COMMISSION STAFF WORKING DOCUMENT EVALUATION Accompanying the document REPORT FROM THE COMMISSION TO THE EUROPEAN PARLIAMENT, THE COUNCIL, THE EUROPEAN ECONOMIC AND SOCIAL COMMITTEE AND THE COMMITTEE OF REGIONS on the interim evaluation of the EU4Health Programme 2021-2024
Date: 2025-11-25
Institutions: Directorate-General for Health and Food Safety, European Commission
Subjects: EU financing, EU programme, cross-border cooperation, disease prevention, health care, health care system, illness, multiannual financial framework, project evaluation, public health

EN 

  EN 

   EUROPEAN COMMISSION  Brussels, 25.11.2025  SWD(2025) 369 final  COMMISSION STAFF WORKING DOCUMENT  EVALUATION        Accompanying the document REPORT FROM THE COMMISSION TO THE EUROPEAN PARLIAMENT, THE COUNCIL, THE EUROPEAN ECONOMIC AND SOCIAL COMMITTEE AND THE COMMITTEE OF REGIONS on the interim evaluation of the EU4Health Programme 2021-2024 {COM(2025) 709 final} - {SEC(2025) 304 final}  
 
 
1. 

INTRODUCTION ................................................................................................................................ 1 

1.1   PURPOSE AND SCOPE OF THE EVALUATION ............................................................................. 1 

1.2   METHODOLOGICAL OVERVIEW ................................................................................................... 1 

1.3   LIMITATIONS AND MITIGATION MEASURES ............................................................................ 2 

2.  WHAT WAS THE EXPECTED OUTCOME OF THE INTERVENTION? ....................................... 6 

2.1  DESCRIPTION OF THE INTERVENTION AND ITS OBJECTIVES ............................................... 6 

2.1.5  EXPECTED ACHIEVEMENTS AT THE TIME OF THE EVALUATION ..................................... 19 

2.2   POINT(S) OF COMPARISON FOR THE EU4HEALTH INTERVENTION ................................... 22 

3.  HOW HAS THE SITUATION EVOLVED OVER THE EVALUATION PERIOD? ....................... 24 

3.1   CURRENT STATE OF PLAY ........................................................................................................... 24 

4. 

EVALUATION FINDINGS (ANALYTICAL PART) ....................................................................... 41 

4.1.  TO WHAT EXTENT WAS THE INTERVENTION SUCCESSFUL AND WHY? .......................... 41 

4.1.1. PROGRAMMING AND IMPLEMENTATION PROGRESS ........................................................... 41 

4.1.2. ACHIEVEMENTS IN IMPLEMENTING POLICIES AND LEGISLATION .................................. 45 

4.2.  HOW DID THE EU INTERVENTION MAKE A DIFFERENCE AND TO WHOM? .................... 58 

4.2.1. MAIN BENEFICIARIES AND RELEVANT GAINS ....................................................................... 58 

4.2.2. THE ADDED VALUE BY PROGRAMME STRAND...................................................................... 63 

4.3  

Is the intervention still relevant? ...................................................................................................... 67 

4.2.3.  The relevance of the EU’s health intervention ................................................................................ 67 

4.2.4.  The relevance of the specific objectives and EU4Health actions .................................................... 67 

4.2.5.  EU4Health’s continued relevance in the context of the European Health Union ............................ 73 

5.  WHAT ARE THE CONCLUSIONS AND LESSONS LEARNT? .................................................... 74 

ANNEX I: PROCEDURAL INFORMATION ......................................................................................... 85 
ANNEX II. METHODOLOGY AND ANALYTICAL MODELS USED .............................................. 87 

ANNEX III. EVALUATION MATRIX AND, WHERE RELEVANT, DETAILS ON ANSWERS TO 
THE EVALUATION QUESTIONS (BY CRITERION)......................................................................... 93 

ANNEX  IV.  OVERVIEW  OF  BENEFITS  AND  COSTS  AND,  WHERE  RELEVANT,  TABLE  ON 
SIMPLIFICATION AND BURDEN REDUCTION ............................................................................. 111 
ANNEX V. STAKEHOLDERS CONSULTATION - SYNOPSIS REPORT ...................................... 128 

ANNEX VI. EU4HEALTH LIST OF INDICATORS FROM THE PROGRAMME PERFORMANCE 
MONITORING AND EVALUATION FRAMEWORK ....................................................................... 139 

ANNEX  VII.  POINTS  OF  COMPARISON:  BASELINES,  EXPECTED  ACHIEVEMENTS  AND 
TARGETS  PER  EU4HEALTH  WORK  PROGRAMME  STRAND  AND  SPECIFIC  OBJECTIVES 
AND DATA FROM 2021, 2022, AND 2023 (WHERE AVAILABLE) ................................................ 155 

ANNEX  VIII.  CURRENT  STATE  OF  PLAY  –  PROGRAMME  PERFORMANCE, 
CONTRIBUTION TO EU’S CROSS-CUTTING PRIORITIES ....................................................... 188 

ANNEX  IX.  ACTIONS  FROM  THE  2021-2024  WORK  PROGRAMMES  (WP)  LINKED  TO 
HORIZON EUROPE ............................................................................................................................... 203 
ANNEX X. INFORMATION ON THE EU4HEALTH WORK PROGRAMMES ADOPTED. ....... 213 
ENDNOTES .............................................................................................................................................. 215 

 
 
 
 
 
Glossary 

This glossary contains a list of relevant acronyms and their meanings, organised 
alphabetically for ease of reference. 

AMR: Antimicrobial Resistance 
ATC: Anatomical Therapeutic Chemical Classification System 
ATMP: Advanced Therapy Medicinal Products  
CBRN: Chemical, Biological, Radiological, and Nuclear Hazards 
Commission: European Commission 
Contracting Authority: Public procurement body  
CORDA: Common Research Data Warehouse 
DEP: Digital Europe Programme 
DG ECFIN: Directorate-General for Economic and Financial Affairs 
DG SANTE: Directorate-General for Health and Food Safety 
Direct Management: Budget implementation by EC  
DURABLE Network: Research Alliance against Epidemics 
ECDC: European Centre for Disease Prevention and Control 
ECHA: European Chemical Agency 
EEA: European Economic Area 
EEHRxF: European Electronic Health Record Exchange Format 
eHAction: Joint Action supporting the eHealth Network 
EHDS: European Health Data Space 
eHDSI: eHealth Digital Service Infrastructure 
EHRs: Electronic Health Records 
EMA: European Medicines Agency 
ePI: Electronic Product Information 
Erasmus+: EU Education and Training Programme 
ERDF: European Regional and Development Fund 
ERNs: European Reference Networks 
ESF+: European Social Fund Plus Programme 
EU: European Union 
EU FAB: Vaccine Manufacturing Contract 
EU4Health Dashboard: Grants and Procurements Database 
EUDAMED: European Database on Medical Devices 
EUonQoL: European Quality of Life in Oncology 
EURLs: European Reference Laboratories 
EUSR: Second European Screening Report 
EU-TOPIA: Improved Cancer Screening in Europe 
EU-WISH: Wastewater Surveillance for Public Health 
EWRS: Early Warning and Response System 
GAPP: Good Practice Guidelines 
GNI: Gross National Income 

 
 
 
HaDEA: European Health and Digital Executive Agency 
HDAB: Health Data Access Bodies 
HERA: Health Emergency Preparedness Authority 
HORIZON: Horizon Europe Research Programme 
HBV: Hepatitis B Vaccine 
HPV: Human Papillomaviruses 
HSC: Health Security Committee 
HTA: Health Technology Assessment  
IHR: International Health Regulations 
Indirect Management: Budget tasks by public bodies 
IOM: International Organization for Migration 
ISCTP: European Cancer Training Programme 
IVDR: In Vitro Diagnostic Medical Devices Regulation  
JACARDI: Cardiovascular and Diabetes Action 
JA GHI: Global Health Strategy Action 
JAMRAI2: Antimicrobial Resistance Action 
JA PreventNCD: Preventing Non-communicable Diseases Action 
JASeHN: eHealth Action 
JA Xt-EHR: Electronic Health Record Systems Action 
JRC: Joint Research Centre  
KPI: Key Performance Indicator 
LFS: Legal Financial Statements 
MDR: Medical Devices Regulation 
MFF: Multiannual Financial Framework 
Mpox: Monkeypox Virus  
NCD: Non-communicable Disease 
NGO: Non-governmental Organization 
OECD: Organisation for Economic Co-operation and Development  
PPMEF: Performance Monitoring and Evaluation Framework 
PYLL: Potential Years of Life Lost 
RRF: Recovery and Resilience Facility  
SDGs: Sustainable Development Goals 
SGPP: Health Promotion and Disease Prevention Group 
SoHO: Substances of Human Origin 
Strands: EU4Health Programme Tool  
UCPM: Union Civil Protection Mechanism 
UNITED4Surveillance: Integrated Surveillance Capacity  
WHO: World Health Organization 

 
 
 
 
1. 

INTRODUCTION 

The EU4Health Programme (referred to as ‘the Programme’) was created by Regulation (EU) 
2021/5221 (‘the EU4Health Regulation’), adopted in March 20212, to improve human health 
throughout the EU and to ensure a high level of protection of human health in all EU policies 
and  activities.  The  Programme  is  being  implemented  through  annual  work  programmes 
prepared by the Commission, based on stakeholders’ input and in consultation with Member 
State representatives  in the EU4Health  Steering  Group. The Commission  adopts the annual 
work  programme  following  a  positive  opinion  of  Member  States  representatives  in  the 
Programme  Committee.  The  Programme  provides  funding  to  address  long-term  health 
challenges  in  the  EU.  This  Staff  Working  Document  presents  the  results  of  the  interim 
evaluation of the EU4Health Programme for the period 2021-2024.  

1.1 Purpose and scope of the evaluation 

The interim evaluation assesses the relevance of the Programme’s objectives, the added value, 
effectiveness  and  efficiency  of  the  funded  actions,  as  well  as  the  coherence  within  the 
Programme and with other relevant EU funding initiatives and policies. The interim evaluation 
provides insights for the ongoing EU4Health Programme implementation, sets the scene for 
the  forthcoming  final  evaluation,  and  informs  the  Commission’s  reflections  on  a  potential 
Programme  successor during  the next multiannual  financial  framework  (MFF). The interim 
evaluation measures the Programme’s progress until April 2024 in the 27 EU Member States 
and the six non-EU countries associated to the Programme3. It provides information on whether 
adjustments are considered necessary in line with Article 20 of the EU4Health Regulation. The 
interim evaluation followed a standard procedure without derogations (Annex I). 

1.2 Methodological overview 

The evaluation and its supporting study applied a mix of qualitative and quantitative methods 
to  address  the  study  questions  under  the  five  evaluation  criteria,  i.e.  the  effectiveness, 
efficiency,  coherence,  EU  added  value  and  relevance  of  EU4Health4  (Annex  II).  The  study 
questions  and  the  evaluation  criteria  were  addressed  by  using  at  least  two  different 
methodological  tools  or  reflect  results  from  more  than  one  data  source.  The  answers  are 
provided in the evaluation matrix (Annex III). 

To measure the Programme’s progress at this interim stage, the evaluation collected data on 
the Programme’s output and results, including data from both completed and ongoing actions. 
The evaluation draws on additional evidence provided by an external study5 conducted between 
December  2023  and  October  2024.  The  data  collected  at  Programme  and  project  level  are 
complemented  by  case  studies,  evidence  collected  from  stakeholders  online  and  through 
interviews, as well as from a literature review. The data analysis includes comparisons against 

1   Regulation (EU) 2021/522 of the European Parliament and of the Council of establishing a programme for 
the Union’s action in the field of health (EU4Health programme) for the period 2021-2027, and repealing 
Regulation (EU) No 282/2014 (OJ L 107, 26.3.2021).  

2   As  stipulated  in  Article  5(7)  of  Regulation  (EU)  2021/522,  activities  supported  by  the  EU4Health 

Programme are eligible as of 1 January 2021. 

3   Bosnia  and  Herzegovina  (since  1 January 2024),  Iceland  (since  1 January 2021),  Moldova  (since 
1 January 2023),  Montenegro  (since  1 January 2024),  Norway  (since  1 January 2021)  and  Ukraine (since 
1 January 2022). 

4   Better regulation toolbox 2023, tool #47. 
5  

To be published together with this staff working document. 

1 

 
 
baseline and targets,  cost-benefit to  the extent possible, and  customer journey mapping.  An 
analysis  of  megatrends  (such  as  demographic  change,  digitalisation  etc.)  was  conducted  to 
assess how they could impact interventions in health systems, including actions funded by the 
Programme. 

The collection of Programme data was enabled by 52 indicators, which are described in the 
EU4Health  Programme  performance  monitoring  and  evaluation  framework  (PPMEF)6.  The 
indicators monitor inputs, outputs, results and impacts. Nine key performance indicators were 
designated for flagship health policies and serve to highlight the key achievements in the annual 
performance reporting7.  

The action data has been collected from grants, procurements and contribution agreements by 
the beneficiaries of EU funds, using action-level indicators developed by the Commission or 
the  beneficiary8  to  monitor  the  effectiveness  and  efficiency  of  the  actions  funded.  The 
quantitative action data are complemented by qualitative data from the final reports and, where 
relevant, from the interim reports and selected deliverables. 

Contextual data were collected from indicators published by Eurostat including health status, 
health determinants, health services or health promotion, etc. 

The three case studies, on operating grants, joint actions and exceptional utility provision, 
substantiate  the  analysis  of  the  effectiveness,  efficiency  and  coherence  of  the  EU4Health 
Programme and take account of results from implemented actions. 

The stakeholders’ consultations used various quantitative and qualitative data collection tools 
and  methods.  These  include  seven  exploratory  interviews,  an  online  call  for  evidence9  and 
targeted surveys, 54 targeted interviews, and two focus group meetings. The call for evidence 
and targeted surveys elicited 30 and 258 contributions, respectively. The targeted interviews 
and the two focus group meetings provided further insights into the stakeholders’ views. 

A literature review was conducted on peer-reviewed and grey literature to complement the 
intervention logic and clarify the details of the implementation and data analysis.  

1.3 Limitations and mitigation measures 

The evaluation covers the implementation of the EU4Health Programme and its annual work 
programmes from 1 January 2021 to 30 April 2024. Consequently, few funded projects were 
completed and limited data on results and impacts was available. Some relevant data available 
after the cut-of date was included in the evaluation. 

EU public health interventions often involve multiple components and stakeholders, making it 
difficult to isolate the effects of specific actions and to evaluate their impact accurately. The 
EU4Health investments complement the relatively larger and significant scale of the national 
health funding, which renders challenging to disentangle the EU4Health effects from those of 
the  national  funding.  This  applies,  for  example,  to  recruiting  health  workers,  or  improving 

6  

See Annex I of the Commission Staff Working Document EU4Health Programme Performance Monitoring 
and Evaluation Framework SWD(2024)223 final.  
See Annex 2 of the SWD(2024)223 final. 

7  
8   All indicators are agreed by the Commission and incorporated in the contracts signed with the beneficiaries.  
9   Call for evidence - EU4Health programme 2021-2027 – interim evaluation. 

2 

 
 
access to healthcare or cancer screening, where guidance from EU level10 and funding provided 
through the EU4Health Programme go hand in hand with nationally led policy initiatives and 
investments.  

Moreover,  investments  in  health  made  by  other  EU  funding  programmes  such  as  Horizon 
Europe, the Digital Europe Programme, the European Social Fund Plus (ESF+), the European 
Regional  Development  Fund  (ERDF)  or  the  Recovery  and  Resilience  Facility  (RRF) 
complement those made by EU4Health and  may contribute to  its objectives. The  effects  of 
these synergies are difficult to quantify at this stage of the implementation process. In addition, 
the results and impacts of the EU4Health actions are influenced by external factors.  

Due to the long-term nature of health outcomes, it is difficult to measure change at the interim 
stage. Many health interventions have long-term goals and outcomes, which require extended 
periods of monitoring and evaluation. This can be resource-intensive and subject to various 
external influences over time. 

All the Programme’s output and results indicators have been operationalised and used for data 
collection except for the ‘Age-standardised five-year net survival rate for paediatric cancer’11 
impact indicator, for which the baseline, milestone and target are expected to be set in 2025 
(Annex VI). The impact indicators corresponding to the other specific objectives and some of 
their relevant policy areas (e.g. mental health, health literacy, etc.) remain to be defined. In 
some  cases,  establishing  a  direct  causal  link  between  the  EU4Health  investments  and  the 
progress in a policy area is challenging. That is the case for some indicators, included in the 
Annex II of the EU4Health Regulation, which inform about actions such as vaccination or other 
similar policies that fall within the competence of the Member States.  

In general, establishing a causal link between the inputs and outputs, results and impacts of an 
EU public  health  intervention  is  challenging  due to  the complex and multifaceted nature of 
such interventions, where multiple variables and external factors can influence the outcomes. 
Additionally, the diversity in healthcare systems and cultural contexts, and varying data quality 
across EU Member States, adds layers of complexity, making it difficult to attribute changes 
directly  to  specific  interventions.  Where  possible,  the  causal  link  between  EU4Health 
investments will be established for relevant policy areas following the review of the PPMEF 
and the definition of additional impact indicators.  

The Programme data are becoming available progressively and was available in full (for the 
reference years 2021, 2022 and 2023) for 28 Programme indicators. Four indicators enabled 
data collection from two years, and ten others from one data point. Data will gradually become 
available for the remaining 10 indicators. The supporting study does not include or analyse the 
data that became available after the cut-off date of 30 April 2024, which is partly included in 
this evaluation report. 

The interim evaluation mainly captures outputs and preliminary results at Programme level. A 
total of 204 actions have been completed (68 were grants entirely managed by the European 
Health and Digital Executive Agency (HaDEA), and 136 were procurements). By the cut-off 
date, 26 final reports from funded projects were available for analysis, of which 22 were funded 
by  operating  grants  and  4  by  direct  grants.  In  addition,  7  periodic  reports  and  8  project 

10   Council Recommendation 2022/C 473/01 of 9 December 2022 on strengthening prevention through early 

detection: A new EU approach on cancer screening. 

11   See footnote 6. 

3 

 
 
deliverables  were  analysed.  Except  for  the  operating  grants,  the  project  reports  are  not  a 
representative sample for the effectiveness and efficiency analysis, and the available results are 
indicative.  

As regards procurement, 136 contracts had been finalised and were available for analysis by 
the cut-off date, of which 104 were executed by DG SANTE and 32 by HaDEA (25 of these 
were delegated by DG SANTE and 7 by HERA). 

The effectiveness of the EU4Health Programme has been determined by analysing data from 
the PPMEF indicators, given that evidence on the outcomes of actions was limited.  

The total budget allocated to one specific objective represents an estimate and is the sum of the 
budgets  (or  part  it)  of  different  actions  that  are  implementing  a  particular  objective.  For 
example,  if  an  action  from  the  annual  work  programme  implements  two  or  more  specific 
objectives,  the  activities  and  the  total  budget  are  not  split  per  objective  in  the  annual  work 
programme. To allow quantification, the budget of that action is divided equally between the 
specific objectives that an action implements.  

The quantification of benefits and costs relies on stakeholders’ estimates. Some of those are 
derived  from  scientific  and  grey  literature  and  may  be  based  on  several  assumptions 
(Annex IV).  

Stakeholders’ views were collected through interviews and focus groups to ensure that different 
perspectives were represented. In some cases, as mentioned in the evaluation supporting study, 
the survey responses included multiple respondents from the same organisation. The response 
rates  for  the  surveys  were  relatively  low,  limiting  the  diversity  of  perspectives,  particularly 
from those who did not benefit from Programme funding. 

The EU4Health dashboard data includes the following assumptions that are considered when 
analysing the data collected with the dashboard indicators12: (i) the budget of an action from 
the annual work programme that implements two or more specific objectives is divided equally 
between the objectives; (ii) the policy areas are not exclusive for a particular strand; and (iii) 
the specific objectives may be addressed by actions from different strands. Since the cut-off 
date  (30 April 2024)  routine  quality  checks  of  the  dashboard  data  have  revealed  some 
inconsistencies that were corrected before they were included in the evaluation report. Thus, 
some  discrepancies  between  the  external  supporting  study  and  the  evaluation  report  are 
possible. 

The values for the Programme indicators’ baselines, milestones and targets were set, except 
for one cancer indicator13. There is variation in the level of detail of the baseline data for the 
EU health policies implemented by EU4Health interventions, being based on publicly available 
information. In addition, the dates on which the baseline value is set differ between policies, 
e.g. the implementation of the cross-border threats to health regulation and others, which makes 
the analysis more complex. 

It was challenging to define the Programme indicators, including their baseline, milestone and 
target  values,  because  the  Programme’s  objectives  are  deliberately  broad  to  allow  for  the 

12   For  example,  number  of  actions  per  specific  objective,  budget  per  strand,  budget  per  specific  objective, 

number of and type of eligible beneficiaries per country, etc. 
13   Age-standardised five-year net survival rate for paediatric cancer. 

4 

 
 
financing of all relevant EU health policy priorities and related actions, including preparatory 
work during the 2021-2027 MFF.  

There is no impact assessment for the EU4Health Programme, as has been proposed by the 
European  Commission14.  The  existing  impact  assessment  was  carried  out  for  a  health 
component under the ESF+ for a much smaller programme with much less funding (EUR 449.4 
million)  and  therefore  has  limitations  as  a  point  of  reference15.  To  mitigate  this,  data  were 
collected  as  far  as  available  for  the  situation  in  2020,  or  in  the  year  for  which  data  were 
available. 

The  evaluation  results  and  findings  are  robust  and  generally  reliable.  The  evidence-based 
approach of the evaluation employed a sound qualitative and quantitative methodology based 
on the best available evidence drawn from diverse sources. 

14   Proposal for a Regulation 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)405 final. 
IMPACT  ASSESSMENT  Accompanying  the  document  Proposal  for  a  Regulation  of  the  European 
Parliament and of the Council on the European Social Fund Plus (ESF+) SWD(2018)289 final. 

15  

5 

 
 
 
 
2.  WHAT WAS THE EXPECTED OUTCOME OF THE INTERVENTION? 

2.1 Description of the intervention and its objectives 

Context of the intervention 

The European Health Union16 was established in November 2020 to better protect the health of 
people in the EU, to equip the EU and its Member States so that they can better prevent and 
address  future  pandemics,  and  to  improve  the  resilience  of  health  systems  in  the  EU.  The 
European  Health  Union  builds  on  the  outcomes  of  decades  of  EU  action  in  public  health, 
including the EU health legislative framework17 (Figure 1).  

Figure 1 The European Health Union: priorities and legislation (a non-comprehensive illustration) 

The EU4Health Programme is the main EU fund that underpins the development of a strong 
European  Health  Union18. EU4Health funds  actions  to build  the European  Health  Union by 
implementing health priorities and policies such as: crisis preparedness and response, including 
to  support  the  mission  of  HERA;  Europe’s  Beating  Cancer  Plan19;  the  reform  of  EU 
pharmaceutical legislation or the comprehensive approach to mental health20, as well as health 
technology assessments (HTA) and the European Health Data Space (EHDS) Regulation21. The 

16   European  Commission  Communication  on  Building  a  European  Health  Union:  Reinforcing  the  EU’s 

resilience for cross-border health threats COM(2020)724 final.  

17   See Public Health, European Commission. 
18   European Health Union initiatives supported by the Programme are outlined in the Political guidelines for 
the next European Commission 2019-2024, in the Mission letter to the Commissioner for Health and Food 
Safety,  Political  guidelines  of  the  next  European  Commission  2024-2029,  and  the  Mission  letter  to  the 
Commissioner-designate for Health and Animal Welfare.  

19   European Commission Communication on Europe’s beating cancer plan COM(2021)44 final. 
20   Communication from the Commission to the European Parliament, the Council, the European Economic and 
Social  Committee  and  the  Committee  of  the  Regions  on  a  comprehensive  approach  to  mental  health 
COM(2023) 298 final. 

21   Regulation  (EU)  2025/327  of  the  European  Parliament  and  of  the  Council  of  11  February  2025  on  the 
European Health Data Space and amending Directive 2011/24/EU and Regulation (EU) 2024/2847, (OJ L, 
2025/327, 5.3.2025). 

6 

 
 
 
EU4Health Programme also supports activities under the extended mandates of the European 
Medicines  Agency  (EMA)  and  the  European  Centre  for  Disease  Prevention  and  Control 
(ECDC). It also supports the new EU Global Health Strategy22 and helps the Member States to 
reach the UN Sustainable Development Goals and targets23. In addition, EU4Health supports 
the development and evaluation of almost all EU health priorities and legislative acts. 

Intervention logic architecture  

The intervention logic (see Figure 2) reflects the complex interlinkages between the EU4Health 
Programme’s intentionally broad specific objectives and those of the EU health policies and 
legislation that are building the European Health Union. The intervention logic is structured 
around  4  general  objectives,  10  specific  objectives,  and  5  strands.  The  strands  –  Crisis 
preparedness,  Health  promotion  and  disease  prevention,  Health  systems  and  healthcare 
workforce, Digital and the fight against Cancer – stem out from the annual work programme’s 
structure.  They  aim  to  simplify  and  facilitate  communication  and  reflect  the  approach  to 
interact  with  Programme  beneficiaries  and  stakeholders  during  programming  and 
implementation. The Programme’s intervention logic is further detailed in the PPMEF24. 

Problems and needs 

In 2020, the European Union was faced with significant health-related challenges that required 
a coordinated and comprehensive response. Key areas of concern included: 

• 

the COVID-19 pandemic and other cross-border threats to health, which highlighted 
the need for strong and proactive public health measures;  

•  preventing  and  managing  infectious  diseases,  including  combating  antimicrobial 

• 

• 

• 

• 

• 

• 

• 

• 

resistance, which are a pressing concern that required attention and action;  
the  burden  of  non-communicable  diseases  (NCDs)  such  as  cancer,  cardiovascular 
diseases, mental health and associated long-term care, which had a significant impact 
on health outcomes and required attention and action;  
cancer, a leading cause of death in the EU that required prioritised research, improved 
access to high-quality care, and more effective screening programmes;  
improving  the  management  of  rare  diseases,  including  by  developing  high-impact 
prevention practices and strengthening the ERNs (European Reference Networks);  
addressing healthcare inequalities and unequal access to healthcare, which undermine 
health outcomes and required targeted efforts to address; 
addressing vaccine hesitancy and misinformation, which could undermine public health 
efforts and compromise the effectiveness of vaccination campaigns;  
improving  health  literacy,  which  is  critical  for  empowering  individuals  to  make 
informed decisions about their health; 
strengthening  the  healthcare  workforce  and  healthcare  systems,  promoting  digital 
transformation, and addressing health determinants;  
ensuring the interoperability of electronic health records, while protecting patient data 
and maintaining confidentiality, and addressing cybersecurity threats; 

22   EU GLOBAL HEALTH STRATEGY - Better Health for All in a Changing World. 
23  

In particular Sustainable Development Goal 3 ‘Ensuring healthy lives and promote well-being for all at all 
ages’  and  in  particular  but  not  exclusively  Target  3.4,  namely,  to  reduce  premature  mortality  from  non-
communicable diseases by one third by 2030 through prevention and treatment and to promote mental health 
and well-being; UN resolution of 25 September 2015. 

24   See footnote 66.  

7 

 
 
• 

• 

• 

• 

• 

• 

• 

addressing the varying levels of digital health literacy among healthcare professionals 
and patients, which could lead to unequal access to digital health services; 
the digital transition also raised questions about the role of artificial intelligence, the 
use  of  data  analytics,  and  the  need  for  a  robust  data  governance  framework  in 
healthcare; 
improving access to quality, patient-centred, outcome-based healthcare and related care 
services, with the aim of achieving universal health coverage; 
ensuring access to medicines and medical devices, which were threatened by shortages 
and lack of affordability;  
addressing challenges related to the production and disposal of medicines and medical 
devices, and the regulation of substances of human origin;  
supporting  the  development,  implementation,  and  enforcement  of  Union  health 
legislation, and promoting the use of health impact assessments of other relevant EU 
policies;  
supporting  global  commitments  and  health  initiatives,  including  by  reinforcing  the 
EU’s  support  for  action  by  international  organisations,  such  as  the  World  Health 
Organization (WHO).  

A comprehensive and coordinated approach, involving Member States and health stakeholders, 
was needed to address these and other health challenges. The EU4Health Programme provides 
a crucial framework to address these challenges in the EU and promote a healthier European 
population and more resilient economy. 

EU4Health  intervention  implements  the  European  Health  Union’s  priorities  and  related 
policies and legislation, addressing problems identified at the time of the EU4Health proposal 
preparation and until its adoption by the co-legislators. 

8 

 
Figure 2 The EU4Health intervention logic  

9 

 
 
 
Programme objectives 

The general and specific Programme objectives are broad, aligned with the  priorities of the 
European Health Union25, and closely interlinked with the objectives of the legislative and non-
legislative  EU  health  initiatives  that  the  Programme  supports  financially.  The  4  general 
objectives (in italics, below) are pursued through 10 specific objectives ((a) to (j))26: 

General objective 1: Protecting people in the Union from serious cross-border threats to health 

➢  Protect  people  from  serious  cross-border  health  threats  and  strengthen  the  EU’s 

prevention, preparedness and rapid response capability (b)27; 

➢  Complement national stockpiling of essential crisis-relevant products at EU level (d);  
➢  Establish a structure and training resources for a Union reserve of medical, healthcare 

and support staff (e);  

General objective 2: Improving and fostering health in the Union 

➢  Improve disease prevention and health promotion, including cancer, and address health 

determinants and health inequalities (a); 

General  objective 3:  Improving  the availability,  accessibility and affordability of  medicinal 
products and medical devices, and crisis-relevant products in the Union 

➢  Improve access to medicinal products, medical devices, and crisis-relevant products (c);  

General objective 4: Strengthening health systems 

➢  Promote  the  digital  transformation  of  healthcare  and  strengthen  health  data,  and  the 

uptake of digital tools and services (f); 

➢  Enhance access to healthcare towards achieving universal health coverage (g); 
➢  Facilitate integrated work on national health systems among Member States through 
Health  Technology  Assessment  (HTA),  European  Reference  Networks  (ERNs)  and 
other transnational networks (i); 

Horizontal specific objectives 

➢  Support the development, implementation, enforcement and revision of Union health 

legislation as well as evidence-based decision-making (h); 

➢  Support global commitments and health initiatives (j).  

The implementation of measures to attain the specific objectives aims to ensure a high level of 
protection of human health in all EU policies and activities, keeping with the ‘One Health’28 
approach, where applicable. The specific objectives are generally operationalised and progress 

25   European  Commission  Communication  on  Building  a  European  Health  Union:  Reinforcing  the  EU’s 

26  

resilience for cross-border health threats, COM(2020)724 final.  
In  order  to  simplify  the  illustration,  the  specific  objectives  are  presented  without  the  detailed  areas  of 
intervention mentioned in Article 4 of the EU4Health Regulation.  

27   The letter indicates the correspondence with the specific objectives (a), (b), (c), (d), (e), (f), (g), (h), (i) or (j) 

from Article 3 of theEU4Health Regulation. 

28   One Health is defined as an integrated, unifying approach that aims to sustainably balance and optimise the 

health of people, animals, and ecosystems. You can find more information on the Commission webpage. 

10 

 
 
 
 
 
 
towards  the  targets  is  measured  by  using  Programme  output  and  results  indicators.  Impact 
indicators remain to be defined. The specific objectives include specific policy areas that are 
not  covered  by  the  Programme  indicators,  and  these  are  measured  using  the  action-level 
indicators defined and included in the funding agreement by the contracting authority and/or 
the  beneficiary  in  agreement  with  the  contracting  authority  (see  Programme  Performance 
Monitoring and Evaluation Framework – PPMEF initial assessment in Section 3). 

Inputs 

The EU4Health inputs consist of the Programme’s budget, the annual work programmes, their 
budget, and the human resources necessary for programming and implementation. According 
to the EU4Health Regulation, at least 20% of the Programme budget must be reserved for 
health promotion and disease prevention. The Programme should invest no more than 12.5% 
of  its  budget  in  procurement  to  complement  national  stockpiling  of  essential  crisis-relevant 
products and no more than 12.5% in supporting global commitments and international health 
initiatives and spend a maximum of 8% on administrative expenses29. The initial Programme 
budget of EUR 5.8 billion was reduced to EUR 4.6 billion30 by the revision of the 2021-2027 
MFF that redeployed funds across the EU budget, including from EU4Health31. The redeployed 
funds  were  allocated,  among  other  things,  to  meet  Ukraine’s  immediate  needs,  to  support 
Ukraine’s  recovery  and  its  European  path,  and  to  address  the  needs  related  to  migration 
pressures, strengthen global partnerships and respond to emergencies. 

29   Article 5(4) of the EU4Health Regulation (OJ L 107, 26.3.2021). 
30   The  initial  EU4Health  budget  was  EUR  5.775  billion.  The  multiannual  financial  framework  revisions 
reduced  it  by  EUR  1  billion.  Furthermore,  there  were  net  decreases  for  compensation  of  agency 
reinforcements of EUR 253 million and net increases of around EUR 40 million, leading to an overall budget 
amounting to EUR 4.562 billion. 

31   Council  Regulation  (EU,  Euratom)  2024/765  of  29 February 2024  amending  Regulation  (EU,  Euratom) 
2020/2093 laying down the multiannual financial framework for the years 2021 to 2027 (OJ L, 2024/765, 
29.2.2024). 

11 

 
 
 
 
Figure 3 The links between the EU4Health Programme and the European Health Union: management 
and beneficiaries (Source: 2023 Programme performance statement for 2024 draft budget) 

In addition to the above legal obligation, other budget pre-allocations (Figure 3) need to be 
considered and are included in the legal financial statements32 that accompanied the legislative 
proposals. For example, those linked to the creation of HERA33 (EUR 2.176 billion for 2022-
2027), Regulation (EU) 2022/237134 (EUR 360.5 million), the European Health Data Space 
Regulation35  (EUR  280  million),  or  the  Medical  Devices36  and  In  Vitro  Diagnostic  Medical 
Devices  Regulations37  (EUR  55  million),  etc.  Some  pre-allocations  are  included  in  relevant 
non-legislative EU health initiatives, for example, Europe’s Beating Cancer Plan (EUR 1.25 
billion)38.  

The  EU4Health  Programme  budget  is  implemented  through  annual  work  programmes39, 
adopted  by  the  Commission  following  a  positive  opinion  of  the  Member  States  in  the 
EU4Health Programme Committee and building on relevant stakeholders’ views. The annual 
EU4Health programming process is based on the Commission’s analysis of the gap between 
the  current  state  of  implementation  and  the  desired  one,  as  prescribed  by  the  Programme’s 
specific objectives. The Programme’s priorities and strategic orientations are defined based on 
stakeholders’ input and in consultation with the Member States to ensure the implementation 
of the EU’s health policy objectives. 

The  ‘strands’  of  the  Programme  cover  one  or  more  specific  objectives:  Strand  1  –  Crisis 
preparedness40,  Strand  2  –  Health  promotion  and  disease  prevention41,  Strand  3  –  Health 
systems and healthcare workforce42, Strand 4 – Digital43, and the fight against Cancer (Cross-

32   The legal financial statements (LFS) accompanying the legislative proposals include the estimated financial 
impact  of  the  proposal  on  appropriations.  The  LFS  therefore  pre-allocates  a  certain  budget  to  the  future 
initiative. To successfully implement the adopted initiative the EU is expected to invest those funds effective 
and efficiently.  

33   LFS of the Proposal for a Council Regulation on a framework of measures for ensuring the supply of crisis-
relevant medical countermeasures in the event of a public health emergency at Union level COM(2021) 577 
final. 

34   LFS of the Proposal for a Regulation of the European Parliament and of the Council on serious cross-border 

threats to health and repealing Decision No 1082/2013/EU COM(2020)727 final. 

35   LFS of the Proposal for a Regulation of the European Parliament and of the Council on the European Health 

Data Space COM(2022)197 final. 

36   Proposal for a Regulation of the European Parliament and of the Council on medical devices, and amending 
Directive 2001/83/EC, Regulation (EC) No 178/2002 and Regulation (EC) No 1223/2009 COM/2012/0542 
final. 

37   LFS of the Proposal for a Regulation of the European Parliament and of the Council on in vitro diagnostic 

medical devices COM(2012)541 final.  

38   See footnote 19. 
39   The  annual  financing  decision,  constituting  the  annual  work  programme  for  the  implementation  of  the 
EU4Health programme for a particular year, is set out in Annex I of the Commission implementing decision. 
The  European  Commission  adopts  implementing  decisions  pursuant  to  Article  17(2)  of  the  EU4Health 
Regulation on the ‘Implementation of the Programme’.  
Includes mainly actions implementing the Programme specific objectives (a,) (b), (c), and (j). 
Includes mainly actions implementing the Programme specific objective (a). 
Includes mainly actions implementing the Programme specific objectives (c), (e), (g), and (i). 
Includes mainly actions implementing the Programme specific objective (f). 

40  
41  
42  
43  

12 

 
 
cutting strand)44. The strands are complemented by cross-cutting actions to improve evidence-
based legislation45 and global health46.  

The Programme is implemented mainly in direct management (90.2% of the total budget) by 
the Commission or the executive agency and uses various forms of EU funding47 for grants48, 
procurements49  and  prizes.  International  organisations  pre-selected  following  ‘pillar 
assessment’50 by the Commission, implement the Programme in indirect management (9.8% of 
the total budget) through contribution agreements and co-delegations. For grants the co-
financing rate is up to 60%, or up to 80% in cases of exceptional utility, and 100% in the case 
of direct grants. Though EU4Health supports innovation, so far it has not funded actions via 
precommercial procurement51 or public procurement of innovative solutions52.  

DG  SANTE  and  HERA,  also  referred  as  the  parent  DGs,  are  responsible  for  the  annual 
programming  of  their  respective  budgets.  HaDEA  implements  part  of  the  annual  work 
programme  as  delegated  by  the  parent  DGs.  A  limited  number  of  procurements  and  all  the 
contribution agreements are launched and monitored by the parent DGs. 

The link between problems and needs, actions and activities, results and impacts 

Actions  funded  by  EU4Health  implement  the  European  Health  Union’s  priorities  and 
contribute to the objectives of the EU Global Health Strategy, addressing problems that were 
identified at the time of the EU4Health proposal preparation and until its adoption by the co-
legislators. 

Protecting people from serious cross-border health threats 

Cross-border threats to health arise from pathogens such as viruses (e.g. pandemic influenza 
A(H1N1) pdm09, Ebola, Zika, SARS-CoV-2 or Mpox) that can emerge at any time or may be 
of  a  continuous  nature  such  as  antimicrobial  resistance  (AMR).  In  recent  years,  AMR  has 
emerged as a major global health threat, with the potential to undermine the effectiveness of 
modern  medicine.  The  overuse  and  misuse  of  antibiotics  have  led  to  the  development  and 
transmission of resistant bacteria in healthcare and intensive care units, which are also resistant 
to  new  antibiotics,  making  infections  harder  to  treat  and  threatening  patients’  lives.  These 
threats are a pressing issue that needs to be addressed at EU level because they pose a serious 

Includes mainly actions implementing the Programme specific objectives (a), (c), (f), (g), (h), (i) and (j). 
Includes mainly actions implementing the programme specific objective (h). 
Includes mainly actions implementing the programme specific objective (j). 

44  
45  
46  
47   Reimbursement of eligible costs actually incurred and unit costs; see Article 125 of the Financial Regulation 

(EU, Euratom) 2024/2509 (recast). 

48   Action grants and operating grants are awarded following competitive calls for proposals. The action grants 
may be awarded without competition to support the collaborative work of Member State authorities (joint 
actions) or to set up Europe-wide structures (e.g. European reference laboratories) or national bodies (e.g. 
data access bodies).  

49   Such as, competitive open procedure, restricted procedure, negotiated procedure;, or joint procurement; see 

Articles 167 and 168 of the Financial Regulation (EU, Euratom) 2024/2509 (recast). 

50   The  ex-ante  pillar  assessment  checks  if  entities  to  be  entrusted  by  the  Commission  with  budget 
implementation tasks under indirect management demonstrate  a level of protection of the EU’s financial 
interests equivalent to that existing when the Commission implements the budget itself. 

51   Precommercial procurement concerns the research and development (R&D) phase before commercialisation. 
For details, see Communication from the Commission on Pre-commercial Procurement: driving innovation 
to ensure sustainable high-quality public services in Europe, COM(2007) 799 final. 

52   Public Procurement of Innovative solutions. 

13 

 
 
hazard  to  Europe  and  globally,  with  the  potential  to  significantly  impact  public  health  and 
disrupt societies and economies.  

To  address  cross-border  threats  to  health  and  achieve  better  preparedness,  the  EU4Health 
Programme  finances  actions  that  help  provide  a  clearer  understanding  of  the  risks  and 
challenges posed by cross-border threats, increase the availability of medical countermeasures, 
increase coordination and planning at Member State and EU level, strengthen the resilience of 
health systems, and support a global health strategy. 

Supporting  the  development  of  surveillance  activities,  data  gathering  and  information 
exchange will  help  improve  our  knowledge, understanding  and rapid  detection  of risks  and 
challenges. The financing of IT platforms, communication modules, laboratory capacity and 
surveillance systems in the EU and the rest of the world will also provide timely information 
for prevention and early response.  

By investing in  the  late-stage  development,  manufacturing,  procurement  and distribution of 
medical  countermeasures  we  can  ensure  that  the  necessary  tools  are  in  place  to  respond 
effectively to these threats. The EU4Health Programme finances actions to improve the ever-
warm capacity for the production of essential medicines, put procurement processes in place 
and ensure supply chains for essential crisis-relevant products, as well as actions that support 
the  national  stockpiling  of  such  products.  The  actions  should  incentivise  the  industrial 
development  of  new  antimicrobials  and  alternative  treatments  to  replace  existing  ones, 
resulting in a reserve of treatments against microbes that have developed multiple resistance. 
Prevention  will  also  be  improved  by  reducing  antimicrobial  consumption,  together  with 
improved infection prevention and control practices in hospitals and long-term care facilities, 
as well as  improved surveillance and monitoring of antimicrobial  resistance combined with 
enhanced global cooperation to track its spread. 

By  facilitating  and  supporting  collaboration  and  the  exchange  of  best  practices  between 
Member States, the EU4Health Programme contributes to a better alignment of existing and 
new national plans, including on AMR. EU4Health includes actions that finance the creation 
of an EU prevention, preparedness and response plan, which complements the national plans 
in a coherent manner. Regular stress tests, simulation exercises and reviews with the Member 
States  provide  Member  States  with  the  necessary  knowledge  to  keep  updated  effective 
prevention, preparedness and response plans.  

Building up capacities to prepare, prevent and manage health crises will make health systems 
more resilient. Financing the training of trainers on preparedness and the response to serious 
cross-border health threats and AMR will help to disseminate knowledge within Member States 
and  improve  the  capacities  of  national  healthcare  services  and  the  skills  of  the  healthcare 
workforce. The EU4Health Programme supports the development of plans and procedures to 
coordinate hospitals’ responses to health crises by combining these measures a more robust 
framework for addressing health threats is being created.  

By supporting international health initiatives and enhancing cooperation with the WHO, the 
EU4Health  Programme  is  helping  to  build  global  resilience  and  strengthen  international 
partners’  capacity  to  prevent,  withstand  and  effectively  respond  to  health  crises.  Fostering 
collaboration  with  EU  candidate  countries  on  medical  countermeasures,  promoting  the 
exchange of knowledge and best practices, and strengthening the prevention, preparedness and 
response  capacities  for  all  threats  (chemical,  biological  and  radio-nuclear)  in  Ukraine  and 

14 

 
neighbouring  countries,  are  expected  to  improve  their  health  systems’  preparedness  and 
response capacity. 

The  success  of  these  actions  depends  on  national  implementation,  which  is  influenced  by 
national  policies  and  the  national  budget  available.  The  successful  implementation  of  these 
measures is expected to result in better prevention, a rapid alert system and a more effective 
response  to  cross-border  threats.  This  can  be  observed  through  the  efficient  distribution  of 
goods and services needed in times of crisis. By taking proactive and coordinated action at EU 
and national level, healthcare systems become more robust and resilient, and better equipped 
to address the challenges posed by cross-border threats to health. The availability of alternative 
treatments  should  lead  to  improved  patient  outcomes  and  reduced  morbidity  and  mortality 
associated  with  AMR.  A  reduction  in  the  spread  of  antimicrobial-resistant  microorganisms, 
together  with  better  treatment,  will  reduce  the  economic  burdens  associated  with  AMR, 
including the costs of medical care and loss of productivity. The EU’s efforts to address cross-
border  threats  to  health,  including  AMR  as  a  major  public  health  concern,  are  helping  to 
improve global health security. Thus, the Programme will contribute to the effective protection 
of people from serious cross-border threats to health. 

Improving and fostering health in the EU 

Non-communicable diseases, including cancer, diabetes and cardiovascular and neurological 
diseases,  which  reduce  life  expectancy  and  quality  of  life,  account  for  around  80%  of  the 
disease burden in the EU. Up to 80%53 of cases of premature heart disease, strokes and diabetes 
are  preventable  by  reducing  major  risk  factors  such  as  tobacco  use,  harmful  alcohol 
consumption, unhealthy diets, physical inactivity, air pollution and exposure to carcinogenic 
agents and radiation. 

Improving  and  fostering  health  in  the  EU  requires  a  holistic  and  comprehensive  approach. 
Investment in health promotion and disease prevention are crucial for creating a healthier and 
more productive society and economy. This not only improves the quality of life of people and 
communities,  but  also  reduces  healthcare  costs,  increases  productivity  and  addresses  health 
inequities. 

For example, in 2020, 2.7 million people in the EU were diagnosed with cancer, and another 
1.3 million people lost their lives to it. The EU accounted for a tenth of the world’s population, 
but a quarter of the world’s cancer cases. To respond to this issue, the comprehensive Europe’s 
Beating Cancer Plan, which aims to tackle the entire disease pathway, was adopted in February 
2021.  

As  the  mental  health  of  many  people  deteriorated  during  the  COVID-19  pandemic,  major 
actions  were  taken  at  EU  level  under  the  EU4Health  Programme  to  address  mental  health 
diseases  and  their  burden  on  societies  and  economies.  The  EU  continues  to  pursue  a 
comprehensive, prevention-oriented approach to mental health. 

The EU funds the development and transfer of best practices on prevention that EU Member 
States can implement through their policies and programmes to promote healthy behaviours 
and provide access to healthy food and physical activity. Financial support is necessary to adapt 
the legislation that encourages behavioural changes and addresses health inequalities and health 
determinants. Actions under the EU4Health Programme that aim to develop communication 

53   World Health Organization (WHO) Noncommunicable diseases. 

15 

 
 
strategies,  identify  barriers  and  facilitators,  raise  awareness,  train  health  professionals,  and 
exchange  of  best  practices,  should  allow  Member  States  to  improve  various  prevention 
activities such as cancer screening, vaccination campaigns, and many more. 

EU4Health  finances  actions  that  facilitate  data  sharing  and  collaboration  between  Member 
States through the development of health information systems, including the development of 
health information frameworks that help track NCDs and monitor their impact. These actions 
should lead to a better understanding of these diseases including related mortality, morbidity 
and the prevalence of  risk factors. Such improved understanding  would  make it possible to 
design and support the development of new diagnostic tools and technologies to improve the 
accuracy and timeliness of diagnosis. By strengthening surveillance and diagnosis, the trends 
and  patterns  in  NCDs  can  be  identified,  which  will  help  support  Member  States  to  make 
informed decisions about  resource  allocation. Providing financial support  for screening  and 
early  detection  methodologies  and  diagnostic  tools  such  as  genetic  profiling  would 
complement early detection measures, in particular for cancer, and help implement the Council 
Recommendation on cancer screening. 

EU4Health  funding  supports  the  sharing  of  best  practice  and  the  creation  of  networks  of 
expertise  that  focus  on  innovative  treatment,  care  models  development  and  solutions  to 
addressing the challenges of long-term care. Direct support to patient groups and vulnerable 
groups  will  make  it  possible  to  identify  and  better  address  their  specific  needs  in  care  and 
treatment. The creation of inequalities registers can help Member States to map disparities in 
treatment and care and thus focus their action on closing these gaps. For cancer patients, access 
to  high-quality  information  and data  are  expected to  be facilitated through digital tools and 
online  platforms,  improving  also  patient-clinician  relationships.  This  leads  to  better 
communication and more personalised care.  

The actions funded will provide national health authorities and care facilities with tools and 
knowledge that they can implement to improve their public health policies to better tackle non-
communicable  diseases,  with  a  particular  focus  on  cancer.  If  Member  States  put  in  place 
initiatives and funding for implementation, this will lead to long-term results such as reduced 
premature mortality, improved cancer survival rates, improved quality of life, and a reduction 
in the burden of NCDs and related risk factors. This approach is expected to improve health 
outcomes,  reduce  healthcare  costs,  increase  productivity  and  reduce  health  inequalities.  By 
working  together,  the  EU  and  its  Member  States  can  create  a  healthier  and  more  resilient 
population, in line with the EU’s goals of improving health promotion, preventing disease and 
reducing  health  inequalities.  This  strand  will  thus  help  the  Member  States  to  reach  the  UN 
SDGs and targets54, and the relevant WHO global NCD targets for 202555. 

Improve  the  availability,  accessibility  and  affordability  of  medicinal  products  and  medical 
devices 

It  is  challenging  to  ensure  that  patients  across  the  EU  have  access  to  essential  healthcare 
resources, including medicinal products and medical devices, due to high costs, disparities in 
access, and regulatory complexities.  

54   UN resolution of 25 September 2015. In particular, Sustainable Development Goal 3 Ensuring healthy lives 
and promote well-being for all at all ages and its Target 3.4, namely, to reduce premature mortality from 
non-communicable diseases by one  third by 2030 through prevention and treatment and promote mental 
health and well-being. 

55   Set of nine voluntary global NCD targets for 2025, World Health Organization 2022. 

16 

 
 
To achieve this objective, the EU4Health Programme provides funding for actions aiming to 
promote the development and availability of generic and biosimilar medicines; improve the 
regulatory  framework  for  pharmaceuticals,  including  through  capacity  building  in  the 
competent  authorities  for  medicines  in  the  Member  States;  support  health  technology 
assessments (HTAs); and increase laboratory and production capacities for medicines, medical 
devices  and  health  crisis  medical  countermeasures.  A  robust  and  harmonised  regulatory 
framework  for  pharmaceuticals  and  medical  devices  will  facilitate  the  development, 
authorisation  and  marketing  of  medicinal  products  and  medical  devices  that  are  safe  and 
effective. Such a framework will also incentivise industry to invest in the EU market and thus 
ensure the availability of these products. Accessibility, availability and affordability of medical 
products  in  Member  States  depends  on  national  pricing  and  reimbursement  policies. 
EU4Health  provides  financial  support  for  the  implementation  of  the  HTA  Regulation56,  for 
example  for  the  training  and  capacity  building  of  national  assessors  and  for  the  training  of 
patients’  experts.  The  expected  output  includes  improved  coordination  and  collaboration 
between Member States and experts through the consolidation of knowledge and experience 
on joint HTA work.  

Supporting the development of generic and biosimilar medicines is expected to increase their 
availability and to have a long-term positive impact on access to affordable medicines, reducing 
healthcare  costs  and  improving  access  to  treatment  for  patients.  Disparities  in  access  to 
healthcare  across  the  EU  will  be  reduced,  ensuring  that  all  patients  have  equal  access  to 
essential healthcare resources.  

The development of laboratory and production capacities for medicines, medical devices and 
crisis countermeasures will improve the EU’s ability to respond to public health emergencies. 

Strengthen health systems 

The  EU’s  health  systems 
fragmented  and 
face  significant  challenges, 
underdeveloped  systems,  limited  capacity  for  health  research  and  innovation,  healthcare 
inequalities, insufficient adaptation to digital developments as well as inadequate planning for 
and skill gaps in the health workforce. To address these challenges, the EU4Health Programme 
aims to strengthen Europe’s health systems by improving access to healthcare with a special 
focus on healthcare for vulnerable groups. It will also tackle these challenges by promoting the 
digital transformation of healthcare and by improving training and planning for the healthcare 
workforce. 

including 

To achieve this objective, EU4Health supports the development of EU legislation on health 
issues, as well as capacity building and networking efforts to enhance collaboration between 
national,  regional  and  local  authorities,  facilitate  more  effective  healthcare  planning  and 
delivery and improve  access  to  healthcare.  EU  funding  would also  strengthen collaboration 
between Member States to: address common health challenges; facilitate the development of 
guidelines  and  health  services  across  borders;  spur  research,  development  and  the  use  of 
innovative solutions in healthcare; support the exchange of knowledge and good practices to 
help health systems become more efficient, resilient and sustainable. 

To  improve  access  to  healthcare  for  vulnerable  populations,  including  Roma,  migrants, 
refugees (including people displaced from Ukraine) and people with a disability, EU4Health 

56   Regulation (EU) 2021/2282 of the European Parliament and of the Council of 15 December 2021 on health 

technology assessment and amending Directive 2011/24/EU (OJ L 458, 22.12.2021). 

17 

 
 
finances  actions  to  improve  health  literacy  and  health  promotion,  particularly  in  rural  and 
remote areas. To tackle rare diseases, the Programme finances the creation and integration of 
European networks for rare diseases, bringing  together specialised healthcare providers and 
experts to improve diagnosis and the coordination of care. This includes the development and 
implementation  of  standardised  care  pathways  and  guidelines,  as  well  as  the  provision  of 
training  and  capacity-building  programmes  for  healthcare  professionals.  By  reducing 
healthcare  inequalities,  the  Programme  will  help  implement  the  European  Pillar  of  Social 
Rights and help reduce poverty and social exclusion. 

Moreover, the EU4Health Programme provides funding and support for the development of 
digital  building  blocks  like  the  European  Health  Data  Space  (EHDS),  the  electronic  health 
records  (EHRs)  system,  and  data  analytics  capabilities.  Supporting  the  development  of 
telemedicine  and  telemonitoring  can  improve  access  to  health  services  for  populations  in 
medical deserts, reduce the costs of long-term care and healthcare services, and support longer 
independent living. The Programme is expected to drive increased national investment in the 
digital  transformation  and  a  skilled  healthcare  workforce,  fuelling  innovation  in  health  and 
improving  health  outcomes,  and  allowing  healthcare  providers  to  use  interoperable  digital 
health tools  and services  across  the  EU. Ultimately,  the  EU’s  efforts  to  promote  the digital 
transformation of healthcare will have a significant impact on the healthcare sector, leading to 
the development of sustainable digital healthcare systems, improved health outcomes, higher 
quality care for patients, and a continued boost in efficiency and productivity. 

The EU provides funding and support for the development of skills in the healthcare workforce 
that are necessary for the digital transformation of health systems, and innovative solutions for 
quality  healthcare  services.  The  Programme  also  aims  to  enhance  the  resilience  and 
sustainability of the healthcare workforce, addressing issues related to working conditions and 
workers’ mental health. The expected results of these efforts include improved capacities in 
Member States to plan, recruit and train a skilled and flexible healthcare workforce. 

The actions funded by EU4Health provide Member States with building blocks and tools that 
they can use to improve their national health systems. To do this, Member States must make 
the  necessary  human  and  financial  resources  available.  Ultimately,  the  expected  impacts 
include: improved access to healthcare; reduced health inequities; improved health and well-
being  for  people  in  the  EU,  with  the  costs  of  healthcare  contained;  the  enhanced  economic 
competitiveness  and  productivity  of  the  EU’s  healthcare  sector;  increased  cooperation  and 
collaboration  between  Member  States  on  health  policy  and  healthcare  delivery;  improved 
resilience of health systems and preparedness for future health challenges;  a lasting impact on 
health systems across the EU.  

2.1.5 Expected achievements at the time of the evaluation  

By April 2024, it was expected that the  Programme’s governance and the programming 
and implementation processes would be well established in the parent DGs and HaDEA, and 
that the parent DGs and HaDEA would be delivering annual work programmes on time, making 
amendments  as  necessary,  and  implementing  the  Programme  and  executing  the  budget 
according to the responsibility of each contracting authority57. 

In terms of crisis preparedness, most of the actions were planned to focus on a rapid response 
to the COVID-19 pandemic, the preparatory actions to implement Regulation (EU) 2022/2371 

57   DG SANTE, HERA or HaDEA. 

18 

 
 
on serious cross-border threats to health58 (as well the provisions of its predecessor59), to address 
the consequences of the pandemic, and increase the preparedness of Member States and the 
EU  in  case  of  a  new  pandemic.  The  EU  must  be  ready  to  ensure  the  development, 
manufacturing, procurement and equitable distribution of key medical countermeasures in line 
with the mission and work plans of HERA60. The Programme’s milestones61 provide that 27 
Member  States  were  expected  to  report  an  increased  level  of  preparedness  and  response 
planning62  and  18  Member  States  were  to  have  improved  their  preparedness  and  response 
planning for medical countermeasures by 2023i. By mid- or end- 2024, it was expected that 20 
actions would contribute to the fight against communicable diseasesii, 26 Member States and 
associated countries would be participating in more than one EU action to improve prevention, 
preparedness  and  response  planning  for  serious  cross-border  threats  to  healthiii,  and  that  3 
Member States and associated countries would have improved their procurement procedures 
for  medical  countermeasures  during  a  health  crisisiv.  At  least  one  Member  State  and  or 
associated  country  should  have  increased  its  laboratory  and  diagnostic  capacity  for  cross-
border health threats, contributing to the mission of HERAv. 

