REPORT FROM THE COMMISSION TO THE EUROPEAN PARLIAMENT AND THE COUNCIL Implementation of the third Programme of Union Action in the field of health in 2019
Date: 2021-11-05
Institutions: Directorate-General for Health and Food Safety, European Commission
Subjects: EU financing, EU programme, health care, health care system, implementation of the budget, medical device, orphan disease, programme budgeting, public health, vaccination

EN 

  EN 

   EUROPEAN COMMISSION  Brussels, 5.11.2021  COM(2021) 680 final  REPORT FROM THE COMMISSION TO THE EUROPEAN PARLIAMENT AND THE COUNCIL Implementation of the third Programme of Union Action in the field of health in 2019 {SWD(2021) 311 final}  
 
 
Table of contents 

1. INTRODUCTION .................................................................................................................. 2 

2. HIGHLIGHTS OF THE YEAR ............................................................................................. 4 

3. BUDGET IMPLEMENTATION ........................................................................................... 7 

3.1 Priorities ............................................................................................................................. 8 

3.2 Execution of the operational budget by financing mechanism ........................................ 11 

3.3 Beneficiaries .................................................................................................................... 12 

4. MAIN COMMUNICATION ISSUES ................................................................................. 12 

 
 
 
 
 
1. INTRODUCTION 

This report covers the implementation of the annual work programme for 2019 (2019 AWP) of 

the third health programme 2014-20201 (hereafter ‘the programme’). Under Article 13(1) of the 

Programme Regulation, the European Commission (EC) must report to the Health Programme 

Committee on the implementation of all actions funded through the programme, and must keep 

the European Parliament and the Council informed. This report meets the latter requirement 

and describes how the programme was implemented and the budget used in 2019.   

The Commission staff working document accompanying this report presents the key actions 

co-funded  under  the  programme  for  which  results  became  available  in  2019,  together  with 

tables  detailing  all  co-funded  activities  and  contracts  in  the  programme’s  2019  operational 

budget.  

The 2019 AWP was built around a number of priority areas, while addressing health inequalities 

as a cross-cutting issue. 

Under Objective 1 (Promote health, prevent diseases and foster supportive environments for 

healthy lifestyles), the EU provided total funding of EUR 20 752 505.10 to five projects and 

one  joint  action.  This  included  a  joint  action  on  implementing  best  practices  in  the  field  of 

nutrition, which aimed to increase the offer of healthier processed foods and/or to reduce salt, 

sugar and saturated fats in the processed foods available in EU supermarkets.  

Under Objective 2 (Protect Union citizens from serious cross-border health threats), the EU 

provided total funding of EUR 8 058 630.32 to three projects, which included organising the 

global summit on vaccination. There was also a joint action to strengthen health preparedness 

and the response to biological and chemical terror attacks; this aimed to detect threats and assess 

risks of health-related terrorism acts, while bridging gaps between partners from public health, 

security and civil protection.   

Under Objective 3 (Contribute to innovative, efficient and sustainable health systems), the EU 

provided total funding of EUR 15 473 042, 80 to several actions supporting innovative, efficient 

and sustainable health systems. A service contract was concluded to identify ways to enhance 

1 Regulation (EU) No 282/2014 of the European Parliament and of the Council of 11 March 2014 on the establishment of a 
third Programme for the Union’s action in the field of health (2014-2020) and repealing Decision No 1350/2007/EC (OJ L 
86, 21.3.2014, p. 1). 

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the cross-border exchange of health data in the EU, in line with the  EC’s priority for a ‘EU 

health data space’ to map, analyse and assess Member States’ rules governing the processing 

of health data. A joint action on implementing digitally-enabled, integrated, person-centred care 

was also launched to help authorities reform their healthcare systems. This aimed to develop 

the  capacity  to  transfer  best  practices  and  implement  integrated  care,  using  a  bottom-up 

approach and following the main design principles and building blocks identified by the expert 

group on Health Systems Performance Assessment (HSPA)2. 

Under Objective 4 (Facilitate access to better and safer healthcare for Union citizens), the EU 

provided  total  co-funding  of  EUR  14  044  589,  5  to  support:  (a)  coordination  activities  and 

registries of the European Reference Networks (ERNs) for rare diseases; (b) non-governmental 

organisations  contributing  to  EU  health  objectives;  (c)  networking  of  national  authorities  to 

transfer best practices; and (d) cooperation with international organisations.  

