Digital health readiness inequity in EU Joint Actions: evidence from eight European cancer centres

Background

Digital health readiness varies across European health systems, yet EU Joint Actions (JAs) often proceed without formally assessing whether participating countries hold comparable institutional capacity. The eCAN+ JA on digital oncology, co-funded by the European Commission, provides an opportunity to document and validate these disparities from a coordination perspective.

Methods

Between January and March 2026, the eCAN+ coordination team (Sciensano) held semi-structured bilateral meetings with partners from eight countries new to the JA: Czechia, Latvia, Croatia, Sweden, Montenegro, France, Romania, and Moldova. Meetings followed a standardised agenda covering coordination, roles and responsibilities, national context, and challenges. Thematic analysis was applied to meeting minutes as qualitative data.

Results

Four dimensions of readiness inequity emerged: 1) Infrastructure, ranging from paper-based systems in some countries to advanced interoperable databases in others; 2) Legislative frameworks, with digital health laws existing in most countries but implementation capacity varying considerably; 3) Institutional capacity, with some teams being understaffed and overcommitted; 4) Dependency, as JA participation represented the only realistic pathway to digital health improvement for countries whose national projects are stalled due to political instability or resource constraints, creating unequal stakes across the consortium.

Conclusions

EU JAs apply uniform timelines and expectations to countries where the consequences of falling behind are categorically different. For some partners, eCAN+ is the only realistic opportunity to advance digital oncology. Early structured check-ins validated this disparity in early project phases, enabling course corrections that standard reporting mechanisms would have missed. We argue that readiness assessment and differentiated support should be built into JAs from the start, not improvised mid-implementation.

Key messages

• EU Joint Actions assume equal readiness, but structural disparities mean participation is not equal in practice. Governance must reflect this from the start.

• For some partners, EU Joint Actions are the only realistic path to digital health progress. Equal participation does not guarantee equitable outcomes.