By mid-2024, it was expected that the Programme would have financed five actions aimed at 
complementing  national  stockpiling  of  essential  crisis-relevant  products,  and  that  five 
Member  States  or  associated  countries  would  be  participating  in  the  joint  action  on 
stockpilingvi. 

It  was  also  envisaged  that  the  Programme  would  finance,  in  synergy  with  other  EU  funds, 
actions  putting  in  place  a  structure  and  training  resources  for  a  reserve  of  medical, 
healthcare and support staff allocated voluntarily by Member States for mobilisation in the 
event of a health crisis. By mid-2024, training actions on preparedness and response to cross-
border  health  threats,  targeting  healthcare  staff  and  public  health  staff63,  and  on  medical 
countermeasuresvii,  were  to  reach  955  participants,  and  the  participants’  satisfaction  rate  in 
HERA training programmesviii was to reach 85%. 

On the ‘One Health’ approach, new investments were expected to contribute to the late-stage 
development  and  uptake  of  new  medical  countermeasures,  as  well  as  to  support  actions 
implementing the Council Recommendation on stepping up EU action to combat antimicrobial 
resistance64 in the areas of human health, animal health and the environment. It was projected 
that the One Health surveillance programmes would have been successfully implementedix in 
23  countries  by  mid-2024.  In  addition,  the  antimicrobial  consumption  for  systemic  use  of 

58   Regulation (EU) 2022/2371 of the European Parliament and of the Council of 23 November 2022 on serious 

cross-border threats to health and repealing Decision No 1082/2013/EU (OJ L 314, 6.12.2022).  

59   Decision No 1082/2013/EU of the European Parliament and of the Council of 22 October 2013 on serious 

cross-border threats to health and repealing Decision No 2119/98/EC. 

60   European  Commission  Communication  on  Introducing  HERA,  the  European  Health  Emergency 
preparedness  and  Response  Authority,  the  next  step  towards  completing  the  European  Health  Union, 
COM(2021)576 final. 
In most cases they are set in 2024 and in few cases in a preceding (e.g. 2023) or subsequent year (e.g. 2026). 
expected data at the time of evaluation stems from the Programme indicators’ milestones set usually in 2024; 
see PPMEF also for more details. 

62  The  Roman  numbers  e.g.  ‘i’  indicate  an  endnote  that  is  found  at  the  end  of  this  document.  To  improve 
readability, repetitive references to the programme indicators are presented in the ‘endnote’ section of this 
document. 

63   Regulation 2022/2371, Article 11, Train the trainers. 
64   Council Recommendation on stepping up EU actions to combat antimicrobial resistance in a One Health 

approach, (OJ C 220, 22.6.2023). 

19 

 
 
anatomical  therapeutic  chemical  (ATC)  group  J01x  was  expected  to  decrease  by  almost  2 
measurement units.  

By the time of the evaluation, it was expected that the annual work programmes would include 
actions  supporting  health  promotion  and  disease  prevention,  as  outlined  by  the  Healthier 
together EU NCD initiative,65 and help the Member States and associated countries to reach the 
UN Sustainable Developmental Goals. By mid- or end-2024, at least five actions were to be 
financed on reducing avoidable mortality in the area of NCDs and associated risk factorsxi. Ten 
Member  States  were  expected  to  implement  and  roll  out  at  the  national  level  EU-funded 
projects on ‘best’ and ‘promising’ practices in health promotion, disease prevention and health 
inequalities. In addition, at least one action was to be funded on addressing the prevalence of 
the harmful use of alcoholxii and four on addressing environmental risk factors for healthxiii. By 
the same deadline, six Member States should have reached 95% coverage for both the first and 
second dose of the measles vaccine for eligible individuals, one Member State was expected to 
reach  75%  coverage  for  the  seasonal  influenza  vaccine  in  older  age  groups,  and  it  was 
anticipated  that  two  Member  States  would  reach  at  least  90%  coverage  for  the  human 
papillomaviruses (HPV) full vaccination course (last dose) in eligible girls.  

The  progress  expected  under  the  health  systems  and  healthcare  workforce  strand  is 
proportional  to  the  amount  of  EU  funding  and  greatly  relies  on  the  Member  States’ 
responsibilities enshrined in the EU Treaty66.  

As  a  general  reference  on  expected  outcomes  from  investing  in  health  systems,  a  societal 
multiplier for spending on healthcare and related public health measures of slightly more than 
three  can  be  assumed.  This  is  based  on  an  analysis  of  megatrends  in  historically  reported 
population  health  outcomes,  of  findings  from  the  literature  on  the  role  of  healthcare 
investments  in  improved  population  health  status  and  using  standard  methods  to  monetise 
health outcomes. Moreover, a recent systematic review67 of the expected return on investment 
for  various  categories  of  health-related  policy  interventions  indicated  a  median  return  on 
investment of 14.3 across reported studies68 for public health interventions, underscoring the 
importance of investing in prevention.  

The Programme’s actions help strengthen national health systems and the health workforce by 
improving  their  resilience  and  resource  efficiency.  Actions  were  expected  to  support  the 
implementation of the HTA Regulation, and the Directive on patients’ rights in cross-border 
healthcare, including as regards the ERNs69.  

By mid-2024, the number of healthcare units involved in ERNsxiv was expected to reach 1 619 
and  the  number  of  patients  referred  to  ERNs  whose  cases  are  reviewed  by  the  members  of 
ERNs to reach 1.5 million.  

65   Healthier Together EU Non-Communicable Diseases Initiative. 
66   Article 168 (7) of the Treaty on the Functioning of the European Union. 
67   Masters R, Anwar E, Collins B,  et  al.,  Return  on  investment  of  public  health  interventions:  a  systematic 

review, J Epidemiol Community Health 2017;71:827-834. 

68   Various caveats apply when comparing studies reporting return-on-Investment outcomes, stemming notably 
from  differences  in  calculation  methods,  timeframe  inconsistencies,  cost  and  benefit  definitions.  The 
methodological quality (and comparability) of studies considered for this systematic review was explicitly 
addressed. 

69   Directive 2011/24/EU on the application of patients’ rights in cross-border healthcare. 

20 

 
 
The  Programme  was  expected  to  improve  the  availability,  accessibility  and  affordability  of 
medicinal products, medical devices and crisis-relevant products. It was expected to support 
the implementation of the pharmaceutical strategy for Europe70; the EU regulatory frameworks 
on pharmaceuticals71, medical devices72 and substances of human origin73, and the measures 
proposed in the Communication on addressing medicine shortages in the EU74. By mid- or end 
2024,  the  number  of  single  marketing  authorisations  of  specific  medicines  valid  across  the 
European  Union  should  have  increased  to  96xv,  and  the  number  of  certificates  for  medical 
devices  to  be  placed  on  the  EU  market  were  expected  to  increase  by  a  factor  of  18xvi.  The 
number of certificates for in vitro diagnostic medical devices intended for the EU market was 
expected to increase by a factor of 32xvii. The level of monitoring and reporting on relevant 
shortages of human and veterinary medicines was expected to reach maturity, and the level of 
shortages was expected to remain at 110 reported medicines shortages.xviii. In addition, at least 
three actions were expected to contribute to increasing the security and continuity of global 
supply chains and to address the EU’s dependence on imports from third countries to produce 
essential active pharmaceutical ingredients and medicinal productsxix. It was expected that four 
new producers, and producers with enhanced capacity to increase the security and continuity 
of  supply  of  medical  countermeasures,  raw  materials  and  components  in  the  EU,  including 
‘ever-warm capacities’, would be identifiedxx. Four times more audits were to be conducted in 
the  EU  and  in  third  countries,  including  the  EU  candidate  countries,  to  ensure  that  good 
manufacturing practices and good clinical practices were in place (EU control on compliance 
with these EU minimum standards)xxi. Lastly, three Member States were expected to participate 
in actions to support innovation, uptake and access to the market of medical countermeasures 
at EU and global levelxxii. 

Improvements  were  expected  on  enhancing  access  to  healthcare  with  the  aim  of  achieving 
universal  health  coverage.  By  mid-2024,  at  least  three  actions  were  to  be  financed  on 
producing guidance on improving access to healthcare services.  

The digital strand was expected to support the actions to prepare the implementation of the 
European Health Data Space Regulation75, which aims to advance the digital transformation of 
health  systems  and  the  creation  of  a  European  Health  Data  Space.  By  mid-2024,  it  was 
projected that the number of actions included under EU4Health work programmes (grants and 
procurements)  to  support  the  digital  transformation  of  healthcare  systems  and  the 
implementation  of  the  EHDS  should  reach  28.  In  addition,  the  number  of  Member  States 
connected  to  MyHealth@EU  and/or  to  the  cross-border  infrastructure  for  secondary  uses 

70   Communication from the Commission to the European Parliament, the Council, The European Economic 
and  Social  Committee  and  the  Committee  of  the  Regions,  Pharmaceutical  Strategy  for  Europe, 
COM(2020)761 final. 

71   A pharmaceutical strategy for Europe. 
72   Regulation  (EU)  2017/745  of  the  European  Parliament  and  of  the  Council  of  5 April 2017  on  medical 
devices, amending Directive 2001/83/EC, Regulation (EC) No 178/2002 and Regulation (EC) No 1223/2009 
and repealing Council Directives 90/385/EEC and 93/42/EEC (OJ L 117, 5.5.2017) , and Regulation (EU) 
2017/746  of  the  European  Parliament  and  of  the  Council  of  5 April 2017  on  in  vitro  diagnostic  medical 
devices and repealing Directive 98/79/EC and Commission Decision 2010/227/EU (OJ L 117, 5.5.2017). 

73   Regulation (EU) 2024/1938 of the European Parliament and of the Council of 13 June 2024 on standards of 
quality and safety for substances of human origin intended for human application and repealing Directives 
2002/98/EC and 2004/23/EC (OJ L, 2024/1938, 17.7.2024). 

74   Communication from the Commission to the European Parliament, the Council, the European Economic and 
Social Committee and the Committee of the Regions, Addressing medicine shortages in the EU, COM(2023) 
672 final. 

75   Proposal for a regulation of the European Parliament and of the Council on the European Health Data Space 

COM(2022)197 final.  

21 

 
 
should more than double, and five times more health data access bodies should be set up by the 
Member States and associated countries. 

Several Programme indicators monitor the progress expected under the cancer strand (a cross-
cutting topic). The number of Member States that have achieved a defined coverage of cancer 
screening among the population was expected to be six for breast cancer and five for cervical 
cancer,  and  to  remain  stable  at  nine  countries  for  colorectal  cancer.  The  percentage  of  the 
population  covered by  cancer  registries  reporting  information  on cervical, breast,  colorectal 
and paediatric cancer at the diagnosis stage was projected to be 60% for each type of cancer.  

On horizontal actions, it was expected that at least two impact assessments, supporting reports 
and staff working documents on EU health policies supported by the Programmexxiii would be 
published.  The  Programme  was  expected  to  finance  14  published  studies  supporting  the 
evaluation,  monitoring  the  implementation,  and  assessing  the  functioning  of  legislative  and 
non-legislative policiesxxiv.  

The Programme contributes to international health initiatives and cooperation supporting the 
implementation of the EU Global Health Strategy, global efforts on pandemic preparedness 
and the implementation of international health legislation. By 2024, it was expected that there 
would  be  19  actions  supporting  global  commitments  and  health  initiatives  concluded  with 
global partnersxxv, that EU and the WHO would collaborate in 9 areasxxvi , and that the EU and 
relevant global partners and EU Member States would coordinate actions in 4 areasxxvii. The 
expected achievements at the time of the interim evaluation as well as the targets for the ex-
post evaluation, including the situation at the time of the evaluation, are presented in Annex 
VII. 

2.2 Point(s) of comparison for the EU4Health intervention  

The  reference  point  of  comparison  for  the  EU4Health  intervention  is  the  2020  situation, 
which existed in the EU and its Member States between the onset of the pandemic early in 
2020  and  June  2021,  when  the  Programme  began  to  be  implemented.  The  baseline  for  33 
Programme indicators is set at 2020, and for 25 indicators the baseline value is zero. In some 
cases,  the  reference  is  the  situation  before  2020  (for  5  indicators)  or  after  2021  (for  14 
indicators), depending on the data available or the time when implementation of the specific 
policy intervention began76. The reference point of comparison for some policy areas and their 
Programme indicators, for example for vaccination coverage for seasonal influenza, was set 
before March 2020 because the data were not available during the baseline period. The baseline 
for some indicators was also set before 2020 because of the lack of available data77. 

The reference point of comparison for some policy areas and their Programme indicators was 
set after March 2021 because the legal base (e.g. the Regulation on serious cross-border threats 
to health, the HTA Regulation) dates from several years after the EU4Health intervention had 
started, or because the data were not available during the baseline period, for example in the 
case  of  vaccination  coverage  for  human  papillomaviruses  (HPV)  and  data  on  the  age-
standardised five-year net survival rate for paediatric cancer (to the extent available)78. 

76   See Annex IV of this document. 
77   Annex I of the PPMEF. 
78   Annex I of the PPMEF. 

22 

 
 
The baselines, milestones and targets for the Programme indicators have been defined as far as 
possible at this stage. The details for all the other indicators are provided in Annex VII. 

The main point  of comparison for assessing  the progress  of the EU4Health  intervention at 
interim stage is the expected situation in 2024 (milestone). The milestone for 44 indicators is 
set as 2024; for 2 indicators it is set before 2024, and after 2024 for 6 indicators, according to 
the availability of data or the stage of implementation of the policy. 

The main point of comparison for the final evaluation of the EU4Health intervention is the 
expected situation in 2027 (target), or in some cases 2030 or 2031  for  actions that will be 
launched under the last annual work programme in 2027. 

The above points of comparison are described qualitatively in Annex VIII based on information 
from the explanatory memorandum of the proposal for an EU4Health Regulation79, the relevant 
recitals  of  the  EU4Health  Regulation80,  the  mid-term81  and  ex  post  evaluation82  of  the  third 
Health Programme83, in relevant reports and evaluations of the various EU health policies, and 
other relevant literature.  

No impact assessment was made for the proposed EU4Health Programme.  

79   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/2020/405 final. 

80   See footnote 1. 
81   European Commission: Directorate-General for Health and Food Safety, Mid-term evaluation of the third 
Office, 

Publications 

report, 

(2014 

2020) 

Final 

– 

Health 
2017, https://data.europa.eu/doi/10.2875/359384. 

Programme 

– 

82   Commission Staff Working Document Evaluation: Final Evaluation of the Third Health Programme 2014-

2020 (SWD(2023)370 final). 

83   The third Health Programme for the years 2014-2020 was established by 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). 

23 

 
 
 
 
3.  HOW HAS THE SITUATION EVOLVED OVER THE EVALUATION PERIOD? 

3.1 Current state of play 

The  EU4Health  programming  process  is  operating  as  expected  and  four  annual  work 
programmes and five amendments were adopted by the Commission by the cut-off date. There 
is a well-established process to consult stakeholders and four consultations, and four events 
have been organised for that purpose. The Member States were initially consulted about the 
programming  for 2021 in an ad  hoc  expert group and, after the adoption of the EU4Health 
Regulation, in 14 meetings of the EU4Health Steering Group. The Member States provided 
their opinion in the Programme Committee, which met on 6 occasions. The Commission made 
amendments to the EU4Health Programme through written procedures. 

At the time of the interim evaluation, the expected achievements consist mainly of outputs (e.g. 
the  number  of  actions  addressing  the  fight  against  communicable  diseases,  the  number  of 
actions contributing to the reduction of avoidable mortality in the area of non-communicable 
diseases and risk factors, etc.). As expected, only a limited number of projects (162) delivered 
results by April 2024, as many of them are still in their early stages. A total of 26 grant final 
reports  and  136  procurements  were  validated  by  the  contracting  authority  and  were  then 
suitable for analysis (e.g. number of Member States and associated countries with improved 
procurement procedures for medical countermeasures during a health crisis, percentage of the 
population  covered by cancer registries  reporting information  on cervical, breast,  colorectal 
and paediatric cancer stage at diagnosis). The impacts are expected to be measurable at a later 
stage, after relevant and significant results have been delivered.  

At the interim stage (by April 2024), the Programme is performing as expected and has made 
substantial financial contributions to the EU’s horizontal priorities such as the digital transition 
(EUR  349.6  million),  gender  equality  (EUR  178.1  million)  and  green  budgeting  (EUR  314 
million). The parent  DGs have programmed about EUR 2.63 billion of expenditure and the 
contracting authority has signed 726 contracts and committed about EUR 1.39 billion, which 
represents more than half (53%) of the programmed budget and covers each specific objective 
(Figure 4; see also Annex VIII).  

Figure 4 Total EU4Health commitments under each specific objective  

24 

 
 
The  commitments  shown  above  include  grants,  procurement,  contribution  agreements  and 
prizes.  

The absorption of EU4Health funding per Member States and their legal entities shows that 15 
Member States and associated countries (see Figure 5) have benefited to a total of EUR 916 
million,  each  receiving  more  than  EUR  20  million.  The  remaining  16  Member  States  and 
associated countries received EUR 163 million, of which 6 have received about EUR 15 million 
and 10 have received about EUR 10 million or less. One country associated to the Programme 
has not managed to access any EU4Health funds (Figure 5). Designated national focal points 
will  intensify  the  promotion  of  the  EU4Health  Programme  and,  where  relevant,  in  the 
dissemination of its results and the information available on its impact in the Member States 
and associated countries. 

Figure 5 Total EU4Health commitments per Member State and Associated non-EU country  

The  grants  beneficiaries  from  22  countries84  are  mainly  national  or  regional  authorities 
nominated by their home country to participate in joint actions or to receive other direct grants. 
The other grant beneficiaries are public health organisations (such as healthcare units, research 
organisations, NGOs, etc.). 

84   Austria, Bulgaria, Croatia, Cyprus, Czechia, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, 

Italy, Latvia, Lithuania, Malta, Netherlands, Norway, Slovenia, Spain, Sweden and Ukraine. 

25 

 
 
 
Figure 6 Total EU4Health commitments through grants per Member States 

HaDEA has managed the largest budget share of procurement of services (Figure 7), which 
were made under the crisis preparedness strand. This includes HERA’s flagship initiatives such 
as EU FAB (the framework contract for the reservation of capacities and a priority right for 
manufacturing of vaccines), which aims to ensure ever-warm facilities for vaccine production. 
The  crisis  preparedness  envelope  also  includes  funding  for  the  development  of  IT  tools  for 
early warning, modelling, simulation and forecasting, as well as to develop and put in place 
infrastructures for the governance of the health data space in Luxembourg. 

Figure 7 Total EU4Health commitments through procurements  with legal entities from 
Member States  

26 

 
 
 
 
Although  EU4Health  supports  innovation,  so  far  it  has  not  funded  any  actions  via 
precommercial procurement85 and public procurement of innovative solutions. 

The  evaluation  supporting  study  found  that  projects  to  support  the  strengthening  of 
preparedness  and  response  capacities  in  the  field  of  medical  countermeasures  are  typically 
awarded  almost  EUR  20  million  each  through  procurement.  Projects  that  support  other  EU 
health priorities, such as implementing the Regulation on serious cross-border threats to health 
or  the  EU  pharmaceutical  framework,  or  which  are  aimed  at  health  promotion  and  disease 
prevention,  or  the health digital transition,  are  typically  granted  around EUR 2.5 million  in 
funding.  

The breakdown of financing per strand (Figure 8) shows that crisis preparedness has received 
close to half of the EU4Health funding so far: 47.7% (EUR 623 million) has been committed 
to actions in this strand. This is followed by 17.2% (EUR 239 million) for health systems and 
15.8% (EUR 220 million) for cancer. For health promotion and disease prevention, the current 
share is 11.2% (EUR 154.4 million). The digital strand has received 9% (EUR 125 million) of 
funding, and 2.3% (EUR 31.4 million) has been committed to other actions.  

Figure 8 Total commitments by strand and specific objectives 

85   See footnote 51, page 13. 

27 

 
 
 
There are a total of 1 274 participants in EU4Health projects. The total EU contribution they 
receive is slightly above EUR 1.39 billion. The main beneficiaries, both in terms of the EU 
contribution  received  and  the  number  of  project  participations,  are  public  entities,  such  as 
national  health  agencies,  institutes  and  laboratories,  national  ministries,  university  hospitals 
and research organisations (see Figure 9)86.  

Figure 9 The main types of EU4Health beneficiaries and % of absorbed budget  

For grants, 303 agreements had been signed by the cut-off date, with 1 162 participants, for a 
total  budget  of  EUR  741.84  million.  The  main  grantees  are  the  public  bodies  of  national 
authorities, research organisations and higher education establishments. 

For procurement, 391 contracts were signed with 104 service providers, committing a total 
budget  of  around  EUR  420.44  million.  The  main  service  providers  are  private  entities  in 
Belgium (service providers in 141 contracts), followed by Luxembourg (104 contracts), Italy 
(21 contracts), Spain (16 contracts), Greece (14 contracts) and the Netherlands (13 contracts) 
as main countries. In terms of the Member States that received the most financing, Ireland is 
in the lead, with over EUR 107 million, followed by Belgium (EUR 63.1 million), Denmark 

86   Other entities, e.g. experts or IT specialists, private entities benefiting from EU4Health funds (procurement 
contracts that were concluded outside the eSubmission system and requiring Participant Identification Code). 

28 

 
 
 
 
 
 
 
 
 
 
(EUR  50  million),  Spain  (EUR  36  million),  the  Netherlands  (EUR  29.72  million),  and 
Luxembourg (EUR 25.86 million) (see Figure 7 for the full list of countries).  

The cumulative financial implementation by April 2024 amounted to EUR 2 215 million87 in 
commitments and EUR 658.2 million in payments88, representing 50.52% and 15.01% of the 
total programmed amount, respectively.  

Overview of the investments by strand with breakdown per specific objective 

Strand 1: Crisis preparedness  

By April 2024, the contracting authorities  had  committed EUR 623 million and signed 103 
financing  agreements  that  contribute  to  the  crisis  preparedness  strand.  EUR 395.69  million 
have been allocated to specific objective (b) on crisis preparedness and response, EUR 110.41 
million to specific objective (c) on improving access to medicinal and medical products, EUR 
79.45 million to specific objective (a) on health promotion and disease prevention, and EUR 
18.86 million contribute to specific objective (j) on global commitments and health initiatives. 
There  are  no  programmed  actions  yet  contributing  to  specific  objective  (e)  on  a  reserve  of 
medical and healthcare staff.  

A total of 70.2% of the budget of the crisis preparedness strand has been committed to actions 
supporting medical countermeasures and intelligence gathering89 and the remaining 29.8% will 
finance  actions  implementing  the  Regulation  on  serious  cross-border  threats  to  health  (e.g. 
setting up European reference laboratories, support for early warning and response capacities, 
the  EU  immunisation  agenda)  including  countermeasures  against  antimicrobial  resistance90. 
These commitments also support the first actions establishing a structure and training resources 
for a reserve of medical, healthcare and support staff. 

On medical countermeasures, several actions were funded by the Commission between 2021 
and  2024.  For  example,  EUR  100  million  were  allocated  to  HERA  Invest,  which  supports 
investments  in  innovative  European  companies  developing  diagnostics,  therapeutics  and 
vaccines  against  priority  cross-border  health  threats  such  as  pathogens  with  high  pandemic 
potential,  AMR,  and  chemical,  biological,  radiological  and  nuclear  (CBRN)  hazards. 
Moreover, the Commission reacted very rapidly to the Mpox outbreak in Africa, mobilising 
EUR 20 million for the purchase of 215 000 doses of Mpox vaccines to be donated to the Africa 
Centres for Disease Control and Prevention (Africa CDC). In addition, since 2022, the EU FAB 
network  –  a  network  of  ever-warm  production  capacities  for  vaccine  manufacturing  in  the 
EU/EEA  –  has  maintained  its  operations  through  regular  funding  from  the  EU4Health 
Programme, with four facilities participating. 

In  2024,  direct  grants  were  signed  for  23  countries  to  close  national  gaps  in  surveillance 
systems,  to  digitalise  surveillance  systems  and  to  build  capacity  for  surveillance,  such  as 
personal data protection and data quality assurance. These grants will support Member States 
in improving their surveillance systems in line with and building on the outcomes of the joint 

87   C1 credits - L1 commitments included. 
88   Payments  as  a  percentage  of  the  total  programmed  amount  for  EU4Health  for  the  period  2021-2027  (C1 

Credits). Potential decommitments have not been taken into account. 

89   See Footnote 60. 
90   Council  recommendation  on  stepping  up  EU  actions  to  combat  antimicrobial  resistance  in  a  One  Health 

approach, 2023/C 220/01. 

29 

 
 
 
 
 
action UNITED4Surveillance91. This is an EU4Health joint action with 40 partners from across 
Europe  promoting  and  supporting  the  development  of  digitalised,  integrated  surveillance 
systems.  Further  support  for  surveillance  was  ensured  through  the  joint  action  EU-WISH92, 
which  aims  to  help  the 26  Member  States  participating  to  develop,  expand  and  consolidate 
national  monitoring  of  wastewater  for  reasons  of  public  health.  In  2024,  the  Commission 
started to designate certain laboratories as European reference laboratories (EURLs) for public 
health  that  will  further  strengthen  the  EU’s  preparedness  for  and  response  to  serious  cross-
border threats. The EURLs bring together scientific expertise from across the European Union, 
to  improve preparedness, rapid  detection and response. EURLs will support national  public 
health laboratories  by ensuring data comparability and capacity strengthening  on laboratory 
methods at EU level. The first six EURLs were designated in March 2024, and three more in 
November  2024.  All  EURLs  receive  direct  grants  from  the  EU4Health  Programme  to  fund 
their work. Furthermore, the DURABLE93 network was established by HERA to respond to the 
threat of any biological agent. It does this by leveraging the broad expertise in the network to 
work across scientific disciplines and different pathogens, with a special focus on developing 
medical  countermeasures  and  novel  detection  methods  for  cross-border  health  threats.  In 
addition, in 2022 agreements for direct grants were signed with 21 Member States to create 
enhanced  whole  genome  sequencing  and  RT-PCR94  infrastructures  and  to  ensure  their 
sustainable use and integration into routine surveillance and outbreak investigation activities. 
HERA launched a similar project with the Africa Pathogen Genomics Initiative to support the 
member  states  of  the  African  Union  in  building  local  data  analytics  capacities  for  rapid 
outbreak response, to scale up sequencing-based surveillance  and to strengthen the network 
capacity to ensure the detection of new SARS-CoV-2 variants and systematically implement 
AMR surveillance.  

Under the EU4Health Programme, EUR 50 million have been committed for a joint action on 
antimicrobial  resistance  (JAMRAI-295).  This  new  joint  action,  which  started  in  early  2024, 
brings together the authorities of all the EU Member States, Iceland, Norway and Ukraine in 
carrying out a range of policies and measures to tackle AMR, applying a One Health approach. 
The Commission also supports the development of innovative diagnostic solutions for AMR. 
Furthermore,  through  the  contribution  agreement  signed  between  HERA  and  the  WHO, 
funding was provided for activities to develop new medical countermeasures against AMR and 
for  the  Global  Antibiotic  Research  &  Development  Partnership96,  which  accelerates  the 
development and provision of treatments for drug-resistant infections. Based on the agreement, 
funding will also be provided to SECURE97 – an action to set up a public health consortium 
dedicated to accelerating access  to  newly registered and generic essential  antibiotics and  to 
support  countries  in  addressing  drug-resistant  bacterial  infections.  Funding  has  also  been 
provided for a new vaccine against tuberculosis and for anti-tuberculosis medicines for children 
in the EU.  

Joint Action UNITED4Surveillance. 
Joint Action EU-WISH. 

91  
92  
93   DURABLE Research Network against Epidemics. 
94   Reverse transcription–polymerase chain reaction. 
95  
96   Global Antibiotic Research & Development Partnership. 
97   SECURE. 

Joint Action on Antimicrobial Resistance and Healthcare-Associated Infections EUJAMRAI2 

30 

 
 
In 2023, around EUR 2 million were mobilised by HERA for training activities and tabletop 
exercises  on preparedness  and response  related to medical  countermeasures, with  particular 
attention paid to public procurement strategies and the procurement instruments available. 

A contribution agreement was signed with the International Nuclear Energy Agency (IAEA) 
in 2024 to create the capacity to use the sterile insect technique as a tool to eliminate the Aedes 
aegypti mosquito in one Member State and, potentially, in other EU countries if detected.  

A contribution  agreement  with  the World Health Organization was signed in  April 2024  to 
enhance public health and crisis-response capacities in Ukraine and neighbouring countries, 
focusing on CBRN hazards.  

A contribution agreement with the ECDC was signed in late 2024 to upgrade and develop its 
early warning and response system. The aim is to increase the effectiveness of how all threat 
events are managed, including preparedness, alerting, situational awareness, risk assessment 
and crisis-response coordination.  

Figure 10 Progress on the 2024 milestones and 2027 targets for crisis preparedness 

 Milestone; 

Legend: 0 Baseline; 
Target; (30) Current value; Indicators: 1 - Member States with preparedness and response planning 
for cross-border health threats – (sub-indicator 1.1); 2 - Member States participating in the prevention, preparedness and response planning 
joint action – (sub-indicator 1.2); 3 - Member States with improved integrated surveillance systems – (sub-indicator 1.3); 4 - New capacity-
building activities (EU, Member States) for improved integrated surveillance systems (sub-indicator 1.4); 5 - Number of Member States with 
improved preparedness and response planning (sub-indicator 6.1); 6 - Member States with improved preparedness and response planning on 
medical countermeasures (sub-indicator 6.2); 7 - Actions addressing the fight against communicable diseases (indicator 22); 8 - Countries 
with  increased  laboratory  and  diagnostic  capacity  for  cross-border  health  threats  (HERA);  9  -  Countries  where  One  Health  surveillance 
programmes were successfully implemented; 10 - Countries with improved procurement procedures for medical countermeasures during  a 
health  crisis;  11  -  Actions  complementing  national  stockpiling  of  essential  crisis-relevant  products;  12  -  Member  States  participating  in 

31 

 
 
 
 
stockpiling activities; 13 - Healthcare and public health staff (Article 11 of  Regulation (EU) 2022/2371 on serious  cross-border threats to 
health); 14 - Stakeholders’ satisfaction rate in HERA training programmes. Data are not available for the lines 2, 3, 5, 8, 9, 11, and 12. 

The World Health Organization receives several grants from the EU4Health Programme. One 
action focuses on the implementation of the new regional roadmap on antimicrobial resistance 
and  associated  infections  in  EU  Member  States  and  EU4Health  associated  countries.  Other 
actions support the work of the WHO in the field of health preparedness and vaccination. 

By the cut-off date, 30 Member States had participated in more than one EU action aimed at 
improving prevention, preparedness and response planning for serious cross-border threats to 
health, and 25 new capacity-building activities for an improved and integrated epidemiological 
surveillance  system  and  21  actions  on  the  fight  against  communicable  diseases  had  been 
launched. By the same date, 26 Member States had improved their preparedness and response 
planning  with  regard  to  medical  countermeasures.  One  country  successfully  implemented  a 
One  Health  surveillance  programme,  and  12  Member  States  and  associated  countries  had 
improved their procurement procedures for medical countermeasures during a health crisis. A 
total of 171 healthcare and public health staff (Article 11 of Regulation (EU) 2022/2371 on 
serious cross-border threats to health) had been trained and 96% of the trainees were satisfied 
with their trainingxxviii. 

Strand 2: Health promotion and disease prevention 

A total of EUR 155.4 million was committed to 108 health promotion and disease prevention 
actions,  which  does  not  include  cancer  investments.  EUR  64.74  million  of  the  budget 
implements specific objective (b) on crisis preparedness and response. The strand receives a 
contribution  of  EUR  53.81  million  from  actions  implementing  specific  objective  (i)  on 
integrated  work  on  national  health  systems,  EUR  12.25  million  from  actions  supporting 
specific objective (j) on global commitments and health initiatives, and smaller amounts from 
all the other specific objectives98.  

37.1% of the strand’s budget was committed to the prevention of cardiovascular disease and 
diabetes.  The  other  policy  areas  covered  are  mental  health  support  to  Ukrainians  (16.9%), 
operating grants (14.9%), mental health in the EU (7.8%), prevention of mental health disorders 
(4.3%), prevention of risk factors (6.2%), HIV and AIDS (4.3%), prevention of NCDs (2.6%), 
tobacco-related actions (2.4%) chronic respiratory diseases (1.9%) and other related actions 
(1.6%). 

In 2024, 24 direct grants supporting the work of the ERNs were signed, for a total value of 77.4 
EUR million and covering their work for a period of four years. The Commission has provided 
continuous funding to the ERNs since their launch in 2017. 

98   The budget of the operating grants has been distributed equally across all the specific objectives, given that 

these types of grants usually cover a broad spectrum of activities.  

32 

 
 
 
 
 
 
Figure 11 Progress on the 2024 milestones and 2027 targets for health promotion and disease prevention.  

  Milestone; 

Legend: 0  Baseline; 
Target;  (30)  Current  value;  Indicators:  1  -  Number  of  actions  contributing  to  the  reduction  of 
avoidable mortality in the area of non-communicable diseases and risk factors; 2 - Number of Member States implementing best practices 
regarding health promotion, disease prevention and addressing health inequalities; 3 - Vaccination coverage for measles(indicator 7.1); 4 - 
Vaccination coverage for seasonal influenza – (indicator 7.2); 5 - Vaccination coverage for human papillomaviruses (HPV) – (indicator 7.3); 
6 - Number of actions addressing the prevalence of major chronic diseases per Member State, by disease, gender, and age – (indicator 12); 7 
- Number of actions addressing the age prevalence of tobacco use, if possible, differentiated by gender – (indicator 13); 8 - Number of actions 
addressing the prevalence of harmful use of alcohol, if possible, differentiated by gender and age  – (indicator 14); 9 - Number of actions 
addressing environmental risk factors for health – (indicator 23). 

A total of 17 actions contributing to the reduction of avoidable mortality in the area of non-
communicable diseases and other risk factors have been launched so far. 25 Member States are 
implementing  best  practices  in  health  promotion,  disease  prevention  and  addressing  health 
inequalities.  Two  Member  States  have  reached  the  vaccination  target  for  measles,  two  for 
seasonal  influenza,  and  two  for  human  papillomaviruses.  A  total  of  nine  actions  have  been 
launched to address the prevalence of major chronic diseases in Member States, by disease, 
gender and age. Two actions have been launched to address the prevalence of tobacco use by 
different  age  groups  and  differentiated,  if  possible,  by  gender.  Three  actions  address  the 
prevalence of the harmful  use of alcohol,  differentiated, if possible,  by gender  and age and 
seven actions addressing environmental risk factors for health have also been launched.  

Strand 3: Health systems and healthcare workforce 

EUR 239 million in funding has been committed for 288 actions under the health systems and 
healthcare  workforce  strand.  EUR  66.66  million  of  that  total  mainly  implement  specific 
objective (i) on integrated work on national health systems, and EUR 49.74 million are aimed 
at implementing specific objective (f) on digital transformation. EUR 37.23 million have been 
allocated  to  specific  objective  (h)  on  support  for  the  development  and  implementation  of 
legislation, EUR 35.75 million to specific objective (c) on improving access to medicinal and 
medical products, EUR 27.5 million to specific objective (g) on access to healthcare, and EUR 
12 million to specific objective (b) on crisis preparedness and response. Some of the actions 

33 

 
 
 
 
under  this  strand  contribute  a  total  of  EUR  5  million  to  specific  objective  (j)  on  global 
commitments and health initiatives.  

A total of 42.2% of the investments have been allocated to ERNs and 25% on health systems 
resilience  and  the  healthcare  workforce,  followed  by  the  pharmaceutical  strategy  and  the 
implementation  of  related  legislation  (11.7%),  implementation  of  the  Medical  Devices 
Regulation  (9.1%),  substances  of  human  origin  (5.9%),  HTA  (2.1%),  global  health  (2%), 
improving the access of Ukrainian refugees to healthcare (2%), and the rest to ‘other’ actions. 
In 2023, ‘State of Health in the EU’99 country health profiles were drafted for all EU Member 
States, Iceland, and Norway to support better policymaking on health. 

In 2023, 68 medicines100 received a centralised marketing authorisation from the Commission, 
which  is  valid  across  the  EU.  In  2022,  103  medicines  were  authorised  and  in  2021,  89 
medicines  were  authorised.  Notified  bodies  under  the  Medical  Devices  Regulation  (MDR) 
issued 5 599 certificates by 2023 and 702 certificates were issued by notified bodies under the 
In Vitro Diagnostic Medical Devices Regulation (IVDR). There were shortages of 54 medicinal 
products in the Member States, as reported through the single point of contact network (SPOC), 
a small increase from 52 in 2022. Two actions were launched that aimed to increase the security 
and continuity of global supply chains and address dependence on imports from third countries 
for the production of essential active pharmaceutical ingredients and medicinal products in the 
EU101. Four production facilities with enhanced capacities in increasing security and continuity 
of supply for medical countermeasures, raw materials, and components at EU level were also 
supported. A total of 28 audits were carried out in the EU and in third countries to ensure good 
manufacturing practices and good clinical practices. Three actions were carried out to produce 
guidance on improving access to healthcare services. 1 619 healthcare units were involved in 
ERNs and 2.24 million patients were diagnosed and treated by the members of the ERNs.  

99   State of Health in the EU. 
100   This is orphan authorisations, advanced therapy medicinal products, medicinal products for paediatric use, 

vaccines. 

101   2021  work  programme  actions  HS-g-18.2.1  with  a  budget  of  EUR  2.15  million  and  CP-g-01.1.1  with  a 

budget of EUR 10 million. 

34 

 
 
Figure 12 Progress on the 2024 milestones and 2027 targets for health systems and healthcare workforce.  

 Milestone; 

Legend: 0 Baseline; 
Target; (30) Current value; Indicators: 1 - Access to centrally authorised medicinal products, for 
example  the  number  of  existing  and  new  orphan  authorisations,  advanced  therapy  medicinal  products  (ATMPs),  medicinal  products  for 
paediatric use or vaccines, for unmet needs- ( indicator 2); 2 - Number of certificates issued by notified bodies under the Medical Device 
Regulation(MDR);  W3  -  The  number  of  certificates  issued  by  notified  bodies  under  the  In  Vitro  Diagnostic  Medical  Devices  (IVDR).; 
HS&HW4 - EU Laboratory capacity index (EULabCap)– (indicator 8); 5 - Number of shortages of medicinal products in the Member States 
as reported through the single point of contact network – (indicator 15); 6 - Number of actions aimed at increasing the security and continuity 
of the global supply chains and addressing dependence on imports from third countries for the production of essential active pharmaceutical 
ingredients and medicinal products in the Union - (indicator 16); 7 - Number of production facilities with enhanced capacities in increasing 
security and continuity of supply for medical countermeasures, raw materials, and components at EU level; 8 - Antimicrobial consumption 
for  systemic  use  ATC  (group  J01)  –  (indicator  18);  9  -  Number  of  audits  conducted  in  the  EU  and  in  third  countries  to  ensure  good 
manufacturing practices and good clinical practices (Union control) - (indicator 17); 10 - Number of Member States participating in actions 
aimed  at  supporting  innovation,  uptake  and  access  to  market  of  medical  countermeasures  supported  at  EU  and  global  level  for  better 
preparedness and response; 11 - Number of actions producing guidance for improving access to healthcare services; 12 - Number of measures 
taken by Member  States  to improve  access to  healthcare  services;  13  -  Number of  Health  Technology  Assessment  (HTA)  reports  jointly 
carried out - (indicator 20); 14 - Number of healthcare units involved in ERNs– (indicator 19.1); 15 - Number of patients diagnosed and treated 
by the members of the European Reference Networks (ERNs)-– (Indicator 19.2); Data are not available for lines 10, 12 and 13. 

Strand 4: Digital 

The  investment  of  EUR  124.96  million  in  108  actions  under  the  digital  strand  is  mainly 
supporting  the  specific  objectives  on  digital  transformation  (f),  on  support  for  legislation 
development  and  implementation  (h),  and  on  access  to  healthcare  (g).  The  investments  are 
balanced between the primary and the secondary use of data. 45.6% of the total budget is being 
invested in MyHealth@EU, an action on the primary use of health data. An additional EU 3.8 
million  has  been  invested  in  a  joint  action102.  The  actions  on  secondary  use  of  data  support 
setting up services by health data access bodies representing 33% of the strands’ budget, and 

102   Extended EHR@EU Data Space for Primary Use (Xt-Ehr). 

35 

 
 
 
 
8.6% was additionally allocated to developing HealthData@EU. The actions on primary data 
therefore receive 58.4% of the funding and those on the secondary use of data receive 41.6%. 
In  addition,  22  European  countries  (including  20  Member  States)  have  received  funding  to 
improve their digital health systems and access to health data. 

37  actions  contribute  to  the  digital  transformation  of  healthcare  systems  and  the 
implementation of the EHDS. A total of 15 Member States are participating in the EHDS and 
6 Member States have set up or are in the process of setting up a health data access body.  

Figure 13 Progress on the 2024 milestones and the 2027 targets for digital.  

Legend:  0-Baseline; 
Target;  (30);  Actual  value;  Indicators:  1  -  Number  of  actions  contributing  to  the  digital 
transformation of healthcare systems and the implementation of the European Health Data Space (EHDS); 2  - Number of Member States 
participating in the European Health Data Space (EHDS); 3 - Progress on setting up health data access bodies in the EU.  

  Milestone; 

Cross-cutting strand: Cancer 

62 actions with a total budget of EUR 220 million are included under the cancer strand, which 
supports  the  implementation  of  the  Cancer  Plan  and  contributes  mainly  to  the  specific 
objectives on health promotion and disease prevention (a), integrated work on national health 
systems (i), on access to healthcare (g), and on global commitments and health initiatives (j).  

Almost  half  (49.3%)  of  the  allocated  budget  under  the  cancer  strand  supports  prevention 
actions against cancer including HPV and tobacco and alcohol-related cancers, followed by 
screening actions including those on breast, colorectal, cervical, gastric, prostate, liver and lung 
cancer  (25%  of  the  budget),  treatment  (including  radiation)  (13.9%),  quality  of  life  (6.8%), 
inequalities (4.6%), and other actions (0.4%).  

Several of the Cancer Plan flagship actions that are supported by the EU4Health Programme 
have been launched. The European Commission Knowledge Centre on Cancer was the first 
flagship to be launched in June 2021, fostering the scientific and technological alignment of all 
the Commission’s initiatives on cancer. The European Cancer Inequalities Registry was created 
in February 2022, with a first set of cancer country profiles published in February 2023, and 
the  first  cross-cutting  report  on  inequalities  in  cancer  prevention  and  screening  in  February 
2024. 

Data  are  not  yet  available  to  assess  the  age-standardised  five-year  net  survival  rate  for 
paediatric cancer. Five Member States have reached the planned screening coverage of 70% of 
the population for breast and cervical cancer. Seven Member States have reached the screening 
coverage of at least 45% for colorectal cancer and 75% of the population is covered by cancer 
registries reporting information on cervical, breast, colorectal and paediatric cancer stage at 
diagnosis. A total of 25 Member States have reported information on cervical, breast, colorectal 
and paediatric cancer stage at diagnosis. 

36 

 
 
 
 
Figure 14 Progress on the 2024 milestones and 2027 targets for cancer.  

  Milestone; 

Legend: 0  Baseline; 
Target;  (30)  Current  value;  Indicators:  1  -  Age-standardised  five-year  net  survival  rate  for 
paediatric cancer (to the extent available); 2 - Screening coverage for breast cancer screening programmes; 3 - Screening coverage cervical 
cancer screening programmes; 4 - Screening coverage for colorectal cancer screening programmes; 5 - Percentage of population covered by 
Cancer Registries reporting information on cervical, breast, colorectal and paediatric cancer stage at diagnosis – (indicator 11); 6 - Number of 
Member States reporting information on cervical, breast, colorectal and paediatric cancer stage at diagnosis. Data are not available for line 1. 

Cross-cutting topic: Global Health  

The  EU4Health  Programme’s  specific  objective  to  support  global  commitments  and  health 
initiatives remains very relevant. In this regard, the Programme supports actions that benefit 
health in Europe and beyond. Since the launch of the 2021-2027 EU4Health Programme, the 
Commission has further committed to prioritise global  health across all relevant EU budget 
financing programmes, including EU4Health103. The EU Global Health Strategy, adopted in 
November 2022, is the external dimension of the Health Union and the main policy framework 
that guides EU health principles and actions at the global level. A one-year study to design and 
test a monitoring framework for the implementation of the EU Global Health Strategy is being 
carried out with EUR 616 120 of funding. The study aims to develop and evaluate an effective 
monitoring  framework  to  assess  the  progress  and  outcomes  of  the  implementation  of  the 
strategy. 

EU4Health’s support to the EU Global Health Strategy amounts to EUR 61.5 million, of which 
around EUR 50 million has been committed to actions such as strengthening preparedness and 
response  at  a  global  level  to  cross-border  threats  to  health,  including,  for  instance,  by 
supporting the Africa Pathogen Genomics Initiative. HERA is also collaborating with the WHO 
to increase intelligence gathering and laboratory capacities in Africa, as well as to support a 
rapid response to outbreaks of diseases with high pandemic potential, such as Mpox, Marburg 
and Ebola. 

In  total,  23  actions  and  contribution  agreements  to  support  global  commitments  and  health 
initiatives  have  been  concluded  with  global  partners  such  as  the  WHO,  the  Red  Cross,  the 
OECD  and  the  IOM.  The  EU  and  the  WHO  collaborate  in  four  thematic  areas104  and 
coordination between the EU, global partners and EU Member States is ongoing in three areas. 

103   EU GLOBAL HEALTH STRATEGY - Better Health for All in a Changing World, page 26.  
104   The thematic areas are health systems, crisis preparedness, cancer and health promotion. 

37 

 
 
 
 
 
Figure 15 Progress on the 2024 milestones and 2027 targets for global health  

Legend: 0 Baseline; 
Target; (30) Current value; Indicators: 1 - Number of impact assessments of Union policies; 2 - 
Number of studies supporting the evaluations of legislative and non-legislative health Union policies; 3 - Number of actions and contribution 
agreements supporting global commitments and health initiatives concluded with global partners; 4 - Number of areas where EU and WHO 
collaborate; 5 - Areas of coordination between EU and relevant global partners and EU Member States; 

 Milestone; 

Support for the development and evaluation of legislation 

The  Programme  has  supported  one  published  impact  assessment  and  supporting  report  and 
Staff  Working  Document  on  EU  health  policies  and  has  funded  three  studies  supporting 
evaluations of legislative and non-legislative EU health policies. 

Synergies and complementarities with other EU funding programmes 

Several  EU  funding  programmes  support  health  priorities.  Horizon  Europe  is  a  key  EU 
programme advancing research and innovation with a strong focus on health through its Cluster 
1 initiatives. It addresses integrated approaches to disease prevention and health promotion, 
and  fosters  synergies  with  public  health  policies  across  Europe.  The  Programme  exhibits 
adaptability, funding research in areas like infectious diseases, preparedness and response for 
health  crisis,  mental  health,  AMR,  cancer  and  other  NCDs,  promoting  the  digital  health 
transition, and enhancing global cooperation on health. Partnerships within Horizon Europe, 
such as  the European Partnership on Transforming Health  and Care Systems, the European 
Partnership on Rare Diseases and the Joint Undertaking for Global Health (EDCTP 3), as well 
as  the  EU  Cancer  Mission  and  Global  Health  initiatives,  are  meeting  their  objectives 
effectively, further strengthening Europe’s health innovation ecosystem. 

The Digital Europe Programme (DEP) aims to upskill individuals in advanced digital skills, 
including in health, and supports platforms for digital skills information. Moreover, the DEP 
plays a key role in implementing the EHDS, facilitating improved access to health data and 
greater interoperability across the EU.  

The RRF is a central component of the NextGenerationEU plan, with EUR 42 billion dedicated 
to reforms and investments in the healthcare sector, including improving primary healthcare, 
transitioning to outpatient care, and deploying digital health solutions.  

38 

 
 
 
 
The European Social Fund+, the European Regional Development Fund (ERDF), and the Just 
Transition Fund plan for investments in eHealth, health infrastructure and improving access to 
healthcare for vulnerable groups. In addition, the Pact for Skills supports partnerships focusing 
on  the  health  workforce  and  the  Erasmus+  BeWell  initiative  pilots  innovative  curricula  for 
digital and green skills in health.  

Synergies and complementarities with Member States’ national funds 

EU Member States make significant investments in health at the national level to improve the 
overall well-being of their populations, and their objectives at national level often concur with 
those at EU level. These investments totalled EUR 1.59 trillion in 2021 and EUR 1.65 trillion 
in 2022105 and encompass a broad range of initiatives aimed at transforming healthcare delivery 
and ensuring health systems are robust and adaptable. A key focus is on modernising healthcare 
infrastructure, which includes upgrading hospital facilities, improving medical equipment, and 
incorporating advanced technologies to enhance diagnostic and treatment capabilities. 

Furthermore, with the growing importance of digital solutions, many countries are investing in 
digital health technologies. This includes the development of EHRs, telemedicine platforms 
and  health  data  analytics,  which  are  designed  to  enhance  patient  care,  facilitate  efficient 
healthcare delivery, and enable the cross-border exchange of health data within the EU. 

Addressing  demographic  challenges,  such  as  ageing  populations  and  the  rise  of  chronic 
illnesses, is another priority. Investments often target preventive care, health promotion and 
disease  prevention,  and  management  strategies  that  include  chronic  disease  management 
programmes and initiatives to foster healthy lifestyles. 

Unexpected or unintended changes  

Interview feedback from EU4Health beneficiaries has indicated that the large budget of some 
actions combined with the high co-funding requirement for beneficiaries (40% or 20% in case 
of  exceptional  utility)  has  posed  absorption  challenges  for  the  authorities  of  some  Member 
States and for some NGOs. This problem was confirmed by health experts from the national 
authorities  from  some  Member  States,  who  said  it  was  due  to  difficulties  in  aligning  the 
EU4Health budget cycle with those of the Member States106. 

External factors  

The Russian war of aggression against Ukraine has triggered the prioritisations of actions to 
address  the  (health)  consequences  of  the  war.  The  swift  deployment  of  actions  under 
EU4Health to support Ukraine during the ongoing crisis  was intended to  improve access to 
healthcare for refugees and people displaced from Ukraine, as well as to reduce the burden of 
mental  health  issues  for  this  group.  Moreover,  the  interventions  aimed  to  reinforce  the 
prevention, preparedness and response capacities for all threats (chemical, biological and radio-
nuclear) in Ukraine and neighbouring countries as well as to increase the vaccination coverage 
of children and adults.  

The COVID-19 pandemic exposed critical vulnerabilities in pandemic preparedness systems 
across Europe, underscoring the need for robust mechanisms to prevent, detect and respond to 

105   Eurostat, Health care expenditure by function [hlth_sha11_hc].  
106   Laurence  Ballieux,  Silke  Baumann  and  Guy  Dargent:  EU  JOINT  ACTIONS  2.0:  A  BOOSTER  FOR 

HEALTH IN THE EU? Eurohealth – Vol.29 | No.3 | 2023.  

39 

 
 
public health emergencies. Lessons learnt from the pandemic highlighted the importance of 
ensuring  supply  chain  resilience,  investing  in  innovative  medical  products,  bolstering 
intelligence-gathering capacities, and investing in cross-border cooperation and data sharing to 
mitigate  future  crises  effectively.  Beyond  COVID-19,  recent  outbreaks  of  diseases  such  as 
Marburg and Ebola in Africa further demonstrate the devastating impact of emerging infectious 
diseases  with  epidemic  potential,  and  the  need  for  Europe  to  be  vigilant  and  prepared. 
Furthermore, the growing impacts  of climate change have intensified the  urgency of health 
crisis preparedness. Climate-related events such as heatwaves, floods and the spread of vector-
borne diseases pose new and complex challenges to public health systems. Addressing these 
threats requires a comprehensive and forward-looking approach to pandemic preparedness.  

Programme performance monitoring and evaluation framework (PPMEF) – initial 
assessment 

The  PPMEF  and  its  indicators  served  well  the  annual  performance  assessment  and  the 
Programme  interim  evaluation  analysis.  The  annual  Programme  performance  analyses  for 
2021, 2022 and 2023107 indicate that the number of Programme indicators is rather high, and it 
will be necessary to cover each of the 10 specific objectives and their policy areas. To fully 
operationalise  the  specific  objectives,  the  existing  action-level  indicators  will  be  used  to 
monitor achievements in policy areas that are not covered by the Programme indicators, such 
as patient safety, mental health and others. 
The  available  Programme  indicators  generally  make  it  possible  to  operationalise  the  broad 
objectives and are measurable against the quantitative milestones and targets. The milestones 
and targets are set in line with the ambition and targets of the EU’s health priorities (e.g. the 
Council  Recommendation  on  AMR108)  and  legal  acts  (e.g.  Regulation  (EU)  2022/2371  on 
serious  cross-border  threats  to  health),  where  those  exist.  The  output  indicators  referring  to 
‘number of actions’ have been very useful in assessing the programming process; however, to 
assess the Programme’s performance  for the final evaluation, they need to better reflect the 
outcomes and the results  of the actions.  Based on the  lessons  learnt,  a revised PPMEF  will 
focus on indicators that better link output, results and impacts for each specific objective. This 
will  make  it  possible  to  measure  progress  on  milestones  and  targets.  The  review  will  also 
leverage the information on health systems collected in the context of the European Semester 
and country profiles109 for the purpose of evaluating EU4Health. 
The nine key performance indicators need to be revised given that for two of them data are not 
available.  

108   Council Recommendation on stepping up EU actions to combat antimicrobial resistance in a One Health 

approach 2023/C 220/01, (OJ C 220, 22.6.2023). 
109   Country Health Profiles - European Commission 

40 

 
 
 
 
 
4.  Evaluation findings (analytical part) 

As expected at the time of the interim evaluation, limited data on results and no data on impacts 
was  available,  which  is  an  unavoidable  drawback.  However,  the  findings  show  that  the 
approach  to  data  collection  is  reliable,  and  that  the  evaluation  methodology  used,  albeit 
improvable,  is  a  good  basis  to  deliver  the  final  evaluation.  The  final  evaluation  should  be 
delivered  by  the  Commission  no  later  than  the  end  of  2031110,  when  evidence  from  most 
EU4Health  actions  (i.e.  deliverables  and  final  reports)  will  be  validated  by  the  contracting 
authority and available for analysis. The data collection made possible by the revised PPMEF 
indicators will ensure that data are available in good time for the final evaluation. 

4.1.  To what extent was the intervention successful and why? 

4.1.1.  Programming and implementation progress  

EU4Health intervention is a policy-driven EU funding programme that successfully provides 
financial  support  to  implement  the  priorities  of  the  European  Health  Union,  the  underlying 
legislation and related preparatory work. It complements Member States’ actions in the field 
of health. The progress that EU4Health has made in reaching the health policy objectives of 
the Programme itself and, more widely, of the EU is consistent with the expectations at the 
interim stage as regards outputs and results. A limited number of actions have been completed, 
many actions have only recently begun, and their results are becoming progressively available.  

The  architecture  of  the  EU4Health  Regulation  is  sound  overall.  The  comprehensive 
specific objectives are coherent and allow the financing of measures to implement EU health 
policy priorities, including the existing EU health legislation for the period 2021-2027, and the 
new health priorities provided in Commission’s mandate.  

EU4Health’s programming and governance processes are effective, as illustrated by the 
delivery of the 2021 and 2022 annual work programmes in less than a year, considering that 
the regular programming cycle is usually around one year for one work programme. The annual 
work programmes for 2023 and 2024 were adopted in the year before implementation began 
(n-1). The actions funded under the work programmes for 2021, 2022 and 2023 are coherent 
with the objectives they are meant to implement, as confirmed by the findings of the evaluation 
supporting study. Thus, the Programme’s governance is agile, although the consultative step 
with the Member States in the EU4Health Steering Group, in advance of and in addition to the 
Programme Committee, is administratively somewhat burdensome. The EU4Health Steering 
Group is convened three to four times a year. The European Parliament is informed about the 
stakeholder consultation proceedings prior to the last Steering Group before approval of the 
work programme. In practice these consultation steps are complemented by the consultation of 
dedicated Commission  expert groups on health policies, including  the  HERA Board, which 
provide  useful  technical  expertise.  These  technical  consultations  of  expert  groups  provide 
useful support in specific areas where the relevant expertise is lacking within the EU4Health 
Steering Group. 

The  annual  programming  and  implementation  process  for  a  programme  of  the 
magnitude  of  EU4Health  is  resource  intensive.  Lessons  learnt  from  four  EU4Health 
programming cycles and the EU’s Horizon research and innovation programme indicate that 

110   Article 20 of EU4Health Regulation. 

41 

 
 
 
setting priorities for a period longer than one year may better inform the Member States and 
other stakeholders on the longer-term perspective.  

HaDEA  is  instrumental  to  the  implementation  of  the  Programme  and  annual  work 
programmes.  The  implementation  processes,  which  were  adapted  very  rapidly  to  the 
severalfold  increase  in  the  budget  of  EU4Health  as  compared  to  the  previous  EU  health 
programmes, are very effective and efficient. Implementation of the 2021, 2022 and 2023 work 
programmes was delegated to HaDEA, which launched all the actions as planned. A total of 
726 financing agreements were signed with 1 274 legal entities such as ministries of health, 
national,  regional and other public authorities, healthcare and health research organisations, 
non-profit organisations and private entities. 

