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EPHA 2019 Annual Report

Sascha Marschang

Acting Secretary General, EPHA

The view from EPHA

2019 was an election year and it represented a turning point in many ways.

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2019 was an election year and it represented a turning point in many ways. At the European level, the new European Commission President, as well as the new Health Commissioner, are both seasoned public health promoters, which should facilitate not only dialogue about the many different and complex dimensions of public health over the coming years but it is also hoped that long-held EPHA messages around the need to scale up prevention and health promotion, and ensuring that “nobody gets left behind” are heard and understood. Europe’s Beating Cancer Plan to be launched in 2020 – coupled with the work of the Cancer Mission Board in defining research priorities –  will be a key vehicle for working in collaboration with members and bringing different  perspectives to the table, in the hope that the process will also positively influence and provide opportunities for our members in other areas.

At global level, it became clear that massive challenges such as climate change and unsustainable production and consumption models can no longer be retained, with youth movements in particular leading the way, emphasising that “enough is enough”. The importance of sustainability and societal transformation were clearly visible in the 2019-2024 Political Guidelines of new Commission President Ursula von der Leyen, with the European Green Deal (which includes many elements to achieve the ambition to make Europe the first climate-neutral continent, from climate change actions to the new “Farm to Fork” Strategy), digitalisation, the rebalancing of economic and social objectives (inter alia via the full implementation of the European Pillar of Social Rights), and a new push for European democracy as visible signs that change is in the air. 

2020 will be the final implementation year of EPHA’s current Five-Year Strategic Plan. At EPHA’s 2019 Annual General Assembly in June, we launched a comprehensive Strategic Review of our policy work with a view to becoming more flexible and responsive to policy developments and members’ needs, without relinquishing the expertise that has been built up over the past years. New European and international priorities, such as the elements of the Green Deal and the digitalisation of society (including ethical aspects of Big Data and Artificial Intelligence and their impacts) will require new capacities to establish new relationships with partners from within and outside the health sector, in the EU and beyond. In 2019, EPHA began exploring some of these new themes and produced briefings and reflection papers that will be complemented by more in-depth explorations in 2020 when key new Commission documents and national/international reports (e.g. the Marmot Review 10-year anniversary report) will be published. 

While on the surface, the world seems to be constantly in crisis (tsunamis, wildfires, record temperatures, cybercrime, far-right terrorism), an awareness of the fact that the current status quo cannot be maintained is rising. Many people in Europe are slowly but surely beginning to change their habits (small gestures such as cycling to work, eating less meat, supporting the local community, travelling less) and the realisation of the importance of individual action in a global context can only be a good thing for public health. We now need to translate this “power of the people” into political will at national and European level, stressing the virtue of solidarity and using the available tools to demonstrate that public health is more relevant than ever in a world in which inequalities have risen, and in which many people do not have the agency to counter the determinants that shape their health. 

EPHA’s diversity remains a unique asset for us, and many of our projects have created stronger links between European and national advocacy priorities, thanks to the active involvement and dedication of members (and members’ own members) working in their countries and regions. Public health is dynamic and together we can find effective and creative solutions for the big challenges we are facing.

Our year in numbers

1,084,212

people reached

w

1,021,666

social media reach

19,255

followers on Twitter, LinkedIn and Facebook

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118

online articles

3

new members

EPHA Membership: a thriving network

EPHA is committed to growing and nurturing a strong network of members and partners, fostering knowledge-sharing and empowering advocates and future public health professionals with the aim to deliver equitable solutions to European public health challenges, to improve health and reduce health inequalities.

In 2019 we welcomed these new Members:

Our most viewed videos

Digital Health

Clean air

Antimicrobial Resistance

Health Inequalities

Our top reads

The Top 5 Issues in Medicines Policy for 2019

Stella Kyriakides’ stance on 5 key public health issues

Health impacts and costs of diesel emissions in the EU

Our most attended events

EPHA 2019 Universal Access and Affordable Medicines Forum

Reinventing the food system

Invest and protect

Our advocacy

Working towards better health for all in Europe

Action on Antimicrobial Resistance (AMR)

In 2019 we created new powerful alliances and boosted existing networks of to ensure the fight against AMR stays high on the political agenda.  

