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Editorial Editorial Welcome to this special doctoral workshop on Research Methodology which forms part of what is now a well-established support mechanism for researchers in the discipline of the Built Environment and more particularly construction management. The ARCOM doctoral series, around now for some seventeen years, has addressed many of the diverse research areas that PhD researchers in the discipline have chosen to focus on in their doctoral journey. This doctoral workshop has as an aim to offer an opportunity to explore and share research and the theoretical underpinnings facing PhD researchers within the construction and engineering sectors where the focus is on not just the topics of research but on the research approach underpinning that work. This workshop provides the opportunity for AEC researchers to come together in an environment where support for their approach to their research enquiry is offered by way of creating the correct conditions to share and discuss their journey. There is evidence to suggest there are many PhD students who would benefit from an environment where they can share their research phenomenon and this workshop session will allow for discourse and interaction to enable 'learning to take place' together. In these proceedings are the seven final papers selected from some fourteen abstracts presented for review. It is important to recognize that the papers selected offer the opportunity for participants to learn from each other but also learn from the guidance of academics in the community who have a depth of knowledge around different methodological approaches. The process of selection for the workshop, while closely aligned with the ARCOM conference proceedings, is such that it is aimed at selecting papers within the scope of the topic but very much directed to allowing doctoral researchers' the opportunity to present work in progress where formative and developmental review can be offered through a constructive support mechanism. The context of each paper is diverse which has added to the richness of this edition of the doctoral workshop series. All papers have been peer reviewed and each author has had the opportunity to receive feedback and update/ improve their paper. Alqatawneh's paper research through design as an approach to investigate design fiction insights and sees focuses on design fiction (DF) as an approach to speculation about the future using a combination of prototyping and storytelling, a type of scenario story telling if you like. They unpack the notion of DF through a link to its five criteria and principles, bringing together the notion of design - the capacity to imagine and make concrete products not yet in existence, and services for everyday life. This research employs research through design approach to investigate the functionality of fiction in design. Further, to explain the notion of design fiction and arising from using fiction in both design practice and design research the author defends the use of this methodology. Alqatawneh argues that the outcome knowledge is utilised to adapt and present fictional objects that suggest pathways to possible futures and sues the example of Self-Driving Vehicles to exemplify this.-.The author argues that DF offers the potential to consider far-reaching questions concerning the consequences of technological development while drawing attention to the social aspects and implications of techno-scientific solutions. Colley and Scott address the philosophical positioning of functional contextualism as an approach to research conflict of interest in the real estate sector in Ireland. In examining the research question of good practice for managing conflict of interest in the real estate valuation process within Ireland a number of research methodologies were engaged with and considered. The author's proffer that once a review of literature in the field has been accomplished a central question arises for the researcher, that of a philosophical position so that the research can be addressed in what they suggest is the 'correct way'. They offer an overall pragmatic approach to the central issues of the formation of an individual's ethical viewpoint and behaviours, the nature of the ethical challenges faced within the real estate 3 valuation process and the possible frameworks that may influence an individual's behaviour going forward. Within the pragmatic realm they argue for a more focused lens of Functional Contextualism. Functional contextualists they suggest seeks to predict and influence events using empirically-based concepts and rules and this they contend addresses the research question suitably. Emphasis is placed on highlighting the areas of the approach that fit and also those that require omission due to their lack of suitability to the subject under investigation. Overall they make the case for using the most appropriate methodological position through correct grounding with research methods that allow the researcher to progress without 'conflict'. Kelly in his paper addressing the impact of human cogitative behaviour and tacit judgement on the development and accuracy of cost estimates for pharmaceutical projects in Ireland and makes the strong case for researching this topic through the lens of 'more thoughtful research design'. He contends that 'more thoughtful research design' would get to the real reasons for cost overruns rather than using the convenient 'default responses' that continuously point in the wrong direction. He makes the case for a 'paradigm shift' towards the general use of the newer non-traditional types of building project contract price forecasting models and there is evidence that this has not been generally achieved. In considering his roadmap through the research topic he suggests the challenge with this proposed research is the adoption and justification of the research methodology. He argues for mixed-method research, methods that require positivist and interpretevist methods as well as multi-paradigm and multi-strategy approaches. The challenges, he contends, include the many different conflicts. For example how the researcher sees the world and the epistemological commitments needed which may cause confusion with the stated committed rules the research might follow and that will impact on the use of both positivism and interpretivism paradigms as well as qualitative and quantitative information. Mdaanayka and Egbu in their paper explore innovative solutions in consideration of exploring the possibilities for improving the utilisation of digital technologies via integrating BIM, Big Data Analytics and Internet of things (together aka BBI )which has the potential to give organisations the long awaited competitive advantage. The study follows a mixed methodological approach which leads to investigate the critical factors that impact on effective implementation and exploitation of BBI for competitive advantage and thereby develop a strategic framework for improved understanding of such critical factors at play. They argue for mixed methods based on epistemological, ontological and axiological perspectives. The factors associated with the research, they argue, fall in to four main themes inter alia; organisational size, culture, structure and skills-knowledge-training needs. The latter will be demonstrated as a separate skill-knowledge-Inventory (SKI). Their philosophical stance is a combination of interpretivist and positivist. They argue for an approach that holds a mixture of inductive and deductive means in different stages as the study starts from literature review to develop the strategic framework consisting of critical factors. Their data collection methods in this study will be the use of semi-structured interviews in pilot study phase and questionnaire surveys in the main study phase. Focus group approach is intended to be employed to validate the framework and SKI. They make the case for mixed methods as the multidimensional constructs/ variable implications demand such methods. O'Cleirigh deals with research within the construction industry which is primarily based on qualitative and quantitative methods but has the potential to include studies that combine both methodologies. The research review considers and outlines the various methods and the differing views of the purists from both traditions, while re-examines the 'war' between them 4 and thus proffers the arguments for and against using mixed-methods. O'Cleirigh also demonstrates that some commonalities and a relationship exist between quantitative and qualitative approaches to social science research and that his research explores that relationship in