The level of commitments is as expected and has reached more than half (53%) of the 
programmed budget. The payment execution is about 15% of the committed budget and is 
expected to steadily increase because of an earlier launch in the year ‘n’111 of the joint actions 
and  other  direct  grants  with  Member  States  authorities,  starting  with  the  2025  annual  work 
programmes. A concerted effort from the nominated national authorities is required to 
shorten the preparatory phase, which is currently about a year. In addition, the launch of 
procurements could be brought forward, although increased human resources may be needed 
to  do  this.  The  potential  simplification  of  procurement  processes  and  better  use  of 
framework contracts could also contribute to a faster execution of payments. After initial 
efforts to draft and sign framework contracts, using them for specific procurement is a simpler 
process, with fewer steps to be followed. 

Under direct management, the larger budget of some actions in combination with a high co-
funding requirement for beneficiaries posed some absorption challenges for the authorities of 
some Member States and for some NGOs. The Commission explored with the Member States 
in the EU4Health Steering Group and in the Council Working Party on Public Health possible 
mitigating measures to address current absorption challenges.  

NGOs  have  benefited  from  both  operating  grants  and  action  grants.  During  2021-2024,  27 
NGOs received operating grants, totalling EUR 23.2 million, and 255 NGOs received action 
grants and participated in 55 projects, with total funding of EUR 41.2 million112. Grants covered 
the following policy areas: strengthening health systems, diabetes, substances of human origin, 
the  health  workforce,  digital  skills,  medical  devices,  health  technology  assessments,  rare 
diseases, tobacco control, thalassaemia and other haemoglobin disorders, alcohol, respiratory 
diseases,  palliative  care,  biomedical  research,  public  health,  health  promotion  and  disease 
prevention, cancer, mental health, HIV/AIDS, cardiovascular diseases and tuberculosis, and 
also provided support to patients’ organisations. 

In the short term, dedicated national info days and awareness-raising events in national or 
EU-level political settings may improve awareness in the Member States, with positive 
effects  expected  on  political  ownership  and  participation.  The  Commission  has  already 
launched  the  joint  action  NFP4Health113  that  aims  to  financially  support  and  strengthen  the 
network  of  national  focal  points  and  offers  applicants  and  beneficiaries  information  and 
guidance on the EU4Health Programme and its calls. The preparations to continue this joint 
action  are  underway  and  the  Commission  is  closely  following  the  process  to  ensure  that 

111   The year for which the annual programme is adopted.  
112   EU Funding & Tenders Portal. 
113   Joint Action on Increasing Capacity building of National Focal Points.  

42 

 
 
additional  and tailored  support is  given to  all categories of applicants.  The joint  action will 
maintain  and  increase  the  capacities  of  the  NFPs  to  deliver  tailored  support  to  potential 
applicants  who  can  implement  EU4Health’s  objectives.  In  the  long  term,  a  possible 
reassessment of the co-funding requirements may be considered.  

The findings of the interim evaluation supporting study underscore that the joint actions are 
instrumental in facilitating collaborations to address shared European health challenges. 
They  are  effective  in  involving  a  diverse  range  of  organisations,  promoting  cooperation 
between  Member  States.  The  scale  of  funding  provided  by  joint  actions  means  that  499 
organisations  have been involved  in  joint  actions, with nearly 40%  of them  participating  in 
several  joint  actions.  Joint  actions  align  with  EU4Health’s  objectives  and  contribute  to 
significant health outcomes. Their effectiveness and sustainability could be enhanced by, 
among  other  things,  a  reassessment  of  the  co-funding  requirements  and  proposal 
evaluation criteria.  

The exceptional utility criteria make it possible to provide up to 80% EU co-funding and are 
instrumental in attracting lower-GNI Member States. The findings of the case study indicate 
that the exceptional utility criteria continue to be relevant in providing increased financial 
support for actions involving lower-GNI countries. However, the criteria are insufficient to 
fully address the difficulties that some countries face because their required contribution (20% 
of the total eligible costs) still poses an obstacle to their participation in joint actions. Despite 
these limitations, the exceptional utility criteria have positively impacted lower-GNI countries’ 
participation in joint actions and encouraged their involvement in more projects compared to 
the previous third Health programme. In addition, lower-GNI countries increasingly taking on 
coordinating roles and leading work packages, showing their increased capacity. The grants to 
ERNs  and  other  networks  (e.g.  crisis  preparedness  EURLs)  may  cover  up  to  100%  of  the 
eligible costs114 and many stakeholders have indicated that such an approach could be extended 
to more areas with proven EU added value. 

The  administrative  burden  is  often  associated  with  an  application  for  funding  (e.g. 
complexity of the budget template) and the implementation of an EU4Health project (e.g. 
the  large  number  of  required  deliverables).  HaDEA  has  already  simplified  the  budget 
template  to  reduce  some  of  the  administrative  burden,  and  Member  States  now  have  the 
possibility to include several competent authorities as beneficiaries in direct grant.  

Under the indirect management of the budget,  the contribution agreements signed with 
international organisations (e.g. the WHO or OECD) allow the EU to reach out effectively 
at global level. The contribution agreements provide a flexible way to deliver actions in the 
EU’s neighbourhood, such as in Ukraine, e.g. by the International Federation of Red Cross and 
Red Crescent  Societies  and help to  mitigate the  health consequences of  the Russian war of 
aggression against Ukraine.  

The annual work programmes are coherent and foster synergies with other relevant EU 
funding programmes, including Pillar 5 of the Single Market Programme (SMP) on the food 
chain,  Horizon  Europe,  the  DEP,  ESF+  and  others,  due  to  an  effective  approach  to 
programming and implementation that eliminates potential overlaps. 

For example, AMR is a key priority addressed under both EU4Health and Pillar 5 of the Single 
Market Programme. Each programme has contributed in a distinct yet  complementary way. 

114   Article 8(4) of Regulation (EU) 2021/522. 

43 

 
 
For  example,  SMP  Pillar  5  implements  veterinary  surveillance  programmes  like  the 
coordinated control plan for AMR Monitoring, which tracks antimicrobial usage and resistance 
in  farmed  animals.  This  effort  directly  contributes  to  reducing  AMR  in  the  food  chain. 
EU4Health complements these efforts by developing cross-border health data tools, promoting 
prudent  antimicrobial  use  in  clinical  settings,  and  bolstering  preparedness  for  AMR-related 
health threats.  

In  addition,  while  both  programmes  engage  in  awareness-raising  campaigns,  their  target 
audiences  differ:  EU4Health  addresses  healthcare  professionals  and  policymakers,  whereas 
SMP Pillar 5 focuses on veterinarians and agricultural stakeholders. This well-defined division 
of responsibilities ensures that the two programmes not only complement each other but also 
avoid duplication of efforts, thus maximising the impact of EU-funded interventions. 

Survey data from the supporting study reveals varying levels of agreement among stakeholders 
on these synergies, with many respondents indicating limited knowledge, potentially because 
they represent an organisation that is not eligible for a particular funding instrument. However, 
when omitting the responses from these stakeholders, 70% of survey respondents perceived a 
strong  alignment  between  EU4Health  and  Horizon  Europe,  particularly  among  research 
institutions (78%). Similar trends were observed with the DEP, where 61% of respondents saw 
a significant coherence with EU4Health, though only 33% of NGOs agreed.  

Horizon  Europe  is  frequently  referenced  in  EU4Health  work  programmes,  with  21  actions 
linked to  it.  These EU4Health actions build on  the results of Horizon Europe or follow 
recommendations  from  entities  supported  Horizon  Europe115.  They  align  with  Horizon 
Europe’s objectives or involve national health authorities and/or healthcare services that are 
also members of European partnerships funded by Horizon Europe. In addition, the EU Cancer 
Mission  spent  EUR  90  million  on  research  focusing  on  cancer  screening  methods  and 
technology  and  early  detection  of  heritable  cancers,  thus  complementing  the  Cancer  Plan’s 
work  contributing  to  the  EU4Health  specific  objective  (a),  the  European  Partnership  on 
Transforming Health and Care Systems, with a budget of over EUR 305 million, contributes 
to EU4Health’s specific objectives on health promotion and disease prevention (a), on digital 
transformation  (f),  on  access  to  healthcare  (g)  and  on  integrated  work  on  national  health 
systems (i). Mental health and AMR are another example of areas where the results of research 
and innovation projects funded by Horizon Europe can contribute to the design of public health 
actions.  At  the  same  time,  the  needs  or  research  gaps  identified  during  implementation  of 
EU4Health actions can be addressed by research supported by Horizon Europe interventions.  

Moreover, the DEP contributes to the EU4Health specific objective on digital transformation 
(f)  by  supporting  the  EHDS,  among  others,  with  specific  actions  totalling  EUR  18  million 
under the 2024 work programme aimed at expanding the adoption of the EHR exchange format, 
and  deploying  solutions  that  make  it  easier  for  patients  to  access  their  health  data  and  that 
develop AI in health through health data access bodies. Additionally, the DEP contributes to 
the EHDS with the development and deployment of infrastructures and initiatives for the reuse 
of cancer images, genomic data and data from intensive care units. 

The redeployed EUR 1 billion had no impact on the programming for 2021, 2022, 2023 and 
2024  annual  work  programmes.  However,  the  significant  budget  reduction  of  the 
EU4Health  Programme  has  an  impact  from  the  2025  programming  onwards. 
Nevertheless, it is important to ensure sufficient support to both ongoing as well as new 

115   For example, the European Innovation Council or the European Research Council. 

44 

 
 
initiatives  and  commitments  of  the  Commission.  The  resources  for  certain  priorities  will 
have to be adjusted and the implementation focus on prioritised initiatives expected to deliver 
significant  impact.  This  will require balancing  the reduced financial capacity with  the legal 
obligation of the EU4Health Regulation to reserve at least 20% for supporting health promotion 
and disease prevention. 

4.1.2.  Achievements in implementing policies and legislation 

Strand 1: Crisis preparedness  

The  EU4Health  Programme  has  demonstrated  particular  efficiency  and  effectiveness  in 
launching  actions  aimed  at  achieving  the  Programme’s  objectives  on  crisis  preparedness  – 
already during the COVID-19 pandemic. In addition, the rapid allocation of funds for capacity 
building on pandemic preparedness and Mpox vaccine procurement and distribution helped to 
limiting the spread of the disease. Similarly, longer-term actions were put in place to increase 
the EU’s preparedness capacities, including through the development of intelligence-gathering 
tools and ever-warm facilities for vaccine production (EU FAB).  

The crisis preparedness actions were amongst the first to be launched soon after the adoption 
of the 2021 annual work programme. They have featured in every annual work programme and 
have the highest overall programmed budget (EUR 623 million).  

through  partnerships  with  national  health  authorities, 

The main factor influencing the efficiency of the actions under this strand was the high level 
international 
of  collaboration 
organisations  and  research  institutions.  This  cooperation  has  been  crucial  in  leveraging 
expertise and resources. The Programme’s ability to respond quickly to emerging health threats 
has  been  crucial  to  mitigating  their  impact.  The  use  of  evidence-based  decision-making  to 
design  the  actions  and  set  their  budgets  has  ensured  that  resources  have  been  allocated 
effectively and efficiently.  

The crisis preparedness programming has been very effective, and the Programme’s outputs 
have  exceeded  expectations  with  25  new  capacity-building  activities  to  improve  integrated 
surveillance systems launched and committed, instead of the 10 planned by 2024. This reflects 
the urgency of properly addressing the COVID-19 pandemic and its consequences, being better 
prepared for potential future health crises, and of fulfilling the legal obligations stemming from 
Regulation (EU) 2022/2371. A total of 21 actions on the fight against communicable diseases 
have been launched, one more than the 20 initially planned. 

Entities from 30 Member States and associated countries have participated in more than one 
EU  action  aimed  at  improving  prevention,  preparedness  and  response  planning  for  serious 
cross-border  threats  to  health,  showing  a  high  level  of  engagement  and  adherence  to  the 
programmed actions. This shows that crisis preparedness is an important priority not only at 
EU level but also for the Member States, especially when we compare the number of countries 
participating (30) with the 2024 milestone target of 26 (see Figure 16 below). In particular, it 
is  very  promising  that  26  Member  States  have  improved  their  preparedness  and  response 
planning  with  regard  to  medical  countermeasures,  compared  to  the  18  planned,  which 
illustrates the importance of a unified European approach that fosters collaboration. 12 Member 
States and associated countries have improved their procurement procedures for health crisis 
medical countermeasures, which is 4 times more than the expected number (3). Furthermore, 
for crisis preparedness, stakeholders attributed the significant progress, and enhanced training 
in preparedness, predominantly to the large budget increase under EU4Health, expressing a 
very high  satisfaction rate (96%) for HERA training  programmes  (see Figure  16 below).  If 

45 

 
funding had not been increased, Member States would likely have continued working on crisis 
preparedness predominantly at national level, resulting in less coordinated and potentially less 
effective outcomes. This underscores the important role that the EU4Health budget plays in 
boosting  the  collective  capacity  of  the  Member  States  to  address  health  crises  in  a  unified 
manner. 

Figure 16 Selected crisis preparedness and response indicators – see Annex VII for a full list of the PPMEF 
crisis preparedness indicators monitored. (Legend: 
 actual). * Percentage 
indicates progress on the 2027 targets. 

 milestone; 

 baseline; 

 target;

EU4Health’s increased budget and its focus on crisis preparedness accelerated the progress on 
related policy areas that were also supported by the third Health programme, which had similar 
objectives  on  crisis  prevention,  preparedness  and  response,  including  provision  for 
countermeasures. Stakeholders indicate that EU4Health plays a vital role in crisis preparedness 
and response. National authorities have benefited significantly from the collaborative efforts 
fostered  by  the  Programme  and,  subsequently,  EU4Health  has  helped  to  strengthen  public 
health systems. It has also fostered the work of international organisations by financing their 
efforts  to  support  vulnerable  groups  during  health  crises  and  implement  community-based 
health interventions. Consequently, people in the EU have fully benefited from the actions of 
the EU4Health Programme. 

The actions launched under the crisis preparedness strand also help countries to comply with 
the International Health Regulations116 (IHR) by strengthening their capacities to address cross-
border  health  threats,  for  example  through  the  EU-WISH  and  UNITED4Surveillance  joint 
actions. 

As key elements responding to the Commission’s policy priorities, the EU4Health Programme 
has funded advanced research and development  on new vaccines, and reinforced prevention 
and response through the acquisition of vaccines and by facilitating their distribution across 
the EU. EUR 205.97 million have already been allocated to on these issues.  

The  provision  of  medical  countermeasures  has  been  supported  with  EUR  20.3  million  in 
funding  and  nine  grants  to  Member  States  with  a  total  value  of  EUR  19.6  million,  which 
contributed to setting up coordinated surveillance systems under the One Health approach, an 
important element in the added value of the Programme. 

The Programme has also supported the fight against AMR, a growing global health threat, with 
funding of EUR 55.5 million. This has prompted 30 Member States and associated countries 

116   International Health Regulations. 

46 

 
  
 
 
 
 
 
to  participate  in  the  joint  action  on  antimicrobial  resistance  and  healthcare-associated 
infections117. 

Horizon  Europe  stands  out  as  the  Programme  most  closely  aligned  with  EU4Health, 
particularly in the Health Cluster of its Pillar II, which focuses on improving and protecting 
health,  mitigating  risks,  and  strengthening  health  systems.  These  goals  closely  align  with 
EU4Health’s objectives. For example, Horizon Europe promotes international cooperation on 
infectious  diseases  and  public  health  emergencies,  which  aligns  with  EU4Health’s  specific 
objectives  on  crisis  preparedness  and  response  (b)  and  on  global  commitments  and  health 
initiatives (j).  

Horizon  Europe  is  frequently  referenced  in  EU4Health  work  programmes,  with  21  actions 
linked to it. These linked actions build on the results of the Horizon programmes or follow 
recommendations  from  its  bodies.  They  align  with  Horizon  Europe’s  objectives  or  involve 
national  health  authorities  and/or  healthcare  services  that  are  also  members  of  European 
partnerships  funded  by  Horizon  Europe.  Three  actions  in  the  crisis  preparedness  strand118 
concern, access to medical countermeasures, including critical medicines, the development of 
novel antivirals and the European Hub for vaccine development, respectively. In total, they are 
funded by EU4Health with an amount of EUR 154.2 million. 

In 2024, a series of workshops and exchange visits were organised in several Member States 
to  assess  training  needs.  They  serve  as  the  basis  on  which  the  general  EU  health  security 
preparedness training programme is being developed.  

Since December 2022, there have been 17 events to train healthcare staff on preparedness and 
the response to cross-border health threats, with the inclusion of all EU Member States and 
EEA  countries.  A  total  of  530  people  participated  in  these  training  courses,  of  whom  79 
participated in one of the four pilot training courses.  

‘One Health’ surveillance programmes were successfully implemented in one country119 and 
the total consumption (by community and hospital sectors) of antibacterials for systemic use 
was reduced to 19.40120, which was within expectations. Data for the remaining Programme 
indicators on prevention and response to cross-border health threats is progressively becoming 
available. Actions under the crisis preparedness strand contribute to Sustainable Development 
Goal  3,  building  on  the  results  of  the  third  Health  programme.  For  example,  in  2020,  22 
Member States integrated coherent approaches into their preparedness plans, as shown by the 
assessment of the reports on national preparedness plans transmitted to the Commission121. 

The number of actions complementing national stockpiling of essential crisis-relevant products 
is lower than expected at this stage, one action122 implemented, compared to five being the 2024 
milestone. This is partly due to the fact that the number and nature of actions depend on the 

117   EU-JAMRAI2. 
118   CP-p-24-15 Support to speed up the development of access to and/or uptake of medical countermeasures 
including critical medicines (HERA), CP-g-24-105 Call for proposals to support the development of novel 
antivirals (HERA), CP-g-24-10 Call for proposals on the European Hub for vaccine development (HERA).  

119   The Netherlands. 
120   The indicator measures the total consumption (community and hospital sectors) of antibacterials for 

systemic use (ATC group J01) expressed as ‘defined daily dose – DDD per 1 000 inhabitants per day’. 

121   Ex-post evaluation of the third Health Programme (see page 25). 
122   Joint  action  CHESSMEN  Coordination  and  Harmonisation  of  the  Existing  Systems  against  Shortages  of 
Medicines – European Network involves 25 Member States. This one joint action was launched instead of 
launching several direct grants with each interested Member State separately. 

47 

 
 
priorities identified each year for the annual work programme during the programming phased 
and agreed between the Commission and Member States.  

The  co-financing  structure  of  EU4Health  encourages  the  efficient  use  of  funds.  As  regards 
administrative costs, while recognising the potential to further improve further efficiency, it 
should be noted that administrative costs have not significantly hindered the achievement of 
the Programme’s objectives under this strand.  

Strand 2: Health promotion and disease prevention  

The implementation of actions targeting the specific objectives of the  health promotion and 
disease prevention strand is ongoing and the results at the interim stage are better than expected. 
The actions of this strand support very effectively the delivery of the ‘Healthier together’ – EU 
NCD  Initiative  as  demonstrated,  for  example,  by  JA  PreventNCD123  and  JACARDI124. 
Moreover, the legal obligation to allocate a minimum of 20% of the total budget to these actions 
has already been fulfilled125.  

The number of implemented actions contributing to reducing avoidable mortality from NCDs 
is  17,  more  than  three  times  what  was  expected  (5),  and  the  number  of  actions  addressing 
environmental risk factors for health is 7, above the planned 4 in 2024. The increased number 
of actions illustrates the importance  of addressing  environmental risk factors for health and 
contributing to the priorities of the Green Deal. In addition, the fact that the Member States 
have significantly increased their participation (more than double the 10 planned for 2024) in 
actions that transfer best and promising practices to reduce the burden of non-communicable 
diseases  indicates  the  need  to  address  this  issue126.  Investments  in  cardiovascular  disease, 
respiratory  diseases  and  diabetes  were  given  priority.  Initial  actions  have  been  rolled  out, 
implementing effectively the ‘Healthier together’ – EU NCD initiative and the Programme’s 
specific objective on health promotion and disease prevention. The roll-out of mental health 
actions  is  in  line  with  the  Commission’s  political  commitments.  The  EU’s  investments  in 
mental health127 have been increased considerably, including to support people suffering due to 
the Russian war of aggression against Ukraine. This covers activities to prevent and manage 
mental health problems, target depression or provide training and capacity building to support 
a  ‘mental  health  across  policies’  approach.  Despite  these  efforts,  stakeholders  consider  that 
mental  health  should  be  given  higher  priority  in  EU4Health,  even  if  it  is  addressed  in  a 
complementary and synergistic manner by other EU funding programmes. 

EU4Health’s actions on vaccination are consistent with the international vaccination agenda, 
complement  the  actions  of  Member  States  and  support  the  delivery  of  national  vaccination 
programmes. Only two countries have reached 95% coverage for both the first and second dose 
of  the  measles  vaccine  for  eligible  individuals,  which  is  below  the  2024  milestone  of  6 
countries. The 2024 milestone for influenza coverage was achieved by 2021 and remains stable. 
The 2024 milestone for HPV vaccination was met in 2023. The national vaccination coverage 

123   https://preventncd.eu. 
124   Joint Action on CARdiovascular diseases and Diabetes. 
125   Article 5 of the EU4Health Regulation provides that a minimum of 20% of the total EU4Health budget shall 

be reserved for health promotion and disease prevention actions. 

126   Programme Performance Statement 2024. 
127   The total amount is EUR 29 million, which amongst others, was committed to the International Federation 
of  the  Red  Cross  to  address  the  relevant  health  consequences  of  the  Russian  war  of  aggression  against 
Ukraine. 

48 

 
 
 
depends  on  several  factors  (not  all  directly  linked  to  EU  funding128),  but  continued  use  by 
Member States of funding opportunities from the EU’s budget could reduce health inequalities 
and health inequities linked to access to and availability of vaccination, increase the uptake of 
HPV and HBV vaccination in a cancer prevention perspective, and improve the monitoring of 
rates of coverage. 

Figure  17  Selected  vaccination  coverage  indicators  –  see  Annex  VII  for  a  full  list  of  PPMEF  vaccination 
  actual).  *  The  percentage  indicates  the 
indicators  monitored.  (Legend: 
progress on the 2031 targets. 

  milestone; 

  baseline; 

  target; 

There are 9 actions addressing the prevalence of major chronic diseases per Member State, by 
disease, gender, and age (instead of 70 as planned), which indicates the need to reassess and 
adjust the milestone and target, which were set at an overly ambitious level. The number of 
actions  launched  by  the  cut-off  date  that  address  the  prevalence  by  age  of  tobacco  use  and 
differentiated, if possible, by gender, is two, while three actions address the prevalence of the 
harmful use of alcohol and differentiated, if possible, by gender – both types of action have 
surpassed  their  2024  milestone  of  one  action.  The  number  of  actions  depends  also  on  the 
prioritisations  made  during  the  programming  process,  which  involves  Member  States  and 
builds on input from stakeholders. 

EU4Health actions on non-communicable diseases build on actions and employ mechanisms 
that  were  already  proven  to  be  effective  in  the  third  Health  programme,  such  as  the 
identification and transfer of best practices. This was done through the EU-Compass for Action 
on Mental Health and Well-being, which is a web-based mechanism to collect and exchange 
best practices and analyse information on policies and stakeholder activities on mental health. 
Another joint action supported the exchange and implementation of best practices in the field 
of mental health with a particular focus on suicide prevention and the reform of mental health 
services129. In addition, the joint action on tobacco control (JATC2) facilitates the exchange of 
good practices between Member States to improve the implementation of the Tobacco Products 
Directive and the Tobacco Advertising Directive. The functioning of the European Reference 
Networks (ERNs), which clearly has a high level of EU added value, is another example130. It 
is,  therefore,  expected  that  the  actions  on  non-communicable  diseases  will  have  positive 
effects. Involving Member States in the programming of the EU4Health actions ensures they 
are consistent with actions taken by Member States at national level, which has been confirmed 
by stakeholders.  

128   COUNCIL RECOMMENDATION of 21 June 2024 on vaccine-preventable cancers. 
129   ImpleMENTAL. 
130   Staff Working Document on Ex-Post Evaluation of third Health Programme, SWD(2023) 369 final. 

49 

 
  
 
 
 
 
The Programme’s coherence with other EU funding programmes such as Horizon Europe is 
ensured through consultation with the relevant Commission departments on the annual work 
programmes, and  the organisation  of joint  stakeholder events  to  present  projects  in  specific 
thematic areas (e.g. mental health). 

Five actions (with  EUR  91.36 million in  funding)131 that support the  Health promotion and 
disease prevention strand are creating synergies with Horizon Europe. Three of these actions 
implement the ‘Healthier together’ initiative, one is on prevention of mental health problems 
in the area of NCDs and the last is on the health determinants of cancer and other NCDs132. 

Figure  18  Selected  health  promotion  and  disease  prevention  indicators  –  see  Annex  VII  for  a  full  list  of 
PPMEF Health promotion and disease prevention indicators monitored. (Legend: 
target;

 actual); * The percentage indicates the progress towards 2027 targets. 

 milestone; 

 baseline; 

Strand 3: Health systems and healthcare workforce  

Actions  under  the  Health  systems  and  healthcare  workforce  strand  have  been  successfully 
launched. These actions aim to strengthen health systems (e.g. by supporting Member States 
in their policies on the healthcare workforce and on access to healthcare or improving expertise 
on reforming health systems); support the functioning of the ERNs; and contribute to the design 
and  implementation  of  EU  health  legislation  in  areas  like  medical  devices  and  in  vitro 
diagnostic medical devices, pharmaceutical legislation and HTA. 

Health systems and healthcare workforce is the strand with the highest number of actions and 
the second lowest average budget per action and is thus very resource intensive133. 

131   DP-g-23-31-01  Direct  grants  to  Member  States’  authorities:  ‘Healthier  Together’  EU  NCD  initiative– 
chronic respiratory diseases (CRDs), DP-g-23-32-01 Direct grants to Member States’ authorities: ‘Healthier 
Together’ EU NCD initiative – Mental health, DP-g-23-33-01 Direct grants to Member States’ authorities: 
‘Healthier Together’ EU NCD initiative – Dementia and other neurological disorders, DP-g-23-32-02 Call 
for proposals on the prevention of NCDs in the area of mental health including actions supporting vulnerable 
population groups, such as migrants, refugees, Roma people and displaced people from Ukraine. 

132   For  more  information  on  the  relationship  between  EU4Health  and  Horizon  Europe,  see  4.1.1  Crisis 

preparedness. 

133   Crisis preparedness – 103 actions programmed, average budget per action EUR 6 048 341; Health promotion 
and disease prevention – 108 actions programmed, average budget per action EUR 1 439 252; Health systems 
and healthcare workforce – 288 actions programmed, average budget per action EUR 830 107; Digital – 108 
actions programmed, average budget per action EUR 1 157 035: Cancer – 62 actions programmed, average 
budget per action EUR 3 549 437: Other activities – 65 actions programmed, average budget per action EUR 
484 167. 

50 

 
  
 
 
 
 
 
 
The  actions  launched  under  this  strand  have  already  helped  improve  knowledge  at  national 
level in the field of health and will support the implementation of the MDR and IVDR (EUR 
19.8 million). They facilitate access to innovative treatment for patients, including for people 
with  rare diseases  (via  the  ERNs). Awareness-raising activities financed  by the  Programme 
have played a part in helping more than 500 000 cross-border patients per year benefit from 
the provisions of the Directive on cross-border healthcare134. Several actions financed by the 
Programme  are  expected  to  enhance  the  quality  of  medicinal  products  and  improve  the 
availability of medical devices and in vitro medical devices. Lastly, they will help to strengthen 
health  systems  for  the  benefit  of  people  in  the  EU  and  will  lead  to  costs  savings  thanks  to 
advancements in HTA.  

Figure 19 Selected ERNs’ indicators – see Annex VII for a full list of PPMEF ERNs’ indicators monitored  
(Legend: 

 actual). The percentage indicates the progress on the 2027 targets. 

 milestone; 

 baseline; 

 target;

EU4Health has committed funding of EUR 100.5 million for the functioning of the ERNs and 
their activities to exchange information and expertise. The Programme indicators show that, as 
expected, 1 619 healthcare units were involved in the ERNs by mid-2024, and that 2.24 million 
patients had been diagnosed and treated by members of the ERNs, which is 50% more than the 
2024 milestone. This result reflects the recommendation in the third Health programme to focus 
on areas with high EU added value, such as rare diseases.  

The  EU4Health  Programme  also  helped  to  prepare  the  ground  for  the  successful 
implementation of the Health Technology Assessment (HTA) Regulation. The Commission 
is mandated by the HTA Regulation to create and maintain an IT environment for cooperation 
on HTA at EU level. EU4Health is funding this IT environment and the governance groups in 
this area (EUR 11.35 million programmed, of which EUR 5 million has been committed)135. A 
dedicated  EU4Health  action  aims  to  prepare  patients  and  train  clinical  experts  so  they  can 
participate in joint clinical assessments and joint scientific consultations.  

134   Cross-border Healthcare in 2022: Recent data on Member States’ implementation of Directive 2011/24/EU. 
135   According  to  the  HTA  Regulation,  the  European  Commission  acts  as  the  HTA  Secretariat  and  serves  a 
complex governance system. It provides administrative, technical and IT support to the HTA Coordination 
Group and its four subgroups, which are chaired by the Member States. In addition, the Commission manages 
the HTA Stakeholders Network and ensures the implementation of the HTA (legal) framework as stipulated 
in the HTA Regulation. 

51 

 
 
 
 
 
The Programme also contributes to the implementation of legislation on substances of human 
origin (SoHO)136. These directives will be replaced by a new Regulation137 which will enter 
into  force  in  2027.  One  action  made  it  possible  to  prepare  a  tailored  plan  to  authorise  and 
improve access to SoHO innovations, while new technical guidelines have been developed to 
help professionals in over 5 000 establishments to ensure the safety and quality of tissues, cells, 
blood  and  organs.  Using  EU4Health  funds,  the  Commission  is  developing  a  new  digital 
platform to support the authorities in all 27 Member States to perform the different oversight 
tasks. Underlying digital public service(s) will be designed with interoperability in mind,  to 
ensure smooth interconnection and exchange of data with relevant national systems such as 
those managing electronic health records or other registries and databases. EU4Health actions 
have also allowed different SoHO sectors to improve the continuity of supply, including for 
organs and plasma-derived medicines. 

The  Programme  contributes  to  the  implementation  of  the  pharmaceutical  strategy  for 
Europe  and  related  legislation  and  has  supported  the  preparation  of  proposals  for  a  new 
directive  and  a  new  regulation  to  reform  EU  pharmaceutical  legislation.  The  Programme 
indicators  recorded  that  103  medicines  received  an  EU-wide  authorisation  in  2022.  This 
number  fell  to  68  in  2023.  This  indicator  reflects  rather  the  capacity  of  the  pharmaceutical 
industry to deliver, which is very little influenced by EU4Health actions. The level of relevant 
shortages  of  human  and  veterinary  medicines  has  remained  under  control.  EU4Health 
contributes to the creation of a regulatory-approved electronic version of medicinal product 
information (ePI). This opens up new possibilities for patients and healthcare professionals to 
access and use vital, up-to-date information about their medicines, when and where needed. 

EU4Health supports the implementation of legislation on medical devices (MDR) and in vitro 
diagnostic medical devices (IVDR) and related tools. For instance, the Programme supports 
the ongoing IT development of the European Database on Medical Devices (EUDAMED), its 
helpdesk and information centre (a repository of all EUDAMED technical documentation) and 
an  independent  audit  verifying  the  systems’  functionality.  New  EUDAMED  modules  for 
voluntary use have been developed, building on investment from the third Health programme. 
Another action funded by EU4Health, which is also a continuation from the previous health 
programme,  supports  the  Commission  and  national  experts  in  appointing  and  reassessing 
notified bodies. This action led to the designation of 50 notified bodies under the MDR and 12 
notified  bodies  under  the  IVDR.  Other  EU4Health  actions  in  this  field  include  the 
establishment and funding of EU reference laboratories, a joint action on market surveillance 
in this field and an initiative to support the development of orphan devices. The culmination of 
all  the  actions  supporting  the  implementation  of  the  MDR  and  IVDR  lead  to  significant 
increases  in  the  number  of  certificates  issued  for  medical  devices  and  in  vitro  diagnostic 
medical devices: 5 599 certificates were issued for medical devices (almost three times more 
than in 2022), and 702 certificates for in vitro diagnostic medical devices (more than double 
the number in 2022).  

136   Directive 2002/98/EC of the European Parliament and of the Council of 27 January 2003 setting standards 
of  quality  and  safety  for  the collection,  testing, processing,  storage  and  distribution  of human  blood  and 
blood components and amending Directive 2001/83/EC (OJ L 33, 8.2.2003); Directive 2004/23/EC of the 
European Parliament and of the Council of 31 March 2004 on setting standards of quality and safety for the 
donation, procurement, testing, processing, preservation, storage and distribution of human tissues and cells 
(OJ L 102, 7.4.2004). 

137   Regulation (EU) 2024/1938 of the European Parliament and of the Council of 13 June 2024 on standards of 
quality and safety for substances of human origin intended for human application and repealing Directives 
2002/98/EC and 2004/23/EC (OJ L, 2024/1938, 17.7.2024). 

52 

 
 
The  digitalisation  of  health  systems  requires  safe,  ethical  and  trustworthy  solutions.  Using 
digital  health  systems  to  their  full  extent  means  that  healthcare  workers  must  be  trained  in 
specific (digital) skills. EU4Health funding is addressing this skills gap and will help digital 
health to play a stronger role in supporting the work of health professionals and facilitating the 
transformation  of  healthcare  models  to  the  benefit  of  patients.  EUR  37.3  million  has  been 
programmed  for  actions  addressing  the  healthcare  workforce.  Among  other  things, 
EU4Health funding contributes to improving databases and to developing effective tools and 
methods used by the Member States to carry out health workforce planning. 

The  Programme  continues  to  fund  the  ‘State  of  Health  in  the  EU’  cycle  that  contributes  to 
health policymaking in the Member States. EUR 17 million has been programmed to co-fund 
two  joint  actions  on  the  transfer  of  best  practices  in  primary  care  and  on  forecasting  and 
planning the needs of the health workforce. These actions improve cooperation between the 
Member States and help to strengthen health systems. 

In  line  with  expectations  for  2024,  EU4Health  funded  three  actions  producing  guidance  on 
improving access to healthcare services. These actions contribute to SDG 3.8138. 

Two actions are helping to address dependence on imports from outside the EU of essential 
active pharmaceutical ingredients and medicinal products. 28 audits were conducted in the EU 
and in third countries, including candidate countries, to ensure good manufacturing practices 
and good clinical  practices (EU control  on minimum  standards). Lastly, Member States  are 
participating  in  actions  to  support  innovation,  uptake  and  access  to  the  market  of  medical 
countermeasures at EU and global levels. 

It was expected that in 2024, there will be 110 shortages of medicinal products in the Member 
States reported through the single point of contact network. This value measured in 2024 was 
69. Although this value also depends on the level of reporting by companies, this suggests EU 
and national policies have become more effective to prevent critical shortages. 

Strand 4: Digital  

The  digital  strand  supported  actions  to  prepare  the  implementation  of  Regulation  (EU) 
2025/327, which aims to advance the digital transformation of health systems and improve the 
accessibility, coverage and interoperability of health data.  

The actions financed by the Programme are focused on improving health data and digital tools 
and services, on supporting digital transformation, and increasing the interoperability of health 
data (a total of EUR 163 million has been programmed in the 2021, 2022, 2023 and 2024 work 
programmes)139.  Several  actions  support  the  development  of  cross-border  digital  health 
infrastructures  (MyHealth@EU  and  HealthData@EU)  to  facilitate  patient  care  for  any  EU 
citizen travelling in Europe while giving the treating medical professionals access to relevant 
medical data.  

A total of 37 actions were launched by the end of 2023 (surpassing the target of 28 actions by 
mid-2024) to support the digital transformation of healthcare systems and the implementation 
of  the  EHDS,  indicating  an  efficient  programming  process  (see  Figure  20).  Two  other 

138   SDG  Target  3.8  Achieve  universal  health  coverage,  including  financial risk  protection, access  to  quality 
essential health-care services and access to safe, effective, quality and affordable essential medicines and 
vaccines for all. 

139   EU4Health – Performance. 

53 

 
 
indicators were on track to be achieved in 2024, with 13 Member States participating in the 
EHDS by mid-2024, and 15 in total by late-2024 (the target for mid-2024 was 15), and with 21 
health data access bodies set up or in the process of being set up (the target for mid-2024 was 
15). 22 European countries, including 20 Member States, have received support to digitalise 
their health systems and to increase the geographic coverage and interoperability of systems 
and/or  improve  patient  access  to  their  own  health  data.  In  addition,  44  key  projects  were 
launched in late 2023 and early 2024 to implement MyHealth@EU and to set up health data 
access bodies that will pave the way for the EHDS. These projects build on the actions launched 
under the third Health programme, such as the joint actions on the primary and secondary uses 
of health data (e.g. TEHDAS and eHAction). 

Figure  20  Selected  digital  transformation  indicators  –  see  Annex  VII  for  a  full  list  of  PPMEF  Digital 
transformation indicators monitored. (Legend: 
 actual); * The percentage 
indicates the progress on the 2027 and 2031 targets. 

 milestone; 

 baseline; 

 target;

The actions funded by EU4Health that contribute to the EHDS are complemented by initiatives 
under the DEP, which aims to drive innovation in data space technologies, such as actions to 
harmonise  exchanges  of  health  data140.  They  are  further  complemented  by  Horizon  Europe 
actions, e.g. on the data quality and utility label for the EHDS141, or by Member State actions 
supported by the RRF.  

This evaluation finds that there is clear complementarity between EU4Health, Horizon Europe 
and the DEP on health research, and health data use, and digital transformation, respectively.   

For example, the specific objective from the DEP on the use of digital technologies refers to 
health  as  one  of  the  areas  of  public  interest  for  digital  transformation,  which  requires  the 
continuation and expansion of digital service infrastructures. However, DEP does not provide 
direct grants for Member States authorities as EU4Health does, which are fundamental for the 
deployment of cross-border infrastructures such as MyHealth@EU. This point emphasises the 
complementarity between these two programmes.  

In addition to the DEP, feedback from stakeholders reveals that digital actions funded through 
EU4Health  are  being  followed  up  with  new  actions,  funded  at  times  through  different 
initiatives.  The  RRF  focuses  on  economic  recovery  post-COVID,  including  action  to 

140   Examples from the 2023-2024 Digital Europe work programme include: Federated European Infrastructure 
for Intensive Care Units’ Data to provide a harmonised approach to accessing acute care-related data and to 
link it with other health data sources, which are interoperable with the EHDS (EUR 5.1 million); Supporting 
patients’ access to their health data in the context of healthcare services for citizens across the EU (EUR 10 
million); and Demonstrating the in-service use of the European Electronic Health Record Exchange Format 
(EEHRxF) in healthcare settings (EUR 4 million). 

141   https://quantumproject.eu/.  

54 

 
    
 
 
 
strengthen the resilience of health systems. RRF expenditure on resilience in 2023 amounted 
to  EUR  84.1  billion,  of  which  around  49%  can  be  linked  to  healthcare142.  In  particular,  the 
RRF’s focus on digital health, access to healthcare, strengthening public health capacities and 
improving  prevention,  show  coherence  with  the  objectives  of  EU4Health.  The  RRF  has 
dedicated EUR 14.5 billion to the digitalisation of healthcare systems. One example from the 
RRF is the EUR 300 million plan by Portugal to invest in the digital transition of its national 
health service.  A  mid-term evaluation  case study  has  found that the coherence between the 
digital health measures in the RRF, the EU4Health Programme and the 2030 Digital Compass 
depends on the country concerned. Given the substantial amounts of money being spent by the 
RRF  on  healthcare  resilience,  it  is  worthwhile  to  improve  the  existing  synergies  and 
complementarities between it and EU4Health funds to strengthen health systems. 

Another example of a complementary source of funding is InvestEU143, which supports projects 
in the health sector. The links between EU4Health actions and the investments under several 
InvestEU  projects  could  be  strengthened.  Investments  in  digital  infrastructure  and  digital 
technologies offer opportunities for complementarity with EU4Health and would set the path 
towards a more competitive EU health sector. In this area, 10 out of 29 InvestEU operations 
show  some  link  with  healthcare.  The  possibility  to  support  large-scale  health  projects  and 
innovations through InvestEU seems to be underutilised. 

Cross-cutting strand: Cancer  

The  fight  against  cancer  is  driven  by  Europe’s  Beating  Cancer  Plan  and  funded  through 
EU4Health (EUR 531 million programmed by April 2024) and other EU funding programmes. 
Horizon Europe and the EU Cancer Mission have already invested EUR 1.8 billion in the fight 
against  cancer.  This  mission  complements  the  objectives  of  EU4Health,  helping  achieve  a 
comprehensive approach to cancer prevention, diagnosis, treatment and care across the EU. 

The actions on cancer funded by EU4Health support better cancer prevention and treatment by 
reducing exposure to and raising awareness of relevant risk factors; ensuring access to high-
quality healthcare and related care services; improving vaccination coverage rates for vaccine-
preventable  diseases;  increasing  screening  coverage  for  certain  cancers,  and  through  a 
comprehensive information system on cancer. 

Three years into the Programme, many initiatives have already been launched and are expected 
to  have  a  tangible  impact  on  the  lives  of  people in  the  Europe.  The  European  Commission 
Knowledge Centre on Cancer has been established and is sharing reliable, independent and up-
to-date information on topics related to cancer. It aims to foster the scientific and technological 
alignment of all Commission activities on cancer, particularly between the Europe’s Beating 
Cancer Plan and the EU Cancer Mission. An upgraded European Cancer Information System 
makes it possible to monitor and forecast the burden of cancer in Europe (EUR 14.5 million), 
alongside  the  European  Cancer  Inequalities  Registry  (EUR  6.6  million),  which  provides 
insights on disparities in rates of cancer, and on prevention and care. The European Cancer 
Imaging  Initiative improves personalised medicine by making an EU ‘atlas’ of anonymised 
cancer-related  images  accessible.  Another  notable  example  is  the  collaboration  between  
EU4Health,  Euratom  and  the  EU  Cancer  Mission  through  the  SAMIRA  Action  Plan,  an 

142   Report from the European Commission to the European Parliament and the Council on the implementation 
of the Recovery and Resilience Facility: Moving forward. Brussels, 25.9.2023 COM(2023)545 final/2. 
143   InvestEU  offers  loans,  guarantees  or  equity  investments  as  a  complement  to  other  public  and  private 

investments. With EUR 100 million, HERA Invest contributes to the InvestEU programme.  

55 

 
 
initiative supporting safe, reliable and effective use of radiological and nuclear technology in 
healthcare144. 

Because  early  detection  through  screening  offers  the  best  chance  of  treating  cancer  and 
increases  treatment  options,  the  European  Guidelines  and  Quality  Assurance  Schemes  for 
cancer screening, diagnosis and care are being rolled out. This initiative is aligned with and 
aims  to  support  the  implementation  of  the  2022  Council  Recommendation  on  cancer 
screening145. 

Several cancer screening projects launched under the EU Cancer Mission financed by Horizon 
Europe are helping to implement the 2020 Cancer Recommendation on cancer screening146 with 
an investment of about EUR 51 million. 

Major initiatives to train the healthcare workforce, personalise cancer care and improve cross-
border  cooperation  have  been  launched.  The  EU  network  linking  recognised  National 
Comprehensive  Cancer  Centres  (EUR  94  million)  and  new  networks  of  expertise  (EUR  44 
million)  tap  into  the  whole  European  oncology  community  to  address  specific,  challenging 
cancer conditions. In a complementary manner, the EU Cancer Mission Comprehensive Cancer 
Infrastructures  (EUR  9.9  million)  project  helps  Member  States  and  associated  countries  to 
enhance research capacities through a capacity building programme147. 

Six  Programme  indicators148  are  being  used  to  assess  the  progress  of  actions  on  cancer.  25 
Member States, one more than expected (the milestone target was 24) are reporting information 
on cervical, breast and colorectal cancer on the percentage of population covered by Cancer 
Registries. 25 Member  States are reporting information on paediatric  cancer  at  the stage of 
diagnosis, very close to reaching the 2024 milestone of 26 countries.  

Cancer screening is one of the pillars of the Cancer Plan, to which EUR 60 million have been 
committed  from  the  EU4Health  budget.  Several  EU4Health-funded  projects  contribute  to 
cancer  prevention  efforts  with  the  goal  of  reducing  the  incidence  of  cancer  and  improving 
overall public health.  

The data from population-based cancer registries are the basis for the estimation of the cancer 
burden and its trends over time and are crucial for the planning and evaluation of cancer control 
programmes. During the Programme implementation, the proportion of the population covered 
by cancer registries reporting information on cervical, breast, colorectal and paediatric cancer 

144   SAMIRA: Strategic Agenda for Medical Ionising Radiation Applications. 
145   Council Recommendation of 9 December 2022 on strengthening prevention through early detection: A new 
EU approach on cancer screening replacing Council Recommendation 2003/878/EC 2022/C 473/01 (OJ C 
473, 13.12.2022). 

146   Pancaid,  Home  -  PANCAID  (pancaid-project.eu)  Lucia  Home  |  LUCIA  (technion.ac.il)  Dioptra  Home 
DIOPTRA  -  DIOPTRA  project  (dioptra-project.eu)  Sanguine  SANGUINE  -  Early  Diagnostics  of 
Haematological  Malignancies  (Blood  Cancer)  |  Cancer  care  (sanguine-project.eu)  Mammoscreen  The 
MammoScreen Project. 

147   CCI4EU fights against cancer, Horizon Europe. 
148   See the end notes on cancer indicators. 

56 

 
 
stage at diagnosis will be assessed during the implementation of EU4Health. The values for 
2024 are already above the 2024 milestone at the time of reporting149, 150, 151. 

When the Cancer Plan was adopted in 2021, 22 EU Member States, Iceland and Norway had a 
national  cancer  plan  in  place.  After  the  adoption  of  the  Cancer  Plan,  four  more  countries 
developed national cancer plans and ten updated their existing plans. In addition, by December 
2023 three countries were updating their plans. The majority of cancer plans were found to be 
well aligned with the Cancer Plan and covering its four pillars, which demonstrates the added 
value  of  an  EU-wide  programme.  All  the  countries  with  national  plans  have  addressed 
prevention  by  including  initiatives  to  tackle  lifestyle  habits  that  are  related  to  cancer  risk 
factors.  For  early  detection,  in  most  countries,  national  cancer  screening  programmes  for 
breast, colorectal and cervical cancer are in place, with a few exceptions, where opportunistic152 
or private screening programmes are available. Additionally, two Member States have set up 
screening programmes for lung cancer, while six other Member States are running or planning 
to run pilot programmes, following the 2022 update of the Council Recommendation on cancer 
screening which proposed the extension of organised screening programmes to include lung, 
prostate and gastric cancer. All the national cancer plans outline a wide range of initiatives to 
improve the quality of diagnosis and treatment, such as strengthening patient involvement in 
decision-making,  boosting  personalised  treatments  and  providing  continuous  training  for 
healthcare professionals. To improve the quality of life of cancer patients and survivors, several 
national plans include actions on financial support for cancer patients and carers, psychological 
support  for  patients  and  relatives,  and  the  introduction  of  legislation  on  the  ‘right  to  be 
forgotten’ to ensure easier access to financial services, such as insurances. Most national plans 
also touch upon the Cancer Plan’s cross-cutting themes of research and innovation, inequalities 
and  paediatric  cancers.  Several  countries  have  financed  cancer  research;  however,  funding 
varies depending on the size of the country and the availability of suitable infrastructure and 
personnel. While paediatric cancers are a priority area in some national plans, this often falls 
under the umbrella of other priority areas on care or quality of life.  

Figure 21 Selected cancer indicators – see Annex VII for a full list of PPMEF cancer indicators monitored. The 
percentage indicates the progress on the 2027 targets. 

149   L Villani, M T Riccardi, A Barbara, T Sabetta, M C Nurchis, A Sabetta, A Solipaca, W Ricciardi, A shared 
battle  against  cancer:  overcoming  screening  uptake  differences  within  European  countries, European 
Journal 
2020, 
30, 
ckaa166.1132, https://doi.org/10.1093/eurpub/ckaa166.1132.  

Public  Health,  Volume 

Supplement_5, 

September 

Issue 

of 

150   Cardoso, R. et al. (2021). Colorectal cancer incidence, mortality, and stage distribution in European countries 
in  the  colorectal  cancer  screening  era:  an  international  population-based  study.  The  Lancet.  Oncology. 
https://doi.org/10.1016/S1470-2045(21)00199-6. 

151   Cardoso, R., Hoffmeister, M., & Brenner, H. (2023). Breast cancer screening programmes and self‐reported 

mammography use in European countries. International Journal of Cancer, 152, 2512 - 2527. 

152   Screening that occurs outside of a structured, population-based screening programme. 

57 

                                                                                                                                                                                                                     
 
 
 
 
 
Overall, the actions on cancer are being successfully implemented and are contributing towards 
the ambitious goal of ‘beating cancer’. These actions complement and expand on the initiatives 
launched  under  the  third  Health  programme.  As  an  example,  the  activities  of  the  European 
Network  of  Cancer  Registries,  coordinated  by  the  Commission,  provided  a  harmonised 
European dataset used for different purposes under the third Health Programme153. This concept 
has  been  further  developed  in  the  Cancer  Plan  through  the  European  Cancer  Information 
System and the European Cancer Inequalities Registry. Similarly, the Joint Action Innovative 
Partnership  for  Action  Against  Cancer154,  also  under  the  third  Health  programme,  aimed  to 
develop  innovative  approaches  to  cancer  control.  The  Cancer  Plan  is  taking  this  forward, 
prioritising research and innovation as a cross-cutting theme in all its flagship initiatives. The 
final evaluation of the third Health programme pointed out the lack of cancer actions aimed at 
children and young people. The Cancer Plan has a section, and a flagship action dedicated to 
childhood  cancer.  In  2021,  the  Commission  launched  the  ‘Helping  Children  with  Cancer 
Initiative’  to  ensure  that  children  have  access  to  rapid  and  optimal  detection,  diagnosis, 
treatment and care. As part of these initiatives the EU Network of Youth Cancer Survivors has 
been launched, and it is collaborating with the EU Cancer Mission. Furthermore, a new section 
on  paediatric  cancers  was  added  to  the  European  Cancer  Information  System  and  renewed 
funding for the PaedCan ERN is ensured. 

Coherence between EU4Health and Horizon Europe is most prominent in the case of cancer 
actions155. This stems from the close alignment of Horizon Europe’s EU Cancer Mission with 
EU4Health’s cancer strand, which is ensured by the joint governance of the EU Cancer Mission 
and the Cancer Plan. 

Of the 21 actions in EU4Health annual work programmes that reference Horizon Europe, 12 
focus on cancer156. Their budget amounts to EUR 262.6 million. Some EU4Health actions are 
building upon the results of projects funded by Horizon Europe157. A visual representation of 
the cancer-related actions and their interconnection, along with a cancer projects dashboard, 
have been developed by the Knowledge Centre on Cancer158. 

4.2.  How did the EU intervention make a difference and to whom? 

4.2.1.  Main beneficiaries and relevant gains  

The Programme finances actions with EU added value under the pillars of the European Health 
Union that reach all Europeans. 54% of stakeholders report that EU4Health delivers to a large 
or very large extent results that go beyond what could reasonably be expected from the Member 
States acting independently159. This view is particularly strong among national authorities and 

153   Staff Working Document on Ex-Post Evaluation of third Health Programme (europa.eu). 
154  
155   For  more  information  on  the  coherence  between  EU4Health  and  Horizon  Europe,  see  4.1.3  Crisis 

iPAAC Home. 

preparedness. 
156   See Annex VIII. 
157   For example, action CR-p-23-43 builds on outcomes from Horizon Europe projects like ‘European Quality 
of  Life  in  Oncology’  (EUonQoL)  and  ‘HORIZON-MISS-2023-CANCER-01-04’,  aiming  to  improve  the 
quality of life for childhood cancer patients and their families. 

158   https://knowledge4policy.ec.europa.eu/visualisation/cancer-projects-tool_en . 
159   Targeted surveys in the context of the study supporting EU4Health interim evaluation. 

58 

 
 
 
 
EU-level  non-profit  organisations,  who  value  the  Programme’s  role  in  addressing  health 
inequalities and supporting smaller Member States.  

The Programme is expected to have significant economic impacts as healthier populations 
contribute  to  higher  productivity  and  reduced  healthcare  costs.  Societally,  the  Programme 
directly contributes to improving public health and the quality of life for people in the Europe, 
by  addressing  critical  health  issues  such  as  cancer,  mental  health,  chronic  diseases  and 
communicable diseases,  ensuring that  all  the participating countries  have  access  to  the best 
practices and innovations in healthcare. Continuous funding of ERNs since 2017, including the 
considerable budget increase received from EU4Health, made it possible to treat and diagnose 
2.24 million patients with rare diseases in 2023.  A total of 1 619 members of the ERNs were 
able to continue to develop their expertise and strengthen links with other healthcare providers 
in the EU. Thus, the ERNs improve the life of patients with rare diseases and add to the capacity 
of healthcare providers. 

The Programme is helping participating countries and their authorities to navigate an era 
of  complex,  overlapping  and  interlinked  crises.  It  provides  significant  added  value  by 
improving the coordination and implementation of health-related legislation across Member 
States, thereby strengthening the collective response to health challenges. Its role is crucial for 
achieving  a  cohesive  approach  to  health  emergencies,  chronic  disease  management  and 
improvements in public health. This is particularly evident in how the Programme supports the 
dissemination and adoption of best practices across borders. EU4Health funds  collaborative 
projects that enhance the capabilities of people in the healthcare workforce, which is vital for 
countries that need to improve their delivery of health services. Additionally, the Programme 
supports the integration of digital health technologies, benefiting health systems by improving 
efficiency and patient outcomes. By financing and fostering HTA cooperation, EU4Health can 
increase the probability that new medical treatments and innovations will reach all Member 
States, not just those with the most resources. The EU4Health Programme helps to improve 
health equity and universal healthcare access across the EU. 

The EU and its Member States stand to benefit from investments in health including through 
EU4Health.  Pooling  resources  at  the  EU  level  can  lead  to  economies  of  scale  in  (joint) 
procurement (for vaccines, medical equipment, etc.), research and health initiatives, making 
them more cost-effective than if each Member State acted independently. The EU’s collective 
voice  and  resources  enable  it  to  play  a  significant  role  in  global  health  matters.  Research 
highlights that the EU’s approach to health impact assessments and its ‘health in all policies’ 
approach offer a more integrated and comprehensive strategy compared to individual national 
efforts, which often face limitations in resources and scope160. While some critiques point to 
weaknesses in strategic planning, they also recognise the broader ambition and scale of EU 
health programmes, suggesting that the EU’s initiatives achieve impacts beyond the reach of 
national actions alone161. The evaluation supporting study found that the Programme’s benefits 
are  especially  pronounced  for  smaller  Member  States,  which  often  face  challenges  in 

160   Hübel, M., & Hedin, A. (2003). Developing health impact assessment in the European Union. Bulletin of the 
World Health Organization, 81 6, 463-4. https://doi.org/10.1590/S0042-96862003000600020.; Koivusalo, 
M. (2010). The state of Health in All policies (HiAP) in the European Union: potential and pitfalls. Journal 
of Epidemiology & Community Health, 64, 500 - 503. https://doi.org/10.1136/jech.2009.102020.; Salay, R., 
&  Lincoln,  P.  (2008).  Health  impact  assessments  in  the  European  Union. The  Lancet,  372,  860-861. 
https://doi.org/10.1016/S0140-6736(08)61337-9. 

161   Watson, R. (2009). European auditors question the value of EU-funded public health programmes. BMJ: 

British Medical Journal, 339. https://doi.org/10.1136/BMJ.B2819. 

59 

 
 
addressing rare diseases due to limited resources and, in their health systems, due to limited 
capacity  and  small  market  size.  Prior  studies  highlight  these  issues,  indicating  that  smaller 
countries  often  struggle  with  healthcare  reforms  and  resource  limitations162  and  receive  a 
disproportionately low share of EU healthcare research funds163. 

Additionally,  the  Programme’s  collaborative  framework  empowers  NGOs  and  other 
organisations  to  operate  on  a  larger  scale,  thereby  increasing  their  impact  and,  through  the 
procurement  of  health-related  services,  stimulating  private  sector  entities  to  provide  and 
maintain specialised jobs. The evaluation supporting study found that NGOs also play a critical 
role in this narrative. They report that without EU4Health, they would struggle to sustain their 
initiatives  due  to  limited  national  funding.  The  Programme  enables  significant  knowledge 
exchange  between  NGOs  and  the  Commission,  fostering  a  more  cohesive  and  informed 
approach  to  health  challenges.  The  cessation  of  EU4Health  could  result  in  a  loss  of  these 
valuable exchanges. 

