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

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

Health is a precondition for our society and economy to function. The aims of the EU include 
promoting the well-being of its peoples1. A high level of human health protection should be 
ensured in the drawing up and implementation of all EU policies and activities2.  

Article 168 of the Treaty on the Functioning of the European Union (TFEU) provides that the 
EU  must  complement  and  support  national  health  policies,  encourage  cooperation  between 
Member States and promote coordination between their programmes. The EU must achieve 
this while respecting the responsibilities of the Member States for drawing up their own health 
policies and for the organisation, management and delivery of health services and medical care.  

Since 2020, drawing on the lessons from the COVID-19 pandemic, the European Commission 
has been building the European Health Union, in which all EU Member States: prepare and 
respond together to health crises; make medical supplies available, affordable and innovative; 
and work together to improve prevention, treatment and aftercare for diseases such as cancer. 
The  main  EU  funding  programme  to  deliver  the  European  Health  Union  is  the  EU4Health 
Programme. 

2.  The EU4Health Programme 

The  EU4Health  Programme  was  established  by  Regulation  (EU)  2021/5223  (‘EU4Health 
Regulation’) to improve human health throughout the EU and to ensure a high level of human 
health protection in all EU policies and activities.  

The  Programme’s  objectives4  are  broad,  aligned  with  the  priorities  of  the  European  Health 
Union5, and closely interlinked with the objectives of the EU’s legislative and non-legislative 
health initiatives that the Programme supports financially. The four general objectives are:  

a)  improving and fostering health in the Union to reduce the burden of communicable and 
non-communicable diseases, by supporting health promotion and disease prevention, 
by reducing health inequalities, by fostering healthy lifestyles and by promoting access 
to healthcare;  

b)  protecting  people  in  the  Union  from  serious  cross-border  threats  to  health  and 
strengthening  the  responsiveness  of  health  systems  and  coordination  among  the 
Member States in order to cope with serious cross-border threats to health;  

c)  improving  the  availability,  accessibility  and  affordability  of  medicinal  products  and 
medical devices, and crisis-relevant products in the Union, and supporting innovation 
regarding such products; 

1   Article 3(1) of the Treaty on European Union (TEU). 
2   Articles 9 and 168 TFEU and Article 35 of the Charter of Fundamental Rights of the European Union. 
3   Regulation (EU) 2021/522 of the European Parliament and of the Council 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).  
The  health  objectives  from  the  initial  proposal  put  forward  in  the  European  Social  Fund  Plus  (ESF+) 
programme  were  retained  with  priority  given  to  the  EU’s  and  Member  States’  response  and  crisis 
preparedness to future health crises in the aftermath of the COVID-19 pandemic. 
European  Commission  Communication  on  Building  a  European  Health  Union:  Reinforcing  the  EU’s 
resilience for cross-border health threats, COM(2020)724 final.  

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d)  strengthening health systems by improving their resilience and resource efficiency, in 
particular through: (i) supporting integrated and coordinated work between Member 
States; (ii) promoting the implementation of best practices and promoting data sharing; 
(iii) reinforcing the healthcare workforce; (iv) tackling the implications of demographic 
challenges; and (v) advancing digital transformation. 

The  general  objectives  referred  to  in  Article  3  of  the  EU4Health  Regulation  are  pursued 
through the following specific objectives, ensuring a high level of human health protection in 
all EU policies and activities, and pursuing the One Health approach: 

a)  in synergy with other relevant Union actions, supporting actions for disease prevention, 
for  health  promotion  and  for  addressing  health determinants,  including  through  the 
reduction of damage to health resulting from illicit drug use and addiction, supporting 
actions to address inequalities in health, to improve health literacy, to improve patient 
rights,  patient  safety,  quality  of  care  and  cross-border  healthcare,  and  supporting 
actions  for  the  improvement  of  the  surveillance,  diagnosis  and  treatment  of 
communicable  and  non-communicable  diseases,  in  particular  cancer  and  paediatric 
cancer, as well as supporting actions to improve mental health, with special attention 
given to new care models and the challenges of long term care, in order to strengthen 
the resilience of the health systems in the Union;  

b)  strengthening the capability of the Union for prevention of, preparedness for, and rapid 
response to, serious cross- border threats to health in accordance with relevant Union 
legislation, and improving the management of health crises, particularly through the 
coordination, provision and deployment of emergency healthcare capacity, supporting 
data  gathering,  information  exchange,  surveillance,  the  coordination  of  voluntary 
stress testing of national healthcare systems, and the development of quality healthcare 
standards at national level;  

c)  supporting  actions  to  enhance  the  availability,  accessibility  and  affordability  of 
medicinal  products,  medical  devices  and  crisis-relevant  products  by  encouraging 
sustainable  production  and  supply  chains  and  innovation  in  the  Union,  while 
supporting  the  prudent  and  efficient  use  of  medicinal  products,  in  particular 
antimicrobials, and actions to support the development of medicinal products that are 
less harmful for the environment, as well as the environmentally friendly production 
and disposal of medicinal products and medical devices;  

d)  in synergy with other Union instruments, programmes and funds, without prejudice to 
Member  State  competences,  and  in  close  cooperation  with  relevant  Union  bodies, 
supporting  actions  complementing  national  stockpiling  of  essential  crisis-relevant 
products, at Union level, where needed;  

e)  in synergy with other Union instruments, programmes and funds, without prejudice to 
Member State competences and in close cooperation with the ECDC [European Centre 
for Disease Prevention and Control], establishing a structure and training resources 
for a reserve of medical, healthcare and support staff allocated voluntarily by Member 
States for its mobilisation in the event of a health crisis;  

