On discharge in respect of the implementation of the general budget of the European Union for the financial year 2024, Section III – Commission

OPINION

The Committee on Public Health calls on the Committee on Budgetary Control, as the committee responsible, to incorporate the following into its motion for a resolution:

1. Regrets that the budgetary expenditure entered in the accounts for the year 2024 is materially affected by error; notes furthermore that the European Court of Auditors (ECA) estimated the overall level of error affecting such expenditure at 3.6%, thus evidencing that a considerable proportion of the expenditure recorded in the accounts is subject to material irregularities; stresses that Union health spending must be assessed not only in terms of legality and regularity, but also with regard to its effectiveness, efficiency and European added value, in particular its capacity to deliver measurable improvements in access to healthcare, including for vulnerable groups; and aligning with the Union's One Health approach;

2. Recalls the findings of the ECA’s Special Report on the Digitalisation of Healthcare, which concluded that Union support to Member States has been overall effective in fostering the digital transformation of healthcare systems; notes, however, that Member States have faced difficulties in utilising Union funds allocated for this purpose and regrets that while the Commission monitors the progress achieved by Member States in the digitalisation of healthcare, it does not yet possess a comprehensive overview of how Union funds are being used to support these activities; calls on the Commission to implement in full the ECA’s recommendations, in particular by improving guidance to Member States, strengthening monitoring and performance-based oversight of EU funds used for digital health and ensuring that digital health investments uphold the highest standards of data protection, cybersecurity and interoperability;

3. Calls on the Commission to take corrective action addressing the shortcomings identified by the ECA and the concerns expressed by the European Parliament, with particular attention to EU4Health and health-related digitalisation and crisis-preparedness spending; emphasizes that budgetary planning and execution should complement national plans on public health, deliver tangible public health benefits to citizens and foster competitiveness in the Union, so that digitalisation results in effective improvements in healthcare delivery;

EU4HEALTH

4. Strongly regrets the disproportionate €1 billion cut to the EU4Health programme schedule for the 2025-2027 period; recalls the importance of the public health policies and the clear political commitment in the Council Regulation (EU, Euratom) 2020/2093 of 17 December 2020 laying down the multiannual financial framework for the years 2021 to 2027 (2020 MFF agreement) to prioritise health funding; emphasizes that health funding should be used as efficiently as possible and targeted at areas with the European added value; recalls that EU4Health 2021–2027, as a standalone programme, has a transformative role in supporting public health and advancing the Union’s public health policy objectives; considers that recent funding reductions undermine the Union’s capacity to invest in prevention, health-system resilience and mental health; calls on the Commission and the Council to reverse these cuts in the next multiannual financial framework and in the annual budgetary procedure; calls for a stronger focus within EU4Health on health promotion and disease prevention, including dedicated funding for mental health, non-communicable diseases, and gender sensitive health approach; further calls on the Commission to strengthen coordination mechanisms and ensure that actions financed under EU4Health complement, rather than duplicate, other Union programmes, thereby maximising efficiency and public health impact;

5. Recalls the Commission’s overall implementation of the budget under the EU4Health programme, noting that 64.5% of commitments and 29.3% of payments were executed; takes note of the level of budget implementation under the EU4Health programme, with execution remaining partial for both commitments and payments; highlights the importance of continued efforts to improve implementation, particularly in light of ongoing and significant public health challenges; calls on the Commission to improve transparency, streamline procedures and provide targeted support, particularly to smaller Member States and civil society organisations, in order to ensure more effective and equitable use of EU4Health resources across the Union; calls on the Commission to improve the absorption rate of EU4Health funds by simplifying procedures and by providing technical support to Member States if needed;

6. Notes that investments in crisis preparedness and response represented approximately 64% of the EU4Health annual budget for 2024; acknowledges that these investments have significantly strengthened the Union’s capacity to respond to health emergencies including medical countermeasures, enabling timely interventions;

7. Notes the importance of transparent and objective allocation of EU4Health funds, ensuring their effective use in line with the programme’s overarching goal of improving healthcare and public health outcomes for European citizens, and in accordance with clear, verifiable and measurable objectives; welcomes the significant progress made in the implementation of the EU4Health programme, noting that several milestones set for 2024 have been met or exceeded across various strands; highlights the advances achieved towards the 2027 targets in key areas, including crisis preparedness and response, health promotion and disease prevention, cancer initiatives, and support for patients with rare diseases through the European Reference Networks (ERNs);

8. Acknowledges that the EU4Health programme has contributed to the InvestEU programme through blending with the EU guarantee, thereby mobilising additional investments; notes in particular the contribution of EUR 110 million via an InvestEU top-up supporting European Investment Bank (EIB) investments in innovative life-science projects related to medical countermeasures; underlines the importance of ensuring transparency, efficient coordination with national and EU funding instruments, and broad access to Member States so that these investments deliver strong European added value and strengthen the resilience of the Union’s health systems; recalls the importance of investing in medical innovation and technologies at a European level and the importance of strengthening the cooperation between research institutions, private medical companies and public authorities to better serve the public interest;

