EU4Health - Performance

Programme in a nutshell

Concrete examples of achievements

^{(*) Excluding cancer.}

Budget for 2021-2027

[notranslate]EU4HealthWeb:budg_01:pie[/notranslate]

Rationale and design of the programme

The EU4Health programme is a key instrument for delivering a comprehensive response to the health needs of EU citizens, reflecting the implementation of priority EU legislative proposals and acts, flagship initiatives such as the Europe Beating Cancer Plan, preventing non communicable and communicable diseases, lessons learned from the COVID-19 crisis, the consequences of Russia’s unjustified and unprovoked war against Ukraine, and previous health programmes.

Budget

Budget programming (million EUR):

[notranslate]EU4HealthWeb:budg_02:table[/notranslate]

Financial programming:
- EUR 211.8 million (- 9%)
compared to the legal basis *

^{(*) Top-ups pursuant to Art. 5 MFF Regulation are excluded from financial programming in this comparison.}

The initial EU4Health envelope has been reduced to take into account the redeployment of funds that were allocated to the extended mandates of the European Centre for Disease Prevention and Control and the European Medicines Agency.

EU4Health is benefiting from funds under Article 5 of the multiannual financial framework regulation. The overall amount under Article 5 of the multiannual financial framework regulation to be allocated to the EU4Health for 2021-2027 was around EUR 3.3 billion in current prices, where the exact amount to be added to the programme for year n is normally known during the draft budgetary procedure for year n. The amount has been reduced by EUR 1 billion following the 2024 midterm revision of the multiannual financial framework and now amounts to EUR 2.3 billion. The redeployment of the programme specific allocation under Article 5 following the agreement of the midterm revision will be implemented in the years 2025-2027. EUR 264.5 million in top-ups are included in the 2025 draft budget. Conversely, in line with the usual procedure, the top-ups for 2026 and 2027 are not yet included in the financial programming.

Budget performance – implementation

Cumulative implementation rate at the end of 2023 (million EUR):

[notranslate]EU4HealthWeb:budg_03:table[/notranslate]

Voted budget implementation (million EUR) ^(*):

[notranslate]EU4HealthWeb:budg_04:table[/notranslate]

Contribution to horizontal priorities

Green budgeting

The actions included in the 2023 annual work programme are not covered by the taxonomy screening criteria for determining the conditions under which an economic activity qualifies as contributing substantially to climate change mitigation or climate change adaptation and for determining whether that economic activity causes no significant harm to any of the other environmental objectives ⁽¹⁾.

Contribution to green budgeting priorities (million EUR):

[notranslate]EU4HealthWeb:budg_05:table[/notranslate]

The EU4Health programme does not contribute directly to the climate, biodiversity and clean air horizontal priorities. To ensure a high level of human health protection in all EU policies, the actions funded by the programme are implemented, where applicable, in keeping with the ‘one health’ approach, which recognises that human health is connected to animal health and to the environment, and that actions to tackle threats to health must consider those three dimensions. The funds allocated to ‘one health’ actions vary over the year, and the total budget is about EUR 314 million. In addition, actions addressing environmental risk factors for health will be included in the upcoming annual work programmes. The 2023 annual work programme includes seven actions addressing environmental risk factors for health under crisis preparedness and under health promotion and disease prevention, and the 2024 annual work programme under crisis preparedness and health promotion and disease prevention.

^{(1)Commission Delegated Regulation (EU) 2021/2139 of 4 June 2021 supplementing Regulation (EU) 2020/852 of the European Parliament and of the Council by establishing the technical screening criteria for determining the conditions under which an economic activity qualifies as contributing substantially to climate change mitigation or climate change adaptation and for determining whether that economic activity causes no significant harm to any of the other environmental objectives.}

Gender

Contribution to gender equality (million EUR) (*):

[notranslate]EU4HealthWeb:budg_06:table[/notranslate]

The EU4Health programme has no significant bearing on the promotion of gender equality, considering that it aims to keep all people healthy and active for longer, irrespective of gender. However, some actions – for example cancer screening for breast cancer and cervical cancer, and vaccination coverage for human papillomaviruses – that focus on women’s health may provide relevant information for the purpose of the gender tracking of the EU4Health programme, which for the time being has been assigned a score of 0*. Several indicators that focus on male-related diseases – such as prostate cancer, and the increase in vaccination coverage for human papillomaviruses in boys – may provide relevant information on gender equality.

