EUROPEAN

COMMISSION

Brussels, 30.11.2022
COM(2022) 675 final

COMMUNICATION FROM THE COMMISSION TO THE EUROPEAN

PARLIAMENT, THE COUNCIL, THE EUROPEAN ECONOMIC AND SOCIAL
COMMITTEE AND THE COMMITTEE OF THE REGIONS

EU Global Health Strategy

Better Health for All in a Changing World

EN EN
1. Introduction
The experience of recent years, particularly the COVID-19 pandemic, has highlighted as never before
that health has no borders: it is a global common good. The well-being and lives of citizens, the
prosperity and stability of societies and economies, and sustainable development in general, all
depend on addressing health from this perspective. Global health is an essential pillar of EU external
policy, a critical sector geopolitically and central to the EU’s open strategic autonomy.
Since the EU’s last 2010 Communication on the EU role in global health1, health challenges are fast
evolving—in an equally rapidly-changing geopolitical environment. More than ever before global
health is being impacted by the triple planetary crisis of climate change, biodiversity and pollution, with a
particularly heavy burden on most vulnerable countries and people. At the same time, new
opportunities linked to areas like research or digitalisation have arisen. A robust Global Health
Strategy (“the strategy”) is needed to provide a new, coherent, effective and focused policy world-
wide.
As the world population has just moved past the 8 billion mark and life expectancy is rising globally,
we should prioritize health and well-being for all throughout the life course.
This strategy represents the external dimension of the European Health Union, which protects the
well-being of Europeans and the resilience of their health systems, and a key component of Global
Gateway2, which builds partnerships of equals with partner countries based on joint responsibility
and co-ownership.
The EU’s leading role in fighting the COVID-19 pandemic has shown that it can make a major
contribution to global objectives with the Team Europe approach3 (see box A). The main message of
this strategy is that the EU intends to reassert its responsibility and deepen its leadership in the
interest of the highest attainable standards of health, based on fundamental values, such as
solidarity and equity, and the respect of human rights.
The challenges are significant. There is a massive unfinished agenda in global health, as progress
inter alia towards the universal health targets enshrined in the 2030 Agenda for Sustainable
Development and its Goals (SDGs)4 has reversed in many countries: collectively, countries have only
achieved about a quarter of what is needed to reach the SDG health targets by 2030. Major
infectious diseases represent a heavy burden on many countries and high infant and maternal
mortality, and malnutrition remain matters of concern among others. At the same time, it is
essential to address global health security swiftly and comprehensively, to better prevent and be
more resilient to face pandemics. High-quality risk-preparedness in the health sector will show
significant positive impacts on the resilience of other key sectors.

1
COM(2010)128 final - 31.3.2010
2
https://ec.europa.eu/info/strategy/priorities-2019-2024/stronger-europe-world/global-gateway_en
3
“Team Europe approach” refers to action by EU institutions and some or all of its Member States, in line with
respective competences.
4
https://www.un.org/sustainabledevelopment/development-agenda/

1
Box A: EU response to COVID-19: leadership through the Team Europe approach
The EU played a decisive role in the global response to the COVID-19 pandemic providing solidarity and effective
support by acting in a Team Europe approach to help implement the global vaccination campaign and reaffirm
the EU’s commitment to multilateralism.
Leadership: The EU was a driving force behind the adoption of the G20 Rome Declaration 5—the internationally
agreed principles for action to fight, prepare for, prevent, and respond to pandemics. Alongside other key global
stakeholders, the EU played a leading role in organizing the first Global Pledging Conference against COVID-19,
and in setting up the Access to COVID-19 Tools Accelerator (ACT-A), a key tool supporting the development and
equitable distribution of the tests, treatments, and vaccines to lower income countries. Together with EU
Member States, the EU contributed over EUR 7 billion to ACT-A, including its vaccine pillar (COVAX).
Cooperation: The EU has been stepping up its cooperation, for example by setting-up the globally pioneering
solution EU Digital COVID Certificate (EUDCC): by October 2022, 49 countries outside the EU were connected to
the EUDCC Gateway, including seven from the African continent, making it the largest interconnected system of
digital COVID certificates in the world. Thanks to EU solidarity, the Union Civil Protection Mechanism put into
action several emergency medical teams and provided medical equipment and supplies6 to third countries. The
EU was a key founding member of COVAX and has increased its efforts to collaborate on therapeutics,
diagnostics, through the ACT-Accelerator, international organisations and research institutions.
Resources: The EU combined its resources to maximise their impact on the COVID-19 pandemic response. Since
the outbreak of the COVID-19 pandemic, the EU, EU Member States and European financial institutions, as
Team Europe, have so far committed EUR 53.7 billion to support 140 countries, covering emergency response to
humanitarian needs, strengthening of health, water and sanitation systems, and mitigation of the social and
economic consequences of the pandemic. The Team Europe way of working proved effective and valuable and
has been rolled out across other global priorities. The EU stepped up research, especially vaccine and medicine
advancement, and created an enabling environment for manufacturing and distribution of four billion COVID-19
vaccine doses both in the EU and globally and supported additional rollout of vaccines7. The European
Commission and EU Member States have also quickly set up a new European reserve of resources including a
stockpile of medical items to respond to health emergencies 8.

To contribute to the delivery of better health for all in a changing world, a different approach is
needed, starting with what must be done. To this end, the strategy focuses on three core priorities.
Going back to fundamentals, the first two essential priorities are: investing in the well-being of all
people and reaching universal health coverage with stronger health systems. To achieve these two
goals, we need to shift our focus, as the landscape is very different from 2010:
- In addition to traditional root causes of ill-health such as poverty and social inequalities, other
drivers of ill-health must be addressed in an integrated manner, such as climate change,
environmental degradation, humanitarian crises, or food insecurity, aggravated by crises like
the Russian war of aggression against Ukraine. Therefore, it is essential to mobilise a wide
number of policies to work on a global health agenda.
- Rising challenges, like antimicrobial resistance and mental health, or evolving challenges of
health and care systems, including workforce imbalances and resources shortages must be
prioritised, alongside maximising new opportunities for health offered by powerful enablers,
like research and digitalisation, including the use of artificial intelligence.
The third core priority is combatting current and future health threats, which also requires a new
focus. It calls for enhanced equity in the access to vaccines and other countermeasures; for a “One

5
https://global-health-summit.europa.eu/rome-declaration_en
6
See key facts and figures under https://civil-protection-humanitarian-aid.ec.europa.eu/what/civil-
protection/eu-civil-protection-mechanism_en#facts--figures.
7
See project 11 in Annex 1.
8
EU develops strategic reserves for chemical, biological and radio-nuclear emergencies (europa.eu)

2
Health approach”9, which tackles the complex interconnection between humanity, climate,
environment and animals; for a more effective disease surveillance worldwide; and for stronger
international rules and cooperation mechanisms on health.
As we shift the focus on what to do, an equally fundamental shift must occur on how to do it. A new
global health order is emerging —and the EU must contribute to shaping it through a more strategic
and effective engagement.
The EU has a unique potential to drive international cooperation. Expanding partnerships with a
wide range of relevant stakeholders is of the utmost importance—promoting health sovereignty for
more resilience and open strategic autonomy supported by partners' political commitment and
responsibility. Our relationship with international partners must be guided by common priorities in
line with this strategy.
To enhance the EU’s role as a strong and effective player, the Commission and Member States will
ensure synergy between national and EU global health strategies and work closer than ever in a
Team Europe approach, with new mechanisms to better coordinate policies, actions and financial
efforts to maximise impact—speaking and acting together.
Global governance will require a new focus to maintain a strong and responsive multilateral system,
with a World Health Organization (WHO) at its core which is as sustainably financed as it is
accountable and effective. Consensus should be built through deepened cooperation through G7,
G20, and other global, regional and bilateral partners. The EU should drive the essential process of
filling the existing gaps in global governance, avoiding duplication and ensuring coherence of action.
This will need close cooperation with the private sector, philanthropic organisations, civil society and
other stakeholders to support this strategy’s objectives.
Effective funding is another key element of the strategy. The EU and its Member States are
collectively among the largest funders of global health – whether in terms of global goods (financing
international organisations and global health initiatives), development aid, or humanitarian
assistance10. This strategy’s ambitions will require high political commitment globally, as well as an
important commitment of resources. The EU financial contribution will follow a new approach
involving innovative finance, co-investment from partners and pooling with other international
actors—and the EU’s influence in shaping the agenda must match its financing support as a
champion of global health.
Success will naturally depend on the contribution of our partners—but the EU will take its full
responsibility. This includes also improving health preparedness and response at home as part of
the European Health Union, as health developments in the EU affect partners across the world and
vice versa. In the EU, universal health coverage and a strong EU health security framework will
continue to be developed by taking forward key initiatives under way or under preparation. These
include the Europe’s Beating Cancer Plan11 the Pharmaceutical Strategy12, and the planned European

