Interim report from the Commission to the European Parliament, the Council, the Economic and Social Committee and the Committee of the Regions on the implementation of the programmes of Community action on the prevention of cancer, AIDS and certain other communicable diseases, and drug dependence within the framework for action in the field of public health (1996-2000) (Decisions No 646/96/EC, 647/96/EC and 102/97/EC of the European Parliament and of the Council)
Date: 1999-10-14
Institutions: European Commission
Subjects: AIDS, EU programme, cancer, disease prevention, infectious disease

EN

COMMISSION OF THE EUROPEAN COMMUNITIES

Brussels, 14.10.1999
COM(1999) 463 final

INTERIM REPORT FROM THE COMMISSION TO THE EUROPEAN
PARLIAMENT, THE COUNCIL, THE ECONOMIC AND SOCIAL COMMITTEE
AND THE COMMITTEE OF THE REGIONS

on the implementation of the programmes of Community action on the prevention of
cancer, AIDS and certain other communicable diseases, and drug dependence within the
framework for action in the field of public health (1996-2000) (Decisions N°646/96/EC,
647/96/EC and 102/97/EC of the European Parliament and of the Council)

TABLE OF CONTENTS

Introduction...................................................................................................................... 3

Consistency and complementarity .................................................................................... 3

Effectiveness and the achievement of objectives............................................................... 3

Monitoring ....................................................................................................................... 4

Adjustments ..................................................................................................................... 4

Excerpt from the experts’ report on the three programmes................................................ 5

The cancer programme........................................................................................... 5

The AIDS and communicable diseases programme ................................................ 6

The drugs programme ............................................................................................ 8

The management of the programmes...................................................................... 9

Links with Member States policies and programmes ............................................ 10

Budget............................................................................................................................ 11

2

Introduction

Following the adoption of three programmes of Community action for prevention of cancer,
AIDS and other communicable diseases, and drug dependence by the European Parliament
and the Council, the Commission presents hereunder an interim report concerning mainly the
implementation period 1996 and 1997. The inclusion of the first half of the budgetary period
1998 has been avoided as it would have unduly delayed a timely presentation of this report.

In this report, the Commission highlights the degree of consistency and complementarity
reached between these plans and the other relevant Community policies, programmes and
initiatives and to increase the value and impact of the three plans, has performed an evaluation
of the actions undertaken. On the latter point, particular regard has been given to effectiveness
and the achievement of the objectives of the measures undertaken. For this purpose, the
Commission has drawn on the opinions of a group of external experts, and from
representatives of the Member States serving on the three management committees. The
Commission also reports on the adjustments which are deemed necessary as a consequence of
the information gathered.

Consistency and complementarity

The Commission sought consistency and complementarity between its public health and other
Community policies, programmes and initiatives by a multitude of efforts on different
operational levels, in particular:

technological
The implementation of
development and demonstration (1994 – 1998) of the European Communities was closely
followed by means of the inter-service consultations on publications of calls for proposals and
on adoption of projects for financing.

the 4th Framework programme

research,

for

The preparation of the 5th Framework programme for research, technological development
and demonstration (1998 – 2002) of the European Union was actively followed by means of
the inter-service consultations on the draft proposal, and consultations on project proposals, in
order to ensure consistency and complementarity.

Further, officials of the public health directorate were invited to all meetings of the
programme committees for the specific research programmes; likewise, officials from the
research directorates were invited to the meetings of the public health programme committees.

In the course of the implementation of the programmes, applicants seemed also to have better
understood the difference between health and health services research as foreseen under the
framework programmes for research and the preventive measures for cancer, AIDS and other
communicable diseases, and drug dependence covered under the relevant action plans.

Effectiveness and the achievement of objectives

Given the kind of objectives laid down in the three action plans, the actual coverage by
specific actions following the first calls for proposals within the period of 1996 and 1997
were generally quite sufficient. A balance between the various areas of each programme was

3

made easier by the adoption of annual work programmes allowing proposals for projects to be
invited in areas not yet sufficiently covered. There was one reservation that initially the
European added value of projects was in many instances under developed, but stress has been
placed on the development of network projects in order to resolve this shortcoming.