Context

EPHA has been working on Antimicrobial Resistance (AMR) since 2011 and used it as an example of a serious cross-border threat to healthcare that can only be mitigated by ambitious, coordinated and well-funded action and research as part of a long-term, multi-stakeholder effort. The 2017 Action Plan shifted attention to the complexity of the problem and the urgent need to address AMR in all domains of the One Health approach (human and animal health, environment, research & development, global health, etc.) 

EPHA’s 2018-19 study on the content and status quo of Member States’ National Action Plans (NAPs) was promoted throughout the year and EPHA was able to share key findings with policymakers and other experts at meetings across Europe, including participation in the Romanian Presidency conference on AMR and the 2019 JAMRAI meeting in Rome. EPHA continued its advocacy to create a level playing field between European countries in terms of the resources required to combat AMR effectively, with a flagship event (“Invest and Protect”) providing further insights for national and civil society stakeholders into potential sources that could be deployed for NAP financing. EPHA also continued to push for appropriate benchmarks and indicators to evaluate the progress Europe and its Member States are actually making. 

It was equally important to ensure that AMR as such remained high on the poltical agenda following the European Parliament elections and institutional renewal process; EPHA was pleased to see that the Mission Letter of the new Health Commissioner included action on AMR, with important synergies to be made between EPHA’s work on AMR and Access to Medicines, e.g. regarding the establishment of appropriate and fair incentives for the development of new antibiotics.  

Moreover, EPHA was pleased that its 2017-18 work led to the release of the Commission’s Strategic Approach to Pharmaceuticals in the Environment, with follow-up joint advocacy actions implemented by EPHA and key partners.

Impact

The readiness of prominent MEPs to become AMR champions by joining the new Interest Group is very encouraging and the continued growth of the AMR Stakeholder Network (with nearly 100 registered individuals) is proof that EPHA’s work is not only appreciated by policymakers but also fills an important gap, which is the lack of a “formal” stakeholder group on AMR at the European level. As a convenor of experts coming from different stakeholder communities, EPHA is supporting the European Commission in ensuring active engagement of all relevant actors.

The Council conclusions released by the Romanian Presidency during the first half of the year have taken up many of EPHA’s policy asks and they promote the idea of increased European coordination and funding so that all Member States are able to develop and implement comprehensive One Health strategies.

Priorities for 2020

  • Strengthen the AMR Stakeholder Network by deciding on priority Roadmap actions that can support the Commission’s AMR activities
  • Formal launch of the MEP Interest Group in the European Parliament, bringing together key European, national and international AMR stakeholders and civil society representatives  . 
  • Revise EPHA’s Position on the One Health Action Plan in light of new policy developments and research studies
  • Present key messages the One Health Network of experts
  • Reinforce the message that better guidance is required for national governments to devise effective strategies and implement actions nationally, regionally and locally.

Clean air for health

In 2019 we campaigned for our right to breathe clean air, pushing scientific evidence, highlighting patient stories and working to bring about real change.  

Context

Breathing is the most basic human function to sustain life. And yet, air pollution remains the largest environmental health risk in Europe, despite increasing awareness and rising concern about  the health impacts of air pollution.  EPHA’s #CleanAir4Health campaign aims to highlight the health impacts and costs of air pollution, particularly diesel emissions, calling for strong action at international, European, national and local level to protect our right to breathe clean air.

Impact

  • Obtaining strong political commitment at EU level to reduce emissions in line with Climate goals.
  • Contributing to the air pollution debate in Germany, focusing on strengthening the voice of science.

Priorities for 2020

  • Ensuring that the EU Climate commitments in the EU Green Deal contribute to fight air pollution, especially to have stricter CO2 emission limits, stricter EURO 7 vehicle standards and a zero pollution strategy adopting the WHO air pollution guidelines.
  • Helping European cities to recognise the health burden of air pollution, drafting and implementing actions to address it.
  • Galvanising the healthcare community and raising the voice of doctors, nurses and other healthcare professionals for clean air.

Digital Health

In 2019 we advocated for a continuity of care in a cross-border Europe and for the strengthening of digital health literacy skills, in order to ensure better access to healthcare for all.

Context

In response to the digital transformation of health and care, EPHA works to ensure a holistic and socially-inclusive approach, where new technology is integrated into current health systems, rather than being used to replace them.

