The #ECHoS consortium has the potential to bring the #CancerMission spirit, vision, and ambition to the Member States and at the societal level, very close to citizens. But only by understanding people’s needs and involving them in research and the immediate implementation of research results can we achieve better results than before.

We need to work together to generate and maintain a new mindset regarding cancer research, as well as the way prevention, screening, diagnosis, and treatment services are delivered to citizens and patients. Research should no longer be viewed as a luxury but as a critical part of cancer control in the 21st century.

The national hub structures must take into account the specificities of each country (or even the local or regional specificities), and cultural and social factors. Still, there will always be a common thread connecting them all, ensuring coordination, multi-directional dissemination of good practices, and continuous feedback mechanisms aimed at continuously improving quality.

We have the opportunity to generate unique, disruptive, and adaptive impact models, as they have never existed before, based on mapping, activating, and involving traditional and non-traditional stakeholders, in an approach to cancer as a societal problem.

An essential role will be played by specialists from non-traditional areas as well: social sciences and humanities, science communication, social innovators, digital media analysts, and so on.

In the complex picture of cancer, oncology research, and European and national initiatives (dozens of research projects approved by the EU in less than 2 years), we need a new type of leadership (distributed leadership; leadership as a process) to respond effectively.

Trust is a key word when considering new possible leadership models and when thinking about effective models for involving citizens in #CancerMission. It is essential to understand the mechanisms by which people’s trust is formed (in doctors, healthcare systems, decision-makers, or trust at the societal level), as well as their attitudes and perceptions of cancer, in order to create new, personalized models of communication, education, and engagement.

I discussed the vision behind ECHoS Project with Hugo Soares, Agency for Clinical Research and Biomedical Innovation AICIB – National Cancer HUB, Portugal, during an event organized in Bucharest by the Executive Agency for Higher Education, Research, Development and Innovation funding (UEFISCDI), ”Working together for a quick and diagnosis and better treatments for cancer EEA & Norway Grants contributions to the EU Mission Cancer”.

• How does the ECHoS project align with the objectives of the Cancer Mission and how will it contribute to reducing inequalities in access to cancer care?

ECHoS is not a research project, it is a project aiming to put together groups of stakeholders, who are not considered conventional when you think about cancer care. This will enable interactions beyond those involving researchers, medical doctors, and the health system, who are traditionally our main players. But when you think about citizens and patients, their needs go beyond what healthcare providers and researchers can do. Employees, municipalities, and regional administration members are also stakeholders. If you think about prevention, in a city there is a lot of space for intervention by local authorities or by the educational sector. Such stakeholders can raise awareness of risk factors such as smoking and promote healthy habits. There is also an opportunity to involve the sports community (e.g., ministry of sports, professional regional teams) who can work with citizens, as well as the spiritual leaders who also can have an influence on how people react and adhere to the national campaigns towards less smoking habits and healthier diets.

When you think about cancer there is much more than just health and research. ECHoS aims to get close to communities, involve them in cancer research and then go to researchers, health professionals, and the EU Commission and share the real needs, involve them, and reach back to the community. By creating this positive feedback loop we will be able to identify needs beyond classical ones. The authorities will create the conditions to answer these needs and implement them. Then again, patients and citizens should be involved in assessing how these solutions and technologies work, revise them, and reconnect again with the initiative, reaching to the European authorities to the local organizations.

• How will the project ensure the sustainability of such multi-stakeholder collaboration?

In Portugal, the sustainability goals might differ from Romania’s or Germany’s. In the EChoS, we will work on developing a set of criteria and guidelines on how to make these sustainable. It is important that structures created in different countries maintain contact and interaction between national goals, otherwise it will evolve differently and create silos that we want to avoid.

What is important is that we have this common framework. (…) You can’t go in all directions at full speed. You have to prioritize according to the needs of citizens, have the right frameworks for implementation with awareness related to what is happening, and evaluate the positives and negatives of the implementation. The good thing about ECHoS is the opportunity to put all the learnings together.

• How do we engage citizens to become actively involved in prevention and ensure they do not become patients?

It doesn’t work just to provide information and expect people to follow and voluntarily adhere to what they are told to do. We need the population to understand, not just to provide directions, but to educate on the benefits of these directions and the risks. It is important that we are open to listening to what the community is saying.

