From Cancer to Cardiovascular Disease: Lessons from Europe’s Beating Cancer Plan

In 2021, the European Commission published Europe’s Beating Cancer Plan (EBCP) in a move of unprecedented political commitment to addressing one of Europe’s most serious health burdens: Cancer.

The plan ambitiously introduced actions to tackle cancer via prevention, early detection, diagnosis and treatment, and improving the quality of life for patients and survivors. Including actions to introduce non-binding recommendations, provide funding for intervention and research, and to revise existing or introduce new legislation, the plan was as ambitious as it was comprehensive.

Four years later, the EBCP has been largely hailed as a success throughout health policy circles. So much so there have been several notable movements to establish dedicated European actions plans in other disease areas, including mental health and rare diseases. The Commission attempted to respond to these calls with a blanket strategy for NCDs in 2022 (Healthier Together Initiative); however, advocacy communities continued to call for disease-specific actions.

In her political priorities for the current mandate, Commission President von der Leyen unveiled the Commission’s next focus area: cardiovascular disease (CVD). She tasked incoming health Commissioner Várhelyi with drawing on the work of the EBCP to guide action on CVD; leading to the announcement of a forthcoming Cardiovascular Health (CVH) Plan.

Amid all the buzz and excitement about this incoming plan, I found myself thinking: what did the EBCP actually get done? Is it possible to measure the success of the EBCP, and if so, what lessons can we learn for the CVH Plan planned for later this year?

The EBCP journey

Leading up to the first von der Leyen Commission in 2019, stakeholders increasingly called on the Commission to take bold action on cancer. Countless meetings, reports and discussions resulted in a common understanding at the highest level: cancer should be a social and political priority.

President von der Leyen included a European plan to fight cancer in the political guidelines for her first mandate and tasked the Health Commissioner at the time, Stella Kyriakides, with its development. While work kicked off in the Commission, the European Parliament set up a special committee on Beating Cancer (BECA).

On World Cancer Day 2021, the European Commission published Europe’s Beating Cancer Plan and announced the establishment of a European Knowledge Centre on Cancer. A year later, the EP approved the BECA committee’s opinion and the Commission announced several additional initiatives under the Beating Cancer plan.

While all of this was going on, the Council adopted a recommendation on a new EU approach on cancer screening (2022), a  recommendation to help combat vaccine-preventable cancers (2023), and a recommendation to reduce exposure to second-hand smoke and aerosols (2024).

Funding the EBCP

Any plan from the Commission is only as good as its funding. Backed by a whopping €4 billion, the EBCP included funding from the EU4Health programme (1.25 billion), Horizon Europe (2 billion), the European Institute of Innovation and Technology and Marie Sklodowska-Curie (500 million) and the Digital Europe Programme (250 million).

As a reminder, EU4Health was cut by €1 billion following a reallocation of EU funds to support Ukraine in 2025. The Commission indicated this reduction would require “adjustments across the entire health portfolio, including the cancer strand”. The implications for what this reduction means for cancer action remain to be fully understood; however, the Commission did commit to limiting impact on policy priorities and implementation of legislation.

Measuring impact of the EBCP

For our purposes, we have considered two metrics to measure the success of the EBCP: progress on flagship initiatives and legislative action.

Beginning with the non-legislative initiatives, out of the 10 flagship actions outlined in the plan, the following have been completed:

• Knowledge Centre on Cancer (2021)
• European Cancer Imaging Initiative (2023)
• European Initiative to Understand Cancer (2022)
• Cancer Inequalities Registry (2022)
• EU Network of Youth Cancer Survivors (2022)

The next group of actions is more challenging to measure and could be labeled as “ongoing”, since some areas have been achieved while others are still in progress:

