To: Jean-Claude Juncker, President , European Commission First Vice-President Günther Oettinger, Commissioner for Budget and Human Resources Vytenis Andriukaitis, Commissioner for Health and Food Safety

Cc: Xavier Prats Monné, Director-General for Health and Food Safety, European Commission John F. Ryan, Director Public Health, European Commission Brussels, 6 March 2018

Subject: Importance of safeguarding a rights-based approach and means to address cross-border health issues in the next EU Multi-Annual Financial Framework

Dear President Juncker, Vice-President Timmermans, Commissioner Andriukaitis and Commissioner Oettinger,

The EU Civil Society Forum on HIV/AIDS, Tuberculosis and Hepatitis, gathering 40 European organisations and networks convened by DG SANTE, is writing to recommend that the European Commission safeguards its rights-based approach to health issues in the next EU Multi-Annual Financial Framework (MFF), together with adequate means to provide a sustainable regional response to the fight against HIV/AIDS, TB and Hepatitis in Europe.

Between 2010 and 2016, there has been a 60% increase in the number of new HIV infections within the wider European region, the only region in the world where the rate of new HIV infections continues to rise. Tuberculosis (TB) under its resistant forms, continues to account for a quarter of all anti-microbial resistant deaths. By 2050, an additional 2.59 million lives could be lost through drug-resistant TB alone in the . The WHO estimates that there are 14 million people affected by hepatitis C across WHO European Region with some 6 million living in the European Union alone.

At the current pace, Europe will not be reaching the SDG goals on HIV, TB and viral Hepatitis by 2030. The European Commission from the European Union, with its longer term of office and regional convening power, can do more than any national government by itself to turn that around and leave a healthy legacy for its future generations.

According to a recent Eurobarometer survey, 70% of Europeans want the EU to do more for health and social issues. Yet the first political signs in the preparation of the next EU MFF, show that health and social matters are completely being overlooked. While discussions currently focus on political considerations linked to the architecture of the next EU budget, thematic priorities such as migration, defense and economic growth are taking central stage over people-centered policy areas.

The public consultation package on the next MFF released on 10 January, includes public health under a broader heading of “investments, single market, research and innovation, SMEs”. This sends the wrong signal that the EU perceives public health as a commodity, rather than as a public good. While healthcare remains a national competence, national strategies by themselves won’t suffice. The work of technical agencies such as WHO and ECDC need to be complemented by strong regional political leadership.

The Civil Society Forum in particular is concerned about negative effects such approach has on key affected populations such as men having sex with men, people who use drugs and other affected groups. Across Europe, the most vulnerable populations are left behind. They are facing scarce political leadership and investments to address their health needs. People living with or affected by HIV, TB and/or hepatitis are facing stigma and discrimination. In Eastern Europe, international donor support to TB and HIV programmes is drastically being reduced and absent for HCV testing and treatment. In some countries, health budgets and prevention programmes have been cut or are at risk of being cut, access to treatment and care for undocumented migrants is limited or not available at all, regulations that result in the discrimination of key affected populations are introduced and access to affordable medicines in a context where prices are skyrocketing is increasingly an issue. Ultimately, this leads to increasing inequalities in health in Europe.

Therefore, political strategies need to be put in place with governments of the region to make sure that progresses made so far do not recede. If we fail to maintain our efforts and investments, we risk that the epidemics flare up anew with severe human and financial consequences. Political commitment from all governments and the EU’s leadership are vital to curb those epidemics. The EU can clearly achieve more than Member States acting along. As the EC communication on a new modern MFF notes “The cross- border nature of challenges means that pan European programmes are both more effective and more efficient”.

We will also contact national authorities to ask for their support and encourage greater prioritisation of regional health issues in the next EU MFF. Thank you for considering our recommendations.

Sincerely,

On behalf of the Civil Society Forum on HIV/AIDS, Tuberculosis and Hepatitis: Sini Pasanen, AIDS Action Europe (AAE) Eberhard Schatz, Correlation Network (CN) Ganna Dovbakh, Eurasian Harm Reduction Association (EHRA) Nikos Dedes, European AIDS Treatment Group (EATG) Fanny Voitzwinkler, Global Health Advocates (GHA)