by Milka Sokolovic, Director General and Sara Bertucci, Policy Manager
The draft 2026 EU4Health Work Programme, presented by the European Commission to Member States on 24 February, again excludes operating grants for health civil society. In a newly issued non-paper sent today to the European Commission, a coalition of 13 Member States is calling on the Commission to reconsider this decision.
Recognising a governance gap that now requires correction, Austria, Belgium, France, Estonia, Greece, Ireland, Latvia, Lithuania, Luxembourg, Poland, Portugal, Slovenia, and Spain formally raise the issue of operating grant withdrawals and call on the Commission to reinstate these funds for 2026 onwards. funds for 2026 onwards. Their argument is straightforward: a modest expenditure guarantees a stable, continuous presence of independent civil society in health policy deliberations. Member States also ask for improved working methods around the development of the EU4Health Work Programme so as to ensure structured, transparent, and meaningful inclusion of Member States’ input.
Last year, the European Commission decided to halt operating grants under the EU4Health Work Programme despite having signed Framework Partnership Agreements with several organisations. The fallout was immediate and continues to grow: since the Commission’s decision, independent NGOs have been forced to close or slash jobs, losing hard-won capacity and expertise at a time when independent technical input, scrutiny of legislative proposals, and balanced stakeholder representation are essential to the quality and legitimacy of EU health policymaking. With no public money, NGOs have scrambled for alternative resources to keep protecting public health and public interest.
Cutting operating grants weakens the EU’s own policymaking capacity. Without stable funding, the sustained and independent expertise that supports balanced, evidence-informed decisions along with their timely dissemination and uptake has been eroding. This is a governance problem, as the Union is undermining its very own infrastructure underpinning the quality, inclusiveness, and legitimacy of its policymaking. All of this occurred for a budget line that barely nudged the total EU4Health spend. Between 2022 and 2024, operating grants represented on average approximately €7.7 million per year – barely 1% of the EU4Health annual budget (which averaged €774.5 million over the same period). While the overall programme was reduced by around 20% following the MFF revision, funding for operating grants was cut by 100%. Eliminating a budget line representing roughly 1% of the programme does not meaningfully improve fiscal efficiency, but it does materially weaken the public-interest pillar of EU health governance.
Investing in civil society is a prudent and strategic commitment to a resilient, democratic health policy ecosystem. A recent editorial in the European Journal of Public Health documents the recent loss of a core EU funding stream for health civil society organisations, coupled with increasing scrutiny and attempts to undermine the legitimacy of their advocacy. This development reflects a recurring pattern of delegitimising, defunding, and constraining an independent civil society while continuing to depend on these organisations’ expertise and community to react – a dynamic that frequently emerges when democratic safeguards and institutional checks and balances are weakened.
At a time when the European Union speaks of strengthening strategic autonomy, preparedness, and resilience in the face of geopolitical uncertainty, sustaining independent public-interest capacity in health policymaking is part of that very architecture. Moreover, with civic space contracting and public-interest infrastructures being weakened across multiple regions, decisions about operating grants carry significance beyond internal budgetary management. The EU has consistently positioned itself as a defender of democratic governance, rule of law, and evidence-based policymaking. In this context, reducing structural support for independent civil society risks sending a contradictory signal about its own commitments. Rather than allowing further erosion of civil society, Europe has a clear opportunity, and responsibility, to reinvest in the sector.
Europe therefore faces a strategic choice: whether to follow a broader drift toward constraining civic capacity, or to step forward as a normative leader by reinforcing the institutional conditions that make democratic resilience possible. Restoring operating grants for health civil society in the 2026 EU4Health Work Programme would send a strong and timely signal of support, demonstrating that the EU understands independent, sustained civic expertise as a core component of governance, and that it intends to exercise leadership in protecting it at a moment of global democratic strain.
Stakeholders from across the board are calling on the European Commission to correct course, and the Member States’ proactive stance and willingness to champion the reinstatement of operating grants is particularly encouraging. Pressure is also mounting from the European Parliament, where a cross-party initiative from the European Parliament’s Interest Group on Civil Society has recently published a Manifesto on Civil Society. It reaffirms the role of civil society as a core democratic actor and commits to protecting, supporting, and meaningfully engaging with civil society organisations (CSOs) across the European Union. The Manifesto also calls for predictable, long-term, and politically independent funding for civil society to serve communities and defend democratic values without pressure or risk of retaliation.
EPHA expresses its appreciation to the Member States and Members of the European Parliament who have taken a clear and principled stand in defence of independent health civil society. Their leadership underscores that the issue at hand concerns democratic integrity and effective health governance, rather than a marginal budgetary matter. We call on the European Commission to align budgetary decisions with stated commitments to democracy and resilience, reinstating operating grants in the 2026 EU4Health Work Programme as a way to demonstrate a genuine commitment to partnership, transparency, and a resilient European health policy ecosystem.