9
A full definition of One Health is provided by OHHLEP under https://www.who.int/news/item/01-12-2021-
tripartite-and-unep-support-ohhlep-s-definition-of-one-health
In the context of the Consultation on the Future of Europe, citizens proposed a One Health Approach: “Adopt a
holistic approach to health, addressing, beyond diseases and cures, health literacy and prevention, and
fostering a shared understanding of the challenges faced by those who are ill or disabled, in line with the “One
Health Approach”, which should be emphasized as a horizontal and fundamental principle encompassing all EU
policies”.
10
According to data from the OECD Development Assistance Committee:
https://www.oecd.org/dac/development-assistance-committee/
11
A cancer plan for Europe | European Commission (europa.eu). This is supported by the EU Mission on
Cancer ( EU Mission: Cancer | European Commission (europa.eu)).
12
https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:52020DC0761&from=EN

3
Health Data Space13. Combatting health threats more comprehensively will be possible with the
implementation of the new cross-border health threats regulation14, the reinforced mandates of the
European Center for Disease Prevention and Control and the European Medicines Agency, the work
of the new Health Emergency Preparedness and Response Authority to improve preparedness and
response in medical countermeasures15, and a One Health network to act against all pathogenic
threats with integrated surveillance16. Better healthcare delivery, open strategic autonomy in health-
related value chains, and strong action on antimicrobial resistance will also all act as powerful
foundations for a strong EU position worldwide. We will continue supporting Member States in
implementing health reforms and investment under the Recovery and Resilience Facility. And we will
implement the European Green Deal17 and particularly the Zero Pollution Action Plan18 and the
Chemicals Strategy for Sustainability to fight root causes of ill health in the EU. All this work,
together with the new strategy, will form a seamless continuum for health protection in the EU and
worldwide.
The strategy offers an agenda leading up to 2030. It sets three policy priorities, provides for twenty
guiding principles to shape global health, makes concrete lines of action that operationalise those
principles, and creates a new monitoring framework to assess effectiveness and impact of EU
policies and funding. It outlines what the Commission will do and what it invites Member States to
do, each strictly within their respective competences and institutional roles as provided for in the
treaties19. To illustrate upcoming actions, Annex 1 lists some of the key projects which underpin this
strategy at global, regional and national levels.

The strategy builds on the important contribution of the European Parliament, successive
Presidencies of the Council, the civil society’s 2020 shadow health strategy20, and other key
stakeholders—including the input received during a wide public consultation. This strategy should be
read together with the first State of Health Preparedness Report, published in parallel with it21.

2. The EU’s global health priorities

The strategy reaffirms the commitment to the SDGs and the European Consensus on Development22,
and to act particularly in the areas that are cornerstones of good health. To ensure success in this
endeavour, it suggests a new approach based on key priorities.
The Commission will therefore focus its efforts on three interrelated priorities23, inviting Member
States to do the same:
(1) Deliver better health and well-being of people across the life course;
(2) Strengthen health systems and advance universal health coverage; and
(3) Prevent and Combat health threats, including pandemics, applying a One Health approach.

13
European Health Data Space (europa.eu)
14
https://www.consilium.europa.eu/en/press/press-releases/2022/06/23/provisional-agreement-on-new-eu-
law-on-serious-cross-border-threats-to-health/
15
The Health Emergency Preparedness and Response Authority.
16
See financial project 2 in Annex 1.
17
A European Green Deal | European Commission (europa.eu)
18
Zero pollution action plan (europa.eu)
19
The relevant references to the EU throughout this document should be understood in this fashion. The same
applies to the use of the terms “we” and “our”.
20
https://www.ghadvocates.eu/wp-content/uploads/Global-Health-Strategy.pdf
21
https://health.ec.europa.eu/health-emergency-preparedness-and-response-hera/key-documents_en
22
european-consensus-on-development-final-20170626_en.pdf
23
These priorities largely correspond with the WHO’s triple billion target agenda:
https://www.who.int/about/what-we-do/thirteenth-general-programme-of-work-2019---2023

4
2.1. Deliver better health and well-being of people across the life course
The EU will concentrate its collective strength and engage with countries to achieve the ambitious
health-related SDGs globally, in particular Goal 3 (ensure healthy lives and promote well-being for
all at all ages), Goal 5 (achieve gender equality) and Goal 10 (reduce inequality within and among
countries).
To do so, the Commission will follow guiding principles, inviting Member States to do the same:

Guiding Principle 1. Prioritise tackling the root causes of ill health, paying particular
attention to the rights of women and girls, and to vulnerable populations and
disadvantaged groups.
Efforts to deliver better health have traditionally focused on fighting specific diseases—a fight that
must continue. However, without addressing the root causes of ill health, that make people prone to
disease in the first place, it will continue to plague wide sections of the population, particularly the
most vulnerable. Hence, as a novelty, the strategy will prioritise addressing the economic, social
and environmental root causes of health and disease –including poverty and discrimination, age,
nutrition and healthy diets, social protection, education, care, water, sanitation and hygiene,
occupational health– and other areas such as healthy ecosystems pollution or contact with
chemicals and waste and threats to security of energy supply. This will also require an integrated
“health in all policies” approach (see section 3).
An approach based on human rights leaving no one behind will be maintained throughout the
implementation of this strategy. This also includes a particular focus on sexual and reproductive
health and rights (SRHR).

Guiding Principle 2. Improve equitable access to a full range of essential health services
from health promotion to disease prevention and affordable quality treatment,
rehabilitation and palliative care to fight communicable and non-communicable diseases.
Resilient public health programmes are critical to disease control, especially of infectious and
neglected tropical diseases, and in addressing underlying risks of non-communicable diseases. At the
same time, increased prevention, expanded resources, and intensified research are needed to tackle
the growing challenge of non-communicable diseases and other health disorders.
To develop these two guiding principles, the following lines of action will be prioritised:

 Prioritise addressing the economic, social and environmental root causes of ill-health through a
“health in all policies” approach.
 Follow a human-rights based approach throughout the strategy, paying particular attention to
the needs and the rights of women, children and young people, in line with the Gender Action
Plan24 III and Youth Action Plan25, persons with disabilities in line with the UN Convention on the
Rights of Persons with Disabilities26, as well as to access to health by other vulnerable groups
such as LGBTIQ people27, older people, migrants, refugees and internally displaced people, also
in the context of natural or man-made disasters and the impacts of climate change.

24
EU Gender Action Plan (GAP) III : https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:52020JC0017
25
EU Youth Action Plan: https://international-partnerships.ec.europa.eu/document/fe1bcd30-58da-4a37-
ab2a-61848789da60_en
26
https://ec.europa.eu/social/main.jsp?catId=738&langId=en&pubId=8376&furtherPubs=yes
27
LGBTIQ Equality Strategy 2020-2025 | European Commission (europa.eu)

5
 Continue to lead the fight against a range of communicable diseases, especially AIDS,
tuberculosis, malaria, poliomyelitis, Ebola virus disease as well as neglected tropical diseases28.
This includes investing with partner countries and through research and development alliances
and global health initiatives, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria29 30.
 Help prevent and manage non-communicable diseases which is increasingly important in an
ageing world where over 65s and over 80s will represent ever larger proportions of the global
population. We will support this via the WHO’s Universal Health Coverage Partnership31 32 and
apply multisectoral approaches that address major risk factors such as substance abuse, diet,
physical inactivity, and air pollution. This applies specially to cancer.
 Support the expanded uptake of vaccines against childhood illnesses and increasingly to
support adult health including by continuing its strong support to Gavi33 34, the Vaccine Alliance
that helps increase equitable and sustainable use of vaccines.
 Ensure that innovative vaccines, treatments, and diagnostics for new, prevalent, or neglected
infectious and non-communicable diseases, are developed and used, including through funding
from Horizon Europe and the EU-Africa Global Health European and Developing Countries
Clinical Trials Partnership (EDCTP3)35 for research, capacity building and strengthening of the
regulatory environment in sub-Saharan Africa.
 Strengthen support for universal access to Sexual and Reproductive Health and Rights36 with a
focus on women, girls, young people and people with disabilities including through designing a
Team Europe initiative on SRHR in Africa and support to the United Nations Population Fund
(UNFPA) Supplies Partnership37. This includes addressing gender-based violence, harmful
practices, unmet needs for family planning, preventable maternal mortality and gender
inequalities. The work relies on ensuring equitable access to quality services, products and
information, including via health systems strengthening toward universal health coverage, and
youth-friendly services.
 Support health, nutrition, mental health, and psychosocial support for communities during and
after crisis situations (natural or man-made), delivered in ways that limit mortality, morbidity,
disability, and disease associated with humanitarian crises38.