The Commission and the Consumers, Health, Agriculture and Food Executive Agency (Chafea) 

ensured that the programme results were publicised widely through appropriate communication 

and dissemination activities. These focused on the key communication priorities indicated by 

DG  SANTE,  such  as  vaccination,  ERNs  for  rare  diseases,  fighting  against  anti-microbial 

resistance,  health  technology  assessment  and  digital  health.  These  promotional  activities 

included  organising  seven  information  days  to  promote  the  funding  opportunities  under  the 

2019 AWP, in cooperation with the National Focal Points (NFP) network3.  

2 Expert group on Health Systems Performance Assessment: 
https://ec.europa.eu/health/systems_performance_assessment/policy/expert_group_en  
3 The NFPs are designated by EU Member States and other countries participating in the programme to help the 
EC promote the programme and disseminate its results and information on its impact. 

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2. HIGHLIGHTS OF THE YEAR 

The 2019 AWP broadly addressed the four specific objectives of the health programme.  

Under Objective 1 (Promote health, prevent diseases and foster supportive environments for 

healthy  lifestyles),  a  number  of  studies  were  launched  to  support  EU  legislation  on  tobacco 

products, related to the assessment of characterising flavours, and support the EC in applying 

Directive  2014/40  on  tobacco  products  (TPD).  Studies  on  alcohol  were  also  funded  to  help 

Member  States  reduce  alcohol-related  harm  and  to  map  their  fiscal  measures  and  pricing 

policies applied to food, non-alcoholic drinks and alcoholic beverages.  

Under Objective 2 (Protect Union citizens from serious cross-border health threats), a study 

was  launched  to  examine  the  feasibility  of  developing  a  common  vaccination  card  for  EU 

citizens4.  

The objective of the study is two-fold: 

  Firstly, to carry out a mapping exercise to examine and compare the form and content 

of  existing  vaccination  cards  to  identify  features  that  could  be  included  in  an  EU 

citizens’ vaccination card.  

  Secondly,  to  develop,  test  and  evaluate  three  different  templates  for  an  EU  citizens’ 

vaccination card, taking interoperability into account. The templates should be in both 

electronic and physical format. 

A future EU citizens’ vaccination card would, first of all, be a self-empowerment tool, helping 

citizens to get their vaccines and those of their children at the right moment, particularly when 

4 On 7 December 2018, EU Health Ministers adopted a Council Recommendation on strengthened cooperation 
against vaccine-preventable diseases 
(https://ec.europa.eu/health/sites/health/files/vaccination/docs/14152_2018_en.pdf). The Recommendation was 
accompanied by a Commission Communication (https://eur-lex.europa.eu/legal-
content/EN/TXT/?uri=COM:2018:245:FIN).   
While the organisation of vaccination programmes is the responsibility of Member States, the Recommendation 
and the Communication call for a multitude of actions at EU level to fight vaccine-preventable diseases. One of 
these actions is to examine the feasibility of developing a common EU citizens’ vaccination card/passport, with 
the main purpose of improving vaccination coverage by addressing the issues caused by cross-border movement 
of people and differences in vaccination programmes across the EU. Such a vaccination card/passport is also in 
line with the ‘participatory approach’ in the way individuals engage in health-related decisions and with the citizen-
centred  approach  adopted  in  the  EC’s  eHealth  Action  Plan  2012-2020  (https://eur-lex.europa.eu/legal-
content/EN/TXT/?qid=1550061597950&uri=CELEX:52012DC0736).  

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moving  between  EU  Member  States.  It  is  proposed  to  test  the  dual  templates  in  at  least  10 

volunteer Member States. 

Under Objective 3 (Contribute to innovative, efficient and sustainable health systems), several 

actions  were launched to  support innovative, efficient  and sustainable health systems,  and  a 

number of activities were funded to run campaigns supporting the implementation of the new 

regulations on medical devices ((EU) 2017/745) and in vitro medical devices ((EU) 2017/746). 

These  campaigns  address  market  players,  healthcare  professionals,  health  institutions,  and 

citizens as patients. Their overall purpose is to inform and raise awareness among stakeholders 

about the regulations on medical devices (MD) and in vitro medical devices (IVD) and their 

requirements,  before  they  enter  into  force  in  May  2021  and  2022  respectively,  to  avoid 

disruption to MD and IVD markets. 

Under Objective 4 (Facilitate access to better and safer healthcare for Union citizens), a call 

was launched to support the development of rare disease (RD) registries for the ERNs5. The 

planned activities concern the building and development of RD patient registries for ERNs and 

further development and quality control of existing registries.  

The main objectives are: 

 

to enable building, upgrading, linking and making interoperable registries covering the 

diseases  and  conditions  relating  to  each  ERN.  This  will  help  link  and  make  patient 

cohorts  visible  at  European level, so as to  follow the natural  course of diseases with 

sufficient  patient  data;  in  addition,  all  of  the  ERNs’  individual  RD  registries  will  be 

registered on the EU RD Platform.  