In Portugal, we have very different rates of people adhering to screening programs in the north versus the south. It is important to highlight that we have national education and health care systems thus, virtually, equal access to both education and care. It might be because of public transportation, costs of commuting, it might be related to local beliefs, local groups influencing them, or maybe traditions. And all this should be addressed.

When you think about patient engagement, it is not about more campaigns on television, it’s about asking why people don’t go to screening programs. And you don’t just ask this in expert groups. You also ask people about this.

It is all about enabling people to participate in the process of developing solutions. Imagine the low adherence is related to public transportation. We might think that a solution could be, for example, cheaper bus tickets – or related. But the actual problem might be there is no actual transport at the right time because people work 9h-to-17h with just 1h for lunch, and they need to spend 1h or 2h just on public transportation to get to the doctor and return. It is really important that we involve them in co-designing and assessing the solutions that are put forward.

• How do we ensure citizens’ trust in disruptive technologies such as genomics, which are transforming cancer care?

We cannot make the technology fully available for everyone at the same time and at the same pace, so it is important to prioritize. Thinking about genomic data and the impact on cancer treatment and risk stratification, people should know that the genomic data belongs to them. This is not part of the research community, not even the healthcare community. It’s their data, they should be able to retrieve it if they want to. It is important that people are aware of their rights and responsibilities because genomic data is very personal. If we think about young people with cancer, who might want to access jobs later in life or get health insurance, people should be informed when they are providing this data to the health system for diagnosis and treatment, that their data will be protected and that they have the right to. It is important for people to break the fear of data sharing. We go back to education and literacy and involve people in all steps of the process.

• Are there any examples of good practices from your country that could be implemented in Central and Eastern European countries? How has Portugal progressed when it comes to the implementation of the objectives of the Cancer Mission?

In Portugal we have the National Cancer Hub which works in synergy with the EU Beating Cancer Plan, coordinated by the Agency for Clinical Research and Biomedical Innovation and the Directorate General for Health, gathering representatives from both research and health ministries. The Hub’s actions are implemented by different groups. A policy group that unites key decision-makers, and a stakeholder group with 400 representatives from healthcare, research, and communities. A plan for this year is to create and moderate a new group called the Citizens and Patient Forum. In the first phase, the goal was to engage the community already involved in cancer care and break silos with the classical agency, create awareness among the policymakers regarding the opportunities in Europe and how could this Portugal benefit from this. Now that we have decision-makers engaged with the Mission on Cancer, we are ready to move to the next phase. Now we go to the individual level and involve patients in activities that emerge from the EU Commission and those organized by the National Cancer Hub.

• What does future cancer control look like 5 years from now, in your opinion?

I would like to appeal to a motto of A cancer-free society, but it is quite ambitious to think of this. However, we know that more than 50% of cancers are preventable, most of those are determined by external factors such as smoke, UV lights, work-related conditions, mining, chemicals exposure, and so on. At least for these ones, I would like to see a dramatic decrease in the level of exposure. If we reach 25%, this will have a huge impact on the lives of everyone, as well as on the economic and healthcare system. If we think that side by side with the cancer revolution, we see the revolution in genomics, you can also think about the 10% of cases that are caused by genomic mutations.

If we can screen for those genetic conditions and become aware that they exist, monitor the evolution of cases, and control the external factors, then we would see Europe as a much better place when it comes to cancer control. We cannot control cancer from developing but screening for genetic conditions and controlling of external factors could make a difference. We know a lot of things in the field of cancer, and with all the knowledge implemented we can do a lot of things in the years to come.

We are witnessing a revolution in oncology. I remember more than 30 years ago when we gave up the previous political regime and started thinking of unthinkable things. Then we had a momentum, we lived a historical moment that changed our lives forever. Probably this is the perfect place to say this, as we are standing in the University Square in Bucharest, where the revolution started. And we are also living a similar momentum in oncology because we have a chance to think beyond the death penalty which cancer was in the past, we have a chance to cure several of our patients and give promises to those who at this point cannot be cured.

We are living through many societal changes, many of which are highlighting the importance of reforming the healthcare systems and more importantly redefining what we understand by health and disease. In the European Union, there is a commitment for the years to come under the ambitious Horizon programme, aiming to address the major challenges citizens face in their daily lives. More than €600 million will be invested in the five EU Missions in 2023, as part of the Horizon Europe framework programme.