In 2019, it became clear that advocacy around the digitalisation of health and care is no longer only a matter of keeping a close eye on digital health itself but closely related to digital developments in other sectors of society, not least due to a whole array of data-driven solutions that are transforming every aspect of people’s lives. 

The increased reliance on technologies and devices powered by Big Data and Artificial Intelligence (AI), which hold the promise to  provide more tailored, effective and sustainable healthcare, can be seen as both a blessing and a curse in the sense that they pose important new ethical, behavioural and regulatory challenges for the health sector. On one hand, more information about diseases, drug interactions, genetic disposition and group-specific health determinants and risk factors is needed to scale up prevention and support new models of care. On the other hand, health data are probably the most sensitive and private data there are, and hence it is important that their use is protected and controlled, guided by public health and human rights objectives rather than market-driven profit goals.

Impact

  • EPHA continued to pursue its vision of inclusive, end user-centric digital health in 2019 and got invited to moderate a workshop on eHealth and health inequalities at the 1st Digital Symposium organised by the WHO European Region in Copenhagen in February. The session showcased various approaches to digital inclusion taken at national and European level.
  • The full-on digitalisation of Europe was confirmed as a key priority in the Political Guidelines issued by new European Commission President Ursula von der Leyen, who envisages major steps forward in a number of areas including health, with a digital package to be released in early 2020. To provide inputs into this important process, EPHA issued a Reflection Paper on Big Data and Artificial Intelligence, as well as a Briefing on Digitalisation in Public Health related areas, both touching upon ethical aspects and reiterating EPHA’s call to policymakers to take into account the needs of end users first and foremost.

Priorities for 2020

  • Working to ensure that the health sector catches up quickly and understands the many complex implications of scaling up data-centred healthcare (including the collection, storage, analysis, use and “disposal” of patient data) for individuals and society. This will include an EPHA-commissioned expert study.
  • Working in partnership with the European Public Health Association (EUPHA), representing the interests of the health research community, to elaborate a joint vision for digital health and engage in advocacy activities.
  • Remain in contact with national members and Ministries around the digital transformation of health and care to support the goal that everybody will be able to gain from Europe’s digital revolution, not only those who already enjoy good access to healthcare.

Europe, let’s do more for health

In 2019 we worked to ensure that health remains at the core of a European Union promoting well-being for all people of all ages, and where people can live, work and age in sustainable and healthy environments. 

Context

Europeans want a healthy Union: 70% of Europeans want more EU action on health according to a recent Eurobarometer survey – yet as negotiations began on the next EU Budget, whether the European Institutions would continue to guarantee health protection and promotion was put into question. Started as a reaction to European Commission’s Future of Europe paper, the EU4Health campaign aims to ensure that EU action on health remains strong after 2020.  

Financing for Health is key for the long term future of the EU. While health still remains a separate programme, within the new ESF+ funding stream, the final negotiations on the amount of funding allocated, and health’s place in the next Commission are areas of concern. European integration and collaboration has brought great benefits for our health and provides vital resources for our health services. EU4Health brings together a number of organisations who share a vision of Europe where all people are as healthy as they can be throughout their lives.

Impact

  • Health remained among the top priorities of the EU. Health made the cut, with Health Commissioner Stella Kyriakides being mandated to implement cross cutting policy topics including the European Beating Cancer Plan and the Farm to Fork strategy, both entry points for wider public health topics. Vice-Presidents Margaritis Schinas is set to oversee the health portfolio.
  • Commissioner Kyriakides highlighted all of EPHA’s priority areas in her hearing.
  • EPHA presents the case for public health in a Study commissioned by and presented to the European Parliament’s ENVI Committee.

Priorities for 2020

  • Continuing to advocate for a common European public health approach.
  • Working to ensure commitment and resources for the EU Green Deal and Farm to Fork strategies, which are also crucial in the longer-term to improve our health.
  • Renewing our calls for:-  a new European public health strategy to deliver targeted and effective EU action on health;
    – an EU leadership at European and national level that respects the current EU treaty provisions on health, as well as our international commitments;
    – measures to ensure effective cooperation between the EU and its Member States to address the unprecedented health challenges we are currently facing.

Food systems and Non-Communicable Diseases (NCD) Prevention

In 2019 we advocated for policies to tackle the common risk factors to NCDs, and to advance a transition towards resilient, sustainable food systems with health-enabling food environments.  