context to the construction industry. The author resolves to position mixed methods as a bridge between traditional qualitative and quantitative research. Discussion, he commends, centre on implications arising from the observation that, models upon which qualitative and quantitative methods are based, have differing philosophical views of real world research and consequently differing views of the research subject. O'Cleirigh strongly argues this positioning will aid advancement of industry knowledge by adapting methods used in academia through providing a robust framework, for construction managers, for designing and undertaking mixed methods research. He makes the point that mixed methods research will become increasingly successful as more construction managers study, use and spread the underpinning philosophy. Opiya and Chan, address the topic of the need for affordable housing and make the point that it has in recent times become a prominent policy issue for countries across the world. Among various challenges to affordable housing sector is the failure of supply to keep up with this growing demand. Consequently, they argue it is unsurprising to find a wealth of studies that focus on supply-side concerns of accommodating increasing demand for affordable housing. Through their research they have found studies tended to emphasize the role providers such as developers, contractors and government institutions can play to improve capacity and capability in the production of affordable housing. The point they do make, because of such emphasis has meant the relative neglect on the demand side. In their review, consideration of the problem of 'demand' to identify fresh perspectives on understanding the challenges associated with affordable housing is called for. They make the case for opening the complexities of studying 'demand' by researching a range of disciplines. The case for inter- disciplinary research aimed to understand a complex problem. They make the point that from an economic perspective, 'demand' is often framed in quantitative terms where balancing supply and demand results from rational, technological choices made by individual actors in the marketplace. They go on to make the point that a linear approach to 'demand' runs counter to a sociological understanding, where the realization is produced by complexes of social practices. They exemplify this making reference to a linguistic turn, the etymology of 'demand' stems from the Latin phrase de mandare, which means 'to formally order'. They proffer from this 'demand' is not simply defined by exogenous forces of the market, but also raises questions as to how society is brought to order. Relating this position to the context of affordable housing, they make the case understanding 'demand' also raises the need to examine ways in which vulnerable segments of society are excluded from formally ordering their requirements. In this review, we will reflect on various perspectives of 'demand' to raise questions about power relations and the problem of building a more inclusive society through housing. While the methodological approach is partly addressed in the paper the authors argue for a methodology that can be adaptable to deal with the complexity that surrounds the various perspectives of 'demand'. Abiodun and Egbu in their paper, Implementation of building information modelling (BIM) on construction projects, is increasing gaining global acceptance as government from various countries are becoming the driving force for its adoption. The purpose of this paper is to present the research methodology and method to be adopted for this research. They present the aim and the objectives of the research, a set of research questions and then propose an approach to move towards methodological positioning. The paper discussed the various 5 research paradigms and philosophical positions available to all researcher and position the research on one considered to be most suitable to achieve the stated aim and objectives of the study. The argument around their justification is well made and the paper further discussed the various research approaches, methods and strategies available. In each case, a position was adopted for the research and attempts were made to justify the position adopted. Abiodun and Egbu conclude by proposing a research design method to be followed that allows the researcher achieve the research aim and objectives but that is fit for purpose. The authors of the papers are to be commended for taking the courageous step in sharing their methodological and philosophical positioning, particularly as novice researchers it can be daunting to 'put on work out there'. It is a pleasure to be associated with this important aspect of the work of ARCOM and the continued support for this type of 'scaffolded experience' for the novice researchers, as they make their own personal research journey, should be supported into the future! Finally, there is a need to address the gaps in methodological approach and allow researchers flourish and blossom by allowing them the opportunity to experiment within their chosen research domain. "It is often necessary to take a decision on the basis of knowledge sufficient for action, but insufficient to satisfy the intellect." Attributed to Kant 1724 - 1804 Professor Lloyd Scott, 09th March 2018

Between 2001 and 2004, the OECD, the European Training Foundation, CEDEFOP and the World Bank carried out extensive reviews of career guidance, looking broadly at related policy and practice in both the labourmarket and the education sectors. In 2002, the European PES Network's Expert Group carried out a study on personalised services with a special focus on guidance and counselling, documenting examples of interesting practice in six Public Employment Services (PES). The present study, commissioned by DG Employment, Social Affairs and Equal Opportunities in October 2004 in collaboration with the Heads of PES Network, sets out to build on the accumulated knowledge of the previous reviews by drawing on the responses of 28 countries—the EU25 plus three EEA countries (Iceland, Norway and Switzerland)—to a questionnaire survey that was specifically developed to facilitate the identification and examination of the place of career guidance in the Public Employment Services across Europe. The survey data was complemented by country visits to Finland, France, Germany, Greece, Poland, Slovenia and Sweden, in order to provide a qualitative dimension to the study, and to enable a deeper examination of the issues that were foregrounded in the survey. The key purpose behind the study was to gauge the manner in which—and the extent to which—personalised employment and career guidance services in the European PES have responded to the widely-adopted goal of implementing a personal service approach, identifying the difficulties they have encountered and the innovative responses they have generated. The study is guided by a concern with the practical, i.e. it sets out to describe the day-to-day realities of work in the PES with a view to identifying some of the more promising and successful practices, and to make proposals for improvement. The report provides details of the various models of career guidance in use, the processes that are being implemented across the range of EU and EEA countries, the outcomes of PES interventions, the tools and instruments used to attain such outcomes, the level of staff preparation for delivering career guidance services, and the strategies that are in place in order to ensure quality provision. An understanding of the context in which the PES across Europe provide career guidance services is crucial. The study is therefore careful to locate the survey within the context of the European Employment Strategy (EES), and particularly the European Employment Guideline on prevention and activation. It also draws a link between the latter and the effort to modernise the PES across Europe through the widespread adoption of a personal service model, which gives pride of place to the client, and which strives to guarantee citizens' rights for quality, proximity, personalisation and individualisation of public services. The report further examines the potential of career guidance in contributing to the attainment of the Lisbon targets, particularly in relation to the priorities established by the EES to increase in the adaptability of workers, to attract more people to the labour market, and to increase quality investment in human capital. It is argued that career guidance and personalised employment services have the potential for making such a contribution by advancing lifelong learning goals, by helping to address a whole