 

to  develop  a  comprehensive  approach  for  RD  registries  that  covers  all  the  ERNs, 

following the standards and tools provided by the EU RD Platform. 

5 Twenty-four ERNs approved by the ERN Board of Member States were launched in March 2017, including more 
than 900 highly specialised healthcare units from around 300 hospitals located in 25 EU Member States and in 
Norway  covering  major  disease  groups,  from  bone  disorders  to  haematological  diseases,  and  from  paediatric 
cancer to immunodeficiency. One member of each network acts as a coordinator.   

5 

 
 
                                                      
Furthermore, a contract was awarded to provide services and technical assistance to the EC for 

an integrated assessment, monitoring, evaluation and quality improvement system (AMEQUIS) 

for the ERNs. Specifically, it will: 

  examine all existing tools and indicators for assessing, monitoring and evaluating the 

ERNs;  

  analyse the lessons learned from the use of existing tools and methods, while conducting 

a  review  of  state-of-the-art  tools  and  methodologies  developed  and  tested  by  other 

organisations at national or international level, in the same and similar contexts.  

This action helps the EC to fulfil its obligations under the cross-border Directive 2011/24/EU 

on  patients’  rights  in  cross-border  healthcare  and  the  2014  Commission  Implementing6  and 

Delegated Decisions7 in relation to the establishment and evaluation of ERNs.   

Finally,  Chafea  launched  a  contract8  to  design,  plan  and  manage  the  implementation  of  a 

programme to facilitate the exchange of visiting professionals between clinical centres in the 

ERNs for rare or low prevalence and complex diseases. The goal of the visits/exchanges is to 

share expertise, experiences and highly specialised knowledge within the scope and framework 

of the 24 ERNs. This programme will help to increase the overall level of highly specialised 

knowledge,  deepen  and  facilitate  cooperation  among  hospitals,  and  strengthen  professional 

relationships within and between the different networks. In addition, the visits/exchanges will 

help to lay the foundations for creating and developing highly specialised training programmes.  

6 https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=OJ:JOL_2014_147_R_0007  
7 https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=OJ:JOL_2014_147_R_0006  
8 Service contract for the provision of services on capacity and knowledge sharing through short-term mobility 
and exchanges of healthcare professionals for ERNs.  

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3. BUDGET IMPLEMENTATION 

The overall budget for the third health programme 2014-2020 was EUR 449.4 million. This 

includes EUR 30.6 million for the operating costs of Chafea, which the EC mandated to manage 

the programme. Chafea has been providing the EC with technical, scientific and administrative 

assistance in implementing the health programme since 20059.  

Chafea  organises  annual  calls  for  proposals,  coordinates  the  evaluation  of  submissions, 

negotiates, signs and manages grant agreements, and disseminates the results of the actions. It 

is also responsible for most procurement procedures. 

The budget set out in the 2019 AWP was EUR 70 424 862, which was broken down as follows: 

  Operational  expenditure:  EUR  62  258  000,  corresponding  to  budget  line  17  03  01 

(Encouraging innovation in health, increasing the sustainability of health systems and 

protecting Union citizens from serious cross-border health threats);  

  EFTA/EEA10  and  other  third  countries11  participating  in  the  programme  made 

additional contributions of EUR 2 116 862  ; 

  Administrative expenditure: EUR 1 500 000, corresponding to budget line 17 01 04 02; 

  Budget for the operating costs of Chafea: EUR 4 550 000, corresponding to budget line 

17 01 06 02. 

The  operational  budget  totalled  EUR  64.614.759,55.  DG  SANTE  and  Chafea  committed  in 

total EUR 63 862 709,64 under the 2019 AWP (99%). Chafea committed EUR 46 888 723,23 

while  DG  SANTE  committed  EUR  16  973  986.41,  covering  part  of  the  procurement 

commitments  and  other  actions.  From  the  overall  commitment,  unused  appropriations 

amounted to EUR 752 050,11, corresponding to 1.2% of the total.    