Context

The inclusion of health as a new policy objective in the proposal for the reform of the Common Agricultural Policy in 2018  was a key milestone in EPHA’s advocacy. In 2019, EPHA continued its advocacy push for a health- and nutrition-sensitive CAP in light of two votes in the European Parliament.

The European elections formed the backbone for extensive civil society advocacy to put sustainable food systems and the need for an EU common food policy high on the European agenda. EPHA has been at the centre of these efforts, including through its role in establishing the EU Food Policy Coalition, a platform for closer coordination between civil society organisations.

Moreover, EPHA has contributed with strategic analytical materials as input to the work of the new European Commission and Parliament, especially with a view on preventing non-communicable diseases (NCDs) and the Farm to Fork Strategy. Here it has, among others, sought to renew public health narratives and put the concept of ‘healthy food environments’ at the heart of an equitable transition towards more healthy, plant-rich diets with less and better animal products.

Through its participation in STOP, a large Horizon 2020 project, EPHA is supporting efforts to identify the best policies and approaches to tackle the epidemic of childhood obesity in Europe.

Impact

  • The Opinion of the European Parliament’s ENVI Committee on the CAP was in line with many of EPHA’s strategic advocacy priorities.
  • The new Farm to Fork Strategy for sustainable food puts the food systems perspective firm on the EU agenda with health as a central pillar, in line with EPHA’s strategic advocacy priorities.
  • Europe’s Beating Cancer Plan has opened a major opportunity to put NCD prevention at the heart of the EU’s health agenda, which aligns closely with EPHA’s strategic advocacy priorities.

Priorities for 2020

  • Provide expertise, strategic input and mobilisation to ensure an effective prevention pillar in Europe’s Beating Cancer Plan that focuses on tackling modifiable risk factors common to cancers and other main NCDs, such as cardiovascular diseases, type 2 diabetes and respiratory diseases.
  • Provide expertise and strategic input to ensure the Farm to Fork Strategy advances a comprehensive transition towards sustainable food systems, with health and well-being as a key pillar of sustainability and with special focus on creating healthy food environments and tackling antibiotics use in animal agriculture.
  • Contribute to elaborating new policy pathways to ensure the rights of the child by minimising the exposure of children to unhealthy food and alcohol marketing.
  • Contribute to effective civil society coordination and action to advance sustainable food systems, with special focus on an equitable transition towards more healthy, plant-rich diets with ‘less and better’ animal products.
  • Support national actors in advocating for the inclusion of public health priorities in national CAP strategic plans.

Health inequalities

In 2019 we up-scaled our advocacy against discrimination, pushing for the deployment of major European policies and instruments for inclusion and equal opportunities for all to live, work and age in sustainable, healthy environments.

Context

Providing equitable solutions to health challenges and improving public health systems is at the heart of EPHA’s mission and vision, and promoting effective policy response to address social and environmental determinants of health is the main goal of EPHA’s advocacy on health inequalities.

Strongly oriented around the UN Sustainable development goals, our work on health inequalities seeks to provide a strong commitment on policies tackling “inequalities within and among countries” and “ensuring healthy lives and well-being at all ages”. EPHA focuses on improving health protection and access to quality healthcare and preventive services for all, while also tackling in parallel social and environmental factors responsible for poor physical and mental health. This comprehensive approach has been advanced by the organisation for boosting the impact on public health systems.

EPHA’s advocacy strategy integrates building capacity of health systems and empowering socially-disadvantaged and vulnerable groups experiencing poverty and social exclusion, discrimination and prejudices, and gives special attention to Roma communities facing a severe health gap due to poor access to quality healthcare and prevention.

2019 was a crucial time for shaping the post-2020 European framework for Roma inclusion and EPHA doubled its efforts to raise issues such as mental health, chronic and non-communicable diseases, child’s and women obesity, which remained under-addressed in the current framework. At the same time, this process presented a momentum for mobilising Roma and pro-Roma organisations through the Roma health network and strengthening the cooperation between national and European stakeholders. Taking an inclusive approach towards inequalities, EPHA focused its advocacy on other vulnerable groups such as migrants and young children. Access to healthcare and prevention, but also mental health services were addressed by the organisation standing for better health protection for migrants, social investment and stronger political commitment. Early childhood development was another strategic area for EPHA’s actions for reducing health inequalities. These actions targeted the European Child Guarantee.