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f)  strengthening the use and re-use of health data for the provision of healthcare and for 
research and innovation, promoting the uptake of digital tools and services, as well as 
the digital transformation of healthcare systems, including by supporting the creation 
of a European health data space;  

g)  enhancing  access  to  quality,  patient-centred,  outcome-based  healthcare  and  related 

care services, with the aim of achieving universal health coverage;  

h)  supporting the development, implementation and enforcement and, where necessary, 
the revision of Union health legislation and supporting the provision of valid, reliable 
and comparable high-quality data for evidence-based decision-making and monitoring, 
and promoting the use of health impact assessments of other relevant Union policies;  
i)  supporting  integrated  work  among  Member  States,  and  in  particular  their  health 
systems, including the implementation of high-impact prevention practices, supporting 
work  on  HTA  [health  technology  assessment],  and  strengthening  and  scaling  up 
networking  through  ERNs  [European  Reference  Networks]  and  other  transnational 
networks,  including  in  relation  to  diseases  other  than  rare  diseases,  to  increase  the 
coverage  of  patients  and  improve  the  response  to  low  prevalence  and  complex 
communicable and non- communicable diseases;  

j)  supporting  global  commitments  and  health  initiatives  by  reinforcing  the  Union’s 
support for actions by international organisations, in particular actions by the WHO 
[World Health Organization], and fostering cooperation with third countries. 

The initial budget of EUR 5.8 billion for years 2021-2027 provided for in Article 5 of the 
EU4Health  Regulation  was  reduced  to  EUR  4.6  billion6  when  the  2021-2027  multiannual 
financial framework (MFF) was revised7. The redeployed funds were allocated to, among other 
things, catering for Ukraine’s immediate needs, recovery and support for its European path; 
addressing  the  needs  related  to  migration  pressures;  strengthening  global  partnerships;  and 
responding to emergencies. 

Under the EU4Health Regulation, at least 20% of the Programme’s budget must be reserved 
for  health  promotion  and  disease  prevention.  The  Programme  should  invest  no  more  than 
12.5% in procurement to complement national stockpiling of essential crisis-relevant products, 
no more than 12.5% to support global commitments and international health initiatives, and a 
maximum of 8% to cover administrative expenses8.  

The  EU4Health  Programme  budget  is  implemented  through  annual  work  programmes9 
adopted  by  the  Commission  following  a  positive  opinion  from  the  Member  States  in  the 

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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. 

7   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). 

8   Article 5(4) of Regulation (EU) 2021/522. 
9  

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 to the Commission implementing decision. 

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EU4Health Programme Committee and building on relevant stakeholders’ views. The annual 
EU4Health programming is based on the Commission’s analysis of the gap between the current 
state  of  implementation  and  the  Programme’s  objectives.  The  annual  work  programme 
priorities and strategic orientations take into account the stakeholders’ input and are developed 
in consultation with the Member States to ensure the Programme’s implementation the EU’s 
overall health policy objectives. 

The Programme is implemented mainly through direct management with the Member States’ 
authorities, academia and education establishments, research institutes, hospitals, civil society 
and other public or private entities. Some budget implementation tasks are entrusted through 
indirect  management  to  bodies  such  as  international  organisations  or  their  agencies  (the 
WHO, the International Federation of Red Cross and Red Crescent Societies, the Organisation 
for the Economic Cooperation and Development (OECD)), the European Investment Bank and 
other organisations10. The Programme may provide funding in any of the forms laid down in 
the Financial Regulation, in particular grants, prizes and procurement.  

For grants the co-financing rate is up to 60% and, in case of exceptional utility, up to 80%. 
In the case of direct grants to the ERNs, other transnational networks set out under EU law 
and the WHO, such grants may be up to 100 % of eligible costs. 

Public  procurement  contracts  may  be  awarded  to  any  legal  entity  that  satisfies  the 
requirements set out in the applicable legal framework.  

The eligible beneficiaries of the Programme are amongst others, national or regional (health) 
administrations  of  Member  States  or  associated  countries,  research  bodies,  educational 
institutes, private and non-profit entities11.  

The  Commission  has  signed  EU4Health  Programme  association  agreements  with 
Ukraine, Moldova, Montenegro and Bosnia and Herzegovina, which allow these countries 
to access EU4Health funding. The association of Norway and Iceland (EEA EFTA countries) 
to the EU4Health Programme is governed by Protocol 31 to the Agreement on the European 
Economic Area on cooperation in specific fields outside the four freedoms. 

