2025/07/08 by Eleanor Brooks, Holly Jarman, Scott L. Greer · 1 voice
Business, Management and Accounting · Health Professions · #Global Public Health Policies and Epidemiology #Health Services Management and Policy #Healthcare Systems and Challenges
paper · pdf · doi:10.1093/eurpub/ckaf117
openalex publication_date 2025/07/08 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/28
At the time of writing in June 2025, the European Commission’s directorate general for health, DG SANTE, has yet to publish its work programme for the year and confirm the financing of activities that health civil society organisations (CSOs) have been undertaking since January. Though a series of framework partnership agreements were put in place for 2025–26, the delivery of funding depends upon the operating grants (OPGs) contained within the work programme, and rumours that the grants may not be renewed continue to circulate. The resulting uncertainty is perpetuated by a wider context in which health is being defunded as a European Union (EU) priority; in February 2024, EU leaders cut €1 billion from the EU’s core health programme, and the head of DG SANTE has previously indicated that the programme’s future is not secure. It was against this backdrop that, in April 2025, several public health CSOs received letters from the Commission advising them that their lobbying and advocacy activities will no longer be eligible for EU funding. Cumulatively, the impact of these decisions is potentially dramatic. The inevitable result will be the reduced activity—or even closure—of a significant proportion of the CSOs operating in the health policy space. For those able to weather the OPG crisis, lobbying and advocacy are core elements of their work programmes and key to achieving impact. The Commission’s guidance suggests that ‘sending letters, organising meetings or providing advocacy material to EU institutions or specific members of an institution’ are potentially risky and, as such, ineligible for EU financing [1]. The Commission’s decisions, which serve to marginalise health and the CSOs that advocate for it, are concerningly similar to recent events in the USA, specifically, the defunding and sidelining of expertise promoted by the new US Department of Government Efficiency (DOGE). Set up by President Trump and spearheaded, until June of this year, by billionaire Elon Musk, DOGE is officially tasked with improving government efficiency. In practice, DOGE has fired policy experts and disrupted or ended funding for proven health interventions, research, and CSOs, acting under the pretext of improving the democratic function of government through an opaque and often unconstitutional process. To date, there is little to no objective evidence that DOGE has uncovered corruption or created efficiency. While explicit calls for a ‘EURO-DOGE’ have been made only by a relatively small group—predominantly comprising technology company CEOs, far-right political parties, and a think tank backed by Victor Orban [2]—and have not gained too much traction, the logics of defunding and sidelining are nevertheless evident, not least in public health. In addition to the Trump administration’s approach to global health governance, foreign aid, and health research [3], it thus seems that Europe will also need to contend with the influence of the DOGE approach to running a government. In the past, the Commission has sought legitimacy by enacting policies designed to appeal to Europeans in areas including health, labour and environmental protection, with the goal of counterbalancing or moderating economic objectives, such as the smooth functioning of the Single Market. ‘Platforming’—the promotion of visible networks of Europe-wide interest groups through a combination of funding and consultation mechanisms—has been a significant part of these legitimation efforts. In theory, the Commission’s compact with civil society benefits both sides: the Commission gains relevant information and potential support for its proposals, while interest groups, particularly CSOs, get better access to the policymaking process [4]. But Europe’s rightward drift threatens to break this compact. Moving forward, the Commission’s EURO-DOGE agenda is not guaranteed to find and eliminate corrupt practices, and it is likely to silence civil society voices. Lobbying will still happen, but only by those interests in society with significant enough funds to have permanent representation in Brussels without Commission assistance. Fundamentally, a reduction in the presence and engagement of health CSOs risks reinforcing the primacy of economic over social interests in EU policy-making at a dangerous time, as the Commission’s ‘deregulation drive’ gains momentum. Since late 2024, the Commission has announced over 15 different tools for systematic deregulation, targeting inter alia agriculture, chemicals and labour rights legislation, and threatening a roll-back of health, social and environmental standards on an unprecedented scale [5]. Avenues for CSO engagement in these processes are already limited—consultation structures focus on tools via which ‘selected stakeholders’ will be asked to input—contributing to a broader sense of sidelining. In this context, DG SANTE’s continued pressure on health CSOs sends a worrying message. As the US experience shows, government–civil society partnerships are easy to break—restoring the value that they bring to policymaking is much harder. Conflict of interest: None declared. EB is supported by UK Research and Innovation (Medical Research Council grant reference MR/T023244/1). No new data were generated or analysed in support of this research.