In addition, in the case of two indicators (i.e. the age-standardised 5-year net survival rate for paediatric cancer and the percentage of the population covered by cancer registries reporting information on colorectal and paediatric cancer stage at diagnosis), relevant data that can be disaggregated are expected to become available in 2025.

In the case of three other indicators, very limited gender disaggregation may be possible when data become available (the indicators ‘Number of actions addressing the prevalence of major chronic diseases per Member State, by disease, gender, and age’, ‘Number of actions addressing the age prevalence of tobacco use, if possible, differentiated by gender’ and ‘Number of actions addressing the prevalence of harmful use of alcohol, if possible, differentiated by gender and age’).

Future action-level indicators may provide relevant information on gender equality during the implementation of the programme, and data will be reported accordingly.

Digital

Contribution to digital transition (million EUR):

[notranslate]EU4HealthWeb:budg_07:table[/notranslate]

The EU4Health programme contributed substantially to the digital transition in 2021, 2022 and 2023, with a total programmed budget of EUR 381.55 million supporting actions in the following intervention fields: (1) human capital – information technology services and applications for digital skills and digital inclusion; support for the development of digital skills; (2) digital public services – government information and communications technology solutions, e-services and applications; e-health services and applications (including e-Care, the internet of things for physical activity and ambient assisted living), and digitalisation in healthcare. The total amount committed in 2021, 2022 and 2023 was about EUR 285.65 million.

The 2023 work programme includes actions (EUR 72.69 million) that contribute to the digital transition goal and are assigned to the following EU4Health annual programme strands: digital, crisis preparedness and health systems. Additional investment is planned in the 2024 annual work programme under the digital strand (EUR 25.75 million).

Budget performance – outcomes

[notranslate]EU4HealthWeb:budg_09:progress[/notranslate]