3.  Interim evaluation approach and methodology 

Evaluation criteria and context  

The interim evaluation report of the EU4Health Programme is a legal obligation in line with 
Article  20  of  the  EU4Health  Regulation  and  is  accompanied  by  a  staff  working  document 
presenting  the  available  evidence.  The  interim  evaluation  assesses:  the  Programme’s 
effectiveness and efficiency; the coherence within the Programme and with other relevant EU 
funding initiatives and relevant policies; the EU added value of the funded actions; and the 

The  European  Commission  adopts  implementing  decisions  pursuant  to  Article  17(2)  of  the  EU4Health 
Regulation on ‘Implementation of the Programme’. 

10   Article 62(1) (c) of Regulation (EU, Euratom) 2024/2509 of the European Parliament and of the Council of 
23  September  2024  on  the  financial  rules  applicable  to  the  general  budget  of  the  Union  (recast),  (OJ  L, 
2024/2509, 26.9.2024). 

11   Article 13 of Regulation (EU) 2021/522. 

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relevance  of  the  Programme  objectives.  The  interim  evaluation  provides  insights  for  the 
ongoing implementation of the EU4Health Programme, sets the scene for the forthcoming final 
evaluation, and informs the reflections on a potential successor Programme for the next MFF.  

The evaluation period 

The interim evaluation measures the Programme’s progress from 1 January 2021 to 30 April 
2024 (cut-off date), across  the 27 Member States and  6 non-EU countries associated to  the 
Programme12.  

The evaluation methodology 

The interim evaluation, as outlined in Article 20(2) of the EU4Health Regulation13, builds on 
output  and  results  data  from  a  limited  number  of  actions  completed  by  the  cut-off  date. 
Consequently, there were only limited data available on results and no data at all on impacts. 
EU  public  health  interventions  often  involve  multiple  components  and  stakeholders  and 
complement those of the Member States. This  can  make it difficult  to  isolate the effects  of 
specific actions and evaluate their impact accurately. Establishing a causal link between inputs, 
outputs,  results,  and  impacts  in  an  EU  public  health  intervention  is  difficult  because  of  the 
complex and multifaceted nature of such interventions, where multiple variables and external 
factors can influence outcomes. 

The evaluation draws on additional evidence provided by an external study 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 and a literature review. The data analysis includes a comparison against baseline 
and targets, a cost-benefit analysis 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. 

4.  Main findings of the interim evaluation  

At the time of the interim evaluation, the available data are limited to early results from the 
financed actions, and the impacts of these actions are yet to materialise. The initial findings 
from 26 grants and 136 procurements show that the data collection approach is reliable, and 
that the evaluation methodology provides a strong basis to deliver the final evaluation.  

Effectiveness and efficiency 

The EU4Health Programme governance was established in a timely manner and allowed 
the  programming  process  to  unfold  swiftly  and  efficiently  during  the  COVID-19 
pandemic. The EU4Health programming process has been a critical enabler in aligning the 
Programme’s activities with its overarching objectives. Coordination between the two parent 
Directorates-General (DGs), the Directorate-General for Health and Food Safety (DG SANTE) 
and  the  Health  Emergency  Preparedness  and  Response  Authority  (HERA),  the  European 

12   Bosnia and Herzegovina, Iceland, Moldova, Montenegro, Norway and Ukraine. 
13   Regulation (EU) 2021/522. 

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Health  and  Digital  Executive  Agency  (HaDEA),  as  well  as  the  active  participation  of  the 
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 annual work programmes have been effective in translating 
the EU4Health Programme’s broad objectives into concrete actions, with clear allocation of 
resources  to  priority  areas  such  as  crisis  preparedness,  digital  health  (eHealth),  and  disease 
prevention. The first annual work programme for 2021 was adopted about three months after 
the EU4Health Regulation had been adopted. The programming processes were run in parallel 
for  the  2021  and  2022  work  programmes,  which  were  adopted  after  a  roughly  ten  months 
preparatory  period.  Programming  in  2023  and  2024  adhered  to  more  regular  programming 
cycles, with timely adoption of work programmes and an effective amendment process.  

All actions programmed for 2021, 2022 and 2023 delegated to HaDEA by the parent DGs 
were successfully launched. Consequently, 726 contracts (covering all these actions for these 
three years) were signed with 1 274 legal entities such as: health ministries; national, regional 
and other public authorities; healthcare and health research organisations; and non-profit and 
private entities. Most of the EU4Health funds were disbursed through grants and procurement. 
Additionally, contribution agreements were used to support global health priorities. By April 
2024, about EUR 2.63 billion of the total EU4Health budget (of EUR 5.8 billion for the years 
2021-2027) had been programmed and EUR 1.39 billion had been effectively committed.  

The EU4Health work programme consists of four overarching ‘strands’: crisis preparedness; 
health  promotion  and  disease  prevention;  health  systems  and  healthcare  workforce;  and 
digital. Cancer is considered to be a horizontal strand.  

The  grants  beneficiaries  from  22  countries14  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.). 

During 2021-2024, 255 NGOs received action grants and participated in 55 projects, absorbing 
EUR  41.2  million.  In  addition,  27  NGOs  received  operating  grants,  absorbing  EUR  23.2 
million.  

