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Brussels, 12 December 2025 Call to EU Member States to safeguard support for health & civil society action under the 2026 EU4Health Work Programme and the 2028–2034 Multiannual Financial Framework We, 38 health and patient advocacy organisations active across the European region and united under the EU4Health Civil Society Alliance, are writing ahead of two key moments that will shape the future of health in Europe, and where Member States support is essential: the upcoming EU4Health Steering Group meeting; and the European Council meeting on 18–19 December, where discussions on the next Multiannual Financial Framework (MFF) 2028–2034 are expected. We urge EU Member States to ensure that the EU4Health 2026 Work Programme reinstates operating support for civil society organisations (CSOs), and that the next MFF dedicates a robust and sustained budget to health, including a strong civil society component. 2025 has been an extremely difficult year for health CSOs, as the political decision to remove operating grants, communicated in July 2025 after months of delay, has led to the closure of at least two of our member organisations and forced many more to significantly reduce their activities and make staff redundant. We are extremely concerned that the lack of financial support for civil society’s involvement in EU health policymaking reflects a weakening of democratic processes, and we warn against institutionalising this dangerous precedent. Funding health and civil society is cost-effective, adds value, and supports equity As confirmed by the recent evidence produced in support to the interim evaluation of EU4Health (2021–2024), it is clear that the programme is cost-effective. Investments in preparedness for health crises generate substantial returns estimated between €9 billion and €27.5 billion, while investments in health promotion and disease prevention deliver additional returns, estimated up to €3.5 billion over time. The evaluation also shows that the EU4Health model delivers real EU added value, fostering cross-border cooperation and transnational initiatives that tackle systemic health challenges more efficiently than individual countries acting alone. This is especially meaningful for smaller or resource-constrained Member States. Since 2021, the programme has become even more relevant, not only in responding to the aftermath of COVID- 19 but also to growing, shared global challenges. According to the same report, CSOs have proven to be vital partners in achieving the EU4Health Programme’s objectives, amplifying its impact across Europe. By supporting CSOs whose missions align with EU4Health priorities, these grants have enhanced policy coherence and facilitated the inclusion of citizens’ voices in EU health policymaking. Thanks to these grants, health CSOs have, for example, promoted physical activity across Europe, expanded access to care for patients with chronic and rare diseases, and responded swiftly to emergencies like the displacement of families during the war in Ukraine. In addition, CSOs have played a decisive role in building capacity, sharing knowledge through international networks, and driving innovation in public health interventions. While technical and financial hurdles, such as complex administrative requirements and high co-funding obligations, still limit the participation of smaller organisations, the evidence clearly shows the value of sustained and simplified support for CSOs under the EU4Health framework.  Brussels, 12 December 2025 In light of this proven value and impact, it is crucial to safeguard operating grants and a strong Health Programme that enables CSOs to contribute to stronger, more equitable and people-centred healthcare systems. We identify two key milestones to reinforce EU health policy and ensure its long-term effectiveness, where Member States’ support and leadership are indispensable. Call for the reinstatement of operating grants for civil society under the EU4Health 2026 Work Programme Operating grants are the only instrument that ensure stable, predictable, multi-annual support to organisations that work directly with and for Europe’s communities, including the most vulnerable and marginalised. Without these grants, many organisations cannot maintain continuity, expertise, or the capacity to contribute meaningfully to EU policy objectives. We therefore urge EU Member States to actively support the reinstatement of operating grants in the 2026 EU4Health Work Programme, recognising their essential contribution to the programme’s effectiveness and to health democracy. Support a substantial, sustained health and civil-society budget in the next MFF (2028–2034) The MFF will determine the scale of EU ambition for health in the years ahead. While the current EU4Health programme has delivered substantial added value, the interim evaluation also reveals areas where investment has been insufficient, particularly in prevention, mental health, antimicrobial resistance, climate-related health risks, and non-communicable diseases. We are concerned that in the current proposal, health does not have a standalone window, thereby risking becoming the “adjustment variable” whenever other priorities arise. A strong, future-proof MFF must provide a robust and stable EU health budget that expands action across the healthcare continuum, from prevention to access to health services, with equity and solidarity at the core. In this context, ensuring dedicated and predictable long-term funding for health CSOs, building on the operating grant model that allows organisations to deliver sustained impact, is of utmost priority. We count on Member States support to ensure that these essential elements are upheld. Investing in health and civil society is indispensable to secure Europe’s resilience, social cohesion, competitiveness and future. The EU4Health Civil Society Alliance stands ready to support all member states in shaping a robust, forward-looking EU4Health 2026 Work Programme, and an MFF 2028–2034 that deliver for all people. Signatories: 1. European Public Health Alliance (EPHA) 2. European Patients’ Forum (EPF) 3. Alzheimer Europe 4. EURORDIS Rare Diseases Europe  Brussels, 12 December 2025 5. European Public Health Association (EUPHA) 6. AIDS Action