Cancer is the first disease that changed the EU’s involvement in healthcare. From a Moonshot approach to a Plan dedicated to cancer, now we live the momentum when all this can become reality in all member states. The Mission on Cancer launched on 29 September 2021 aims at improving the lives of more than 3 million people by 2030 through prevention, and innovative treatments, and for those affected by cancer including their families, to live longer and better.

I had the honor to meet Prof. Jeliazko Arabadjiev, the first Balkan in the EU Mission on Cancer Board, Ambassador for Bulgaria, Romania, and Lithuania, during an event organized in Bucharest by the Executive Agency for Higher Education, Research, Development and Innovation funding (UEFISCDI), ”Working together for a quick and diagnosis and better treatments for cancer EEA & Norway Grants contributions to the EU Mission Cancer”.

An oncologist by profession, Prof. Arabadjiev explained how the Cancer Mission implementation should look in the Central and Eastern European countries (CEE region), discussed his priorities, and shared his motivation to make the voice of the Balkans heard at the highest level to transform the lives of citizens and cancer patients.

• Transformation of culture and communication are key objectives in the Mission implementation Plan. As Balkans, we share a cultural background that influences the way we relate to cancer. How do you see the objectives of the Mission being implemented in the region and maybe the perspective of building a CEE Cancer Mission Network?

Bulgaria and Romania joined the European Union more recently, and we made huge efforts to make sure we fulfill the criteria for joining the EU. I believe that citizens in both countries are happy we are part of the EU. Unfortunately, we might not have been prepared for this because being part of the EU requires a specific behavior that is different from the cultural heritage, we Balkans share.

When it comes to cancer, we need to overcome the stigma we lived with for decades. I remember a time when cancer was a disease nobody wanted to speak about and was considered a death penalty.

My grandmother died of colorectal cancer 42 years ago. I remember she was diagnosed in November and died in January. At that time. once we heard the diagnosis, the whole family went to tears. The only option was chemotherapy and there was no support from society, no psychological support, no program to help the patient, no innovative treatment, and no personalized medicine.

I became an oncologist because oncology reflects the best innovation society expects from science. I speak as a board member of Cancer Mission but also as an Oncologist. I can use my knowledge of cancer and the opportunity to be the first Balkan Oncologist elected to the Board of the EU Mission on Cancer. I have great plans on how to synchronize our efforts and create the types of synergies that the EU Commission expects.

All recommendations from the first Board Mission on Cancer and all efforts of the current board are towards changing the perception of cancer in countries like ours. We need to battle the inequity not only to ensure access to personalized treatment but to all aspects of the disease, from the perspective of cancer patients as well as the perspectives of the family. The EU Beating Cancer Plan and Mission on Cancer will tackle the inequities between member states. This will be very beneficial for Balkan countries because we will get access more quickly to cancer care. But we need to speak up about this, to encourage transborder collaboration.

• Citizen empowerment in the CEE can be a challenging task because the patient-doctor relationship is a traditional one with many inequalities specific to the area. How to change the mindsets of citizens to engage actively when it comes to their own health?

We need to provide citizens with a proper roadmap of their disease and a proper outline of progress, and also for relatives and family. Cancer is more than the relationship between oncologist and patient. We need to ensure the continuum of cancer care, which doesn’t include only treatment. We need to make sure patients and citizens get the full benefits out of cancer care, the way it often happens in Western Europe. The Implementation Plan outlines every aspect needed to achieve this.

We need to establish structures and involve stakeholders in this process of synchronizing cancer care in our countries so we can manage to implement all that. The first board tackled all the problems with cancer patients and outlined the measures we need to take in our countries. The mission of this Board is not only to show things but to propel the action, to achieve all that we put in the implementation plan.

Cancer will be best treated in a multidisciplinary team, and in a diverse way, which will attract stakeholders who were not visible before. I am talking about insurance companies, social care providers, and such stakeholders. We need to encourage cooperation between institutions, this will make things happen. Unfortunately, we need to consider our cultural background and understand the differences from the Western countries, but we have a chance to learn from best practices implemented in other countries and recognized at the EU level. It is a very beneficial time for us. We don’t have to recreate the wheel or find hot water.

• How can we ensure that disruptive technologies such as genomics and data science make full impact in the regions since there are major gaps to be covered?

We are lagging behind other countries because we do not have proper cancer registries. We need to create a proper organization to restore or implement cancer registries and digitalize them. There is no wonder there are so many topics dedicated to digitalization in Horizon Europe.