• The programme performance is on track and is reflected by the key achievements highlighted below. All the actions (593) of the annual work programme for 2021 and 2022, and almost all from 2023, have been launched. The implementation of the 2024 annual work programme is on schedule. 
• The 2023 annual work programme will continue to support crisis preparedness, with almost half (48.7%) of the annual budget allocated to this strand by DG Health and Food Safety and HERA. The programme supports the implementation of Regulation (EU) 2022/2371 with a budget of EUR 97 million. This budget is spent on Member State actions for crisis preparedness, surveillance, European reference laboratories, early warning and response capacities, the EU immunisation agenda and setting up advisory committees. The digital passenger locator form is ongoing. In addition, EUR 50 million are supporting a joint action on anti-microbial resistance and international collaboration and coordination in preparedness and response are ensured through grants to the World Health Organization, also with a focus on preparedness against CBRN threats. 
• The 2021 and 2022 crisis preparedness achievements relating to HERA activities include enhanced infrastructure and capacities for pandemic preparedness and response related to medical countermeasures, for instance by supporting whole genome sequencing and reverse transcription polymerase chain reaction infrastructure and capacities in EU Member States. In addition, progress has been made on the development of an information technology system to collect intelligence and assess threats in order to inform the prioritisation of medical countermeasure development. In addition, with EU FAB, HERA established a network production capacities for vaccine and medicine manufacturing that can be activated quickly in the event of future crises. HERA also purchased and distributed vaccines against mpox virus to all Member States. On antimicrobial resistance, a comprehensive assessment of innovation for medical countermeasures was performed, including a gap analysis and needs assessment in Member States, along with a feasibility study on antimicrobial resistance to determine critical medical countermeasures and establish means of storage. International collaboration for pandemic preparedness as relates to medical countermeasures, for example with the World Health Organization, was also supported and developed. 
• The 2023 performance of the programme regarding implementation of the health promotion and disease prevention strand (4.55% of the annual budget) is on track to deliver the policy objectives of the ‘healthier together – EU non-communicable diseases’ initiative, in particular on dementia and other neurological disorders, and on chronic respiratory diseases, and the Commission’s communication on a comprehensive approach to mental health with a specific focus on vulnerable groups and cancer patients. Moreover, it is on track to support the prevention of vaccine-preventable cancers and cancers caused by infections, thereby supporting Europe’s Beating Cancer Plan and the implementation of the Commission proposal for a Council recommendation on vaccine-preventable cancers, once adopted in the Council. It is also on track to support the implementation and enforcement of tobacco control legislation and other related EU health initiatives. 
• A total of 21 actions addressing the prevalence of major non-communicable diseases by Member State and one action on the environmental risk factors for health have been launched successfully. 
• Eighteen Member States are implementing ‘best’ and ‘promising’ practices regarding health promotion, disease prevention and health inequalities and the target has been almost achieved. 
• The number of Member States that had reached 95% coverage for both the first and the second dose of the measles-containing vaccine for eligible individuals fell from five in 2020 to three in 2021, and rose again to four in 2022 (the target for 2031 being eight Member States). The number of Member States that had reached at least 90% coverage for a full human papillomaviruses vaccination course (last dose) in eligible girls fell from one in 2021 to none in 2022, and more data are necessary to understand the reason for this decline. 
• The challenge of developing synergies between different actions identified in the last performance assessment in 2023 is progressively being overcome. Several joint actions under the ‘healthier together’ initiative are complemented by projects implemented by stakeholders on the same topic to ensure maximum impact. Synergies within the EU4Health programme, and between EU4Health and other EU funding instruments, have been developed through the organisation of joint events bringing together relevant actors to present projects on thematic areas such as mental health. 
• The total budget for health promotion and disease prevention in 2021, 2022 and 2023 met the requirement of reserving a minimum of 20% for that purpose. 
• Implementation of the cancer strand (25.45% of the annual budget) is on track to deliver the policy objectives of Europe’s Beating Cancer Plan. A total of 51 actions that address the prevalence of cancer have been launched successfully. All country cancer profiles for EU Member States (plus Iceland and Norway) were published, highlighting key achievements and challenges in cancer prevention and care for each country. 
• In addition, with funding from the EU4Health programme, and developed by the Commission’s Joint Research Centre, the European guidelines and quality assurance scheme for breast cancer was piloted in 20 breast cancer settings in nine Member States. Following this successful pilot project, the scheme is now ready for large-scale implementation across the EU. 
• Also funded under the EU4Health programme, work on improving oncological training is ongoing, with the Interact-Europe project having developed an inter-speciality training curriculum, which is now being piloted and rolled out through the Interact-Europe 100 follow-up project to 100 cancer centres across 15 Member States. In this context, two new modules are also being introduced focusing on paediatric oncology and specific needs for displaced people with cancer, with a special focus on Ukraine. 
• Based on estimates from the Joint Research Centre, the percentage of the population covered by cancer registries reporting information on cervical, breast, colorectal and paediatric cancer stage at diagnosis was 56.1% for cervical cancer, 54.5% for breast cancer, 56.5% for colorectal cancer and 54.1% for paediatric cancers in 2022. The number of Member States with at least one cancer registry that had submitted the stage, also based on preliminary estimates, was 26 across all four cancer types in 2022, therefore only one Member State was missing. Data for 2023 are not yet available. 