Added value of EU-wide cooperation  

Stakeholders  consistently  emphasise  that  EU4Health’s  most  evident  contribution  is  in 
facilitating collaboration between Member States164. This collective effort enables countries 
to share knowledge, exchange information, and build connections that would be much harder 
to establish individually. For example, one interviewee highlighted how EU4Health enabled 
the  adoption  and  implementation  of  a  mental  health  strategy  from  another  Member  State, 
underscoring the importance of sharing best practices. Such exchanges foster innovation and 
prevent  duplication  of  efforts,  ensuring  a  more  efficient  use  of  resources  across  the  EU. 
Without  such  a  collaborative  approach,  many  of  these  innovations  might  have  taken  much 
longer to develop or would have required far more resources, leading to inefficiencies. The 
provision  of  European  evidence-based  guidelines  and  quality  schemes  that  ensure  essential 
levels of quality care and can be deployed and adapted at national level, maximises the use of 
resources  and  facilitates  equity  in  access  to  quality  care.  Joint  actions  of  Member  States 
coordinated  at  EU  level  help  to  reduce  disparities  in  the  availability  and  affordability  of 
healthcare,  especially  for  rare  diseases  or  cancer,  and  to  address  vulnerable  groups.  The 
growing  emergence  of  medical  deserts  underscores  the  need  to  prioritise  support  to  reduce 
disparities in health outcomes and the levels of unmet needs within and across Member States, 
remote regions and partner countries to ensure territorial cohesion. 

Cross-border regional cooperation on healthcare improves knowledge sharing, management, 
and patient treatment and strengthens the preparedness of both regional and national authorities 
for crisis management. Several EU border regions played a vital role during the COVID-19 
crisis  by  providing  intensive  care  places  and  treatment  to  relieve  over-burdened  hospitals 
across the border or by sending healthcare professionals and essential medical equipment to 
other  regions  in  need.  The  significant  added  value  of  health  investments  in  facilitating 
collaboration and fostering the alignment of priorities across Member States is confirmed 
by the literature. Studies on cross-border healthcare collaboration reveal that such initiatives 
are more effective in regions with established cooperation, and which have received significant 

162   Azzopardi-Muscat, N., Funk, T., Buttigieg, S., Grech, K., & Brand, H. (2016). Policy challenges and reforms 
in small EU member state health systems: a narrative literature review. European journal of public health, 
26 6, 916-922. https://doi.org/10.1093/eurpub/ckw091. 

163   Kaló, Z., Akker, L., Vokó, Z., Csanádi, M., & Pitter, J. (2019). Is there a fair allocation of healthcare research 

funds by the European Union. PLoS ONE, 14. https://doi.org/10.1371/journal.pone.0207046. 

164   Targeted surveys in the context of the study supporting EU4Health interim evaluation. 

60 

 
 
support from EU funding. For example, a comprehensive study on cross-border cooperation 
found that EU-funded projects in healthcare lead to improved knowledge sharing, management 
and patient treatment, demonstrating both economic and social benefits165. Similarly, a review 
of cross-border health activities in various EU regions identified that these projects, which span 
education, training and disaster control, have considerable potential for development and offer 
substantial improvements in healthcare delivery166. The importance of these collaborations was 
particularly  evident  during  the  COVID-19  pandemic,  which  highlighted  how  cross-border 
efforts can enhance access to healthcare and create synergies between regional capacities.  

EU4Health funding ensures the creation of interoperable systems at EU level via setting up and 
maintaining the data standards and federated structure of the EHDS. These are necessary for 
EU-wide access to health datasets by both public services and industry.  Access to large and 
diverse datasets will assist in the developments of policies and innovation, provide developers 
of  AI-based  devices  with  solutions  and  AI  algorithm  datasets  sufficiently  large  for  more 
accurate  and  inclusive  applications  in  healthcare,  and  help  public  services  in  finding  better 
healthcare solutions. 

The evaluation supporting study revealed that the Programme also creates a level playing field 
across Member States, as the negative externalities for certain countries are much smaller. This 
is also evident from the different responses from Member States on whether they can continue 
all or at least some EU-funded initiatives and actions by themselves at national level. Some 
Member  States  indicate  that  national  funding  alone  is  insufficient,  and  initiatives  would 
discontinue. Others indicate that all national initiatives would still exist but perhaps at a smaller 
scale or slower pace. This might be explained by differences in the dependence of Member 
States on EU4Health funding.  

The percentage effect or multiplier of EU cross-country cooperation in cohesion policy and 
research and innovation varies based on the area and type of cooperation. However, multipliers 
generally range from 1.3167 to 5.0168, depending on the specific context and sector. These values 
highlight the significant economic impact of EU-wide initiatives, which benefit from pooling 
resources, reducing barriers and fostering greater integration among Member States.  

Added value of healthcare expenditure  

Based on an analysis of megatrends in historically reported population health outcomes and 
findings from the literature on the role of healthcare investments in improved population health 
status, a societal multiplier for spending on healthcare and related public health measures of 
slightly above 3 can be  assumed (see Annex II). This result is derived from monetising the 

165   Bobek,  J.,  Schmidt,  A.,  Röhrling,  I.,  Seethaler,  J.,  Feichter,  A.,  Habimana,  K.,  Piso,  B.,  Bachner,  F., 
Miteniece,  E.,  Groot,  W.,  &  Pavlova,  M.  (2018).  Study  on  Cross-Border  Cooperation:  Capitalising  on 
existing initiatives for cooperation in cross-border regions Final report. https://doi.org/10.2875/825256. 
166   Brand, H., Hollederer, A., Wolf, U., & Brand, A. (2008). Cross-border health activities in the Euregios: good 
245-54. 

policy, 

2-3, 

for 

86 

practice 
health. Health 
https://doi.org/10.1016/J.HEALTHPOL.2007.10.015. 

better 

167   Christou, T., Garcia Rodriguez, A., Heidelk, T., Lazarou, N., Monfort, P. and Salotti, S., A RHOMOLO 

assessment of 2014-2027 cohesion policy, European Commission, Seville, 2024, JRC136790. 

168   COMMISSION STAFF WORKING DOCUMENT EVALUATION Accompanying the document REPORT 
FROM  THE  COMMISSION  TO  THE  EUROPEAN  PARLIAMENT  AND  THE  COUNCIL  Ex-post 
evaluation of Horizon 2020, the EU Framework Programme for Research and Innovation, SWD(2024) 29 
final. 

61 

 
 
estimated number of life years saved through healthcare investments. As such, it sets a general 
benchmark for the expected return on investment in the healthcare domain.  

The EU ‘health response’ in Ukraine and neighbouring countries  

The  EU4Health  Programme  addressed  the  health  consequences  of  the  Russian  war  of 
aggression against Ukraine through four projects169 supporting persons displaced from Ukraine. 
It also supports, with a budget of EUR 23.19 million, the work of the International Federation 
of  Red  Cross  and  Red  Crescent  to  improve  mental  health  and  psychosocial  support  for 
displaced  people  coming  from  Ukraine.  In  2023,  600  000  displaced  people  from  Ukraine 
received psychological first aid and mental health services in 22 Member States and three non-
EU countries. 

169   MESUR – Mental Health Support for Ukraine Refugees, U-RISE – Ukraine’s displaced people in the EU: 
Reach  out,  Implement,  Scale-up  and  Evaluate  interventions  promoting  mental  wellbeing,  Well-U  – 
Promoting the mental health and psychosocial wellbeing of refugee children and their caregivers through lay 
professionals amidst Ukraine’s displacement crisis, and Peace of Mind and Strength of Heart.  

62 

 
 
 
 
4.2.2.  The added value by Programme strand 

Strand 1: Crisis preparedness 

The stakeholders consulted for the supporting study170 broadly agree that many of EU4Health’s 
objectives  are  best  met  through  coordinated  action  at  the  EU  level.  Survey  results  indicate 
significant support for this view, particularly for objectives related to protecting people from 
cross-border health threats  –  general  objective (b) – with  66% of respondents  agreeing  to  a 
large  or  very  large  extent  that  EU-level  action  is  needed.  This  perspective  is  echoed  in 
interviews,  where  stakeholders  highlighted  the  fact  that  certain  results,  especially  those 
involving cross-border challenges and crisis preparedness, could not be achieved as effectively 
by Member States acting alone. For instance, the fight against medicine shortages benefits from 
EU-level coordination and funding that would be difficult to replicate nationally. 

EU4Health has played a pivotal role in strengthening the EU’s preparedness for health crises 
such as COVID-19 and Mpox. This has been achieved by fostering collaboration, promoting 
advanced research and development on medical countermeasures and related technologies, and 
reinforcing early warning response systems and surveillance, thus also supporting the mandate 
of HERA. The Programme has enhanced the EU’s capacity to respond effectively to emerging 
threats. The Programme has also helped to ensure that the EU has sufficient stocks of essential 
medical supplies to respond to crises.  

By pooling resources and efforts across Member States, for example, by establishing European 
reference  laboratories  and  early  warning  and  response  capacities,  or  developing  the  EU 
immunisation agenda, the EU significantly increases its capacity to respond to public health 
crises,  improve  population  health  outcomes,  and  strengthen  political  cohesion  and  social 
resilience.  The  EU4Health  funds  have  mobilised  23  Member  States  to  work  together  on 
creating and scaling up a coordinated surveillance system under the One Health approach for 
cross-border pathogens. 

From a political perspective, the EU4Health Programme reflects a collective effort to tackle 
shared challenges, such as cross-border epidemics and pandemics, which no single country can 
fully address alone. Additionally, joint EU health actions reduce fragmentation within the EU 
and foster trust between Member States.  

In terms of social added value, the EU4Health Programme allows for a proactive approach that 
safeguards public health across Member States by strengthening early warning and surveillance 
systems for the early detection and assessment of threats, ensuring timely access to essential 
medical countermeasures, such as vaccines, therapeutics and diagnostics. For people living in 
the EU, this translates to increased protection from emerging health threats, reducing the social 
disruption caused by crises like COVID-19. 

Actions  under  the  crisis  preparedness  strand  demonstrate  additionality  by  helping  countries 
comply with the International Health Regulations171 by strengthening their capacities to address 
cross-border  health  threats.  Projects  such  as  EU-Wastewater Integrated Surveillance  for 
Public Health  (EU-WISH172)  and  UNITED4Surveillance  directly  contribute  to  these  aims, 

170   Targeted surveys in the context of the study supporting the EU4Health interim evaluation. 
171   International Health Regulations. 
172   EU-WISH and UNITED4Surveillance on EU – Wastewater Integrated Surveillance for Public Health. 

63 

 
 
enhancing EU-wide prevention of and preparedness for health crises and ensuring that the EU 
can respond to health emergencies more effectively. 

The stakeholders interviewed as part of the supporting study173 acknowledged the additionality 
of the Programme since they had observed significant progress in creating bigger reserves of 
vaccines and better training on preparedness. In their view, this was predominantly due to the 
large  budget  increase  under  EU4Health.  This  underscores  the  importance  of  EU4Health  in 
increasing the collective capacity of Member States to address health crises in a unified manner. 
It is also to be noted that further emphasis on crisis preparedness was a natural consequence of 
the COVID-19 pandemic, which was further substantiated by the creation of HERA. 

It is highly unlikely that the EU could have achieved the same level of preparedness for health 
crises  without  the  EU4Health  Programme.  The  Programme’s  ability  to  coordinate  efforts 
across Member States, leverage economies of scale, and promote innovation has been essential 
in strengthening the EU’s resilience. 

Limiting  the  EU4Health  Programme  would  have  significant  negative  consequences  on  the 
EU’s ability to respond to health crises. This would likely lead to a fragmentation of efforts, 
less innovation, and a weakened capacity to prevent, detect and respond to emerging threats. 

In  summary,  the  EU4Health  Programme  has  played  a  vital  role  in  enhancing  the  EU’s 
preparedness  for  health  crises.  Its  continued  operation  is  essential  for  ensuring  the  EU’s 
resilience and protecting the health of its population. 

Strand 2: Health promotion and disease prevention 

The  EU4Health  Programme  demonstrates  significant  EU  added  value  by  strengthening 
collaboration between Member States and by facilitating targeted interventions in the field of 
health  promotion  and  disease  prevention.  By  supporting  exchanges  of  best  practices, 
EU4Health enables Member States to tackle common health challenges more effectively than 
they could alone. 21 Member States have taken steps to implement elements of the Belgian 
mental health reform and Austrian initiative on suicide prevention174, multiple Member States 
have  engaged  to  enhance  mental  health  systems  and  reduce  stigma175,  and  several  Member 
States  and  other  stakeholders  have  decided  to  implement  training  and  capacity  building 
activities for the support of a mental health across policies approach. 

By  providing  targeted  funding,  fostering  collaboration  and  promoting  the  exchange  of  best 
practices  through  platforms  like  the  Commission’s  Best  Practice  Portal176,  and  the  Health 
Promotion  and  Disease  Prevention  Knowledge  Gateway177,  the  EU4Health  Programme 
empowers  Member  States  to  strengthen  their  national  health  systems,  and  improve  health 
outcomes across Europe, demonstrating a clear added value that goes beyond what individual 
countries  could  achieve.  Shifting  the  investments  from  EU4Health  to  individual  Member 
States’ national budgets would likely result in fragmentation and reduced coordination. 

Strand 3: Health systems and healthcare workforce 

173   Targeted surveys in the context of the study supporting EU4Health interim evaluation. 
174   Joint Action ImpleMENTAL. 
175   European Alliance Against Depression-Best action. 
176   Best Practice Portal. 
177   Health Promotion and Disease Prevention Knowledge Gateway.  

64 

 
 
Support for the ERNs is exemplary in demonstrating the EU added value of EU4Health. The 
Programme  makes  it  possible  to  share  scarce  knowledge  which  would  not  otherwise  be 
available, especially in Member States where the number of patients with rare diseases is not 
big enough to allow the health service to build up the necessary expertise. ERNs give patients 
an opportunity to access diagnosis and treatment services without the added burden of having 
to travel to other countries.  

EU4Health funded the joint action CIRCE-JA, which focuses on transferring best practices in 
primary  healthcare  between  Member  States,  demonstrates  how  EU-level  collaboration 
leverages  shared  experiences  and  builds  capacity  to  improve  the  quality  of  healthcare178. 
Individual Member States, in the absence of such collaborative efforts, might resort to isolated 
approaches and less efficient implementation179. 

Similar  benefits,  mainly  for  the  Member  States  that  do  not  have  the  necessary  capacity 
themselves, stem from the EU HTA legislation. EU4Health has contributed to the preparations 
to implement the HTA Regulation by financing several actions in this field, which enhance the 
pooling of expertise and resources and provide added value to Member States’ HTA activities. 

EU4Health  funds  the  continuous  professional  development  of  health  professionals,  with  a 
focus on digital skills in the areas of oncology, AMR, gynaecology and hospital care as well 
as more transversal  and  advanced digital skills  in healthcare.  This helps  professionals  from 
different  countries  to  improve  their  professional  skills  in  a  coherent  manner.  EU4Health 
supports the successful implementation of the MDR and IVDR as well as the legislation on 
pharmaceuticals, and their contribution to the Single Market. It funds initiatives that increase 
the availability of safe and effective medicines, ensuring that Member States can benefit from 
more efficient clinical trial frameworks and improved public health outcomes. 

Without  the  Programme,  the  health  challenges  and  related  investments  would  rest  with  the 
Member States, and implementation would have been slower and uneven across the EU. 

Strand 4: Digital 

The EU4Health Programme plays a critical role in developing and facilitating interoperability 
and  aligning  Member  States’  digital  health  priorities  with  broader  EU  and  international 
objectives  such  as  on  developing  comprehensive,  interoperable  and  secure  EHR  systems, 
aligned with the objectives of the EHDS180.  

Interoperability is at the core of the EHDS and the work in the area of digital health at EU level. 
Through joint work between Member States, EU4Health also supports the deployment of key 
cross-border digital health infrastructures (such as MyHealth@EU or HealthData@EU) and 
capabilities for the reuse of health data that might otherwise remain out of reach for individual 
Member States. These efforts align with the Interoperable Europe Act, notably by promoting 
the  uptake  of  shared  interoperability  solutions.  EU4Health  serves  as  a  catalyst  for  digital 
innovation  within  healthcare  systems,  particularly  benefiting  smaller  Member  States.  The 
Programme drives the adoption of digital tools that are interoperable, such as services for the 
exchange of e-prescriptions and other categories of electronic health records in cross-border 

178   Borghini,  A.,  Scotellaro,  M.,  Baldini,  L.,  Cosi,  R.,  Carriazo,  A.,  Elarre,  V.,  Guerrero,  V.,  Carini,  E.,  & 
Mantoan, D. (2023). Sustainability of organisational models implementation in primary care: the CIRCE-JA 
approach. The European Journal of Public Health, 33. https://doi.org/10.1093/eurpub/ckad160.1381. 

179   Targeted surveys in the context of the study supporting EU4Health interim evaluation. 
180   XT-EHR. (n.d.). Home. 

65 

 
 
settings, ensuring that these advancements are implemented more swiftly and effectively across 
the EU. 

Stakeholders also noted that without EU4Health, these digital transitions would likely progress 
much  more  slowly  or  might  not  occur  at  all  in  some  Member  States,  highlighting  the 
Programme’s  critical  role  in  modernising  healthcare  systems  across  the  EU.  Similarly, 
feedback from a stakeholder in one Member State highlighted EU4Health’s role as a catalyst 
for advancing digital health initiatives. Without EU4Health support, the development of the 
EHDS in that country would have been significantly slower and less efficient. They noted that 
while the EHDS would have been established eventually, the accelerated progress and greater 
efficiency provided by EU4Health funding were crucial for achieving timely advancements in 
digital health. 

Cross-cutting strand: Cancer 

The coordinated joint actions on cancer under EU4Health are facilitating the roll-out of cancer 
screening programmes and standardising screening protocols and treatment guidelines across 
Member  States.  These  initiatives  not  only  improve  immediate  health  outcomes  but  also 
establish a framework for future collaborative health initiatives under the Programme. They 
are  also  pooling  specific  medical  capacity  to  provide  high  quality  standards.  This  makes  it 
possible to draw on complementary knowledge and skills in a highly interdisciplinary field to 
advance knowledge and improve treatment. 

The European Cancer Inequalities Registry covers all Member States, as well as Iceland and 
Norway, and helps to identify challenges and specific areas of action to guide investment and 
interventions  at  EU,  national  and  regional  levels.  The  European  Guidelines  and  Quality 
Assurance  Scheme  for  Breast  Cancer  funded  by  the  Programme  support  better  quality  and 
person-centred care in breast cancer services across Europe and can be rolled out in Member 
States.  The  inter-speciality  training  curriculum  developed  and  rolled  out  with  EU4Health 
support in 105 cancer centres across 21 Member States and 4 associated countries will ensure 
the sustainability of the Inter-Speciality Cancer Training programme in these countries181. In 
this context two new modules have been introduced, focusing on paediatric oncology and the 
specific needs of displaced people with cancer, with a special focus on Ukraine. 

The adoption of the Cancer Plan and the support pledged by EU4Health gave an impulse to 17 
more countries to develop national plans, the majority of which are aligned with the Cancer 
Plan’s  structure,  reflecting  EU-wide  added  value.  In  all  plans,  prevention  efforts  have 
addressed lifestyle-related cancer risks. Most countries have screening programmes for breast, 
colorectal and cervical cancer, with some offering screening for lung cancer, spurred by the 
2022 update of the Council Recommendation. Plans emphasise the improvement of diagnosis 
and  treatment  quality  through  patient  involvement,  personalised  treatments,  and  training  of 
healthcare professionals. To enhance quality of life, actions include financial and psychological 
support,  and  ‘right  to  be  forgotten’  legislation.  Cross-cutting  themes  such  as  research, 
inequalities and paediatric cancers are prevalent, though research initiatives vary by the size of 
the country and its resources. Paediatric cancer is often integrated with other priorities. 

181   INTERACT-EUROPE 100. 

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4.3 Is the intervention still relevant? 

4.2.3.  The relevance of the EU’s health intervention  

Across the board, the overall health of the EU population, measured as the rate of Potential 
Life  Years  Lost  (i.e.  life  years  lost  before  the  age  of  70,  or  PYLL)  per  100  000  residents, 
improved  between  2011  and  2021.  However,  the  variance  across  Member  States  increased, 
with  some  low-performing  countries  not  showing  an  improvement  over  time.  Assuming  all 
Member States would perform as well as Sweden (which has the lowest rate of PYLL) would 
yield a reduction of almost 6 million PYLL per year (monetised to a value of almost EUR 530 
billion). 

Preventable182 and treatable183 mortality make up the bulk of PYLL, with mental health (as part 
of preventable mortality) as well as cancer and cardiovascular diseases confirmed as the leading 
causes of premature death. 

Figure 22 Total potential years of life lost by type of mortality and main therapeutic area  

4.2.4.  The relevance of the specific objectives and EU4Health actions  

The findings of the evaluation supporting study indicate that all of the general and specific 
objectives  of the  EU4Health  Programme  were highly  relevant, reflecting  accurately  and 
comprehensively the health needs and challenges at the time the Programme was drawn up. 
The specific objectives were well aligned with the EU’s strategic public health priorities for 
the period 2019-2024, which include improving the supply of affordable medicines, ensuring 
the  effective  implementation  of  the  new  regulatory  framework  on  medical  devices,  and 
prioritising eHealth184.  

Given  that  all  the  2020  health  challenges  persisted  during  the  implementation  of  the 
Programme, the study’s findings, and further analysis, also revealed that, during 2021-2024, 

182   Deaths which could have been avoided by public health interventions focusing on wider determinants of 
public health, such as behaviour and lifestyle factors, socio-economic status and environmental factors. 

183   Deaths which could have been avoided by more effective and timely healthcare. 
184   European  Commission  (2019),  Mission  letter  from  Ursula  von  der  Leyen,  President  of  the  European 

Commission, to the Commissioner for Health and Food Safety. 

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EU4Health was very relevant to European Health Union priorities such as cross-border 
health  threats,  the  Cancer  Plan,  Healthier  together,  HTA,  the  EHDS,  the  pharmaceutical 
strategy for Europe; and generally relevant to all the other initiatives managed by the parent 
DGs. The objectives of EU4Health and the initiatives just mentioned are closely aligned, and 
their implementation is supported by EU4Health’s budget.  

The  Programme’s  continued  relevance  is  underscored  by  stakeholders’  high  opinion  of  its 
relevance over the implementation period: at least two thirds of survey respondents reported 
that each general objective was relevant to either ‘a very large’ or ‘a large’ extent, while at least 
half of the respondents felt the same way about each specific objective. These findings were 
confirmed  in  the  targeted  interviews.  The  actions  funded  in  the  2021-2024  annual  work 
programmes  were  considered  highly  relevant  for  implementing  all  the  general  and  specific 
objectives,  as  confirmed  by  a  mapping  exercise  and  stakeholders’  agreement  in  the 
consultation.  

Strand 1: Crisis preparedness 

The Programme has successfully launched a wide range of initiatives to support the specific 
objectives on crisis preparedness and response (b), and on a reserve of medical and healthcare 
staff  (e)185.  This  includes  the  substantial  efforts  to  improve  preparedness  and  response 
capabilities as regards cross-border health threats, which strengthen the EU’s ability to manage 
and  respond  to  health  crises  effectively.  Funding  has  supported  various  Member  States  to 
enhance  their  surveillance  and  intelligence-gathering  capabilities,  strengthen  European 
reference laboratories, and boost the development of early warning and response systems. The 
Programme’s efforts in pandemic preparedness have led to significant progress in improving 
research  and  development,  innovation  and  manufacturing  infrastructure  for  medical 
countermeasures.  For  instance,  the  establishment  of  the  EU  FAB  network,  which  rapidly 
activates vaccine production in the event of a crisis, is a significant achievement. Additionally, 
the  Programme  has  made  advances  in  addressing  AMR,  conducting  comprehensive 
assessments and feasibility studies to determine critical needs in Member States. International 
collaboration  has  also  been  strengthened,  particularly  with  the  WHO,  to  enhance  global 
pandemic preparedness.  

The EU4Health Programme also supports the integration of the European Chemical Agency 
and the European Environment Agency into the network of EU agencies and bodies that will 
perform a rapid risk assessment in case of a serious cross-border threat to health.  

Stakeholders indicate that EU4Health plays a vital role in crisis preparedness and response, as 
it offers flexibility and anticipatory capabilities essential for addressing health threats. National 
authorities  have  benefited  significantly  from  the  collaborative  efforts  fostered  by  the 
Programme.  These  collaborations  have  enabled  Member  States  to  work  together  to  address 
common health threats, developing and implementing tools that enhance the safety and quality 
of health activities. Moreover, the  Programme has helped strengthen public health systems, 
particularly in their ability to respond to cross-border health threats. 

International  organisations  have  also  seen  benefits,  particularly  in  their  efforts  to  support 
vulnerable groups during health crises. The Programme has empowered these organisations to 

185   b) Protect people from serious cross-border health threats and strengthen the EU’s rapid response capacity, 
d) Complement national stockpiling essential crisis-relevant products, e) establish a structure and training 
resources for a Union reserve of medical, healthcare and support staff. 

68 

 
 
implement  community-based  health  interventions,  contributing  to  the  overall  resilience  and 
capacity of public health systems in the EU. 

Stakeholder feedback shows that nearly half (48%) of the respondents believe that EU4Health 
has contributed to a (very) large extent to protecting people from cross-border health threats 
(general objective b). They also broadly consider that many of EU4Health’s objectives are best 
met through coordinated action at the EU level, with 66% of respondents agreeing to a large or 
very large extent that EU-level action is needed. This finding is echoed in interviews, where 
stakeholders highlighted that the Programme’s results, especially those involving cross-border 
challenges  and  crisis  preparedness,  could  not  be  achieved  as  effectively  by  Member  States 
acting alone. 

The  EU  needs  to  continue  to  invest  in  crisis  preparedness  to  protect  its  population  from 
emerging and future threats. The recent outbreak of Mpox in Africa serves as a stark reminder 
of the unpredictable nature of infectious diseases. The swift mobilisation of EU4Health funds 
made it possible to rapidly procure and deliver 215 000 vaccine doses to the affected countries 
in Africa186.  

By maintaining a robust crisis preparedness framework and adequate EU funding, the EU can 
ensure that it is better equipped to respond to such outbreaks, mitigating their impact on public 
health and the economy.  

By  sustaining  funding  for  crisis  preparedness,  the  EU  can  support  the  development  of  new 
treatments,  enhance  surveillance  and  detection  capabilities,  and  bolster  the  resilience  of  its 
healthcare  systems.  This  proactive  approach  will  not  only  save  lives  but  also  reduce  the 
economic burden of responding to a crisis. Consequently, prioritisation and continued funding 
of crisis preparedness is necessary and essential to ensure the health, security, and prosperity 
of Europeans. 

Strand 2: Health promotion and disease prevention  

The health promotion and disease prevention strand has remained highly relevant throughout 
the implementation period, as demonstrated by strong stakeholder support. Survey responses 
indicate  that  ‘improving  and  fostering  health’  is  perceived  as  the  most  relevant  general 
objective, with 82% of respondents affirming its importance to a very large extent. Specific 
objectives such as ‘Health promotion and disease prevention’ were particularly well aligned 
with current needs, with 83% of respondents recognising its relevance. The Programme has 
addressed  pressing  health  issues  effectively,  including  disease  prevention  and  health 
promotion,  as  well  as  health  inequalities,  which  were  given  high  priority  by  stakeholders. 
Actions such as the multidisciplinary training and exchange programme on mental health (EU 
PROMENS) support the capacity building of health and other professionals such as teachers 
and  social  workers,  in  a  comprehensive,  prevention-oriented  approach  to  mental  health.  To 
support EU tobacco control policy, the Programme has funded a series of studies on combined 
health-warning strategies across countries and on packaging and labelling strategies. 

Despite  the  strong  alignment,  stakeholders  also  highlighted  some  areas  requiring  further 
attention, such as protection of vulnerable groups, further promotion of mental health, NCDs, 

186   First  delivery  of  mpox  vaccine  doses  from  the  Commission  arrive  today  in  the  Democratic  Republic  of 

Congo.  

69 

 
 
healthy  lifestyles,  and  addressing  socio-economic  inequalities,  indicating  the  ongoing 
relevance of these issues and the need to invest more in them. 

Despite all efforts, 80% of the overall burden of disease in Europe187 is due to NCDs such as 
cardiovascular diseases, cancer and respiratory diseases, which are all exacerbated by factors 
such as unhealthy lifestyles and environmental pollution. This trend persists and NCDs place 
a significant burden on health systems188. There is still a need for sufficient investment in health 
promotion and disease prevention measures, which are essential for building resilient health 
systems and improving the overall health of the European population. This need will increase 
with an ageing population, increasing health inequalities and growing demand for mental health 
support.  

Strand 3: Health systems and healthcare workforce 

Specific objectives under the strand Health systems and health workforce have been relevant 
throughout the whole period covered by the interim evaluation and are highly likely to remain 
so  in  the  future.  The  COVID-19  pandemic  only  exacerbated  difficulties  with  access  to 
medicines, medical devices and crisis-relevant products. To ensure its proper implementation 
and effectiveness, the EU health legislation on HTA, medical and in vitro diagnostic medical 
devices, and medicinal products requires continuous support. Many patients in the EU have 
struggled with difficulties in accessing healthcare for many years. Problems like shortages of 
health  professionals  or  their  uneven  geographical  distribution  remain.  Cooperation  between 
Member States to exchange best practices on reforming health systems needs to continue and 
EU4Health is instrumental for this. The ERNs proved to be effective in ensuring that patients 
suffering from rare diseases could access the right diagnosis and treatment. In the future, all 
patients  should  continue  to  benefit  from  such  services.  The  launch  of  the  European  Rare 
Diseases  Research  Alliance  (ERDERA)  under  Horizon  Europe,  which  is  creating  ‘national 
mirror  groups’  to  enhance  national  activities  in  the  field  of  rare  diseases,  should  further 
strengthen these efforts.  

Actions supported by the EU4Health Programme are aligned with the challenges in reforming 
health  systems  at  national  level.  Such  challenges  have  been  raised  in  the  country-specific 
recommendations issued under the European Semester process189. Over the period 2019-2024 
the  recommendations  touched  upon  a  range  of  issues,  including  the  need  to  improve  the 
resilience of health systems (with all Member States receiving such a recommendation under 
the 2020 European Semester), enhance healthcare access and equity, boost healthcare financing 
and sustainability, address shortages in the health workforce, and improve health infrastructure 
and technology. 

Workforce shortages are set to further increase, both for nurses and physicians. An analysis, 
using Eurostat data on the number and age composition of the nursing workforce in the EU, as 
well  as  time  trends  for  nursing  graduates,  has  been  developed  to  assess  how  the  currently 
reported workforce shortages are likely to evolve. The analysis assumed an active career for 
nurses between the ages of 23 and 67. The projected supply of nurses would increase by around 
5% up to 2040. This should be compared to the likely change in the demand for healthcare. For 
example, the population aged 85 or older in the EU is expected to grow by more than 50% over 
the  same  period.  This  suggests  a  further  intensification  of  recent  trends  (between  2014  and 

187   Health at a Glance: Europe 2022. 
188   European Commission, Shifting health challenges, accessed in October 2024. 
189   The European Semester. 

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2020 the number of practising nurses increased by around 15% whereas the number of people 
aged  85  or  older  increased  by  20%).  Under  current  trends,  the  difficulty  in  supplying  the 
workforce to meet the increase in demand for healthcare is expected to be further exacerbated 
in the coming decades. EU4Health is financing a number of targeted actions to help address 
challenges  in  the  health  workforce:  the  joint  action  HEROES  to  improve  forecasting  and 
planning  for  the  health  workforce  in  Member  States;  a  project  in  collaboration  with  WHO 
Europe to improve the recruitment and retention of nurses; and several collaborative projects 
to develop new training programmes to upskill the health workforce, with particular attention 
to  digital  skills.  Some  Member  States  have  the  possibility  to  use  ESF+  funds  for  health 
workforce training in regional or national settings. These Member States can benefit from the 
new  training  programmes  developed  by  EU4Health-funded  projects;  they  could  consider 
rolling out such programmes regionally or nationally with the use of their ESF+ funds.  

Strand 4: Digital 

EU4Health has contributed to developing the capacity to maintain and operate cross-border 
infrastructures  at  EU  level  by  financing,  among  other  things,  the  central  services  for 
MyHealth@EU and HealthData@EU, as well as to building capacity in Member State public 
authorities though dedicated actions. 

In total, 81% of survey respondents perceived that specific objective on ‘strengthening health 
data, digital tools and services, and the digital transformation of healthcare’ were relevant to a 
large extent  (35%) or to  a very large extent  (46%); this was perceived to be the  third most 
relevant  of  all  the  specific  objectives.  Survey  respondents  also  perceived  that  some  current 
health  needs  relating  to  this  specific  objective  were  either  missing  from  current  health 
objectives or required further attention.  

The  COVID-19  pandemic  accelerated  the  adoption  of  digital  health  technologies,  such  as 
telemedicine, EHR systems190 and digital contact tracing, showing that continued investment 
in digital health infrastructure was able to support efficient data sharing, improve patient care, 
and  ensure  rapid  responses  to  health  threats.  These  innovations  are  now  an  integral  part  of 
healthcare delivery in many parts of Europe.  

The  financial  contribution  of  the  EU4Health  Programme  is  fundamental  for  the  EHDS191. 
Therefore, there is a strong alignment between the EHDS and EU4Health’s general objective 
(d) of ‘Strengthening health systems’, as well as specific objective (f) on digital transformation.  

However, despite significant progress, there are still important gaps in the Member States in 
the adoption and integration of digital health technologies in health systems.  

Cross-cutting strand: Cancer 

The  overall  relevance  of  the  fight  against  cancer  is  borne  out  by  the  survey  results  since 
respondents that deemed that each specific objective was relevant ‘to a very large extent’ or to 
‘a large extent’, including the cancer strand covered by the general and specific objectives on 
health promotion and disease prevention. A total of 66 EU4Health actions contribute towards 

190   World Health Organization (WHO) (2022) COVID-19 and the use of digital health tools: opportunity amid 

crisis that could transform health care delivery Eurohealth, Vol.28, No.1, 2022. 

191   European Commission (2022) COMMUNICATION FROM THE COMMISSION TO THE EUROPEAN 
PARLIAMENT AND THE COUNCIL A European Health Data Space: harnessing the power of health data 
for people, patients and innovation, COM(2022) 196 final and the EU4Health Regulation. 

71 

 
 
the objectives of the Cancer Plan objectives and 9 out of the 10 flagship initiatives supporting 
the Cancer Plan will be fully or partially funded by the Programme. 

The EU4Health actions supporting the Cancer Plan have greatly contributed to tackling cancer-
related challenges in Europe since its creation. However, recent societal  megatrends such as 
‘shifting  health  challenges’192  have  the  potential  to  significantly  impact  the  occurrence  and 
awareness  of  cancer  in  Europe.  Obesity  rates  continue  to  rise,  contributing  to  a  significant 
cancer  burden.  Work-related  and  environmental  carcinogen  exposure  remains  a  concern. 
Socio-economic disparities exacerbate inequalities in cancer care between European regions, 
highlighting  the  need  for  comprehensive  policy  responses.  The  number  of  cancer  cases  is 
projected to increase to an additional 504 000 diagnoses by 2040. The European population is 
ageing, and this trend is set to continue. By 2040, the 65+ age group is estimated to increase 
by 29%. Given that the risk of cancer is higher in this age group, the European cancer burden 
is expected to increase by about 31% in terms of new cancer cases and 35% of cancer deaths193. 
A continued investment in tackling cancer will be essential in the future.  

Through  the  2022  Council  Recommendation  on  cancer  screening,  Member  States  have 
emphasised the ongoing importance of taking action in this area at EU level with the support 
of EU funding. The Council Recommendation calls on Member States to both ensure the full 
implementation of cancer screening programmes for breast, colorectal and cervical cancer, as 
well  as  to  prepare  for  the  stepwise  roll-out  of  screening  programmes  for  lung,  prostate  and 
gastric cancer.  

Therefore, major improvements still need to be achieved made in lifestyle habits (healthy diets, 
regular physical activity) and in addressing other major risk factors, with relevant disparities 
persisting  across  between  Member  States  and  among  between  different  socio-economic 
categories.  Moreover,  early-onset  cancer  morbidity  has  continued  to  increase  worldwide  in 
recent  years  with  notable  variances  in  mortality  and  disability-adjusted  life  years  (DALYs) 
between  areas,  countries,  sex  and  cancer  types.  This  is  highlighting  the  need  to  further 
encourage a healthy lifestyle which can reduce the rate of early-onset cancer disease burden. 
These findings show that the concerning trends in the prevalence of harmful lifestyle habits 
continue  to  require  action  at  EU  level,  while  the  technology  and  policy  developments 
contribute to achieving the objectives of the Cancer Plan194. 

Cross-cutting topic: Global Health  

The investment made to support the EU Global Health Strategy remains below the maximum 
12.5% ceiling that is reserved for supporting global commitments and health initiatives. There 
are two main actions  under this strand.  The first is  ongoing  support amounting to  EUR 4.7 
million for the 2-year joint action seeking to strengthen the EU’s leadership in global health by 
improving the coordination of actions and the exchange of knowledge between Member States 
and  EU  institutions,  as  well  as  with  civil  society  and  non-EU  stakeholders.  It  also  aims  to 
improve coordination and advance on the implementation of the strategy195. The second is an 
ongoing study (with a total budget of EUR 0.6 million) on designing and testing a monitoring 
framework for the implementation of the EU Global Health Strategy.  

192   European Commission, Shifting health challenges, accessed in October 2024.  
193   European Commission – Joint Research Centre (2023). Cancer in 2040: Estimates for an ageing Europe. 
194   Zhao et al. (2023). Global trends in incidence, death, burden and risk factors of early-onset cancer from 1990 

to 2019.  

195   European Joint Action to maximise the impact of the EU Global Health Strategy (JA GHI). 

72 

 
 
The investments made under other strands  (e.g. crisis preparedness or health promotion and 
disease prevention) are expected to have spillover effects and to contribute as well to global 
health through the impact they may have on global health challenges. 

4.2.5.  EU4Health’s  continued  relevance  in  the  context  of  the  European  Health 

Union 

In addition to the health needs identified in 2020, some important additional needs have arisen 
during the EU4Health implementation period, mainly as direct consequences of the COVID-
19  pandemic.  These  include:  accelerating  the  introduction  of  digital  health  measures;  an 
increase in vaccine hesitancy and the related spread of misinformation and disinformation; the 
increase in mental health issues, including as a result of the Russian war of aggression against 
Ukraine;  long  COVID;  the  increased  pressure  on  health  services  caused  by  chronic  health 
issues,  and  increased  pressure  on  healthcare  workers.  The  Russian  war  of  aggression  on 
Ukraine  and  the  related  health  consequences  for  people  fleeing  Ukraine  brought  new 
challenges. 
EU4Health  fits  well  with  initiatives  that  are  part  of  the  European  Health  Union196.  The  link 
between EU4Health and the European Health Union was again underlined in June 2024 when 
the European Council called on the Commission to keep health as a priority197. The evaluation 
supporting study found that all four European Health Union objectives, as stated in the EU’s 
communication ‘The European Health Union: acting together for people’s health198 are backed 
by the EU4Health Programme and its specific objectives. 

In summary, the analysis set out in the evaluation supporting study revealed that EU4Health 
was very relevant to the priorities of the European Health Union as well as to existing European 
Health Union initiatives.  

196   European Commission website. What is the European Health Union. https://commission.europa.eu/strategy-

and-policy/priorities-2019-2024/promoting-our-european-way-life/european-health-union_en.  

197   European Council (2024). European Health Union: Council calls on Commission to keep health as a priority. 

https://www.consilium.europa.eu/en/press/press-releases/2024/06/21/european-health-union-council-calls-
on-commission-to-keep-health-as-a-priority/. 

198   European  Commission  (2024).  Communication  from  the  Commission  to  the  European  Parliament,  the 
Council, the European Economic and Social Committee and the Committee of the Regions - The European 
health. 
together 
Health 
https://commission.europa.eu/document/download/98c6e4dc-0fc3-4ec6-8ec2-
bfcdcb2f018a_en?filename=policy_com-2024-206_en.pdf.  

people’s 

Union: 

acting 

for 

73 

 
 
 
5.  WHAT ARE THE CONCLUSIONS AND LESSONS LEARNT? 

The EU4Health Programme, launched in the wake of the COVID-19 pandemic, has proven 
to be a vital element in the European Union’s efforts to improve public health and strengthen 
healthcare systems across its Member States, building the European Health Union. For the 
first time, a programme of this magnitude has been dedicated exclusively to health, marking 
a  significant  milestone  in  European  health  policy.  This  initiative  has  enabled  the  EU  to 
address  critical  issues  on  a  large  scale,  issues  that  would  not  typically  receive  front-line 
attention,  such  as  screening  programmes  and  antimicrobial  resistance.  This  represents  a 
quantum leap not only in terms of the scope of health initiatives but also in the capacity of 
Member States to respond more effectively to these challenges. This unprecedented focus on 
health has fostered collaboration and innovation across the EU, ensuring that vital areas of 
public  health  receive  the  attention  and  resources  they  deserve.  As  the  interim  evaluation 
reveals,  the  Programme  has  made  valuable  progress  in  several  key  areas  while  also 
highlighting  opportunities  for  further  improvements  to  maximise  its  long-term  impact 
including  addressing  administrative  inefficiencies  and  disparities  in  funding  allocation 
across the EU Member States.  

The programming processes  

Conclusions 

The  architecture  of  the  EU4Health  Regulation  is  overall  sound,  and  the  intervention 
remains very relevant, as shown in the analysis in the previous chapters and in the replies 
received  during  the  consultation  of  stakeholders.  All  of  the  Programme’s  general  and 
specific  objectives  are  highly  relevant,  accurately  and  comprehensively  reflecting  the 
EU’s health needs and challenges. 

The comprehensive specific objectives of the Programme are highly relevant and coherent and 
make it possible to fund the EU’s current (2021-2027) EU health policy priorities, including 
the existing EU health legislation. It should be noted that the health challenges that arose in 
2020 due to the COVID-19 pandemic persisted throughout the Programme’s implementation. 
The findings of the study reveal that during the period 2021-2024, the EU4Health Programme 
has proven to be highly  relevant  for  achieving the priorities of the  European Health Union, 
including:  health  crisis  prevention,  preparedness  and  response,  the  implementation  of 
Regulation  (EU)  2022/2371  on  serious  cross-border  threats  to  health199,  Europe’s  Beating 
Cancer  Plan200,  the  ‘Healthier  together’  initiative201,  the  Health  Technology  Assessment 
Regulation202, the European Health Data Space Regulation203, and the pharmaceutical strategy 
for  Europe204.  The  EU4Health  Programme  is  vital  for  achieving  the  objectives  of  these 
important 
their  successful 
implementation.  Stakeholders  expressed  a  high  level  of  appreciation  of  the  Programme’s 
crucial  role  during  the  implementation  period,  which  highlights  the  relevance  of  the 

initiatives  and  provides 

foundation  for 

the  budgetary 

199   Regulation (EU) 2022/2371, OJ L 314, 6.12.2022, p. 26. 
200   European Commission Communication on Europe’s beating cancer plan COM(2021)44 final. 
201   Healthier Together EU Non-Communicable Diseases Initiative. 
202   Regulation (EU) 2021/2282 (OJ L 458, 22.12.2021). 
203   Regulation (EU) 2025/327 (OJ L, 2025/327, 5.3.2025). 
204   A pharmaceutical strategy for Europe. 

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EU4Health Programme for the effective and efficient implementation of important EU 
health initiatives. 

EU4Health’s governance and programming processes have been successfully established 
and have proved effective in the timely adoption of four annual work programmes and 
necessary amendments.  

The EU4Health Programme governance was set up promptly, which allowed the programming 
process  to  unfold  swiftly  and  efficiently.  The  EU4Health  programming  process  has  been  a 
critical  enabler  in  aligning  the  Programme’s  activities  with  its  overarching  objectives. 
Coordination between DG SANTE, HERA and HaDEA as well as the active participation of 
Member States in steering committees and Programme development processes, have ensured 
that actions address urgent public health needs and align with broader EU strategies including 
the European Health Union. The process to consult stakeholders is well established, and four 
consultations and four stakeholder events have been organised for this purpose. Member States 
were first consulted in an ad hoc expert group for the 2021 programming exercise, and after on 
the adoption of the EU4Health Regulation in the EU4Health Steering Group. Member States 
continued to provide their opinion on the Programme and it annual work programmes in the 
Programme  Committee.  The  annual  work  programmes  have  been  effective  in  translating 
EU4Health’s  broad  objectives  into  concrete  actions,  with  a  clear  allocation  of  resources  to 
priority areas such as crisis preparedness, digital health and disease prevention. The first work 
programme, for 2021, was adopted about three months after the adoption of the EU4Health 
Regulation.  The  programming  processes  were  run  in  parallel  for  the  2021  and  2022  work 
programmes,  which  were  adopted  in  around  ten  months.  The  2023  and  2024  programming 
cycles did not encounter any problems, and the work programmes were adopted on time. The 
written amendments process was effective.  

The  programmed  actions  are  designed  to  provide  significant  EU  added  value  through 
capacity building, strategic planning, the promotion and upscaling of innovation, and the 
translation of research results into practice. 

The Programme’s actions aim to  address  the following aspects,  among  others:  cross-border 
threats  to  health,  health  challenges  such  as  antimicrobial  resistance,  the  burden  of  non-
communicable diseases (notably the fight against cancer) and unmet healthcare needs.  

The EU4Health Programme launched actions worth EUR 623 million on crisis preparedness 
and health security, improving the EU’s ability to better prevent, prepare for and respond to 
health  emergencies  and  to  ensure  access  to  medical  countermeasures.  Examples  include 
activities  on  vaccine  development  and  procurement,  European  reference  laboratories,  the 
enhancement of surveillance and intelligence-gathering capabilities, as well as early warning 
and response systems. These actions are crucial to counteracting future cross-border threats to 
health in the EU. 

The Programme has made considerable investments to directly support health promotion and 
disease prevention (EUR 155.4 million), particularly on non-communicable diseases including 
cancer,  mental  ill  health,  cardiovascular  diseases,  diabetes,  respiratory  diseases,  and  the 
promotion of healthier lifestyles, which are expected to have positive impacts on the long-term 
health  of  people  in  the  EU.  Actions  under  other  strands  also  include  health  promotion  and 
disease  prevention  activities.  Together  with  the  direct  support  in  this  area  of  intervention, 
EU4Health has programmed an investment of EUR 536.7 million in this area, which meets the 
20% legal commitment made by the EU4Health Regulation. 

75 

 
EU4Health has invested EUR 239 million in actions to strengthen the national health systems, 
for example with the CIRCE Joint Action which transfers best practices in primary healthcare 
between the Member States, by increasing funding for the ERNs to EUR 100.5 million, and by 
actions to increase the resilience of the healthcare workforce, which build on the outcomes of 
previous health programmes. The ERNs have facilitated and enhanced collaboration between 
healthcare  providers  and  they  continue  to  provide  useful  advice  on  the  most  appropriate 
diagnoses and best treatments available to rare diseases patients. Furthermore, the Programme 
has  improved  the  preparedness  of  the  healthcare  workforce  through  targeted  training  and 
capacity-building initiatives, ensuring that Member States are better equipped to manage surges 
in demand for healthcare. 

The  digital  transformation  of  healthcare  systems  across  the  EU  has  advanced  through  the 
preparatory  work  for  and  the  development  of  the  EHDS  infrastructure,  supported  by  EUR 
124.96  million  in  funding  from  EU4Health.  The  EHDS  infrastructure  makes  it  possible  to 
exchange health data across borders and improves access to quality healthcare. People in the 
EU have easier access to their health records and can receive continuous care when travelling 
between EU countries. The Member States are better connected, paving the way for a more 
integrated and efficient healthcare infrastructure across the EU. The Programme’s focus on the 
secondary use of health data for research and policymaking aims to make the EU a global leader 
in  medical  research  and  healthcare  innovation.  Relevant  actions  from  other  strands  include 
digital transformation activities, which also contribute to the EU’s cross-cutting priorities.  

The investments supporting the implementation of Europe’s Beating Cancer Plan (EUR 220 
million  in  total)  include  funding  for  key  actions  that  aimed  to  reduce  cancer  risk  factors, 
increase the coverage of vaccination and screening, and enhance cancer registries by improving 
data collection for effective early detection and treatment strategies. Progress has been made 
in several other areas, including on the European Commission Knowledge Centre on Cancer 
and the European cancer inequalities registry, as well as the EU Network linking recognised 
National Comprehensive Cancer Centres and new Networks of Expertise. The latter supports 
the European oncology community on specific, challenging types of cancer that benefit from 
cross-border cooperation. 

EU4Health support to the EU Global Health Strategy amounted to EUR 61.5 million, of which 
around  50  million  has  been  committed  to  actions  such  as  strengthening  preparedness  and 
response to cross-border health threats at global level. An ongoing study aims to develop an 
effective monitoring framework to assess the progress and outcomes of the global strategy’s 
implementation.  The  EU4Health  support  to  Member  States  and  associated  countries 
strengthens  the  EU’s  leadership  in  global  health  by  improving  the  coordination  of  actions 
between these countries and the EU institutions. The global commitments and health initiatives 
agreed with global partners such as the WHO and the Red Cross have addressed, amongst other 
things, the health consequences of the Russian war of aggression against Ukraine and the needs 
of refugees.  

The  Programme  contributed  to  the  EU’s  cross-cutting  priorities  such  as  the  digital 
transition  (EUR  349.6  million),  gender  equality  (EUR  178.1  million)  and  green  budgeting 
(EUR 314 million) through the funds committed to relevant EU4Health actions. 

76 

 
 
 
 
The implementation processes, forms of funding, and EU4Health beneficiaries  

The implementation processes are effective and have been adapted in good time to the 
manifold  increase  in  the  budget  as  a  result  of  the  creation  of  the  Health  and  Digital 
Executive  Agency  (HaDEA).  The  executive  agency  is  essential  to  the  Programme  and  the 
implementation of its annual work programmes.  

All actions programmed for 2021, 2022 and 2023 and delegated to HaDEA by the parent DGs 
have  been  successfully  launched,  and  the  implementation  of  those  actions  programmed  for 
2024 has started. A total of 726 financing agreements have been signed with 1 274 legal entities 
such  as  ministries  of  health,  national,  regional  and  other  public  authorities,  healthcare  and 
health research organisations, non-profit organisations and private entities. Most of these funds 
were disbursed through grants and procurements. Contributions to global health priorities were 
financed  through  contribution  agreements  with  international  organisations.  By  April  2024, 
around EUR 2.63 billion of the total EU4Health budget had been programmed and EUR 1.39 
billion had been committed.  

The overall distribution of EU4Health funding per Member State and their legal entities 
is uneven, as is the distribution of grants and procurement contracts across the EU.  

A total of EUR 916.3 million in funding has been absorbed by 15 Member States and associated 
countries with longer experience in accessing EU funds, and EUR 163.2 million by the 16 other 
countries205. Most of the beneficiaries from 21 Member States206 are grantees (EUR 346 million) 
that are national or regional authorities nominated by their home country to participate in joint 
actions  or  other  direct  grants.  Other  public  health  organisations  such  as  healthcare  units, 
research  organisations  or  NGOs,  etc.  have  accessed  EUR  279.7  million  in  funding  through 
competitive  processes.  94  legal  entities  from  18  Member  States207  benefited  from  funding 
through procurement amounting to EUR 346.3 million. The largest procurements of services 
were made under the crisis preparedness strand and included, for instance, support for ever-
warm facilities for vaccine production (EU FAB) and support to develop IT for early warning, 
modelling, simulation and forecasting. Most of the procurement funds were absorbed by six 
Member States208, each receiving at least EUR 22 million. The crisis preparedness strand has 
committed close to half (44.7%) of EU4Health’s funding so far, i.e. EUR 623 million. This is 
followed by 17.2% (EUR 239 million) for the health systems strand, and 15.8% (EUR 220 
million) for the cross-cutting cancer topic. For the health promotion and disease prevention 
strand, the current share is 11.2% (EUR 154.4 million). Finally, the digital strand has received 
9% (EUR 125 million) of the funding, and 2.8% (EUR 31.4 million) has been committed to 
other actions.  

Grants,  procurements  and  contribution  agreements  have  been  instrumental  in 
operationalising the Programme’s objectives and translating them into action.  

Grants and the procurement of goods and services have enabled targeted actions to take place 
under all work programme strands. The joint actions and other direct grants to Member States 
bring  together  national  authorities,  thus  facilitating  and  enhancing  collaboration,  capacity 

205   See Figure 5. 
206   Austria, Bulgaria, Croatia, Cyprus, Czechia, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, 

Italy, Latvia, Lithuania, Malta, Netherlands, Norway, Slovenia, Spain, Sweden and Ukraine. 

207   Austria,  Belgium,  Croatia,  Czechia,  Denmark,  France,  Germany,  Greece,  Hungary,  Ireland,  Italy, 

Luxembourg, Netherlands, Poland, Portugal, Romania, Spain and Sweden. 

208   Belgium, Denmark, Ireland, the Netherlands, Luxembourg and Spain. 

77 

 
 
building and the transfer of knowledge. The procurement of goods and services engages private 
sector providers mainly  from  the Member States and, in  a  few cases, from  outside the  EU. 
Contribution agreements with international organisations have enabled initiatives beyond the 
EU’s  borders  as  well,  such  as  addressing  the  health  consequences  of  the  Russian  war  of 
aggression  against  Ukraine  or  supporting  crisis  preparedness  actions  that  address  emerging 
cross-border health threats at the place of origin (such as Africa, in the case of Mpox, Marburg 
and Ebola). 

Joint  actions  provide  crucial  funding  to  national  authorities,  including  from  lower-GNI 
countries, through the ‘exceptional utility’ criteria. They enable collaboration that addresses 
common European health challenges and implements effective solutions at the national level.  

In joint actions, funds are awarded directly to legal entities nominated by the Member States’ 
and  associated  countries’  ministries  of  health,  which  has  enabled  499  organisations  to 
collaborate between European countries, with 40% of all organisations participating in more 
than one joint action. There is a good spread of European regions in joint actions, however, 
organisations from countries in the eastern part of the EU could benefit further. The exceptional 
utility criteria have demonstrated their relevance as a funding mechanism in the EU4Health 
Programme,  providing  increased  financial  support  (up  to  80%  EU  contribution)  for  actions 
involving at least 14 Member States (of which at least 4 are lower-GNI countries209), or where 
30% of the action’s budget is directed to such countries. 

The main beneficiaries, in terms of both the EU contribution received and in the number 
of  project  participations,  are  public  entities,  such  as  ministries  of  health,  national  health 
agencies,  institutes,  laboratories,  universities,  hospitals  and  research  organisations.  In  total, 
1 274  beneficiaries  from  the  Member  States  and  associated  countries  are  participating  in 
EU4Health projects, which receive a total EU contribution of around EUR 1.39 billion. This 
allows these countries and their public institutions to work, within their areas of competence, 
on improving their national health systems and public health and preparedness policies. 

Administrative burdens remain a significant challenge, particularly for smaller Member 
States and NGOs. These include complex application and reporting requirements, which may 
discourage  participation.  Improving  the  transparency  and  efficiency  of  procurement 
management processes, for example through improved digital tools, could reduce delays and 
increase stakeholder satisfaction. 

Initial results and achievements 

The  Programme’s  performance  is  as  expected  at  interim  stage  when  only  a  limited 
number of actions have been completed and delivered results. The impacts of these results 
are expected to increasingly unfold in the years to come and will be analysed in the final 
evaluation.  

As  expected  at  this  stage  of  implementation,  a  limited  number  of  projects  have  delivered 
results,  which  have  been  analysed  for  this  evaluation.  The  analysis  includes  26  grant  final 
reports (of which 22 were operating grants) and 136 contracts for procurement validated by the 
contracting authority.  

209   Article 8(3) of the EU4Health Regulation. 

78 

 
 
 
 
 
 
 
The latest annual performance analysis indicates that overall, the Programme is on track 
to achieve its objectives. The key 2024 milestones were reached for 13210 indicators. The 
actions measured by 10 indicators have already reached their 2027 targets.  

The progress of the nine key performance indicators is illustrative. The 2027 target was already 
overachieved  for  ERNs,  by  the  Member  States  implementing  best  practices  on  health 
promotion and disease prevention. 10% more patients than planned have benefited from the 
ERNs’  services  and  25  Member  States  (instead  of  the  20  expected)  have  implemented  best 
practices.  Almost  all  Member  States  and  associated  countries  (30  in  total)  have  received 
support to improve their preparedness and response planning for serious cross-border threats 
to health. The 2024 milestone is close to being met with four production facilities in place to 
increase the security and continuity of supply for medical countermeasures and raw materials 
at EU level. The milestone is on track to be met for the number of Member States participating 
in the EHDS, for the number of audits conducted in the EU and in third countries to ensure 
good manufacturing  practices and good clinical  practices, for the training  of healthcare and 
public health staff, and for studies supporting evaluations of legislative and non-legislative EU 
health policies.  