range of labour market issues, and by supporting efforts to attain social equity and social inclusion goals. While career guidance services are offered in a range of settings, and there is an overlap in the way that these services are understood in such settings, specific attention needs to be given to the way career guidance is defined within the overall mission of the PES. Here we can distinguish three main categories of activities: - The first are those activities that fall within the area of 'personalised employment services', and that have elements of career guidance embedded in them. Employment advisers register and interview clients, and in the process of doing so utilise several guidance-related skills, particularly where efforts are being made to personalise services through client segmentation. While the employment adviser's work at this level—in relation to the initial interview, personal action planning, and assistance in the job-search process through job-broking and other means—cover processes and tasks that are largely administrative, they can also have strong guidance elements embedded in them. The report acknowledges the tensions that arise in the mix and balance between administrative and guidance roles, stressing that both elements are critical in the consolidation of career guidance elements within services that have, as their primary objective, the placing of people in employment. - The second category of activities are specialised career guidance services. These are distinguished from the first category by their more intensive and more focused engagement with the client, on the basis of a deeper knowledge base and extended competence. It is noted that the two categories are increasingly becoming blurred, and that this carries with it both opportunities and challenges for career guidance in a PES context. - A third category of activities considers other career guidance provision that the PES may be involved in, including the production and/or dissemination of labour market information, as well as occupational information, and the provision of career guidance services to students. These three categories of activities need to be considered within the changes in the overall organisational context of the public employment services. One of the key trends that have an impact on the way personalised employment and career guidance services are delivered is responsibility-sharing. The study considers three key aspects in relation to this organisational trend. The first is the sharing of responsibility with regional and local employment offices through decentralisation. The second is the sharing of responsibility with partners through joint service delivery, or through outsourcing and contracting-out. In both cases, the different modalities by means of which the process can be organised are discussed in some detail, particularly with a view to identifying how they can improve—or jeopardise— quality career guidance provision. Indeed, a key challenge that the PES has to confront is to find the right balance between, on the one hand, encouraging innovative, flexible and context-sensitive responses in its decentralised mediation between clients and local labour markets, and on the other, maintaining standards across the whole range of providers, thus ensuring that citizens, irrespective of their geographical or social location, have guaranteed access to the same quality of service that they are equally entitled to. The issue of quality standards in the attempt to manage the decentralisation process is therefore pivotal, and constitutes the third aspect considered. The study highlights different approaches to quality assurance across the 28 European countries, pointing to some of the formative experiences in the use of both quantitative and qualitative strategies in this respect. The change in the organisational context, as well as the paradigmatic shift towards a 'personal service model', has given rise to a number of trends in the delivery of career guidance and career-guidance-related services within Europe's PES. One of the more important is the increase in the range and depth of services that contain career guidance elements. This increase in both supply and demand for services can lead to tensions resulting from the attempt to develop personalised approaches while at the same time catering for increasingly large numbers of unemployed in a differentiated manner. Such tensions are particularly accentuated in those contexts where human and material resources have either remained stable or even been decreased. Europe's PES have developed three key ways to manage these tensions. These include: a resort to partnership and to outsourcing; a shift to self-service modes of delivery; and the introduction of tiering, to provide career guidance in self-access modes and in groups to the majority of clients, reserving to the rest more intensive individual career guidance interviews if and when needed. Employment advisers and career guidance staff are at the crucible of most of the transformations taking place in the PES, and their training, competence levels and motivation have a great bearing on the quality and nature of services provided. The study considers PES staff involved in delivery of personalised employment and career guidance services from a variety of angles. First, attention is given to aspects of their profile, including age, gender and conditions of work. The focus then turns to the distribution of career guidance roles among PES staff, with distinctions being drawn between those systems that have specialised tiers of staff, and those that require their staff to be multi-functional. The implications that such role distributions have for the provision of specialised services on the one hand, and holistic services on the other, are also examined. A third major consideration in regard to staff is the profile required of career guidance and career-guidance-related personnel at the point of recruitment, as well as the opportunities that such staff have for pre-service, induction and continued training. While many systems do not provide initial training, and recruitment is often effected on the basis of proxy qualifications, there is a trend for improved induction and in-service professional development opportunities—linked, for example, to the range of tools and instruments that career-guidance-related staff use in delivering services. Details of the modalities for the provision of training are presented, as are examples of commendable practice from a variety of countries. Training gaps are also identified, many of which were signalled by respondents to the survey who felt that expanded roles required the targeting of specific competence development. In their attempt to modernise their delivery systems, Europe's PES have striven to reach out to a range of clients, giving special attention to those categories that have particularly acute needs for individualised and tailor-made support on the road to employment: these include the long-term unemployed, women returnees, persons with disability, the unqualified and low-skilled, company-closure clients, and customers with a variety of social problems and/or tenuous links to citizenship rights. The study provides details of the different career guidance models and strategies used to deliver services to such clients. It also considers the results of client-satisfaction surveys, which are being used by PES in several countries as an indicator of effectiveness. Despite major improvements in catering for differentiated needs, it is also clear that there are other categories of customers that the PES are finding more challenging to reach. In particular, rising unemployment levels in a tight resource environment are often leading PES to focus narrowly on the unemployed, despite the fact that lifelong career guidance perspectives are adhered to in principle. Swift placement in employment remains a pivotal challenge for the PES, even as they strive to balance this with other career guidance-related goals such as client clarification of occupational strengths and interests, as well as career management and development in a lifelong perspective. In their attempt to maintain the dynamics of transformation into effective and client-oriented organisations, Europe's PES face a number of important challenges. Four are particularly relevant to personalised employment and career guidance services: - The first challenge concerns the need for PES career guidance and careerguidance- related services to be more systematic in the evaluation of their effectiveness. While there is a strong tradition of critical assessment of PES functions overall, the targeted evaluation of career