 14 — paragraph 5

Text proposed by the Commission Amendment 5. Under the Programme, direct grants may be awarded without a call for proposals to fund actions having a clear Union added value co-financed by the competent authorities that are responsible for health in the Member States or in the third countries associated to the Programme, relevant international health organisations or by public sector bodies and non-governmental bodies, acting individually or as a network, mandated by those competent authorities. 5. Under the Programme, direct grants may be awarded without a call for proposals to fund actions if such grants are duly justified, if they have a clear Union added value co-financed by the local, regional or national competent authorities that are responsible for health in the Member States or in the third countries associated to the Programme, relevant international health organisations or by Interreg programmes, public sector bodies and non-governmental bodies, acting individually or as a network, mandated by those competent authorities.

Amendment 87

Proposal for a regulation

Article 14 — paragraph 6

Text proposed by the Commission Amendment 6. Under the Programme, direct grants may be awarded without a call for proposals to European Reference Networks . Direct grants may also be awarded to other transnational networks set out in accordance with EU rules . 6. Under the Programme, direct grants shall be awarded without a call for proposals to ERNs with a simplified financial and technical reporting system . Direct grants may also be awarded to other transnational networks, including to Interreg programmes, set out in accordance with Union law .

Amendment 88

Proposal for a regulation

Article 14 — paragraph 6 a (new)

Text proposed by the Commission Amendment 6a. Adequate funding shall be ensured to consolidate and expand the ERN model of cross-border healthcare by securing the provision of a range of clinical services through different channels, including online second opinions and specialist advice for patients on treatment and management and ‘online out-patient’ clinics.

Amendment 89

Proposal for a regulation

Article 16 — paragraph 1

Text proposed by the Commission Amendment The Commission shall consult the health authorities of the Member States in the Steering Group on Health Promotion, Disease Prevention and Management of Non-Communicable Diseases on the work plans established for the Programme and its priorities and strategic orientations and its implementation. The Commission shall consult the health authorities of the Member States in the Steering Group on Health Promotion, Disease Prevention and Management of Non-Communicable Diseases on the annual work plans established for the Programme and its priorities and strategic orientations and its implementation and on possible synergies with Member States’ own resources to ensure long-term effectiveness and sustainability of actions.

Amendment 90

Proposal for a regulation

Article 16 — paragraph 1 a (new)

Text proposed by the Commission Amendment The Commission shall consult the EU4Health Steering Group on the annual work plans established for the Programme and on the Programme’s priorities, strategic orientations and implementation, and on possible synergies with European funds to ensure the long-term effectiveness and sustainability of actions.

Amendment 91

Proposal for a regulation

Article 16 — paragraph 1 b (new)

Text proposed by the Commission Amendment The Commission shall also consult relevant Union decentralised agencies and stakeholders, such as representatives of civil society organisations, in particular patients’ organisations, on the annual work plans established for the Programme and the Programme’s priorities, strategic orientations and implementation.

Amendment 92

Proposal for a regulation

Article 16 — paragraph 1 c (new)

Text proposed by the Commission Amendment The Commission shall adopt the annual work plans by means of delegated acts. Those delegated acts shall be adopted in accordance with Article 24 of this Regulation.

Amendment 93

Proposal for a regulation

Article 16 a (new)

Text proposed by the Commission Amendment Article 16 a Establishment of EU4Health Steering Group 1. The Commission shall establish a EU4Health Steering Group (‘the Steering Group’). 2. The Steering Group shall: (i) provide input, in the form of a comprehensive strategy and steering, and contribute to the annual work plans for the Programme; (ii) elaborate a blueprint for steering coordination, cooperation and synergies between the Programme and other Programmes in which a health dimension is integrated; (iii) provide value-oriented health actions, sustainability, better health solutions, foster access to health and reduce health inequalities, promote engagement by patients and society. 3. The Steering Group shall be an independent stakeholder group, composed of actors in the field of public health, such as representatives of the European Parliament, independent health experts and patient representatives. 4. The Steering Group shall be composed of 20 high-level individuals respecting the principle of geographical and gender balance, drawn from various disciplines and activities referred to in paragraph 3. 5. The members of the Steering Board shall be appointed by the Commission in consultation with the Parliament, following an open call for nominations or for expression of interest. The members shall be appointed for the period referred to in Article 1(2). The Commission shall also appoint a Chair from among its members. 6. The Steering Group shall meet at least three times a year, which allows regular and transparent exchanges of views. The blueprint for steering coordination, cooperation and synergies shall facilitate ensuring visibility and coordination of all the existing financial mechanisms relevant to health, and shall help to steer coordination and cooperation. The Commission may consult the Steering Group on matters other than those referred to in paragraph 2.