A total of 94 legal entities from 18 Member States15 benefited from funds through procurement 
between  2021  and  2024.  The  largest  procurement  of  services  was  made  under  the  crisis 
preparedness  strand.  This  procurement  includes  ensuring ever-warm facilities (the EU FAB 
project)  for  vaccine  production  and  IT  development  to  enhance  early  warning  systems, 
modelling, simulation and forecasting16. Of the total budget amounting to EUR 396.4 million, 
six Member States17 have absorbed most of the procurement funds with at least EUR 22 million 
per Member State.  

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

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

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

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

16   ATHINA – the Advanced Technology for Health INtelligence and Action IT System. 
17   Belgium, Denmark, Ireland, the Netherlands, Luxembourg and Spain. 

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The grants and procurement for services have enabled targeted actions under all strands 
of the work programme. The overall budget committed by the cut-off date amounts to EUR 
1.39 billion. Direct management includes grants of EUR 741.84 million and procurement of 
EUR 420.44 million. Indirect management comprises the remaining EUR 227.72 million. The 
joint  actions  and  other  direct  grants  to  Member  States  bring  together  national  authorities 
facilitating  and  enhancing  collaboration,  capacity  building  and  knowledge  transfer.  The 
procurement of services involves private sector providers mainly from the Member States, and 
in a few cases from other countries18, international organisations19 or Commission services20. 
Contribution agreements with international organisations have facilitated the implementation 
of initiatives including beyond the EU’s borders, such as addressing the health consequences 
of  Russia’s  war  of  aggression  against  Ukraine  or  crisis  preparedness  actions  to  address 
emerging cross-border health threats at the place of origin, such as in Africa in the case of the 
Mpox virus. 

By  the  cut-off  date,  the  joint  actions  enabled  499  organisations  to  collaborate  across 
European countries, with 40% of all organisations participating in more than one joint 
action.  The  exceptional  utility  criteria  have  demonstrated  their  relevance  as  a  funding 
mechanism  in  the  EU4Health  Programme,  providing  increased  financial  support  (an  EU 
contribution of up to 80%) for actions involving at least 14 Member States of which at least 4 
are countries whose gross national income (GNI) per inhabitant is less than 90% of the EU 
average21 or where 30% of the action budget is directed to such countries. 

Administrative  burdens  remain  a  significant  challenge,  particularly  for  smaller  Member 
States and NGOs. This includes 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. 

The Programme has already made significant progress at this interim stage.  

The Programme contributes to disease prevention and health promotion by supporting very 
effectively the delivery of the Healthier together – EU non-communicable diseases (NCD) 
initiative22, as demonstrated by, among other things, the joint work of the Member States23.  
Moreover, the legal obligation to allocate a minimum of 20% of the total Programme budget 
to disease prevention and health promotion actions has been fulfilled until 202424. There has 
been a substantial progress in improving healthcare networks. The ERNs, which provide 
specialised care for rare diseases, now include 1 619 healthcare providers, marking by the cut-
off date a 40% increase compared to 2021. This expansion has had a tangible impact, as by 

18   The United States. 
19   The WHO; grant for the African Society for Laboratory Medicine. 
20   The Joint Research Centre. 
21   Article 8(3) of the EU4Health Regulation. 
22   Healthier together – EU non-communicable diseases initiative. 
23   Joint Action Prevent Non-Communicable Diseases (JA  PreventNCD) and  Joint Action on Cardiovascular 

diseases and Diabetes (JACARDI). 

24   Article 5 of the EU4Health Regulation budget includes provisions to reserve a minimum of 20% of the total 

EU4Health budget for health promotion and disease prevention actions. 

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2024, 2.24 million rare disease patients have received expert advice on the most appropriate 
diagnoses  and  treatments.  Digital  health  initiatives  are  also  advancing,  through  the 
implementation of MyHealth@EU, the infrastructure enabling cross-border continuity of care 
by providing  access  to  Patient  Summaries and ePrescirptions and  is  paving the way for the 
European  Health  Data  Space.  This  work  has  been  made  possible  through  44  key  projects 
funded by the Programme, ensuring better access to – and management of – health data across 
the EU. Innovation and accessibility in medical countermeasures have been further supported 
by  a  EUR  104  million  investment  aimed  at  fostering  advancements  in  the  field,  including 
incentives to ensure access to antibiotics. In addition, under EU FAB, six economic operators 
have secured manufacturing capacities to ensure that vaccines can be fully produced within the 
EU in case of an emergency. Meanwhile, in the fight against cancer the Member States are 
adapting and adopting the European guidelines on breast cancer screening and diagnosis, and 
the  questions  and  answers  scheme  has  been  completed  and  ready  for  implementation  after 
being  tested  across  nine  Member  States.  A  crucial  step  following  the  2022  Council 
recommendation on cancer screening. Moreover, in response to the increasing risk of cross-
border  pathogens,  in  January  2024,  23  Member  States  began  implementing  a  One  Health 
surveillance system, reinforcing the EU’s preparedness against health threats that transcend 
national borders. Similarly, the joint action EU wastewater integrated surveillance for public 
health  (EU-WISH)  initiative  has  also  brought  together  26  countries  to  boost  their  ability  to 
prevent,  prepare  for,  and  respond  rapidly  to  serious  cross-border  health  threats  through 
wastewater surveillance.  