2.2 Strengthen health systems and advance universal health coverage

Achieving health systems that are effective, resilient and accessible in all their fundamental aspects
(service delivery, health workforce, health information systems, access to essential medicines,
financing, and leadership/governance) is a core priority of the strategy. Advancing universal health
coverage in an equitable way will ensure financial risk protection, access to quality essential
healthcare services and safe, effective, quality and affordable essential medicines and vaccines.

28
Neglected tropical diseases are a diverse group of 20 conditions that are mainly prevalent in tropical areas,
where they mostly affect more than 1 billion people who live mostly impoverished communities. They are
‘neglected’ because they are almost absent from the global health agenda.
29
See project 7 in Annex 1.
30
https://www.theglobalfund.org/en/
31
https://extranet.who.int/uhcpartnership/
32
See project 8 in Annex 1.
33
See project 9 in Annex 1.
34
https://www.gavi.org/
35
See project 18 in Annex 1.
36
Considering the European Consensus on Development (2017) https://eur-lex.europa.eu/legal-
content/EN/TXT/?uri=celex%3A42017Y0630%2801%29
37
See project 6 in Annex 1.
38
Directorate-General for European Civil Protection and Humanitarian Aid Operations, Health: General
Guidelines, 2014.

6
To do so, the Commission will follow guiding principles, inviting Member States to do the same:

Guiding principle 3. Improve primary healthcare with built-in surge capacity39, and
enhance core public health capacities to meet the requirements of the International Health
Regulations40.
The pandemic has shown the importance of having proper available medical capacity to evaluate
and care for a markedly increased volume of patients—one that challenges or exceeds normal
operating of health systems. Prioritising this area in our work is a novel approach and will have an
important added value: it is the first barrier against the spread of pandemics and other health
threats. Support to primary healthcare will also help ensure the management of non-communicable
diseases.
To develop this guiding principle, the following lines of action will be prioritised:
 Engage with partner countries to expand access to a basic package of health services covering
prevention and care with particular focus on poor and marginalised populations through
bilateral and regional programmes41. The Universal Health Coverage Partnership under WHO
enables targeted technical support in 119 countries, taking leadership in harmonising national
efforts to achieve the national SDG3 targets.
 Encourage investments in health systems by implementing targeted incentives and increasing
accountability42. The EU should consider improvement of health systems and public health as a
core aspect of international cooperation with partners, including financial support.
 Strengthen social protection systems through bilateral country programmes, particularly by
supporting the creation of minimum social protection rules that include equitable access to
essential healthcare.
 Foster international standards in pharmaceutical medical devices and technologies through
the Commission’s participation in international organisations and bodies, and promote a high
level of quality, effectiveness and safety standards, and training in regulatory matters, with the
support of the European Medicines Agency and in collaboration with the WHO.

Guiding principle 4. Foster digitalisation as a fundamental enabler.

To develop this guiding principle, a digital action for global health will display EU leadership and
shape the ongoing digital transformation in an equitable way43:
 Address underinvestment in digital health and care in low- and middle-income countries, with
a Team Europe initiative on digital health, building on the principles underpinning the planned
European Health Data Space. This would focus on achieving a transformational impact for
advancing universal health coverage, primary healthcare, pandemic preparedness and response,

39
This refers to a health system’s ability to prepare for, and cope with, “surges” (sudden large-scale
escalations) in treatment needs.
40
These are the internationally accepted characteristics that health systems must meet to “to prevent, protect
against, control and provide a public health response to the international spread of disease”. See International
Health Regulations (2005) Third Edition (who.int)
41
See project 20 in Annex 1
42
See Kickbusch, Ilona, et al., https://urldefense.com/v3/__https://globalchallenges.org/wp-
content/uploads/2021/12/A-new-understanding-of-global-heath-security-
UPDATED.pdf__;!!DOxrgLBm!FfwKtCBNDEEFdv0Lhhm84mxHTFJ8hsQ0BQMCPJAfrez0deRI_jLni1swaTgq5XZ7EB
HjoJF3f4CdHtU7soD0FII0igpx4g7IYurdHQ$. Donor funds and technical assistance will always play a role, but
structures (aid, financial, political and geopolitical) must incentivize a clearly understood national
responsibility.
43
See project 3 in Annex 1.

7
 improved diagnosis and personalised medicine and continuum of care. A specific example is how
providing digital health and care services may facilitate access to expertise even in
geographically remote locations e.g. through m-health (mobile health) and telemedicine. The
development and/or implementation of national and regional strategies such as the upcoming
African Union/African CDC digital health strategies will be supported.
 Build on the EU being pioneers in regulation of health data, digital certificates, using the cloud
for data sharing, data protection and privacy. The EU will leverage the potential of health data
worldwide in line with the principles of the planned European Health Data Space and foster the
use of new technologies including artificial intelligence to boost their potential to improve
diagnosis and treatments worldwide.
 Contribute to shaping the digital health ecosystem globally (rules, norms, standards,
interoperability), using European examples and best practice like the EU Digital Covid Certificate
and supporting international rules that are compatible with the EU framework while facilitating
person-centred health data governance and protection.
Guiding principle 5. Boost global health research to develop the technologies and
countermeasures which are necessary to improve health.
Research is also a key enabler of better health. Leveraging research efforts worldwide can make a
step change to advancements in diagnostics and treatments. Drawing on the success of COVID19
vaccines, a research action for global health will drive change to ensure research and innovation
benefit people worldwide.

To develop this guiding principle, the following lines of action will be prioritised:
 Extend international research and innovation cooperation, making research data as open,
standardised and interoperable as possible, and promoting the dissemination and exploitation
of results as a common good. This is in line with the Commission Communication “The Global
Approach to Research and Innovation” and the respective Council conclusions.
 Support research end-to-end by creating a conducive research environment, bolstering the
entire value chain from fundamental to preclinical and clinical research, in order to bridge the
gap between generating and implementing knowledge and evidence.
 Support the design of regulation, production, procurement, and delivery, so that research
conducted in low- and middle-income economies is relevant for local pharmaceutical and health
technology production.
 Contribute to mutual capacity building through Joint Undertakings, such as the Global Health
European and Developing Countries Clinical Trials Partnership, to foster ever closer
collaboration with low- and middle-income countries44.
 Leverage the industrial dimension to reinforce local production capacity, ensuring effective
cooperation between public and private actors.
 Boost support of international processes that strengthen the scientific base for policy action,
including the creation of a Science-Policy Panel on Chemicals, Waste and Pollution.

Guiding principle 6. Address workforce imbalances and foster skills.

Through a health workforce action, this strategy will address both the necessary development of
right skills and the challenge of personnel shortages. It requires a long-term, integrated approach
with the involvement of social partners, collaboration across countries, and recognition that
problems are more acute for the nursing and care segments – and disproportionately affect women:

44
See projects 12 and 19 in Annex 1.

8
 Strengthen international cooperation and adherence to international commitments on
recruitment, developing reliable monitoring and data collection on workforce and its flows.
 Foster mutually beneficial mobility arrangements with partners in a context of health
workforce shortages45 promoting circular mobility and countering brain drain, including by
drawing on the Skills and Talents package, in particular the forthcoming talent partnerships with
partner countries.
 Support partner countries in training, recruiting and putting into action healthcare workers
and ensuring their professional development through appropriate education as well as
vocational training (VET) programmes for auxiliary staff in partnership with other donors, while
respecting the need to support retention of skilled healthcare workers. The Opportunity Driven
Vocational Training Team Europe initiative46 will help analyse the need for technical profiles and
help deliver the required training.
 Support partnerships working through the Pact for Skills and Blueprint for sectoral skills to
increase understanding of specific skills needs in health and care and develop relevant training
solutions

2.3 Prevent and combat health threats, including pandemics, applying a One Health
approach
Combating health threats has become a top priority. The world is entering what may well be an age
of pandemics47 due to the interconnectedness of today’s societies and our interplay with climate,
the environment and animals. Health threats can be of different origins, including environmental
pollution, and chemical, biological, radiological or nuclear (CBRN), which calls for a comprehensive
all-hazards approach. In July 202248, the Commission established a list of top three cross-border
health threats (e.g. pathogens with high pandemic potential, CBRN and anti-microbial resistance) to
prepare against, which should guide both internal and external action.
The EU drew the early lessons of the pandemic, adopting a new Regulation on serious cross-border
health threats and improving preparedness and response in the field of medical countermeasures
notably with the creation of the Health Emergency Preparedness and Response Authority (HERA).
Regarding such countermeasures, the State of Health Preparedness Report presented in parallel to
the strategy outlines the robust action that has been taken including at the global level.
Efforts must continue because as stressed by the Independent Panel for Pandemic Preparedness and
Response a lot of work remains to be done before the world is collectively ready for this task.49
Therefore, the strategy will continue to tackle the ongoing COVID-19 pandemic and its aftermath
and, building on lessons from the past three years, build a comprehensive approach to ensuring
global health security.
To lead these global efforts, the Commission will follow guiding principles, inviting Member States to
do the same:

Guiding principle 7. Strengthen capacities for prevention, preparedness and response and
early detection of health threats globally.