• Vaccinate 90% of the EU target population of girls and increase vaccination of boys, and invest in infrastructures to eliminate cancers caused by HPV: Proximity to this goal varies across countries with Belgium having achieved 90%, and France only 19%.
• Launch a New EU Cancer Screening Scheme: The Council updated its recommendation on screening in 2022, launched the Cancer Imaging Initiative in 2023, and updated the European quality assurance scheme for breast cancer services. Updated QA schemes for cervical and colorectal cancers are still under development.
• Ensure high standards in cancer care: The Commission established CraNE to support national cancer centres in every Member State, ultimately reaching 25 EU countries before the end of the program in 2024. Ambitions to establish new European Reference Networks on cancer and cancer conditions have also not yet been achieved.
• Launch a Cancer Diagnostic and Treatment for All initiative: The Commission launched the HEAL platform to improve access to innovative cancer diagnosis and treatments.
• Better life for cancer patients: The Commission introduced efforts for a Cancer Survivor Smart-Card via the SmartCare initiative; however, the level of uptake remains unclear. Progress on the European Cancer Patient Digital Centre outlined in the EBCP seems to have stopped following publication of the operational concept.

Moving on to the legislative aspects of the EBCP, there were three types of legislative action: review existing, propose new and adopt ongoing legislation. Those completed include:

• Review Carcinogens and Mutagens Directive (2020, with work beginning prior to EBCP publication)
• Review Regulation on carcinogenic contaminants in food (2023)
• Proposal for mandatory labelling of ingredients and nutritional information on alcohol products (2021, requires info on allergens and a QR code to full nutritional information)
• Review Asbestos at Work Directive (2022)
• Adopt Health Technology Assessment (2025)

Actions ongoing include:

• Review legal framework on cross-border purchases of tobacco by private individuals: No updates since 2020 impact assessment.
• Review Tobacco Products Directive: Commission proposal complete, awaiting EP and Council positions.
• Review Tobacco Advertising Directive: Evaluation remains ongoing.
• Review EU legislation on cross-border purchase of alcohol and excise duties: Following a Commission assessment, this may be included in the EU’s Tax Action Plan for Fair and Simple Taxation.

Actions for which work has yet to begin include:

• Proposal for mandatory front-of-pack nutrition labelling: Commissioner Várhelyi has confirmed this is a priority in the current mandate.
• Review Alcohol Tax Rates Directive: To be potentially included in the EU’s Tax Action Plan for Fair and Simple Taxation.
• Proposal for health warnings on labels alcohol products: No update since a 2024 study on health warnings on alcoholic beverages in Member States.

From Cancer to CVD: Applying lessons from the EBCP to the CVH Plan

There are five key takeaways which can help us set some expectations for the CVH plan based on learnings from the EBCP.

Work won’t stop with publication: Work on the CVH Plan will be ongoing throughout the next 4 years, with opportunities to input into recommendations, initiatives and legislation in the years following publication. For example, the EP’s opinion will be handled in SANT with MEP Romana Jerković (S&D, HR) as rapporteur. While this report will be approved after the plan’s publication, the text will provide an opportunity to weigh in on where the Commission should go further and how initiatives announced, but yet-to-be implemented, should be managed.

Funding may limit ambition: As health spending is deprioritised in the EU’s budget, it is unlikely that future action plans will receive comparable levels of funding. This ultimately throws effectiveness into question. Without new funding or drastic action, the CVH Plan may fall short of expectations.

Tools will be simple: For the non-legislative aspects, funding was key to setting up the networks, registries, and initiatives outlined in the plan. As funding for health actions remains largely absent as covered in the previous section, it’s unlikely we will see a wide array of new initiatives. On the legislative front, a plan with a high level of legislative action is unlikely to receive a warm welcome in a Commission embracing the mantra of simplification. With that in mind, initiatives which harness public-private funding and non-binding guidelines or recommendations are likely to be embraced as they require limited funding and no legislative action.

With that being said, a lot can happen prior to publication. Earlier in September, Health Commissioner Várhelyi revealed the plan will tackle the “main creators” of the damage being done, particularly when it comes to the younger generations who are experiencing high levels of obesity and diabetes. To quote the Commissioner, we continue to expect a “substantial” package.