The  2024  milestones,  for  example,  have  been  reached  and  even  exceeded  under  different 
strands.  All  the  planned  actions  on  the  fight  against  communicable  diseases  have  been 
programmed. As a result, all the expected Member States plus four additional ones211 were able 
to develop their preparedness and response plans for cross-border threats to health. Moreover, 
25 new capacity-building actions to improve integrated surveillance systems were supported, 
instead of the 10 actions expected. A total of 21 actions on the fight against communicable 
diseases  were  launched  instead  of  the  20  planned.  Entities  from  30  Member  States  and 
associated  countries  have  participated  in  more  than  one  EU  action  aimed  at  improving 
prevention, preparedness and response planning for serious cross-border threats to health. 26 
Member States have improved their preparedness and response planning with regard to medical 
countermeasures, compared to the 18 envisaged. 12 Member States and associated countries 
have improved  their  procurement procedures for health  crisis  medical countermeasures.  On 
health  promotion  and  disease  prevention,  17  actions  were  launched,  contributing  to  the 
reduction  of  avoidable  mortality  from  non-communicable  diseases  and  risk  factors,  and 
exceeding the planned 5 actions. The number of Member States with vaccination coverage for 
seasonal influenza and for HPV has also reached its 2024 milestone.  

As  implementation  of  the  Programme  advances,  several  key  indicators  have  made 
significant progress towards their 2027 targets in key areas such as crisis preparedness 
and response, health promotion and disease prevention, cancer, and addressing the needs 
of patients with rare diseases through the ERNs. 

As data available in 2024 for milestone values show, there are indicators that require further 
attention to be sure that their values will achieve expected levels in the future. These are the 
number of shortages of medicinal products in the Member States reported through the single 
point  of  contact  and  the  number  of  actions  complimenting  national  stockpiling  of  essential 
crisis-relevant  products.  In  case  of  these  indicators,  there  are  many  external  factors  (e.g. 
national policies, including funding, or shortages’ monitoring systems at the national level) that 

210   Out of 52 indicators. 
211   The 2024 milestone was 26 Member States. 

79 

 
 
 
 
 
 
are beyond the control of the Commission, that influence their values. This should be accounted 
for when the Programme’s overall performance is assessed.  

The  Programme’s  performance  at  interim  stage  is  reflected  in  the  most  relevant  policy 
achievements, which are:  

•  600 000  people  displaced  from  Ukraine  received  psychological  first  aid  and  mental 
health services in 22 Member States and three non-EU countries (Iceland, Norway and 
Ukraine);  

•  over  215 000  doses  of  the  Mpox  vaccine  were  purchased  and  donated  by  the 
Commission to the Africa Centres for Disease Control and Prevention (Africa CDC);  
•  6 economic operators have reserved manufacturing capacities for vaccines to be fully 

produced within the EU in case of an emergency through EU FAB; 

•  26 countries (24 EU Member States, plus Norway and Ukraine) participate in the joint 
action  EU-WISH,  aimed  at  strengthening  their  capacity  to  prevent,  prepare  for  and 
respond rapidly to serious cross-border health threats through wastewater surveillance; 
•  1 619 healthcare providers are now part of the ERNs, an increase of approximately 40% 

compared to 2021;  

•  2 240 000 patients with rare diseases received advice on the most appropriate diagnosis 

and the best treatment available for their disease;  

•  22  European  countries  (20  EU  Member  States,  plus  Iceland  and  Norway)  received 
support  for  the  digitalisation  of  their  health  system  and  to  increase  its  geographic 
coverage and interoperability, and/or to improve patients’ access to their own health 
data; 

•  44 key projects were selected for the implementation of MyHealth@EU and to set up 

health data access bodies that will pave the way for the EHDS; 

•  EUR 104 million was made available to support innovation in and access to medical 

countermeasures, including pull incentives to ensure access to antibiotics; 

•  20 breast cancer services in nine Member States have piloted the European guidelines 
and quality assurance scheme for breast cancer, an action linked to the 2022 Council 
Recommendation on cancer screening212; 

•  by January 2024, 23 Member States had started implementing a surveillance system 

under the One Health approach for cross-border pathogens that threaten the EU. 

EU FAB has played a crucial role in establishing a network of vaccine manufacturers capable 
of responding rapidly to public health emergencies. Additionally, EU4Health funding has made 
a  significant  contribution  to  improving  outbreak  detection  capabilities,  as  demonstrated  by 
HERA’s  data  collection  and  capacity  to  respond  during  events  such  as  the  Mpox  outbreak. 
Furthermore,  the  investment  in  tackling  AMR  and  fostering  international  collaboration 
underscores the EU’s dedication to global health initiatives and preparedness. 

212   Council Recommendation of 9 December 2022 on strengthening prevention through early detection: A new 
EU approach on cancer screening replacing Council Recommendation 2003/878/EC 2022/C 473/01 (OJ C 
473, 13.12.2022). 

80 

 
 
 
 
 
 
EU4Health  has  successfully  created  synergies  with  Horizon  Europe  and  the  Digital 
Europe Programme and contributed to the Green Deal objectives by financing actions that 
support health promotion, disease prevention and the environmental risk factors to health.  

The programme performance monitoring and evaluation framework (PPMEF) 

The  EU4Health  PPMEF  served  well  the  annual  performance  assessments  and  the 
Programme’s interim evaluation analysis. 

The annual Programme performance analyses for 2021, 2022 and 2023  have found that the 
Programme indicators cover each of the 10 specific objectives and most of their policy areas. 
The  output  and  results  indicators  were  useful  in  monitoring  the  programming  process  and 
annual performance. The Programme indicators, in general, make it possible to operationalise 
the broad objectives, which are measurable against the quantitative milestones and targets set 
according to the ambition and the figures defined by the EU’s health priorities (e.g. Council 
Recommendation on AMR213) and legal acts (e.g. Regulation (EU) 2022/2371), where those 
exist. The Programme indicators aim to provide relevant data to make it possible to follow the 
progress in performance each year and during the entire MFF. However, in many cases, such 
as with proxy indicators, the causal link between inputs and results is difficult to analyse 
and confirm. 

The impact of the EUR 1 billion redeployment  

The EUR 1 billion redeployment had no impact on the programming for 2021, 2022, 2023 
and  2024  annual  work  programme.  However,  this  significant  budget  reduction  of  the 
EU4Health  Programme  has  an  impact  from  the  2025  programming  onwards.  
Nevertheless, it is important to ensure sufficient support to both ongoing as well as new 
initiatives and commitments, including those with international bodies, while supporting the 
policy priorities in the area of public health for the Commission’s 2024-2029 mandate. Since 
2021, EUR 2.6 billion have been programmed under work programmes for 2021, 2022, 2023 
and  2024.  With  several  commitments  already  made  in  recent  years  to  support  the 
implementation of both legislative obligations and ongoing flagship initiatives, the remaining 
funding available is more limited than planned and needs careful consideration if it is to support 
new health priorities.  

The health challenges that the EU4Health Programme was designed to address will be 
increasingly relevant in the years to come. Digitalisation, the increased risk of outbreaks 
and epidemics or pandemics due to global environmental and climate change, growing 
antimicrobial  resistance,  and  increased  longevity  (which,  in  the  absence  of  continued 
support, is associated with an increased prevalence of non-communicable diseases) will 
require EU-level action and commensurate resources. Action on these issues will entail, for 
example: , the continued building of a One Health approach; upscaling innovation across health 
policies;    the  digital  transition;    the  mitigation  of  workforce  shortages;    stepping  up  the 
prevention  of  non-communicable  diseases;  and    enabling  healthy  ageing  through  a 
comprehensive  approach  to  health  promotion  and  disease  prevention  across  one’s  lifetime 
(including cardiovascular diseases and the continued fight against cancer).  

213   Council Recommendation on stepping up EU actions to combat antimicrobial resistance in a  One Health 

approach 2023/C 220/01 (OJ C 220, 22.6.2023). 

81 

 
 
 
Lessons learnt 

The  evidence  collected  and  analysed  during  this  interim  Programme  evaluation  makes  it 
possible  to  extract  concrete  lessons  learnt  and  distil  lessons  from  certain  aspects  to  further 
refine how the Programme is carried out.  

Programming and implementation  

In the programming phase, setting strategic and thematic priorities for periods longer than 
one year would enable stakeholders to make long-term plans. Moreover, where appropriate, in 
some specific areas such as health systems and the healthcare workforce, the strategic grouping 
of actions within specific instruments may be beneficial. This could offer greater flexibility in 
accommodating the Programme’s actions to changing policy needs.  

The  growing  impacts  of  climate  change  have  intensified  the  urgency  of  health  crisis 
preparedness.  Climate  change-related  events  such  as  heatwaves,  floods,  and  the  spread  of 
vector-borne diseases pose new and complex challenges to public health systems. 

Forms of funding  

Fostering political ownership and engagement within Member States in joint actions can 
help  these  initiatives  to  realise  their  full  potential  and,  ultimately,  improve  health 
outcomes across the EU.  

It is challenging to set out the roles and responsibilities (e.g. coordinator or affiliated entities) 
of participants in consortia. The EU4Health Programme provides a robust set of tools to assist 
in this task, which could be further improved through closer collaboration and alignment of 
priorities at both EU and national/regional levels. The EU4Health Programme complements 
the  efforts  of  Member  States  by  providing  essential  tools  and  resources  to  support  national 
health actions as well as collaboration between Member States and associated countries. The 
success  of  health  actions  at  national  level  requires  the  active  engagement  of  Member  State 
authorities, who play a key role in implementing impactful initiatives.  

In addition, innovative funding mechanisms and schemes should be explored to maximise 
the impact of the Programme, considering the existing legal frameworks and challenges. This 
is  particularly  important  for  fostering  innovation  in  the  development  of  medicines  and 
prototypes  for  medical  devices,  highlighting  some  categories  which  are  often  affected  by 
market failures due to a lack of commercial viability (e.g. communicable diseases and CBRN 
hazards).  Leveraging  stronger  and  larger  public-private  partnerships,  blended  financing 
models, and incentive-based funding strategies, among other mechanisms, could bridge critical 
gaps in development, manufacturing, and market access for new medical countermeasures that 
target both communicable and non-communicable diseases. 

Simplification and reduction of administrative burden 

Improving  administrative  efficiency  by  simplifying  complex  procurement  procedures, 
introducing  flexible  tendering,  reducing  reporting  burdens  and  streamlining  grant 
application processes could significantly ease the workload for beneficiaries, especially 
smaller Member States and organisations.  

Simplifying administrative requirements for funding applications and streamlining monitoring 
and  reporting  processes  could  improve  efficiency  and  encourage  a  broader  range  of 

82 

 
organisations  to  apply  to  participate  grants  or  participate  in  projects.  Simplified  templates, 
fewer required documents, simplified reporting deliverables, simplified cost reporting, the use 
of actual costs (for travel) or simplified cost models like those in Horizon Europe and recording 
staff activity via timesheets are specific examples of how the administrative burden could be 
reduced. Expanding the use of framework contracts could make procurement processes more 
cost-effective  and  reduce  the  administrative  workload  for  beneficiaries  and  Programme 
managers  alike.  The  burden  of  proving  that  an  affiliated  entity  is  connected  to  the  national 
competent authority could be shifted to the stage when the affiliated entity is nominated rather 
than  during  the  application  stage.  Additional  improvements  could  include  the  provision  of 
clearer and more concise financial guidelines as well as further consolidation of the information 
available on the EU Funding & Tenders Portal214, where applicants submit their calls.  

The possibility to adjust, when justified, and provide for more flexibility in the co-funding 
rates, including full coverage of eligible costs, could be considered. With the exception of 
the ERNs215, most of the actions in the Programme have only partially covered their eligible 
costs (60% to 80%). 

Standardising procedures and aligning administrative requirements across different EU 
funding  programmes,  such  as  Horizon  Europe,  could  reduce  duplication  of  administrative 
actions and streamline operations, particularly in areas like audit certificates, where different 
rules increase the complexity of implementation. Also, this would improve coherence between 
different initiatives. 

The  identified  measures  to  reduce  the  administrative  burden  in  the  EU4Health 
Programme  can  enhance  the  effectiveness  and  efficiency  of  its  implementation,  while 
actively  contributing  to  the  Commission’s  priority  of  greater  simplification  across  all 
policies.  

Promoting innovation upscale  

Looking ahead, there are further opportunities to unlock the potential of innovation in 
health, in particular by mobilising additional funds for the deployment of health innovation in 
healthcare  systems  and  clinical  practice,  including  innovative  organisational  models  and 
technological solutions. This is especially the case for investments in digital tools, given their 
potentially huge positive impact on people’s health, the economy, and the competitiveness of 
the  European  healthcare  sector.  Additionally,  fostering  innovation  is  crucial  for  medical 
countermeasures  that  strengthen  preparedness  and  the  capacity  to  respond  to  existing  and 
emerging health threats.  

By investing more in the deployment and upscaling of innovative solutions in healthcare 
in Europe, the EU4Health Programme will continue to play a vital role in achieving the 
Commission’s  objective  of  positioning  the  EU  as  a  global  innovation  and  technology 
leader, and in boosting the competitiveness of the European health sector.  

214   EU Funding & Tenders Portal. 
215   The direct grants to  the WHO may also be financed up to 100%  of the eligible costs. However, after the 
pillar  assessment  of  the  WHO,  the  OECD  and  other  international  organisations  was  completed,  the 
Programme financed them via contribution agreements (indirect management). 

83 

 
 
 
 
The methodology for the final evaluation  

To optimise the performance monitoring and evaluation methodology in light of the upcoming 
final  evaluation,  the  Commission  will  carry  out  a  comprehensive  assessment  of  the 
programme  performance  monitoring  and  evaluation  framework.  An  update  on  this  is 
expected by the end of 2025. Based on the lessons learnt, a revised PPMEF will focus on 
better links between the output, result and impact indicators for each specific objective. This 
will make it possible to better measure progress towards milestones and targets and to assess 
the ultimate impact of EU4Health’s investments. The review will also consider information 
collected in the context of drafting the country profiles and attempt to define a methodology to 
link and quantify the contribution of relevant EU4Health actions to addressing health (system) 
challenges at Member State level. 

Synergies and complementarities 

EU4Health  has  harnessed  synergies  with  Horizon  Europe  and  the  Digital  Europe 
Programme,  showcasing  the  value  of  collaboration.  By  systematically  seeking  these 
synergies,  the  impact  of  the  Programme  will  be  further  enhanced  across  its  different 
components. By expanding partnerships with other funding mechanisms, such as InvestEU, the 
Technical Support Instrument, the European Regional Development Fund, and the European 
Social  Fund  Plus,  there  will  be  opportunities  to  further  amplify  the  Programme’s  impact. 
Strengthening these complementarities will support a more integrated approach to addressing 
health  challenges,  while  also  optimising  investments  that  enhance  the  EU’s  global 
competitiveness in key sectors like pharmaceuticals, medical devices and digitalisation. 

84 

 
 
 
 
ANNEX I: PROCEDURAL INFORMATION 

1.  LEAD DG, DECIDE PLANNING/CWP REFERENCES  

This evaluation was carried out by DG SANTE as an initiative published in Decide with 
the reference number PLAN/2023/1633. The call for evidence was published in December 
2023 
(https://ec.europa.eu/info/law/better-regulation/have-your-say/initiatives/14055-
EU4Health-programme-2021-2027-interim-evaluation_en).  

2.  DEROGATIONS GRANTED AND JUSTIFICATION 

N/A 

3.  ORGANISATION AND TIMING 

An  interservice  steering  group  (ISG)  was  established  in  September  2023.  It  included 
representatives of the following DGs: AGRI, BUDG, CLIMA, CNECT, COMP, DEFIS, 
DGT,  DIGIT,  ECFIN,  EEAS,  EMPL,  ENER,  ENV,  ESTAT,  GROW,  HERA,  HOME, 
INTPA, JRC, JUST, Legal Service, MOVE, NEAR, REFORM, RTD, SG and TAXUD.  
The  ISG  was  consulted  in  writing  on  the  main  deliverables  of  the  supporting  study:  in 
February 2024 on the inception report, in May 2024 on the interim report and in October 
on the draft final report. One ISG meeting took place on 11 October 2024 on the draft Staff 
Working Document. 
The 
December 
for 
call 
(https://ec.europa.eu/info/law/better-regulation/have-your-say/initiatives/14055-
EU4Health-programme-2021-2027-interim-evaluation_en). 
A study supporting the evaluation started in December 2023 and was completed by October 
2024. 

published 

evidence 

2023 

was 

in 

4.  CONSULTATION OF THE REGULATORY SCRUTINY BOARD 

The evaluation  was  selected for scrutiny by the Regulatory Scrutiny Board  (the Board). 
The upstream meeting with the Regulatory Scrutiny Board took place on 22 April 2024. 
The  Board  received  the  draft  of  the  evaluation  Staff  Working  Document  on 
17 October 2024.  The  hearing  took  place  on  13 November 2024.  The  Board  issued  a 
negative opinion on 15 November 2024. 

5.  CHANGES MADE TO THE STAFF WORKING DOCUMENT TO ADDRESS COMMENTS MADE BY 

THE REGULATORY SCRUTINY BOARD 

In response to the Board’s recommendations, the Staff Working Document was redrafted 
before the interservice consultation was launched. 
−  Intervention logic and causal links  

The intervention logic was redrafted, further described and simplified.  

−  Operationalisation of specific objectives 

The redrafted text clearly shows how concrete actions funded by the Programme are linked 
to its specific objectives so as to make them operational.  

85 

 
 
 
 
 
 
 
 
 
 
−  Programme Performance Monitoring and Evaluation Framework (PPMEF) 
The  values  of  the  PPMEF  indicators  that  were  already  described  in  the  Staff  Working 
Document were updated. Information about additional indicators measured was added. The 
Staff Working Document provides information on the planned revision of the PPMEF. 

−  Points of comparison 

In the Staff Working Document, the section on points of comparison was shortened. Graphs 
illustrating the baseline, expected achievements and situation at the interim evaluation cut-
off date (30 April 2024) were added. Annex VII provides more information on points of 
comparison. 

−  EU4Health additionality 

The  additionality  of  EU4Health  has  been  further  developed  to  include  aspects  like  the 
Programme’s social and economic benefits and its ability to support the EU and its Member 
States when cooperating to respond to common challenges.  

−  Limitations of the interim evaluation 

The Staff Working Document clarifies the limitations of the EU4Health interim evaluation. 
It points out that the Programme is still being implemented and that it is therefore possible 
to properly evaluate the Programme’s efficiency and effectiveness. 

−  Return on investment 

The  return  on  investment  is  not  used  for  the  analysis  because  its  estimates  in  the  Staff 
Working Document are not specific for EU4Health. 

−  Overview of the costs and benefits of the Programme 

Annex  IV,  which  provides  an  overview  of  the  Programme’s  costs  and  benefits,  was 
amended to present the most comprehensive information possible at the interim evaluation 
stage. 

−  Conclusions and lesson learnt 

The  relevant  parts  of  the  Staff  Working  Document  were  revised  to  ensure  that  the 
conclusions and lessons learnt from the EU4Health interim evaluation are supported by the 
analysis. 

86 

 
 
 
 
ANNEX II. METHODOLOGY AND ANALYTICAL MODELS USED 

The EU4Health interim evaluation covers the implementation of the EU4Health Programme 
and its annual work programmes from January 2021 until April 2024 across the 27 Member 
States  and  5 non-EU  countries.  The  evaluation  was  carried  out  by  the  relevant  units  in  the 
Commission, supported by an external study which took place between December 2023 and 
October 2024. 

To measure the Programme’s progress at the interim stage, the Commission collected output 
and  results  data  from  the  Programme,  and  action  results  data  from  completed  and  ongoing 
actions. To complement this data, a supporting study contractor carried out a literature review, 
collected evidence from stakeholders via online surveys and interviews, organised focus groups 
and conducted case studies. The contractor also analysed data from the call for evidence that 
was launched by the Commission. Its data analysis included comparison against the baseline 
and  targets;  cost-benefit  analysis  (as  far  as  possible);  and  consumer  journey  mapping.  A 
megatrends  analysis  (complementing  the  contractor’s  work)  was  carried  out  by  another 
external contractor in order to assess how these megatrends could impact interventions in health 
systems, including actions funded by the Programme. 

Throughout the evaluation and its supporting study, the Commission and the supporting study 
contractor applied a mix of qualitative and quantitative methods to address the study questions 
under  five  evaluation  criteria  (effectiveness,  efficiency,  coherence,  EU  added  value  and 
relevance). All the study questions and the evaluation criteria were either addressed using at 
least  two  different  methodological  tools  or  reflect  results  from  at  least  two  different  data 
sources.  

Limitations and mitigating measures 

The Commission encountered certain limitations during the evaluation process. For instance, 
the evaluation covers the implementation of the EU4Health Programme and its annual work 
programmes  from  25  July  2021  until  the  cut-off  date  of  30 April 2024.  Consequently,  only 
limited data were available on results and impacts. In some cases, the analysis includes relevant 
data after the cut-off date and all Programme indicators are used for data collection. However, 
in other cases (e.g. the ‘Age-standardised five-year net survival rate for paediatric cancer’) it 
is  expected  that  the  baseline,  milestone  and  target  will  only  be  defined  by  early  2025.  The 
Programme  data  become  available  progressively.  29  Programme  indicators  were  fully 
available at the time of the study. 2 data points were available for 3 indicators and 1 data point 
was available for another 10 indicators. Data will gradually become available for the remaining 
10 indicators (see Annex I). 

At  this  point,  the  Commission  has  data  mainly  on  outputs  and  preliminary  results  at  the 
Programme level. By 30 April 2024, 57.2% of the Programme’s budget (EUR 4.6 billion) was 
programmed; and 53% of the programmed budget was committed in 726 grant agreements, 
procurement  contracts  or  under  indirect  management.  However,  only  204  (68 grants  and 
136 procurements) of the 726 actions had been concluded by April 2024. 

41 grant reports accepted by the contracting authority were available for analysis. This included 
26  final  reports  (22  concerned  operating  grants  and  4  concerned  direct  grants),  7 periodic 

87 

 
 
 
reports  and  8  project  deliverables.  Except  for  the  operating  grants,  the  reports  were  not  a 
representative sample for the analysis and the available results could only be indicative.  

136  procurement  contracts  were  finalised  by  the  interim  evaluation  cut-off  date  (30  April 
2024). 104 contracts were executed by DG SANTE and 32 by HaDEA.  25 of the contracts 
executed  by  HaDEA  implemented  actions  for  which  DG  SANTE  is  responsible  and  7 
implemented actions for which HERA is responsible.  

There were also certain limitations on actions that targeted two or more specific objectives. If 
an action from the annual work programme implements two or more specific objectives, the 
activities  or  the  total  budget  are  not  split  per  objective  in  the  annual  work  programme. 
Consequently,  the  total  budget  allocated  to  one  specific  objective  is  an  estimation. For  the 
purposes of data collection, the EU4Health Dashboard uses the following assumptions when 
analysing the data with the dashboard indicators: the budget of an action from the annual work 
programme  that  implements  two  or  more  specific  objectives  is  split  equally  between  the 
objectives; the policy areas are not exclusive for a particular strand; and the specific objectives 
may be addressed by actions from different strands.  

Baseline, milestone and target values were set for the Programme indicators (except for one 
cancer  indicator). The  level  of  detail  of  the  baseline  data  for  the  EU’s  health  policies 
implemented  by  EU4Health  intervention  varies  because  it  is  based  on  publicly  available 
information.  In addition,  the dates on which the  baseline value is  set  vary between policies 
(e.g. between the implementation of the Regulation on serious cross-border threats to health, 
on  the  one  hand,  and  other  policies,  on  the  other  hand)  and  this  makes  the  analysis  more 
complex. The definition of the Programme indicators (including their baselines, milestones and 
targets values) was challenging because the Programme objectives are deliberately broad in 
order  to  allow  the  financing  of  all  relevant  EU  health  policy  priorities  and  related  actions 
(including related preparatory work during the 2021-2027 MFF). 

No impact assessment exists for the Commission’s proposal for the Regulation establishing the 
EU4Health  Programme.  The  existing  impact  assessment  for  a  health  component  under  the 
ESF+  was  developed 
funding 
(EUR 449.4 million), as compared to EU4Health budget of EUR 5.8 billion, and is of limited 
value as a point of reference. To mitigate this, data were collected as far as available for the 
situation in 2020 (or for the latest time before that for which data were available).  

for  a  programme  of  much  smaller  scope  and 

Establishing a direct causal link between the EU4Health investment and the progress made in 
a policy area is challenging in some cases. That is the case for some indicators (as described in 
the  PPMEF  and  in  Annex  II  to  the  EU4Health  Regulation),  which  provide  information  on 
measures such as vaccination and other similar policies that fall within the competence of the 
Member States. 

In addition to these limitations, the supporting study contractor highlighted further restraints 
that  it  had  during  their  study,  including  potential  inaccuracy  in  linking  specific  projects  to 
specific objectives. They nevertheless acknowledged that these discrepancies were limited and 
had only a minimal impact on the study findings. 

Limited quantitative data were available during the interim stage of the EU4Health Programme 
(specifically  on  project  administration  and  implementation  costs).  The  quantification  of 
benefits  and  costs  was  therefore  constrained,  and  the  supporting  study  contractor  relied  on 

88 

 
estimates derived from scientific and grey literature, as well as on several assumptions. These 
assumptions are explicitly stated but they may reduce the reliability of the conclusions drawn 
by the supporting study team. 

The  supporting  study  contractor  also  noted  that  the  response  rates  for  the  surveys  were 
relatively low (particularly from those members of the survey sample who did not benefit from 
the  Programme  funding)  and  that  this  limited  the  diversity  of  perspectives.  The  supporting 
study contractor tried to address this by, for example, sending multiple reminders and taking 
alternative contact approaches. This helped increase participation and broaden the diversity of 
input. Stakeholders’ views were also collected through interviews and focus groups to further 
enhance the representation of perspectives. 

In some cases, survey responses included multiple respondents from the same organisation. 
The  supporting  study  team  employed  flexible  data  analysis  techniques  to  ensure  that  all 
relevant insights were captured without introducing bias. This included consolidating multiple 
responses from the same organisation. 

The supporting study contractor also raised concerns about some indicators (particularly those 
related to results and impacts), which they believed could be influenced by external factors, 
including both the fact that national health funding is larger than EU4Health’s and the long-
term nature of health outcomes. 

Despite  these  limitations,  the  Commission  believes  the  evaluation  results  and  findings  are 
robust and generally reliable. The supporting study contractor took various steps to mitigate 
the  limitations  they  encountered  and  addressed  the  objectives  of  the  study  through  various 
quantitative and qualitative data-collection tools and methods. These included desk research, 
targeted surveys, targeted interviews, focus group meetings and case studies. The evaluation’s 
evidence-based approach applied sound qualitative and quantitative methodology to the best 
available evidence drawn from diverse sources. 

Detailed description of the evaluation process 

Throughout the evaluation process, the supporting study contractor and the Commission relied 
on a wide range of data collected from various sources. Programme data were collected taking 
into account the 52 indicators described in the PPMEF. The indicators monitor inputs, outputs, 
results and impacts. 9 key performance indicators are related to flagship health policies and 
reflect key achievements in the annual performance reporting. 

Action  data  were  collected  by  the  EU4Health  beneficiaries  using  action-level  indicators 
developed by the Commission or the beneficiary (and agreed by the Commission) with a view 
to monitoring the effectiveness and efficiency of the funded actions (grants, procurements and 
contribution  agreements). The  action data  are complemented by data  from  the  final  reports 
and, where relevant, from the interim reports and selected deliverables. 

Contextual  data  were  collected  from  indicators  published  by  Eurostat  (e.g. health  status, 
health determinants, health services and health promotion). The initial phase of the supporting 
study contractor’s study involved extensive desk research that integrated both quantitative and 
qualitative data from various reputable sources. The primary sources included peer-reviewed 
literature accessed through databases such as Google Scholar; grey literature from international 
organisations (e.g. the WHO and the OECD); reports from EU institutions and agencies; and 

89 

 
interim and final reports from grants provided by DG SANTE. The study also used data from 
the EU4Health Dashboard, which provided detailed information on funded actions. The data 
from  the  EU4Health  Dashboard  were  analysed  to  assess  the  distribution  of  funding  across 
various dimensions (including the managing DG, funding instruments, stakeholder groups and 
specific objectives). The supporting study contractor analysed data from the PPMEF, which 
includes data collected by DG SANTE, HERA, HaDEA, the Joint Research Centre, the ECDC 
and Eurostat. The aim of the literature review was to complement the intervention logic and 
clarify the details of the implementation and this analysis. 

After  conducting  the  desk  research,  the  supporting  study  contractor  consulted  stakeholders, 
applying various quantitative and qualitative data-collection tools and methods. Those included 
7 exploratory  interviews,  the  call  for  evidence  and  online  targeted  surveys;  54  targeted 
interviews; and 2 focus group meetings. The stakeholder consultation was a key component of 
the  methodology,  which  involved  a  broad  range  of  groups.  These  groups  included 
intergovernmental  organisations,  EU  institutions,  national  authorities,  non-governmental 
organisations, research bodies, businesses, social partners and citizens. A comprehensive list 
of  308  stakeholders  was  compiled  using  public  information  and  additional  research.  This 
ensured that all relevant sectors were represented. 

The following consultation activities were conducted: 

•  Feedback was gathered through the Commission’s ‘Have Your Say’ portal during the call 
for evidence period. 30 responses were received. This feedback helped shape the survey and 
interview  questions  by  providing  initial  insights  into  the  Programme’s  impact. The 
Commission conducted the call for evidence and the supporting study contractor carried out 
data  analysis.  The  Commission  considered  that,  for  the  interim  evaluation  of  the 
Programme, the call for evidence as the possibility for public feedback was sufficient. The 
call for evidence was expected to provide general feedback on the Programme’s relevance. 
The  aim  of  the  interim  evaluation  was  to  assess  the  progress  made  to  date  and,  where 
relevant, the need to adjust the Programme. DG SANTE considered, on the basis of Better 
Regulation  Tool  #52216,  that  targeted  consultation  of  the  potential  beneficiary  groups 
(i.e. Member States’ authorities, NGOs and academia) was a sufficient means to achieve 
that aim. For the final evaluation, the Commission will conduct a public consultation. The 
EU4Health Programme is a matter of public interest, but many of the programmed actions 
have only just started and others are still at the planning stage. The Programme’s effects will 
only come to the public indirectly and with a time-lag. 

•  The  contractor  conducted  2  surveys.  One  targeted  the  successful  applicants  (grant 
beneficiaries) of the EU4Health Programme. The other focused on unsuccessful applicants. 
The  aim  of  the  surveys  was  to  capture  different  perspectives  on  the  Programme’s 
effectiveness, efficiency and overall impact. The surveys were conducted using EUSurvey, 
with a response rate of 8% for beneficiaries and 4% for unsuccessful applicants. 

•  7 scoping interviews were conducted at the beginning of the study to refine the study’s focus. 
54 targeted interviews were then conducted with 75 individuals from various stakeholder 
groups, thus ensuring a balanced representation across regions and sectors. These interviews 
provided deeper insights and validated the findings from the desk research and surveys. 

216   Better Regulation Tool #52. 

90 

 
 
•  2 focus groups were held towards the end of the data-collection period, focusing on specific 
funding instruments (operating grants and joint actions). These discussions helped address 
gaps in the findings and test hypotheses. 

The supporting study contractor also carried out case studies for each of the three following 
topics: operating grants (OGs), joint actions (JAs) and the exceptional utility criterion (EUC). 
The role of the case studies was to investigate the functioning of OGs, JAs and the EUC in the 
EU4Health  Programme.  The  contractor  together  with  the  Commission  defined  the  list  of 
questions to be answered by each study. 

The case studies built on preliminary findings from the overall  study, desk research, survey 
and interviews. The two above-mentioned focus groups were also used as part of these case 
studies. The findings of these consultations were analysed and complemented with additional 
data collection activities that were specific to the case studies and consisted of desk research 
and in-depth interviews (with a small number of stakeholders that used OGs or that participated 
in  JAs  or  other  actions  benefiting  from  the  EUC).  These  stakeholders  were  selected  by  the 
contractor  together  with  the  Commission.  Desk  research  included  analysis  of  funding  call 
documents (including application forms and funding agreements), project monitoring reports, 
peer-reviewed articles, EU regulations and EU4Health Dashboard data. 

In the study, the supporting study contractor used data triangulation to enhance the reliability 
and validity of the findings. The supporting study team drew on various data sources (including 
the  Programme  indicators  as  per  PPMEF,  EU4Health  Dashboard,  stakeholder  surveys, 
interviews,  focus  groups,  and  peer-reviewed  and  grey  literature)  in  order  to  cross-verify 
information and identify patterns or inconsistencies.  

The megatrends analysis supporting this evaluation suggests that healthcare and related public 
health policies directly account for 20% of the observed extra potential years of life lost (PYLL) 
in  the  modelling  exercise  (some  56  million PYLL).  For  example,  factors  such  as  improved 
sanitation and nutrition have played an important role in mortality reductions observed since 
the nineteenth century.  

A value of EUR 90 000 per life year can be assumed (by estimating EUR 3.5 million for the 
statistical value of life 217 and by factoring in the EU median age of 44 and conditional life 
expectancy at age 44. Multiplying this value by the assumed avoided loss of 56 million PYLL 
through  healthcare  and  related  public  health  policies  produces  a  monetised  outcome  of 
approximately EUR 5 trillion annually.  

Total expenditure on healthcare in the EU-27 amounted to some EUR 1.6 trillion in 2021 xxix. 
The  societal  multiplier  for  spending  on  healthcare  and  related  public  health  measures  was 
therefore  slightly  greater than  3. This  is  in  line with  findings  (for instance by Reeves et  al. 
2013218) that there is a ‘fiscal multiplier’ (measuring the contribution of public spending on 

217   Better Regulation tool #57. For example, the OECD has done a study to explain the variation in the estimates 
of value of statistical life (VSL) according to the characteristics of risk (type and size of risk, baseline risks, 
latency,  etc.)  and  socio-economic  characteristics  (age,  income,  gender,  health  status,  etc.).  Their 
meta-analysis suggests a VSL of around EUR 3.5 million.  

218   See Does investment in the health sector promote or inhibit economic growth? | Globalization and Health | 

Full Text (biomedcentral.com). 

91 

 
 
healthcare to GDP growth) of 4.3 for health (95% CI: 2.5 to 6.1). The study also found that the 
multiplier for total government spending was 1.61 (95% CI: 1.37 to 1.86). 

This  multiplier  effect  varies  across  specific  subdomains  of  healthcare  and  public  health  (as 
evidenced  by  a  review  conducted  by  the  contractor  of  the  study  supporting  the  interim 
evaluation – Annex X). It can therefore be argued that healthcare and public health investments 
may be marginally declining  because  payers will prioritise high  value investments  (such as 
maternal and infant care). 

92 

 
 
 
 
ANNEX III. EVALUATION MATRIX AND, WHERE RELEVANT, DETAILS ON ANSWERS TO THE EVALUATION QUESTIONS (BY CRITERION) 

Table III.1 

Evaluation matrix – Effectiveness 

Evaluation questions 

Sub-questions (where 
needed) 

Judgement criteria 

Indicators  

 Data sources 

EQ5: To what extent and 
in which way has the 
EU4Health Programme 
been effective? 

EQ6: How successful 
has the EU4Health 
Programme been in 
achieving (or 
progressing towards) its 
SOs? To what extent 
were the expected 
changes resulting from 
the EU action delivered? 

EQ6.1: What have the 
quantitative and 
qualitative outputs and 
results of the 
intervention been (by 
area, sector, etc)? 
Were they as expected 
when introducing the 
intervention? If not, 
why not? 

The EU4Health 
Programme contributes 
towards achieving its 
GOs 

Outputs and results of the 
Programme are 
quantifiable for the 
defined indicators  

Additional qualitative 
information on outputs, 
results and impacts of the 
Programme are available 
to complement the 
quantifiable information 
or to substitute for data 
gaps 

Summative results from 
other effectiveness 
evaluation questions. 

See the other effectiveness 
evaluation questions 

Reference in the 
report 

Section 4.1.1 (To what 
extent was EU4Health 
effective) 

Specification of output and 
result indicators in the 
PPMEF 

Desk research: 

PPMEF 

Section 4.1.1 
(Achieving objectives 
and measuring impact) 

Statistics on the 
Programme indicators as 
defined in the PPMEF for 
each of the related SO 
Statistics on key metrics of 
the Programme, notably:  

Number of actions per 
strand  

EU4Health Dashboard 

Statistics and data of the 
stakeholder consultations 
in relation to the 
EU4Health Annual Work 
Programme 

Annual Work Programmes 

Case studies 

93 

 
 
 
 
 
Consultation activities:  

Call for Evidence  

Targeted surveys 

Interviews 

The results of the 
Programme are in line 
with the expectations  

Number of financed 
projects per action, and per 
strand  

Number of actions per 
policy area  

Number of financed 
projects per action and per 
policy area  

Number of actions per SOs  

Number of financed 
projects per SOs  

Number of beneficiaries 
per eligible countries, per 
strand, per policy area and 
per SO.  

Stakeholder perception on 
the progress of the 
Programme to date 

Stakeholder expectations 
on delivery under the 
Programme to date 

Financial allocation by 
strand and SO  

94 

 
EQ6.2: How do the 
outputs, results (and 
impacts) achieved so 
far as measured by the 
PPMEF compare to 
the milestones and 
targets defined by the 
Programme? 

EQ6.3: What success 
and hindering factors 
have affected progress 
towards the SOs and 
how are they linked to 
the EU intervention?  

Outputs, results (and 
impacts) for the different 
indicators of the 
Programme correspond to 
the milestones and targets 
as defined in the PPMEF 

Statistics on the milestones 
and targets defined for the 
individual indicators as 
presented in the PPMEF 
(including impact 
indicators) 

Desk research: 

PPMEF (Programme 
Performance Measuring 
and Evaluation Framework  

EU4Health Dashboard  

Section 4.1.1 
(Achieving objectives 
and measuring impact) 

Section 4.1.1 (Success 
and hindering factors) 

Statistics on the outputs 
and results (and impacts) 
to date (see sub-question 
above) 

There have been internal 
factors that benefitted the 
progress towards the SOs 

Stakeholder perception on 
success and hindering 
factors 

Evidence from studies and 
reports on related 
initiatives and policies that 
mention relevant factors 
for the EU4Health 
Programme 

There have been external 
factors that benefitted the 
progress towards the SOs 

There have been internal 
factors that hindered the 
progress towards the SOs 

There have been external 
factors that hindered the 
progress towards the SOs 

Desk research:  

Studies and reports on the 
factors contributing to or 
hindering the progress of 
the EU4Health 
Programme, including 
sources from related 
policies and initiatives 

Case studies 

Consultation activities: 

Targeted surveys 

Interviews 

Focus groups  

Case studies 

95 

 
EQ6.5: If the SOs have 
not been achieved as 
expected at the interim 
stage, can they and the 
targets still be 
achieved in time? If 
not, what is needed to 
do that? 

EQ7: Are there any 
unexpected or 
unintended effects that 
have occurred, and 
which drove or hindered 
progress towards the 
SOs? What can explain 
these effects? 

The targets can be 
achieved in time 

Annual Work Programmes 

Desk research: 

The SOs can be achieved 
in time 

Stakeholder perception on 
the achievability of the 
targets and objectives 

Annual Work Programmes 

Consultation activities: 

Section 4.1.1 (Success 
and hindering factors) 

Section 4.1.1 (Success 
and hindering factors) 

Interviews 

Focus groups 

Case studies 

Desk research:  

Annual Implementation 
Reports (if available) 

Studies and reports on the 
effects of the EU4Health 
Programme, including 
sources from related 
policies and initiatives 

Input from the coherence 
analysis 

Case studies 

Consultation activities: 

Call for Evidence  

Targeted surveys 

Interviews  

There have been 
unexpected or unintended 
positive effects 

There have been 
unexpected or unintended 
negative effects 

Additional qualitative 
information on 
unexpected or unintended 
effects 

Stakeholder perspectives 
on unintended or 
unexpected positive or 
negative effects 

Evidence from the annual 
implementation report 
about unintended or 
unexpected effects 

Evidence from studies and 
reports on related 
initiatives and policies that 
mention potential 
interlinkages with the 
EU4Health Programme 

96 

 
 
Table III.2 

Evaluation matrix – Efficiency 

Evaluation questions 

Sub-questions (where 
needed) 

EQ8: To what extent is 
the EU4Health 
Programme cost 
effective? 

EQ8.1: What are the 
costs of implementing 
the actions of the 
Programme? 

Reference in the 
report 

Section 4.1.2 (Cost-
effectiveness of the 
EU4Health 
Programme) 

Judgement criteria 

Indicators  

 Data sources 

Identification of different 
types of costs, such as 
application costs, 
implementation costs, 
reporting costs, possible 
other costs 

Assessment of the size of 
the costs per type per 
actions or group of 
actions and procurement 
type (grant, joint actions, 
exceptional utility) 

Costs for applicants 

Desk research: 

Costs for others involved 
in implementing the 
actions 

Costs for reporting for 
beneficiaries 

Data on costs for 
application and reporting 
processes under similar 
EU programmes, (e.g. 
ESF+, Horizon Europe, 
Digital Europe, rescEU, 
and the Innovation Fund) 

Eurostat data on labour 
costs  

EU4Health Dashboard 

Budget allocations 
(breakdown) and 
resources (human and 
capital) used for the 
management of the 
Programme 

Case studies 

Consultation activities: 

Call for Evidence  

97 

 
 
 
Targeted surveys 

Interviews 

Focus groups 

Case studies 

Findings from the 
effectiveness analysis 

Desk research: 

Studies and evidence on 
the monetisation of help 
impacts 

Section 4.1.2 (Costs 
and benefits of 
EU4Health) 

EQ8.2: What are the 
benefits of the 
Programme? 

Data on outputs and 
outcomes (indicators 
explored under 
effectiveness) 

Quantification of benefits 
where possible219 

Qualitative information on 
the benefits for 
contextualisation and 
where a quantification 
does not appear feasible.  

The EU4Health 
Programme achieves the 
following type of 
benefits, e.g.: diseases 
prevented; avoided health 
care treatments; avoided 
operational health care 
costs, sharing of best 
practices, enhancing 
knowledge and skills, 
improved populations 
health outcomes for 
treating diseases through 
enhanced access and 
affordability 

The approximate size of 
these benefits in terms of 
numbers 

219   Please  note  that  in  line  with  the  PPMEF,  benefits  of  the  Programme  could  mostly  be  measures  through  its  impact  indicators.  However,  at  this  interim  stage  of  the 

Programme implementation, not all impacts have yet materialised and limited data on these impacts are available.  

98 

 
 
EQ8.3: How do the 
costs and benefits of the 
Programme compare? 

EQ9: What are the costs 
and benefits for different 
actors involved? 

EQ9.1: How are costs 
and (monetised and non-
monetised) benefits 
distributed over the 
actors involved, such as: 
governments, health 
care services, patients, 
informal carers, 
production companies 
(pharmaceutical and 
medical devices)? 

If possible: the monetised 
value of these benefits 

A qualitative assessment 
of the benefits and costs 
of the programme leads 
to the conclusion that the 
benefits outweigh the 
costs 

(The monetised benefits 
of the Programme 
outweigh its costs) 

(The monetised benefits 
of the Programme are 
below costs, but there 
also non-monetised 
benefits) 

The identified costs and 
benefits (monetised and 
non-monetised) are 
shown by type of actor 

The balance is shown by 
type of actor 

Findings from EQ8.1 and 
EQ8.2 

Section 4.1.2 (Costs 
and benefits of 
EU4Health) 

Case studies 

Data on costs of actions in 
the Programme explored 
through the case studies, 
including additional costs 
for actors involved not 
covered by Programme 
actions (from above) 

Data on outputs, results 
and impacts from (a 
sample of) the Programme 
actions, converted into 
benefits (from above) 

Data on costs of actions in 
the Programme (from 
above) 

Findings from the cost-
effectiveness analysis. 

Section 4.1.2 (Costs 
and benefits of 
EU4Health) 

Data on outputs, results 
and impacts from the 
Programme actions 
(covered by the case 
studies), converted into 
benefits (from above) 

Case studies 

Consultation activities: 

Call for Evidence  

Targeted surveys 

Focus groups 

99 

 
 
 
EQ10: To what extent are 
the administrative costs 
of the EU4Health 
Programme justified, 
given the changes/effects 
it has achieved? 

EQ10.1: How do 
administrative costs of 
EU4Health compare to 
other, comparable 
interventions with 
similar objectives and 
similar outcomes? 

The administrative costs 
of the Programme appear 
justified in light of its 
achievements and 
compared to comparable 
interventions. 

Data on administrative 
costs for applicants and 
beneficiaries for 
EU4Health and 
comparable interventions 

Desk research: 

Information on costs and 
outputs and results of 
comparable interventions 

Data on outputs/ results/ 
impacts, including those of 
comparable interventions 

Case studies 

Consultation activities: 

Section 4.1.2 (Costs 
and benefits of 
EU4Health) 

Targeted surveys 

Focus groups 

Case studies 

Findings from the cost-
effectiveness analysis 

Consultation activities: 

Interviews 

Focus groups 

Case studies 

Findings from the cost-
effectiveness analysis 

Findings from the 
coherence analysis 

Section 4.1.2 
(Inefficiencies and 
simplification) 

EQ11.1: Have any 
inefficiencies been 
identified? What are the 
reasons for 
inefficiencies identified? 

EQ11: Which factors 
influenced the efficiency 
with which the observed 
achievements were 
attained and to what 
extent are these factors 
linked to the EU4Health 
Programme? 

Inefficiencies can be 
reduced 

Evidence from the analysis 
of costs 

Stakeholder perception on 
inefficiencies and their 
causes 

Evidence on inefficiencies 
due to overlaps or 
contradictions with 
national interventions, 
policies and priorities  

100 

 
EQ11.2: Is there scope 
for simplification to 
make the programme 
more efficient? 

Simplifications are 
achievable 

Evidence from the analysis 
of costs 

Consultation activities: 

Evidence on inefficiencies 

Stakeholder perception on 
opportunities for 
simplification 

Interviews 

Focus groups 

Case studies 

Findings from the cost-
effectiveness analysis 

Section 4.1.2 
(Inefficiencies and 
simplification) 

Table III.3 

Evaluation matrix – Coherence 

Evaluation questions 

Sub-questions (where 
needed) 

Judgement criteria 

Indicators  

 Data sources 

Reference in the 
report 

EQ12: To what extent is 
the EU4Health 
Programme internally 
coherent? 

EQ12.1: To what 
extent are the various 
elements (objectives, 
priorities, actions, etc.) 
of the EU4Health 
Programme coherent 
with one another? 

The different elements of 
the EU4Health Programme 
are coherent with each 
other 

Stakeholder perception on 
the coherence of the 
elements of the Programme 

Desk research: 

Annual Reports 

Section 4.1.3 
(Internal conference 
of EU4Health) 

Evidence from the desk 
research on the internal 
coherence of the 
Programme 

Annual work 
programmes 

Regulation 2021/522 

Consultation activities: 

Call for Evidence 

Targeted surveys 

Interviews 

101 

 
 
EQ12.2: To what 
extent have the various 
elements (objectives, 
priorities, strands, 
actions, etc.) of the 
EU4Health Programme 
generated synergies 
and complementarities 
and/or compensated 
possible trade-offs 
among them?  

The different elements of 
the Programme have 
created synergies and/or 
complementarities 

The Programme is able to 
compensate for potential 
trade-offs among its 
elements internally 

Examples from 
stakeholders highlighting 
synergies, 
complementarities, or the 
internal compensation of 
trade-offs 

Evidence from desk 
research highlighting 
synergies, 
complementarities, or the 
internal compensation of 
trade-offs 

EQ13: To what extent is 
the EU4Health 
Programme externally 
coherent? 

EQ13.1: To what 
extent is the 
EU4Health Programme 
coherent with other EU 
and national financing 
instruments that have 
similar objectives? 

The Programme is coherent 
with other EU interventions 

The Programme is coherent 
with other national 
interventions 

Stakeholder perception on 
the coherence of the 
Programme with other EU 
and national interventions 

Examples of synergies, 
complementarities, or 
inconsistencies between the 
Programme and other 
interventions 

Section 4.1.3 
(Internal conference 
of EU4Health) 

Section 4.1.3 
(External conference 
of EU4Health) 

Desk research: 

Annual Reports 

Annual work 
programmes 

Regulation 2021/522 

Consultation activities: 

Call for Evidence 

Targeted surveys 

Interviews 

Case studies 

Desk research: 

EU policies in health and 
other relevant fields (e.g., 
ESF+, UCPM/rescEU, 
Digital Europe and 
Connecting Europe 
Facility, European 
Regional and 
Development Fund, 
Horizon Europe, TSI) 

Consultation activities: 

Call for Evidence 

102 

 
 
EQ13.2: To what 
extent is the 
EU4Health Programme 
coherent with current 
wider EU policies and 
priorities?220  

The Programme is coherent 
with wider EU policies 

The Programme is coherent 
with wider EU priorities 

Stakeholder perception on 
the coherence of the 
Programme with other 
policies and priorities 

Examples of synergies, 
complementarities, and 
inconsistencies between the 
Programme and other 
policies and priorities 

EQ13.3: 'How did the 
SOs of the EU4Health 
Programme correspond 
to wider EU policy 

The SOs of the Programme 
have been coherent with 
wider EU policy goals and 
priorities  

Stakeholder perception on 
the past coherence of the 
SOs with other policies and 
priorities 

Targeted surveys 

Interviews 

Case studies 

Desk research: 

EU policies in health, 
environment, digital 
transformation, 
development, and other 
relevant fields 

Consultation activities: 

Call for Evidence 

Targeted surveys 

Interviews 

Case studies 

Desk research: 

EU policies in health, 
environment, digital 
transformation, 

Section 4.1.3 
(External conference 
of EU4Health) 

Section 4.1.3 
(Coherence with 
wider EU policies 
and priorities) 

220   This  encompasses  policies  including  InvestEU,  SMP,  RRF,  Erasmus+,  and  the  Emergency  Support  Instrument,  and  the  six  Commission priorities for 2019  to  2024: 
European Green Deal, a Europe fit for the digital age, an economy that works for people, a stronger Europe in the world, promoting our European way of life, and a new 
push for European democracy. 

103 

 
 
 
 
goals and priorities in 
the past years? 

The Programme is coherent 
with international 
obligations 

EQ13.4: To what 
extent is the 
EU4Health Programme 
coherent with 
international 
obligations, including 
the SDGs 

development, and other 
relevant fields 

Consultation activities: 

Call for Evidence 

Targeted surveys 

Interviews 

Case studies 

Desk research: 

WHO, UN, OECD 
priorities. relevant policy 
documents and treaties 

Consultation activities: 

Interviews 

Examples of synergies, 
complementarities, and 
inconsistencies between the 
SOs and other policies and 
priorities 

Evidence on relevant 
international obligations 

Stakeholder perception on 
the coherence of the 
Programme with 
international obligations 

Evidence on synergies, 
complementarities, or 
contradictions between the 
EU4Health Programme and 
its provisions and 
international obligations 

Section 4.1.3 
(Coherence with 
international 
obligations) 

104 

 
 
Table III.4 

Evaluation matrix – EU added value 

Evaluation 
questions 

Sub-questions (where 
needed) 

Judgement 
criteria 

Indicators 

Data sources 

Reference in the report 

EQ14: What is 
the additional 
value resulting 
from the 
programme, 
compared to what 
could reasonably 
have been 
expected from 
MS acting at 
national and/or 
regional levels? 

EQ14.1: Could the 
identified 
outputs/results/impacts 
have been achieved 
without the EU4Health 
Programme? 

The identified 
outputs, results, 
and impacts could 
not have been 
achieved without 
the EU4Health 
Programme 

The outputs, results and 
impacts of the Programme 

Stakeholder perception on 
the possibility to achieve 
the same without EU 
intervention 

Desk research: 

(Academic) studies and grey 
literature on the benefits of the 
EU4Health Programme and its 
ability to add value 

Consultation activities: 

Section 4.2.1 (Added value 
compared to Member States 
action) 

Evidence on the added 
value of the Programme 
from (academic) research 

Targeted surveys 

Interviews 

Findings from the effectiveness 
analysis 

EQ14.2: Is it still valid to 
assume that the 
objectives of the 
EU4Health Programme 
can best be met by action 
at EU level? 

The objectives of 
the EU4Health 
Programme can 
still be best met 
by EU action 

Evidence from the 
previous analysis of the 
past and current relevance 
and external coherence of 
the Programme 

Consultation activities: 

Targeted surveys 

Interviews 

Section 4.2.2 (Necessity of 
EU action for achieving 
objectives) 

Stakeholder perception on 
the continued added value 
of the EU4Health 
Programme 

Findings from the relevance 
analysis 

Findings from the external 
coherence analysis 

105 

 
 
EQ14.3: What would be 
the most likely 
consequences of 
stopping or withdrawing 
the EU4Health 
Programme? 

The objectives of 
the EU4Health 
Programme 
cannot be met 
without EU action 

The objectives of 
the EU4Health 
Programme can 
still be (partially) 
met by action 
from other actors 
(i.e. IGOs) 

Stakeholder perception on 
potential implications of 
the withdrawal or stop of 
the EU4Health Programme 

Evidence from (academic) 
research on aspects that 
can only be delivered at 
EU-level but not at 
national level 

Desk research: 

(Academic) studies and grey 
literature on the benefits of the 
EU4Health Programme and its 
ability to add value  

Consultation activities: 

Targeted surveys 

Interviews 

Section 4.2.2 (Necessity of 
EU action for achieving 
objectives) 

Table III.5 

Evaluation matrix – Relevance 

Evaluation questions 

Sub-questions (where 
needed) 

EQ1: To what extent did 
the scope and SOs of the 
EU4Health Programme 
remain relevant over the 
implementation period? 

EQ1.1: To what extent 
did the scope defined by 
the GOs of the 
EU4Health Programme 
remain relevant over the 
implementation period? 

Judgement criteria 

Indicators  

Data sources 

The scope defined by the 
four GOs of the 
Programme remained 
relevant over the 
implementation period 

Jointly, the four GOss 
capture the most 
important needs in 
relation to health 

The four general 
objectives are aligned 

Stakeholder perception 
on the relevance of the 
four GOs and their 
exhaustiveness 

Desk research: 

Annual Work 
Programmes 

Evidence from desk 
research on potential gaps 

Findings from the 
coherence analysis on the 
consistency of the GOs 

Statistics and data 
gathered from the 
stakeholder consultations 
in relation to the 
EU4Health Annual Work 
Programme 

Reference in the 
report 

Section 4.3.2 
(Relevance of the 
GOs and SOs to 
health needs over the 
implementation 
period) 

106 

 
 
with the general (health-
related) principles of the 
EU 

with the (health-related) 
principles of the EU 

Annual Strategic 
Foresight Reports 

Studies and reports 
financed through the 
EU4Health Programme 
procurement221  

Findings from the 
external coherence 
analysis 

Consultation activities: 

Call for Evidence 

Targeted surveys 

Interviews 

Desk research: 

Annual Work 
Programmes 

EQ1.2: To what extent 
did the SOs of the 
EU4Health Programme 
remain relevant over the 
implementation period? 

The ten SOs of the 
Programme remained 
relevant over the 
implementation period 

Stakeholder perception 
on the relevance of the 
ten SOs and their 
exhaustiveness 

Section 4.3.2 
(Relevance of the 
GOs and SOs to 
health needs over the 
implementation 
period) 

There are no major need 
gaps created by the 
definition of the ten SOs 

There are no SOs where 
related calls received very 
low numbers of 

Evidence from desk 
research on potential gaps 

Number of applications 
by call 

Annual implementation 
reports (pending 
availability) 

Statistics and data 
gathered from the 
stakeholder consultations 

221  https://hadea.ec.europa.eu/programmes/EU4Health/studies_en.  

107 

 
 
 
applications because the 
calls and the related SOs 
were deemed less relevant 

Views of stakeholders on 
the continued relevance 
of the objectives  

in relation to the 
EU4Health Annual Work 
Programme 

Annual Strategic 
Foresight Reports 

Input from the external 
coherence on SO/ call 
specific overlaps 

Consultation activities: 

Call for Evidence  

Targeted surveys 

Interviews 

Desk research: 

Annual Work 
Programmes until 2024  

Annual Strategic 
Foresight Reports 

Studies and reports on 
current and likely trends, 
developments, and 
challenges in the health 
sector in the EU and 
globally 

Section 4.3.3 
(Continued relevance 
of EU4Health) 

EQ2: How well do the 
SOs of the Programme 
correspond to the current 
needs within the EU? 

The SOs of the 
Programme correspond to 
the current needs withing 
the EU 

The SOs are likely to 
correspond to the main 
needs in the foreseeable 
future 

Stakeholder perception 
on the annual work 
programmes until 2024 in 
relation to these 
addressing the needs 
identified by stakeholders 

Stakeholder perception 
on the most important 
needs in the near future 

Evidence on relevant 
recent and potential 
trends and developments 

108 

 
 
Section 4.3.2 
(Alignment of actions 
in the AWPs over the 
implementation 
period to the GOs and 
SOs) 

Input from the coherence 
analysis 

Consultation activities: 

Call for Evidence 

Targeted surveys 

Interviews 

Desk research:  

Annual Work 
Programmes 

Annual implementation 
reports 

Data from the PPMEF 
and the EU4Health 
Dashboard  

Desk research: 

Annual Work 
Programmes 

Annual implementation 
reports (pending 
availability) 

EQ3: To what extent 
were the actions included 
in the 2021, 2022, 2023, 
and 2024 annual work 
programmes covered by 
the programme SOs and 
were relevant to those 
objectives?  

EQ3.1: To which extent 
did the actions included 
in the 2021, 2022, 2023, 
and 2024 annual work 
programmes implement 
the EU4Health 
Programme's general / 
SOs? 