The social, economic, environmental factors increasing health inequalities between socio-economic groups will remain strategic priorities for EPHA for the next year. Resolving these complex issues require stronger political commitment and cooperation for achieving health equity and social justice.

Impact

  • Improving the quality and sustainability of health systems, which is at the heart of EPHA mission and vision, becomes a priority for the Commission
  • Supporting the European Child Guarantee and its objectives for promoting access to healthcare for vulnerable children.

Priorities for 2020

  • Working towards better social investment for tackling inequality.
  • Pushing for the deployment of major European policies and instruments to tackle social and environmental determinants of health causing inequalities.
  • Advocating to make public health systems more inclusive and equitable, contributing to provide an effective response to health crises, but also limiting the long-term impact both on public health and economy.

Trade for health

In 2019 we worked to protect and promote public health in trade agreements, to ensure policy coherence between trade and public health and to guarantee policy and regulatory space for governments and the EU.

Context

We are living in a complex and fast-paced world, and now more than ever the public health advocacy community is faced with navigating this constant state of flux and the multiple challenges that arise in protecting and promoting health and health equity, particularly in the realm of the wider determinants of health. This is especially true when it comes to trade, and attempts to ensure public health, social and environmental protections are key considerations within of trade negotiations and finalised agreements. Trade negotiations between large global economic actors with considerable implications for current and future generations, the environments in which they live and the domestic policy-making process, continue to be held, with the recent final agreement reached between the EU and Mercosur demonstrating that the focus afforded to health and the environment continues to be far from optimal.

This is a time of uncertainty, created by the precarious future of the WTO in its current form, the ever-evolving Brexit situation, and the rocky ride ahead for the Mercosur agreement as it makes its way through the ratification process. But this provides public health advocates with an opportunity to reflect on their next moves and consider what can be learned from previous trade advocacy efforts, and from the experiences and ideas of our colleagues in other disciplines to help us think outside the box.

Impact

  • Engaging with the European Commission, sharing the public health chapter to make sure that public health aspects will be coherently represented during the negotiations led by the Commission.
  • EPHA inputs have been recognised in EU documents including the sustainable impact assessment of EU-Australia and EU-New Zealand agreements.

Priorities for 2020

  • Advocating for future EU trade agreements to ensure policy coherence between trade and public health.
  • Monitoring the compliance of the EU with provision of the WHO Framework Convention on Tobacco Control and making sure that the tobacco industry does not have undue influence, undermining public health policies linked to trade.

Universal Access and Affordable Medicines

In 2019 we campaigned to guarantee better and affordable medicines for Europe by questioning and reforming the current pharmaceutical business model and calling for better access to medicines for all.

Context

EPHA’s Universal Access and Affordable Medicines advocacy promotes transparency, accountability and the public interest in the field of pharmaceuticals in line with our members’ priorities. We work for better and affordable medicines for Europe by questioning and calling for reforms to the current pharmaceutical business model to ensure better access to medicines for all. Developed in response to the growing risk to patients and healthcare systems from the increasing prices of medicines, our advocacy is driven by our members’ interests, complimenting their work at local, national and European level. 

Impact

Since the relaunch of EPHA’s access to medicines advocacy in early 2016, we have raised the bar on the debate and succeeded in introducing a new, meaningful and genuine dialogue on all of the issues around pharmaceutical and medicines policies on the agenda in Brussels and beyond. 