At this point, we have the technology to get the full genomic profile of a tumor. Once we find the mutation, we can find a truly effective treatment, which should be available for all those who need it. So far, genetic testing has been left in the hands of the health authorities, ministries, and national health funds. Both are not prepared for such an extent of knowledge, because so far genetic testing has been expensive, and are not ready for the cost of the treatment informed by genetic profiling.

We need to start discussing this with the health authorities, educate them, we need to show them in a very professional way the benefit for patients and for citizens, who are not patients yet, and for society. And also, from an economical point of view. Let’s say we have a patient in his 40s and if he is put on a personalized treatment he can live many years, with a proper quality of life, and the capacity to work and be an active part of society. We need to start explaining this to the institutions and brainstorm with them. We cannot afford to miss genomic profiling just because there is no money for this.

We don’t have just oncology anymore, we are not <<chemotherapists>> – how they used to call my profession 20 years ago. Genetic testing is crucial. We are oncologists who can offer a precision approach to our patients.

EU efforts to help the Ukrainian migrants while protecting its own citizens: policies and the role of ECDC

Since 24th of February, more than 4,5 million Ukrainians fled the country, with millions being displaced internally. Beyond the immediate threat to individual safety, this situation causes long-term trauma, emotional distress and long-term health problems.  

In its March operational report, the European Centre for Disease Prevention and Control (ECDC) sets out guidelines and priorities for the control of communicable diseases in the context of the humanitarian tragedy in Europe. Experts warn that Ukrainian refugees are at an increased vulnerability in what they have identified as infectious diseases due to the living conditions they face during relocation. However, the main recommendation is for the state hosting migrants to ensure that they have access to medical services in a similar way to their local populations. Thus, possible complications of pre-existing medical conditions can be prevented, and acute conditions can be treated early (including non-communicable diseases and mental disorders). This approach not only ensures the continuity of medical care, but also helps in the early detection of communicable diseases that can cause outbreaks, such as COVID-19.  

These recommendations can be put in place based on the Temporary Protection Directive enacted by the Council of the European Union on 4 March 2022 (Council Implementing Decision (EU) 2022/382) in response to refugees arriving in the EU from Ukraine. Temporary protection, which is distinct from asylum, can last up to three years depending on circumstances. When invoked, the directive compels all member states (except Denmark, which has an opt-out clause) to accept refugees, issue residence permits, minimise red tape, and take other steps to assist displaced people. Refugees are to be distributed among member states on a voluntary basis, based on member states’ capacity to host them.  

However, not all the countries have the legislative basis for equal implementation and this differences affect the equal management of the Ukrainian migrants across the EU. By adding the layer of already existing inequalities between Eastern and Western EU Member States, the most noticeable being the ones regarding health and care, these vulnerabilities become exacerbated. To compensate for the current and future vulnerabilities, the EU Institutions should focus on the Eastern Europe in terms of vision, planning and funding.

Open letter to the European Parliament, the European Council and the European Commission from the Centre of Innovation in Medicine  

In the context of the war in Ukraine and the humanitarian and health crisis in neighbouring countries (Hungary, Moldova, Poland, Romania, Slovakia), the Centre for Innovation in Medicine addressed to the European Union legislative bodies the following requests:   

• Prioritisation of funding for CEE Member States and Eastern Partnership countries in the ongoing Funding programs: EU4Health, Horizon Europe, Digital Europe, NextGenerationEU, as well in the context of the Beating Europe Cancer Plan and Mission on Cancer.  
• The establishment of a public health program, in coordination with ECDC, with a focus on vaccination and genomic and syndromic surveillance of pathogens (SARS-CoV-2, but as well pathogens involved in tuberculosis, poliomyelitis etc) for the migrants.  
• The immediate start of the process to define a mechanism to provide access to healthcare for migrants, when the temporary protection mechanism will end, is coordinated at the EU level.  
• The establishment of a working group designed to re-think and help the post-war transformation of the public health system and the healthcare system in Ukraine.  

European Council updates the 2003 Council Recommendation on cancer screening  

The Europe’s Beating Cancer Plan proposes a new cancer screening scheme, aiming to help EU countries ensure that 90% of the EU population who qualify for breast, cervical and colorectal cancer screenings are offered screening by 2025. A first step into achieving this is updating the 2003 guidance (Council Recommendation) on cancer screening based on the latest scientific advice and consider extending screening to other types of cancer, i.e. lung and prostate cancer. The Call for Evidence from Member States and civil society was launched in January 2022.   