All actions in each annual 
work programme can be 
attributed to at least one 
of the 10 SOs 

Number and share of 
actions that can be 
attributed to a SO from 
the work programmes (by 
year), by SO 

Number and share of 
actions that cannot be 
attributed to any of the 
SOs, for each work 
programme 

EQ3.2: To which extent 
did the actions included 
in the 2021, 2022, 2023, 
and 2024 annual work 
programmes implement 
the list of possible 
eligible actions in Annex 
I of the EU4Health 
Regulation? 

A majority of actions 
included in each annual 
work programme can be 
subsumed under the non-
exclusive list of eligible 
actions in Annex I of the 
EU4Health Regulation 

Actions that cannot be 
subsumed under Annex I 
actions can be attributed 

Number and share of 
actions from the work 
programmes (by year) 
that can be attributed to 
each of the actions listed 
in Annex I 

Number and share of 
actions (matching Annex 
I as well as those not 
matching Annex I) from 

109 

 
 
to at least one of the SOs 
directly. 

the work programmes (by 
year) that can be directly 
attributed to each SO 

Data from the PPMEF 
and the EU4Health 
Dashboards 

EQ4: To which extent 
were the actions included 
in the 2021, 2022, 2023, 
and 2024 annual work 
programmes relevant to 
achieving the objectives 
set out in existing 
legislative and non-
legislative EU health 
initiatives? 

Taken together, actions 
included in each annual 
work programme 
contribute to achieving 
EU’s objectives set out in 
existing legislative and 
non-legislative EU health 
initiatives 

Section 4.3.3 
(Relevance of 
EU4Health to the 
objectives of existing 
European Health 
Union initiatives) 

Evidence from desk 
research of links between 
EU4Health actions and 
relevant health initiatives 

Desk research: 

Annual Work 
Programmes 

Number and share of 
EU4Health actions that 
cannot be linked to any 
other initiatives, for each 
work programme 

List of relevant initiatives 
that are not reflected in 
the actions of the 
Programme, for each 
work programme 

Stakeholders’ view on the 
relevance and 
contribution of actions to 
other health initiatives 

Annual implementation 
reports (pending 
availability) 

Statistics and data 
gathered from the 
stakeholder consultations 
in relation to the 
EU4Health Annual Work 
Programme 

Input from the coherence 
analysis 

Consultation activities: 

Targeted survey 

Interviews 

110 

 
 
 
 
 
ANNEX IV. OVERVIEW OF BENEFITS AND COSTS AND, WHERE RELEVANT, TABLE ON SIMPLIFICATION AND BURDEN REDUCTION 

Table 1. Overview of costs and benefits identified in the evaluation222 

Citizens/Consumers  

Businesses 

Administrations 

Beneficiaries of the 
programme including  

Quantitative 
in EUR 
million  

Comment 

Quantita
tive in 
EUR 
million  

Comment 

Quantitative 
in EUR 
million  

Comment   Quantit
ative in 
EUR 
million  

Comment 

Cost or Benefit description: 

COSTS:  

Direct compliance costs – 
administrative costs 

Type: 

one-off or 
recurrent 

impossible to 
distinguish  

111 

63.6 

Admin labour cost 
associated with 
reporting on 
implementation, 
coordination of 
tasks; The value 
represents the 
admin cost not 
covered by 
EU4Health. 

 
 
 
 
 
 
 
 
 
 
Direct costs 

Type: 

one-off or 
recurrent 

impossible to 
distinguish 

1390 

135.7 

EU4Health 
committed 
budget 

Beneficiary’s co-
funding. Total co-
funding for the 
whole project 
duration. 

Enforcement costs: (costs 
associated with activities 
linked to the implementation 
of an initiative such as 
monitoring, inspections and 
adjudication/litigation) 

Costs: 

Indirect costs  

(indirect compliance costs or 
other indirect costs such as 
transaction costs) 

Type: 

None 

n/a 

None 

n/a 

None 

n/a 

one-off or 
recurrent 

Type: 

one-off or 
recurrent 

impossible to 
distinguish 

10.87 

Unrecognised 
overhead costs 
based on 
stakeholders’ 
estimates, not 
covered by the 
EU4Health  

222   Where  there  is  a  prior  impact  assessment,  the  table  should  contain  as  a  minimum  the  costs/benefits  identified  in  the IA  with  the  information  gathered  on  the  actual 
cost/benefit. As available, the table should include the monetisation (€) of the costs/benefits based on any quantitative translation of the data (time taken, person days, 
number of records/equipment/staff etc. affected or involved represented in monetary value  – see Standard cost model, for example). For all information presented, it 
should be included in the comments section whether it relates to all Member States or is drawn from a subset. An indication of the robustness of the data should be provided 
in Annex II on Methodology and analytical models used. 

112 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Benefits: 

Direct benefits (such as 
improved wellbeing: changes in 
pollution levels, safety, health, 
employment; market efficiency) 

BENEFITS 

Increased access of 
Ukrainian refugees to 
first-aid psychological 
and mental health. 

Faster and more 
effective solutions that 
target major NCDs and 
address environmental 
threats. 

More and deeper 
knowledge of AMR 
facilitates more 
accurate identification 
and mitigations of 
risks.  

Analysis of the needs 
and stockpiling of 
critical medicines 
improves the speed 
and effectiveness of 
actions in pandemic 
situations.  

Improved ability of 
early warning systems 
to foresee health 
threats. 

113 

Not 
quantif
iable 

Country 
health profiles 
for all EU 
Member 
States, 
Iceland, and 
Norway 
supporting 
better health 
policymaking. 

Support to 22 
European 
countries 
(including 20 
Member 
States) to 
improve 
digital health 
systems and 
data access. 

Doubling in 
the Member 
States’ 
participation 
in the EDHS 
from 7 in 

Improved health 
outcomes as a 
result of 
implementing best 
practices. 

Improved 
international 
collaboration and 
more effective 
sharing of best 
practices thanks to 
leveraged EU 
networks. 

Establishment of 
the EU FAB 
network to ensure 
sufficient and 
agile 
manufacturing 
capacities for 
different vaccine 
types. 

Capacity building 
and increased 
training/education
, with improved 

 
 
 
 
 
  
 
 
 
 
2020 to 15 in 
2024. 

healthcare 
knowledge. 

Alignment of 
funding with 
activities 
contributing to the 
Global Health 
Strategy. 

Better 
international 
coordination and 
collaboration with 
EU institutions 
and Member 
States. 

Identified 32 
antibiotics for EU 
stockpiling. 

Increased capabilities, 
coordination and data 
exchange among the 
Member States via the 
1 619 clinical centres 
within the framework 
of the ERNs. 

Double increase in the 
number of patients 
diagnosed and treated 
by the members of 
ERNs – from 1 million 
in 2020 to 2.24 million 
in 2023. 

Investments in the 
development of the 
EDHS facilitates the 
even and simultaneous 
implementation of the 
EHDS directive, 
whose objective is to 
provide EU citizens 
with cross-border 
healthcare services. 
Greater cooperation of 
the EU research and 
academia leads to the 
development of new 
treatments and 
covering unmet 

114 

 
Indirect benefits (such as 
wider economic benefits, 
macroeconomic benefits, 
social impacts, environmental 
impacts) 

medical needs, 
especially for the 
medicines for rare 
diseases and children. 

Measures on 
identification and 
stockpiling 32 critical 
antibiotics contributes 
to the better crisis 
preparedness. 

Support to 22 
European countries to 
improve digital health 
systems and data 
access. 

Long-term welfare 
benefits: Reduced 
health inequalities 
through improved 
health promotion, and 
increased health access 
for rare diseases 
patients. 

115 

 
 
 
 
 
 
 
 
 
Implemented practices 
in health promotion, 
disease practices and 
reduction of health 
inequality in 25 
Member States would 
contribute to the 
healthy behaviours and 
creation of supportive 
environments for 
health. 

Advanced training 
focused on paediatric 
oncology and the 
needs of displaced 
cancer patients 
facilitates more 
targeted and 
customised care for 
these patient groups. 
Improved vaccine-
coverage – the 
purchase of 334 540 
doses of vaccine 
improved coverage 
leading to reduced risk 
for public health and 
outbreak of Mpox. 

The cumulative effect 
of the actions brings 

116 

Improvement of 
country 
knowledge in the 
field of health sets 
a basis for better 
understanding of 
the national 
characteristics and 
their better 
consideration in 
planning health 
initiatives at EU 
level. 

Improved 
collaboration with 
NGOs/IGOs and 
Member States. 

Adoption of best 
practices in 
cancer, tobacco 
control, physical 
exercise, nutrition, 
cardiovascular 
disease and 
diabetes. 

EU-level 
production of new 
knowledge on 

 
 
 
 
 
 
 
 
 
 
health threats, 
specifically AMR. 

better protection of the 
population against 
cross-border health 
threats. 

Easier access to 
(innovative) treatment 
for patients, including 
rare diseases patients. 
Enhanced quality of 
health services through 
European guidelines. 
and quality assurance 
for breast cancer. 

Increased availability 
of safe and performant 
medical devices. 

Improved expertise, 
access to specialised 
care and patient 
outcomes due to 
ERNs. 

Strengthening Member 
State health systems to 
benefit EU citizens 
and patients. 

Improved protection 
against health crises. 

117 

 
 
Report any simplification, burden reduction and cost savings achieved already by the intervention evaluated, including the points of comparison where available 
(e.g. REFIT savings predicted in the IA or other sources). 

TABLE 2: Simplification and burden reduction (savings already achieved)  

Tenderers for procurements covering 
business or NGOs 

Tenderers for grants covering national 
administrations only 

Tendering process covering all applicants and 
executive agency 

Quantitative   Comment 

Quantitative  Comment  

Quantitative  Comment 

Not 
quantified 

Direct 
compliance 
costs 

recurrent 

Integrating framework 
contracts into a new e-
procurement system that 
includes e-contracting to 
launch, sign and implement 
contracts. This speeds up and 
makes the management of 
contracts smoother. 

In October 2023, the Funding 
and Tender Portal was 
activated. It is more user-
friendly, is a single contact 
point for economic operators 
contacting with contracting 
authorities and allows for more 
efficient handling of questions 
asked by the economic 
operators. 

Calls are published earlier in a 
given year, allowing the 

118 

 
 
 
 
 
 
operators to plan better their 
activities. 

Moving fully to using qualified 
electronic signature speeds up 
the awarding process. 

Not 
quantified 

Indirect cost 
savings 

recurrent 

Indirect cost 
savings 

recurrent 

Use of the e-grants system 
allows the speeding up the 
granting process. The e-grant 
tool is more user-friendly and 
replaces paper-based 
procedures.  

Guides for applicants for grants 
are available online in the 
Funding and Tender Portal. 
This allows the applicants to 
easily find the information they 
need. 

EU4Health grant management 
templates are the same as for 
all other e-grants programmes. 
The beneficiaries can act more 
efficiently. 

119 

Not 
quantified 

All EU4Health projects and their non-
sensitive deliverables (once approved) 
are publicly available through the 
Funding and Tenders Portal, making 
them more accessible for applicants, 

 
 
 
 
 
 
 
 
 
Compliance 
costs 

recurrent 

Compliance 
cost 

recurrent 

Not 
quantified 

beneficiaries and other stakeholders. 
This can help to better identify and 
thus increase synergies between 
proposals and thus projects, once 
funded. 

Since February 2024, applicants have 
been using a simplified budget table in 
the proposal preparation phase. This 
has reduced the administrative burden 
on applicants, the granting authority 
and evaluators; and reduced the risk of 
errors. 

Not 
quantified 

Member States can nominate 
more than one competent 
authority in the case of joint 
actions. This makes it possible 
to reduce the number of 
affiliated entities. Affiliated 
authorities do not have full 
access to grants’ IT systems. 
Part of their financial reporting 
therefore had to be done by 
competent authorities, and this 
was a burden for them. 
Moreover, having fewer 
affiliated authorities simplifies 
the process of establishing joint 
action consortia. 

120 

 
 
 
 
 
 
 
 
 
Indirect cost 

recurrent 

Indirect cost  

recurrent 

Internal platforms used by the 
executive agency (HaDEA) enable 
more efficient handling of online 
opening sessions and the participation 
of interested tenderers. 

HaDEA has (by providing more 
information via information sessions, 
publishing guidelines and attending 
kick-off meetings) intensified its 
efforts to support the applicants during 
calls for proposals, grant agreement 
preparation and project 
implementation. 

Identify further potential simplification and savings that could be achieved with a view to make the initiative more effective and efficient without prejudice to its policy 
objectives223. 

PART II: II Potential simplification and burden reduction (savings) 

Citizens/Consumers/
Workers 

Businesses 

Administrations 

MS national administrations, NGOs 
academia _ specify 

223   This assessment is without prejudice to a possible future Impact Assessment. 

121 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Quantitativ
e  

Comment 

Quantitative  

Comment 

Quantitativ
e 

Comment  

Quantitative 

Comment 

Description 

Type:  One-off / 
recurrent (select) 

Expected reduction of man-
hours for application and 
reporting. Quantification not 
possible due to lack of data. 

Time for the 
preparation of 
the proposal – 
simplify 
templates. 

Reporting on 
the progress – 
move from 
preparation of 
reports to 
encoding data 
by the 
beneficiaries 
directly into 
the 
Commission’s 
IT systems 
(thus avoiding 
having to go 
through the 
Member 
States). 

Increase the 
use of the 
framework 

122 

Expected 
reduction of 
man-hours for 
application and 
reporting. 
Quantification 
not possible due 
to lack of data. 

Time for the 
preparation of the 
proposal – simplify 
templates. 

Reporting on the 
progress – move 
from preparation of 
reports to encoding 
data by the 
beneficiaries 
directly into the 
Commission’s IT 
systems of, thus 
avoiding having to 
go through the 
Member States. 

Increase the use of 
the framework 
contracts in 
procurement.  

Standardising 
procedures and 
aligning 
requirements across 

 
 
 
 
 
 
contracts in 
procurement. 

Standardising 
procedures and 
aligning 
requirements 
across EU 
funding 
programmes. 

Modernising 
procurement 
by integrating 
framework 
contracts into a 
new e-
procurement 
system that 
includes e-
contracting, 
thus digitising 
contract 
management 
[IN 
PROGRESS]. 

Offering e-
translation and 
AI-based tools 
to simplify 
translation, 
reporting and 

123 

EU funding 
programmes 

Modernising 
procurement by 
integrating 
framework 
contracts into a new 
e-procurement 
system that includes 
e-contracting, thus 
digitising contract 
management [IN 
PROGRESS]. 

Offering e-
translation and AI-
based tools to 
simplify translation, 
reporting, and 
monitoring [IN 
PROGRESS] 

Introducing a two-
tier selection 
process where 
complex and 
detailed budget 
information only 
needs to be 
provided for 

 
 
monitoring [IN 
PROGRESS]. 

Introducing a 
two-tier 
selection 
process where 
complex and 
detailed budget 
information 
only needs to 
be provided for 
proposals 
above a 
minimum 
threshold. 

Revised and 
reduced the 
number of 
deliverables 
and the 
frequency of 
reporting by 
NGO 
recipients of 
operating 
grants. 

Standardising 
procedures and 
aligning 
requirements 

124 

proposals above a 
minimum threshold. 

Revised and 
reduced the number 
of deliverables and 
the frequency of 
reporting by NGO 
recipients of 
operating grants. 

Standardising 
procedures and 
aligning 
requirements across 
programmes 
(e.g. Horizon 
Europe) could 
reduce duplication 
of administrative 
actions and 
streamline 
operations. 

Recording staff 
activity via 
timesheets is seen 
as cumbersome. 
Stakeholders 
suggest adopting 
simplified cost 
models (action-
based costs) similar 

 
to those in Horizon 
Europe. 

Multiannual work 
programme 
planning also helps 
in better preparation 
for future calls. 

Modification of the 
requirements of the 
current tendering 
process to make 
team formation 
more flexible and 
clearer. 

across 
programmes 
(e.g. Horizon 
Europe) could 
reduce 
duplication of 
administrative 
actions and 
streamline 
operations. 

Recording staff 
activity via 
timesheets is 
seen as 
cumbersome. 
Stakeholders 
suggest 
adopting 
simplified cost 
models (action-
based costs) 
similar to those 
in Horizon 
Europe. 

Multiannual 
work 
programme 
planning also 
helps in better 

125 

 
preparation for 
future calls.  

Modification 
of 
requirements 
of the current 
tendering 
process to 
make team 
formation more 
flexible and 
clearer. 

126 

 
 
ANNEX V. STAKEHOLDERS CONSULTATION - SYNOPSIS REPORT  

Introduction 

This report provides an overview of the consultation activities carried out in the context of the 
interim  evaluation  of  the  EU4Health  Programme.  It  provides  an  outline  of  the  consultation 
strategy, lists the consultation activities, and provides key results for each of them. 

The following consultations took place: 

• 
• 
• 
• 

feedback on the call for evidence224 (from 5 December 2023 to 9 January 2024); 
targeted stakeholder survey (from 11 April 2024 to 17 May 2024); 
interviews (from 11 April 2024 to 25 May 2024); 
focus groups on joint actions (10 June 2024) and operating grants (11 June 2024). 

The  Commission  carried  out  the  first  consultation,  but  the  external  contractor  analysed  the 
replies to the call for evidence. The other three consultations were carried out entirely in the 
context of the external study underpinning this evaluation. 

The key objectives of the consultations were to gather input from the impacted stakeholders in 
order to assess the effectiveness, efficiency, coherence, EU added value and relevance of the 
EU4Health Programme.  

The  following  stakeholder  groups  were  identified  and  involved  in  different  consultation 
activities:  intergovernmental  organisations;  competent  authorities  in  the  Member  States; 
governmental  public  health  organisations;  NGOs;  research  and  academia;  businesses  and 
consultancy; social partners225; and the general public226. 

The  consulted  groups  represent  the  stakeholders  that  were  targeted  for  funding  under 
EU4Health (potential beneficiaries), as well as those benefiting from the effects of EU4Health 
on health-related areas (potential final beneficiaries). 

Representatives  of  DG  SANTE,  HERA  and  HaDEA  were  also  consulted  via  interviews. 
Stakeholder groups were consulted in the same way. 

Call for evidence feedback 

The call for evidence for the evaluation was published on the Commission’s Have Your Say 
website 227. 30 replies were submitted during the consultation. 22 replies came from NGOs and 
5  replies  came  from  the  representatives  of  the  general  public.  1  reply  each  came  from  the 
representatives  of  competent  authorities  in  the  Member  States;  research  and  academia;  and 
businesses and consultancy. 11 replies to the call for evidence were sent by stakeholders from 
Belgium; 5 by stakeholders from France; 3 by stakeholders from Italy; 2 by stakeholders from 

224   EU4Health call for evidence, 2023-2024. 
225   For example, industry associations and trade unions. 
226   This stakeholder group was only directly consulted in the call for evidence feedback. 
227   EU4Health Programme interim evaluation – call for evidence.  

127 

 
 
 
 
 
the  Netherlands;  and  1  each  by  stakeholders  from  Cyprus,  Denmark,  Germany,  Ireland, 
Luxembourg, Poland, Romania, Slovakia and the United Kingdom. 

Targeted surveys 

The surveys resulted in a satisfactory sample of respondents. 3 352 beneficiaries were targeted 
through the first survey and 262 responses were received from successful applicants (an 8% 
response rate). 669 stakeholders were targeted through the second survey and 24 responses 
were received from unsuccessful applicants (a 4% response rate). 

Table V.1 

Number of respondents per survey and stakeholder group 

Stakeholder group 

Number of survey responses 
(beneficiaries) (%) 

1.        Intergovernmental organisations 
2.        EU institutions and agencies 
3.        National authorities228 
4.        Non-governmental organisations 
5.        Research and academia 
6.        Businesses and consultancy 
7.        Social partners 
8.        Other 229 
 Total respondents 

6 (3%) 
n/a 
88 (37%) 
43 (18%) 
68 (29%) 
11 (5%) 
2 (1%) 
17 (7%) 
235 

Table V.2 

Country of respondents per survey 

Country 

Number of beneficiaries 

Austria 
Belgium 
Bosnia and Herzegovina  
Bulgaria 
Croatia 
Cyprus 
Czechia 
Denmark 
Estonia 
Finland 
France 
Germany 
Greece 
Hungary 
Iceland 
Ireland 
Italy 
Latvia 
Lithuania 
Luxembourg 
Malta 
Netherlands 
Norway 
Poland 
Portugal 
Romania 

12 
18 

4 
9 
4 
7 
5 
3 
5 
13 
9 
13 
3 
1 
7 
23 
2 
6 
4 
3 
12 
1 
5 
11 
12 

Number of 
unsuccessful 
applicants 
1 
2 
1 

2 

1 
1 

1 

1 
3 
1 

1 

1 
1 
2 

Number of survey 
responses (unsuccessful 
applicants) (%) 
0 (0%) 
n/a 
3 (13%) 
10 (43%) 
5 (22%) 
1 (4%) 
0 (0%) 
4 (17%) 
23 

Total per country 

13 
20 
1 
4 
11 
4 
8 
6 
3 
6 
13 
9 
13 
3 
1 
8 
26 
3 
6 
4 
3 
13 
1 
6 
12 
14 

228   These are competent authorities in the Member States and governmental public health organisations. 
229   This category is made up of the respondents that did not identify their organisation as belonging to any of 

the other groups. 

128 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Slovakia 
Slovenia 
Spain 
Sweden 
Uganda 
Ukraine 
Total respondents 

Interviews 

4 
9 
24 
4 

2 
235 

1 
1 
1 
1 
23 

4 
9 
25 
5 
1 
3 
258 

Seven scoping interviews were undertaken with international organisations (the WHO and the 
European Observatory on Health Systems and Policies); EU institutions and agencies (HaDEA 
and DG SANTE); and national authorities (national contact points from the Member States).  

Targeted interviews were conducted to complement the broader survey data. The qualitative 
information obtained from these interviews was used to enrich the analysis, offering examples 
and contextual understanding. 

54 interviews were conducted, involving 75 individuals. The overall response rate was 61%. 
The interviews were distributed across stakeholder groups as shown in Table V.3.  

Table V.3 

Number of interviewees per stakeholder group 

Stakeholder group 

Number of interviews (attendees) (%) 

1.        Intergovernmental organisations 
2.        EU institutions and agencies 
3.        National authorities230 
4.        Non-governmental organisations 
5.        Research and academia 
6.        Businesses and consultancy 
7.        Social partners231 
 Total interviewees 

Focus groups 

8 (12) (15%) 
10 (14) (19%) 
16 (24) (30%) 
10 (14) (19%) 
4 (4) (7%) 
5 (6) (9%) 
1 (1) (2%) 
54 

Two focus groups were held on the funding instruments of operating grants and joint actions. 

Table V.5 Participating organisations in the 2 FGDs 

FGD1: Joint actions   

FGD2: Operating grants 

• 

JAVNA AGENCIJA REPUBLIKE SLOVENIJE ZA 
ZDRAVILA IN MEDICINSKE PRIPOMOCKE 
(Slovenia) 

•  NARODOWY FUNDUSZ ZDROWIA (Poland) 
•  TERVISEAMET (Estonia) 
•  MINISTERE DE LA SANTE ET DE LA 

PREVENTION (France) 

•  NORWEGIAN MINISTRY OF HEALTH (Norway) 

•  BREAST INTERNATIONAL GROUP (Belgium) 
•  EUROPEAN ASSOCIATION FOR PALLIATIVE CARE 

(Ireland)  

•  EUROPEAN PUBLIC HEALTH ALLIANCE (Belgium) 
•  TB EUROPE COALITION (Ukraine) 
•  SMOKE FREE PARTNERSHIP COALITION (Portugal, 

Belgium) 

230   These are competent authorities in the Member State and governmental public health organisations. 
231   For example, industry associations and trade unions. 

129 

 
 
 
 
 
 
 
•  TERVISEAMET (Estonia) 
•  STATE INSTITUTION PUBLIC HEALTH CENTER 
OF THE MINISTRY OF HEALTH OF UKRAINE 
(Ukraine) 

•  AGENCE NATIONALE DE SANTE PUBLIQUE 

(France) 

•  CHILDHOOD CANCER INTERNATIONAL - Europe 

(Austria) 

•  AIDS Action Europe (Germany) 
•  CORRELATION EUROPEAN HARM REDUCTION 

NETWORK 

•  EUROPEAN FOOD INFORMATION COUNCIL 

•  STATNI USTAV PRO KONTROLU LECIV (Czechia) 
•  AGENZIA NAZIONALE PER I SERVIZI SANITARI 

(Belgium) 

REGIONALI (Italy) 

•  HEALTH SERVICE EXECUTIVE (Ireland) 
•  FUNDACION PARA LA INVESTIGACION 

BIOMEDICA DEL HOSPITAL UNIVERSIATRIO LA 
PAZ (Spain) 

•  FEDERAL AGENCY FOR MEDICINES AND 

HEALTH PRODUCTS (Belgium) 

•  ETHNIKOS ORGANISMOS DIMOSIAS YGEIAS 

(Greece) 

Results per evaluation criteria 

Relevance 

Most survey respondents considered that the general objectives of the EU4Health Programme 
were  relevant  in  the  EU  over  the  implementation  period  (2021-2024).  66%  or  more  of  the 
responses indicated that each objective was relevant to a very large or to a large extent232. 

The  positive  aspects  that  were  highlighted  were  the  appropriate  level  of  focus  on  health 
promotion  and  disease  prevention  (16  respondents);  improved  EU  vaccine  manufacturing 
capacity; improved digital literacy for healthcare workers; and progress in cancer screening. 

Overall, the survey respondents considered that all 10 specific objectives were relevant during 
the implementation period. More than 50% of the responses indicated that each objective was 
relevant  to  a  very  large  or  to  a  large  extent233.  They  overall  considered  that  all  10  specific 
objectives would continue to be relevant in the near future.  

It emerged from the interviews that the stakeholders broadly acknowledged the relevance of 
the  Programme’s  objectives,  especially  in  the  light  of  recent  health  crises.  However,  they 
expressed  concern  about  an  overemphasis  on  certain  areas  (e.g. cancer),  which  might 
overshadow  other  crucial  aspects  like  mental  health,  digital  health  tools  and  public  health 
infrastructure. There is a call for greater flexibility within the Programme to ensure that it aligns 
better  with  the  Member  States’  differing  needs.  Concerns  were  also  expressed  about  the 
balance of funding and the transparency of prioritisation processes. Stakeholders called for a 
more nuanced approach to effectively address both long-term health challenges and emerging 
threats. 

232   The survey responses from beneficiaries and unsuccessful applicants were combined because no significant 

differences between the answers of these two groups were identified. 

233   The survey responses from beneficiaries and unsuccessful applicants were combined because no significant 

differences between the answers of these two groups were identified. 

130 

 
 
 
 
The stakeholders recognised Programme’s significant role in managing health crises, such as 
the COVID-19 pandemic. However, they identified a need to shift from a crisis-centric focus 
to  enhancing  long-term  health  resilience.  The  Programme  effectively  addresses  immediate 
health needs, but there is a growing call for more attention to be paid to emerging areas like 
mental health and digital health, as well as to address health inequalities. The stakeholders also 
highlighted the need for improved transparency in priority-setting and budget allocation. They 
considered that it is essential to ensuring the Programme’s flexibility and align resources with 
evolving  health  needs  in  order  to  maintain  its  effectiveness  and  address  diverse  regional 
challenges. 

Effectiveness 

The Programme’s effectiveness is evident in its focus on crisis preparedness, health inequality, 
vaccination coverage and the strengthening of health systems. For the four general objectives, 
the most positive result in the survey was that 53% of respondents agreed that the Programme 
had contributed to a large extent or to a very large extent to improving and fostering health. 
However, only 40% agreed that the Programme had contributed to a large extent or to a very 
large extent to improving access to medicinal products and devices and crisis-relevant products. 

Overall, the survey highlights the need for improved collaboration, stakeholder engagement 
and  alignment  of  priorities,  as  well  as  improved  expertise,  data  and  knowledge  within  the 
Member  States.  The  Commission’s  role  as  a  knowledge  broker  is  also  crucial,  but  its 
performance in this regard was considered modest. 

The stakeholders’  considered that  EU4Health’s success  relies on several  key factors. These 
included:  

−  Collaboration between Member States. 84% of stakeholders acknowledged that this 
is important for achieving the Programme’s objectives, but only 52% considered that 
the current level of collaboration is sufficient.  

−  Stakeholders’ engagement. 83% of stakeholders saw this as important for achieving 
the  objectives,  but  only  49%  recognised  that  how  the  stakeholder  engages  now  will 
contribute to EU4Health effectiveness to a large or very large extent. 

−  Political will in the Member States. 84% of stakeholders considered this an important 

factor, but only 41% considered that it is currently sufficient.  

−  Expertise,  data  and  knowledge  within  Member  States.  84%  of  stakeholders 
recognised  its  overall  importance,  but  only  49%  considered  that  it  is  currently 
sufficient. 

−  Alignment  of  national  health  priorities  with  EU  health  priorities.  85%  of 
stakeholders considered this crucial, but only 45% considered that it is currently at a 
sufficient level. 

−  Synergies between different EU programmes. 77% of stakeholders considered that 
synergies  (if  sufficiently  strong)  would  significantly  contribute  to  EU4Health 

131 

 
effectiveness.  45%  of  stakeholders  considered  that  the  currently  observed  synergies 
were satisfactory in this regard. 

The EU4Health Programme received positive feedback from stakeholders, particularly for its 
contribution to specific objectives on disease prevention and health promotion, as well as on 
international health initiatives and cooperation (54% and 58% respectively reported significant 
contributions).  However,  opinions  on  the  Programme’s  effectiveness  varied  as  regards  the 
alignment of specific objectives with the general objective of protecting people from serious 
cross-border threats to health. 49% of respondents acknowledged EU4Health’s contribution to 
specific objective prevention, preparedness and response to cross-border health threats. 14% 
and 18% of respondents respectively assessed the Programme’s support for specific objectives 
that complement the national stockpiling of essential crisis-relevant products and establishing 
a reserve of medical, healthcare and support staff (including training) as ‘limited’ or ‘not at 
all’. The Programme received the least recognition for its contribution to the general objective 
of improving access to medicinal products, medical devices and crisis-relevant products, but 
40% of respondents did consider that it contributed significantly to achieving this objective. 

EU4Health aims to enhance cross-border health networks, digital health capabilities and health 
infrastructure. Specific areas of interest include the effectiveness of joint actions and grants, 
transparency  issues  and  challenges  in  measuring  impact  (particularly  in  addressing  health 
disparities). 

The  stakeholders  have  acknowledged  the  Programme’s  successes  but  have  also  expressed 
concerns about the Programme’s effectiveness. Their criticisms include the lack of concrete 
results, administrative burdens and difficulties in measuring impact due to incomplete early 
results and funding constraints. They were also worried about the underfunding of critical areas 
was affecting the Programme’s overall effectiveness. 

The Programme has achieved success in managing health crises and fostering collaboration, 
but  there  are  ongoing  concerns  about  transparency,  funding  stability  and  addressing  health 
disparities. To improve effectiveness,  there is  a need for enhanced data  collection, strategic 
funding allocation and a balanced approach that meets both immediate and long-term health 
needs. 

Efficiency 

There  are  no  direct  data  on  administrative  costs,  but  estimates  can  be  derived  from  survey 
responses that indicate the percentage of administrative implementation costs. Analysis shows 
that average administrative costs are 11.8% of total costs for national authorities, 12.5% for 
EU-level NGOs, 11.5% for national NGOs, 12.6% for research and academia, and 14.4% for 
other organisations. 

Overall, stakeholders consider that the benefits of EU4Health outweigh its costs. 61% view the 
benefits as exceeding the costs to a large or very large extent. Most groups shared this positive 

132 

 
 
view,  but  NGOs  and  business  organisations  were  more  critical  and  saw  the  benefits  as 
exceeding costs by a smaller margin than the other groups. In addition, administrative costs are 
generally at least to some extent, to a large extent or to a very large extent considered to be 
proportionate for participating by comparison with a reasonable amount for administering an 
EU-funded  action.  39%  of  stakeholders  considered  the  administrative  procedures  to  be 
somewhat  clear  and  simple,  but  44%  had  encountered  significant  difficulties  with  them. 
Financial  challenges  were  particularly  significant  for  smaller  organisations,  NGOs,  and 
countries with a lower gross national income. They were struggling to meet the co-financing 
requirements,  particularly  for  covering  personnel,  travel  and  subcontracting  costs.  Many 
stakeholders  considered  that  the  structure  of  reimbursement  (with  frequent  recording  and 
reporting of staff activity through timesheets) was very time-consuming. In addition, unit travel 
reimbursement costs often do not  reflect  the  actual  costs  that stakeholders  incur before  and 
during the projects.  

87% of the survey respondents viewed financial resources as crucial for EU4Health’s success, 
but only 55% considered them sufficient. Similarly, 86% rated human resources as vital at the 
national  level,  but  only  40%  considered  them  sufficient.  At  the  EU  level,  79%  considered 
human resources important, but only 46% considered them sufficient. The recent 20% budget 
cut could further limit Member States’ ability to handle health emergencies and affect research, 
potentially jeopardising the Programmes’ ability to achieve its objectives. 

Coherence 

73%  of  the  survey’s  respondents  considered  that  the  EU4Health  Programme’s  objectives, 
priorities and actions were internally coherent. Only a small percentage (3%, distributed evenly 
across  stakeholder  groups)  considered  that  coherence  was  limited.  The  opinions  shared  in 
response  to  the  call  for  evidence  appreciated  the  broad  scope  of  the  Programme,  but  some 
diseases  were  seen  as  overrepresented  –  to  the  detriment  of  other  health  challenges.  This 
suggests that the  Programme’s design  and implementation are generally  coherent, but  there 
may be some room to enhance its overall coherence.  

The  results  on  coherence  between  the  EU4Health  and  other  EU  funding  programmes  were 
more nuanced. A majority of respondents (51%) considered EU4Health and Horizon Europe 
to be well aligned. Responses to the call for evidence included appreciation of the alignment 
with the EU’s Beating Cancer Plan. There was, however, a noticeable lack of awareness about 
the Programme’s overall external coherence. A significant percentage of respondents (ranging 
between 69% and 80%) chose the ‘do not know’ option when asked whether the Programme 
is coherent with other EU funding programmes (e.g. the Innovation Fund, the Recovery and 
Resilience Facility, the Technical Support Instrument and the Single Market programme). This 
lack  of  awareness  may  indicate  that  the  Programme’s  external  coherence  is  not  well-
communicated or understood by stakeholders.  

Stakeholders during the interviews generally expressed their appreciation of the Programme’s 
alignment  with  EU  priorities,  but  they  also  expressed  concerns  about  complexity,  potential 
overlaps  and  inefficiencies.  These  issues  include  duplication  of  efforts  and  inadequate 

133 

 
structural  mechanisms  for  coordination.  There  is  a  call  for  clearer  mission  statements  and 
improved  integration  with  other  EU  initiatives  (e.g. Horizon  Europe)  in  order  to  avoid 
redundancy and enhance overall effectiveness. 

58% of the survey participants considered to a very large extent or to a large extent that the 
Programme’s objectives are well aligned with the health priorities of the Member States and 
national  stakeholders  in  health.  However,  a  significant  proportion  (33%,  mostly  national 
authorities, NGOs and academia) felt that the coherence is only to some extent or to a limited 
extent  present.  This  suggests  that  there  may  be  scope  to  better  align  the  Programme  with 
national priorities.  

The interviewed representatives of the Member States authorities were more critical than the 
stakeholders taking part in  the surveys as  regards the coherence of EU4Health actions  with 
national challenges. They considered that the actions proposed in the annual work programmes 
are too generalised and insufficiently tailored to national-level or regional-level needs. 

Many survey  respondents felt  that EU4Health complements international commitments to a 
large or very large extent. This was particularly the case for the SDGs and International Health 
Regulations, where a large majority of respondents (65% and 70% respectively) considered 
that  EU4Health  complements  these  international  commitments.  The  results  of  the  call  for 
evidence present the same picture.  

A  significant  percentage  of  respondents  were  unsure  or  did  not  know  how  the  Programme 
aligns with certain international commitments (e.g. TRIPS and the Convention for the Rights 
of  the  Child).  This  highlights  the  need  for  increased  awareness  and  understanding  of  the 
Programme’s alignment with international commitments and obligations. 

EU added value 

The stakeholders participating in the surveys overwhelmingly indicated that the  Programme 
delivers results that go beyond what could reasonably be expected from Member States acting 
independently.  The  survey  results  show  that  a  significant  majority  of  stakeholders  (54%) 
believe  that  the  Programme  delivers  added  value  to  a  large  or  very  large  extent.  National 
authorities and NGOs operating at EU level believe this particularly strongly. The results of 
interviews are consistent with these findings. Rare diseases and cross-border threats to health 
were mentioned as examples of challenges that EU4Health addresses better than the individual 
Member  States  could  by  themselves.  In  the  event  of  a  crisis,  however,  the  Programme’s 
potential is seen as constrained by funding limitations and differing national commitments. 

The survey’s results also highlight the perceived benefits of EU4Health actions compared with 
those of national health policy actions. A significant proportion of respondents (33%) believe 
that EU4Health-financed actions deliver more value for money. They cite benefits such as the 
sharing of best practices, leveraging funding to address health issues, and sustained funding for 
long-term actions at the EU level. In addition, the Programme promotes collaboration between 

134 

 
Member  States,  thus  increasing  knowledge,  innovation  and  support  for  implementing 
evidence-based interventions and good practices.  

However, a significant proportion of survey respondents (34%) had no view on the value for 
money provided by EU4Health actions. This highlights  a need for increased awareness  and 
understanding of the Programme’s impact. Furthermore, a small but noteworthy proportion of 
respondents (4%) believed that EU4Health actions offer less value for money – citing concerns 
related to funding, administrative challenges and implementation.  

The  survey’s  results  also  provide  insights  into  the  perceived  effectiveness  of  EU4Health 
actions  in  achieving  the  Programme’s  objectives.  Most  respondents  (66%)  believe  that  the 
objectives of EU4Health related to protecting people from cross-border threats to health are 
best met through action at EU level. However, there is a significant difference of views when 
it comes to the objectives related to access to medicinal products, medical devices and crisis-
relevant products – 16% of respondents expressed uncertainty.  

This  disparity  in  opinions  highlights  the  need  for  a  more  nuanced  understanding  of  the 
Programme’s  impact  and  effectiveness  in  achieving  its  objectives.  It  also  underscores  the 
importance of effective communication and stakeholder engagement in increasing awareness 
and understanding of the added value and impact of EU4Health.  

This finding is consistent with the opinions expressed by the Member States’ authorities in the 
interviews. They recognised the added value of EU level coordination, such as fostering cross-
border cooperation and sharing best practices. However, some argued that the Programme’s 
unique benefits are unclear, especially in cases where the Member States also apply their own 
robust approach. There was a call for better showcasing of the Programme’s impact through 
data and case studies, particularly as regards health resilience and preparedness.  

The survey’s results suggest that the Programme is seen as a valuable complement to national 
health policy actions. 29% of respondents believe that EU4Health actions provide similar value 
for money. This highlights the Programme’s role in supporting and enhancing national health 
policy initiatives, rather than duplicating or replacing them.  

Overall,  the  results  of  stakeholders’  consultations  constitute  a  positive  assessment  of 
EU4Health’s  added  value  and  impact.  They  highlight  the  Programme’s  role  in  delivering 
results  that  go  beyond  what  could  reasonably  be  expected  from  Member  States  acting 
independently. However, the results also highlight areas for improvement (including the need 
for increased awareness and understanding of the Programme’s impact) and the importance of 
effective communication and stakeholder engagement. 

135 

 
 
 
 
 
ANNEX  VI.  EU4HEALTH  LIST  OF  INDICATORS  FROM  THE  PROGRAMME  PERFORMANCE 
MONITORING AND EVALUATION FRAMEWORK 

136 

 
Indicator name 

Definition 

Notes 

Number of actions 
contributing to the reduction 
of avoidable mortality in the 
area of non-communicable 
diseases and risk factors 

Number of Member States 
implementing best practices 
regarding health promotion, 
disease prevention and 
addressing health inequalities 
– KEY PERFORMANCE 
INDICATOR 

Relative proxy indicator; static indicator in 
some years; uncertain target and milestone 
because the number of actions depends on 
the programming process that involves 
Member States; the ‘Healthier together’ 
initiative presented in June 2022 is being 
implemented and the decision to roll out a 
particular best practice resides with the 
Member States; projects supporting work in 
the area of NCDs and Europe’s Beating 
Cancer Plan are mutually complementary. 
The actions considered under this indicator 
are aimed at improving health promotion 
and disease prevention via the reduction of 
avoidable mortality in the area of NCDs and 
risk factors. 

Relative proxy indicator; static indicator in 
some years; uncertain target and milestone; 
the ‘Healthier together’ initiative presented 
in June 2022 is under development and the 
decision to roll out a particular best practice 
resides with the Member States. 

The number of actions 
contributing to the reduction 
of avoidable (preventable 
and treatable) mortality in 
the area of NCDs and 
associated risk factors and 
delivering the policy 
objectives of the ‘Europe’s 
Beating Cancer Plan’ and the 
‘Healthier together – EU 
non-communicable diseases’ 
initiatives. The actions 
considered are those that 
address the following causes 
of avoidable mortality from 
cancer: health determinants; 
cardiovascular diseases; 
diabetes; chronic respiratory 
diseases; mental health and 
neurological disorders; 
external causes of death; 
alcohol and drugs effects; 
and other related causes of 
avoidable mortality. The 
actions that contribute to 
reducing avoidable mortality 
of NCDs and risk factors 
(tobacco, alcohol, healthy 
lifestyles, screening, 
vaccination), including those 
related to cancer will be 
included under the relevant 
indicators (12, 13, 14) 
referred to in Annex 2 to the 
EU4Health Regulation 

The number of Member 
States implementing ‘best’ 
and ‘promising’ practices 
that are rolled-out at the 
national level with EU 
funding support and 
addressing health promotion, 
disease prevention and 
health inequalities. The 
‘best’ and ‘promising’ 
practices counted are those 
selected by the Expert Group 
on Public Health established 
by the Commission (C(2022) 
8816 final). 

Vaccination coverage for 
measles – (sub-indicator 7.1) 

The number of EU Member 
States having reached 95% 
coverage for both the first 

Relative proxy indicator; uncertain targets 
and milestones; no direct causal link, any 
progress is an achievement. To 

137 

 
and the second dose of the 
measles vaccine for eligible 
individuals. 

Vaccination coverage for 
seasonal influenza – (sub-
indicator 7.2) 

The number of EU Member 
that have reached 75% 
coverage for the seasonal 
influenza vaccine in older 
age groups. 

operationalise it, indicator 7 Vaccination 
coverage by age for vaccine-preventable 
diseases such as measles, seasonal 
influenza, human papillomaviruses (HPV) 
and coronavirus COVID-19 referred to in 
Annex 2 to the EU4Health Regulation has 
been broken down into its four components 
(7.1, 7.2, 7.3 and 7.4). The actions on 
vaccination contribute to disease 
prevention. 

Relative proxy indicator, baseline from 
2018, last time when data were collected; 
uncertain targets and milestones; no direct 
causal link, any progress is an achievement. 
The public health target, set in the Council 
Recommendation on seasonal influenza 
from 2009, is for all Member States to reach 
75% coverage for the seasonal influenza 
vaccine in older age groups, extending, if 
possible, this coverage rate to other at-risk 
groups. To operationalise it, indicator 7 
Vaccination coverage by age for vaccine-
preventable diseases such as measles, 
seasonal influenza, human papillomaviruses 
(HPV) and coronavirus COVID-19 referred 
to in Annex 2 to the EU4Health Regulation 
it has been broken down into its four 
components (7.1, 7.2, 7.3 and 7.4). The 
actions on vaccination contribute to disease 
prevention 

Vaccination coverage for 
human papillomaviruses 
(HPV – (sub-indicator 7.3) 

n/a 

The number of EU Member 
having reached at least 90% 
coverage for a full 
vaccination course (last 
dose) in eligible girls. 

Age-standardised five-year 
net survival rate for paediatric 
cancer (to the extent 
available) – (indicator 9) 

Percentage of the population 
covered by Cancer Registries 
reporting information on 
rates of European children 
(aged 0–14 years) that have 
survived five-years post 
cancer diagnosis. 

Breast cancer screening 
coverage74 – (sub-indicator 
10.1) 

Number of Member States 
that have achieved a breast 
cancer screening 
examination coverage of 
over 70%. The coverage 
level is calculated as the 
number of women aged 50-
69 who have received a 
bilateral mammography 
within the past 2 years (or 
according to the specific 

138 

This indicator is still under construction and 
more details are expected by early 2025; 
static indicator in some years; data not 
available earlier than 2025; data analysis 
might be influenced by the low number of 
cases. Monitoring the survival rate allows 
investigations into the causes of higher or 
lower survival rates supporting health 
promotion by identifying specific needs. 

This indicator envisages ongoing annual 
data collection. As this was voluntary until 
2020, only partial coverage is provided. The 
first year with data available for all Member 
States is 2021. Eurostat releases the data in 
July every year as of 2023. These 
administrative data are collected by the 
competent authorities of Member States 
indicating the screening coverage (uptake) 
within organised programmes. To 
operationalise it, indicator 10 ‘Screening 

 
Cervical cancer screening 
coverage75 – (sub-indicator 
10.2) 

Colorectal cancer screening 
coverage – (sub-indicator 
10.3) 

coverage for breast, cervical and colorectal 
cancer screening programmes, by type, 
target population, and Member State’ 
referred to in Annex 2 to the EU4Health 
Regulation has been broken down into its 
three components (10.1, 10.2 and 10.3). 

This indicator envisages ongoing annual 
data collection. As this was voluntary until 
2020, only partial coverage is provided. The 
first year with data available for all Member 
States is 2021. Eurostat releases the data in 
July every year as of 2023.These 
administrative data are collected by the 
competent authorities of Member States 
indicating the screening coverage (uptake) 
within organised programmes. To 
operationalise it, indicator 10 ‘Screening 
coverage for breast, cervical and colorectal 
cancer screening programmes, by type, 
target population, and Member State’ 
referred to in Annex 2 to the EU4Health 
Regulation has been broken down into its 
three components (10.1, 10.2 and 10.3) 

Indicator 10 ‘Screening coverage for breast, 
cervical and colorectal cancer screening 
programmes, by type, target population, and 
Member State’ from Annex 2 to the 
EU4Health Regulation has been broken 
down into its three components (10.1, 10.2 
and 10.3) to operationalise it. 

screening frequency 
recommended in each 
country) divided by the 
number of women aged 50-
69 eligible for an organised 
screening programme (for 
programme-based data); the 
data are reported by the 
competent authorities of 
Member States indicating the 
screening coverage (uptake) 
within organised 
programmes. 

Number of Member States 
that have achieved a cervical 
cancer screening 
examination coverage of 
70%. The coverage level is 
calculated as the number of 
women aged 20-69 who have 
been screened for cervical 
cancer within the past 3 
years (or according to the 
specific screening frequency 
recommended in each 
country) divided by the 
number of women aged 20-
69 eligible for an organised 
screening programme (for 
programme-based data). 

Number of Member States 
that have achieved a 
colorectal cancer screening 
examination coverage of 
45%. The coverage level is 
calculated as the number of 
men and women aged 50-74 
who have been screened for 
colorectal cancer within the 
past 3 years (or according to 
the specific screening 
frequency recommended in 
each country) divided by the 
number of men and women 
aged 50-74 eligible for an 
organised screening 
programme (for programme-
based data). 

Percentage of population 
covered by Cancer Registries 
reporting information on 
cervical, breast, colorectal and 
paediatric cancer stage at 
diagnosis – (indicator 11) 

Percentage of population 
covered by Cancer Registries 
reporting information on 
cervical, breast, colorectal 
and paediatric cancer stage at 
diagnosis, which is 
computed as the ratio 
between the population 

The above cancer registries record 
information on cervical, breast, colorectal 
and paediatric cancer cases. The more 
representative the coverage is, and the more 
detailed the information, the easier it is to 
identify and tackle underlying causes, for 
example for a high number of late-stage 
diagnoses. Thus, the results assessed 

139 

 
Number of Member States 
reporting information on 
cervical, breast, colorectal and 
paediatric cancer stage at 
diagnosis 

Number of actions addressing 
the prevalence of major 
chronic diseases per Member 
State, by disease, gender, and 
age – (indicator 12) 

Number of actions addressing 
the age prevalence of tobacco 
use, if possible, differentiated 
by gender – (indicator 13) 

contribute to health promotion and disease 
prevention. 

n/a 

Static indicator in some years; uncertain 
target and milestone because the number of 
actions depends on the programming 
process that involves Member States; the 
actions delivered are across gender and age 
category and data cannot be properly 
disaggregated; action-level indicators to 
collect data related to gender will be 
designed and data collected after the launch 
of the actions. 

Uncertain target and milestone because the 
number of actions depends on the 
programming process that involves Member 
States; actions on tobacco use may directly 
or indirectly address tobacco use with a 
primary focus on young people. Therefore, 
this indicator aims to differentiate by age 
and gender. Action level indicator to 
differentiate by gender and age will be 
defined. 

covered by the cancer 
registry/ies (residents in a 
specific area) over the total 
population of the Member 
State. 

Number of Member States 
with at least one cancer 
registry (for the countries 
with regional registries) 
having submitted the stage at 
diagnosis for cervical, breast, 
colorectal and paediatric 
cancer for the respective data 
call. 

The sum of actions 
addressing the prevalence of 
major chronic diseases - 
cancer, cardiovascular 
diseases, diabetes, chronic 
respiratory diseases, mental 
health and neurological 
disorders - and delivering the 
policy objectives of the 
Europe’s Beating Cancer 
Plan and of the ‘Healthier 
together’ EU NCD initiative 
per Member State, by 
disease. Actions that address 
prevalence through various 
activities, in particular 
related to health promotion 
and prevention and early 
detection, will be counted, 
including tobacco-related 
actions. 

Sum of actions addressing 
the prevalence of use of 
tobacco and related products, 
if possible, differentiated by 
gender and age and 
delivering the policy 
objectives of the relevant 
tobacco legislation, Europe’s 
Beating Cancer Plan and of 
the ‘Healthier together’ EU 
NCD initiative. Actions that 
address the age prevalence of 
tobacco use, in particular the 
activities related to health 
promotion and prevention 
and early detection, will be 
counted. 

Number of actions addressing 
the prevalence of harmful use 
of alcohol, if possible, 

The sum of actions 
addressing the prevalence of 
harmful use of alcohol and 

Uncertain target and milestone because the 
number of actions depends on the 
programming process that involves Member 

140 

 
differentiated by gender and 
age – (indicator 14) 

Number of actions addressing 
environmental risk factors for 
health – (indicator 23) 

Preparedness and response 
planning of the Union and of 
Member States for serious 
cross-border threats to health 
– (sub-indicator 1.1) KEY 
PERFORMANCE 
INDICATOR 

Number of Member States 
participating in the 
prevention, preparedness and 
response planning joint action 
– (sub-indicator 1.2) 

Number of Member States 
with improved integrated 
surveillance systems     – 
(sub-indicator 1.3) 

States; differentiation by age and gender 
may not always be possible; indicators will 
be defined at action level to collect data by 
gender. 

Uncertain target and milestone because the 
number of actions depends on the 
programming process that involves Member 
States. 

The value for the target will increase in the 
future with the number of countries 
associated to the EU4Health Programme. 

The joint action is expected to be launched 
towards the end of the MFF at earliest in 
2026.  static indicator in some years; 
relative proxy indicator; targets and 
milestones will be set in line with 
Regulation 2022/2371 on serious cross-
border threats to health and expected to be 
available at the end of 2023 when the 
reporting is due. 

Indicators based on Article 13 of Regulation 
2022/2371 – epidemiological surveillance. 
It monitors joint actions from the 2021 
annual work programme (JA 
UNITED4SURVEILLANCE) and direct 
grants to Member States from the 2023 
annual work programme. The data also 
includes the data from JA EU-WISH from 
the 2023 annual work programme. Static 
indicator in some years; relative proxy 
indicator; uncertain targets and milestones.  

delivering the policy 
objectives of the Europe’s 
Beating Cancer Plan and the 
‘Healthier together’ EU 
NCD initiative. Actions 
addressing the prevalence of 
the harmful use of alcohol 
will be counted. 

The sum of actions 
contributing to addressing 
environmental risk factors 
for health and delivering the 
policy objectives of the 
Europe’s Beating Cancer 
Plan and the ‘Healthier 
Together’ – EU non-
communicable diseases 
initiative. Actions that 
address environmental risk 
factors for health will be 
counted. 

Number of Member States 
and associated countries 
participating in more than 
one Union action aiming to 
improve prevention, 
preparedness, and response 
planning for serious cross-
border threats to health 
excluding capacity-building 
activities to improve 
integrated surveillance.  

Number of National 
Competent Authorities    in 
Member States and 
associated countries 
participating in the joint 
action on prevention, 
preparedness and response 
planning according to the 
Article 7-11 of Cross-border 
health threats Regulation 
(EU) 2022/2371. 

Number of Member States 
and associated countries with 
improved integrated 
epidemiological surveillance 
systems (including 
wastewater) as reflected by 
the final reports of the direct 
grants co-financed by 
EU4Health.  

141 

 
Number of new capacity- 
building activities (EU, 
Member States) for improved 
integrated surveillance 
systems (sub-indicator 1.4) 

Number of new capacity 
building activities (EU, 
Member States) for 
improved integrated 
epidemiological surveillance 
systems 

Number of Member States 
with improved preparedness 
and response planning (sub-
indicator 6.1) 

Number of Member States 
with improved preparedness 
and response planning with 
regard to medical 
countermeasures (sub-
indicator 6.2) 

The number of Member 
States that reported an 
increased level of 
preparedness and response 
planning assessed against the 
indicator levels (1-5) 
described in COMMISSION 
IMPLEMENTING 
REGULATION (EU) 
2023/1808 

Number of Member States 
that reported an increased 
level of preparedness and 
response planning with 
regard to medical 
countermeasures compared 
to the baseline. assessed 
against the indicators A 6.8 
to A 6.13 described in the 
COMMISSION 
IMPLEMENTING 
REGULATION (EU) 
2023/1808 () 

Indicators based on Article 13 of Regulation 
2022/2371 - Epidemiological surveillance; 
relative proxy indicator; uncertain targets 
and milestones due to ongoing needs 
analysis for surveillance based on the 
results of a joint action that started in 
January 2023.   The joint actions from the 
2021 annual work programme (JA 
UNITED4SURVEILLANCE) that started 
in February 2023 will provide information 
to define target and milestone. In addition, 
the JA EU-WISH that will kick-off in 
February 2024 (EU contribution is from the 
2023 annual work programme) will also 
provide relevant information. 

Uncertain targets and milestones; no direct 
causal link; the grants provided are only one 
part of the total financial contribution to 
improving preparedness and response 
planning by the Member States, any 
progress is an achievement.  

Uncertain targets and milestones; no direct 
causal link, any progress is an achievement. 
Increased level of preparedness and 
response planning with regard to medical 
countermeasures is monitored through 
Member States’ participation in EU4Health 
actions related to medical countermeasures. 

Number of actions addressing 
the fight against 
communicable diseases 
(indicator 22) 

Number of actions 
contributing to address the 
fight against communicable 
diseases. 

Static indicator in some years; uncertain 
targets and milestones due to the 
programming process that involves the 
Member States. 

Number of Member States 
and associated countries with 
increased laboratory and 
diagnostic capacity for cross-
border health threats, 
contributing to the mission of 
HERA 

Total number of Member 
States and associated 
countries with additional 
laboratory and diagnostic 
capacity for cross-border 
health threats supported with 
EU funding contributing to 
the mission of HERA 
excluding EURLs and EU 
LabCap survey. 

Static indicator in some years; “Laboratory 
capacity for cross-border health threats” 
refers to the ability to detect and respond to 
public health threats through laboratory 
testing, from threat detection, evolutionary 
analysis and threat characterisation, taking a 
One Health approach, This indicator will 
rely on the actions’ final reporting outputs 
(including deliverables and milestones), 
against the baseline defined by the initial 
proposals, focusing exclusively on the 
EU4Health actions contributing to the 
mission of HERA. 

142 

 
Number of countries where 
One Health surveillance 
programmes were 
successfully implemented  

Number of Member States 
and associated countries with 
improved procurement 
procedures for medical 
countermeasures during 
health crisis 

Number of countries where 
One Health surveillance 
programmes were 
successfully implemented 
following implementation of 
the grants. 

This indicator measures the 
number of Member States 
and associated countries with 
newly designed and 
improved processes that 
have a direct impact on their 
procurement procedures for 
emergencies therefore 
strengthening preparedness 
and response to cross border 
health threats on the basis of 
data sharing, better 
coordination and exchange 
of best practices. 

Static indicator; relative proxy indicator.   

Static indicator in some years; uncertain 
targets and milestones; no direct causal link, 
any progress is an achievement. It is not 
possible to provide a general definition of 
“improved procurement procedures”, which 
needs to be assessed on a case-by-case 
basis, considering the specific baseline in a 
given Member State. 

Access to centrally authorised 
medicinal products, for 
example the number of 
existing and new orphan 
authorisations, advanced 
therapy medicinal products 
(ATMPs), medicinal products 
for paediatric use or vaccines, 
for unmet needs – (indicator 
2) 

Number of certificates issued 
by notified bodies under the 
Medical Device Regulation 
(MDR) 

Number of medicines, (i.e. 
orphan authorisations, 
advanced therapy medicinal 
products, medicinal products 
for paediatric use, vaccines 
with a single marketing 
authorisation issued by the 
Commission and valid across 
the EU). 