To ensure subsidiarity, the opinion of Member States was invited through the programme
committees as laid down in the specific action programmes. Thus, the necessary support of
Member States for implementation of the actions selected in their countries was encouraged.
At the same time, the programme committees guaranteed the required transparency of the
European Commission’s actions towards the Member States. The transparency towards the
European Parliament was ensured by the prior transmission to that Institution of reports and
documents intended for each of the programme Committees as well as an annual list of
projects financed.

To ensure the highest possible standards for the quality of the actions selected, each
committee not only gave a favourable opinion on the annual work plans, but was also
consulted on the preparation of the calls for proposals, the selection of projects and the
follow-up of their implementation. In addition, for the Cancer Programme, the Commission
has formalised the existence of an Advisory Committee for Cancer prevention, formerly
known as the High Level Cancer Experts Committee, composed of independent scientific
experts who provide opinions to the Commission on projects to be financed and on cancer
prevention issues in general.

Monitoring

Monitoring of the specific actions has been performed mainly through a continuous follow-up
by the Commission Services of the contractual obligations of the projects financed.

Adjustments

To improve the European added value as an important general objective, the Commission
Services have embarked on a strategy to ask for enhanced networking of applicants to ensure
better cross-border co-operation, e.g., as a means of dissemination of best practice in Europe.

To cover areas of Community interest, which were not covered by specific actions selected to
date, following a thorough analysis of the active portfolio, the Commission adapted each
annual work plan respectively. In turn, the annual work plans aided in establishing priorities
for the next calls for proposals as well as in the selection of the newly proposed actions.

For the Cancer Programme, a document was agreed by the management committee and
adopted by the Commission concerning simplification of procedures.

4

To further improve transparency and simplify dissemination at the same time annual reports
have been produced for 19961 and 19972 by the Commission’s Services jointly for the three
programmes, which give a comprehensive picture of the work of the respective unit of the
Commission’s services.

Following external suggestions and internal review of shortcomings the linkages between the
three programmes and other public health programmes have been improved.

Excerpt from the experts’ report on the three programmes

Finally, excerpts from the findings of a group of independent experts who, under contract to
the Commission, analysed each individual programme, are presented below:

THE CANCER PROGRAMME

With few exceptions,
the projects have been evaluated as appropriate or very
appropriate and relevant in relation to the objectives of the programme. Mostly, they
properly address the various actions in terms of aims, specific objectives, design and
achievements. However, in some cases such as health education projects, the targets
and methods are quite often badly specified.

Nevertheless, the projects in general appear to be competently implemented and
managed. In addition,
the timing of outputs in comparison with the proposed
schedule has generally been maintained, with some exceptions.

the dissemination of results has basically followed quite traditional
However,
pathways, such as scientific conferences and publications within scientific journals.
Although these means of dissemination are certainly appropriate,
they are
undoubtedly not sufficient to ensure involvement of the general public or even of a
majority of health professionals.

Positive results of note include:

– The expansion and development of European networks, especially in the fields of:
nutrition and cancer (mainly through the EPIC project), breast and cervical cancer
screening, fight against tobacco and cancer registration;

– The production and diffusion of consensus documents, guidelines, appropriate
software for increasing comparability and uniform quality of data registration and
anti-cancer activities over Europe;

1

2

Directorate Public Health and Safety at Work, Unit V/F/2, Implementation of action programmes
targeted on diseases, Annual report 1996, Implementation of the actions: - Europe against cancer -, -
AIDS and other communicable diseases -, - drug addiction prevention -, Internal document CE-V/3-97-
002-EN-C.
Directorate Public Health and Safety at Work, Unit V/F/2, Implementation of action programmes
targeted on diseases, Annual report 1997, Implementation of the programmes - Europe against cancer, -
AIDS and other communicable diseases, - Drug addiction prevention, Internal document CE-V/3-98-
009-EN-C.

5

– The implementation of prevention and early detection programmes of appropriate

quality in European areas previously uncovered or with little coverage; and,

– The diffusion of quality control practices in the fields of data registration and
cancer health services, according to common criteria and aiming to obtain a more
uniform quality of these activities across Europe.