• One indicator (age-standardised 5-year net survival rate for paediatric cancer) is still under construction. 
• Under the health systems and healthcare workforce strand (16.09% of the annual budget), the EU4Health programme supports policies that aim to generate country-specific and cross-country knowledge on health systems and to strengthen the resilience of Member State’s health systems, including by transferring best practices in primary care, implementing high-impact prevention practices, supporting work on health technology assessment and enhancing access to healthcare, with the aim of achieving universal health coverage. The European reference networks continued to facilitate access to diagnosis and treatment by patients with rare conditions and continued to be focal points for medical training and research and the dissemination of information. The 24 networks have just completed their first evaluation, and all 24 received a positive assessment. Currently, 1 619 clinical centres’ healthcare providers are part of the European reference networks across the EU Member States and Norway.  
• In 2023, the fourth cycle of the state of health in the EU project, financed by EU4Health programme, delivered a set of 29 country health profiles (for the 27 Member States plus Iceland and Norway), each highlighting the latest challenges and policy responses in the respective national health systems, including a spotlight analysis about mental health. 
• The development of guidelines and recommendations for Member States on how to assess and improve access to healthcare services was supported by one action financed by the EU4Health programme since 2021. This action has so far delivered a ‘universal health coverage’ tool that consolidates quantitative and qualitative data on financial protection in access to healthcare, and has also carried out a comparative analysis of financial protection in access to healthcare in the European region. The programme continues to support Member States in addressing health workforce challenges related to shortages and skills mismatches, including through health workforce planning and forecasting, and skill building (e.g. via seven training projects with a focus on digital skills). Work to set up an EU system for health technology assessment, under Regulation (EU) 2021/2282, has progressed. With support from EU4Health, the full governance structure of the new EU health technology assessment system is operational (Member State Coordination group, its four subgroups and a stakeholder network) and the first release of a dedicated secure information technology platform went live in 2023. The implementation of the cancer-related actions is on track, but performance monitoring and data collection is expected to be delayed as several indicators are under development. The Commission expects to recover the delay incurred and collect the data by the end of 2023. 
• The health systems work well if medicinal products, medical devices and crisis-relevant products are readily available to patients. The number of medicines authorised centrally by the European Commission and valid across the EU increased by around 5% in 2023. The number of medical devices placed on the market also increased. Between March and August 2023, the number of certificates for medical devices under Regulation (EU) 2017/745 increased from 2 951 to 3 899. In the same period of time, there was also an increase in the number of certificates for in vitro diagnostic medical devices under Regulation (EU) 2017/746, from 331 to 500. More devices being certified on the European market under these two regulations increases the safety of patients and lead to a higher level of public health.  
• This was, however, only partly influenced by the actions funded under the EU4Health programme, given that the causal link between the challenge and those actions is very weak. It should also be acknowledged that, while the relative increase in the availability of medical devices and in vitro diagnostic medical devices is a positive development, more efforts have to be made to meet the needs of healthcare systems to make devices available and avoid shortages. With this objective, co-legislators adopted a regulation (Regulation (EU) 2023/607) in 2023 as an urgent measure to facilitate the transition to the legal framework set out in Regulation (EU) 2017/745. In early 2024, the Commission proposed a further amendment to Regulation (EU) 2017/746 to give in vitro diagnostics more time to comply with the new rules. It is expected that these measures (in Regulation (EU) 2023/607 and the Commission proposal, if adopted)) will have an impact on the indicators. This will be considered in upcoming reporting. This strand may be negatively impacted by external shocks, such as monetary and fiscal shocks, which may negatively affect the capacity of the Member States’ public authorities to commit human and financial resources to the ongoing or planned actions. 
• The digital strand of EU4Health, with 3.5% of the annual budget, continued to support the preparations for the European Health Data Space in 2023. The financial support from EU4Health focused on supporting Member States’ work on increasing semantic interoperability, preparing the groundwork for the implementation of the European Health Data Space and developing cross-border digital health infrastructures (MyHealth@EU and HealthData@EU). The participation of Member States in the European Health Data Space remained stable, with a new Member State joining MyHealth@EU in 2023, making it a total of 12 Member States participating in cross border exchange of health data. Over 20 new projects were selected that will allow the roll-out of new services across the EU in the coming years. More than 20 new projects were also selected for setting up health data access bodies, which will play a fundamental role in enabling the reuse of health data in the European Health Data Space. The total EU contribution committed in these projects exceeded original forecasts by over 20% (EUR 13 million), showing the significant investment needs in Member States in this area. These projects are complemented by others launched under the digital Europe programme (e.g. for enabling the reuse of cancer images and genomic data) and Horizon Europe (e.g. on the development of a data quality and utility label for the European Health Data Space). The timely implementation of the digital strand is dependent on the upcoming regulation on the European Health Data Space. This is the case, for example, for the implementation of the database for electronic health record systems, the execution of which relies heavily on the provisions in the final text. The implementation of this strand will also depend on the availability of resources and specialised technical expertise in Member States, which could affect the performance of some actions. To address these limitations, the Commission is providing extensive support to Member States, for example in the eHealth Network, in the eHealth Member States Expert Group and through the creation of a community of practice in the area of secondary uses of health data. 