Amendment 94

Proposal for a regulation

Article 18 — paragraph 1

Text proposed by the Commission Amendment The Programme shall be implemented by work programmes referred to in Article 110 of Regulation (EU, Euratom) 2018/1046. Work programmes shall set out, where applicable, the overall amount reserved for blending operations. The Programme shall be implemented by annual work programmes referred to in Article 110 of Regulation (EU, Euratom) 2018/1046. Work programmes shall set out, where applicable, the overall amount reserved for blending operations.

Amendment 95

Proposal for a regulation

Article 18 — paragraph 1 a (new)

Text proposed by the Commission Amendment The work programmes shall be informed by a gender impact assessment.

Amendment 96

Proposal for a regulation

Article 19 — paragraph 1

Text proposed by the Commission Amendment 1. Indicators to report on progress of the Programme towards the achievement of the general and specific objectives set out in Articles 3 and 4 are set out in Annex II. 1. Indicators , including programme- and action-specific indicators, to report on progress of the Programme towards the achievement of the general and specific objectives set out in Articles 3 and 4 are set out in Annex II.

Amendment 97

Proposal for a regulation

Article 19 — paragraph 1 a (new)

Text proposed by the Commission Amendment 1 a. The Commission shall monitor continuously the management and implementation of the Programme. In order to enhance transparency, the constantly updated data on the management and implementation shall be made publicly available in an accessible manner on the Commission's website. In particular, data for projects funded shall be included in the same database. Those data shall include: (a) information on the types of financing and the types of beneficiaries, that allows for a transparent tracking of the financial allocations; a detailed overview of the synergies with other Union programmes, including the activities implemented by Union agencies, that allows for a proper analysis of the complementarity between different activities to be carried out. (b) the levels of expenditure disaggregated at project level in order to allow for specific analysis, including per intervention area as defined in Article 13 and Annex I.

Amendment 98

Proposal for a regulation

Article 19 — paragraph 2

Text proposed by the Commission Amendment 2. The Commission is empowered to adopt delegated acts in accordance with Article 24 concerning amendments to Annex II to amend and supplement the indicators where considered necessary. 2. The Commission is empowered to adopt delegated acts in accordance with Article 24 concerning amendments to Annex II to amend and supplement the indicators , including programme- and action-specific ones, where considered necessary.

Amendment 99

Proposal for a regulation

Article 19 — paragraph 2 a (new)

Text proposed by the Commission Amendment 2 a. Indicators shall be collected, where relevant, dissagregated by gender.

Amendment 100

Proposal for a regulation

Article 19 — paragraph 3

Text proposed by the Commission Amendment 3. The performance reporting system shall ensure that data for monitoring programme implementation and results are collected efficiently, effectively, and in a timely manner. To that end, proportionate reporting requirements shall be imposed on recipients of Union funds and, where relevant, on Member States. 3. The performance reporting system shall ensure that data for monitoring programme implementation and results are collected efficiently, effectively, and in a timely manner without increasing the administrative burden for beneficiaries . To that end, proportionate reporting requirements shall be imposed on recipients of Union funds and, where relevant, on Member States.

Amendment 101

Proposal for a regulation

Article 20 — paragraph 4

Text proposed by the Commission Amendment 4. The Commission shall communicate the conclusions of the evaluations accompanied by its observations, to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions. 4. The Commission shall publish, communicate and present the conclusions of both the interim and final evaluations accompanied by its o