The  Programme  data  collection  is  enabled  by  52  indicators,  which  are  described  in  the 
EU4Health  Programme  performance  monitoring and  evaluation  framework (PPMEF)25. The 
indicators  monitor  inputs,  outputs,  results,  and  impacts.  Nine  designated  key  performance 
indicators are related to flagship health policies and serve to reflect the key achievements in 
the annual performance reporting26.  

The 2023 annual performance analysis (the latest available before the interim evaluation 
cut-off date 30 April 2024) indicates that the overall Programme performance is on track 
to achieve its objectives.  

The  progress  of  the  nine  key  performance  indicators  is  illustrative.  The  2027  target  has 
already been exceeded in 2024 for the indicator related to ERNs and for the indicator on the 
number  of  Member  States  implementing  best  practices  on  health  promotion  and  disease 
prevention. Almost all Member States and associated countries (30) have taken steps to develop 
their  preparedness  and  response  plans  for  serious  cross-border  health  threats.  The  2024 
milestone is close to being met for the key performance indicator ‘Number of healthcare and 
public health staff trained’ and on track to be met for four other indicators27.  

25   See Annex I to the Commission Staff Working Document EU4Health Programme Performance Monitoring 

and Evaluation Framework SWD(2024)223 final.  

26   See Annex 2 to SWD(2024)223 final. 
27   For information on performance results of EU4Health indicators see (2024) 2021-2027 Performance Data 

Tables. 

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The 2024 milestones, for example, have been reached and even exceeded under different 
strands. As the Programme’s implementation advances, significant progress has been made 
on several indicators towards meeting the 2027 targets in key areas such as: crisis preparedness 
and response; health promotion and disease prevention; cancer; and addressing the needs of 
rare disease patients through ERNs. 

Coherence 

The design of the EU4Health Regulation is sound overall, and the objectives are coherent. 
All  the  Programme’s  general  and  specific  objectives  accurately  and  comprehensively 
reflect the EU’s health needs and challenges. The comprehensive specific objectives allow 
for  the  financing  of  the  implementation  of  existing  EU  health  policy  priorities,  including 
existing EU health legislation.  

The  Programme  is  consistent  with  other  EU  funding  programmes  such  as  Horizon 
Europe,  the  Digital  Europe  programme,  European  Social  Fund+  the  Union  Civil 
Protection  Mechanism  (rescEU),  the  European  Regional  Development  Fund,  the 
Recovery  and  Resilience  Facility,  the  Technical  Support  Instrument,  and  the 
Neighbourhood,  Development  and  International  Cooperation  Instrument  –  Global 
Europe (NDICI-GE). Horizon Europe advances health research and innovation through its 
Cluster 1 initiatives and the EU Cancer Mission, addressing disease prevention and promoting 
synergies with  public health policies.  It  funds research in  areas like infectious diseases  and 
cancer and helps to incorporate digital technologies into healthcare and promotes global health 
cooperation.  Partnerships  within  Horizon  Europe,  such  as  those  focusing  on  transforming 
health systems  and rare  diseases, bolster Europe's health innovation  ecosystem.  The Digital 
Europe  programme  improves  digital  skills  in  health  and  is  helping  to  set  up  the  European 
Health  Data  Space  for  better  data  access  and  interoperability.  Additionally,  funds  like  the 
European Regional Development Fund, European Social Fund+, ERASMUS+ the Recovery 
and  Resilience  Facility,  the  Technical  Support  Instrument,  support  health  infrastructure, 
eHealth, and workforce skills development. 

The coherence of the EU4Health Programme with other EU funds is also ensured through inter-
service  consultation  on  the  annual  work  programmes  and  organisation  of  joint  stakeholder 
events to present projects on specific thematic areas (e.g. mental health). Coherence between 
EU4Health and Horizon Europe is most prominent in the case of cancer actions28. This stems 
from the close alignment of Horizon Europe’s EU Cancer Mission with EU4Health’s cancer 
strand, which is ensured through the joint governance of the EU Cancer Mission and Europe’s 
Beating Cancer Plan. 

There  is  also  potential  for  synergy  between  the  European  Green  Deal  and  EU4Health.  15 
actions representing EUR 23.5 million, directly support Green Deal priorities. 

28   For  more  overview  on  coherence  between  EU4Health  and  Horizon  Europe,  see  section  4.1.3  Crisis 

preparedness in accompanying Staff Working Document. 

9 

 
 
 
 
EU added value 

Actions  under  the  EU4Health  Programme  have  provided  significant  EU  added  value 
through capacity building, strategic planning, and the setting of priorities and actions to 
upscale and promote innovation and make the best use of research results.  