The Centre for Innovation in Medicine proposed three key recommendations:  

• to include the social innovation in the screening programs design (attitudes, perceptions and behaviours) 
• to take into consideration the site agnostic testing for screening  
• to include real-time real-world data, digital-enabled screening  

While the 2003 recommendations urged the Member States to take common actions to implement such programmes through a population-based approach, in accordance with the European quality assurance guidelines, the current scientific understanding of cancer must be reflected in the screening practices. Changes take time, but we cannot afford to screen for cancer as we did 20 years ago, not taking into consideration the molecular characteristics of the disease, the biological traits of the person, and all the health determinants that can be integrated at this point due to scientific advance.  

Currently, the best case scenario in a country is to have cancer screening programmes for three types of cancer: cervical cancer, breast cancer, colorectal cancer. The EC will extend this by adding probably two others: prostate and lung cancers. You can read more in the Report of the Federation of European Academies of Medicine (FEAM).  

As of 2020, 25 EU Member States had introduced in their national cancer control plans population-based screening programmes for breast cancer, while 22 member states had done so for cervical cancer and 20 member states had done so for colorectal cancer. Full implementation has not yet been achieved, and inequalities persist within and between Member States. In 2019, two-thirds (66%) of women aged between 50 and 69 years in the EU reported that they had received a mammogram (breast examination by X-ray) within the previous two years. In Romania, the percentage was 9%, while in Germany it was 66% and in France, almost 70%.  

Citizen engagement in Cancer Mission, a priority at the European level, highlighted by the French Presidency for the European Council  

The 5 EU Missions of the Horizon Europe programme aim at fostering the emergence of solutions and initiatives to address major contemporary challenges such as adaptation to climate change, protection of the oceans, the fight against cancer, carbon neutral cities and soil health.  

The Mission on Cancer was launched on 29 September 2021 and together with the Europe’s Beating Cancer Plan adopted on 3 February 2021 aims at improving the lives of more than 3 million people by 2030 through prevention, treatment and overall, for those affected by cancer, including their families, to live longer and better. Missions are a novel instrument in Horizon Europe – the Framework Programme for Research and Innovation.  

The four Cancer Mission objectives include: understanding cancer, prevention and early detection, optimise diagnosis and treatment and support quality of life. Over the years, the approach in the cancer care continuum was patient-centred. The pandemic showed us more than ever that this paradigm must end, that health and care should be citizen-centred. A citizen-centric model is more suitable for cancer because first of all, prevention refers to ‘healthy’ or at least cancer-free citizens. With more than 40% of cancers being preventable, this means that prevention should play a major part in addressing cancer.  And second of all, cancer should be addressed from the citizens perspective because of the stigma attached to cancer survivors. We are all citizens, humans, and getting cancer doesn’t make us less. 

Citizen engagement is one of the topics that the French Presidency of the EU Council (1st of January 2022 – June 2022) is trying to address. The first step was the conference held on the 21st of March: Conference on Civic Engagement in EU Missions. 

Romania, through the activities of the Centre for Innovation in Medicine, has the potential to become a pioneer and a model regarding the citizens’ engagement in cancer. During the high-level online event “From Cancer Plan to Action and Mission. Implementation of the cancer agenda in Romania” organised by InoMed in collaboration with the Romanian Parliament, this model was discussed and detailed. 

“A key focus is on prevention. We must see what methods we must perform screening; we must work with citizens to make them understand the need for screening and change their behaviour. We must ensure that survivors of cancer live the life of a citizen not of a patient. This involves another level of engagement.”  

Christine Chomienne, Professor of Cellular Biology at the Université de Paris, France, Vice-Chair, Cancer Mission, Phase I.

The first draft of the European Partnership for Personalised Medicine was published 

The writing of the birth certificate for personalised medicine in the European Union, in 2015, was a major policy success of the European Alliance for Personalized Medicine. The Luxembourg Presidency Council Conclusions of December 2015 recognized that “personalized medicine refers to a medical model that uses the characterization of personal phenotypes and genotypes (e.g. molecular profiling, medical imaging), lifestyle data) for tailoring the right therapeutic strategy for the right person at the right time, and/or to determine the predisposition to disease and/or to deliver timely and targeted prevention.” Personalized medicine refers to the broader concept of patient-centered care and states that, in general, health care systems need to better meet the needs of patients and/or citizens (we might now add).