Relative proxy indicator; the baseline (86) 
represents the annual average between 2017 
and 2021. It is expected that the current 
trend where about half of the medicines 
authorised every year are orphan medicines 
will continue in the future. The availability 
of medicinal products can be measured by 
how many medicines are authorised 
centrally. 

The number of MDR 
certificates issued by notified 
bodies under Regulation 
(EU) 2017/745 on medical 
devices  

The number of certificates for medical 
devices is an indicator to measure the 
number of devices placed on the market 
under the MDR and contributes to 
monitoring the transition of devices to the 
new rules. 

Number of certificates issued 
by notified bodies under the 
In Vitro Diagnostic Medical 
Devices Regulation (IVDR) 

The number of IVDR 
certificates issued by notified 
bodies under Regulation 
(EU) 2017/746 for medium- 
and high-risk IVDs  

The number of certificates for in vitro 
diagnostic medical devices is an indicator to 
measure the number of devices placed on 
the market under the IVDR and contributes 
to monitoring the transition of devices to 
the new rules. 

ECDC will revise the format of the survey 
including the indicators in 2023/2024. 
Comparability needs to be seen by the time. 

EU Laboratory capacity index 
(EULabCap) – (indicator 8) 

The EULabCap monitoring 
tool combines 60 indicators 
to assess the capability and 
capacity of microbiology 
laboratories to provide 
essential public health 
functions, as defined in EU 
policies and action plans, 
international health 

143 

 
Number of reported shortages 
of medicinal products in the 
Member States through the 
single point of contact 
network – (indicator 15) 

Number of actions aimed at 
increasing the security and 
continuity of the global 
supply chains and addressing 
dependence on imports from 
third countries for the 
production of essential active 
pharmaceutical ingredients 
and medicinal products in the 
Union – (indicator 16) – KEY 
PERFORMANCE 
INDICATOR 

Number of production 
facilities with enhanced 
capacities in increasing 
security and continuity of 
supply for medical 
countermeasures, raw 
materials, and components at 
EU level – KEY 
PERFORMANCE 
INDICATOR 

regulations, and technical 
standards. The target 
measures are aggregated into 
the EULabCap Country 
system index, with 10 being 
the maximum score. The 
methodology is described in 
further detail in the 
EULabCap report (ECDC, 
2018). – see details ECDC. 

This indicator measures the 
level of monitoring and 
reporting on relevant 
shortages of human and 
veterinary medicines by 
measuring the number of 
shortages of medicines that 
were reported and identified 
as critical given their impact 
on human/animal health, by 
the SPOC (single point of 
contact) at EMA. 

Number of actions 
contributing to increasing the 
security and continuity of the 
global supply chains and 
addressing dependence on 
imports from third countries 
for the production of 
essential active 
pharmaceutical ingredients 
and medicinal products. 

Relative proxy indicator; uncertain targets 
and milestones; no direct causal link, given 
that an increase in reported shortages can 
either be due to better reporting and 
monitoring or due to an increase in the 
number of actual shortages even if a one 
joint action on shortages contributes to 
strengthening the structure and reporting in 
the Member States, any progress is an 
achievement; the values for this indicator 
may increase in the short term (2020 - mid-
2024) until the forthcoming Pharmaceutical 
package starts to take effect. The initial 
increase in numbers would be linked to a 
higher level of reporting and monitoring. 

Static indicator in some years; relative 
proxy indicator; uncertain targets and 
milestones because the number of actions 
depends on the programming process that 
involves Member States. 

n/a 

Number of new producers 
and producers with enhanced 
capacities in increasing 
security and continuity of 
supply of medical 
countermeasures, raw 
materials, and components in 
the Union, including ever-
warm capacities. 

144 

 
Antimicrobial consumption 
for systemic use ATC (group 
J01) – (indicator 18)  

Number of audits conducted 
in the EU and in third 
countries to ensure good 
manufacturing practices and 
good clinical practices (Union 
control) – (indicator 17) - 
KEY PERFORMANCE 
INDICATOR 

Number of Member States 
participating in actions aimed 
at supporting innovation, 
uptake and access to market 
of medical countermeasures 
supported at EU and global 
level for better preparedness 
and response  

This indicator is based on one of the targets 
agreed under Council Recommendation of 
13 June 2023 on stepping up EU actions to 
combat antimicrobial resistance taking a 
One Health approach, where the baseline is 
set in 2019 as defined in the Council 
Recommendation because 2020/2021 is not 
representative for AMC due to the effects of 
the COVID-19 pandemic; no direct causal 
link, any progress is an achievement. The 
target is defined by the Council 
Recommendation; the milestones are policy 
proposals that assume a linear trajectory of 
reduction to the target. 

n/a 

Static indicator in some years; relative 
proxy indicator; uncertain targets and 
milestones. 

The indicator measures the 
total consumption 
(community and hospital 
sectors) of antibacterials for 
systemic use (ATC group 
J01) expressed as defined 
daily dose’(DDD) per 1 000 
inhabitants per day’. It has 
been selected as the primary 
harmonised outcome 
indicator by ECDC, the 
European Food Safety 
Authority (EFSA) and the 
European Medicines Agency 
(EMA) to describe total 
antimicrobial consumption 
(AMC) in humans, 
combining both the 
community and hospital 
sectors. AMC   data were 
collected using the 
Anatomical Therapeutic 
Chemical 
(ATC)classification system 
and analysed using the 
defined daily dose (DDD) 
methodology developed by 
the World Health 
Organization (WHO). 

The number of audits 
conducted in the EU and in 
third countries, including 
candidate countries, to 
ensure good manufacturing 
practices and good clinical 
practices (EU control). This 
indicator shows to what 
extent the EU ensures high 
quality medicines and proper 
implementation of the 
Clinical Trial Regulation and 
supports the implementation 
of the legislation. 

This indicator measures the 
number of Member States 
that participate in actions 
contributing at supporting 
innovation, uptake, and 
access to market of medical 
countermeasures in EU and 
global level and therefore to 
increasing availability and 
accessibility of new or 
repurposed medical 
countermeasures for priority 
threats that are closer or have 
gained access to the market 

145 

 
Number of actions 
complementing national 
stockpiling of essential crisis-
relevant products  

Number of Member States 
participating in stockpiling 
activities 

Number of healthcare and 
public health staff trained 
(Article 11 of the CHBT 
Regulation and Decision 
establishing HERA) - KEY 
PERFORMANCE 
INDICATOR 

Stakeholders’ satisfaction rate 
in HERA training 
programmes 

to improve preparedness and 
response. 

This indicator measures the 
number of actions aimed at 
complementing national 
stockpiling, these could be 
purchases intended to 
increase the national 
stockpile or actions intended 
to gather information to 
strengthen national or EU 
stockpiles. 

Total number of Member 
States participating in the 
Joint Action on stockpiling 
foreseen in the EU4Health 
2024 annual work 
programme and contributing 
to the development and 
implementation of activities 
outlined in the EU stockpile 
strategic approach and 
vision. The involvement of 
the EU Member States, 
participating in the Joint 
Action on stockpiling 
foreseen in the EU4Health 
annual work programme for 
2024, will be assessed by 
looking at the various reports 
and deliverables of the Joint 
Action 

Number of participants in 
training actions (regardless 
of the implementing mode - 
e.g. eLearning, in person 
training) on preparedness 
and response to cross-border 
health threats targeting 
healthcare staff and public 
health staff (Article 11 of 
Regulation 2022/2371, train 
the-trainers) and addressing 
medical countermeasures 

Percentage of participants to 
any training activity 
supported by the EU Health 
Preparedness training 
Programme / the HERA 
Training Programme that 
report positive feedback on 

146 

Static indicator in some years; relative 
proxy indicator; uncertain targets and 
milestones because the number of actions 
depends on the programming process that 
involves Member States 

Uncertain targets and milestones because 
the number of actions depends on 
programming processes that involves 
Member States. 

Static indicator in some years; relative 
proxy indicator; uncertain targets and 
milestones. 

Uncertain baseline; training activities 
starting in 2024 

 
content and organisation of 
the event; satisfactory 
feedback corresponds to a 
score equal or higher to 70 
out of 100; feedback 
collected via surveys or 
questionnaires after each 
training activity 

This indicator measures the 
number of actions included 
under EU4Health work 
programmes (including 
grants and procurements) to 
support the digital 
transformation of healthcare 
systems and the 
implementation of the EHDS 
(cumulative). 

Number of actions 
contributing to the digital 
transformation of healthcare 
systems and the 
implementation of the 
European Health Data Space 
(EHDS) 

Number of Member States 
participating in the European 
Health Data Space – 
(indicator 5) - KEY 
PERFORMANCE 
INDICATOR 

This indicator measures the 
number of Member States 
connected to MyHealth@EU 
and/or to the cross-border 
infrastructure for secondary 
uses (cumulative). 

Progress on setting up health 
data access bodies in the EU 

Number of actions producing 
guidance for improving 
access to healthcare services 

Number of measures taken by 
Member States to improve 
access to healthcare services  

This indicator measures the 
number of Member States 
that have set up or are in the 
process of setting up a health 
data access body 
(cumulative). 

The sum of EU4Health 
actions that produce 
guidelines or 
recommendations for 
Member States on how to 
assess and improve access to 
healthcare services. These 
may include guidelines or 
recommendations on 
affordable access to 
healthcare, access to mental 
healthcare, access to 
healthcare for vulnerable 
groups, as well as 
information about new 
indicators for measuring 
access to healthcare 

The sum of measures taken 
by Member States supported 
by EU4Health Programme to 
improve access to healthcare 
on the basis of guidance 
provided by EU4Health 
projects. This may include 
measures regarding 

147 

n/a 

n/a 

n/a 

The milestone and target are the same 
because it is highly unlikely that similar 
actions could be prioritised in the coming 
years. The three actions included in the 
annual work programmes for 2021, 2022 
and 2023 are expected to address the most 
relevant challenges in this area. 

n/a 

 
affordability of healthcare, 
access to mental health care, 
access to healthcare for 
vulnerable groups, as well as 
new indicators for measuring 
access to healthcare. 

Number of published impact 
assessments and supporting 
reports and staff working 
documents of EU health 
policies supported by the 
Programme. 

Number of impact 
assessments of Union 
policies        

Static indicator in some years; uncertain 
milestones and targets a target for 2027 may 
be set only in 2025 after the new College 
sets out defines its priorities. 

Number of studies supporting 
the evaluations of legislative 
and non-legislative health 
Union policies – KEY 
PERFORMANCE 
INDICATOR 

Number of studies published 
supporting the evaluations, 
monitoring the 
implementation and 
assessing the functioning of 
legislative and non-
legislative policies 

Static indicator in some years; data are 
collected from the Interinstitutional-Studies 
Database, which is revised depending on 
needs and political priorities; uncertain 
targets and milestones because of the 
political priorities of the Commission and 
the regulatory cycle. 

Number of Health 
Technology Assessment 
(HTA) reports jointly carried 
out – (indicator 20) 

Number of joint clinical 
assessments on medicinal 
products and on medical 
devices in the context of the 
new HTA Regulation (EU) 
2021/2282 

Number of healthcare units 
involved in ERNs – (sub-
indicator 19.1) 

Number of healthcare units 
involved in ERNs 

Number patients diagnosed 
and treated by the members of 
ERNs – (sub-indicator 19.2) - 
KEY PERFORMANCE 
INDICATOR 

The sum of the number of 
patients referred to ERNs 
whose cases are reviewed by 
ERNs 

148 

HTA Regulation (EU) 2021/2282 is to 
apply    from January 2025; the ‘number of 
joint clinical assessments’ depends on the 
number of newly filed marketing 
authorisation requests for medical products 
by the industry and  then, on the 
collaboration of Member States in 
conducting Joint Clinical Assessments in 
the context of the corresponding marketing 
authorisation processes; uncertain targets 
and milestones which may need to be 
revised in 2025  depending on the state-of-
play on implementation. 

The milestone is not expected change unless 
another call to enlarge the ERNs takes 
place; the number of hospital units involved 
in ERNs is at this stage mostly stable and is 
not expected to change substantially. To 
operationalise it, the indicator 19 Number 
of healthcare units involved in European 
Reference Networks (ERNs) and of patients 
diagnosed and treated by the members of 
ERNs referred to in Annex 2 to the 
EU4Health Regulation has been broken 
down into its two components (19.1 and 
19.2). 

To operationalise it, the indicator 19 
Number of healthcare units involved in 
European Reference Networks (ERNs) and 
of patients diagnosed and treated by the 
members of ERNs referred to in Annex 2 to 
the EU4Health Regulation has been broken 
down into its two components (19.1 and 
19.2). 

 
Number of actions and 
contribution agreements 
supporting global 
commitments and health 
initiatives concluded with 
global partners 

Number of areas where EU 
and WHO collaborate 

Areas of coordination 
between EU and relevant 
global partners and EU 
Member States 

Number of contribution 
agreements and actions 
supporting global 
commitments and health 
initiatives concluded with 
global partners including the 
organisations pillar assessed. 

Milestone and target will be available at the 
end of 2023 given that this is a new 
initiative, and the actions are in the making; 
uncertain target and milestone because the 
number of actions depends on the 
programming process that involves Member 
States. 

Only the actions supported by the 
EU4Health Programme are relevant to this 
indicator; actions funded by other EU 
funding programmes are excluded. 

Only the actions supported by the 
EU4Health Programme are relevant to this 
indicator. Actions funded by other EU 
funding programmes are excluded. 

Number of areas where EU 
and WHO align policies 
and/or actions (such as crisis 
preparedness and response, 
health promotion, disease 
prevention, health systems, 
healthcare workforce, digital 
and cancer). 

Number of areas of 
coordination between EU 
and relevant global partners 
such as crisis preparedness 
and response, health 
promotion and disease 
prevention, cancer, health 
systems and health 
workforce, digital 
infrastructure and digital 
skills and cancer. 

149 

 
 
 
 
ANNEX  VII.  POINTS  OF  COMPARISON:  BASELINES,  EXPECTED  ACHIEVEMENTS  AND 
TARGETS  PER  EU4HEALTH  WORK  PROGRAMME  STRAND  AND  SPECIFIC  OBJECTIVES  AND 
DATA FROM 2021, 2022, AND 2023 (WHERE AVAILABLE) 

Crisis preparedness and response  

2020 baseline 

The 2020 crisis preparedness baseline was framed legally by Decision No 1082/2013/EU234 on 
serious cross-border threats to health and other relevant legal acts. During the baseline period, 
the  Commission  stepped  up  relevant  EU-level  action  in  three  ways.  Firstly,  it  adopted 
recommendations  (such  as  those  for  a  common  EU  testing  approach  for  COVID-19235)  on 
COVID-19 testing strategies, including the use of rapid antigen tests236. Secondly, it adopted 
legal proposals: for a Regulation on serious cross-border threats to health237; and to extend the 
mandates  of  both  the  European  Medicines  Agency238  and  that  of  the  European  Centre  for 
Disease  Prevention  and  Control239.  Thirdly,  it  adopted  relevant  communications  such  as  the 
Communication  ‘Building  a  European  Health  Union:  preparedness  and  resilience’  that 
accompanied  the  legal  proposals240.  These  actions  have  built  on  the  existing  health  security 
framework established in 2013 to: protect EU citizens; promote coordination between Member 
States and with neighbouring countries; and respond to the increasing threat of communicable 
diseases241. Valuable experience had already been acquired by the EU following:  the pandemic 
influenza outbreak of 2009; the completion of the joint procurement agreement signed by the 
first countries in 2014242; and experience in the fight against three epidemics (HIV/AIDS, viral 
hepatitis B and C, and tuberculosis). The Commission took stock of the fight against these three 
epidemics in 2018 when it became clear that: investment in prevention was key; there was no 
one-size-fits-all  solution;  and  each  situation  required  a  thorough  and  targeted  analysis, 
involving all stakeholders in the implementation of preventive and treatment measures243. By 
the  end  of  the  baseline  period,  it  was  possible  to  identify  the  related  challenges  and  needs 
confronting countries, the EU, and the world more generally. Some of these challenges had 
already been addressed by the end of the baseline period thanks to urgent actions, while for 

234   Decision No 1082/2013/EU of the European Parliament and of the Council of 22 October 2013 on serious 

cross-border threats to health and repealing Decision No 2119/98/EC (OJ L 293, 5.11.2013). 
235   EU health preparedness: Recommendations for a common EU testing approach for COVID-19. 
236 Commission recommendation of 28.10.2020 on COVID-19 testing strategies, including the use of rapid antigen 

tests.  

237   Proposal for a Regulation of the European Parliament and of the Council on serious cross-border threats to 

health and repealing Decision No 1082/2013/EU, COM(2020)727 final.  

238   Proposal  for  a  Regulation  of  the  European  Parliament  and  of  the  Council  on  a  reinforced  role  for  the 
European Medicines Agency in crisis preparedness and management for medicinal products and medical 
devices, COM(2020)725 final. 

239   Regulation (EU) 2022/2370 of the European Parliament and of the Council of 23 November 2022 amending 
Regulation (EC) No 851/2004 establishing a European centre for disease prevention and control (OJ L 314, 
6.12.2022).  

240   Communication from the Commission to the European Parliament, the Council, the European Economic and 
Social Committee and the Committee of the Regions, Building a European Health Union: Reinforcing the 
EU’s resilience for cross-border health threats, COM(2020)724 final.  

241   Decision No 1082/2013/EU of the European Parliament and of the Council of 22 October 2013 on serious 

cross-border threats to health and repealing Decision No 2119/98/EC (OJ L 293, 5.11.2013). 
242   European Health Union: HERA signs Joint Procurement contract for Pandemic Influenza Vaccine. 
243   Commission  Staff  Working  Document  on  Combating  HIV/AIDS,  viral  hepatitis  and  tuberculosis  in  the 
European  Union  and  neighbouring  countries  -  State  of  play,  policy  instruments  and  good  practices, 
SWD(2018)387 final. 

150 

 
 
other challenges, measures were progressively rolled out and the implementation started during 
the baseline period.  

The ambition of the EU4Health Programme’s intervention (as set out in the milestones) and 
end results (targets) were drawn from existing and upcoming EU health policies and legislation.  

Current situation and actions planned  

Under the crisis preparedness strand, the EU4Health Programme supports the implementation 
of: Regulation (EU) 2022/2371 on serious cross-border threats to health244;  the Commission 
Communication  introducing  HERA245;  the  Commission  Decision  establishing  HERA246;  and 
(iv) HERA’s annual work plans247. Help from the EU4Health Programme in these areas include 
support  for:  coordinated  public  health  measures  at  EU  level  related  to  serious  cross-border 
threats to health; the surveillance of those health threats; training activities; data gathering and 
analysis; and information exchange. Furthermore, the Programme supports: the creation of an 
EU plan for preventing, preparing for and responding to serious cross-border threats to health; 
upcoming regular updates and stress tests of the Programme itself; and simulation exercises 
and reviews with the Member States248. Under this crisis-preparedness strand, the Programme 
also  supports  actions to  ensure the development, manufacturing, procurement and equitable 
distribution  of  key  medical  countermeasures;  procure  and  supply  essential  crisis-relevant 
products; and support the national stockpiling of such products.  

The  EU4Health  Programme  supports  actions  that  take  a  One  Health  approach,  where 
applicable, and these actions include the development of new medical countermeasures against 
AMR.  Some  of  the  upcoming  actions  are  expected  to  deliver  on  the  June  2023  Council 
Recommendation  on  stepping  up  EU  action  to  combat  AMR  in  the  areas  of  human  health, 
animal health and the environment249.  

2020 baseline  

AMR remained a major public health concern in the European region and worldwide250. The 
EU has prioritised efforts against AMR for over two decades now. More recent EU action on 
AMR has been driven by the European One Health action plan against AMR (the ‘2017 AMR 
action plan’)251. This plan outlines over 70 actions covering human health, animal health and 
the environment. In addition, the EU guidelines for the prudent use of antimicrobials in human 
health adopted by the Commission in June 2017 helped Member States to draw up their own 

244   Regulation (EU) 2022/2371 of the European Parliament and of the Council of 23 November 2022 on serious 

cross-border threats to health and repealing Decision No 1082/2013/EU (OJ L 314, 6.12.2022). 

245   Communication from the Commission to the European Parliament, the Council, the European Economic and 
Social Committee and the Committee of the Regions, Introducing HERA, the European Health Emergency 
preparedness  and  Response  Authority,  the  next  step  towards  completing  the  European  Health  Union, 
COM(2021)576 final.  

246   Commission Decision of 16 September 2021 establishing the Health Emergency Preparedness and Response 

Authority (OJ C 393I, 29.9.2021).  

247   HERA Work Plan 2022, HERA Work Plan 2023, HERA Work Plan 2024.  
248   As stipulated by Article 5(5) of Regulation (EU) 2022/2371 of the European Parliament and of the Council 
of 23 November 2022 on serious cross-border threats to health and repealing Decision No 1082/2013/EU 
(OJ L 314, 6.12.2022). 

249   Council Recommendation on stepping up EU actions to combat antimicrobial resistance in a One Health 

approach, 2023/C 220/01. 

250   See Section 2.1 ‘Problems and needs.’ 
251   A European One Health Action Plan against Antimicrobial Resistance (AMR), 2017. 

151 

 
 
national guidelines and recommendations. In February 2020, the fourth progress report252 on 
the implementation of the 2017 AMR action plan highlighted substantial progress made since 
mid-2019.  This  progress  included  meetings  of  both  the  AMR  One  Health  Network  and  the 
Health Security Committee to improve cooperation and coordination on AMR, as well as ‘One 
Health’ visits to Member States to support the implementation of national One Health action 
plans.  Other  milestones  include  the  publication  of  two  overview  reports.  The  first  of  these 
overview reports was published in 2017 on measures to tackle AMR through the prudent use 
of antimicrobials in animals. The second was published in 2018 on a series of audits carried 
out  in  order  to  evaluate  the  monitoring  and  reporting  of  AMR  in  zoonotic  and  commensal 
bacteria in certain food-producing animal populations and food. The publication in December 
2020 of the fifth progress report253 on the implementation of the 2017 AMR action plan detailed 
the further action that had been taken on AMR. For example, in May 2020 the Commission 
adopted the EU ‘farm to fork’ strategy254, which contained a target aiming to reduce by 50% 
overall EU sales of antimicrobials for farmed animals and in aquaculture by 2030. In addition, 
by  December  2020  work  was  ongoing  on  implemented  and  delegated  acts  for  the 
implementation of the recently adopted Regulations on Veterinary Medicinal Products255 and 
Medicated Feed256. Commission Implementing Decision (EU) 2020/1729257 on the monitoring 
and reporting of AMR in zoonotic and commensal bacteria was in place in December 2020 and 
the pharmaceutical strategy for Europe258 – adopted in November 2020 – also flagged the fight 
against  AMR  as  a  key  objective.  The  EU4Health  programme  also  played  a  crucial  role  in 
addressing AMR by funding the EU-JAMRAI joint action with EUR 6.9 million (originally set 
out in the 2017 annual work programme) to help EU Member States develop and implement 
effective One Health national action plans against AMR and healthcare-associated infections 
(HCAIs). 

In 2020, the baseline was set (value 0) for eight Programme indicators characterising the crisis 
preparedness strand and monitoring the implementation of the specific objectives (b), (d) and 
(e). In 2022, the baseline was set (value 0) for two other Programme indicators. And in 2023, 
the  baseline  was  set  (value  0)  for  four  other  Programme  indicators  to  monitor  the  progress 
made  in  implementing  the  Regulation  on  serious  cross-border  threats  to  health  and  AMR 
actions. For more on the setting of these baselines, see Section 2.1, Figure 2. 

Current situation and actions  

252   AMR: Commission publishes its [4th] progress report on Action Plan. 
253   AMR: Commission publishes its [5th] progress report on the EU’s Action Plan. 
254   Communication from the Commission to the European Parliament, the Council, the European Economic and 
Social  Committee  and  the  Committee  of  the  Regions,  A  Farm  to  Fork  Strategy  for  a  fair,  healthy  and 
environmentally-friendly food system, COM(2020)381 final. 

255   Regulation (EU) 2019/6 of the European Parliament and of the Council of 11 December 2018 on veterinary 

medicinal products and repealing Directive 2001/82/EC (OJ L 4, 7.1.2019).  

256   Regulation  (EU)  2019/4  of  the  European  Parliament  and  of  the  Council  of  11 December 2018  on  the 
manufacture, placing on the market and use of medicated feed, amending Regulation (EC) No 183/2005 of 
the European Parliament and of the Council and repealing Council Directive 90/167/EEC (OJ L 4, 7.1.2019). 
257   Commission Implementing Decision (EU) 2020/1729 of 17 November 2020 on the monitoring and reporting 
of  antimicrobial  resistance  in  zoonotic  and  commensal  bacteria  and  repealing  Implementing  Decision 
2013/652/EU (OJ L 387, 19.11.2020). 

258   Communication from the Commission to the European Parliament, the Council, the European Economic and 
Social Committee and the Committee of the Regions Pharmaceutical Strategy for Europe, COM(2020)761 
final. 

152 

 
 
 
The  EU4Health  Programme  supports  actions  that  take  a  One  Health  approach,  where 
applicable, and these actions include the development of new medical countermeasures against 
AMR. Some of the forthcoming actions under the Programme are expected to deliver on the 
June  2023  Council  Recommendation  on  stepping  up  EU  action  to  combat  antimicrobial 
resistance in the areas of human health, animal health and the environment259.  

Expected Programme milestones and targets 

The expected 2024 achievements and 2027 targets for the Programme indicators for the crisis 
preparedness strand and its three specific objectives (b, d and e) are illustrated in the below 
figure. 

259   Council Recommendation on stepping up EU actions to combat antimicrobial resistance in a One Health 

approach, (OJ C 220, 22.6.2023).249 

153 

 
 
 
 
Figure: Baselines, milestones and targets for the crisis preparedness strand and its three 
specific objectives (b, d and e) - Legend: 
 baseline; 

 target;   actual. 

 milestone; 

Indicator 

Graph based on recorded values 

Preparedness  and  response  planning  of  the  Union  and  of 
Member States for serious cross-border threats to health – 
(sub-indicator 1.1) – KEY PERFORMANCE INDICATOR 
– monitoring specific objective (b). 

Number of Member States participating in the prevention, 
preparedness  and  response  planning  joint  action  –  (sub-
indicator 1.2) – monitoring specific objective (b).  

*Percentage indicates the progress towards 2027 target. 

Number of Member States with improved integrated 
surveillance systems – (sub-indicator 1.3) – monitoring 
specific objective (b). 

*No data available. 

Number of new capacity building activities (EU, Member 
States) for improved integrated surveillance systems (sub-
indicator 1.4) – monitoring specific objective (b). 

*No data available. 

*Percentage indicates the progress towards 2029 target. 

154 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             
 
 
Number of Member States with improved preparedness and 
response planning (sub-indicator 6.1) – monitoring specific 
objective (b). 

Number of Member States with improved preparedness and 
response planning with regard to medical countermeasures 
(sub-indicator 6.2) – monitoring specific objective (b). 

*No data available. 

fight  against 
Number  of  actions  addressing 
communicable diseases (indicator 22) – monitoring specific 
objective (b). 

the 

*Percentage indicates the progress towards 2026 target. 

*Percentage indicates the progress towards 2027 target. 

Number  of  Member  States  and  associated  countries  with 
increased  laboratory  and  diagnostic  capacity  for  cross-
border health threats, contributing to the mission of HERA 
– monitoring specific objective (b). 

*No data available yet. 

155 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
 
Number  of  countries  where  One  Health  surveillance 
programmes were successfully implemented – monitoring 
specific objective (d). 

*Percentage indicates the progress towards 2031 target. 

Number  of  Member  States  and  associated  countries  with 
improved 
for  medical 
countermeasures during health crisis– monitoring specific 
objective (d). 

procurement 

procedures 

Number of actions complementing national stockpiling of 
essential  crisis-relevant  products  –  monitoring  specific 
objective (d). 

*Percentage indicates the progress towards 2027 target. 

Number  of  Member  States  participating  in  stockpiling 
activities – monitoring specific objective (d). 

*Percentage indicates the progress towards 2027 target. 

*Percentage indicates the progress towards 2027 target. 

156 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
Number  of  healthcare  and  public  health  staff  trained 
the  CHBT  regulation  and  Decision 
(Article  11  of 
establishing 
PERFORMANCE 
INDICATOR - monitoring specific objective (e). 

HERA)- 

KEY 

Stakeholders’ 
in  HERA 
programmes - monitoring specific objective (e). 

satisfaction 

rate 

*Percentage indicates the progress towards 2027 target. 

training 

*Percentage indicates the progress towards 2027 target. 

2020 baseline 

The baseline for the health promotion and disease prevention strand and related action was 
framed by several  successive 2011 and 2010 Council conclusions on action against cancer; 
Council  Conclusions  on  the  European  pact  for  mental  health  and  well-being260;  Council 
Conclusions  on  innovative  approaches  for  chronic  diseases  in  public  health  and  healthcare 
systems261; and earlier Council recommendations such as a 2003 Recommendation on cancer 
screening262. The Commission and EU Member States’ health authorities have collaborated on 
non-communicable diseases for many years. This collaboration has covered: cancer screening 
(e.g. European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis263); 
mental health (e.g. joint action ImpleMENTAL264); depression care and suicide prevention (e.g. 
the  EAAD-Best  project265);  cardiovascular  diseases  (e.g.  the  YOUNG50  Stay  Healthy 

260   Council conclusions on the European Pact for Mental Health and Well-being: results and future action, (OJ 

C 202, 8.7.2011). 

261   Council conclusions ‘Innovative approaches for chronic diseases in public health and healthcare systems’ 

(OJ C 74, 8.3.2011). 

262   Council Recommendation of 2 December 2003 on cancer screening (2003/878/EC).  
263   European Commission: Directorate-General for Health and Consumers, Karsa, L., Holland, R., Broeders, 
M., Wolf, C. et al., European guidelines for quality assurance in breast  cancer screening and diagnosis – 
Fourth edition, supplements, Karsa, L.(editor), Holland, R.(editor), Broeders, M.(editor), Wolf, C.(editor), 
Perry, 
2013, 
https://data.europa.eu/doi/10.2772/13196.  

Publications 

S.(editor), 

Törnberg, 

N.(editor) 

Office, 

and 

264   JA on Implementation of Best Practices in the Area of Mental Health. 
265   EAAD-Best. 

157 

                                                                                                                                                                                                                                                                                                                                        
 
 
project266);  and  improving  physical  activity  (e.g.  the  EUPAP  project267)268.  In  2018,  the 
Commission launched an online portal on best practices, which detailed best practices collected 
by  previous  health  programmes.  The  portal  also  enabled  stakeholders  to  submit  their  own 
practices for evaluation. As of 2020, more than 10 best practices selected by the Member States 
in  the  Steering  Group  on  Health  Promotion,  Disease  Prevention  and  Management  of  Non-
Communicable Diseases269 had been taken up in 75% of Member States. The areas covered by 
these  best  practices  include  integrated  care;  mental  health  and  the  fight  against  depression; 
nutrition  and  physical  activity;  the  prevention  of  alcohol  abuse;  and  the  prevention  and 
management of chronic diseases. 

In 2018, the baseline for 1 Programme indicator (value 0) was set. In 2020, seven Programme 
indicators  (value  0)  characterising  the  health  promotion  and  disease  prevention  strand  and 
monitoring the implementation of specific objective (a) was set. And in 2021, the baseline for 
another Programme indicator was set (value 1). For more on the setting of these baselines, see 
Section 2.1, Figure 3.  

Current situation and actions  

Under  the  health  promotion  and  disease  prevention  strand,  the  EU4Health  Programme 
supports actions that: focus on reducing the burden of NCDs and relevant health determinants; 
and address health inequalities, as outlined by ‘Healthier together’ – the EU NCD initiative270. 
The EU4Health Programme also supports: the promotion of good mental health; the prevention 
of mental health problems; and the treatment and care of mental health problems, throughout 
the lifetime of an individual,  and through a comprehensive prevention-oriented approach to 
mental  health271.  This  strand  will  also  help  the  Member  States  to  reach  the  UN  SDGs  and 
targets272 in this area, as well as the relevant WHO global NCD targets for 2025273. 

The EU4Health Programme may also fund actions to improve the surveillance, diagnosis, and 
treatment  of  communicable  and  non-communicable  diseases.  The  Programme  gives  special 
attention to both the development of innovative care models and addressing the challenges of 
long-term care to strengthen the resilience of health systems in the EU.  

Expected Programme milestones and targets. 

Indicator 

Graph based on recorded values 

266   YOUNG50 #Stay Healthy – Cardiovascular Risk Prevention. 
267   EUPAP – A European Physical Activity on Prescription model. 
268   Healthier Together EU Non-Communicable Diseases Initiative. 
269   In December 2022, the Steering Group on Health Promotion, Disease Prevention and Management of Non-

Communicable Diseases was replaced by Expert group on public health. 

270   The Healthier Together EU Non-Communicable Diseases Initiative. 
271   Communication from the Commission to the European Parliament, the Council, the European Economic and 
Social  Committee  and  the  Committee  of  the  Regions  on  a  comprehensive  approach  to  mental  health, 
COM(2023)298 final. 

272   UN resolution of 25 September 2015. In particular, Sustainable Development Goal 3 ‘Ensuring healthy lives 
and promote well-being for all at all ages’ and its Target 3.4, namely, to reduce premature mortality from 
non-communicable diseases by one  third by 2030 through prevention and treatment and promote mental 
health and well-being. 

273   Set of nine voluntary global NCD targets for 2025, World Health Organization 2022. 

158 

 
 
Number of actions contributing to the reduction of avoidable 
mortality in the area of non-communicable diseases and risk 
factors – monitoring specific objective (a). 

Number  of  Member  States  implementing  best  practices 
regarding  health  promotion,  disease  prevention  and 
addressing  health  inequalities  –  KEY  PERFORMANCE 
INDICATOR – monitoring specific objective (a). 

*Percentage indicates the progress towards 2027 target. 

Vaccination coverage for measles (indicator 7.1) – monitoring 
specific objective (a). 

*Percentage indicates the progress towards 2031 target. 

Vaccination coverage for seasonal influenza – (indicator 7.2) 
– monitoring specific objective (a). 

*Percentage indicates the progress towards 2031 target. 

*Percentage indicates the progress towards 2031 target. 

159 

                                                                                                                                                                                                           
 
 
 
 
Vaccination  coverage  for  human  papillomaviruses  (HPV)– 
(indicator 7.3) – monitoring specific objective (a). 

Number of actions addressing the prevalence of major chronic 
diseases  per  Member  State,  by  disease,  gender,  and  age  – 
(indicator 12) – monitoring specific objective (a). 

*Percentage indicates the progress towards 2031 target. 

Number of actions addressing the age prevalence of tobacco 
use,  if  possible,  differentiated  by  gender  –  (indicator  13)  – 
monitoring specific objective (a). 

*Percentage indicates the progress towards 2027 target. 

Number of actions addressing the prevalence of harmful use 
of  alcohol,  if  possible,  differentiated  by  gender  and  age  – 
(indicator 14) – monitoring specific objective (a). 

*Percentage indicates the progress towards 2027 target. 

*Percentage indicates the progress towards 2027 target. 

160 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
 
 
Number of actions addressing environmental risk factors for 
health – (indicator 23) – monitoring specific objective (a). 

*Percentage indicates the progress towards 2027 target. 

Health systems and healthcare workforce 

2020 baseline 

The health systems and healthcare workforce strand covers multiple areas, so baselines apply 
to each of these areas separately. On the healthcare workforce, the baseline was set in the 2012 
Commission  action  plan  for  the  EU  health  workforce.  This  action  plan  identified  various 
actions where the EU could add value to address challenges faced by the health workforce. 
These actions include: (i) health workforce planning; (ii) the anticipation of skills requirements; 
(iii) recruitment and retention; and (iv) ethical international recruitment274. The baseline was 
further  influenced  by  the  COVID-19  pandemic,  which  put  the  spotlight  on  shortages  of 
healthcare  workers  and  the  problem  of  well-being  in  the  health  workforce.  Evidence-based 
policymaking in the area of health systems and the healthcare workforce was supported by the 
recurrent ‘State of Health in the EU’ project cycle. This project cycle has been carried out by 
a  partnership  between  the  Commission,  the  European  Observatory  on  Health  Systems  and 
Policies, and the Organisation for Economic Cooperation and Development. Every two years 
since 2016, the project provides a regular update of indicators and statistics on the performance 
of EU health systems, with related publications released every year275. The most recent ‘State 
of Health in the EU’ report276 identifies healthcare as a sector facing critical labour shortages. 

Health technology assessment (HTA) is an important part of evidence-based decision-making 
on health in most EU countries, and the Commission has supported cooperation projects in this 
field  for  decades.  In  particular,  the  EUnetHTA  project  was  set  up  in  2006  and  led  to  the 
establishment  of  both  and  EU  HTA  network  and  the  scientific-technical  EUnetHTA  joint 
actions277. The EUnetHTA joint actions ran from 2010 until 2021. In 2021, a call for tender was 
launched to continue EU cooperation on HTA beyond the end of the EUnetHTA joint action 
3. As a result, the EUnetHTA 21 consortium was created. It ran from 2021 to 2023, supporting 
the preparatory phase for the implementation of the HTA Regulation, which finally came into 
application in January 2024. 

274   Commission staff working document on an Action Plan for the EU Health Workforce, SWD(2012)93 final.  
275   State of Health in the EU.  
276   OECD/European Commission (2024), Health at a Glance: Europe 2024: State of Health in the EU Cycle, 

OECD Publishing, Paris, https://doi.org/10.1787/b3704e14-en. 

277   EUnetHTA joint actions Behind the HTA regulation - European Commission 

161 

                                                                                                                                        
 
 
The  24  European  reference  networks  (ERNs)  were  already  set  up  in  March  2017  under 
Directive 2011/24/EU on patients’ rights in cross-border healthcare278. These ERNs brought 
together European hospital centres of expertise and reference to tackle rare, low-prevalence 
and  complex  diseases  and  conditions  requiring  highly  specialised  healthcare.  In  2017,  the 
ERNs included 956 highly specialised healthcare units from 313 hospitals in 26 countries (25 
EU Member States plus Norway). Following a call for new members on 30 September 2019, 
620 new applicants joined. In addition, Directive 2011/24/EU meant that patients could travel 
to another EU country to receive medical care and reimbursement.  

In 2020, the baseline for a Programme indicator on the patients diagnosed and treated by ERN 
members (value 1 million) was set. In 2021, the baseline was set for a Programme indicator 
(value 1139) for the number of ERN healthcare units. And in 2025, the baseline was set for 
three  Programme  indicators  monitoring  the  implementation  of  the  HTA  and  ERN  actions 
implementing specific objective (i) for the HTA. 

The EU’s actions and regulatory framework on  increasing the availability, accessibility  and 
affordability  of  medicinal  products,  medical  devices  and  crisis-relevant  products  were 
advanced when the pharmaceutical strategy for Europe279 was adopted in November 2020. That 
strategy, a key action of the European Health Union,  is  the largest  reform  in  over 20 years 
aiming to modernise the pharmaceutical sector with a patient-centred approach that supports 
an  innovative  and  competitive  pharmaceutical  industry.  Prior  to  the  introduction  of  this 
strategy, the EU had already a comprehensive pharmaceuticals system in place (e.g. Directive 
2001/83/EC280, Regulation (EC) 726/2004281, the Orphan Medicinal Products Regulation282 and 
the  Paediatric283  Regulation).  This  comprehensive  pharmaceutical  system  covered  the 
development and authorisation of medicines as well as their post-authorisation monitoring. The 
Commission,  the  European  Medicines  Agency  (EMA),  and  the  medicines  regulatory 
authorities in the Member States and the European Economic Area now work together in the 
European Medicines Regulatory Network to ensure that patients have access to high-quality, 
effective  and  safe  medicines.  Together  with  other  public  and  private  actors,  the  strong  and 
competitive pharmaceutical industry in the EU has served public health well and acts as a driver 
of  job  creation,  trade  and  science284.  However,  concerns  remained  that  investment  was  not 
necessarily focusing on the greatest unmet needs. Many unmet and pressing medical needs do 

278   Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of 

patients’ rights in cross-border healthcare (OJ L 88, 4.4.2011). 

279   Communication from the Commission to the European Parliament, the Council, the European Economic and 
Social Committee and the Committee of the Regions, Pharmaceutical Strategy for Europe, COM(2020)761 
final.  

280   Directive  2001/83/EC  of  the  European  Parliament  and  of  the  Council  of  6 November 2001  on  the 

Community code relating to medicinal products for human use (OJ L 311 28.11.2001). 

281 Regulation (EC) No 726/2004 of the European Parliament and of the Council of 31 March 2004 laying down 
Union procedures for the authorisation and supervision of medicinal products for human and veterinary use 
and establishing a European Medicines Agency (OJ L 136 30.4.2004). 

282   Regulation  (EC)  No  141/2000  of  the  European  Parliament  and  of  the  Council  of  16 December 1999  on 

orphan medicinal products (OJ L 018 22.1.2000). 

283   Regulation (EC) No  1901/2006 of the European Parliament and of the Council of 12 December 2006 on 
medicinal products for paediatric use and amending Regulation (EEC) No 1768/92, Directive 2001/20/EC, 
Directive 2001/83/EC and Regulation (EC) No 726/2004 (OJ L 378, 27.12.2006). 

284   Communication from the Commission to the European Parliament, the Council, the European Economic and 
Social Committee and the Committee of the Regions, Pharmaceutical Strategy for Europe, COM(2020)761 
final.  

162 

 
 
not attract commercial interest or are affected by limitations in the science, and only about 5% 
of those needs are addressed.  

Since  2017,  medical  devices  and  in  vitro  diagnostic  medical  devices  (IVDs)  have  been 
regulated in the EU/EEA by Regulation (EU) 2017/745285 (the Medical Device Regulation or 
MDR) and Regulation (EU) 2017/746286 (the In Vitro Diagnostic Medical Devices Regulation 
or IVDR) respectively. These Regulations aim to create a robust, transparent and sustainable 
regulatory framework that maintains a high level of safety, while supporting innovation. To 
achieve these objectives, the Regulations impose more stringent rules across the lifecycle of 
developing, certifying and monitoring medical devices and IVDs. All new devices as well as 
devices already placed on the market must comply with these more stringent rules. 

It was already possible for Member States to apply the MDR and IVDR on a voluntary basis 
before their dates of application became applicable in  2021 and 2022 respectively.  For this 
reason, some parts of infrastructure set out by the Regulations for building in the future were 
already partly delivered by the beginning of 2021. By February 2021, 18 notified bodies were 
designated under the MDR,  and 4 notified bodies  were designated under the IVDR. By the 
beginning  of  2021,  the  Commission  had  also  made  progress  on  developing  the  European 
database on medical devices by making available the first versions of three out of the planned 
six  inter-connected  modules.  Similarly,  a  first  version  of  the  European  Medical  Device 
Nomenclature was released in May 2021 and made available free of charge to manufacturers 
and other stakeholders required by the Regulations to use that nomenclature. 

At the end of the baseline period: the number of single marketing authorisations of specific 
medicines valid across the EU was 86; the total number of medical devices certificates issued 
by notified bodies under Regulation (EU) 2017/745 on medical devices intended to be placed 
on the EU market was 502; the number of in vitro diagnostic medical devices issued by notified 
bodies  under  Regulation  (EU)  2017/746  for  medium-  and  high-risk  devices  intended  to  be 
placed  on  the  EU  market  was  31;  and  the  level  of  monitoring  and  reporting  on  relevant 
shortages  of  human  and  veterinary  medicines  to  reach  maturity  showed  that  this  level  of 
shortages remained under control. At the end of the baseline period, actions were also being 
drawn  up  to  increase  the  security  and  continuity  of  global  supply  chains  and  address 
dependence  on  imports  from  third  countries  for  the  production  of  essential  active 
pharmaceutical ingredients and medicinal products. Similarly, the actions to support innovation 
in, uptake of, and access to the market  for medical countermeasures at EU and global level 
were at an early stage. In total, 11 audits had been conducted in the EU and in third countries, 
including  candidate  countries,  to  ensure  good  manufacturing  practices  and  good  clinical 
practices (EU control). Improvements were expected on increasing access to healthcare with 
the aim of achieving universal health coverage.  

The  baseline  for  two  Programme  indicators  monitoring  the  implementation  of  the  actions 
improving  the  availability,  accessibility  and  affordability  of  medicinal  products,  medical 
devices and crisis-relevant products was set in 2019 (value above 0). The baselines for five 
such Programme indicators (values of 0 or above 0) were set in 2020. And the baselines for 

285   Regulation  (EU)  2017/745  of  the  European  Parliament  and  of  the  Council  of  5 April 2017  on  medical 
devices, amending Directive 2001/83/EC, Regulation (EC) No 178/2002 and Regulation (EC) No 1223/2009 
and repealing Council Directives 90/385/EEC and 93/42/EEC (OJ L 117, 5.5.2017). 

286   Regulation  (EU)  2017/746  of  the  European  Parliament  and  of  the  Council  of  5 April 2017  on  in  vitro 
diagnostic medical devices and repealing Directive 98/79/EC and Commission Decision 2010/227/EU (OJ 
L 117, 5.5.2017).  

163 

 
 
three  such  indicators  were  set  in  2021  (values  above  0).  For  more  on  the  setting  of  these 
baselines, see Section 2.1, Figure 4. 

Achieving  universal  access  to  healthcare  is  one  of  the  targets  of  the  UN’s  Sustainable 
Development Goal 3 – Ensure healthy lives and promote well-being for all at all ages. The 
European  Pillar  of  Social  Rights  action  plan287,  published  in  2021,  contained  measures  to 
improve  access  to  healthcare.  The  European  strategy  for  the  rights  of  persons  with 
disabilities288, also published in 2021, entails commitments to provide guidelines to Member 
States on how to  improve access  to  healthcare for persons with  disabilities.  The  EU’s third 
health  programme,  which  ran  from  2014-2020  and  was  a  precursor  to  the  EU4Health 
Programme,  supported  an  action  on  access  to  healthcare,  which  showed  the  need  for  more 
robust indicators to measure and explain the hurdles experienced by more vulnerable groups, 
who experience specific challenges in accessing healthcare289.  

The baseline for two Programme indicators monitoring the implementation of the actions on 
universal access to healthcare and specific objective (g) were set in 2020 (value 0). For more 
on the setting of these baselines, see Section 2.1, Figure 4. 

Current situation and actions  

Under  the  health  systems  and  healthcare  workforce  strand,  the  EU4Health  Programme 
finances  actions  to  help  strengthen  national  health  systems  and  the  health  workforce  by 
improving  their  resilience  and  resource  efficiency.  To  that  end,  the  Programme  funds: 
networking  through  ERNs  and  other  transnational  networks;  the  work  on  HTA;  and  other 
measures  implementing  the  Directive  on  patients’  rights  in  cross-border  healthcare290.  The 
Programme helps to strengthen the healthcare workforce and advance the digital transformation 
of  health  systems.  This  strand  also  supports  actions  to  improve  access  to  quality,  patient-
centred,  outcome-based  healthcare,  and  related  care  services,  with  the  aim  of  achieving 
universal health coverage. It also supports access to health and care services for people with 
disabilities  and  other  vulnerable  or  disadvantaged  population  groups.  In  addition,  the 
EU4Health  Programme  supports  actions  to  increase  the  availability,  accessibility,  and 
affordability  of  medicinal  products,  medical  devices,  crisis-relevant  products  and  medical 
countermeasures  (these  devices,  products  and  countermeasures  include  diagnostic  tools, 
therapeutics,  and  vaccines)  including  through  the  development  and  uptake  of  innovative 
products. The actions: encourage sustainable production and supply chains and innovation in 
the EU, in synergy with Horizon Europe; contribute to the implementation of the Commission 
Communication  on  tackling  medicine  shortages  in  the  EU291;  and  are  also  aligned  with  the 

287   Communication from the Commission to the European Parliament, the Council, the European Economic and 
Social Committee and the Committee of the Regions, The European Pillar of Social Rights Action Plan, 
COM(2021)102 final. 

288   Communication from the Commission to the European Parliament, the Council, the European Economic and 
Social Committee and the Committee of the Regions, Union of Equality: Strategy for the Rights of Persons 
with Disabilities 2021-2030, COM(2021) 101 final.  

289   Study ‘Report on the comparative assessment of the accessibility of healthcare services: comparability of 

indicators on unmet needs for medical examination or treatment across EU Member States’. 

290   Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of 

patients’ rights in cross-border healthcare (OJ L 88, 4.4.2011). 

291   Communication from the Commission to the European Parliament, the Council, the European Economic and 
Social  Committee  and  the  Committee  of  the  Regions,  Addressing  medicine  shortages  in  the  EU, 
COM(2023)672 final.  

164 

 
 
measures proposed in HERA’s annual work plans292. The EU4Health Programme also supports: 
actions  contributing  to  the  prudent  and  efficient  use  of  medicinal  products,  in  particular 
antimicrobials;  actions  contributing  to  the  development  of  medicinal  products  that  are  less 
harmful  for  the  environment;  and  the  environmentally  friendly  production  and  disposal  of 
medicinal products and medical devices. The implementation of EU regulatory frameworks, 
such as those for pharmaceuticals, medical devices and substances of human origin (SoHO), is 
also supported by specific actions and activities. Other actions financed under this strand are 
expected  to  increase  the  capacity  building  of  Member  States  and  strengthen  collaboration 
between the Member States and the EMA.  

Expected Programme milestones and targets 

Indicator 

Graph based on recorded values 

Access  to  centrally  authorised  medicinal  products,  for 
the  number  of  existing  and  new  orphan 
example 
authorisations,  advanced 
therapy  medicinal  products 
(ATMPs), medicinal products for paediatric use or vaccines, 
for  unmet  needs-  (indicator  2)  –  monitoring  specific 
objective (c). 

Number of  certificates  issued  by  notified  bodies  under  the 
Medical  Device  Regulation  (MDR)  –  monitoring  specific 
objective (c). 

*Percentage indicates the progress towards 2031 target. 

Number of certificates issued by notified bodies under the In 
Vitro  Diagnostic  Medical  Devices  Regulation  (IVDR)  – 
monitoring specific objective (c). 

*Percentage indicates the progress towards 2027 target. 

*Percentage indicates the progress towards 2027 target. 

292   HERA Work Plan 2022, HERA Work Plan 2023, HERA Work Plan 2024. 

165 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            
 
EU Laboratory capacity index (EULabCap)– (indicator 8) – 
monitoring specific objective (c). 

Number of reported shortages of medicinal products in the 
Member States through the single point of contact network – 
(indicator 15) – monitoring specific objective (c). 

*Percentage indicates the progress towards 2027 target. 

*Percentage indicates the progress towards 2027 target. 

Number  of  actions  aimed  at  increasing  the  security  and 
continuity  of  the  global  supply  chains  and  addressing 
dependence  on  imports  from  third  countries  for  the 
production  of  essential  active  pharmaceutical  ingredients 
and medicinal products in the Union -(indicator 16) – KEY 
PERFORMANCE  INDICATOR  –  monitoring  specific 
objective (c). 

*Percentage indicates the progress towards 2027 target. 

Number of production facilities with enhanced capacities in 
increasing  security  and  continuity  of  supply  for  medical 
countermeasures, raw materials, and components at EU level 
–  KEY  PERFORMANCE  INDICATOR  –  monitoring 
specific objective (c). 

*Percentage indicates the progress towards 2027 target. 

166 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
Antimicrobial  consumption  for  systemic  use  ATC  (group 
J01) – (indicator 18) – monitoring specific objective (c). 

*Percentage indicates the progress towards 2030 target. 

Number of audits conducted in the EU and in third countries 
to  ensure  good  manufacturing  practices  and  good  clinical 
(indicator  17)  –  KEY 
practices 
PERFORMANCE  INDICATOR  –  monitoring  specific 
objective (c). 

(Union  control) 

*Percentage indicates the progress towards 2027 target. 

Number of Member States participating in actions aimed at 
supporting  innovation,  uptake,  and  access  to  market  of 
medical countermeasures supported at EU and global level 
for better preparedness and response  – monitoring specific 
objective (c). 

*Percentage indicates the progress towards 2027 target. 

167 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
Number of actions producing guidance for improving access 
to healthcare services – monitoring specific objective (g). 

Number  of  measures  taken  by  Member  States  to  improve 
access to healthcare services – monitoring specific objective 
(g). 

*Percentage indicates the progress towards 2027 target. 

Number  of  Health  Technology  Assessment  (HTA)  reports 
jointly  carried  out  -(indicator  20)  –  monitoring  specific 
objective (i). 

*NO data available yet. 

Number  of  healthcare  units  involved  in  ERNs  (indicator 
19.1) – monitoring specific objective (i). 

*NO data available yet. 

*Percentage indicates the progress towards 2027 target. 

168 

                                                                                                                                                                                                                                                                                                                                                                                                                     
Number of patients diagnosed and treated by the members of 
the European Reference Networks (ERNs) (Indicator 19.2) 
–  KEY  PERFORMANCE  INDICATOR  –  monitoring 
specific objective (i). 

*Percentage indicates the progress towards 2027 target. 

Digital 

2020 baseline 

The  digital  strand  baseline  consisted  of  the  eHealth  Network,  set  up  under  Article  14  of 
Directive  2011/24/EU  on  the  application  of  patients’  rights  in  cross-border  healthcare.  The 
eHealth Network was the main forum for cooperation since its inception in the early 2010s. 
Over  the  years,  the  work  of  the  eHealth  Network  has  focused  mostly  on  digital  health  and 
health  interoperability  matters.  An  existing  eHealth  Digital  Service  Infrastructure  (eHDSI) 
computer  system  was  already  ensuring  continuity  of  care  for  European  citizens  when  they 
travelled abroad within the EU. The eHDSI gave EU countries the possibility of exchanging 
health data in a secure, efficient, and interoperable way. Citizens could easily recognise the 
availability  of  the  services  under  the  brand  ‘MyHealth@EU’.  Two  electronic  cross-border 
health services  were available in  some EU/EEA countries and were in  the process  of  being 
introduced in all EU countries: ePrescription and eDispensation. Much of the groundwork for 
these  two  services  was  funded  through  joint  actions  under  the  EU4Health  Programme’s 
predecessor, the EU’s third Health programme (JASeHN293 and eHAction294), which ran from 
2014  to  2020.  By  2020,  seven  Member  States  were  connected  to  these  two  services,  and 
supported  by  funding  from  the  Connecting  Europe  Facility  (Telecom)  programme295. 
Moreover, the 2019 mission letter of the Health Commissioner Stella Kyriakides underlined 
the need to make the most of the potential of e-eHealth to provide high-quality healthcare and 
reduce inequalities by creating the European Health Data Space.  

Fragmentation in the infrastructure for the reuse  of health data persisted in the EU in 2020, 
with only 13 Member States having centralised their health data authorities dedicated to the 
secondary use of health data296. This fragmentation continued to hamper the seamless sharing 
and analysis of health data, which is needed for research and improving health outcomes. For 
example, in 2021, only 64% of EU Member States had put in place national regulations on the 

293   Commission Staff Working Document Accompanying the document Report from the Commission to the 
European Parliament and the Council Implementation of the third programme of Union action in the field of 
health, SWD/2020/256 final. 

294   Joint Action Supporting the eHealth Network. 
295   CEF Telecom. 
296   European Parliament resolution of 17 September 2020 on the shortage of medicines  – how to address an 

emerging problem, (2020/2071(INI)).  

169 

                                                                                                                                                                                                                                 
 
 
cross-border sharing of EHR data. Furthermore, only 68% of EU Member States had allocated 
specific  budgets  for  their  digital  health  strategies,  and  only  43%  had  incorporated  cloud 
services into their health systems’ infrastructure297. 

In  2020,  when  the  EU4Health  Programme  was  developed,  there  were  already  preparatory 
actions underway for the upcoming regulation to set up the EHDS298. The supporting studies299 
for this upcoming regulation showed that people faced difficulties in controlling the sharing of 
– and access to – their health data. Healthcare professionals also faced difficulties accessing 
health records and making decisions regarding individual patient’s health, particularly in cross-
border settings. Moreover, the lack of a consistent framework for the sharing of health data 
inhibited the reuse of health data by researchers, innovators, regulators, and policy makers for 
secondary  purposes  to  support  their  activities.  In  addition,  the  COVID-19  pandemic 
highlighted even further the importance of electronic health data for the development of policy 
in response to health emergencies. In this context, plans to develop the EHDS were included 
under the EU4Health Programme to improve the use and reuse of health data. 

The baseline for three Programme indicators characterising the digital strand and monitoring 
the implementation of specific objective (f) were set in 2020 (value 0 and above 0). For more 
on the setting of these baselines, see Section 2.1, Figure 5. 

Current situation and actions  

To advance both the digital transformation of health systems and the creation of a European 
Health Data Space Regulation, the EU4Health Programme is taking several actions under the 
digital strand. These actions strengthen the use and reuse of health data for: the provision of 
healthcare;  research  and  innovation;  and  regulatory  and  policymaking  activities.  The 
EU4Health Programme is also funding actions that promote the uptake of validated digital tools 
and services. Some actions will improve users’ access to interoperable high-quality data, and 
facilitate  policymaking  and  regulatory  activities,  including  health  research  and  innovation. 
They will also provide the foundations for secure and trustworthy access to – and reuse of –
health data. 