However, a greater amount of innovation would be welcome, especially in some
actions. For example, more innovation is recommended in the fields of health
education techniques;
for health
professionals; application of new techniques for improving the performance and the
effectiveness of public health programmes such as in breast and cervical cancer
screening, of screening for cancers other than breast and cervix, and of methods for
quitting smoking in high risk groups.

teaching methods

tobacco;

against

fight

In general, from a review of the reports it is clear that all the listed projects greatly
benefited and indeed were often made possible by the financial support of the Europe
Against Cancer programme. For many of them, the Community financial support
allowed a high intensity of inter-country exchanges, the agreement on methods, the
achievement of a uniform quality and the production of common documents and
statements.

It is quite remarkable that in no case do the projects’ activities, given the programme
framework, appear to conflict or even overlap with national programmes. On the
contrary, some project documents claim synergy and beneficial effects on national
health activities. However, the relation with other agencies active in the field is not
always clear. For some clusters and actions, it was difficult to evaluate if there is an
overlap with other activities supported by the European Community, such as
BIOMED.

in terms of European added value,

the evaluation identified some
Finally,
contributions and some room for improvement. A significant majority of the projects
is multinational. The tendency to finance multinational projects should be maintained
and encouraged. However, multi-nationality does not automatically guarantee an
acceptable level of European added value, for which a rigorous methodology, a
sufficient degree of innovation and a good dissemination of results are also needed.
These features characterise many, but not all the projects and actions.

THE AIDS AND COMMUNICABLE DISEASES PROGRAMME

With few exceptions, the projects have been evaluated as appropriate and relevant in
relation with the objectives of the programme. In general, these projects delivered a
range of effective and appropriate studies and interventions. Unfortunately, action 10
was not addressed by any project in 1996 and 1997 (Member States vaccination
policies and programmes).

Funded projects provided a mix of innovative approaches and expansion of pre-
existing effective projects. In general, these properly address the various actions in
terms of aims, specific objectives, design and achievements. In a few cases, such as
the EchinoEuroReg project (about echinococcosis), activities do not really fit into the

6

annual priorities defined for the programme, but this relates to only a very small part
of the cluster’s budget.

Populations targeted by the projects were generally appropriate. However, sometimes
projects excluded high priority sub-populations, which should be redressed in the
future. For example, greater attention within the cluster on combating transmission of
AIDS should be allocated to projects targeting the range of men who have sex with
men, and also to intravenous drug users whether or not they are ‘marginalised young
people’.

Projects were usually well managed, and resources used cost-effectively.

the
The results from a number of projects are quite impressive. Many of
multinational networks supported by the programme seem at first sight to be a cost-
effective way of creating Community added value. However, the project reports of
the networks quite often fail to give a convincing picture of actual capacity to gather
expertise and experience from all the Member States and from all the relevant
agencies in the Member States, as well as to disseminate information provided by
these networks.

It will be important
to pay substantially greater attention to the issue of
discrimination, which is seldom dealt with adequately in the projects, and which
should be integrated into the framework of the response at all levels to AIDS,
sexually transmitted and other communicable diseases.

Positive results of note include:

– Improvement of the co-ordination of communicable disease surveillance systems
and the co-ordination of the Community response, with initial efforts focused on
HIV/AIDS, tuberculosis, drug resistance;

– The regular production of the monthly bulletin ‘Eurosurveillance’ and a weekly

electronic bulletin.

– Building of a network (EARSS), standardisation and validation of antibiotic

resistance susceptibility testing and reporting;

– Creation and development of a European network for HIV/STD (Sexually
transmitted diseases) prevention for prostitutes resulting from the merging of two
existing networks: EUROPAP and TAMPEP;

– Analysis of border issues with regard to HIV/AIDS, STDs and development of

co-operative, border crossing methods of prevention;

– Maintenance and enhancement of the European network on HIV/AIDS and
hepatitis prevention in prisons; expansion and further development of
the
European public policy network on HIV/ AIDS (EPPNA); creation of a European
AIDS and enterprise network (EAEN);

– Creation of two European centres for AIDS prevention, information and education

(addressing youth and mobility respectively).