guidance within PES settings needs further attention, even if there are a number of examples of good practice in several countries that could serve to provide models for emulation. A stronger evidence base on the match between career guidance services and policy objectives buttresses claims for improved resourcing. On the other hand, a lack of systematic evidence leads to a situation where the major shifts in the modalities of service delivery—particularly in relation to responsibility-sharing with partners and outsourced agencies—remain unexamined in terms both of efficiency in resource use, and of impact on quality of service. - A second challenge is to get the right balance between integrating career guidance elements in the services and activities provided by the PES, while at the same time maintaining specialist services for deeper engagement with clients when this is required. In many ways this implies the foregrounding of the identity of career guidance within PES settings. In addition, the attempt to deepen career guidance and career-guidance-related services towards a larger range of clients signals the need for more intensive preparation of staff, and for a more careful consideration of the ways in which the administrative and the career guidance roles of providers can be kept in appropriate balance. - A third challenge arises from the necessity to open up guidance services within the PES to embrace a more long-term, life-long perspective: one that is more in tune with the needs of citizens in the emergent knowledge economy. This vision presents enormous resource and training challenges for the PES, but it is likely to be one that it will need to rise to as citizens increasingly move through occupational and training pathways in more complex, non-linear ways. A lifelong perspective on career guidance would entail the PES in stronger collaboration with education institutions and with companies, so that service delivery is experienced by the client in a seamless, holistic way, with community resources being mobilised in support of goals that have, as an outcome, both the private good and the public good. - Finally, the PES has to rise to the challenge of addressing key gaps in service delivery, and to focus on those areas that require further attention and investment in order to facilitate the provision of quality services for all. The way forward lies in addressing these challenges. ; peer-reviewed

"Major technological advances in the last few years have increased our knowledge of the role that genetics has in occupational diseases and our understanding of genetic components and the interaction between genetics and environmental factors. The use of genetic information, along with all of the other factors that contribute to occupational morbidity and mortality, will play an increasing role in preventing occupational disease. However, the use of genetic information in occupational safety and health research and practice presents both promise and concerns [McCanlies et al. 2003; Kelada et al. 2003; Henry et al. 2002; Christiani et al. 2001; Schulte et al. 1999]. Use of genetic information raises medical, ethical, legal and social issues [Clayton 2003; Ward et al., 2002; McCunney 2002; Christiani et al 2001; Rothstein 2000a; Schulte et al. 1999; Lemmens 1997; Barrett et al. 1997, Van Damme et al. 1995; Gochfeld 1998; Omenn 1982]. The purpose of this report is to bring together the diverse literature and opinions on genetics in the workplace, to highlight important issues, and to provide some considerations for current and future practice. Occupational safety and health professionals and practitioners may have particular interest in this report as the understanding of gene-environment interactions at the mechanistic and population levels may result in improved prevention and control strategies. This report is divided into topic areas for ease of reading. Specifically, the role of genetic information in occupational disease is discussed in Chapter 2, followed in Chapter 3 by a presentation of how genetics is incorporated into occupational health research. Health records as a source of genetic information are discussed in Chapter 4. The report continues in Chapter 5 with a focus on genetic monitoring, followed in Chapter 6 by a theoretical discussion of genetic screening. The final chapter presents an overview of the most important aspects of this report, which are the ethical, social, and legal implications of genetics in the workplace. In addition, ethical issues specific to health records and genetic testing are discussed in Chapters 4 and 6, respectively. To assist our audience in finding additional sources of information or more in-depth discussion of the issues surrounding genetic information, a list of web sites is provided at the conclusion of this document. Role of Genetic Information in Occupational Disease: The role of genetic information in occupational disease is being explored. The framework for considering genetics in the exposure to disease paradigm arose from a National Academy of Sciences review on biomarkers [NRC 1987]. Biomarkers are measurements using biological tissues that give information about exposure, effect of exposure, or susceptibility. Evaluation of genetic damage can provide information about exposure or effect of exposure. However, the presence of a specific genetic biomarker will not itself result in an occupational disease; exposure to a workplace hazard is necessary. The presence of a disease risk biomarker in the absence of exposure may be innocuous. The study of biomarkers of genetic susceptibility in the context of workplace exposures can provide information about gene-environment interactions. One major emphasis of genetic research in occupational disease has been in the area of response variability. Extensive variability in the human response to workplace exposures has been observed. Genes can have multiple variations known as polymorphisms, which may contribute to some of this variability [Grassman et al. 1998]. Research has been conducted over the last approximately 30 years to identify the role of genetic polymorphisms in a wide range of occupational and environmental diseases, particularly those involving occupational carcinogens [Hornig 1988; Berg 1979]. The risk of biological effects or diseases attributable to an occupational exposure can be decreased, unchanged, or increased among individuals with certain genetic polymorphisms. Incorporating Genetics into Occupational Health Research: The main influence on genetic research with respect to occupational health is the large number of technological advances in molecular biology. Because of these new techniques, it is now feasible to evaluate the relationship of disease with individual genes and their variants or even with the whole genome. These technologies promise to set the stage for new discoveries in understanding mechanisms and the preclinical changes that might serve as early warnings of disease or increased risk [NRC 2007]. " ; (Cont'd) "They also present difficult challenges in terms of handling large data sets, understanding the normal range, standardizing technologies for comparison and interpretation, and communicating results [King and Sinha 2001; Wittes and Friedman 1999]. As our understanding of the role of specific genes and their variants increases, genetic tests are being developed to look at specific genotypes. One critical issue in genetics is the validity of such genetic tests. Much contemporary genetic research involves the collection of biological specimens (usually DNA in white blood cells) that are then tested either for changes (damage) to genetic material or for genetic polymorphisms. These genetic tests, while useful in occupational health research, are not ready for clinical use; in other words, they are not validated for clinical interpretation. Validation is a process by which a test's performance is measured both in the laboratory and in populations, resulting in the evaluation of the clinical utility or the risks and benefits of the test. Until clinically validated, the information from such tests may be meaningless with regard to an individual's health or risk. In contrast, genetic tests may be validated for assessing exposure or effect modification in research even if they have no clinical utility. Health Records: A Source of Genetic Information: Genetic tests are not the only source of genetic information in the workplace. Genetic information is kept in workers' personnel and workplace health records [Rothenberg et al. 1997]. This information is in the family history of diseases with known strong genetic etiologies as well as in the results of physical examinations and common