9. Highlights that special attention was devoted to antimicrobial resistance (AMR), notably through cooperation on antibiotics’ innovation with the Global Antibiotic Research and Development Partnership;

10. Notes that direct grants to Member States aimed at strengthening national surveillance systems, attracted 23 proposals, launched between October 2024 and January 2025, with a Union contribution of approximately EUR 87 million; further notes that the joint action on counteracting antimicrobial resistance, supported by EUR 50 million, engaged all Member States and a broad consortium of beneficiaries; recalls the programme’s contributions to international coordination with the World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC), supporting efforts to respond to recent Ebola, mpox, and Marburg virus outbreaks in Africa;

11. Observes the continued investment in the EU Early Warning and Response System and in three waves of new European reference laboratories for human pathogens; notes that nine laboratories have been appointed to date, with funding secured for the next seven years;

12. Notes with satisfaction that implementation of the health promotion and disease prevention strand (representing 9.7% of the annual budget) is on track; welcomes the 142 pilot projects under the joint action on cardiovascular diseases and diabetes, as well as the wide participation of Member States in public health interventions across all stages of life; stresses, however, that major inequalities persist in access to prevention and screening between and within Member States, and calls on the Commission to use EU4Health to support targeted interventions for disadvantaged regions and persons in vulnerable situation;

13. Welcomes the broad involvement in the Mental Health Together joint action, with 20 Member States adopting a comprehensive approach to mental health, and the European Programme for Mental Health Exchanges, Networking and Skills, enabling the participation of around 300 professionals; calls on the Commission to dedicate more resources in future work programs to community-based mental health services, with a particular focus on children and young people, LGBTIQ+ persons and people in precarious work or housing situations; underlines the need to address psychosocial risks at work, including stress and burnout and to consider the impact of digitalization and social media on mental health;

14. Notes the launch of new grants for European Reference Networks (ERNs) for rare diseases, with a total budget of EUR 77.4 million and a funding rate of 100%; welcomes the introduction of harmonised work packages and indicators to improve comparability, synergies, and best-practice exchange among ERNs; notes furthermore the joint action on the integration of ERNs into national healthcare systems, launched in January 2024, involving 58 partner institutions across all Member States, Norway and Ukraine, with total funding of EUR 18.75 million;

15. Welcomes the health systems and healthcare workforce strand (representing 5.4% of the annual budget) for delivering tangible results, including the publication of Health at a Glance: Europe 2024 and progress under the new regulatory framework for medical devices; takes note that by October 2024, 10 554 certificates for medical devices and 1 273 certificates for in-vitro diagnostic devices had been issued; welcomes the creation of an IT platform to support the implementation of the Health Technology Assessment Regulation, involving nearly 500 users from EU and EEA countries, as well as the training of 350 patients to contribute to joint work on assessments; expresses concern about chronic staff shortages and burnout in the health and care workforce across the Union; calls on the Commission to fully leverage EU4Health and other EU programmes to make healthcare careers more attractive, notably through continuous training, fair working conditions, and to encourage sustainable staffing and robust retention policies for health workers, particularly in underserved regions;

16. Acknowledges EU4Health support for Member States in implementing the new Substances of Human Origin Regulation, and notes funding for studies on pricing and reimbursement and on the Clinical Trials Regulation;

17. Welcomes the digital strand’s contribution (3% of the annual budget) to the digital transformation of healthcare, particularly through the expansion of MyHealth@EU and HealthData@EU, both key enablers of the forthcoming European Health Data Space; stresses that 22 countries launched 44 key projects to improve interoperability and access to health data; stresses that investments in the digital transformation of healthcare must deliver tangible benefits for patients and healthcare professionals, notably by ensuring interoperability, robust cybersecurity and user-friendly solutions across all Member States; highlights the need to provide targeted support to smaller health systems in island, remote, peripheral and outermost regions, which often face limited administrative and technical capacity; insists that all such projects fully comply with EU data protection legislation, uphold high security and anonymisation standards, prevent the commercial exploitation of health data without meaningful patient consent, and guarantee that patients retain control over their personal data;

18. Welcomes the implementation progress under the cancer strand (21.5% of the annual budget) contributing to Europe’s Beating Cancer Plan, with 74 initiatives launched; regrets, however, that only 18 Member States participated in the CanScreen-ECIS project, underscoring persistent gaps in national data collection capacities and the need for further EU support and funding in this area; acknowledges the advances made under Europe’s Beating Cancer Plan, including actions on vaccine-preventable cancers and cancer screening; encourages Member States to strengthen HPV and HBV vaccination efforts, supported by the EU4Health initiative with particular focus to have equal access for vulnerable populations;