Some critical issues were identified, in particular:

7

– Dissemination of results often occurs only through traditional pathways, such as
scientific conferences and publication within scientific journals. These approaches
need to be enhanced to ensure that a much wider audience is aware of the results
and conclusions of funded projects;

– Vaccination policies and programmes with respect to HIV/AIDS are assuming
greater significance, and projects investigating this area should be encouraged in
the future.

For many projects, Community financial support allowed a high intensity of inter-
country exchanges, agreement on methods,
the achievement of a uniform and
enhanced quality, and the production of common documents and statements. In most
cases, projects appeared to clearly demonstrate synergism with national actions.

The assessment in terms of European added value is quite complex. However, the
project results in the majority of cases have significant practical relevance, and
theoretically, should better inform the HIV/STD policy framework and the design
and delivery of programmes in the Member States. At present, there is only limited
evidence that project results are actually being disseminated widely and influencing
key policy-makers regarding future direction on HIV/STD issues within the Member
States and in the European Community as a whole.

THE DRUGS PROGRAMME

Implementation of most of the actions of the programme commenced during the first
two years of the 5-year programme. However, much remains to be achieved in areas
such as: relapse prevention and rehabilitation; evaluating the effectiveness of
information and health education campaigns; tools with polysubstance dependence;
the extension of European network of ‘test towns’ and promoting initiatives to
improve the drug prevention aspect of vocational training of teachers; and, health and
social care professions and other professionals responsible for young people.

Much also depends on the follow up of the projects and on opportunities for the
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and other
European institutions to disseminate results, because dissemination by the project
contractors often remains quite restricted. In the same vein, funding of European
networks in the field of public health action related to drug dependence should be a
priority, with the aim of disseminating project results.

There are quite impressive results from a number of projects. Many of the
multinational networks and teams supported by the programme seem to be a quite
cost-effective way of creating Community added value. However, the project reports
of the networks quite often fail in giving a convincing picture of their actual capacity
to gather expertise and experience from all the Member States and from all the
relevant agencies in the Member States, as well as to disseminate information when
provided through these networks. A positive development is the number of networks
that have proceeded in providing electronic information channels such as websites,
electronic databases and other uses of the Internet.

The projects funded seem to emphasise approaches targeted directly to individuals,
contrasted with a lack of projects with a broader public policy approach towards

8

public health problems related to drugs. Such projects would be needed to increase
the impact of the larger public policy context on the drug
knowledge about
phenomenon and on the feasibility of specific intervention models in different public
policy contexts.

As there are large political debates, both at international and European level as well
as at national and municipal level, on future public policy strategies with regard to
drug problems, there is a great need for research-based evidence to help policy
makers to choose between different strategic alternatives.

The linkages between the programme and other public health programmes managed
by Directorate General V seem weak. The projects that are funded seldom use, to the
maximum extent, experience in policy development outside the field of drugs, such
as with addictions to chemical substances (drugs, nicotine, alcohol) or with the
general training of professionals or peer training programmes.

The decision to adopt the programme placed a significant emphasis on co-operation
with other international and intergovernmental organisations as well as with other
Community programmes and initiatives and the EMCDDA. The projects’
documentation indicates that there have been quite a few links to the EMCDDA,
while the indications of co-operation with other international agencies are rather few.

THE MANAGEMENT OF THE PROGRAMMES

Programme management since the first years of the implementation of these
programmes has improved, but there are still opportunities for further improvement.

The cancer and AIDS and communicable diseases programmes were adopted in
1996, with the drugs programme not being finalised until January 1997. Thus, the
creation of the formal management infrastructure, including the setting up of the
programme committees and their rules of procedure and working practices, only
occurred after the formal commencement of the programmes at the beginning of
1996.

There has been some continuity in the management of public health actions by the
Commission, from the period prior to the establishment of the programmes, to the
development of management practices of the new programmes in its first years.
Those responsible for managing the programmes were the same until mid-1998, but
several changes among the collaborators took place, affecting continuity of
knowledge.