laboratory tests. This type of information is reported routinely by workers or obtained by employers from workers' job applications, health questionnaires, health and life insurance applications, physicals, and workers' compensation proceedings [Anderlik and Rothstein 2001]. The line between what is and is not genetic information in health records is unclear. States have enacted legislation with widely varying definitions of what constitutes genetic information from an employee's health record. Questions concerning confidentiality, privacy and security remain as the handling of health records may be influenced by various federal and state regulations. Genetic Monitoring and Occupational Research and Health Practice: Genetic information can be a scientific tool to understand mechanisms and pathways in laboratory research and as independent or dependent variables in population research studies of workers. In occupational safety and health practice, genetic tests may be used in a variety of ways. As in other areas of health science, genetic information may be used in the differential diagnosis of disease, allowing clinicians to consider or exclude various diagnoses. Monitoring for the effects of exposure on genetic material, such as chromosomes, genes, and constituent deoxyribonucleic acid (DNA), has been used to evaluate risks and potential health problems for more than 50 years, particularly those from ionizing radiation [Mendelsohn 1995; Langlois et al. 1987; Berg 1979]. Such monitoring is not unlike monitoring for metals in blood, solvents in breath, or dusts in lungs and presents less ethical concern than assessing heritable effects [Schulte and DeBord 2000]. Tests for genetic damage have been advocated as a way to prioritize exposed individuals for more thorough medical monitoring [Albertini 2001]. Genetic monitoring highlights the confusion that exists between individual and group risk assessment. Unlike other monitoring methods, the risks linked to cytogenetic changes are interpretable only for a group, not for an individual [Schulte 2007; Murray 1983; Lappe 1983]. Currently, no U.S. regulations exist that mandate genetic monitoring. Questions arise whether genetic monitoring indicates a potential health problem, an existing health problem, or compensable damage. More research is needed to understand the science before the individual's risk of disease can be interpreted from genetic monitoring results. However, genetic monitoring to determine exposure may be useful for the occupational health practitioner Theoretical Use of Genetic Screening and Occupational Health Practice: Genetic monitoring may have some application in occupational health practice, but perhaps the most controversial use of genetic information would be in making decisions about employment opportunities and health and life insurance coverage [Schill 2000; Bingham 1998; Van Damme et al. 1995; Murray 1983; Lappe 1983]. This would occur primarily as a result of genetic screening, in which a job (and insurance) applicant or a current worker might be asked to undergo genetic testing to determine if he or she has a certain genotype. However, the Genetic Information Nondiscrimination Act of 2008 (GINA) prohibits discrimination on the basis of genetic information with respect to health insurance and employment [U.S. Congress 2008]. Genetic screening which was not strictly prohibited by the Americans With Disabilities Act of 1990 (ADA) is now prohibited. Under ADA an employer may not make medical inquiries about an applicant until a conditional offer has been extended. Once the offer has been tendered, an employer could have obtained medical, including genetic, information about a job applicant. ADA did not prohibit obtaining genetic information or genetic screening, nor did it prohibit an employer from requesting genetic testing once an applicant has been hired provided the testing is job related. and can be used for the purposes of job placement after a conditional job offer is made. Most criteria for genetic screening programs indicate that participation should be voluntary, with informed consent in place. Genetic screening for these purposes cannot be supported at this time because of the current lack of linkage of causation of a given genetic polymorphism with a given occupational disease and its implications with regard to the Occupational Safety and Health Act (OSH Act of 1970) that the workplace be safe for all workers [OSHA 1980b]. Accurate genetic screening information may eventually be useful to workers considering employment options. Obtaining this information for the worker would become appropriate only after the screening tests have been validated regarding risk. Various ethical arguments have been advanced in the discussion of genetic screening, and a broad range of implications of genetic testing has been discussed in the literature and in this document, including the oversight of genetic testing laboratories. The Ethical, Social, and Legal Implications of Genetics in the Workplace: A concern about the use of genetic information in occupational safety and health is that the emphasis in maintaining a safe and healthful workplace could shift from controlling the environment to excluding the vulnerable worker. This would be counter to the spirit and the letter of the OSH Act of 1970 [OSHA 1980b]. Actions that attempt to depart from providing safe and healthful workplaces for all should not be supported. Nevertheless, understanding the role of genetic factors in occupational morbidity, mortality, and injury is important and could lead to further prevention and control efforts. However, occupational safety and health decision-makers, researchers, and practitioners may find that genetic factors do not contribute substantially to some occupational diseases. Environmental risk factors will probably always be more important for developing strategies for prevention and intervention in occupational disease and ultimately for the reduction of morbidity and mortality. The challenge is to identify and apply genetic information in ways that will improve occupational safety and health for workers. The use of genetic information in occupational safety and health research requires careful attention because of the real or perceived opportunities for the misuse of genetic information. Society in general and workers in particular have concerns that discrimination and lack of opportunity will result from the inappropriate use of genetic information [MacDonald and Williams-Jones 2002; Maltby 2000]. While only sparse or anecdotal information supports this contention, a wide range of workers, legislators, scientists, and public health researchers have concern that such discrimination could occur. Thus, GINA and other regulations were passed to prevent the potential misuse and abuse of genetic information in the workplace. Examples of safeguards include rules and practices for maintaining privacy and confidentiality, prohibition of discrimination, and support of a worker's right of self-determination (autonomy) with regard to genetic information. Many of these safeguards have been built into biomedical research in general, and occupational safety and health research in particular, through guidance given in the Nuremberg Code [1949], the Belmont Report [1979], and the Common Rule (45 CFR. 46) [DHHS 2005; CFR 2007], as well as in the National Bioethics Advisory Commission (NBAC) reports [1999], the ADA [1990], Health Insurance Portability and Accountability Act (HIPAA) [1996] and GINA in 2008 [U.S. Congress 2008]. ADA and HIPAA provided some safeguards against the potential misuse of genetic information in the workplace before GINA was signed and in 2000, Executive Order 13145 was signed that prohibits discrimination in federal employment based on genetic information [65 Fed. Reg. 6877 (2000)]. In summary, the use of genetic information in the workplace has the potential to affect every worker in the United States. This NIOSH document provides information on the scientific, legal, and ethical issues with regard to the use of genetics in occupational safety and health research and practice." - NIOSHTIC-2 ; Introduction -- The Role of genetic information in occupational disease -- Incorporating genetics into occupational health -- Research -- Health records: a source of genetic information -- Genetic monitoring: occuptional research and practice -- The Theoretical use of genetic screening and occupational health practice. -- The Ethical, social, and legal implications of genetics in the workplace ; "November 2009." ; Also available via the World Wide Web. as an Acrobat .pdf file (1.62 MB, 151 p.). ; Includes bibliographical references (p. 81-114) and index.