9 Commission Decision 2004/858/EC of 15 December 2004 setting up an executive agency, the ‘Executive Agency 
for the Public Health Programme’, for the management of Community action in the field of public health – pursuant 
to  Council  Regulation  (EC)  No  58/2003  (OJ  L  369,  16.12.2004,  p.  73)  amended  by  Commission 
Decision 2008/544/EC  of  20 June  2008  amending  Decision  2004/858/EC  in  order  to  transform  the  ‘Executive 
Agency  for the Public Health Programme’ into the  ‘Executive  Agency  for Health and Consumers’ (OJ L 173, 
3.7.2008, p. 27). From December 2014, the Executive Agency for Health and Consumers (EAHC) was replaced 
by  the  Consumers,  Health,  Agriculture  and  Food  Executive  Agency  (Chafea)  by  Commission  Implementing 
Decision  2014/927/EU  of  17  December  2014  amending  Implementing  Decision  2013/770/EU  in  order  to 
transform  the  ‘Consumers,  Health  and  Food  Executive  Agency’  into  the  ‘Consumers,  Health,  Agriculture  and 
Food Executive Agency’ (OJ L 363, 18.12.2014, p. 183). 
10 Norway and Iceland. 
11 Serbia, Bosnia and Herzegovina, and Moldova. 

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3.1 Priorities 

In 2019, the total operational budget that was implemented EUR 63 862 709,44 was assigned 
to the four specific programme objectives as follows:  

1.  Health promotion - EUR 20 752 505,10 (32% of the operational budget) for promoting 

health, preventing diseases and fostering supportive environments for healthy lifestyles, 

taking into account the ‘health in all policies’ principle; 

2.  Health  threats - EUR  8  058 630.32  (13% of the operational  budget)  for protecting 

Union citizens from serious cross-border health threats; 

3.  Health systems - EUR 15 473 042,80 (24% of the operational budget) for contributing 

to innovative, efficient and sustainable health systems; 

4.  Better and safer healthcare - EUR 14 044 589,5 (22% of the operational budget) for 

facilitating access to better and safer healthcare for Union citizens. 

In  addition,  horizontal  activities  (IT  activities,  communication,  reimbursement  of  expert 

evaluators)  and transversal  actions amounted to  EUR 5 533  943, 24  (9% of the operational 

budget).   

Chart 1:  2019 operational budget per objective of the third health programme  

2019 operational budget per objective of the 
third health programme

9%

22%

32%

24%

13%

Promotion of health

Health Threats

Health systems

Better and safer healthcare

Horizontal activities

In relation to the 2019 budget allocation for each of the programme’s thematic priorities, 

Chart 2 below shows that activities under thematic priority 1 to promote health, prevent 

8 

 
 
  
diseases and foster supportive environments for healthy lifestyles rank highest, followed by 

vaccination, medical devices and rare diseases.  

Chart 2: 2019 operational budget per thematic priority (in EUR million) 

2019 operational budget per thematic priority (in 
EUR million)

25,0

20,0

15,0

10,0

5,0

0,0

To achieve its objectives, the programme was implemented through a wide range of funding 

instruments. These included: 

  project grants; 

  operating grants in support of non-governmental organisations; 

  actions co-financed with Member State authorities (joint actions); 

9 

 
 
 
 
  direct grant agreements with international organisations; 

  public procurement; and 

  other actions, such as support for the Scientific Committees, administrative agreements 

with the Joint Research Centre and EUROSTAT, and grants for Presidency conferences. 

Competitive calls were used to select actions for funding, e.g. for projects and procurement. 

Joint actions, grants to international organisations and conferences organised by EU Council 

Presidencies are direct grant agreements because of their monopoly situations (de facto or de 

jure). External reviewers (joint actions), DG SANTE and Chafea officers ensure the quality of 

these co-funded actions through the evaluation of proposals. 

The  administrative  budget  covered  expenditure  such  as  studies,  meetings  of  experts, 

communication and technical and administrative assistance for IT systems. 

10 

 
 
 
3.2 Execution of the operational budget by financing mechanism 

Type of financing mechanism 

Implementation 

Share of mechanism 

(EUR) 

in total implemented 

budget (%) 

1. Grants under calls for 

26 314 180.36 

proposals or by invitation: 

1.1 Project grants, including other 

5 774 147.36 

DGA projects 

1.2 Operating grants for NGOs 

1.3. Joint action grants 

1.4. Conference grants to the 

Member States holding the 

Presidency of the EU 

5 434 283 

14 992 063 

113 687 

2. Direct grant agreements with 

5 750 000 

international organisations 

TOTAL GRANTS 

32 064 180,36 

3. Procurement (service 

24 359 690,04 

contracts), prizes and horizontal 

actions 

Managed by Chafea 

14 149 296,55 

Managed by DG SANTE 

10 210 393,49 

4. Other actions 

Managed by Chafea 

7 438 839,29 

675 246,37 

Managed by DG SANTE 

6 763 592,92 

5. Budget implemented under 2019 

AWP  

41% 

9% 

8.4% 

23% 

0.17% 

9% 

50% 

38% 

22% 

16% 

12% 

1% 

11% 

Managed by Chafea 

46 888 723,30 

Managed by DG SANTE 

16 973 986,41  

72,6% 

26.2% 

63 862 709,44 

11 

 
 