Due to the late setting up of the formal management structure for the programmes, a
proper evaluation of the management can only be done in the second phase of the
evaluation. However, it is possible to make some preliminary comments at this stage
the implementation. A more detailed evaluation of management will be
of
undertaken during the second phase of the evaluation.

A number of suggestions for further improving the timing and procedures for
processing and deciding on project applications need to be carefully considered.
the institution of an
Among the points emerging,

important were:

the most

9

independent evaluation of all project proposals by external experts3; the need for
some means of stable funding for the various European networks that were being
established and that should function as a key mechanism in the accumulation and
dissemination of knowledge; improved documentation through better specification of
what was required both in applicants’ proposals and in contractors’ reports; a need
for better links within and between programmes, with other Commission activities
and with other bodies involved in public health in Europe. Various recommendations
are made to address these concerns.

In summary, there does not appear to be any obvious mismanagement of any aspect
of the European public health programmes, but there are many opportunities for
refinement of procedures and practices.

LINKS WITH MEMBER STATES POLICIES AND PROGRAMMES

A questionnaire was dispatched to members of the programme committees for each
of the three public health programmes on 30 October 1998. The information
requested focused on a description of national prevention policies, links between it
and Community policy, and how these links had developed. Further questions asked
for information on the management of the programmes.

This attempt to canvass responses from Member States should be seen, at least, as an
important step forward in the larger task of creating coherence and synergy between
Community level, national and local initiatives in tackling public health problems,
the seriousness of which is recognised throughout
the European Community.
Although unsuccessful in achieving a comprehensive picture of the specific impact
of these three programmes in all Member States, these responses from a third of the
Member States, nevertheless give some indications of the complexity of what is
needed (21 clusters in 15 Member States, not mentioning the regionalisation of
public health programmes in most of these).

It is proposed that before the end of the programmes, an independent, comprehensive
and comparative study be commissioned to investigate the relevant policies and
practices in all Member States and to review the contribution of Community policy
and initiatives to the national and local level in the Member States.

3

NB. Commission Services: this role is already carried out by the Advisory Committee for Cancer
Prevention in the case of project proposals submitted to the Europe Against Cancer Programme.

10

Budget

An overview of the budget allocation for the years 1996 and 1997 for the three programmes is
presented as follows

Budget allocation for the Europe against cancer programme:

1996

1997

1996 & 1997

Area

Number
of projects

Budget
(~MECU)

Number
of projects

Budget
(~MECU)

Number
of projects

Budget
(~MECU)

A-Data collection
and research

B-Information and
health education

C-Early detection
and screening

D-Training and
quality control

15

29

32

24

4.191

2.746

1.721

1.757

TOTAL

100

~10.416

9

16

27

14

66

3.901

2.532

1.591

1.339

24

45

59

38

8.092

5.278

3.312

3.097

~9.363

166

~19.779

11

Budget allocation for the Europe against AIDS and other communicable diseases
programme:

1996

1997

1996 & 1997

Area

Number of
projects

Budget
(~MECU)

Number of
projects

Budget
(~MECU)

Number of
projects

Budget
(~MECU)

6

15

18

10

3.246

2.190

2.757

1.329

9

17

16

10

3.316

2.351

2.148

1.348

15

32

34

20

6.562

4.541

4.905

2.677

A - Surveillance
and monitoring

B - Combating
transmission

C – Information,
education and
Training

D – Support for
persons with
HIV/AIDS and
combating
discrimination

TOTAL

49

~9.522

52

~9.163

101

~18.685

12

Budget allocation for the Europe against drug dependence programme:

1996

19974

1996 & 1997

Area

Number of
projects

Budget
(~MECU)

Number of
projects

Budget
(~MECU)

Number of
projects

Budget
(~MECU)

A- data research
and evaluation

B- Information,
health education
and training

16

18

3.080

3.420

TOTAL

34

~6.500

33

~4.908

67

~11.408

4

NB. For 1997 a breakdown into rubrics A and B was not done. Instead the summary figures have been
used.

13