Abstract Climate change poses growing risks to population health and health system functioning across Europe. Building climate-resilient and low-carbon health systems requires a workforce equipped with appropriate competencies. However, structured climate and health education remains unevenly implemented. This study evaluated the 2025 ASPHER–GCCHE European Climate Resilient Health Systems Course, a large-scale, competency-based online training programme designed to strengthen climate-health capacity among health professionals. We conducted a longitudinal evaluation of a 10-week, open-access, fully virtual course delivered in English between January and April 2025. Participants completed pre- and post-course surveys assessing self-reported confidence across six climate-resilience competency domains using a 10-point Likert scale. Paired Wilcoxon signed-rank tests assessed pre–post changes overall and by geographical region. A total of 4432 individuals from 164 countries registered for the course. Among 1029 participants (1029) from 119 countries, 446 participants were from the WHO European Region, met attendance and assessment criteria and were included in the analysis. Statistically significant improvements were observed across all six competency domains (P < .001), with mean confidence increases ranging from 45% to 59%. Self-reported confidence gains were consistent across European subregions, indicating comparable learning effects despite differing policy and institutional contexts. Nearly half of all registrants were from low- and middle-income countries, highlighting the reach of the open-access model. This evaluation demonstrates that competency-based online education was associated with improved self-reported confidence in climate-resilient health-system competencies. Integrating similar training into formal education and professional development pathways may support implementation of climate-resilient and low-carbon health system policies across Europe and beyond.
Abstract There are major concerns regarding the risk of antimicrobial resistance evoked through the inappropriate use of antibiotics. The WHO AWaRe classification has identified antibiotics that have high resistance potential. This cohort study utilized data from seven UK databases, including two community care databases and five hospital databases. The study period was from 2012 to 2025, or from the start of electronic prescription data. Longitudinal trends in Watch antibiotic use and patient demographic information were summarized. Data-driven large-scale characterization was used to identify conditions of interest, and prior use of Access and other Watch antibiotics was summarized. The study included 433 368 hospital and 11 705 843 primary care records of Watch antibiotic use. Quarterly crude incidence rates showed seasonal variation in community prescribing, with rates generally higher in the third and fourth quarters. Although use in community care increased during the COVID-19 pandemic, it remained below prepandemic levels. Most community users were female, while most hospital users were male. Hospital users had more severe conditions, including healthcare-associated infections and sepsis, while community care users were more commonly treated for skin and respiratory tract infections. Prior Access antibiotic use was generally recorded in fewer than 50% of patients. Prior Access of Watch antibiotic use was minimal in community care. Our results highlight the complexity of antibiotic use across different healthcare settings. Regional and demographic variation indicates areas where prescribing practices could be refined. Ongoing surveillance and targeted stewardship interventions are essential to promote appropriate use and prevent resistance.
Abstract Rare diseases are individually uncommon but collectively affect a substantial share of any population. The medicines developed for them combine severe conditions, very small treatable populations, high prices, and evidence that is often immature at launch. Conventional cost-effectiveness analysis handles this poorly, and systems relying on it heavily tend to reimburse fewer orphan medicines than those applying alternative evidence standards. Türkiye offers an instructive current case. Of the 66 orphan medicines granted central marketing authorization in the European Union between 2021 and 2024, 3 were available in Türkiye at the start of 2026, against a European Union average of 28. The comparable figure for all new medicines was 9 of 168, against an average of 76. Restricted access to orphan medicines should therefore not be read solely as an orphan-specific exclusion, but as part of a broader constraint on new medicines, distinguished by one feature: a parallel route in which medicines are authorized for named patients, imported, and reimbursed outside the standard list. That route carries real access that list-based indicators capture only in part, and it makes a patient entitlement depend on which list a medicine occupies. A rule issued in June 2026 restricting reimbursement of spinal muscular atrophy medicines after gene replacement therapy illustrates the limited public availability of the clinical and economic reasoning behind reimbursement restrictions. Broadening the basis of appraisal, rather than reducing reliance on economic evaluation, requires published criteria, instruments for managing uncertainty, and monitoring of the pathway as well as the list.
