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facilitate and encourage the continuous voluntary exchanges (21) on health system innovation aimed at knowledge sharing and mutual learning in order to inform decision-making and support national policy actions based on Member States’ needs;

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review the process for the evaluation, diffusion and implementation of best practices and innovative solutions, in order to optimise their application and impact, as appropriate;

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facilitate and encourage collaboration among Member States for external peer evaluation of innovative solutions;

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encourage discussions on strategic approaches to strengthening the resilience of health systems, and taking into account the ageing of populations and the need to promote life-long policies, at existing or future Member State health fora, such as the Expert Group on Health Systems Performance Assessment (HSPA) (22) and the Steering Group on Health Promotion, Disease Prevention and Management of Non-Communicable Diseases (23);

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continue and support further work of the Expert Group on HSPA in its role to improve our understanding on how to strengthen effectiveness of care, increase accessibility and improve the quality of care and safety of patients and explore the potential of this group to address strategic approaches to health system innovation and transformation;

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continue and encourage further the successful collaboration among Member States in the field of digital health, such as the eHealth Network (24) to support wider deployment of digital solutions and services that have a clear potential to strengthen the effectiveness, the accessibility and the resilience of health systems, while ensuring respect of privacy;

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encourage and promote the use of the Technical Support Instrument (25) and other EU mechanisms to undertake reforms in order to enhance the resilience of health systems, including through innovation;

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support collaborative research and partnerships among Member States on transforming health and care systems to develop evidence-based strategies, policies and innovative ways of delivering care and maintaining population health;

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encourage collaboration and partnerships, where needed, with international organisations providing expert support to health system analysis, innovation development, knowledge sharing and the implementation of innovative solutions;

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support relevant civil society organisations in their endeavours to promote health and reach out to vulnerable groups.

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strengthen the coordination across the EU programmes and policies to support more effectively the implementation of national health systems reforms with all available EU mechanisms;

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explore the provision of an advisory service with a single point of access to assist Member States on request in optimising the use of EU funds, mechanisms and instruments to support the planning, financing and implementation of changes in their healthcare systems;

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promote and support the opportunities for capacity building of professionals working on health systems, in particular for those in the early stages of their careers; the opportunities should increase their knowledge and skills of health system management and financing, and thus contribute to strengthening the resilience of health systems and a One Health approach.

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find ways to improve the accessibility and the availability of medicinal products, notably of antimicrobials and of repurposed medicinal products for the treatment of unmet medical needs, where a lack of commercial interest is a hindering factor;

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support further elaboration and piloting of a ‘pull’ incentive mechanism for antibiotic procurement in the EU as proposed by the EU Joint Action on Antimicrobial Resistance and Healthcare-Associated Infections (EU-JAMRAI) (34) as an option to be explored in order to address the persisting challenges of access and delayed availability of antimicrobials, to better understand its implications for Member States, such as the impact of these incentives on the sustainability of their health systems, and to determine the possibility of participation by countries beyond the EU, while keeping an open strategic autonomy for raw materials for medicines and medical devices;

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support the training of health workers in the human, animal and environment sectors in antimicrobial resistance, infection prevention and control, rational use of antibiotics and appropriate antibiotic waste disposal and promote population awareness;

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engage, within the framework of the Network of Competent Authorities on Pricing and Reimbursement (NCAPR), in the exchange of best practices in order to optimise access to repurposed medicinal products, particularly those that are intended to fulfil an unmet medical need;

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ensure that longstanding technical cooperation on HTA among Member States’ authorities is taken to the next step in an effective and timely manner, in accordance with the Member States-driven approach outlined in the future Regulation on Health Technology Assessment;

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consider proposing legislation that supports repurposing efforts to obtain clear evidence of the safety and efficacy of the medicinal product, also in cases where there is no direct commercial interest. Legal requirements for marketing authorisation holders may include labelling changes for repurposed medicinal products to cover additional indications after a positive assessment of the clinical data submitted by third parties;

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explore the potential for reliance on adaptive platform trials, innovative trial designs for clinical research in repurposing to complement the clinical research efforts, including by taking into account Real-World Evidence, while ensuring that the data generated in clinical trials are of high quality, reliable and robust;

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consider addressing the need for repurposing of medicinal products in paediatric indications in order to avoid off-label use, to the benefit of this most vulnerable population;

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strengthen the governance linked to the implementation of the new regulations for MD and IVMD and develop the European expertise in this field for the benefit of EU patients.