45
Supported by project 4 in Annex 1.
46
See under https://europa.eu/capacity4dev/tei-jp-tracker/.
47
Professor Peter Piot, quoted in https://ec.europa.eu/research-and-innovation/en/horizon-magazine/how-
we-prepare-age-pandemics.
48
https://ec.europa.eu/commission/presscorner/detail/en/IP_22_4474
49
The Independent Panel for Pandemic Preparedness and Response was established by the Director-General
of WHO in response to World Health Assembly resolution WHA73.1: https://theindependentpanel.org/

9
COVID-19 has shown the importance of robust preparedness and response capacities and adequate
funding to save lives. The pandemic has also demonstrated that spending billions would have saved
trillions. It will be essential to provide the WHO with sustainable financing and spearheading
innovative ways to fill gaps such as the Pandemic Fund50, which the Commission and some EU
Member States co-founded as major contributors.
The EU should continue to focus on improving biosafety and biosecurity measures in relevant
institutions, and on increasing public awareness and training staff.
To develop these guiding principles, the following lines of action will be prioritised:
 Prioritise health security on the global health agenda, including by designing and implementing
the Team Europe initiative with Africa51 on health security using a One Health approach to
strengthen systems and capacities for sustainable and risk-informed prevention of,
preparedness for, and response to infectious and non-infectious threats, including those
stemming from environmental pollution and antimicrobial resistance (see below also under
principle 11).
 Support regional and country efforts to strengthen pharmaceutical systems and manufacturing
capacity for vaccines and other medical products and technologies to increase quality, safety,
equitable access, and health sovereignty. To this end, boost the ongoing Team Europe initiative
on Manufacturing and Access to Vaccines, Medicines and Health Technologies in Africa52 and
the EU and Latin America and the Caribbean manufacturing and health partnership53. The EU
will invest in strengthening health commodity markets and supporting end-to-end procurement
and supply chain management, including transparency and monitoring, using inter alia business
support networks to favour matchmaking, facilitate marketplace exchanges and dialogue of
industrial actors.
 Diversify and build EU capacity of supply chains for critical equipment and countermeasures,
diagnostics and therapeutics with targeted action to avoid supply shortages and secure
worldwide providers. This will enhance the EU’s strategic resilience and, crucially, increase the
global supply of countermeasures, thus enhancing access by partners to such goods and opening
cooperation avenues.
 Develop capacities for early detection, sound and sustainable management of hazardous
waste and materials54, building on the work under the Union Civil Protection Mechanism and
strengthening the legislative framework related to biosafety and biosecurity measures in all
relevant institutions. Awareness raising and training of staff should be helped by the EU CBRN
Risk Mitigation Centres of Excellence55 and their activities in 63 partner countries.
 Support the development of a comprehensive disease outbreak humanitarian response
system that also includes coverage for areas outside the EU, building on Union Civil Protection
Mechanism (UCPM) and the European Humanitarian Response Capacity (EHRC).
 Continue to support the implementation of Security Council Resolution 228656 on protection of
civilians in armed conflict, by advocating respect for international humanitarian law and

50
https://www.worldbank.org/en/programs/financial-intermediary-fund-for-pandemic-prevention-
preparedness-and-response-ppr-fif
51
See project 15 in Annex 1.
52
https://europa.eu/capacity4dev/tei-jp-tracker/tei/manufacturing-and-access-vaccines-medicines-and-
health-technology-products-africa
53
https://ec.europa.eu/commission/presscorner/detail/en/ip_22_3890
54
Including those under waste shipments (europa.eu)
55
https://cbrn-risk-mitigation.network.europa.eu/index_en
56
http://unscr.com/en/resolutions/2286

10
 supporting accountability for attacks against medical workers and infrastructure, and continuity
of healthcare and access in armed conflicts.
 Expand and strengthen European and global research partnerships including clinical trial
networks that can be pivoted to address new and emerging pathogens to ensure timely
availability of effective medical countermeasures.

Guiding principle 8. Work towards a permanent global mechanism that fosters the
development of and equitable access to vaccines and countermeasures for low- and middle-
income countries.
One of the key lessons of the COVID-19 pandemic is that equitable access to medical
countermeasures is core to pandemic preparedness and response. This calls for a permanent
solution, building on the Access to COVID-19 Tools Accelerator (ACT-A), the Pandemic Influenza
Preparedness Framework57 and other relevant experiences.
For effective medical countermeasures to become available quickly, effective surveillance needs to
identify pathogens early, and effective research platforms need to be ready to produce the
necessary evidence for quick development and rollout, supported by a conducive research
environment with clinical trial platforms that can be quickly pivoted to new diseases, and an
effective regulatory environment for the conduct of clinical trials.
Guiding principle 9. Negotiate an effective legally binding pandemic agreement with a One
Health approach and strengthened International Health Regulations.
This fills the gaps in the international rulebook for pandemic preparedness and response, requiring
countries and empowering the WHO to report and investigate pandemic threats rapidly58. The
pandemic agreement should include concrete provisions on anti-microbial resistance59.
Guiding principle 10. Build a robust global collaborative surveillance network to better
detect and act on pathogens
The strategy supports the creation of a new reliable network that surveys and detects pathogens in
key hotspots, and not only identifies threats but also advises on action to take. This work would be
supported by EU Delegations on the ground and complement the G7 initiative connecting existing
networks60. It will include digitalisation and integration of surveillance systems across the human,
animal and environment spectrum, strengthening laboratory capacities and genomic sequencing
capabilities, as well as workforce training.
Guiding principle 11. Apply a comprehensive One Health approach and intensify the fight
against antimicrobial resistance.
Two critical challenges have become more urgent in recent years. The first concerns the complexity
and the consequences of animal, environmental and human interactions calling for a multisectoral,
integrated and transdisciplinary “One Health” approach. This includes the increased risk of major
pandemic outbreaks due to in particular to changes in land-use, environmental degradation,
complex food production systems and intensified trade and travel, but also the burden in low- and

57
https://www.who.int/initiatives/pandemic-influenza-preparedness-framework
58
https://www.consilium.europa.eu/en/press/press-releases/2022/03/03/council-gives-green-light-to-start-
negotiations-on-international-pandemic-treaty/
59
See below also under principle 11.
60
G7 Pact for Pandemic Readiness:
https://www.g7germany.de/resource/blob/974430/2042052/2d5b55bcdfc0f1aa46b979566288e9a5/2022-05-
20-pact-for-pandemic-readniness-data.pdf?download=1

11
middle- income economies of neglected pollution-related or endemic diseases, most of which can be
zoonotic, air-, water or vector-borne.
The second is the silent pandemic of antimicrobial resistance (AMR), which the WHO has identified
as one of the top 10 current global health threats61. AMR is also an aggravating factor during
pandemics. Moreover, antimicrobials pollute the environment and affect the biodiversity62.
Countries, institutions and global stakeholders must collectively and comprehensively address these
challenges as a priority.
To develop this guiding principle, the following lines of action will be prioritised:
 Intensify work with the Quadripartite, including WHO, the Food and Agriculture Organization of
the United Nations (FAO), the World Organisation for Animal Health (WOAH), and the United
Nations Environment Programme (UNEP) to implement its One Health Joint Plan of Action.
 Seek ‘deep prevention’63 – identifying and addressing threats before pathogens cross from
animals to humans, not after human outbreaks have occurred and strengthen capacity to
prevent pollution related health threats.
 The Commission will explore existing international conventions that affect the ‘upstream’
course of potential pandemics, to examine whether their provisions or implementation plans
could be strengthened to support a One Health approach64.
 Work towards the inclusion of concrete provisions on anti-microbial resistance in the pandemic
agreement.
 Support the development of and access to innovative medical countermeasures to address
AMR, including antimicrobials, vaccines, and diagnostics65.

3. A new internal governance to tackle global health challenges

Achieving this strategy’s goals requires a more joined-up way of working within the Commission and
with Member States and partners. This is because global health is increasingly shaped by multiple
policies (such as climate, environment, energy, nutrition, food security, social protection,
demography, education, research, humanitarian assistance, finance, trade, industrial policy or
foreign and security policy) that either affect health or enable the solution to health challenges,
with various agencies and bodies at EU and national levels and different financial institutions actively
involved. This calls for reinforced coordination to help achieve the priorities of this strategy and
implement a true ‘health in all policies’ governance—a novelty of this strategy.