The EU4Health Programme launched actions worth EUR 623 million on crisis preparedness 
and health security, between January 2021 and the cut-off date of the interim evaluation (30 
April 2024). These actions improved the EU’s ability to better prevent, be better prepared and 
respond to health emergencies. They also ensured the EU’s ability to ensure access to medical 
countermeasures. Examples include activities on  medical countermeasures development and 
procurement;  European  reference  laboratories;  surveillance  and  intelligence  gathering 
capabilities; and early warning and response systems. Such actions are crucial for counteracting 
future cross-border threats to health in the EU.  

EUR 27 million has been made available to support  intelligence gathering 
through  open  sources,  wastewater  surveillance  systems  and  sequencing 
capacities and epidemic intelligence gathering at global level. 

The Programme has made considerable investments to directly support health promotion and 
disease  prevention  (EUR  155.4  million),  particularly  concerning  NCDs  (including  cancer), 
mental health, cardiovascular diseases, diabetes, respiratory diseases and to promote healthier 
lifestyles that are expected to have positive impacts on the long-term health of EU citizens. The 
actions  from  other  strands  also  include  health  promotion  and  disease  prevention  activities. 
Together with the direct support in this area of intervention, EUR 536.7 million has now been 
programmed  for  health  promotion  and  disease  prevention.  This  meets  the  20%  legal 
commitment made under the EU4Health Regulation. 

600 000 displaced people from Ukraine received psychological first aid and 
mental health services in 22 Member States and 3 non-EU countries 

The EU4Health Programme has deployed EUR 239 million on actions to strengthen national 
health  systems,  for  example:  through  the  CIRCE  joint  action  transferring  best  practices  in 
primary  healthcare  among  EU  Member  States;  by  increased  financing  of  the  European 
Reference Networks (EUR 100.5 million), and by increasing the resilience of the healthcare 
workforce, building on the outcomes of the previous health programmes. Established in 2017, 
the  European  Reference  Networks  have  continued  to  facilitate  and  enhance  collaboration 
between healthcare providers and gave advice on the most appropriate diagnosis and the best 
treatment  available  to  rare  disease  patients.  The  Programme  has  also  improved  healthcare 
workforce preparedness  through targeted training and capacity-building initiatives, ensuring 
that Member States are better equipped to manage surges in demand for healthcare. 

10 

 
 
 
 
 
 
 
 
Between November 2023 and April 2024, 15 medicines had their electronic 
product  information  published  as  part  of  their  marketing  authorisation 
procedure,  paving  the  way  for  the  wider  digitalisation  of  the  regulatory 
network. 

The  digital  transformation  of  healthcare  systems  (EUR  124.96  million)  across  the  EU  has 
advanced  through  the  preparatory  work  and  the  development  of  the  European  Health  Data 
Space infrastructure supported by the EU4Health  Programme. This allows health data to be 
exchanged  across borders and improves access  to quality  healthcare. EU citizens  now have 
easier access to their health records and can receive continuous care when travelling between 
Member  States.  Member  States  are  also  better  connected,  leading  to  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 leader in medical research 
and  healthcare  innovation.  The  actions  from  other  strands  include  digital  transformation 
activities that contribute together to the EU’s cross-cutting priorities.  

22 European countries, including 20 EU Member States, received support for 
the  digitalisation  of  their  health  systems  and  increased  the  geographic 
coverage of MyHealth@EU services, interoperability and/or patient access 
to their own health data. 

The  investments  supporting  implementation  of  Europe’s  Beating  Cancer  Plan  (EUR  220 
million) include key actions to reduce cancer risk factors, improve vaccination and screening 
coverage,  and  improve  cancer  registries  by  enhancing  data  collection,  thus  contributing 
effectively to early detection and more effective treatment strategies. Progress has been made 
in several other areas, including on the European Commission Knowledge Centre on Cancer29, 
the European cancer inequalities registry30, and the EU Network linking recognised National 
Comprehensive Cancer Centres and new networks of expertise. The EU Network taps into the 
entire European oncology community for specific, challenging cancer areas that could benefit 
from cross-border cooperation. 

In December 2023, 29 country cancer profiles from all EU Member States 
and Iceland and Norway were published, highlighting the key achievements 
and challenges in cancer prevention and care. 

29   Knowledge Centre on Cancer. 
30   ECIR - European Cancer Inequalities Registry. 

11 

 
 
 
 
 
 
 
 
 
 
 
 
 
The support to the EU’s Global Health Strategy31 amounts to EUR 61.5 million32, of which 
about EUR 50 million has been committed to actions such as strengthening preparedness and 
response to cross-border threats to health at global level. An ongoing study aims to design and 
test a monitoring framework to assess the progress and outcomes of the EU’s Global Health 
Strategy's  implementation.  Supported  by  EU4Health  Programme  financing,  Member  States 
and  associated  countries  are  strengthening  the  EU’s  role  in  global  health  by  improving  the 
coordination of actions between Member States and EU institutions. The global commitments 
and health initiatives concluded with international partners such as the WHO and the Red Cross 
and Red Crescent Societies have addressed, among other issues, the health consequences of 
Russia’s war of aggression in Ukraine and the needs of refugees.  