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include a comprehensive end-to-end optimised regulatory framework of evidence-based, holistic and future-proof proposals in the context of the Pharmaceutical Strategy for Europe, with the aim of improving the affordability, availability and accessibility of medicinal products and, in particular, antimicrobials, personalised, advanced therapy medicinal products, therapies for (very) small patient groups and repurposed medicinal products, while fully respecting Member States’ competence;

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develop specific joint EU research capacities that would also facilitate cooperation with national/academic research institutions and offer support in translating research findings into the development of antimicrobials for clinical practice, while also reinforcing the use of Union-wide clinical trials networks and data-sharing platforms and, as appropriate, learning from e.g. the Innovative Medicines Initiative project ENABLE (35);

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analyse what is needed to ensure the availability and development of today’s and tomorrow’s medicines and therapies within the EU and assess the potential costs and benefits as well as the market implications of organising manufacturing facilities at EU level in addition to existing financial arrangements, including publicly financed or not-for-profit manufacturing facilities, bearing in mind their potential market-distorting effects and well-known limitations, to ensure the availability of antimicrobials in the case of lack of commercial interest, or in emergency situations, and assess the costs and benefits of other possible initiatives identified in the work under the Pharmaceutical Strategy, in addition to mechanisms supporting innovation, leading to breakthrough methods of manufacturing that result in sustainable production of affordable medicines;

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continue to prioritise the implementation of the MDR and IVDR, including through the provision of targeted support to Member States, to secure smooth implementation and thus contribute to the accessibility and availability of MDs and IVDs for the benefit of EU patients;

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address the aspects that impact the competitiveness of the European pharmaceutical industry with a view to mitigating security of supply concerns and to promoting open strategic autonomy in the EU, notably for the production of off-patent APIs and medicinal products;

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consider, in cooperation with Member States, and also taking into account the outcomes of the pilot project of the STAMP repurposing framework, a central repurposing coordinator at EU level to support the cooperation and coordination among different stakeholders and to assist with the development of the scientific arguments required to obtain the regulatory approval for repurposed financially unattractive medicinal products;

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specifically consider the repurposing potential for unmet medical needs in the context of the announced European Health Data Space, taking full advantage of trustworthy Artificial Intelligence and Big Data in a responsible manner, also with the aim of supporting the successful selection of candidates;

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consider creating possibilities for and supporting the repurposing of existing medicinal products by facilitating the gathering of data on off-label use of medicinal products in rare cancers, including paediatric cancers, in the context of the Knowledge Centre on Cancer (36).

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encourage the implementation of the planned piloting of the STAMP repurposing framework, which has been delayed due to the COVID-19 pandemic.

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cooperate and share available data on shelved products that are no longer protected by patents with academic institutions and not-for-profit organisations in the interest of repurposing them in order to address unmet medical needs.

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ensure, as appropriate, effective implementation of the actions in the Europe’s Beating Cancer Plan, and support Member States in implementing effective cancer control actions, by means of appropriate instruments and tools;

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take a comprehensive approach to health promotion and prevention of cancer, in order to ensure that best practices developed in cancer prevention and control can benefit other non-communicable diseases;

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consider submitting a proposal for an update of the Council recommendation on cancer screening (38).