Less than one year later, in 2016, the International Consortium for Personalised Medicine was initiated during several workshops organised by the European Commission. The basis for this was the previous project, PerMed, that was funded from 2013-2015 by the European Union’s 7th Framework Programme and brought together many organisations active in the area.

One of the main current activities of ICPerMed is promoting the establishment of a European Partnership for Personalised Medicine, EP PerMed, together with the closely connected ERA-Net ERA PerMed. 

As the next step towards a European Partnership for Personalised Medicine, a drafting group was established by the Member States in close collaboration with the European Commission. With support and guidance from the European Commission, they developed a draft proposal for the Partnership that was published by the European Commission in February 2022. The next step is the establishment of the partnership for personalised medicine to be co-funded by the EC in the European Union’s 9th Framework Programme for Research and Innovation, Horizon Europe.  

The EP PerMed aims to align and promote national and regional priority setting and funding for research and implementation projects in the area of personalised medicine between the EU Member States (MS), regions and associated countries as well as international partner countries. 

Centre for Innovation in Medicine contributes with recommendations for setting AMR public health objectives in the European Union 

In February 2022, the European Commission launched a call for public evidence in setting the concrete objectives and activities to strengthen Member States’ action against AMR mainly in the area of public health, where the EU has only supporting and complementary competence. 

The Centre for Innovation in Medicine emphasised the AMR threat coming from and within the Eastern European countries. Many experts argue that the next pandemic will be a bacterial pandemic. Eastern Europe already had high levels of AMR and by adding the migration generated by the war in Ukraine – more than 4,5 million people displaced in neighbouring countries – creates the perfect outbreak point. Poland, Moldova, Slovakia, Hungary, Romania are their new homes, in some cases for a couple of days or for longer in others.  

Communication campaigns on antibiotics usage awareness were created in the one size fits all manner. One of the main components of a public health policy aiming to prevent AMR by reducing irresponsible antibiotic use should be the understanding of what are the main factors that influence antibiotic consumption in countries from Eastern Europe, like Romania, with a history of communism, with conservative views, high rate of emigration in young populations, with 45% population living in rural areas and many more living in disadvantaged areas and in small, isolated communities. By understanding these factors, communication campaigns and personalised (targeted) preventive actions could be employed. 

• To prioritise the social innovations when creating communication campaigns for prevention of antibiotics use.
• To asses periodically, on multiple layers the attitudes, perceptions and behaviours of the citizens with regards to antibiotic consumption, identifying vulnerable groups. 
• To build a new model of personalised communication, education and engagement for reducing the risk of AMR, based on individual behaviour, influencers and perceptions.

You might also want to read:

• Redefining health: the multi omics revolution
• Behaviour: The missing piece of the health innovations

If we’re looking at the vaccination against Covid, despite the immediate availability of the vaccines (on December 27, 2020), for the entire eligible population, Eastern European countries are considerably behind the European average rate of vaccination with two doses; the gap increases if we take into account the administration of the booster.

In Eastern European countries that are not members of the European Union, such as Moldova and Ukraine, vaccination rates against Covid are lower than the average rate of vaccination in EU member states from Eastern Europe.

European Immunization Week is an opportunity to bring to the fore the issue of inequalities, the East-West divide in vaccination: both anti-HPV and anti-Covid.

The Berlin Wall, which has divided Europe for decades, fell in 1989. In terms of vaccination, the Iron Curtain still persists, after decades in which Eastern European countries have either become EU members or are on their way to EU membership.

The standard of living has risen every year, GDP has risen steadily with the shift from centralized to liberal economy and globalisation, but public health lags behind the other socio-economic sectors, despite the fact that public health is a prerogative of the EU, not of the Member States.

In recent years, we have contributed to the European Commission’s Cancer Initiatives (BECA, Cancer Mission) by trying to explain inequalities from the perspective of the citizens and of the civil society institution that takes the daily pulse and understands the deep realities of Eastern society.

Reducing these inequalities is possible by including in the research, local, cultural, specific and common factors of many CEE member states, which determine people’s attitudes, perceptions and behavior, including in relation to vaccination.

This change of mindset is possible, and the European Commission and HADEA have already created through the 2022 Calls of #EU4Health and #HorizonEurope, the framework for potential implementation of truly innovative projects aiming to increase the vaccination rate, both against HPV and against Covid. It remains for these projects to be selected, funded and well implemented.

Dear EU Leaders, please tear down this Iron Curtain of vaccination.