Managing Frailty. A comprehensive approach to promote a disability-free advanced age: the ADVANTAGE initiative
ADVANTAGE will build a common understanding on frailty to be used by Member States on which to base a common management approach of older people who are frail or at risk for developing frailty in the European Union.
The identification of the core components of frailty and its management should promote the needed changes in the organization and the implementation of the Health and Social Systems to provide those models of care that, stemming from the particular health profile of each Member State (MS), will allow them to face the challenge of frailty within a common framework.
ADVANTAGE will summarise the current State of the Art for the different components of frailty and its management, both at individual and population level, will collect information on the development of programs to manage frailty in older adults in the EU and will propose, as its main outcome, a common European model to approach frailty. This model will include a road map that, considering the degree of frailty policies� development, will propose interventions for frail and at risk people and will establish tailored milestones for each MS in order to achieve a comprehensive approach to promote a disability-free advanced age. Furthermore, the model will identify gaps of knowledge in the field that would benefit from further research.
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Europe have experienced several terror attacks in recent years. Health preparedness and cross sectoral response also involves planning for terror attacks including biological or chemical agents. To be better prepared to handle these types of terror attacks EU have set up a call, as part of the Third Health Programme 2014-2020, to develop a proposal for Joint Action to Strengthen Health Preparedness and Response to Biological and Chemical Terror Attacks. This acronym for the Joint Action is JA BICTRA.

The JA BICTRA is under development, and the main objectives are to (1) to address gaps in health preparedness and (2) the urgent need to strengthen cross-sectoral work with the security, civil protection and health sectors.
The coordinator, has in the development of the proposal, focused on attracting relevant technical expertise from health, law enforcement and civil defense sectors to support delivery on the main objectives.
The work of the Joint Action will be done in eight work packages. Four of which are core work packages: coordination, dissemination, evaluation and integration & sustainability. And four technical work packages that will be addressing the following areas: preparedness and response planning, cross sectorial collaboration, risk and crisis communication and novel threats.
The proposal is supported by 18 applicants, and at the time of submission it includes 34 affiliated entities. If successful, the project will have a running time of 36 months.

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InfAct (Information for Action) is a JA on health information (HI). HI is essential to build up country specific and cross-country knowledge. HI is the basis to inform national health policies, to steer population health investment decisions, to assess the effectiveness of different approaches to enhance population health through promotion, prevention, treatments and care. Timely, up-to-date HI is also vital in framing EU wide programs and policies.

The major outcome expected of the JA is a sustainable solid infrastructure on EU HI through improving the availability of comparable, robust and policy-relevant health status data and health system performance information. Through country collaboration, the JA streamlines HI activities, reduces the data collection burden and works for a sustainable and robust data collection in Europe that facilitates and supports country knowledge, health research and policy making.

The JA gives attention to:

• develop the business case and roadmap for implementation of the European Research Infrastructure Consortium on Health Information for Research and Evidence-based Policy
o governance structures,
o national HI consortia and domain specific HI research networks
• assess HI systems (HIS) in MS and regions
• develop a roadmap for training in HI with the objective to tackle HI inequality through Europe
• standardize HI instruments, tools and methods
• strengthen the HI efficiency for public health policy through new ways of using health and non-health data sources
• enhance the introduction of the interoperability of health data sources
• enhance the translation of HI into public policy

The JA watches for the sustainability of all actions taken by the JA. Coordination, dialogue and interaction with the Commission Expert Groups on HI and on HSPA, Eurostat, DG Research and other relevant DGs, international organization (WHO, OECD) reinforce further the sustainability of the JAs’ work and outcomes.

