This week, the European Commission officially released its 2025 work plan for the €571 million health budget known as EU4Health—a key project initiated following the COVID-19 crisis to enhance public health throughout the European Union.
The release came after months of uncertainty and postponement, as significant financial reductions have already greatly affected NGOs and community organizations working in the health field.
A representative from the Commission cited multiple reasons for the delay, including the shift to the new Commission that began operating in December 2024 and the processing of revised mission letters for commissioners, which were received in September of the previous year.
The requirement to account for previous budget reallocations was also mentioned, particularly a €1 billion figure.diversionFrom EU4Health to assist Ukraine, revealed in February 2024.
But more concerning for health non-governmental organizations is what the new program reveals: a full removal of operating grants—funds that support an organization's basic operations—leaving only project-based grants, which cover specific initiatives.
"It doesn't imply that NGOs will be unable to take part directly. It's simply that we are currently handling funding in a different manner," a Commission representative said to Euronews, referring to this new emphasis on action grants instead of operational ones.
However, for these organizations, what might seem like a simple administrative change actually signifies a major structural transformation, as much of their fundamental work—such as in digital health and air pollution—does not easily align with separate, short-term initiatives.
Civil society operating in 'survival mode'
The postponement of the work programme caused health civil society organizations to struggle with planning and obtaining temporary funding, leading to staff cuts and halted activities.
"The lack of operational funding has forced many within our field to operate in survival mode, particularly for us, being a major organization that has traditionally depended on such support," Milka Sokolović, the general director of the European Public Health Alliance (EPHA), said to Euronews.
Being one of the biggest health-oriented civil society organizations in Europe, EPHA has had to reduce its workforce by 40% this year because of the uncertainty and lower financial support.
It is not the only one. EURORDIS, the European group advocating for patients with rare conditions, also expressed disapproval of the reductions.
"It is profoundly disappointing that the EU4Health 2025 Work Programme not only reaffirms the exclusion of operational grants for health-related NGOs, but also offers limited—perhaps none—other funding options for civil society," stated Virginie Bros-Facer, CEO of EURORDIS.
"Over the last 20 years, DG SANTE [the Commission’s health service] has acknowledged the importance of operational grants as the sole funding method that facilitates substantial engagement between civil society and EU institutions," stated Florence Berteletti from the European Alcohol Policy Alliance.
She mentioned that operational grants make up only a small portion of the EU's health budget—only 1%.
Due to reductions in operational funding, numerous such NGOs are anticipated to face difficulties in remaining operational, as they will no longer be capable of performing critical functions.
EU, a diminishing area for civil society
The lack of financial support arises alongside growing worries that civil society is being pushed to the margins.
Criticism from conservative groups regarding the Commission's support for environmental non-profits has led to an atmosphere that some perceive as becoming more unfriendly towards such organizations.
For Sokolović, the Commission's financial support for non-governmental organizations is intended to counteract the power of more affluent private interest groups.
"It enables us to serve as guardians of democracy during a period of democratic regression. Without it, commercial interests would take control of EU decision-making, without any oversight. And I must emphasize — this extends well beyond health," she stated.
Another trend is the decreased emphasis on health initiatives within the EU's agenda, as compared to when EU4Health was introduced following the COVID-19 pandemic. At that time, it was established as the EU's first separate health budget, with €5.3 billion set aside to enhance the sector.
However, five years later, and without strong backing for non-governmental organizations, many are now doubting if public health is still a genuine EU focus.