19. Regrets the Commission’s decision to discontinue operating grants for health civil society organisations under the EU4Health 2025 Work Programme, noting that such grants represented only a small share of the programme’s budget; notes the concerns expressed by many organisations regarding the impact on staffing, project continuity and support for patients and communities; emphasises the importance of stable and predictable support mechanisms for health civil society organisations, where appropriate and in full respect of the principle of subsidiarity; takes note of findings from the external evaluation of the EU4Health Programme confirming that organisations receiving operating grants meet their objectives, use public funds responsibly and provide valuable expertise and community input to EU health policy; underlines the need for future funding to continue to be based on clear criteria of European added value, transparency, neutrality and measurable impact, in order to sustain meaningful civil society contributions to Union health objectives;

HERA

20. Notes that DG HERA, established in 2021, has reached a consolidated and stable staffing level, with 107 staff members recruited by the end of 2024 compared to the 120 initially foreseen at its creation; welcomes the maintenance of a 50% gender balance in middle management and deputy positions; acknowledges the progress made by HERA in implementing actions within its mandate, strengthening the Union’s preparedness and crisis-response capacity for health emergencies, and expanding cooperation with international partners to enhance global preparedness, prevention and detection of health threats;

21. Acknowledges the Commission’s report on HERA’s three years of operation and its central role within the EU’s reinforced health security framework in strengthening the Union’s capacity to develop, produce and deploy medical countermeasures in response to health threats; notes, however, that further improvements are needed to fully realise HERA’s potential in protecting citizens and enhancing preparedness; recalls the Commission’s commitment to conduct a comprehensive review of HERA’s implementation by 2025, including possible adjustments to its structure and governance, and calls on the Commission to ensure that the findings of this review are effectively addressed in order to enhance HERA’s capacity;

22. Notes the measures taken to reinforce the Union’s manufacturing preparedness capacities, including the establishment of EU FAB, an “ever-warm” network for vaccine production; underlines the importance of further developing flexible and rapidly deployable production capacities for vaccines and medical countermeasures to ensure better preparedness for future health emergencies; notes the EU’s strengthened action against antimicrobial resistance (AMR), including the joint action co-funded through EU4Health with a €50 million investment engaging all Member States and a broad consortium of partners; underlines that AMR remains a major cross-border health threat and stresses the importance of continued support for prevention, surveillance, stewardship and responsible antimicrobial use as essential elements of the Union’s health security;

23. Recalls that Parliament advocated for enhanced parliamentary oversight of its activities; reiterates its call for regular, public reporting by HERA to Parliament;

24. Notes that the targeted revision of the MFF in 2024 resulted in reductions across several programmes, including EU4Health and Horizon Europe, which had a direct impact on the resources available for health preparedness; welcomes the Commission’s decision to mitigate the impact of these reductions by postponing the majority of the budgetary adjustments to 2027, when the budget for preparedness will reach its peak level; warns, however, that preparedness funding must not come at the expense of investments in prevention, health promotion and health system strengthening; calls for better coordination to ensure a balanced and coherent use of limited health resources;

25. Observes that, because DG HERA was created in the middle of the 2021-2027 MFF, its activities had to draw upon existing Union programmes, they are subject to multiple legal frameworks and governance arrangements, each involving different stakeholders and reflecting broader policy objectives beyond DG HERA’s specific mandate; stresses, therefore, the need for the continuation of current efforts on effective coordination among the relevant Commission services, as well as for close cooperation between DG HERA’s stakeholders and Member States’ representatives participating in the governance and programme committees of the respective funding instruments to prevent inefficiencies, duplication of efforts and overlapping mandates;

26. Calls on the Commission to improve the quality of communication, by clearly defining communication roles, in order to strengthen stakeholders' engagement and public support;

27. Notes that concerns have been raised about potential overlaps and a lack of clarity regarding HERA’s role within the Union’s broader health security framework, including in relation to DG SANTE, which has at times led to confusion among external stakeholders; underlines the importance of effective coordination and complementarity between HERA and other Union bodies involved in health emergency preparedness and response, including ECDC, EMA and relevant advisory and coordination structures; welcomes the clarifications provided through the Union Prevention, Preparedness and Response plan;

28. Emphasises that greater coherence in governance, operational coordination, external communication and institutional representation will enhance transparency, strengthen stakeholder engagement and improve the Union’s resilience and preparedness for future health crises

Conclusion

Is of the opinion, based on the data and reports available, that discharge can be granted to the Commission in respect of expenditure in the areas of public health for the financial year 2024.

ANNEX: DECLARATION OF INPUT

The rapporteur for opinion declares under her exclusive responsibility that she did not include in her opinion input from interest representatives falling within the scope of the Interinstitutional Agreement on a mandatory transparency register, or from representatives of public authorities of third countries, including their diplomatic missions and embassies, to be listed in this Annex pursuant to Article 8 of Annex I to the Rules of Procedure.

INFORMATION ON ADOPTION BY THE COMMITTEE ASKED FOR OPINION