  • EPHA collaborates with several governments (including Presidencies of the EU) to drive the access to medicines debate forward and to ensure that all voices, including those of patients, are heard. In this respect, EPHA has been a pioneer in bringing together independent expert civil society and senior decision-makers. As the only representative of expert civil society, in May 2017, EPHA took part in the third round-table discussion between Health Ministers and European heads of pharmaceutical companies in Valletta, Malta. EPHA is now a member of the High-Level Group mandated by the Health Ministers to prepare the agenda for the future round-table discussions.
  • The annual Universal Access and Affordable Medicines Forum has become a highlight for pharmaceutical policy. “Healthy Innovation for All”, the EPHA 2016 Universal Access and Affordable Medicines Forum (November 2016) was the first ever pharma-related, civil society event to take place under the auspices of an EU Member State (Poland). The second forum, the following year, “Game Changers for better and affordable medicines for Europe”, under the auspices of the incoming Bulgarian Presidency of the EU provided input to the Presidency’s work by fostering an honest discussion around the hottest topics in pharmaceutical policy. The 2018 and 2019 editions were equally successful with opinion leaders from EPHA’s members, EU institutions and Member States setting the tone and the agenda for the coming years.
  • EPHA and our members have been centre stage in influencing the agenda, forging new coalitions, highlighting the public health perspective and ensuring a more inclusive and balanced discussion around medicines policy. 
  • EPHA also contributes to the debate at global level, partnering in June 2017 with the Collaboration for Research Integrity and Transparency (CRIT) of Yale University to co-host an international conference in New Haven, Connecticut titled “Ensuring Safety, Efficacy, and Access to Medical Products in the Age of Global Deregulation.” EPHA is regularly invited by the Organisation for Economic Cooperation and Development (OECD) and the World Health Organization (WHO) to contribute to ongoing access to medicines policy debates. EPHA’s members view Health Technology Assessment (HTA) as a powerful ally of patients and health care systems. As one of the members of the HTA Stakeholder Pool, EPHA helps to shape the future of European collaboration in the field of HTA, publishing our recommendations to improve the European Commission’s proposal in July this year. Committed to supporting the work of the European Medicines Agency (EMA) and defending its independence, EPHA’s recommendations calling for more transparent scientific advice by the EMA to the pharmaceutical sector, are endorsed by numerous organisations including two national Health Technology Assessment Agencies (KCE and LBI-HTA) and by the Belgian Social Insurance Agency (RIZIV/ INAMI). EPHA also actively participates in the Patient and Consumer Working Party (PCWP) of the EMA and contributes to the ongoing discussions around the regulatory science strategy towards 2025 of the top EU regulator. 
  • In May 2019, EPHA’s Policy Manager for Universal Access and Affordable Medicines, Yannis Natsis was appointed by EU Member States to the EMA’s Management Board as a patient representative with a 3-year mandate, recognition of EPHA’s credibility and strong access to medicines advocacy.
  • EPHA is a long-standing partner of the European Health Forum Gastein (EHFG), joining forces with Open Society Foundations and the European Alliance for Responsible R&D and Affordable Medicines in 2018 and the European Public Health Association (EUPHA) in 2016 and 2017 to organize agenda-setting sessions on different aspects of the access to medicines debate. Finally, EPHA is a founding member and hosts the secretariat of the European Alliance for Responsible R&D and Affordable Medicines, an informal coalition of more than 80 European and national organisations working exclusively on access to medicines issues.

Priorities for 2020

  • 2020 is a special year for the EU policy world. During the second half of 2019, we heard a lot about the overarching themes of the von der Leyen Commission. From now onwards, there will be a lot of pushing and turning to zoom in on the big themes and narrow down the priorities and initiatives for possible new legislation. 2020 could therefore be branded as the sneak preview, preparatory year which comes around every five years at the start of each Commission mandate. 
  • Generally, the new Commission will be equally sceptical and hesitant as its predecessor in launching new pieces of legislation especially in health. Nonetheless, medicines’ policies are expected to dominate the Commission’s health agenda, as they did under Juncker, fuelled by the systemic problem of excessive prices. It is very important that the Directorate-General for Health and Food Safety (DG Santé) finally will have, for the first time ever,  a clear mandate on access and affordability. That says a lot about the problem but is it enough
  • EPHA will keep up its bold, action-oriented access to medicines advocacy with its members. Medicines’ shortages, transparency in pharmaceuticals, the distorting effect of incentives on biomedical R&D, the role of public support into medicines’ development will be our key priorities. 2020 will be the first year of a legislative cycle which will close in 2024.

Who we are

The leadership, team and scientific advisors that make it all possible

Our financial information

The Operational budget

In 2019, the total income of EPHA was 1.203.438 €

The operational budget is devoted to our core activities to improve health and strengthen the voice of public health in Europe.

Our biggest contributor is the Operating Grant received from the European Commission. In 2019 their contribution represented 46.12% of EPHA’s total income.

In 2019, the total contribution of the membership fees represented 7.31% of the total income.

Projects

In addition to the Operational budget, EPHA is a partner in EU health research projects.

Other projects and grants from foundations represented the remainder of our income.