 
 
 
 
Total available budget under 2019 

64.614.759,55 

AWP  

Credits not used 

3.3 Beneficiaries 

by Chafea12 

by DG SANTE 

752 050,11 

752 046,35 

3.76 

1.20% 

In 2019, Chafea and DG SANTE signed over 27313 grants and contracts with beneficiaries and 

service  providers:  governmental  organisations,  academic  institutions,  non-governmental 

organisations,  private  companies,  and  individual  experts14.  Other  beneficiaries  included 

international organisations and EU services. Around 479 beneficiaries and contractors received 

EU funding, with the two main categories being private companies (for procurement and other 

actions) and governmental organisations (for joint actions and for projects).  

4. MAIN COMMUNICATION ISSUES 

In 2019, Chafea organised dissemination activities to raise the visibility of results and successes 

achieved under the third health programme, to promote DG SANTE’s specific communication 

priorities and to continue expanding outreach to potential programme beneficiaries. Extensive 

information on these activities can be found in Chafea’s 2019 Activity Report for the third EU 

health Programme.  

The EU Health Programme Conference on 30 September 2019 was the major event of the year, 

with  over  350  targeted  participants  in  attendance.  The  aim  of  the  event  was  two-fold:  to 

highlight the success stories of the third health programme and to present EU health funding 

under  the  post-2020  multiannual  financial  framework.  In  cooperation  with  the  Health 

Programme  NFPs,  Chafea  organised  several  information  days  (in  Bosnia  and  Herzegovina, 

Czechia,  Greece,  Ireland,  Italy,  Malta,  Poland  and  Sweden)  with  over  250  participants,  on 

topics connected with national policy priorities.   

12 The contract on the feasibility options for physical stockpiling was not awarded  following the change of DG 
Sante policy needs for an expected total amount of 700 000 EUR.  

13  Joint  Actions  (3),  project  grants  (20),  operating  grants  SGA  (14),  Direct  Grant  agreement  (4),  prizes  (3), 
presidency conferences (2), tenders (21), horizontal actions (186) and other actions (20).  
14 This figure does not include contracts with individual experts participating in Scientific Committees, evaluators 
of calls for proposals, etc. 

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Chafea  also  actively  participated  in  other  major  European  public  health  conferences,  where 

scientists and health professionals were the target audience:  

 

the 19th International Conference on Integrated Care, 1-3 April 2019, San Sebastian, 

Spain15.  

 

the  22nd  European  Health  Forum  Gastein,  2-4  October  2019,  Austria16  (Chafea 

organised a stand).  

 

the 12th European Public Health Conference, 20-23 November 2019, ‘Building bridges 

for solidarity and public health’, Marseille, France17 (lunch symposium on ‘How can we 

join  forces  to  engage  in  multiple  stakeholder  actions  to  reach  optimal  influenza 

vaccination coverage rates in Europe?’).  

Other web communication and web dissemination activities included the publication of over 

120 cross-linked news items on the Chafea website and partly via social media, the publication 

of  webinars  on  funding  opportunities,  the  development  of  dissemination  guidance  for 

beneficiaries and the upgrade of the database download features.  

In  terms  of  producing  and  promoting  web  publications  (and  print-on-demand),  Chafea 

produced a booklet on ‘Health for the EU’ presenting the programme’s success stories18, and 

two info-sheets on ‘e-health’19 and ‘frailty’20. They are available in 24 EU languages.  

15 https://integratedcarefoundation.org/events/icic19-19th-international-conference-on-integrated-care-san-
sebastian-basque-country  
16 https://www.ehfg.org/archive/2019/programme 
17 https://ephconference.eu/conference-2019-marseille-271  
18 https://op.europa.eu/en/publication-detail/-/publication/98986869-e049-11e9-9c4e-01aa75ed71a1  
19 https://op.europa.eu/en/publication-detail/-/publication/08e68564-67fe-11e9-9f05-01aa75ed71a1/language-
en?WT.mc_id=Selectedpublications&WT.ria_c=19980&WT.ria_f=3171&WT.ria_ev=search  
20https://op.europa.eu/en/publication-detail/-/publication/b3cbce3e-5ccd-11e9-9c52-01aa75ed71a1/language-
en?WT.mc_id=Selectedpublications&WT.ria_c=19980&WT.ria_f=3171&WT.ria_ev=search   

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