Relevance 

The findings of the evaluation’s supporting study published together with this report indicate 
that all general and specific objectives of the EU4Health Programme were highly relevant, 
reflecting accurately and comprehensively the health needs and challenges in existence in 2021, 
when  the  Programme  was  created.  The  study  found  that  the  specific  objectives  were  well-
aligned with the EU 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 eHealth33.  

During  the  period  2021-2024,  the  EU4Health  Programme  remained  very  relevant  with 
regards to European Health Union priorities such as: health crisis prevention, preparedness 
and response; implementation of Regulation (EU) 2022/2371 on serious cross-border threats 
to  health34;  Europe’s  Beating  Cancer  Plan35;  the  ‘Healthier  Together’  initiative36;  Europe’s 
pharmaceutical  strategy37;  supporting  health  technology  assessment  work  and  building  the 
European Health Data Space38. 

The  actions  funded  in  the  2021,  2022,  2023  and  2024  annual  work  programmes  were 
highly relevant for implementing all general and specific objectives. A mapping exercise 
and further analysis of the annual work programmes confirmed that all four general objectives 
and the ten specific objectives were largely  and  adequately  covered.  In line with  this, most 

31   EU GLOBAL HEALTH STRATEGY - Better Health for All in a Changing World. 
32   For this interim evaluation, financial support for the EU’s Global Health Strategy is meant as total budget of 
actions  implementing  specific  objective  (j)  of  EU4Health  –  supporting  global  commitments  and  health 
initiatives.  

33   Mission letter from Ursula von der Leyen, President of the European Commission, to the Commissioner for 

Health and Food Safety, 1 December 2019. 

34   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). 

35   Europe’s Beating Cancer Plan. 
36   Healthier Together EU Non-Communicable Diseases Initiative. 
37   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. 

38   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). 

12 

 
 
stakeholders agreed that the actions in the 2021-2024 annual work programmes were relevant 
for all four general and all ten specific objectives.  

The continued relevance of the Programme during the implementation period is underscored 
by the high opinion of stakeholders expressed via surveys and during targeted interviews in 
April  and  May  2024:  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. Stakeholder-targeted interviews 
confirmed a consensus across all stakeholder groups that the EU4Health Programme’s general 
and specific objectives remained relevant over the Programme’s implementation period from 
January 2021 until April 2024.  

The health challenges that the EU4Health Programme was designed to address, remain 
relevant for the years to come, in particular in relation to:  the increased risk of outbreaks and 
epidemics or pandemics; growing antimicrobial resistance; increased longevity which, in the 
absence of further action, is associated with an increased prevalence of NCDs. These health 
challenges will require EU level action and commensurate resources. Such action includes:  

1.  continuing to build a One Health approach;  
2.  upscaling innovation across health policies;  
3.  improving regulatory frameworks for pharmaceuticals and medical devices, including 

critical medicines;  

4.  laying the groundwork for the digital transition;  
5.  mitigating workforce shortages;  
6.  improving access to healthcare; 
7.  stepping up prevention of NCDs;  
8.  enabling  healthy  ageing  through  a  comprehensive  and  lifelong  approach  to  health 
promotion and disease prevention, including cardiovascular diseases, and the continued 
fight against cancer;  

9.  reducing health damage due to illicit drug use and addiction, including information and 
prevention;  amplifying  threat  detection  activities  and  supporting  new  medical 
countermeasures against outbreaks; 

10. improving the security of supply of critical medicines and medical countermeasures;   
11. developing health biotechnologies. 

The EU4Health Programme remains relevant because it finances the implementation of 
the Union health acquis and facilities collaboration and coordination with Member States to 
build  the  European  Health  Union.  The  EU4Health  Programme  is  the  main  EU  fund  that 
underpins the development of a strong European Health Union, including both its internal and 
external dimensions. It finances actions to build the European Health Union by implementing 
health priorities and policies such as:  

1.  crisis preparedness and response;  
2.  Europe's Beating Cancer Plan;  
3.  the reform of EU pharmaceutical legislation; 

13 

 
4.  a comprehensive approach to mental health39; 
5.  HTA; 
6.  the European Health Data Space;  
7.  medical devices40;  
8.  in vitro diagnostic medical devices41;  
9.  rules on substances of human origin42.  

The  EU4Health  Programme  also  supports  activities  under  the  extended  mandates  of  the 
European Medicines Agency and the European Centre for Disease Prevention and Control. It 
furthermore supports the EU’s Global Health Strategy and helps the Member States meet the 
UN Sustainable Development Goals and targets. The EU4Health Programme supports the EU 
health priorities and the development and evaluation of legal acts. 

5.  Conclusions and lessons learned 

Conclusions 

The  EU4Health  Programme’s  governance  and  programming  processes  were  set  up 
successfully  and  have  proven  to  be  effective  for  the  timely  adoption  of  the  annual  work 
programmes  and  the  necessary  amendments.  The  consultation  process  with  stakeholders  is 
well-established.  The  work  programmes  have  been  effective  in  translating  the  EU4Health 
Programme’s  broad  objectives  into  concrete  actions,  with  clear  allocation  of  resources  to 
priority areas such as crisis preparedness, digital health, and disease prevention. The first work 
programme  in  2021  was  adopted  about  three  months  after  the  EU4Health  Regulation  was 
adopted.  The  programming  processes  were  run  in  parallel  for  the  2021  and  2022  work 
programmes, which were adopted over a record period of roughly ten months. 