• The international health initiatives and cooperation cuts across several areas, and in particular implements the global health strategy adopted in November 2022. The total budget supporting global commitments and health initiatives is below the maximum threshold of 12.5% of the programme’s total budget. The EU global health strategy is already supported by total investment of about EUR 21 million under the 2021, 2022 and 2023 work programmes. However, the strategy is delivered to a large extent by international organisations, such as the World Health Organization. Following its association to the EU4Health programme in July 2022, Ukraine successfully engaged in all joint actions, and a considerable number of the actions launched under the 2022 work programme have addressed health challenges related to the consequences of the Russian war of aggression against Ukraine. The Commission launched a grant in 2023 to establish a Member State joint action to put in place rolling mechanisms for closer coordination between the EU institutions and Member States, and therefore strengthen the EU’s leadership in global health. However, the unpredictable current geopolitical context, dominated by the war of aggression, may trigger new jeopardising factors that will need to be addressed in as timely a way as possible. The implementation of the global commitments and health initiatives also depends to a great extent on the performance of the international organisations entrusted by the Commission to deliver through indirect management. Adequate monitoring and regular contacts are necessary to ensure a good implementation. 
• The EU4Health programme finances studies to support the preparation of impact assessments and the evaluation of health policy initiatives. The focus of these studies is on a one-off assessment, and they do not necessarily provide, in a continuous manner, data and specific economic analysis addressing the needs of the Commission. In some cases (e.g. pharmaceutical and medical device policies), this requires the development of new framework contracts to provide health-specific economic analyses and the necessary data for these targeted analyses. In principle, all projects funded by the EU4Health programme include action-specific indicators. The data will be collected and reported by the beneficiaries, and proper monitoring has been put in place by the European Health and Digital Executive Agency to avoid any delays or low data quality. Four studies assessing the progress of policy initiatives are currently being funded by the EU4Health programme. These are on the EU action plan on childhood obesity, the tobacco control acquis, Europe’s Beating Cancer Plan and the EU4Health programme. In addition, two studies were funded and finalised in 2023: one on the evaluation and impact assessment of pharmaceutical legislation and one on the use of sunbeds and cancer risks. To date, there have been no published studies supporting the evaluation of health policies. 
• The annual work programmes for 2021 and 2022 were amended on two and three occasions respectively. The amendments were necessary to address the evolving COVID-19 pandemic and the health consequences of Russian war of aggression against Ukraine. The third amendment to the 2022 work programme was necessary to reallocate unspent budget to a new action to help the World Health Organization conduct clinical trials in Africa addressing the need to support the timely development of safe and effective medical countermeasures against filoviruses, including Marburg virus. The implementation of related actions may be influenced by the specific conditions on the field of action and the absorption capacity of the potential beneficiaries. 
• The budget of the programme has increased almost tenfold in comparison to the previous multiannual financial framework. The revision of the 2021-2027 multiannual financial framework redeployed funds across the EU budget, including EUR 1 billion from the EU4Health programme, a decrease of almost 20% in the total budget. Based on implementation experience acquired up to now by the European Health and Digital Executive Agency and the Commission, the financial absorption capacity of some entities (e.g. non-governmental organisations and some public authorities) is limited. The Commission and the European Health and Digital Executive Agency will continue to address this type of challenge in the same way as it implements the previous two annual work programmes, by reallocating unspent budget to other actions. The issue remains, however, that the co-funding rate of the EU4Health programme is limited to a 60% contribution by the EU. Only in exceptional utility cases can it reach up to 80%, making the contribution from some beneficiaries, in particular non-governmental organisations, difficult to achieve. The regulation includes a provision for the blending of funds from various EU funding programmes. However, the fact that the associated administrative and financial burden falls mainly upon the beneficiary only allows the absorption capacity concerns to be resolved to a limited extent. 
• The EU4Health programme is interconnected with several other key EU funding and policy initiatives, such as Horizon Europe, the Digital Europe programme, the Recovery and Resilience Facility and the Cohesion Policy Funds. The coordination of cluster 1 (health) in the Horizon Europe programme creates a seamless pathway from research to practical applications. The Digital Europe programme drives the digital transformation in Europe, supporting the development and deployment of digital technologies in healthcare (such as the digital wallet). The two programmes work together to support the expansion of digital health infrastructure such as electronic health records and telemedicine services. The Digital Europe programme promotes innovation in dataspace technologies, and EU4Health supports the Member States in coordinating their work and in capacity building. EU4Health also strategically complements national activities under the Recovery and Resilience Facility and the Cohesion Policy Funds on health resilience at the EU level. In this case, it is the European semester and the ‘state of health in the EU’ cycle that provide a coherent framework for investments by Member States and across the EU. 
• The EU4Health work programme is aligned with the goal of the proposed Strategic Technologies for Europe Platform of supporting investment in companies that contribute to preserving a European edge on critical biotechnologies. Reaping the full benefits of biotechnology can help the EU economy grow in respect of priorities such as sustainable development, public health and environmental protection. 