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Since 2011 the geopolitical instability in the Middle East and North Africa has been contributing to exceptional flows of migrants to South European countries. According to IOM estimates, 769,399 refugees and migrants crossed the Mediterranean Sea to reach Italy, Greece and Malta during the period 1 January - 6 November 2015. WHO does not recommend obligatory screening of refugee and migrant populations for diseases, because there is no clear evidence of benefits but strongly recommends offering and providing health checks at the entry points to ensure access to health care for all refugees and migrants in need of health protection, specific population groups (children, pregnant women, elderly) included. But migrant’s health deserves to be profoundly understood and clinical attitude accordingly adapted. That’s why migrants’ health needs are at the very centre of the today discussion and multidisciplinary teams identified as the most appropriate approach to tackle them. This model results to be effective particularly in approaching even more fragile subgroups, such as minors, pregnant women and victims of violence. The project, which can count upon the endorsement of 5 MS governments experiencing strong migration flows, deploys its potential throughout 8 WPs, all tailored addressing different aspects of migrant’s health, with a view to hosting societies. Among them, three WPs are horizontal, namely coordination, results dissemination and evaluation. Other WPs do sustain the health of migrants within the hotspots and migrants’ centres, produce evidence based instruments to manage health threats and syndromic surveillance, offer a way for tracking migrant’s health on the move, produces training and information material for health staff and general public as well as intervene into the public/private relationships to promote a new governance model for migration public policies.
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The general objective of the Joint Action – Innovative Partnership for Action Against Cancer (iPAAC JA) is to develop innovative approaches to advances in cancer control. The innovation that will be covered within the JA consists of further development of cancer prevention, comprehensive approaches to the use of genomics in cancer control, cancer information and registries, improvements and challenges in cancer care, mapping of innovative cancer treatments and governance of integrated cancer control, including a new analysis of National Cancer Control Plans. The development of innovative approaches to cancer control will be supplemented by a Roadmap on Implementation and Sustainability of Cancer Control Actions, which will support Member States in implementation of iPAAC and CANCON recommendations. The Roadmap will act as the central pillar of the JA, integrating the diverse topic areas, providing synergies between the topics, ensuring consideration of transversal issues for all topics and acting as the central comprehensive deliverable, integrating all the JA outputs. A variety of methods will be used to fulfil the general and specific objectives including pilot studies, working groups, expert panels, literature review and surveys. A governmental board will be in place to ensure that implementation and sustainability in national contexts are duly considered for each topic area. The proposal for the iPAAC JA proposes actions to address objective 1 of the 2017 annual work programme, that is promoting health, preventing diseases and fostering supportive environments for healthy lifestyles taking into account the ‘health in all policies’ principle. The work to be developed by the iPAAC JA is complementary to the outcomes of the EPAAC and CANCON Joint Actions, funded by the Second and Third Health Programmes and will build on their outputs, using the stakeholder networks as an optimal base for the development of innovative cancer control actions.
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The SHARP Joint Action will strengthen implementation of Decision 1082/2013/EU, supporting the EU level preparedness and responses to health threats and the implementation of the International Health Regulations (2005). The Joint Action implements actions mentioned in Annex 1 of the Annual Work plan 2018 of the EU Health Programme 2014-2020.
Through the Joint Action, the member and partner states and the Unions common ability to prevent, detect and respond to biological outbreaks, chemical contamination and environmental and unknown threats to human health will be strengthened. Special efforts will be employed to fill gaps that have been or will be identified in priority countries (countries that have biggest gaps in the capacity required for full IHR capability). The Joint action consists of 10 Work Packages, covering core public health capacities according to the IHR (2005). In addition to a coordination function, these will cover areas such as Communication, Evaluation, Sustainability, IHR core capacity, Preparedness, Laboratories, Training and exercises, Chemical threats and Clinical management.
SHARP will also collaborate with several other Joint Actions, specifically the “Healthy Gateways” that addresses Points of Entry, the Joint Action on Vaccination (EU-JAV) and the Joint Action on Antimicrobial Resistance (EU-JAMRAI).
The partnership of the joint action consists of 26 Associated Partners and 33 Affiliated Entities, which all will receive Commission co-funding. In addition there are 9 Collaborating Partners that will self-fund all activities that they participate in. Totally 30 countries (24 EU members, 3 EEA/EFTA members and 3 European neighborhood countries) participate in the Joint Action. The SHARP JA will liaise with and collaborate with the ECDC, the WHO EURO regional office and the WHO Health Emergency and IHR unit in Lyon, and IANPHI in relevant activities. Special emphasis will be made to avoid duplication of work for the member states.