Expected Programme milestones and targets 

Indicator 

Graph based on recorded values 

297   European Parliament resolution of 17 September 2020 on the shortage of medicines  – how to address an 

emerging problem, (2020/2071(INI)).  

298   Proposal for a regulation of the European Parliament and of the Council on the European Health Data Space, 

COM(2022)197 final.  

299   European Health Data Space - European Commission (europa.eu). 

170 

 
 
 
Number of actions contributing to the digital transformation 
of  healthcare  systems  and  the  implementation  of  the 
European Health Data Space (EHDS) – monitoring specific 
objective (f). 

Number  of  Member  States  participating  in  the  European 
Health  Data  Space  (EHDS)  (indicator  5)  –  monitoring 
specific objective (f). 

*Percentage indicates the progress towards 2027 target. 

Progress on setting up health data access bodies in the EU – 
monitoring specific objective (f). 

*Percentage indicates the progress towards 2031 target. 

*Percentage indicates the progress towards 2031 target. 

Cancer 

2020 baseline 

In 2019, cancer became one of the main political priorities of the von der Leyen Commission, 
and a European plan to fight cancer and support Member States in improving cancer control 
and care was announced in President von der Leyen’s political guidelines. The 2019 mission 
letter to the Health Commissioner Stella Kyriakides asked her to draw up a European plan to 
beat cancer, which was adopted in February 2021. Europe’s Beating Cancer Plan (the Cancer 
Plan) was the first all-encompassing plan at EU level to tackle the whole disease pathway, a 
holistic plan bringing together scientists, patients, researchers and further stakeholders for the 
first  time,  strengthening  the  Commission’s  political  commitment  to  beating  cancer.  The 
baseline for the cancer strand of the EU4Health Programme is broadly described in the Cancer 
Plan. The EU has now been working to tackle cancer for decades, and its actions, for example 
on  tobacco  control  and  protection  from  hazardous  substances,  have  saved  and  prolonged 

171 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        
 
lives300. The final evaluation of the EU’s third Health Programme301 highlights that about EUR 
19 million was invested in a variety of cancer-related actions over the course of the Programme 
(which ran from 2014-2020). These actions included: support for screening programmes in the 
Member  States;  improving  the  quality  of  patients’  lives;  addressing  survivorship  issues; 
assessing the impact of cancer research; and facilitating the uptake of innovative treatments. 
More than half of this amount, EUR 11 million, was allocated to addressing major risk factors 
of cancer  and other chronic diseases, i.e.  alcohol and tobacco control, physical  activity and 
nutrition. By 2020, 6 Member States were implementing the European accreditation scheme 
for  breast  cancer  services,  a  decrease  from  10  in  2018.  By  2019,  the  European  Quality 
Assurance scheme was developed in a harmonised, evidence-based, and flexible way to grant 
equal and quality-benchmarked healthcare treatment to patients. The activities of the European 
Network of Cancer Registries coordinated by the Joint Research Centre (JRC) provided a data-
brokering service to ensure the integrity of a single European dataset for different purposes. 
The European Cancer Information System (ECIS) hosting data from128 cancer registries in 29 
European countries has now been set up (including on breast, colorectal and cervical cancers) 
providing  data  from  more  than  25.9  million  records  and  giving  access  to  researchers  and 
specialised healthcare professionals as tools for: improving and accelerating diagnostics; and 
providing patients with more tailored treatments302. 

The baselines for two Programme indicators characterising the cancer strand and monitoring 
the implementation  of the specific objective  (a)  were set  in 2015  (values above 0),  and the 
baseline  for  three  such  indicators  were  set  in  2015  (values  above  0).  The  baseline  for  one 
indicator is under development. For more on the setting of these baselines, see Section 2.1, 
Figure 6. 

Current situation and actions  

The cancer strand supports the  nine flagship initiatives of  the Cancer Plan:  the Knowledge 
Centre on Cancer; the Cancer Diagnostic and Treatment for All initiative; the European cancer 
imaging initiative; the initiative to eliminate cancers caused by human papillomavirus (HPV); 
the initiative to ensure a better life for cancer patients; the EU cancer screening scheme; the 
European  Cancer  Inequalities  Registry;  the  EU  network  of  national  comprehensive  cancer 
centres; and the initiative on helping children with cancer303. The EU contributes to the Cancer 
Plan through many other actions, described in the list of actions304, which are supported by the 
EU4Health Programme and other EU funding programmes such as Horizon Europe (and its 
EU Cancer Mission), and the Digital Europe programme.  

Expected Programme milestones and targets 

Indicator 

Graph based on recorded values 

300   Communication from the Commission to the European Parliament and the Council Europe’s Beating Cancer 

Plan, COM(2021)44 final. 

301   Commission report – Final evaluation of the third Health Programme 2014-2020. 
302   Staff Working Document on Ex-Post Evaluation of third Health Programme SWD(2023) 369 final. 
303   Factsheet – Europe’s Beating Cancer Plan flagship initiatives.  
304   Annexes to the European Commission communication on Europe’s Beating Cancer Plan,  COM(2021)44 

final ANNEX. 

172 

 
 
 
Age-standardised  five-year  net  survival  rate  for  paediatric 
cancer (to the  extent  available)  – (indicator 9) – monitoring 
specific objective (a). 

Screening coverage for breast, cervical and colorectal cancer 
screening programmes – Breast cancer screening coverage – 
(sub-indicator 10.1) monitoring specific objective (a). 

Not available/not defined yet. 

Screening coverage for breast, cervical and colorectal cancer 
screening programmes – Cervical cancer screening coverage 
– (sub-indicator 10.2) monitoring specific objective (a). 

*Percentage indicates the progress towards 2030 target. 

Screening coverage for breast, cervical and colorectal cancer 
screening  programmes  –  Colorectal  cancer  screening 
coverage – (sub-indicator 10.3) monitoring specific objective 
(a). 

*Percentage indicates the progress towards 2030 target. 

Percentage  of  population  covered  by  Cancer  Registries 
reporting  information  on  cervical,  breast,  colorectal  and 
paediatric  cancer  stage  at  diagnosis  –  (indicator  11)  – 
monitoring specific objective (a). 

*Percentage indicates the progress towards 2031 target. 

*Percentage indicates the progress towards 2027 target. 

173 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                
Number of Member States reporting information on cervical, 
breast,  colorectal  and  paediatric  cancer  stage  at  diagnosis  – 
monitoring specific objective (a). 

*Percentage indicates the progress towards 2027 target. 

General cross-cutting actions (covering specific objective (h)) and global health initiatives 
(specific objective (j)). 

2020 baseline 

The development, implementation, enforcement and revision of EU health legislation was 
already supported by the EU4health Programme’s predecessor, the third Health programme, 
which ran from 2014 to 2020 and funded studies, evaluations and impact assessments.  
Ensuring  that all existing and new  EU  health legislation  is soundly developed and properly 
implemented requires continued support from the EU4Health Programme. This support covers 
the delivery of studies informing impact assessment, activities by Commission expert groups, 
the creation of databases and IT tools, etc.  
The  baseline  for  two  Programme  indicators  monitoring  the  implementation  of  actions 
supporting  the  development,  implementation,  enforcement  and  revision  of  EU  health 
legislation and of specific objective (h) were set in 2020 (value 0). For more on the setting of 
these baselines, see Section 2.1, Figure 7. 
Before the EU Global Health Strategy was adopted in 2022, and even before EU4Health actions 
were deployed in the summer of 2021, EU action in global health was guided by policy set in 
2010305, 306, which drew up the principles for a stronger EU vision, voice, and action on global 
health. These principles were: leadership, universal coverage, coherence of EU policies, and 
knowledge. The EU has long supported the World Health Organization as the leading authority 
on global health in the United Nations system, and the EU speaks with one voice in the WHO’s 
governing bodies. The Commission cooperates with the WHO Secretariat on health security, 
R&D, noncommunicable diseases, health inequalities, health systems and health information. 
The  EU  also  supports  other  global  health  multilateral  processes,  and  in  particular:  the  UN 
Human Rights Council; the UN General Assembly initiative on Non-Communicable Diseases; 
the  health-related  Sustainable  Development  Goals;  the  Framework  Convention  on  Tobacco 
Control; and the post-2015 development agenda307.  

305   Communication from the Commission to the Council, the European Parliament, the European Economic and 
Social Committee and the Committee of the Regions, The EU Role in Global Health, COM(2010)128 final. 

306   Council conclusions on the EU role in Global Health, 2010.  
307   The EU in Global Health. 

174 

                                                                                                                                                                                                                     
 
 
The baseline for one Programme indicator was set in 2020 (value 0). And the baselines for two 
Programme indicators (one of which was to monitor the implementation of actions supporting 
the  international  health  initiatives  and  cooperation,  and  the  other  was  to  monitor  specific 
objective (j)) were set in 2022 (value 0). For more on the setting of these baselines, see Section 
2.1, Figure 7. 

Current situation and actions  

The  EU  has  a  central  role  to  play  in  tackling  global  health  challenges  and  the  EU4Health 
Programme consolidates EU support for the EU Global Health Strategy, international health 
initiatives  and  cooperation  with  the  WHO.  The  EU4Health  Programme  also  supports 
cooperation with non-EU countries, in particular the exchange of knowledge and best practices 
to improve health systems’ preparedness and response capacity. For EU candidate countries, 
the EU4Health Programme will help to align their respective health systems with EU health 
standards.  The  Programme  helps  to  strengthen  the  global  structures  for  responding  with 
medical  countermeasures  to  health  emergencies.  It  does  this  in  by  financing  both:  the 
collaboration between EU and international partners; and the implementation of a variety of 
actions  (such  as  the  global  consortium  for  wastewater  surveillance,  clinical  trials,  AMR 
initiatives,  sequencing  and  environmental  surveillance  capacities,  and  enhancing  data 
collection and exchanges).  

The EU4Health Programme works in synergy with other EU funding instruments, for example 
the EU research and innovation framework programme, Horizon Europe, where many actions 
on health research have results and outputs taken up by health policies and healthcare systems. 
These actions on health research include Cluster 1 ‘Health’, the Cancer Mission308 and various 
European partnerships (such as the partnership on transforming health and care systems309, the 
partnership on personalised medicine, the partnership on rare diseases, etc.).  

The Joint Transnational Call 2023 ‘Healthcare of the Future’ is an EU-funded call for tenders 
that aims to: (i) encourage research on optimising patient care pathways; and (ii) contribute to 
the transition towards more sustainable, efficient, resilient, ethical, high-quality, and accessible 
person-centred healthcare systems.  The 2024 Joint Transnational Call ‘Innovate to  Prevent’ 
will fund projects to support the implementation of innovative person-centred health and care 
models addressing prevention strategies, with help from existing IT and digital technologies 
and services.  

The  EU4Health  Programme  supports  cross-cutting  actions 
the  development, 
implementation,  enforcement  and,  where  necessary,  evaluation  and  revision  of  EU  health 
legislation. It finances the provision of valid, reliable, and comparable high-quality data for 
evidence-based decision-making and monitoring. It also promotes health impact assessments 
of other relevant EU policies.  

for 

The  EU4Health  Programme  also  supports  recurrent  actions  and  activities,  such  as: 
communication activities; the organisation of health-related events; and logistical support for 
meetings of expert groups and relevant scientific committees310 in the field of risk assessment 

308   EU Mission: Cancer. 
309   European Partnership on transforming health and care systems. 
310   For example, the Scientific Committee on Consumer Safety, Scientific Committee on Health, Environmental 

and Emerging risks, etc. cover specific objectives (h) and (j) from Article 4 of the EU4Health Regulation. 

175 

 
 
for  health,  environment,  emerging  risks,  and  consumer  safety.  Lastly,  the  EU4Health 
Programme  also  supports  interaction  with  stakeholders  and  synergies  among  different 
stakeholder groups including through the EU Health Policy Platform. 

Expected Programme milestones and targets 

Indicator 

Graph based on recorded values 

Number of impact assessments of Union policies. 

*Percentage indicates the progress towards 2027 target. 

Number of studies supporting the evaluations of legislative 
and non-legislative health Union policies – KEY 
PERFORMANCE INDICATOR. 

*Percentage indicates the progress towards 2027 target. 

Number of actions and contribution agreements supporting 
global commitments and health initiatives concluded with 
global partners. 

*Percentage indicates the progress towards 2027 target. 

176 

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
 
 
 
 
 
Number of areas where the EU and WHO collaborate. 

*Percentage indicates the progress towards 2027 target. 

Areas of coordination between EU and relevant global 
partners and EU Member States. 

*Percentage indicates the progress towards 2030 target. 

177 

                                                                                                                                                              .                                                                                                 
 
 
 
 
 
 
 
ANNEX VIII. CURRENT STATE OF PLAY – PROGRAMME PERFORMANCE, CONTRIBUTION TO 
EU’S CROSS-CUTTING PRIORITIES 

Programme performance 2021-2023 in a nutshell311 

By early 2024, all  593 actions of the annual  work programme for 2021 and 2022 had been 
launched,  and  almost  all  the  actions  from  2023  had  been  launched.  By  early  2024,  the 
implementation of the 2024 annual work programme  was also on schedule, with 22 actions 
launched312.  

✓  Contribution  to  EU  cross-cutting  priorities.  The  EU4Health  Programme  has 
contributed to gender equality with EUR 178.1 million in funding, and to the digital 
transition with EUR 349.6 million in funding. Additional investment in gender equality 
and the digital transition is planned in the 2024 annual work programme (EUR 25.75 
million). The funds allocated by the EU4Health Programme to ‘One Health’ actions 
vary over the year. The total committed EU4Health budget over the 2021-2024 period 
contributing indirectly to green budgeting priorities is about EUR 314 million. 

Figure 4: EU4Health key performance indicators. 

311   EU4Health Programme – Programme Performance Statement, 2024. 
312   The Programme Performance Statement, as part of the Commission’s strategic planning and programming 
cycle, is a key tool for annual reporting on the results achieved, challenges encountered and areas for possible 
improvement. 

178 

 
 
 
 
Out of 9 key performance indicators313 related to flagship health policies314 the target for 2 
indicators has been achieved. Policies are on track for 4 indicators, while moderate progress 
has been achieved for 2 others. Attention is still needed for one indicator.  

The programmed budget vs the committed budget315 

The  EU4Health  Programme  has  well-established  governance  programming  and 
implementation  processes  in  place.  Employing  these  processes,  the  parent  DGs  have 
programmed about EUR 2.63 billion in four annual work programmes (2021, 2022, 2023 and 
2024). This represents more than half (57.2%) of the EUR 4.6 billion total revised EU4Health 
budget. About 90% of the EU4Health Programme’s programmed budget is implemented under 
direct  management  through  grants,  prizes  and  procurement  (i.e.  EUR  2.37  billion),  and  the 
remaining 10% is implemented under indirect management through contribution agreements 
and co-delegation with other Commission DGs316 (i.e. EUR 0.26 billion).  

The contracting authority317 has committed about EUR 1.39 billion by signing 726 contracts, 
which represents more than half (53%) of the programmed budget in years 2021 to 2024. Most 
of the committed budget, i.e. EUR 1.16 billion, was assigned under direct management, while 
EUR 0.23 billion was assigned under indirect management (see Figure 8). 

About  two  thirds  of  the  direct  management  commitments  (EUR  742  million)  were 
accomplished  through  grants,  and  almost  a  third  (EUR  420  million)  were  accomplished 
through  procurement.  Prizes  were  used  once  in  2021  work  programme  and  the  amount 
allocated through that form of funding was EUR 0.4 million. 

313   See Annex 2 of the PPMEF. 
314   Healthier Together Initiative, Cross-border threats to health Regulation (EU) 2022/2371, Introducing HERA, 
the European Health Emergency preparedness and Response Authority, the next step towards completing 
the European Health Union (COM(2021)576 final), the pharmaceutical strategy for Europe (COM(2020)761 
final), the planned European Health Data Space (COM(2022)197 final), the European Reference Networks 
(C/2019/5470), etc. 

315   Programmed amounts refer to budgetary allocations planned within a EU funding work programme actions, 
whereas  committed  amounts  are  those  already  formally  obligated  through  legal  contracts  or  agreements 
when implementing those actions. 

316   DG ECFIN. 
317   In most cases HaDEA, and for some procurements and all the contribution agreements the parent DGs. 

179 

 
 
Figure 5 EU4Health budget – programmed vs committed per year and management mode. 

During  the  period  covered  by  this  interim  evaluation,  in  direct  management,  HaDEA 
commitments were made in four ways. The first way was via action grants following open calls 
for proposals (EUR 171.36 million). The second way was via operating grants (EUR 23.16 
million). The third way was upon invitation for joint actions (EUR 295.79 million). The fourth 
way was upon invitation for other direct grants (EUR 251.54 million). HaDEA and the parent 
DGs  committed:  EUR  62.8  million  for  procurement  open  calls  for  services;  EUR  190.61 
million for specific contracts under framework contracts; EUR 143.24 million for negotiated 
procedures and other procurement such as prizes; and EUR 23.30 million for administrative 
arrangements and service-level agreements. 

The EUR 231.70 million in total commitments under indirect management were accomplished 
by the parent DGs. This includes EUR 121.70 million for contribution agreements with ‘pillar-
assessed’318 international organisations and EUR 110 million for co-delegation to DG ECFIN. 

Investments and results 

The largest investment was made under specific objective (b) on the prevention of and response 
to  cross-border  health  threats,  followed  by:  specific  objective  (a)  on  health  promotion  and 
disease  prevention;  specific  objective  (i)  on  integrated  work  on  national  health  systems; 
specific objective (f) on digital transformation; specific objective (c) on access to medicines 
and medical products; specific objective (g) on access to healthcare; specific objective (h) on 
support  for  health  legislation;  specific  objective  (j)  on  global  health  commitments;  specific 

318   The purpose of the ex-ante assessment (‘pillar assessment’) is to check whether entities to be entrusted by 
the  Commission  with  budget  implementation  tasks  under  indirect  management  demonstrate  a  level  of 
protection of the EU’s financial interests equivalent to that existing when the Commission implements the 
budget itself. It must be guaranteed that the entity or person carrying out the action respects the principles of 
sound  financial  management,  transparency,  non-discrimination  and  visibility  of  the  EU  action  (Article 
154(2) of Regulation (EU, Euratom) 2018/1046). 

180 

 
  
 
objective (d) on EU stockpiling; and specific objective (e) on an EU reserve of medical staff 
(see Figure 6). 

Figure 6 Total EU4Health commitments under each specific objective 

The  EU4Health  Programme  strands  include  actions  that  implement  two  or  more  specific 
objectives, and almost all strands include actions with a global health dimension. 

181 

 
 
 
Figure 7 Total commitments by strand and specific objectives 

182 

 
 
 
Crisis preparedness  

Since the EU4Health implementation began in January 2021, by April 2024, the contracting 
authorities had committed EUR 623 million and signed 103 actions that contribute to the crisis 
preparedness strand. EUR 395.69 million was allocated to the specific objectives on prevention 
and response to cross-border health threats including antimicrobial resistance (b), while EUR 
110.41  million  was  allocated  to  actions  on  access  to  medicines  and  medical  devices  (c).  In 
addition,  EUR  79.45  million  was  allocated  to  actions  on  health  promotion  and  disease 
prevention (a), and EUR 18.86 million was allocated to contribute to the international health 
initiatives (j). There  are  no programmed actions  yet  complementing  the  actions  on  national 
stockpiling (d) and the actions on reserve for medical and healthcare staff (e).  

Crisis Preparedness

a - Health Promotion & Disease Prevention

b - Prevention, preparedness & response to SCBTH

c - Medicinal Products, Devices & Crisis Products

d - National stockpiling of crisis products

e   Reserve of medical and healthcare for health…

f - Digitalisation & use and re-use of health data

g - Enhancing access to healthcare

h - Developing & implementing EU health legislation

i - Integrated work among MS health systems

j - International health initiatives & cooperation

0,00 €

200.000.000,00 €

400.000.000,00 €

Figure 8 The distribution of crisis preparedness investments per specific objective  

70.2% of the EU4Health Programme’s budget is committed to countermeasure actions, while 
the remaining 29.8% addresses cross-border threats to health. These commitments also support 
the first actions to set up a structure and training resources for a reserve of medical, healthcare 
and support staff. 

The  largest  single  investment  (EUR  361.7  million)  supports:  EU  FAB,  a  network  of  ‘ever-
warm’  production  capacities  for  manufacturing  vaccine  and  medicines;  the  procurement  of 
vaccines  against  infectious  diseases;  and  the  national  action  plans  on  AMR.  Other  funded 
actions: ensure fast access to manufacturing capacities in the event of outbreaks of diseases; 
strengthen the fight against AMR; and improve surveillance of health threats.  

In addition, in a joint action (funded with EUR 15 million) 26 Member States are collaborating 
on the surveillance of their national wastewater319. In another action320 (receiving EUR 7 million 

319   EU-WISH. 
320   UNITED4Surveillance (January 2023 - December 2025). 

183 

 
 
 
in funding), 22 Member States are working to deploy state-of-the-art national and European 
surveillance systems and a coordinated response among the Member States to any future cross-
border threats to health. The EU has strengthened the One Health collaboration including on 
AMR policies with the WHO and the OECD. The overall committed EU4Health funding for 
actions tackling AMR amounts to EUR 56.48 million. EU collaboration with partners such as 
the WHO and the Global Antibiotic Research & Development Partnership strengthens global 
health security and ultimately ensures better protection against cross-border health threats.  

30 EU Member States and associated countries participate in more than one EU action aimed 
at improving prevention, preparedness and response planning for serious cross-border threats 
to health. As expected, 171 healthcare staff were trained on preparedness and response to cross-
border health threats. One Health surveillance programmes were successfully implemented in 
eight countries and the total consumption (community and hospital sectors) of antibacterials 
for  systemic  use  was  19.40 defined  daily  doses  (DDD)  per  1000  population  and  within  the 
expectations. The data for the remaining Programme indicators on prevention and response to 
cross-border health threats are progressively becoming available. 

Health promotion and disease prevention 

EUR  155.4  million  was committed  to  108  health  promotion  and  disease  prevention  actions 
(this does not include investments in the fight against cancer). EUR 64.74 million of the budget 
implements mainly the specific objective on health promotion and disease prevention (b). The 
health  promotion  and  disease  prevention  strand  also  receives:  (i)  EUR  53.81  million  in 
contributions  from  actions  implementing  specific  objective  (i)  on  integrated  work  among 
Member States health systems; (ii) EUR 12.25 million implementing specific objective (j) on 
global  health  initiatives  and  cooperation;  and  (iii)  smaller  amounts  from  all  other  specific 
objectives321.  

321   The budget of the operating grants has been distributed equally over all specific objectives, given that these 

types of grants cover usually a broad spectrum of activities.  

184 

 
 
Health Promotion and Disease Prevention

a - Health promotion & disease Prevention

b - Prevention, preparedness & response to SCBTH

c - Medicinal products, devices & crisis products

d - National stockpiling of crisis products

e   Reserve of medical and healthcare for health…

f - Digitalisation & use and re-use of health data

g - Enhancing access to healthcare

h - Developing & implementing EU health legislation

i - Integrated work among MS health systems

j - International health initiatives & cooperation

0,00 €

20.000.000,00 €40.000.000,00 €60.000.000,00 €

Figure 9 The distribution of investments in the health promotion and disease prevention 
strand per specific objective 

37.1%  of  the  strand’s  budget  was  committed  to  prevention  of  cardiovascular  disease  and 
diabetes.  The  other  policy  areas  covered  are  mental  health  support  to  Ukraine  (16.9%), 
operating grants (14.9%), mental health in the EU (7.8%), preventive work to improve mental 
health  (4.3%),  prevention  risk  factors  (6.2%),  HIV  and  AIDS  (4.3%),  prevention  of  NCDs 
(2.6%), tobacco-related actions (2.4%) chronic respiratory diseases (1.9%) and other related 
actions (1.6%). 

For example, 17 actions contribute to reducing avoidable mortality in the area of NCDs and 
associated  risk  factors.  25  Member  States  implement  ‘best’  and  ‘promising’  practices 
addressing  health  promotion,  disease  prevention  and  health  inequalities,  rolling  out  these 
practices  at  the  national  level  with  EU  funding  support.  There  are  three  funded  actions 
addressing  the  prevalence  of  harmful  use  of  alcohol  and  seven  actions  addressing 
environmental risk factors for health322. On vaccination, two EU Member States have reached 
95% coverage for both the first and the second dose of the measles vaccine for eligible people, 
while two EU Member States reached 75% coverage for the seasonal influenza vaccine in older 
age groups.323 

Data  from  the  2022  EU4Health  Programme  indicators  show  that  Member  States  are 
exchanging best and promising practices to reduce the burden of NCDs more than expected. 
Finally,  eight  actions  contribute  to  reducing  avoidable  mortality  in  the  area  of  non-
communicable diseases and risk factors, which is almost twice as many as had been expected.  

Health systems and healthcare workforce 

322   EU4Health Programme Performance Statement 2024. 

185 

 
 
 
 
 
EUR  239  million  was  committed  for  288  actions  under  the  strand  on  health  systems  and 
healthcare workforce. EUR 66.66 million of that is implementing mainly specific objective (i) 
on integrated work among Member States health systems, while EUR 49.74 million is going 
to support the digitalisation, use and reuse of health data (specific objective (f)). In addition: 
EUR  37.23  million  is  being  allocated  to  the  development  and  implementation  of  health 
legislation (specific objective (h)); EUR 35.75 million is supporting access to medicines and 
medical  devices  (specific  objective  (c));  EUR  27.5  million  is  going  to  enhance  access  to 
healthcare (specific objective (g)); and EUR 12 million to the specific objective on prevention 
and response to cross-border threats to health (specific objective (b)). Some of the actions under 
this  strand  are  benefiting  from  EUR  5  million  to  support  global  health  initiatives  (specific 
objective (j)).  

Health Systems and Health Workforce

a - Health promotion & disease prevention

b - Prevention, preparedness & response to SCBTH

c - Medicinal products, devices & crisis products

d - National stockpiling of crisis products

e   Reserve of medical and healthcare for health…

f - Digitalisation & use and re-use of health data

g - Enhancing access to healthcare

h - Developing & implementing EU health legislation

i - Integrated work among MS health systems

j - International health initiatives & cooperation

0,00 €

20.000.000,00 €40.000.000,00 €60.000.000,00 €

Figure  10  The  distribution  of  investments  in  the  health  systems  and  health  workforce 
strand per specific objective 

42.2%  of  the  investments  in  the  strand  on  health  systems  and  the  healthcare  workforce  are 
allocated  to  ERNs  and  25%  to  health  system  resilience  and  the  healthcare  workforce.  The 
remainder  is  distributed  to  implementation  of  the  pharmaceutical  strategy  and  related 
legislation  (11.7%),  the  regulation  of  medical  devices  (9.1%),  substances  of  human  origin 
(almost  5.9%),  HTA  (2.1%),  global  health  (2%),  and  improving  the  access  of  Ukrainian 
refugees to healthcare (2%) and others.  

The work of the ERNs for Rare Diseases has been supported in this strand with EUR 100.47 
million324 to facilitate the exchange of best practices, increase collaboration, and increase the 
comparability of the ERNs’ outputs.  

324   EU4Health Dashboard policy area ERNs. 

186 

 
 
 
 
 
EUR 52.5 million was allocated under this strand to actions to improve the resilience of health 
systems  by, for  example,  strengthening primary  care systems.  To  help test the resilience of 
health systems, a contribution agreement between the OECD and the European Observatory 
on Health Systems and Policies was carried out. This developed a methodology for testing the 
resilience of health systems, and this methodology is now publicly available to European health 
authorities325.  

Medicines  and  medical  devices  are  specific  categories  of  products  available  on  the  single 
market. Aspects like their manufacturing, certification or access to the market are regulated at 
EU  level.  Implementation  of  the  legislation  that  regulates  these  aspects  is  supported  by 
EU4Health  funding  worth  EUR  21.70  million.  The  funds  support:  the  maintenance  of  the 
European  Medical  Device  Nomenclature326;  the  development  and  maintenance  of  the 
EUDAMED  database327;  and  the  creation  of  the  EU  common  standard  for  ePI  (electronic 
medicinal product leaflet information). 

Several actions contribute to improving access to healthcare with the aim of achieving universal 
health coverage. Three actions that will produce guidance for improving access to healthcare 
services were launched to  support policymaking in  Member States  on measures  to  improve 
access  to  healthcare  services.  Access  to  healthcare  is  one  of  the  principles  of  the  European 
Pillar of Social Rights328. Actions under the EU4Health Programme, with funding worth EUR 
24.83  million,  help  Member  States  to  design  better  policies  for  access  to  healthcare, 
considering in particular the needs and challenges faced by vulnerable groups. The EU4Health 
actions  in  this  area  present  Member  States  with  policy  solutions  for:  more  affordable 
healthcare;  the  fairer  distribution  of  health  benefits;  and  improving  access  to  healthcare  for 
people with disabilities.  

The  Programme  indicators  show  that,  as  expected,  1 619  healthcare  units  were  involved  in 
ERNs by mid-2024, and the number of patients diagnosed and treated by the members of ERNs 
was 2.24 million, which is 50% more than the 2024 milestone329.  

103 medicines received an EU-wide authorisation in 2022, and this decreased to 68 in 2023. 
5 599 certificates330 were issued in 2023 for new medical devices, which is almost three times 
more than in 2022, and 702 certificates were issued in 2023 for in vitro diagnostic medical 

325   Strengthening Health Systems: A Practical Handbook for Resilience Testing. 
326   European Medical Device Nomenclature. 
327   EUDAMED – provide  a living picture of the lifecycle  of medical devices that are  made available in the 
European Union (EU). It will integrate different electronic systems to collate and process information about 
medical  devices  and  related  companies  (e.g.  manufacturers).  In  doing  so,  EUDAMED  aims  to  enhance 
overall  transparency,  including  through  better  access  to  information  for  the  public  and  healthcare 
professionals, and to enhance coordination between the different Member States in the EU. 

328   Principle 16: Everyone has the right to timely access to affordable, preventive and curative healthcare of 

good quality. 

329   PPS 2024. 
330   Issued by notified bodies under Regulation (EU) 2017/745 on medical devices intended to be placed on the 

EU market. 

187 

 
 
devices,  which  is  almost  twice  as  many  as  were  approved  in  2022331.  The  level  of  relevant 
shortages of human and veterinary medicines remained under control. 

Two  actions  in  this  area  help  to  address  dependence  on  imports  from  third  countries  for 
essential active pharmaceutical ingredients and medicinal products. As planned, 28 audits were 
conducted  in  the  EU  and  in  third  countries,  including  candidate  countries,  to  ensure  good 
manufacturing  practices  and  good  clinical  practices  (EU  control).  In  addition,  EU  Member 
States participated in actions to support innovation in, uptake of and access to the market for 
medical countermeasures at EU and global level332. 

Digital 
Investments  of  EUR  124.96  million  in  the  strand  on  digital  are  promoting  mainly  specific 
objective (f) on digitalisation and  the use and reuse of health data. Some of the investment 
under this strand is  funding  actions  to implement the specific objectives  on developing and 
implementing EU health legislation (specific objective (h)), and the one on enhancing access 
to healthcare (specific objective (g)).  

The investments are balanced between the primary and the secondary use of data. Of the total 
budget under this  strand,  45.6% is  invested in  the  primary use of health  data  as part of the 
action  MyHealth@EU  (an  additional  EUR  3.8  million  is  invested  in  a  joint  action)333.  In 
addition, 3.1% of the budget under this strand is being invested in the primary use of data for 
patient-facing services, and 2.5% is being invested in databases for EHR systems. The actions 
on the secondary use of data support the setting up of services by health data access bodies, 
with 33% of the budget from this strand. The secondary use of health data is also receiving 
8.6%  of  this  strand’s  budget  via  Healthdata@EU.  Consequently,  the  actions  to  support  the 
primary use of health data are receiving 58.4% of this strand’s budget and the actions to support 
the secondary use of health data are receiving 41.6% of this strand’s budget. 

331   Issued by notified bodies under Regulation (EU) 2017/746 for medium- and high-risk devices intended to 

be placed on the EU market. 

332   PPS 2024. 
333   Extended EHR@EU Data Space for Primary Use. 

188 

 
 
 
Digital

a - Health promotion & disease prevention

b - Prevention, preparedness & response to SCBTH

c - Medicinal products, devices & crisis products

d - National stockpiling of crisis products

e   Reserve of medical and healthcare for health…

f - Digitalisation & use and re-use of health data

g - Enhancing access to healthcare

h - Developing & implementing EU health legislation

i - Integrated work among MS health systems

j - International health initiatives & cooperation

Figure 11 The distribution of digital strand investments per specific objective 

0,00 €

40.000.000,00 €80.000.000,00 €120.000.000,00 €

The EU4Health Programme indicators reveal that: 37 actions support the digital transformation 
of healthcare systems and the implementation of the EHDS (cumulative); 12 Member States 
participate  in  the  EHDS  and  are  connected  to  MyHealth@EU  and/or  to  the  cross-border 
infrastructure for secondary use; and 6 health data access bodies were set up by the EU Member 
States.  

For example, a joint action334 under the digital strand (EUR 4.7 million) brings together experts 
from  25  Member  State  authorities  to  lay  the  groundwork  for:  the  implementation  of  the 
European Electronic Health Record Exchange Format; common specifications for electronic 
health  record  systems;  and  the  development  of  MyHealth@EU.  An  action  grant335  (EUR  5 
million) supports the precursors and basis to set up an EU-wide infrastructure for the secondary 
use of health data. 

Cancer 

62 actions with a EUR 220 million total budget are included under the cancer strand, which 
supports the implementation of the Cancer Plan and contributes mainly to the achievement of 
specific objectives (a) on health promotion and disease prevention. This strand also receives 
considerable contributions from actions implementing specific objective (i) on integrated work 
among Member States health systems; specific objective (g) on enhancing access to healthcare; 
and specific objective (j) on global health initiatives.  

Almost half of the allocated budget under the cancer strand supports prevention actions against 
cancer including: actions against HPV, tobacco and alcohol-related diseases (49.3%); followed 
by screening actions including those on breast, colorectal, cervical, gastric, prostate, liver, and 

334   Extended EHR@EU Data Space for Primary Use. 
335   HealthData@EU Pilot October 2022 – December 2024. 

189 

 
 
 
 
lung  cancer  (25%);  and  treatment  including  radiation  (13.9%),  quality  of  life  (6.8%), 
inequalities (4.6%), and other actions (0.4%). 

Cancer

a - Health promotion & disease prevention

b - Prevention, preparedness & response to SCBTH

c - Medicinal products, devices & crisis products

d - National stockpiling of crisis products

e   Reserve of medical and healthcare for health…

f - Digitalisation & use and re-use of health data

g - Enhancing access to healthcare

h - Developing & implementing EU health legislation

i - Integrated work among MS health systems

j - International health initiatives & cooperation

Figure 12 The distribution of Cancer strand investments per specific objective 

0,00 €

40.000.000,00 €80.000.000,00 €120.000.000,00 €160.000.000,00 €

The ongoing actions are focusing on the prevention of cancer and other NCDs; the creation and 
transfer  of  knowledge  on  cancer  screening;  targeting  cardiovascular  diseases  and  diabetes 
together  with  their  health  determinants;  and  or  identifying  and  overcoming  obstacles  to  the 
high uptake of vaccinations. These four areas were funded through joint actions, action grants 
and  procurement  instruments.  These  actions  help  to:  counteract  the  risk  factors  for  NCDs; 
promote the early detection of NCDs, including cancer; and protect the EU population from 
vaccine-preventable diseases. For example, an action grant336 with a EUR 1.6 million budget 
was  awarded  to  strengthen  the  collection  of  cancer-screening  data  to  update  the  European 
Cancer  Information  System  and  improve  the  quality  and  coverage  of  cancer-screening 
programmes across Europe. This action grant made it possible to: identify 19 key performance 
indicators for breast, cervical, and colorectal cancer screening; determine the relevance of – 
and feasibility of using – these key performance indicators – with existing cancer screening 
programmes across Europe; and test these key performance indicators in a pilot programme. 
The project outcomes will be used for the third EU cancer-screening report, as required by the 
2022  Council  Recommendation  on  cancer  screening337.  Also  funded  under  the  EU4Health 
Programme (with EUR 9.1 million in support) is work on improving oncological training. This 
ongoing  project  involves  developing  an  inter-speciality  training  curriculum.  The  activities 
linked to the training of trainers will target experts in the fields of clinical oncology, surgery, 

336   CanScreen-ECIS September 2022 - February 2024. 
337   Council  Recommendation  on  strengthening  prevention  through  early  detection:  A  new  EU  approach  on 

cancer screening replacing Council Recommendation 2003/878/EC. 

190 

 
 
 
 
 
radiation oncology, cancer nursing and other specialised staff from at least 100 cancer centres 
in Europe. These training activities will ensure the future sustainability of the inter-speciality 
cancer training programme in EU Member States338 339. Recruitment for the training programme 
began in July 2024. 

Funding from the EU4Health Programme made it possible to create the new Knowledge Centre 
on  Cancer,  the  first  ever  EU  Cancer  Inequalities  Registry,  and  the  EU  Network  for  Youth 
Cancer Survivors. All Member States (plus Iceland and Norway) published their country cancer 
profiles, highlighting key achievements and challenges in cancer prevention and care for each 
country. In addition, with funding from the EU4Health Programme and development assistance 
from the JRC, the European guidelines for breast cancer screening and diagnosis were made 
available, and the corresponding quality assurance scheme for breast cancer was piloted in 20 
breast  cancer  settings  in  nine  Member  States.  Programme-level  data  on  cancer  actions  is 
progressively becoming available. 

Global health initiatives 

The  EU4Health  Programme  contributes  to  international  health  initiatives  and  cooperation 
supporting the implementation of the EU Global Health Strategy; global efforts for pandemic 
preparedness; and the implementation of international health regulations.  

By  2024,  the  EU  had  concluded  23  contribution  agreements  and  actions  supporting  global 
commitments  through  specific  objective  (j)  on  international  health  initiatives  with  global 
partners including the pillar-assessed organisations.  

EUR 33.6 million from  the EU4Health budget has been already committed via contribution 
agreements to cooperation on health initiatives with global partners.  

Impact assessments and evaluations 

The  EU4Health  Programme  funded  an  impact  assessment  of  published  EU  health  policies 
along  with  supporting  studies  and  related  staff  working  documents340.  In  addition,  the 
Programme funded three studies to support the evaluations of, monitor the implementation of, 
and assess the functioning of legislative and non-legislative policies in the area of the EU’s 
Health Union. 

338   INTERACT-EUROPE – Innovative collaboration for Inter-specialty cancer training across Europe. (June 

2022 – November 2023). 
339   INTERACT-EUROPE 100. 
340   Annex I PPMEF; see other references on the previous page. 

191 

 
 
 
 
 
ANNEX IX. ACTIONS FROM THE 2021-2024 WORK PROGRAMMES (WP) LINKED TO HORIZON 
EUROPE 

Action title 

Year 

Strand 

Funding 
instrument 

2021 

Cancer 

Direct grant to 
MS authorities 

Amount 
allocated 
within 
the 
AWP (in 
EUR) 

7 million 

Link to Horizon 
Europe 

This action is in line 
with the Horizon 
Europe Cancer 
Mission Board 
recommendation to 
establish 
Comprehensive 
Cancer Care 
Networks in MS and 
network these at the 
Union level.  

The action is in line 
with the Horizon 
Europe Cancer 
Mission Board 
recommendation to 
establish 
Comprehensive 
Cancer Care 
networks. 

2021 

Cancer 

Open call for 
proposals (action 
grant) 

1.2 
million  

2022 

Health 
promotion 
and disease 
prevention 

Direct grant to 
MS authorities 
(Joint Action) 

75 
million 

Rolled out in close 
synergy with 
Horizon Europe’s 

Mission on Cancer. 

192 

DP/C-g-10.1.2/3 
Direct grants to 
Member States’ 
authorities: 
network of 
Comprehensive 
Cancer Centres 

DP/C-g-10.1.1 
Call for proposals: 
action grants for 
‘EU Cancer 
Treatment 
Capacity and 
Capability 
Mapping’ project 
- Network of 
Comprehensive 
Cancer Centres 

CR-g-22-08.01 
Direct grants to 
Member States’ 
authorities: 
Cancer and other 
NCDs prevention 
– action on health 
determinants 

 
 
Action title 

Year 

Strand 

Funding 
instrument 

Amount 
allocated 
within 
the 
AWP (in 
EUR) 

2022 

Cancer  

Open call for 
proposal 

30 
million 

2022 

Cancer 

Open call for 
proposals (action 
grant)  

11 
million 

CR-g-22-
09.01/02/03 Call 
for proposals to 
monitor and 
strengthen the 
implementation of 

innovative 
approaches to 
prostate, lung and 
gastric cancer 
screening at 
Union level 

CR-g-22-08.02 
Call for proposals 
on cancer and 
other NCDs 
prevention – 
action on health 
determinants 

CR-g-22-
10.01/02/03341 

2022 

2022 

Cancer 

Service 

0.5 
million 

CR-p-22-11.01 
Study on obstacles 
for cancer 
survivors to return 
to work 

Link to Horizon 
Europe 

Rolled out in close 
synergy with 
Horizon Europe’s 

Mission on Cancer. 

Rolled out in close 
synergy with 
Horizon Europe’s 

Mission on Cancer. 

Rolled out in close 
synergy with 
Horizon Europe’ 
Mission on Cancer. 

Rolled out in close 
synergy with 
Horizon Europe’s 

Mission on Cancer. 

341   This action is listed in the 2022 work programme as being rolled out in close synergy with Horizon Europe, 

but no further information on the action is available. 

193 

 
 
 
 
 
Action title 

Year 

Strand 

Funding 
instrument 

2022 

Cancer 

Service 

Amount 
allocated 
within 
the 
AWP (in 
EUR) 

1.5 
million 

2023 

Crisis 
preparedness 

84 
million 

Open call(s) for 
tender for 
framework 
contracts and/or 
service contracts 

CR-p-22-13.01 
Mapping and 
evaluating the 
implementation of 
the Europe’s 
Beating 

Cancer Plan 

CP-p-23-15 
Support to speed 
up the 
development of, 
access to and/or 
uptake of 
innovative 
technologies and 
critical medicines 
(HERA). 

CR-p-23-43 Study 
on the quality of 
life of cancer 
survivors 

2023 

Cancer 

Open 
procedure/service 

1.5 
million 

194 

Link to Horizon 
Europe 

Rolled out in close 
synergy with 
Horizon Europe’s 

Mission on Cancer. 

This action supports 
the policy priority to 
enhance the 
availability and 
accessibility of 
medical 
countermeasures 
and support 
innovation 
regarding such 
products to enhance 
preparedness for 
future health 
emergencies in 
synergy with 
Horizon Europe. 

This study builds on 
the results of 2 
Horizon Europe 
projects: 
“EUonQoL” and 
“HORIZON-MISS-
2023-CANCER-01-
04: Establish best 
practices and tools 
to improve the 
quality of life for 
childhood cancer 

 
Action title 

Year 

Strand 

Funding 
instrument 

Amount 
allocated 
within 
the 
AWP (in 
EUR) 

2023 

Cancer 

A direct grant to 
MS (Joint 
Actions) 

31 
million 

2023 

Cancer 

Two direct grants 
(JAs) 

90 and 
40.5 
million 

CR-g-23-38 
Direct grants to 
Member States’ 
authorities: 
Implementation of 
cancer screening 
programmes 

CR-g-23-40.1-2 
Direct grants to 
Member States’ 
authorities: to 
establish an EU 
network of 
Comprehensive 
Cancer 
Infrastructures 
and new networks 
of expertise on 
cancers and 
cancer conditions 

Link to Horizon 
Europe 

patients, survivors 
and their families”. 

This action links to 
the Horizon Europe 
Mission on Cancer 
(e.g., projects 
funded under the 
call topic “Develop 
new methods and 
technologies for 
cancer screening 
and early detection 
(HORIZON-MISS-
2021-CANCER-02-
01). 

This action aims to 
implement the 
concepts developed 
and upscale the 
initial piloting work 
in WP2021, which 
is in line with the 
Horizon Europe 
Cancer Mission 
Board 
recommendations to 
establish 
Comprehensive 
Cancer Care 
Networks in MS and 
network these at the 
Union level. 

DP-g-23-31-01 
Direct grants to 
Member States’ 

2023 

Health 
promotion 

Direct grant to 
MS (Joint Action) 

4 million 

This action takes 
into account the 

195 

 
Action title 

Year 

Strand 

Funding 
instrument 

Amount 
allocated 
within 
the 
AWP (in 
EUR) 

Link to Horizon 
Europe 

authorities: 
‘Healthier 
Together’ EU 
NCD initiative– 
chronic 
respiratory 
diseases (CRDs) 

DP-g-23-32-01 
Direct grants to 
Member States’ 
authorities: 
‘Healthier 
Together’ EU 
NCD initiative – 
Mental health 

DP-g-23-33-01 
Direct grants to 
Member States’ 
authorities: 
‘Healthier 
Together’ EU 
NCD initiative – 
Dementia and 
other neurological 
disorders 

DP-g-23-32-02 
Call for proposals 
on the prevention 
of NCDs in the 
area of mental 
health including 
actions supporting 
vulnerable 
population groups, 
such as migrants, 

and disease 
prevention 

results of Horizon 
Europe projects. 

2023 

Health 
promotion 
and disease 
prevention 

Direct grant to 
MS (Joint Action) 

6 million 

This action takes 
into account the 
results of relevant 
Horizon Europe 
projects. 

2023 

Health 
promotion 
and disease 
prevention 

Open call for 
proposals 

4 million 

This action takes 
into account the 
results of relevant 
Horizon Europe 
projects. 

2023 

Health 
promotion 
and disease 
prevention 

Open call for 
proposals 

2.36 
million 

With the objective 
of promoting mental 
health and reducing 
the burden of mental 
health problems, the 
action will take into 
account the results 
of relevant Horizon 
2020 and Horizon 
Europe projects. 

196 

 
Action title 

Year 

Strand 

Funding 
instrument 

Amount 
allocated 
within 
the 
AWP (in 
EUR) 

Link to Horizon 
Europe 

2024 

Crisis 
preparedness 

Open call for 
tender 

40 
million 

2024 

Cancer 

Service contract 

0.5 
million 

refugees, Roma 
people and 
displaced people 
from Ukraine. 

CP-p-24-15 
Support to speed 
up the 
development of 
access to and/or 
uptake of medical 
countermeasures 
including critical 
medicines 
(HERA). 

CR-p-24-97 
Administrative, 
logistic and 
scientific support 
for the Sub-group 
on Cancer 

under the PHEG 
and for the EU-
US Health Task 
Force (Cancer) 

This action 
ultimately enhances 
preparedness for 
future health 
emergencies in 
synergy with 
Horizon Europe. 

The sub-group on 
cancer was set up to 
facilitate the 
governance of the 
implementation of 
the Europe’s 
Beating Cancer Plan 
and the Horizon 
Europe Cancer 
Mission and to 
ensure synergies 
between the two 
Commission 
initiatives. The 
purpose of this 
action is to provide 
support services to 
DG SANTE in its 
role as secretariat of 
the Sub-group on 
Cancer. 

197 

 
 
Action title 

Year 

Strand 

Funding 
instrument 

Amount 
allocated 
within 
the 
AWP (in 
EUR) 

2024 

Cancer 

Direct grant to 
MS (Joint Action) 

20 
million 

2024 

Cancer 

Direct grant to 
MS (Joint Action) 

27.9 
million 

CR-g-24-36 
Direct grants to 
Member States’ 
authorities: 
Strengthening 
digital capabilities 
including e-health, 
telemedicine, 
remote monitoring 
systems, health 
data access and 
health data 
exchange services 
in cancer centres 
in the Union 

CR-g-24-41 
Direct grants to 
Member States’ 
authorities: 
Personalised 
Cancer Medicine. 

Link to Horizon 
Europe 

With the aim of 
enhancing the 
digital capabilities 
of the cancer centres 
in the Union, 
particularly in 
Eastern Europe, this 
action makes use of 
the guidelines, 
protocols, and best 
practices, developed 
under the previous 
Horizon Europe 
projects such as 
UNCAN.eu and 
European Cancer 
Patient Digital 
Centre projects. 

With the objective 
of strengthening the 
Personalised Cancer 
Medicine network 
within the Union, 
this action will build 
on the results of 
relevant Horizon 
Europe projects and 
will improve the 
collaboration 
between different 
institutions/organisa
tions from national, 

European and 
international level 
that are offering 
personalised cancer 
medicine including 
Horizon Europe co-
funded projects on 

198 

 
Action title 

Year 

Strand 

Funding 
instrument 

Amount 
allocated 
within 
the 
AWP (in 
EUR) 

2024 

Crisis 
preparedness 

Open call for 
proposals (Action 
Grant) 

10 
million 

CP-g-24-105 Call 
for proposals to 
support the 
development of 
novel antivirals 
(HERA) 

2024 

Crisis 
preparedness 

Open call for 
proposals (Action 
Grant) 

102  
million 

CP-g-24-10 Call 
for proposals on 
the European Hub 
for vaccine 
development 
(HERA) 

199 

Link to Horizon 
Europe 

personalised cancer 
medicine. 

With the aim of 
diversifying and 
advancing the 
pipeline of broad-
spectrum antiviral 
candidates, this 
action will pay 
attention to 
complementarity 
with existing 
Horizon Europe 
projects (e.g., 
HORIZON-HLTH-
2023-DISEASE-03-
04: Pandemic 
preparedness and 
response: Broad 
spectrum anti-viral 
therapeutics for 
infectious diseases 
with epidemic 
potential). 

The Hub should 
establish 
connections with the 
future Horizon 
Europe-funded 
European 
Partnership on 
Pandemic 
Preparedness 
(HORIZON-HLTH-
2024-DISEASE-12-
01) and private 
manufacturers 
including through 

 
 
 
Action title 

Year 

Strand 

Funding 
instrument 

Amount 
allocated 
within 
the 
AWP (in 
EUR) 

Link to Horizon 
Europe 

specific 
manufacturing 
agreements such as 
EUFAB or 
comparable national 
models. 

200 

 
 
 
 
ANNEX X. INFORMATION ON THE EU4HEALTH WORK PROGRAMMES ADOPTED.  

2021 EU4Health work programme (2nd amendment) 

The EU4Health work programme 2021, focuses in part on: addressing the mental health impact 
of the COVID-19 pandemic; reducing the burden of non-communicable diseases; improving 
access  to  healthcare  and  tackling  health  inequalities;  strengthening  health  systems  and  the 
healthcare workforce; and improving preparedness and response to cross-border health threats. 
Additionally, the work programme aims to: support the implementation of the Cancer Plan; 
improve  the  quality,  safety,  and  availability  of  substances  of  human  origin;  and  promote 
healthy lifestyles. 

EU4Health 2022 work programme 

The 2022 EU4Health work programme focuses in part on: improving and fostering health in 
the  EU;  protecting  people  from  serious  cross-border  health  threats;  improving  access  to 
medicinal products; and strengthening health systems. The work programme also focuses on 
cancer prevention and control, mental health, and digital health, with a specific emphasis on 
addressing  the  burden  of  NCDs  and  reducing  health  inequalities.  Additionally,  the  work 
programme aims to support the implementation of the Cancer Plan, the pharmaceutical strategy 
for Europe, and the Health Union package. 

EU4Health 2023 work programme  

The  2023  EU4Health  work  programme  addresses  health-related  emergencies  caused  by  the 
COVID-19  pandemic  and  the  Russian  war  of  aggression  against  Ukraine.  It  also  supports 
emerging policy initiatives by President von der Leyen in the State of the Union Address and 
in  the  associated  letter  of  intent  with  a  special  focus  on  mental  health,  global  health, 
developments in digital health, and medicinal products. The 2023 EU4Health work programme 
will also address actions related to the recently adopted proposal for a Council recommendation 
on a new EU approach on cancer screening. 

EU4Health 2024 work programme 

The 2024 EU4Health work programme addresses issues such as: health-related issues resulting 
from  the  COVID-19  pandemic  and  the  Russian  war  of  aggression  against  Ukraine;  and 
supporting people displaced from Ukraine. It also supports emerging policy initiatives with a 
special attention on mental health, global health, developments in digital health and medicinal 
products. In addition, the 2024 EU4Health work programme addresses actions related to the 
adopted  Council  recommendation  on  a  new  EU  approach  on  cancer  screening.  The  work 
programme  also  addresses  the  challenges  identified  in  the  Commission  Communication 
‘Addressing  medicine  shortages  in  the  EU’,  especially  the  challenge  of  boosting  Europe’s 
capacity to produce and innovate in the manufacturing of critical medicines and ingredients. 
Furthermore,  in  light  of  the  growing  number  of  health  threats  emerging  globally,  the  work 
programme addresses potential new crises, including the Mpox outbreak. The work programme 

201 

 
also aims to ensure that our health systems are resilient and equipped to tackle future challenges 
effectively. 

202 

 
 
 
ENDNOTES 

i  

ii  

Annex I of the PPMEF: Number of Member States with improved preparedness and response planning with 
regard to medical countermeasures (sub-indicator 6.2). 
Programme indicator: Number of actions addressing the fight against communicable diseases (indicator 22), 
Annex I of the PPMEF. 

iii   Programme indicator: Preparedness and response planning of the Union and of Member States for serious 

cross-border threats to health, Annex I of the PPMEF.  

iv   Annex I of the PPMEF: Number of Member States and associated countries with improved procurement 

procedures for medical countermeasures during health crisis. 

v   Annex I of the PPMEF: Number of Member States and Associated Countries with increased laboratory and 

diagnostic capacity for cross-border health threats, contributing to the mission of HERA. 

vi   Annex I of the PPMEF: Number of actions complementing national stockpiling of essential crisis-relevant 

products. 

vii   Annex  I  of  the  PPMEF:  Number  of  healthcare  and  public  health  staff  trained  (Article  11  of  the  CHBT  

Regulation and Decision establishing HERA) - KEY PERFORMANCE INDICATOR. 
viii   Annex I of the PPMEF: Stakeholders’ satisfaction rate in HERA training programmes. 
ix  

Programme indicator: Number of countries where One Health surveillance programmes were successfully 
implemented, Annex I of the PPMEF. 

x   Annex I of the PPMEF: The indicator measures the total consumption (community and hospital sectors) of 
antibacterials for systemic use (ATC group J01) expressed as ‘defined daily dose (DDD per 1 000 inhabitants 
per day’. It has been selected as the primary. Therapeutic subgroup of the Anatomical Therapeutic Chemical 
Classification System - ATC code J01. 

xi   Annex I of the PPMEF: Number of actions contributing to the reduction of avoidable mortality in the area 

of non communicable diseases and risk factors. 

xii   Annex I of the PPMEF: Number of actions addressing the prevalence of harmful use of alcohol, if possible, 

differentiated by gender and age – (indicator 14). 

xiii   Annex I of the PPMEF: Number of actions addressing environmental risk factors for health – (indicator 23). 
xiv   Annex I of the PPMEF: Number of healthcare units involved in ERNs – (sub-indicator 19.1).  
xv   Annex  I  of  the  PPMEF:  Access  to  centrally  authorised  medicinal  products,  for  example  the  number  of 
existing and new orphan authorisations, advanced therapy medicinal products (ATMPs), medicinal products 
for paediatric use or vaccines, for unmet needs – (indicator 2). 

xvi   Annex  I  of  the  PPMEF:  Number  of  certificates  issued  by  notified  bodies  under  the  Medical  Device 

Regulation (MDR). 

xvii   Annex I of the PPMEF: The   number of certificates issued by notified bodies under the In Vitro Diagnostic 

Medical Devices(IVDR).   

xviii   Number of reported shortages of medicinal products in the Member States through the single point of contact 

network – (indicator 15). 

xix   Annex I of the PPMEF: Number of actions contributing to increasing the security and continuity of the global 
supply chains and addressing dependence on imports from  third  countries for the production of essential 
active pharmaceutical ingredients and medicinal products. 

xx   Annex I of the PPMEF: Number of production facilities with enhanced capacities in increasing security and 
continuity  of  supply  for  medical  countermeasures,  raw  materials,  and  components  at  EU  level  –  KEY 
PERFORMANCE INDICATOR. 

xxi   Annex  I  of  the  PPMEF:  Number  of  audits  conducted  in  the  EU  and  in  third  countries  to  ensure  good 
manufacturing  practices  and  good  clinical  practices  (Union  control)  –  (indicator  17)  -  KEY 
PERFORMANCE INDICATOR. 

xxii   Annex I of the PPMEF: Number of Member States participating in actions aimed at supporting innovation, 
uptake  and  access  to  market  of  medical  countermeasures  supported  at  EU  and  global  level  for  better 
preparedness and response. 

xxiii   Annex I of the PPMEF: Number of impact assessments of Union policies. 
xxiv   Annex  I  of  the  PPMEF:  Number  of  studies  supporting  the  evaluations  of  legislative  and  non-legislative 

health Union policies – KEY PERFORMANCE INDICATOR. 

xxv   Annex I of the PPMEF: Number of actions and contribution agreements supporting global commitments and 

health initiatives concluded with global partners. 

xxvi   Annex I of the PPMEF: Number of areas where EU and WHO align policies and/or actions. 

203 

 
 
 
xxvii   Annex I of the PPMEF: Areas of coordination between EU and relevant global partners and EU Member 

States. 

xxviii   See endnote IX. 

204