MFF 2014-2020 – Health programme

The third programme for EU action in the area of health (2014-2020) is a financial instrument for policy coordination at EU level. It aims to complement, support and add value to Member States' policies for improving the health of their citizens, reducing health inequalities, encouraging innovation in health and increasing the sustainability of their health systems.

Budget implementation

Cumulative implementation rate at the end of 2023 (million EUR):

[notranslate]EU4HealthWeb:budg_08:table[/notranslate]

The entire budget (EUR 452.35 million for 2014-2020) was committed by the first quarter of 2021 through projects and other actions pursuing the programme’s objectives.

By the end of 2023, 88% of the total budget (i.e. EUR 400 million) had been paid to participants and/or beneficiaries or for the procurement of necessary services. Considerable part of the outstanding amount will be paid under projects or actions launched in the last 2-3 years of the 2014-2020 multiannual financial framework, which have not yet been completed and therefore have not led to final payments by the Commission. Around 5-10% of the outstanding balance, which is the average implementation rate of the actions, might result in decommitments which will be done after the incurred expenses have been evaluated and therefore upon the completion of the actions. By the end of 2024 DG Health and Food Safety estimates that it will have paid in total EUR 410 million.

Performance assessment

[notranslate]EU4HealthWeb:budg_10:progress[/notranslate]

In the 2014-2020 period, the European Court of Auditors published several reports assessing the implementation of the health programme. In EU Actions for Cross-border Healthcare – Special report 07/2019, the Court of Auditors found that ‘EU actions in cross-border healthcare enhanced cooperation between Member States. The Commission has overseen the implementation of the Cross-border Healthcare Directive well.’ The special report also identified certain shortcomings and improvements that were necessary in terms of reducing administrative burden and the long-term financial sustainability of the European reference networks. In Addressing Antimicrobial Resistance – Special report 21/2019, the Court emphasised that ‘Fighting against antimicrobial resistance is complicated … The Commission and [European Centre for Disease Prevention and Control] support to strengthen Member States One Health approach to [antimicrobial resistance] was valuable’. However, it also pointed out some challenges, particularly with regard to the sustainable implementation of the results in the Member States. These were addressed in the new EU4Health programme. 