The  implementation  processes  are  effective  and  were  adapted  in  a  timely  manner  to 
accommodate large increase of the budget by the newly created HaDEA. The executive agency 
is  instrumental and essential  for the  implementation  of the  Programme  and its annual  work 
programmes. The programmed actions are designed to provide significant EU added value 
upon delivery through strategic planning of EU priorities and actions to upscale and promote 
innovation  and  capacity  building  and  make  the  best  use  of  research  results  across  Europe. 
Subsequently,  the  Programme  contributed  substantially  to  the  EU’s  cross-cutting  priorities, 

39   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. 

40   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).  

41   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). 

42   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). 

14 

 
 
such  as  the  digital  transition,  gender  equality  and  green  budgeting  by  committing  funds  to 
relevant EU4Health actions.  

The EUR 1 billion redeployment in 2024, had no impact on the programming for the 2021, 
2022,  2023  and  2024  annual  work  programme.  However,  this  major  budget  cut  to  the 
EU4Health  Programme  will  have  an  impact  on  the  programming  from  2025  onwards. 
Nevertheless, is important to ensure sufficient support to both ongoing and new initiatives and 
commitments.  

The joint actions continue to provide crucial funding to national authorities, including those 
of  countries  with  a  lower  GNI  through  the  exceptional  utility  criteria.  They  also  enable 
collaboration  that  addresses  common  European  health  challenges  and  implement  effective 
solutions at national level. The main beneficiaries, in terms of both received EU contribution 
and number of projects, are public entities, such as health ministries, national health agencies, 
institutes, laboratories, university hospitals and research organisations. NGOs benefited from 
both operating and action grants, with 27 NGOs having benefited from operating grants and 
255 NGOs from action grants in the 2021-2024 period.  

The Programme’s performance is as it was expected to be at this interim stage when only a 
limited number of actions have reached completion and delivered results. The impacts of these 
results are expected to unfold in the years to come and will be analysed in the final evaluation, 
due by the end of 2031. The EU4Health Programme also 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 and disease prevention and tackle 
environmental risk factors to health.  

Looking ahead  

In the programming phase, setting strategic and thematic priorities for periods longer than 
one year may enable stakeholders to plan for a longer time frame. Where appropriate, in some 
specific areas (e.g. health systems and healthcare workforce) the strategic grouping of actions 
within  specific  instruments  could  also  be  explored.  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.  

In  addition,  fostering  political  ownership  and  engagement  within  Member  States  in  joint 
actions  can  help  realise  the  full  potential  of  these  initiatives  and  ultimately  improve  health 
outcomes  across  the  EU.  The  success  of  health  actions  at  national  level  requires  the  active 
engagement  of  the  Member  States’  authorities,  which  play  a  key  role  in  implementing 
impactful  initiatives.  Closer  collaboration  and  alignment  of  priorities  at  both  EU  and 
national/regional level are essential to assign clear roles  and responsibilities in joint actions 
(e.g. coordinator and affiliated entities).  

15 

 
Enhancing administrative efficiency  by  simplifying complex procurement  procedures and 
flexible tendering, reducing reporting burdens, and streamlining grant application processes, 
could  significantly  ease  the  workload  for  beneficiaries.  Moreover,  standardising  procedures 
and  aligning  requirements  across  EU  funding  programmes  could  reduce  duplication  of 
administrative actions and streamline operations, particularly  in  areas like audit certificates, 
where differing rules add complexity. Coherence across initiatives could be further improved 
by aligning administrative requirements with other EU programmes, such as Horizon Europe, 
to avoid duplication of efforts and harmonising procedures. In addition, the simplification of 
administrative  requirements  for  funding  application,  reducing  co-financing  burdens,  and 
streamlining monitoring and reporting processes could improve efficiency and attract broader 
participation. The identified measures for reducing administrative burden  in  the EU4Health 
Programme can potentially enhance effectiveness and efficiency of its implementation, while 
actively contributing to the new Commission’s priority of enhancing simplification across all 
policies.  

The possibility to  adjust  co-funding rates, when justified, and  to  provide  more flexibility, 
including full coverage of eligible costs, could be considered. This would be helpful because 
most of the actions in the Programme, with the exception of the ERNs43, only partially cover 
their eligible costs. In addition, by expanding partnerships with other funding mechanisms, 
such as InvestEU44, the Technical Support Instrument45, the European Regional Development 
Fund46, and the European Social Fund Plus47, there would be opportunities to further amplify 
the Programme’s impact.  

By investing 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 
health policy priorities and objectives.  

43   The direct grants to the WHO may also be financed up to 100% from the eligible costs. However, after the 
pillar assessment of the WHO, OECD and other international organisations was completed the Programme 
financed them via contribution agreements (indirect management). 
InvestEU. 

44  
45   Technical Support Instrument. 
46   European Regional Development Fund. 
47   European Social Fund Plus. 

16