Europe 7. Association of European Cancer Leagues (ECL) 8. Association of European Coeliac Societies (AOECS) 9. Childhood Cancer International Europe 10. Correlation - European Harm Reduction Network (C-EHRN) 11. Digestive Cancers Europe 12. EUROCAM 13. EuroHealthNet 14. European AIDS Treatment Group (EATG) 15. European Alcohol Policy Alliance (Eurocare) 16. European Association for Palliative Care (EAPC) 17. European Central Council of Homeopaths (ECCH) 18. European Federation of Allergy and Airways Diseases Patients' Associations (EFA) 19. European Federation of Neurological Associations (EFNA) 20. European Heart Network (EHN) 21. European Health Management Association (EHMA) 22. European Kidney Health Alliance (EKHA) 23. European Liver Patients’ Association (ELPA) 24. European Network for Smoking and Tobacco Prevention (ENSP) 25. European Respiratory Society (ERS) 26. Fertility Europe 27. Health Action International (HAI) 28. Infectious Disease Alliance (IDA) 29. International Diabetes Federation (Europe) 30. International Federation of Anthroposophical Medical Associations (IVAA) 31. International Sport and Culture Association 32. Mental Health Europe (MHE) 33. Psychedelic Access and Research European Alliance (PAREA) 34. Salud por Derecho 35. SIOPE – European Society for Paediatric Oncology 36. Smoke Free Partnership (SFP) 37. TB Europe Coalition (TBEC) 38. Wemos Brussels, 12 December 2025 Saatja: "Karmen Joller - SOM" <[email protected]> Saaja: "Liis Paas - SOM" <[email protected]>, "Info - SOM" <[email protected]>, "Agne Nettan-Sepp - SOM" <[email protected]> Teema: Fw: EU4Health CSA statement – support needed on EU4Health 2026 WP & MFF 2028–2034 Kuupäev: 2025-12-19 16:51 Karmen Joller sotsiaalminister Sotsiaalministeerium _____ From: Milka Sokolovic <[email protected]> Sent: Friday, December 12, 2025 7:19:17 PM To: Karmen Joller - SOM <[email protected]> Cc: Sara Bertucci <[email protected]> Subject: [DKIM katki] FW: EU4Health CSA statement – support needed on EU4Health 2026 WP & MFF 2028–2034 Tähelepanu! Tegemist on välisvõrgust saabunud kirjaga. Tundmatu saatja korral palume linke ja faile mitte avada. HOIATUS! See e-kiri võib olla liba-, õngitsus- või pahaloomuline, kuna on saadetud asutusest, kus meiliserver on vigaselt seadistatud. Rohkem infot: KKK | teenusveeb <https://teenused.rit.ee/et/kkk> -> E-post ja kalender. Dear Karmen, I hope this message finds you well. Following our brief but very pleasant exchange at RC75 in Copenhagen, I wanted to follow up and share the attached statement from the EU4Health Civil Society Alliance, which has already been transmitted to national focal points and Permanent Representations in Brussels. I would first like to sincerely thank you for the openness you have shown. This is both encouraging and important for us, particularly in a year that has proven exceptionally challenging for EU-level health civil society. As discussions move forward on the EU4Health 2026 Work Programme, I very much hope we can continue to count on Estonia’s voice to help ensure that the absence of operating grants in 2026 does not become a structural precedent. As you may know, the consequences of the 2025 decision are already being felt, with closures and significant downsizing across the health CSO community. We are encouraged by the constructive signals received from a number of Member States, and we believe that a continued, coordinated push at this stage could make a decisive difference – both for reinstating operating grants under EU4Health and for safeguarding a strong healht and civil society dimension in the next MFF. Should it be useful, I would of course be very happy to brief you further or exchange views at your convenience. With many thanks once again, and warm regards, Milka <https://twitter.com/epha_eu> <https://www.linkedin.com/company/european-public-health-alliance/> <https://www.youtube.com/@epha_eu> Dr Milka Sokolović Director General Rue de Trèves 49-51,1040 Brussels, Belgium <mailto:[email protected]> [email protected] | +32 474 287 289 <http://www.epha.org/> www.epha.org | @milkasokolovic.bsky.social I sometimes send emails outside of working hours, as that works for me. Feel free to read or reply at a time that works for you! From: Sara Bertucci <[email protected]> Sent: Friday, 12 December 2025 10:08 am To: [email protected] Cc: Milka Sokolovic <[email protected]> Subject: EU4Health CSA statement – support needed on EU4Health 2026 WP & MFF 2028–2034 Dear Permanent Representation of Estonia to the European Union, On behalf of the <https://eu4health.eu/> EU4Health Civil Society Alliance, representing 38 health and patient organisations and co-led by EPHA, I am sharing our attached statement ahead of the EU4Health Steering Group meeting and the European Council discussions on the next Multiannual Financial Framework next week. The removal of operating grants in 2025 has already led to closures and major downsising among health CSOs, weakening their ability to contribute to EU health priorities and to democratic participation in EU policymaking. In this context, we kindly ask for your support to: * Reinstate operating grants in the EU4Health 2026 Work Programme; and * Ensure that the MFF 2028–2034 includes a substantial, predictable EU health budget, with a strong and dedicated civil society component. Evidence from the interim evaluation shows that EU4Health and civil society involvement are cost-effective, deliver clear EU added value, and play a proven role in supporting EU public health objectives – from improving prevention and access to care, to strengthening preparedness and delivering innovation. Without member states’ support for a strong health ecosystem, we are concerned that health policy will become detached from citizens’ priorities and miss the perspectives of those it aims to serve. We would welcome the opportunity to brief you in more detail on the work of our organisations and are remain at your disposal should you have any questions. Kind regards, Sara Bertucci <https://twitter.com/epha_eu> <https://www.linkedin.com/company/european-public-health-alliance/> <https://www.youtube.com/@epha_eu> Sara Bertucci (she/her) Policy Manager - Global Public Health Rue de Trèves 49-51,1040 Brussels, Belgium <mailto:[email protected]> [email protected] | <http://www.epha.org/> www.epha.org