While reorienting and gearing a proportion of its resources towards fighting the COVID-19 pandemic, the third health programme continued to implement its main actions with a view to enhancing and further consolidating key achievements over the 2014-2020 implementation period. 

With regard to objective 1 ‘promote health, prevent diseases and foster supportive environments for healthy lifestyles’, the targets were reached in all respects except the number of Member States involved in the European accreditation scheme for breast cancer. 

With regard to objective 2 ‘protect EU citizens from serious cross-border health threats’, the target of 28 Member States integrating coherent approaches in the design of their preparedness plans was achieved in 2020. 

With regard to objective 3 ‘support public health capacity-building and contribute to innovative, efficient and sustainable health systems’, 41 notices of advice were produced and 23 Member States used the tools and mechanisms identified in order to contribute to effective results in their health systems. 

With regard to objective 4 ‘facilitate access to better and safer healthcare for EU citizens’, 24 European reference networks were established in accordance with Directive 2011/24/EU. Currently, 1 619 clinical centres healthcare providers are a part of the European reference networks across the EU Member States and Norway. 

The final evaluation of the third programme for the EU's action in the field of health (2014-2020) (the programme) has been completed. It assesses the performance of the programme, its main outcomes and achieved results and identifies the main problems and solutions with regard to its implementation. 

The main achievements of the programme are the following. 

1. The establishment of a portal for the exchange and implementation of best practices in health promotion and disease prevention. 
2. An ‘EU compass for action on mental health and wellbeing’, a web-based mechanism used to collect best practices and analyse information on policy and stakeholder activities in mental health. 
3. On cancer, the European quality assurance scheme, a harmonised and evidence-based way to grant equal and quality-benchmarked treatment to patients, and the European network of cancer registries coordinated by the Joint Research Centre (128 cancer registries from 29 European countries, with more than more than 25 900 000 records). 
4. A feasibility study was carried out for the development of a common EU vaccination card. The resulting template was tested by a sample of 10 000 citizens in 10 Member States. 
5. In 2018, the joint action on efficient response to highly dangerous and emerging pathogens at EU level (EMERGE joint action) delivered on its work for the improvement of capabilities for rapid laboratory diagnosis of new or emerging pathogens (e.g. sample sharing). The joint action also contributed to combating the outbreaks of ZIKA and Ebola. 
6. During the Ebola and Zika outbreaks, part of the funds of the programme were used to support interventions to limit the spread of these threats by strengthening Member States preparedness and response through the actions of the Health Security Committee. 
7. The European Health Data Space joint action, with 25 participating countries, facilitated the establishment of a European Health Data Space, by developing principles for the cross-border secondary use of health data. The Commission published its proposal for the establishment of the European Health Data Space in 2022. 
8. The joint actions for EU cooperation on health technology assessment enabled to produce 41 joint reports (joint assessment and early dialogues). These led to the adoption of legislation, securing EU cooperation on health technology assessment in the long-term. 
9. In 2023, the joint action on market surveillance of medical devices enabled the reinforcement of the market surveillance system for medical devices and the improvement of coordination and cooperation among all Member States. 

10. A total of 24 European reference networks – virtual networks involving healthcare providers across Europe – were established. They aim to tackle complex or rare medical diseases or conditions that require highly specialised treatment and a concentration of knowledge and resources. Currently, 1 619 clinical centres healthcare providers are a part of the European reference networks across the EU Member States and Norway. 

     

Key findings per evaluation criterion, lessons learned and recommendations 

Effectiveness 

The evaluation found that knowledge produced by the programme was used in policy making and the programme contributed to the improvement of health and healthcare policy developments in the EU (e.g. in the areas such as anti-microbial resistance, health technology assessment, health inequalities, alcohol, tobacco control, European reference networks for rare diseases). 

Funded actions helped achieve the programme’s objectives to a good extent, in particular for objective 1 (promote health, prevent diseases, and foster supportive environments for healthy lifestyles) and objective 4 (facilitate access to better and safer healthcare for EU citizens). This is demonstrated by the positive trend of the quantitative indicators associated with each of the 4 specific objectives of the programme. 