Under its Health in Africa Initiative, IFC intended to conduct a country assessment of the private health sector in Mali, working in close collaboration with the World Bank and the Government of Mali.The Core objective of the Mali Country Assessment Report was to work closely with the Government of Mali and Development partners to develop recommendations for a reform program to strengthen the existing policy framework for the public-private interface in the health sector and to improve the delivery of health related goods and services for all Malians.As part of this, the purpose of the book wa

Reducing carbon emissions entails a fundamental shift in energy production and consumption. It requires significantly more mineral products, such as copper and lithium, to manufacture low-carbon and mobility products. However, accessing the critical raw materials (CRMs) and related cleantech products needed to keep global warming under the 1.5°C threshold is increasingly challenging.[1] Mineral and cleantech supply chains have become highly geopolitical, especially after the Covid-19 pandemic and the Russia-Ukraine war.[2] Green or cleantech value chains comprise raw materials sourcing such as lithium and cobalt; component manufacturing such as solar cells, turbine blades and battery cells; integrating components into clean technologies; and recycling and circular economy. At the moment, the EU is largely dependent on China for its CRMs supply, with the latter being responsible for 100 per cent of the EU's supply of heavy rare earth elements, 71 per cent of gallium, 40 per cent of natural graphite and 62 per cent of vanadium, among others.[3]
Thus, a stronger collaboration with Africa on CRMs could be mutually beneficial by helping the EU with alternative supplies while supporting African industrialisation. With its significant endowments of CRMs, the African continent has become a hotbed of ongoing geopolitical contestations on economic diplomacy. Traditional partners such as the United States, Europe, and China, as well as new actors from the Gulf (United Arab Emirates, Saudi Arabia and Qatar), Turkey and India,[4] are all seeking access to these prized resources. At the same time, many African governments see the renewed global demand for CRMs as a starting point to boost their national and regional CRMs processing capabilities. The expectation is that local processing will help drive innovation and productivity, thereby meeting age-old aspirations of industrialisation in Africa.[5] Despite several attempts since the decolonisation period (1950s–1970s), Africa is the least industrialised region globally while having almost 20 per cent of the global population and land area.[6] The continent's contribution to economic output is about 3 per cent of global GDP and 2 per cent of world manufacturing value added.[7]
Africa largely remains a primary raw materials exporter to the world, including key Asian economies such as China, where most of its CRMs are further processed into value-added products such as precursor cells and batteries for electric vehicles (EVs).[8] The African continent accounts for about 30 per cent of the world's mineral reserves and 12 per cent and 8 per cent of the world's oil and natural gas reserves.[9] In addition, Africa also has 40 per cent of the world's gold, about 90 per cent of chromium and platinum, and the largest reserves of cobalt, diamonds, platinum and uranium. Sub-Saharan Africa alone is reported to have over 30 per cent of the volume of critical minerals needed for the green energy transition.[10]
African countries want to leverage these resources to address their energy and industrialisation needs, creating much needed jobs, productivity enhancements and structural change. They want to avoid the risk of the centuries-long extractivist practices, whereby African raw materials have been mined and exported by foreign companies with little local value addition, and with little regard for environmental, social and governance (ESG) standards.The added value of strengthening EU-Africa's ties on cleantech supply
Africa provides unique advantages to help increase and diversify the EU's CRMs supply while the EU supports the continent's development and industrialisation efforts. On the one hand, the continent is uniquely placed at the centre of the world, with many potential African CRM supply countries having two to three weeks shipping times to Europe. The EU sources 63 per cent of its aluminium from Guinea, 35 per cent of its tantalum from the Democratic Republic of the Congo (DRC) and 41 per cent of its manganese from South Africa.[11]
Many African countries are highly likely to continue with measures such as raw ore export bans to assert more beneficiation and in-country value addition. Against this backdrop, there is an opportunity to further increase and deepen ties with Africa as a friend-shoring partner of choice. This could be done by European private sector companies with funding and support from European financial institutions to set up mining ventures and processing facilities in the continent. While Europe's financial and technical support for initiatives such as the Lobito Corridor railway project[12] is welcome, the commitments of the EU and its member states to funding mining and processing ventures in Africa are still insufficient. Helping build a railway line is a good entry point for the EU, but it does not necessarily make Brussels a preferred partner of choice as compared to other geopolitical actors. The EU can do more beyond infrastructure and logistics. Beijing, through State-funded initiatives like the Belt and Road Initiative involving the Chinese private sector, is investing in both mining ventures and value addition, as well as railways and other logistical infrastructure.[13]
European leaders must bear in mind that for Africa, true added value in its relations with Europe or any other geopolitical partner means moving away from simply exporting primary commodities to using them for local production and manufacturing of components such as solar cells, turbine blades, battery cells and semiconductors to be sold on the continent, leveraging the African Continental Free Trade Area (AfCFTA), as well exports to other markets.Africa's development priorities: Electricity provision and financing
Industrialisation and integration of Africa into global green value chains cannot happen without electricity. In order words, there cannot be proper cleantech supply chains in Africa if the fundamental prerequisite of the electricity needed for mining and processing into value-added products like EVs is not available. Without electricity provision to drive industry, Africa will only still end up exporting the raw mineral ores to China, Europe and other places that have the factor endowments such as cheaper electricity to turn them into useful products.
The foremost priority for many African countries is getting the needed investments to upgrade the existing and to build new energy systems. The continent faces pervasive energy deficits and industrialisation challenges despite its abundant energy and mineral resources. Without increasing the production of energy from multiple sources, economic growth will stall, and so will the associated trickle-down to the micro-levels that are needed to reduce poverty and inequality. To that extent, the EU can and should assist African countries in attracting the necessary investments to develop context-specific energy pathways leveraging renewable energy – solar, wind, hydrogen and natural gas, among others. The deployment of high renewable energy shares is constrained by the "transition speed, cost and technology mix" for individual African countries.[14] Also, legacy resources like natural gas and hydropower are needed to balance the grid from the intermittencies associated with renewable sources like solar and wind, especially for industries like steel and aluminium production that require non-stop operations.
Much like Africa, EU policymakers, especially with the aftershocks of the Russian-Ukraine war, recognise that multiple sources of energy supply are needed to meet trilemma goals of security of supply, affordability and sustainability.[15] It is within this context that the EU has included natural gas and nuclear energy in its taxonomy under the Complementary Delegated Act (CDA)[16] which is a key component of the Union's sustainable finance agenda. On the back of this, the EU must support African countries, especially those with significant endowments, to use natural gas for domestic power generation to meet household energy demand and industrial needs. The CDA provides a means for EU financial institutions to continue financing natural gas to power projects, albeit with stricter environmental requirements.[17] To attract investment, new projects must introduce measures such as carbon capture and storage to reduce their carbon intensity – that is, the CO2 emissions per kilowatt hour (kWh) of electricity produced.
Furthermore, the EU could also advocate rechannelling the unused International Monetary Fund's (IMF's) Special Drawing Rights (SDRs) into financing climate action in Africa, emphasising the development of the continent's nascent green value chains. Climate finance flows to Africa were a mere 30 billion US dollars in 2020, just 11 per cent of the annual target and only 3 per cent of global climate finance.[18] To close this financing gap, the EU could lobby other advanced economies to rechannel approximately 73 billion US dollars of unused SDRs[19] to low- and middle-income countries, several of whom are in Africa, for climate action.
These funds could be provided to regional multilateral development banks such as the African Development Bank (AfDB) to finance climate action, including green value chain projects on the continent. They would serve as catalytic financing for new renewable energy and cleantech investments on the continent, enabling domestic innovation and productivity gains. EU member states such as France and Spain as well as institutions such as the European Bank for Reconstruction and Development (EBRD) are already in such discussions at the global level, but efforts could be doubled to ensure that rechannelling of SDRs becomes a reality by 2025. The longer this is delayed, the more difficult it becomes for African countries to integrate into global cleantech value chains due to domestic and external debt vulnerabilities.