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collaborate effectively on the implementation of the Europe’s Beating Cancer Plan and make best use of the available EU funding;

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invest in sustainable cancer prevention by addressing health determinants of cancer as an intersectoral challenge through a ‘Health in All Policies’ and ‘One Health’ approach; develop and implement cost-effective interventions targeting tobacco use, alcohol use, physical inactivity and unhealthy diets by developing and implementing strategic actions as well as facilitating cooperation between Member States, existing EU agencies and fora such as the Steering Group on Health Promotion, Disease Prevention and Management of Non-Communicable Diseases (SGPP);

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promote vaccination, early detection, and screenings based on evidence and European recommendations for the quality assurance of screening programmes;

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explore innovative approaches in health promotion and integration of prevention activities as an integral part of healthcare services delivery;

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encourage an active role of health professionals, patient groups and other relevant non- governmental organisations and other stakeholders in the implementation process of the Europe’s Beating Cancer Plan;

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implement comprehensive approaches to the challenges of survivorship related to the quality of life of cancer survivors, with special regard for children and young adults and with reference to the established right to be forgotten;

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build on the conclusions and recommendations from The Innovative Partnership for Action Against Cancer (iPAAC) Joint Action (39), as appropriate, in the forthcoming activities of the implementation of the Europe’s Beating Cancer Plan. This applies in particular to recommendations for new screening programmes, for updated recommendations on screening, amended datasets on population cancer registries, approaches to complex treatments for cancers as well as governance issues, such as comprehensive cancer centres, quality indicators, comprehensive cancer care networks and patient pathways. Existing networks and expertise such as the European Reference Network (ERN) should be taken into account to avoid duplication and overlapping;

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strengthen the cooperation between the Commission and the Member States through cross-sector actions that build bridges between the objectives of health systems and those of sustainable and healthy food systems. Our common aim is to ensure healthy nutrition and a reduction in diet-related non-communicable diseases in line with the objectives of the Europe’s Beating Cancer Plan and recommendations from the Joint Action on Implementation of Validated Best Practices in Nutrition (BestReMap) (40);

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collaborate to secure the future supply of medical radioisotopes, in order to be self- sufficient in the EU and to make full use of the potential of nuclear medicine for the diagnosis and treatment of European patients with cancer in line with the Commission Staff Working Document on a Strategic Agenda for Medical Ionising Radiation Applications (SAMIRA) (41) adopted on 5 February 2021. A more coordinated approach and sustainable funding of European production capacity is particularly important in the light of the ageing European production infrastructure.

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further explore how the EU, in the context of the stronger European Health Union, could have a more strategic approach in global health, including through a possible new Joint Action on global health;

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demonstrate a leadership role in global health, and in the post-pandemic negotiations at global level including through the negotiation of an important instrument on pandemic preparedness and response;

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explore how to further improve existing mechanisms of coordination to support regular exchange of information, and in particular between EU and Member States’ representatives and experts based in national capitals, Brussels, Geneva and New York, to allow cooperation in establishing EU positions on health issues in a timely and efficient manner;

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encourage collaboration on non-health issues that impact global health and the well- being of the population, including thematic discussions on cross-sectoral issues relevant to global health;

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promote and support educational opportunities in the field of global health and global health diplomacy;

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encourage closer cooperation and active involvement of relevant stakeholders, including civil society and non-governmental organisations to contribute to global health, including health security and a comprehensive ‘One Health approach’;

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encourage the use of existing EU mechanisms and instruments such as EU4Health, to strengthen the role of the EU in Global Health as well as to draw benefits from international cooperation, particularly in the field of pandemic preparedness and response, including antimicrobial resistance;

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prepare a review of mechanisms and instruments through which the EU, its Member States and non-state actors support the strengthening of health systems globally in order to help identify gaps and enhance the role of the EU in global health and health security;

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continue and encourage partnerships and networks that provide support in strengthening health systems globally in terms of preparedness, capacity building, health promotion, health research and development, and digital health;

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keep in mind the importance of avoiding unnecessary duplication and overlap with the work of other international actors and institutions and ensure coherence and complementarity with existing mechanisms and initiatives.