Guiding principle 12. Link effectively all policies and measures that have an impact on
global health within the Commission, EU agencies and EU financing institutions.
The Commission will fully integrate global health considerations into all EU policy areas that have an
impact on global health by reinforcing internal coordination mapping roles and responsibilities,
policies and tools, and how they will help achieve the priorities of this strategy.

61
https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance
62
See Biodiversity Strategy (COM(2020) 380), Farm to Fork Strategy (COM(2020) 381) and Zero Pollution
Action Plan (COM(2021) 400).
63
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00948-X/fulltext
64
Including the United Nations Framework Convention on Climate Change; the Convention on Biological
Diversity and its Nagoya Protocol on Access to Genetic Resources and the Fair and Equitable Sharing of
Benefits Arising from their Utilization; the United Nations Convention to Combat Desertification in those
Countries Experiencing Serious Drought and/or Desertification, Particularly in Africa; the Protocol on Water
and Health to the Convention on the Protection and Use of Transboundary Watercourses and International
Lakes; and the Convention on International Trade in Endangered Species of Wild Fauna and Flora.
65
See also under principles 7 and 9.

12
This involves lines of action in the following key policy areas:
 Pursue global climate neutrality by 2050, increasing the capacity to adapt, strengthen resilience
reducing vulnerability to climate change in accordance with the Paris Agreement.
 Promote ambitious global action to tackle biodiversity loss, wildlife trafficking, air, water and
soil pollution, exposure to toxic substances. Fostering the One Health approach in the future
Global Biodiversity Framework to be agreed at the UN Biodiversity Conference (COP15), and in
global action to tackle wildlife trafficking to reduce the risk of zoonoses. Support soil biodiversity,
the international pursuit of air pollution reduction and mitigation of global emissions, the
promotion of key international instruments and a global mechanism for the management of
chemicals and waste beyond 2020, the negotiation of a new, legally binding instrument to end
plastic pollution, and ambitious outcomes on water and health at the upcoming 2023 UN Water
Conference.
 Promote effective health and safety standards worldwide, by continuing to engage with the
International Labour Organization (ILO) in supporting the integration of the right to safe and
healthy working conditions into the ILO framework of fundamental principles and rights at work.
 Step up humanitarian assistance and support to regions and populations most affected by food
insecurity and high incidence of malnutrition, track food prices and make stocks available to
countries in need, as reflected in the March 2022 Commission Communication on Safeguarding
food security and reinforcing the resilience of food systems66 and the Communication on
fertilisers. Adopt a systemic approach by accelerating the transition to a sustainable food system
that can bring health, environmental and social benefits.
 Leverage investment in education to support health in the short and long term, as per the
commitments taken at the Transforming Education Summit, while prioritising early childhood
development, health education, SRHR, and school meals through its programmes with partner
countries.
 Strengthen humanitarian assistance and civil protection operations related to global health in
emergency and crisis settings through increasing operational, analytical, monitoring and
communication capabilities of the Emergency Response Coordination Centre and the European
Humanitarian Response Capacity –and placing more public health experts into action in crisis
areas. Support disaster management capacity building with organisations such as the ASEAN
Coordinating Centre for Humanitarian Assistance. Reinforce the availability of health-related
response capacities under the Union Civil Protection Mechanism; develop new medical and
CBRN related capacities under the European Civil Protection Pool and RescEU; and strengthen
cooperation with WHO on emergency response and continue to support their work on standards
development and classification processes for emergency medical teams deployable globally.
 Make the behaviour of public and private stakeholders work for global health in a range of
finance-related measures by (i) promoting a pro-health behaviour by domestic and foreign
companies by including health impacts in the EU Non-Financial Reporting Directive67; (ii) working
with international financial institutions and rating agencies so that they embed the same health
criteria in their decisions; and (iii) engaging with the International Monetary Fund (IMF) so that it
includes health investment in its regular assessment of countries’ macroeconomic stability –
encouraging investment in public health.
 Ensure that international trade policy works for global health, so that international
pharmaceutical supply chains are not broken, that partners benefit from medicines, medical
devices and services – strengthening the resilience of health systems through the World Trade

66
https://eur-lex.europa.eu/resource.html?uri=cellar:5391557a-aaa2-11ec-83e1-
01aa75ed71a1.0002.02/DOC_1&format=PDF
67
DIRECTIVE 2014/95/EU OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL of 22 October 2014
amending Directive 2013/34/EU as regards disclosure of non-financial and diversity information by certain
large undertakings and groups (https://eur-lex.europa.eu/legal-
content/EN/TXT/PDF/?uri=CELEX:32014L0095&from=EN).

13
 Organization (WTO) Trade and Health Initiative68 and sharing experiences with WTO partners on
trade facilitation. This includes annual stocktaking with WTO partners of lessons learned from the
pandemic, and monitoring the implementation of the Ministerial Decision on the WTO
Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS)69 that makes it
possible to authorise the manufacture and export of COVID-19 vaccines in a fast and simplified
manner without the consent of the patent owner. We will discuss constructively whether to
extend this mechanism to cover COVID-19 therapeutics and diagnostics, and support the scaling
up of the production capacity of vaccines and other products in developing countries.
 In supporting the High Representative, shape the common foreign and security policy and
promote the full implementation of that policy by including health in political dialogues with
partners to facilitate international cooperation. External action can serve as a vector to
promoting global health by such means as mapping external security threats. Global health
should consolidate with other factors that affect health, like environment, migration,
demography or food security. Future lines of action should include: (i) supporting the creation of
pandemic surveillance mechanisms in non-EU countries; (ii) circulating mutual information about
partners’ plans to advance foreign policy and commercial goals through health; (iii) ensure in
Geneva, New York and across the world cooperation with like-minded partners; and (iv)
prevention of and response to foreign information manipulation and interference (FIMI), which
can weaponise global health. Effective communication on EU health action has proven to be a
very useful tool in this regard.
 Ensure an active role of EU Delegations in implementing this strategy. During the COVID-19
pandemic, the EU Delegations have proven to be an effective source, gathering health-related
intelligence around the globe and communicating and reaching out on EU priorities, while raising
political awareness. The role of the EU Delegations will need to be bolstered, ensuring specific
expertise in health-related areas of geostrategic importance. Strengthening specific health
expertise in Delegations, also through the secondment of experts, will be explored.

Guiding principle 13. Better link and coordinate policies and measures of the EU and its
Member States to speak with one voice and deliver effective action worldwide.
EU leadership has played a key role in the fight against the COVID-19 pandemic globally through the
Team Europe approach, with the EU and Member States acting within their respective
competences. Strengthening this leadership is essential to boost the impact of the EU contribution
to global health and to shape a new global health order based on our fundamental values. There is
wide consensus amongst EU Member States and stakeholders that this calls for closer coordination
in practical ways, which would not only respect the specific competences, but facilitate the decision
making that would take place through the established statutory channels.
Building on ideas from EU Member States, this strategy suggests defining practical ways to enhance
coordination in 202370, with the following lines of action:
 Ensure synergy between national and EU global health strategies.
 Facilitate information and intelligence sharing among the EU and Member States in the many
focal points dealing with global health (Brussels, Member State capitals, Geneva and New
York), with increased health capacities and/or expertise in the latter two. This will build on an
ongoing initiative of the Czech Presidency of the Council to address this need.
 Collect views from Member States, including by carrying out periodic surveys on specific topics,
to facilitate the shaping of positions.

68
WTO | Ministerial conferences - Twelfth WTO Ministerial Conference - Geneva Switzerland
69
https://www.wto.org/english/tratop_e/trips_e/trips_e.htm
70
With the support of the EU4Health project 1 in Annex 1.

14
 Undertake permanent mapping of key measures and financing efforts of the EU and its
Member States to better understand what actions are taking place and to allow for tying means
to the strategy’s priorities, considering when necessary, the help of joint ministerial meetings in
the areas of health, finance, foreign affairs and development.
 Strengthen upstream coordination with Member States, particularly in fora in which not all
Member States are directly participating (e.g. the G7, the G20 and the Organisation for
Economic Co-operation and Development (OECD)).
 Step-up EU coordination and building allies to ensure due EU presence and decision-making
role in international organizations.
 Strengthen external communication catered to the strategy, so that efforts by the EU and its
Member States receive adequate recognition, with ‘Team Europe approach’ as a trademark for
EU effective action in health, in line with the Global Gateway strategy.