Also, the EU Commission and European financial institutions such as the European Investment Bank (EIB) could help African countries with technical assistance in designing and launching new financing instruments such as green bonds and other ESG instruments. For example, sustainability-linked bonds (SLBs), a financing tool used at the sovereign level by Chile[20] and other countries, have key performance criteria that have to be met (such as gender criteria). It is worth noting, however, that this ESG funding still adds to African countries' existing debt burdens.[21]Engaging across regional and bilateral levels
In engaging with African partners – be them national governments, regional institutions and local actors – the EU should refrain from a one-size-fits-all policy prescription to embrace a nuanced and multifaceted approach. Brussels, for example, should work with regional economic blocs such as the African Union, Southern African Development Community, Common Market for Eastern and Southern Africa and others – to promote greater regional cooperation across CRMs value chains beyond the rhetoric. This should emphasise joint regional research and innovation, policy and market alignment, and regional processing infrastructure.
African governments, policymakers and civil society are increasingly advocating for more regional value chains/corridor development approaches to cleantech value chains on the continent. For example, the DRC, South Africa, Zambia and Zimbabwe could use their mineral resources and proximity to create a battery manufacturing opportunity, such as making the precursor cells needed for EVs. Local actors, including civil society, also advocate for more ESG considerations in projects, further driven by higher EU ESG standards.Looking ahead
Developing clean industrial capacities with real added value would benefit Africa by addressing the many interconnected "nexus" challenges of energy access, poverty and limited industrial development capacities. Cleantech and industrial capacities using renewable energy such as solar and geothermal would drive the expansion of renewable energy infrastructure, providing access to affordable and reliable electricity for many on the continent. Africa could move up the value chain by developing industries that locally process CRMs and make component parts for domestic and export markets, creating a more diversified and resilient continental economy. From the EU's perspective, this would also mean less vulnerability or dependence on China for cleantech supply chains for Europe.Theophilus 'Theo' Acheampong is a visiting fellow with the Africa programme at the European Council on Foreign Relations. This commentary was prepared within the framework of the project Nexus25–Shaping Multilateralism. Views expressed are the author's alone.[1] United Nations website: Net Zero Coalition, https://www.un.org/en/node/134483.[2] Melanie Müller, "The 'New Geopolitics' of Mineral Supply Chains: A Window of Opportunity for African Countries", in South African Journal of International Affairs, Vol. 30, No. 2 (2023), p. 177-203, https://doi.org/10.1080/10220461.2023.2226108.[3] Council of the EU website: An EU Critical Raw Materials Act for the Future of EU Supply Chains, https://europa.eu/!WgTCVv.[4] Maddalena Procopio and Corrado Čok, "Beyond Competition: How Europe Can Harness the UAE's Energy Ambitions in Africa", in ECFR Policy Briefs, June 2024, https://ecfr.eu/?p=123736.[5] African Union, 10 Things Africa Must Do to Accelerate Industrialization and Economic Diversification in Africa, 14 November 2022, https://au.int/en/node/42375.[6] Theophilus Acheampong and Prince Asare Vitenu-Sackey, "Industrialisation in Africa: Leading Countries and Reasons for Their Success", in APRI Short Analyses, 10 October 2024, https://afripoli.org/industrialisation-in-africa-leading-countries-and-r....[7] UN Industrial Development Organization (UNIDO), Factsheet: Africa. Highlights from the International Yearbook of Industrial Statistics 2023, December 2023, https://www.unido.org/sites/default/files/unido-publications/2023-12/doc....[8] Theophilus Acheampong, "From Mines to Markets: How Africa and Europe Can Become Green Industry Partners of Choice", in ECFR Policy Briefs, April 2024, https://ecfr.eu/?p=121258.[9] UN Environment Programme (UNEP) website: Our Work in Africa, https://www.unep.org/regions/africa/our-work-africa.[10] Wenjie Chen, Athene Laws and Nico Valckx, "Harnessing Sub-Saharan Africa's Critical Mineral Wealth", in IMF Country Focus, 29 April 2024, https://www.imf.org/en/News/Articles/2024/04/29/cf-harnessing-sub-sahara....[11] Council of the EU website: An EU Critical Raw Materials Act, cit.[12] European Commission DG for International Partnerships, Connecting the Democratic Republic of the Congo, Zambia, and Angola to Global Markets through the Lobito Corridor, 24 October 2023, https://international-partnerships.ec.europa.eu/node/2801_en.[13] Lobito Corridor Investment Promotion Authority, Confronting the China Challenge in Africa: The Lobito Corridor, 17 April 2024, https://www.lobitocorridor.org/post/confronting-the-china-challenge-in-a....[14] Yacob Mulugetta et al., "Africa Needs Context-Relevant Evidence to Shape Its Clean Energy Future", in Nature Energy, Vol. 7, No. 11 (November 2022), p. 1015-1022 at p. 1015, DOI 10.1038/s41560-022-01152-0.[15] Yana Popkostova, "Europe's Energy Crisis Conundrum. Origins, Impacts and Way Forward", in EUISS Briefs, No. 2/2022 (January 2022), p. 2, https://www.iss.europa.eu/node/2689.[16] European Commission DG Finance website: EU Taxonomy: Complementary Climate Delegated Act to Accelerate Decarbonisation, https://finance.ec.europa.eu/node/849_en.[17] For example, gas power plants would be categorised as green if "direct GHG emissions of the activity are lower than 270g CO2e/kWh of the output energy, or annual direct GHG emissions of the activity do not exceed an average of 550kg CO2e/kW of the facility's capacity over 20 years". See European Commission, Commission Delegated Regulation (EU) 2022/1214 of 9 March 2022 Amending Delegated Regulation (EU) 2021/2139 as Regards Economic Activities in Certain Energy Sectors and Delegated Regulation (EU) 2021/2178 as Regards Specific Public Disclosures for those Economic Activities, http://data.europa.eu/eli/reg_del/2022/1214/oj. See also EU Platform on Sustainable Finance, Response to the Complementary Delegated Act, 21 January 2022, https://finance.ec.europa.eu/system/files/2022-01/220121-sustainable-fin....[18] Akinwumi Adesina, "Mobilising Private Sector Financing for Climate and Green Growth in Africa", in NewAfrican, 30 May 2023, https://newafricanmagazine.com/29682.[19] Stephen Paduano, "SDR Rechanneling and ECB Rules. Why Rechanneling SDRs to Multilateral Development Banks Is Not Always and Everywhere Monetary Financing", in FDL Policy Notes, No. 7 (May 2023), https://findevlab.org/?p=30845.[20] Environmental Finance: Environmental Finance's Bond Awards 2023: Sustainability-linked Bond of the Year: Republic of Chile, https://www.environmental-finance.com/content/awards/environmental-finan....[21] Carlos Lopes, "The African Debt Dilemma: Unpacking the Three Unfavourable Factors", in ODI Expert Comments, 10 June 2024, https://odi.org/en/insights/the-african-debt-dilemma-unpacking-the-three....