Despite effective contribution of the programme funded actions to combatting the COVID-19 pandemic, particularly in its early stages, the pandemic uncovered weaknesses in the preparedness and response to a major cross-border health threat of such magnitude at EU and at Member States level. These weaknesses and fragilities mainly related to the availability of tests and testing materials; to contact tracing, public health surveillance and rapid response to avoid further spread of the virus; to the availability of medical countermeasures (personal protective equipment, medicines and medical devices); to healthcare surge capacity (shortages of intensive care units, insufficient availability of healthcare staff).  

The preparedness and planning strand was found, at the beginning of the pandemic, to be underfunded and underdeveloped, implying the need for preparedness and response systems and cultures to be strengthened. 

It can therefore be concluded that objective 2 (Protect citizens against cross-border health threats) was only met to a moderate extent by the programme. 

Finally, the participation of countries with a low gross national income in the programme did not increase significantly, despite the exceptional utility criteria designed to do so. 

Efficiency 

The programme was relatively cost-effective. In particular, its functioning costs (administrative costs plus the costs allocated to the functioning of the Consumers, Health, Agriculture and Food Executive Agency) were found reasonable, moreover on decreasing trend and comparable with those of other EU programmes of similar size. 

The introduction of electronic tools, SYGMA-COMPASS for the submission of proposals, management of grants, monitoring and reporting mechanisms (also used by the Horizon 2020 framework programme for research and innovation), enabled, along with other simplifications measures (e.g. the introduction of framework partnership agreements for operating grants), to improve the efficiency of the programme implementation. However, according to some beneficiaries, there was some scope to further simplify the processes, especially in relation to funding applications, monitoring and reporting. 

Cost-effectiveness of actions could have been improved with a more centralised information system () dedicated to disseminating information about EU funding, ensuring synergies across projects, and further communicating on the results of the implemented actions. 

Coherence 

The actions funded by the programme were aligned with its objectives and coherent with each other.  

The programme also encouraged cooperation and was aligned with other instruments financing health-related activities, in particular the European Structural and Investment Funds and Horizon 2020. Moreover, actions funded by the programme contributed to wider EU policies and priorities (i.e. the Europe 2020 strategy for smart, sustainable and inclusive growth in 2014-2015, the Juncker Commission’s priorities in 2016-2019 and the von der Leyen Commission’s priorities in 2020), and were aligned with wider international obligations, in particular the World Health Organization’s Health 2020 common policy framework, as reflected in the Commission communication on an EU global health strategy. 

EU added value 

The programme provided added value in comparison with what could have been achieved by the EU without the programme and by Member States acting alone. In particular, it funded multiple actions which demonstrated strong EU added value by encouraging Member States to exchange best practices and cooperate and coordinate with each other on pertinent policy issues. Furthermore, it enabled mutual learning and knowledge exchange in areas such as health promotion, health technology assessment, rare diseases, antimicrobial resistance, alcohol and tobacco policy. 

Relevance 

The programme has for the most part remained relevant to changes in health needs over time and was flexible enough to respond to emerging health needs such as the migrant/refugee crisis in 2015 and to undertake and fund emergency actions to combat the COVID-19 pandemic in 2020, in its early stages. 

With the COVID-19 outbreak at the beginning of 2020 and the lessons learned from this pandemic, the protection of EU citizens from serious cross-border health threats became the highest health priority at EU level and in Member States. 

Lessons learned from the programme and from the COVID-19 pandemic in terms of unforeseen challenges, as well as new health needs, were taken into account in the design of the EU4Health programme (2021-2027) which succeeded the third health programme (2014-2020). They also led, notably, to the Commission proposals for establishing HERA, for the revision of the cross-border health threats regulation, for the revision of the mandate of the ECDC and for the building the European health union. This was a set of key actions and legal instruments helping to: 

• better protect the health of EU citizens; 
• equip the EU and its Member States to better prevent and address future pandemics; 
• improve the resilience of Europe’s health systems. 

Contribution to the sustainable development goals