4. A new multilateral governance for the emerging global health order

Since the 2010 Communication, a new global health order is emerging: an ever-evolving system
with a multiplicity of new stakeholders and initiatives that reshape global health relations against a
complex geopolitical backdrop. The COVID-19 pandemic has been a litmus test of what is essential,
what must change and what is missing to bring about effective global health governance. The
Commission will follow guiding principles, inviting Member States to do the same:
Guiding principle 14. Support a stronger, effective and accountable WHO.
All EU27 Member States are members of the WHO, and even though the EU is formally not a WHO
member, the WHO has always received steadfast EU support, including at times when its role was at
stake. The COVID-19 pandemic has demonstrated that WHO is the indispensable cornerstone of the
multilateral health system – and at the same time it has also revealed areas of certain shortcomings.
This strategy should aim at ensuring further strengthening of WHO’s leadership, effectiveness,
efficiency, accountability and align EU and WHO priorities.
The following lines of action will be prioritised:

 Seek formal EU observer status with full participation rights as a first step towards full WHO
membership.
 Contribute to making the financing of WHO more sustainable in line with the decisions of the
75th World Health Assembly71 by 2030-2031.
 Advance WHO reform to strengthen its governance, efficiency, accountability and
enforcement of rules, in accordance with its member-driven nature.
 Strengthen WHO’s focus on its normative role in areas of global relevance, starting with
strengthened International Health Regulations and a future pandemic agreement by 2024, and
explore other areas like health data governance and workforce.
 Enhance cooperation with the WHO, at central and regional European level, using the
aforementioned mapping mechanisms to ensure greater alignment of EU and WHO priorities.
These common goals will guide the EU’s sizeable voluntary contribution to the WHO. In 2020
and 2021, Commission voluntary contributions were the fourth largest overall, and the EU and
its Member States accounted for more than 20% of the WHO budget, being the largest
contributor72.

71
WHA75(8): https://apps.who.int/gb/ebwha/pdf_files/WHA75/A75(8)-en.pdf
72
Source: WHO | Programme Budget Web Portal. Consulted on 3 November 2022.

15
Guiding principle 15. Steer the new global health governance by filling gaps and ensuring
coherence of action
As shown again during the COVID-19 pandemic, the global health governance (the set of institutions,
actors, rules, and financing strands in this field) needs strengthening to ensure (i) the necessary
mechanisms are available to address health challenges; and (ii) the plurality of bodies active in global
health are sufficiently aligned—avoiding duplication and fragmentation that make effective and
efficient responses to health challenges more difficult.
In the short term, the United Nations system, the G7, the G20 and the OECD have provided
important impetus to global action. The G7 Pact for Pandemic Readiness73 is a good example – in the
absence of a global pathogen surveillance network, it seeks to connect existing partial networks.
Another good example is the G20-born Pandemic Fund74 that fills immediate financing gaps at
global, regional and national level.
In the longer term a robust global health governance requires to fill existing gaps and ensure
coherence. In addition to seeking a pandemic agreement (see section 2.3), the following lines of
action will be prioritised:

 Work towards permanent cooperation and synergies between the health and finance tracks,
with a standing arrangement between health and finance policies to deal effectively with
threats to global health and the global economy, building on the work of the G20 Joint Health
and Financing Task Force. This arrangement would assess economic impacts of global health
threats and vulnerabilities, identifying what governments would need to do to be better
prepared for a potential crisis. It would also mobilise the necessary financial resources after the
WHO declares a pandemic emergency, so countries can better manage the resulting economic
and social effects.
 Strengthen alignment and coordination between global health initiatives to ensure maximum
efficiency and explore permanent solutions75 which may combine or expand the operations of
several existing health funds and continue to provide important funding to their core work76.
 Ensure that global health challenges stay at the top of the global agenda and that top
leadership is structurally involved to provide impetus to global health work, with the WHO at its
core, and to take individual and collective responsibility. Support a structure involving, where
required, heads of state and government, to do so, in the context of on-going multilateral
discussions.

Guiding principle 16. Ensure a stronger EU role in international organisations and bodies.
The EU and its Member States make sizeable financial contributions in a Team Europe approach to
all key international institutions and global health initiatives. Therefore, it is key to ensure that these
financial contributions translate into commensurate decision-making powers to achieve the
objectives of this strategy.
The following lines of action will be prioritised:

73
https://www.g7germany.de/resource/blob/974430/2042058/5651daa321517b089cdccfaffd1e37a1/2022-
05-20-g7-health-ministers-communique-data.pdf
74
See project 10 in Annex 1.
75
As suggested by the Lancet Commission, see https://www.thelancet.com/journals/lancet/article/PIIS0140-
6736(22)01585-9/fulltext
76
For three financing windows: commodities for disease control, pandemic preparedness and response, and
primary health system strengthening in low and middle income economies.

16
 Ensure a level of participation and a decision-making role in all institutions and bodies that is
commensurate with EU and Member State contributions to increase our impact.
 Monitor the EU financial contributions to international organisations and agencies and to
initiatives and how they support EU priorities.
 Develop a plan to further increase the EU’s influence within a reasonable timeframe wherever
EU impact in institutions and bodies is not commensurate with EU contributions, with the aim of
ensuring alignment.

5. Expand the Union’s strategic partnerships on health and reshape its

engagement with different stakeholders
The wide challenges in global health across the world require an expansion of our partnerships,
exploiting the EU’s unique potential to drive international cooperation.
The Commission will follow guiding principles, inviting Member States to do the same:

Guiding principle 17. Expand partnerships based on equal footing, co-ownership, mutual
interest and strategic priorities.
The aim of the Global Gateway strategy is to deepen meaningful and mutually beneficial
partnerships with a wide range of traditional and non-traditional partners and stakeholders. Health
is a key pillar of this. The EU will continue developing partnerships to support improving health
across the world, with a particular attention to countries with weaker health systems.
The EU’s relations with partners must be based on ownership – with the EU and our partners taking
the responsibility that is key to achieve health sovereignty.
The EU’s bilateral partnerships will build on the ongoing collaboration with a wide range of partners
and counterparts including national health authorities, public health institutions, and other relevant
bodies. In the spirit of meaningful partnership, the EU will encourage partner countries to make and
meet ambitious commitments to prevent health threats, improve health and invest in health
services for their whole population, increasing domestic resource commitment to health in the long
term. This includes for instance advancing in Africa towards the target set in the 2001 African Union
Abuja Declaration77 to allocate ‘at least 15% of [the] annual budget to the improvement of the
health sector while taking account of the necessary fiscal space’.
The EU is expanding partnerships in health at regional level. Regionalism is important in global
health, and regional stakeholders play an increasingly important role. Deepening health partnerships
at regional level, including in Africa, Latin America and the Caribbean, the Asia-Pacific region, as
well as supporting South-South cooperation will be essential.
The February 2022 EU-African Union summit strengthened the health partnership between the EU
and Africa, which underpins five Team Europe initiatives with African partners78. The EU is also
committed to the EU-Africa Global Health EDCTP3 3 Joint Undertaking that builds on the European
and Developing Countries Clinical Trials Partnership bringing together 15 members from the EU with
21 members from Africa and other public and private actors, from industry, philanthropy, or non‑EU,
non‑African countries.
A regional Team Europe initiative79 is being developed in Latin America and the Caribbean focusing
on 1) private sector engagement, 2) improved regional supply chains, trade integration and business
environment, 3) regulatory strengthening, 4) demand consolidation and pooled procurement, 5)
scientific cooperation, 6) pandemic preparedness and health security, and 7) other health-related

77
https://au.int/sites/default/files/pages/32894-file-2001-abuja-declaration.pdf
78
See projects 13, 14, 15, 16 and 17 in Annex 1.
79
See project 19 in Annex 1, https://ec.europa.eu/commission/presscorner/detail/en/ip_22_3890