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Topic: Joint Action to strengthen preparedness including laboratories in the EU against serious cross-border threats to health and support the implementation of International Health Regulations (IHR)
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The action aims at supporting cooperation and coordination of Member States (MS) to improve their capacities at points of entry (PoE) including ports, airports and ground crossings, in preventing and combating cross-border health threats from the transport sector. In future public health emergencies of international concern, the action will move from interepidemic mode to emergency mode supporting coherent response as per Decision No 1082/2013/EU, International Health Regulations and temporary recommendations. The action objectives will be achieved through: a) facilitating exchange of identified best practices for management of public health events, vector surveillance and control, contingency planning, validated preparedness and response plans and options for improved detection and surveillance of public health events at PoE; b) supporting MS in validating contingency plans by using assessment tools and conduct of tabletop/simulation exercises; c) providing distance and face-to-face training at local, national, European levels about contingency planning and management of events due to infections, vectors, chemical, environmental or other agents at PoE; d) supporting rapid information exchange through electronic tools by the established network for PoE; e) supporting execution of inspections on ships and airplanes; f) producing guidelines to be used by MS for dealing with chemical threats, inter-country communication and information flow in outbreak investigations and management of events on ships, for vector surveillance and control activities at PoE, for inspecting aircrafts and ships including their cargoes for vectors and auditing guidelines for hygiene inspections on ships; g) supporting intersectorial cooperation by promoting implementation of MoU among different sectors at PoE and organizing exchange of visits and exercises among PoE of neighbouring countries. The action falls under the thematic priority 2.2 of Annex I of the 2017 Annual Work Programme.
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The human population is confronted with emerging and re-emerging infectious pathogens that can cause serious cross-border outbreaks. A recent example is the Ebola outbreak requiring strong diagnostic, clinical, and public health measures in Europe and abroad in order to get this incident under control. The JA EMERGE is in compliance with the European policy (Decision No 1082/2013/EU) where the need for an efficient, rapid and coordinated response to high threat pathogens is defined. The JA EMERGE comprises a European network with more then 40 diagnostic laboratories focused on risk group 3 bacteria and risk groups 3 and 4 viruses. It will act in a so-called inter-epidemic mode (IEM) which can be activated and switched into an outbreak response mode (ORM) on request by the Health Security Committee in order to direct all activities to the outbreak management. A number of other laboratory networks, institutions and agencies are contributing to the management of cross-border infectious outbreaks. EMERGE will provide a platform for establishment and consolidation of a common, coordinated and effective response to infectious disease outbreaks at EU level and abroad (WP4). State of the art and new diagnostic methods for high threat pathogens, including in-house and commercial kits, will be evaluated for their applicability and recommended in outbreak situations when suitable (WP5). External quality assurance exercises will ensure best approaches for laboratory responsiveness in outbreak situations (WP6). These activities must be supported by an appropriate training to share best practices of diagnostics and bio-risk management (WP7). In conclusion, the general objective will be to ensure efficient response to serious emergent and re-emergent cross-border events by reinforcing the existing EU network of BSL 3 and BSL 4 laboratories which are already active in the field of identification of dangerous bacterial and viral human pathogens.
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The general objective for EUnetHTA JA3 is to increase the use, quality and efficiency of joint HTA work at European level to support evidence-based, sustainable and equitable choices in healthcare and health technologies and ensure re-use in regional and national HTA reports and activities, in order notably to avoid duplication of assessments. An overarching objective is to develop a general strategy, principles and proposal for a scientific and technical mechanism of permanent sustainable European Collaboration on HTA in the light of the Directive on CBHC. During the JA3 the collaborative production of structured HTA core information, including rapid HTAs will be structurally implemented and the methodologies and production related information and communication technology infrastructure will be finalised as to stand alone from 2020 onwards. EUnetHTA JA3 will also aim to increase the alignment between HTA reports used for reimbursement decisions and clinical practice guidelines that are used by physicians in daily practice. Additionally, EUnetHTA JA3 will also support more alignment of different processes in the lifecycle of health technologies. For instance, processes on market authorization and HTA of pharmaceuticals could be organised in a more closely aligned fashion which may lead to a timelier and more efficient process promoting earlier patient access to products that have a real added value. EUnetHTA JA3 will also contribute to the discussion on the assessment of the effectiveness and safety of new medical devices as is currently taken place as part of the debate on new European legislation for medical devices. Finally, all these outcomes will contribute to the dissemination of health information and knowledge, thus improving policy-and decision-making in the health systems, which turns into protection of citizens against unsafe or ineffective technologies and improves access to high value health technologies. Ultimately this contributes to imTo be developed
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The effects of health inequalities within and between EU MS are widely recognized,and reducing health inequalities is on the agenda of many MS. Moreover new challenges like the huge migration flows and the economic crisis and austerity policies that affect EU citizen’s everyday life are worsening the scenario. Despite an increasing concern and awareness on health inequalities, a wide gap exists in Europe in terms of political response.
The Joint Action Health Equity Europe will represent an important opportunity for MS to work jointly to address health inequalities and underlying social determinants of health.
The general objective of the project is to improve health and well-being of the EU citizens and achieve greater equity in health outcomes across all groups in society by a focus on socio-economic determinants of health and lifestyle related health inequalities. A particular priority will be given to migrants, since poor health and lack of access to health services can be an obstacle to integration.
This Joint Action aims to: deliver a policy framework with a menu of actions and recommendations for national, regional and local uptake and implementation; develop better policies improve monitoring, governance, implementation and evaluation; implement good practices and facilitate exchange and learning; identify factors of success, barriers and challenges and how to overcome them.
The Joint Action will contribute meeting two objectives of the Third health Program by introducing the equity lens in “Objective1: Promoting health, preventing diseases and fostering supportive environments for healthy lifestyles taking into account the ‘health in all policies” and in “Objective4: Facilitating access to better and safer healthcare for Union citizens”.
This Joint Action will follow a three-step approach that will facilitate: identification of policy options to tackle health inequalities; implementation of feasible and effective actions in all MS involved; elaboration and dissemination of further recommendations and guidelines.
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