17
areas (health data, digital and emerging technologies, non-communicable diseases, health systems,
etc.). The partnership will support ongoing regional efforts, notably the Plan for self-sufficiency in
health matters, endorsed by the Community of Latin American and Caribbean States (CELAC) in
September 2021, which sets out action to strengthen capacities to produce vaccines and medicines
in the region. A key partner will be the Pan American Health Organization (PAHO/WHO).
In line with its Strategy for Cooperation in the Indo-Pacific, the EU will continue working with Indo-
Pacific partners to strengthen their capacities, health sovereignty and pandemic preparedness, in
particular for the least-developed countries in the region. The EU will enhance collaborative research
on communicable diseases in the context of the Horizon Europe research programme. In line with its
Pharmaceutical Strategy, the EU will strengthen multilateral cooperation to secure safe and diverse
pharmaceutical and health-related industrial supply chains, to facilitate access to quality medicines
and health products. The EU will explore further EU-ASEAN cooperation enshrined within a “One
health approach”, promoting tighter connections between regional health capacities, such as the
new ASEAN Centre for Public Health Emergencies and Emerging Diseases (ACPHEED).
The EU will further prioritise health resilience in its neighbourhood. The EU is actively assisting its
partners in the Western Balkans and the neighbourhood to raise their healthcare standards and
reduce the likelihood of future border closures due to health emergencies. The EU supports
candidate countries and potential candidates, including Ukraine, Moldova and Georgia, to align
their health legislation with EU health law and to be able to implement it. This includes mobilising EU
Agencies (ECDC and EMA) to support this, notably via the implementation of EU acquis on cross
border health threats in line with EU standards, field epidemiology training programme for
strengthening national public health workforce capacities across the neighbourhood and Western
Balkans, advancement on One-Health approaches on antimicrobial resistance, strengthening
surveillance systems and public health microbiology capacities, and regional cooperation in the field
of epidemic intelligence, risk assessment, preparedness, response, and public health emergency.
The Western Balkan partners and Ukraine were invited to join the Health Security Committee as
observers, and the Western Balkans are all signatories to the EU Joint Procurement Agreement for
medical countermeasures.
The United States (US) is a key partner in global health as shown by ‘U.S.-EU Agenda for Beating the
Global Pandemic: Vaccinating the World, Saving Lives Now, and Building Back Better Health
Security’,80 the administrative arrangement with the US Department of Health and Human Services
on public health threats81, the Transatlantic Taskforce on Antimicrobial Resistance82, the EU and US
joint task force addressing Covid-19 Manufacturing and Supply Chain challenges83 and coordination
with US Agency for International Development. The EU-US partnership should be expanded to cover
a more comprehensive set of health issues, with an EU-US taskforce on health cooperation,
encompassing health security, cancer policy, and global health governance.
Close collaboration with like-minded partners and donors such as Canada, Japan and the United
Kingdom amongst others on issues such as health system strengthening, equity and universal health
coverage, will continue to be instrumental in building multilateral approaches to solving global
challenges. The European Centre for Disease Prevention and Control collaborates with other centres
for disease control in non-EU countries, including the US Centers for Disease Control and Prevention.
To develop this guiding principle, the following lines of action will be prioritised:

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This has subsequently turned into a plurilateral initiative including other partners (Canada, Norway and the
United Kingdom).
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 Focus, in all regions, on the partners most in need and where results on the ground can be
achieved, while taking into account specific challenges such as conflict settings, promoting
cooperation where governments take responsibility and facilitate the effectiveness of support.
 Further prioritise health in its neighbourhood and in support to candidate countries and
potential candidates; and stand with Ukraine and Moldova, whose health systems are under
enormous strain due to Russia’s war of aggression against Ukraine and give comprehensive
support to post-war reconstruction efforts, modernising and re-building their health systems.
 Deploy the EU’s strengths with unique regional bodies (like the European Centre for Disease
Prevention and Control (ECDC) and the European Medicines Agency (EMA)) that can collaborate
with other regional initiatives worldwide, sharing EU data, science and knowledge, and benefit
from non-EU expertise. This would strengthen collaboration with bodies such as the Africa
Centres for Disease Control and Prevention, the African Medicines Agency, and similar entities in
the neighbourhood and programmes in Latin-America, and the Indo-Pacific (such as the South-
East Asia Pandemic Response and Preparedness programme, supporting ASEAN countries in
strengthening national capacity to control COVID-19).

Guiding principle 18. Strengthen engagement with key global health stakeholders
Some global civil society organisations, philanthropic organisations, global health initiatives (such
as the Global Fund, Gavi, CEPI, and others), other UN bodies (including UNFPA, UNICEF, UNAIDS),
multilateral development banks and private stakeholders have larger funding volumes than many
donor countries provide on their own. Engagement with these stakeholders is key to ensure
coordination and complementarity of efforts. Cooperation with all types of civil society
organisations (including youth organisations), patients’ organisations, social partners, parliaments,
and communities more broadly, is fundamental in enabling the EU to express its support for
solidarity and democracy, and its focus on open and transparent governance and human rights.
Equally important is engagement with communities and localisation, which may support
effectiveness of action. Finally, the role of the private sector is key in particular in the
pharmaceutical, biotech or med-tech industries and for digital solutions, to help improve self-
sufficiency.
To develop this guiding principle, the following lines of action will be prioritised:
 Continue to build strong partnerships with global health stakeholders (i) advancing common
priorities; (ii) helping achieve public sector objectives; (iii) ensuring accountability; and (iv)
avoiding fragmentation that may undermine the effectiveness of global health action. The EU
will support efforts by these organisations to better coordinate their action, avoid duplication
and maximise their effect on the ground. The EU will continue to advocate for strong
collaboration and setting shared goals, for example under the Global Action Plan for Healthy
Lives and Well-being for All84.
 Continue support to strengthen civil society as partners of the strategy and the role and voice
of people in securing their own health including by holding governments and health providers
accountable. The EU will extend this support to cover community participation and
engagement across health processes. Communities are key and localisation may support
effectiveness of action.
 Ensure that the private sector and health industries are appropriately considered and
involved in its various forms including production of commodities, service delivery and
support.

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6. Finance
The COVID-19 pandemic made the risks related to underfunded health systems more explicit than
ever. It has led to an unprecedented mobilisation of funding for global health and has increased the
awareness on the importance of preventive actions to fight pollution and protect nature. These
financing efforts need to be sustained and ensure they duly contribute to better health and well-
being of people, to stronger health systems, and to combatting health threats globally.
The Commission will follow guiding principles, inviting Member States to do the same:
Guiding principle 19. Enhance EU finance for global health with maximum impact
The EU and its Member States should invest in global health in a predictable and sustainable way
commensurate with needs and ambitions. Importantly, results will depend not only on how much,
but increasingly on how we finance so there is a need for closer monitoring of the impact of EU
financial contribution overall. In addition, other funding sources need to be leveraged including
partners’ own contributions and also using novel finance instruments to match the high ambition set
by the strategy.
To develop this guiding principle, the following lines of action will be prioritised:

 Prioritise global health across all relevant EU budget financing programmes, including the
EU4Health programme, Horizon Europe, the NDICI-Global Europe, the Instrument for Pre-
Accession Assistance and the Technical Assistance and Information Exchange instrument. Budget
support will remain a key method, where appropriate, to steer national policies and reforms and
ensure strong policy dialogue with partner countries.
 Fulfil its commitment on financing for global health within the framework of the multi-annual
financial framework. The EU has committed itself to allocating at least 20% of its official
development assistance to human development and social inclusion85 under the
Neighbourhood, Development and International Cooperation Instrument – Global Europe
(NDICI-Global Europe). Under the NDICI-GE, in the 2021-2027 period, the EU has programmed so
far over EUR 4.4 billion86 in grants for global health at national, regional and global levels, which
should duly unfold in line with this strategy.
 Seek new ways to financing with an effective Team Europe approach where EU and Member
State resources can be pooled to achieve maximum impact. The EU will advocate for EU Member
States to increase financing for global health in line with the priorities in the strategy.
 Encourage the use of innovative financial instruments and build on the European Fund for
Sustainable Development Plus (EFSD+) that facilitates access to blended finance and budgetary
guarantees. A specific window on human development under the EFSD+ open architecture
provides opportunities to leverage further investment in health. Together with the European
Investment Bank and the European Bank for Reconstruction and Development, the
Commission intends to develop a framework for global health financing, aligned with our
priorities and those of our partner countries and respective mandates of both banks. Encourage
participation of private investors where relevant and in line with EU priorities.
 Prioritise co-investment initiatives with local partners, and pooled financing with other
international stakeholders. The EU must shape the future of the various funds and initiatives by
being at the heart of their governance and by influencing their priorities, financial flows and
action. The EU will encourage and help domestic resource mobilisation in partner countries and
efficiency as the most sustainable source of public financing.
 Advocate for increased accessible finance for countries through multilateral development bank
lending and for increased sustainable finance, for example through special drawing rights on

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 lending to contribute to the International Monetary Fund (IMF) Poverty Reduction and Growth
Trust and the IMF Resilience and Sustainability Trust.
 Together with Member States, the EU will promote new financing methods, including debt
swaps or loan buy-downs to convert debt into investment in health system reforms and new
life-saving programmes. Such transactions could be facilitated by concessional loans and
guarantees in partnership with development finance institutions to help make available
government money and incentivise health system reforms. Increasing the amount of revenues
raised through environmental taxation has the potential to reduce debt financing, and to
mobilise resources for public health services. Countries should be encouraged to ensure
whenever possible, polluters bear the costs of their pollution.
 Diversify domestic health financing, support health financing and system reforms both in
countries and across global health initiatives, and strengthen public expenditure management.
 Monitor health expenditures benefiting low and middle income countries (LMICs), notably
Official Development Assistance (ODA), trends in domestic financing and other donors funding.

7. Way forward: accountability through monitoring and evaluation

Achieving the priorities of this strategy will require an inclusive and comprehensive process. It
relies on sustained action carried out in a Team Europe approach and strong interaction with
partners worldwide. Implementation of this strategy will be strengthened significantly by effective
partnerships with Member States, partner countries, civil society including youth organisations,
global and regional stakeholders, international financing institutions, academia, and the private
sector.
Guiding principle 20. Assess progress and ensure the accountability of the EU’s global
health action through permanent monitoring and assessment.
To develop this guiding principle, the following lines of action will be prioritised:

 Implementation of the strategy will be monitored using metrics and key indicators that will be
developed in 2023 with the help of an EU4Health project, starting to monitor actions carried out
as of 2020. Metrics and indicators will be tied directly to actions and health outcomes that
respond to EU priorities, and will be made publicly available87. The aim is to assess the impact of
our actions and funding and be able to adjust as necessary to achieve the ambition set by the
strategy and meet EU priorities more widely.
 The Commission will carry out a mid-term review and also a final evaluation of the strategy’s
implementation in 2030.
 The Commission will keep the European Parliament, the Council and civil society closely
informed about financing and implementation progress by organising regular high-level
exchanges and publication of a report in principle every two years. The EU will notably host a
structured dialogue with stakeholders as part of the annual Global Health Policy Forum process,
to discuss implementation and make necessary adjustments.

8. Conclusion
An ambitious global health strategy is crucial in a world where diseases have no borders – and where
health is essential to protect the well-being of people, guarantee the stability of societies, and
deliver sustainable development in a complex geopolitical landscape.
Rooted in equity, solidarity and human rights, powered by the spirit of partnership and fuelled by
the determination to strengthen global governance, this strategy sets three policy priorities,

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provides 20 guiding principles and defines concrete lines of action to contribute to better health for
all in a changing world.
Looking forward to 2030, this Strategy will strive to reverse the tide and regain the lost ground as to
universal health targets in the 2030 Sustainable Development Goals by focusing our firepower on
the fundamental issues (health systems strengthening, universal health coverage, primary health
care, public health, health determinants), tackling workforce imbalances and paying particular
attention to women, girls and vulnerable persons.
Digitalisation and research will be key enablers and shape the ongoing digital transformation and
innovation potential in an equitable way.
A quantum leap in health security will be achieved with a permanent mechanism that enhances
equity in development of and access to tools such as vaccines, a global surveillance network which
fully embodies One Health principles, and robust international rules, including enhanced measures
to tackle anti-microbial resistance.
The EU will continue showing leadership in global health and seek to shape the emerging new global
health order with a more effective and accountable WHO at its core where the EU has formal
observer status. Fill existing gaps in global governance with a permanent link between global health
and finance efforts, sustained attention by top political leadership, and effective funding will be
novel ways forward. Harness the impetus of global health stakeholders and private initiatives to
advance common objectives—fighting duplication and ensuring coherence of action in the
multilateral health system will allow a step change to ensure better health security globally.
Our international partnerships will be expanded with the new Global Gateway focus based on co-
ownership and co-responsibility by our partners to promote health sovereignty, more resilience
and autonomy, allowing to target those most in need where our engagement can achieve highest
impact, and to deliver on our health priorities, matching broader EU interests.
We will leverage the Team Europe approach with a genuinely single and powerful voice, assuring
synergy between national and EU global health strategies, mobilising all policies (internal and
external) to work for global health, and ensuring close coordination with Member States so political
action and financial means are tied to the new priorities.

We will render our important financial contribution to global health even more impactful, through
innovative finance, pooling of funding internationally, and co-investing by partner countries.

The establishment of a robust and transparent monitoring system that maps EU efforts and
identifies impacts with the help of stakeholders, will ensure accountability of our action in the crucial
area of global health and maximise EU support and influence capacity.
The Commission calls on Member States, the European Parliament, other European bodies,
stakeholders and partners across the globe to join our efforts and turn this ambitious strategy into a
reality, delivering better health for all in a changing world.

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ANNEX 1: Key projects
The non-exhaustive list of projects presented in this annex support the lines of action mentioned
throughout this strategy.
Projects Indicative
timeframe
Global projects
1. Set up a coordination system with EU Member States to ensure a powerful Second half of
EU voice and leadership in global health in a Team Europe approach. Support 2023
by EU4Health envisaged.
2. Expand the existing European Antimicrobial Resistance Surveillance 2023-2024
Network into an integrated surveillance mechanism covering all pathogens.
Supported by EU4Health.
3. Leverage the potential of health data worldwide. Supported by EU4Health. 2023-2024
4. Foster mutually beneficial mobility arrangements with partners, including by 2023-2025
supporting partner countries in training, recruiting, putting into action and
retaining healthcare workers and ensuring their professional development
through education as well as vocational training programmes for auxiliary
staff. Supported by the Neighbourhood, Development and International
Cooperation Instrument – Global Europe (NDICI-Global Europe) and
EU4Health.
5. Follow up, monitoring and evaluation of the implementation of the EU 2023
global health strategy, publishing a report in principle every two years,
supporting continuous dialogue and involvement of key stakeholders. Support
by EU4Health envisaged.
6. Support the United Nations Population Fund’s Supplies Partnership on 2023-2027
reproductive health commodities, helping to end unmet needs for family
planning and preventable maternal mortality. Supported by the NDICI- Global
Europe (EUR 45 million pledged).
7. Support the Global Fund against AIDS, tuberculosis and malaria, and health 2023-2025
system strengthening. Supported by the NDICI-Global Europe
(EUR 715 million pledged).
8. Support the Universal Health Coverage Partnership administered by the 2023-2027
WHO to advance universal health coverage and strengthen health systems
in partner countries. Supported by the NDICI-Global Europe and the
Emergency Support Instrument (EUR 125 million programmed).
9. Support Gavi, the Vaccine Alliance to ensure the expanded uptake of 2021-2025
vaccines against childhood illnesses and increasingly to support adult health
(for example by administering the human papillomavirus vaccine). Supported
by the NDICI-Global Europe (EUR 300 million pledged).
10. Support the Pandemic Fund. Supported by the NDICI-Global Europe 2023-2027
(EUR 427 million pledged).
11. Support the roll-out of COVID-19 vaccines in selected most under-vaccinated 2023
countries. Supported by the NDICI-Global Europe and the Emergency Support
Instrument (EUR 375 million pledged).
12. Support research and development of vaccines against emerging 2021-2024
infectious diseases, including through the Coalition for Epidemics
Preparedness Innovations (CEPI). Supported by Horizon Europe.

Regional projects
13. Team Europe initiative on Manufacturing and Access to Vaccines, Medicines 2021-2027

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 and Health Technologies in Africa to strengthen pharmaceutical systems and,
together with health industries, the regional manufacturing capacity. EU
contribution supported by NDICI-GE and other instruments.
14. Team Europe initiative to improve sexual and reproductive health and rights 2022-2027
in sub-Saharan Africa, particularly among adolescent girls and young women.
EU contribution supported by NDICI-GE.
15. Team Europe initiative on sustainable health security using a One Health 2022
approach in Africa to strengthen systems and capacities for sustainable, risk-
informed prevention, preparedness, and response to infectious threats and
antimicrobial resistance. EU contribution supported by NDICI-GE.
16. Team Europe initiative for Africa-based public health capacity through 2023
support to public health institutes in Africa, at national and regional levels and
through partnerships between African Union and EU public health institutes.
EU contribution supported by NDICI-GE.
17. Team Europe initiative on digital health for health system strengthening and 2023
universal health coverage to support strong and digitally enabled health
systems in Africa. EU contribution supported by NDICI-GE.
18. Support the Global Health EDCTP3 Joint Undertaking through a Team Europe 2021-2027
approach and Team Africa coming to drive forward new solutions to reduce
the burden of infectious diseases in sub-Saharan Africa, also addressing the
rising threat of antimicrobial resistance and climate-crisis-related infectious
disease challenges. Supported by Horizon Europe (EUR 800 million
programmed).
19. EU-Latin America and Caribbean Partnership on manufacturing vaccines, 2022
medicines and health technologies and strengthening health systems. EU
contribution supported by NDICI-GE.
Bilateral projects
20. Health system support and health system strengthening in partner countries
to improve equitable access to essential care. List of countries where health is
prioritised in the NDICI-GE multiannual indicative programmes: Egypt, Tunisia,
Libya, Morocco, Democratic Republic of the Congo, Central African Republic,
Burundi, Kenya, South Sudan, Sudan, Uganda, Madagascar, Ethiopia, Zambia,
Zimbabwe, Nigeria, Mauritania, Guinea, Guinea-Bissau, Mali, Tajikistan, Laos,
Afghanistan, Iran, Cuba, Palestine, Lebanon.

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