Since the 1990s, Italy has progressively become a country of destination for migration movements especially from Africa and South Asia. In 2022, Italy received a total of 84,289 claims for international protection. The main nationalities of origin were Bangladesh, Pakistan, Egypt, Tunisia and Nigeria.[1] The causes of migration are multiple and complex, and could refer to political, economic, social and/or cultural grounds. Yet, and not without hurdles, another relevant factor that contributes to driving people to move to a different country has started to emerge: climate change (and its related impacts on disasters, environmental degradation and other environmental factors). Although the nexus between climate change and migration is complex to define and to identify, it is relevant to note that many protection-seekers in Italy come from countries most exposed to climate change that, in certain cases, may have played a role either in directly shaping migration movements or in exacerbating more proximate causes of migration, such as worsening conflicts over scarce resources, violence, poverty or discrimination dynamics in the aftermath of a disaster.[2] Against this backdrop, in the following, I will first examine how the climate change-migration nexus has been approached by the Italian legal system, to then move to the Meloni government's political strategy in the field of migration governance, followed by an assessment of their respective efficacy.Legislative actions endorsed by Italy
Not only have Italian courts and tribunals long recognised that protection needs can arise from climate and environmental factors, but decision-makers have acknowledged the influence of climate change and disasters on migration too. This is a first and extremely relevant point to stress. Unlike most countries in the EU and beyond, Italy has explicitly recognised the nexus between climate change and migration through the adoption of specific pieces of legislation. This is not common in the EU or elsewhere, where either such a link has been simply ignored, or it has been sporadically addressed through fragmented and ad hoc measures, usually in an emergency context. What makes Italy stand out as a pioneering case study is that the country's judicial system incorporates the different types of protection needs that can stem from climate and environmental factors, hence providing for different protection statuses. These refer to temporary protection due to natural disasters (Art. 20 Testo Unico Immigrazione – TUI), a six-month and renewable residence permit as a result of calamities (Art. 20bis TUI), and special protection where the return to the country of origin would violate basic human rights (Art. 19 TUI).[3] In addition, humanitarian protection, which although repealed could still apply on pending cases that had been lodged before the Decree-Law No. 113/2018 repealing humanitarian protection entered into force, has covered cases of sudden- and slow-onset disasters, such as droughts, earthquakes, floods etc. Notably, these provisions complement the statuses available at the EU level – that is, the refugee status and subsidiary protection – that have also been recognised by judicial authorities to people fleeing climate change.
Although not shielded from flaws, these legislative measures have the merit to concretely and explicitly address protection needs stemming from climate and environmental factors and have been considered noteworthy in several institutional settings. The latter include the Platform of Disaster Displacement, which is a state-led initiative aiming at enhancing protection for people displaced across borders in the context of disasters and climate change, and the UN High Commissioner for Refugees.[4]The Meloni government and the Mattei Plan
In addition (and sometimes in opposition) to essential provisions at the national level aimed at protecting migrants from climate change, the current Meloni's government is implementing a series of political initiatives in the field of migration governance that may have an impact also on migration movements in the context of climate change.
A first set of initiatives delves around building ties with African countries in the field of migration management in order to prevent migration flows. Arrangements signed, renewed or promoted with strategic countries, such Albania, Libya and Tunisia, have been harshly criticised for violating human rights and the constitutional and international obligations of the Italian state.[5] In particular, such informal arrangements foresee Italy's technical and financial support in externalising asylum processing (such as in the case of Albania) and curbing migration flows (such as in the case of Libya and Tunisia), thus hampering migrants' right to asylum, including those fleeing climate change.
The second line of initiatives sponsored by the Meloni government is about investing in partnership and cooperation with Africa. Among others, the Mattei Plan for Africa seems to inaugurate a new and comprehensive approach in Italy's relations with Africa, through which "the Italian government intends to trigger a paradigm change in the relations with the African continent and build a partnership on an equal footing, which rejects the paternalistic and compassionate approach as well as the predatory approach, and which is able to generate benefits and opportunities for all".[6] The Mattei Plan engages with key thematic areas of utmost importance for both Italy and Africa, including food security; energy, water and natural resources; healthcare; education; research and innovation; climate change and environmental protection; migration, among others.[7] In principle, therefore, it seems that managing migration and reducing African countries' vulnerability to climate change are relevant elements in the architecture of the Mattei Plan.
The Plan envisages key climate change adaptation and mitigation strategies for Africa as well as actions to limit desertification and water scarcity. Interventions and programmes in these areas will benefit from the funding available under the Italian Climate Fund – that is, the principal instrument to achieve the commitments endorsed through international agreements on climate change and managed by public development bank Cassa Depositi e Prestiti. Yet, these initiatives are not detailed nor well-defined in the document. If and how the Mattei Plan will concretely foster environmental protection, communities' resilience, and a just transition in Africa is therefore still not clear. Similarly, and crucially, the way in which the Mattei Plan will combine with other multilateral actions in the field of climate change, such as the EU Global Gateway and the G7 Partnership for Global Infrastructure and Investment, is still uncertain. Indeed, although the Mattei Plan itself mentions these initiatives as part of its synergies with EU and international programmes, the document only provides a brief description of these instruments and does not clarify to what extent and how these will interact with the Mattei Plan, or what kind of financial support these could provide to which particular areas, priorities and projects.
Likewise, migration seems prominent in the goals and objectives of the Mattei Plan. Emblematically, it argues that the initiatives set forth therein are aimed at granting African youth "the right not to migrate" and to remain in Africa.[8] Yet, this topic seems scarcely addressed as the word "migration" appears only ten times in a 102-page-long document. In addition, migration is not included in the six priorities of the Mattei Plan (education; healthcare, water, agriculture, energy, infrastructure). Actions to ensure "the right not to migrate" are mainly indirect, vaguely defined, and clustered in broader socio-economic initiatives, such as 1) the possibility to open regular pathways for labour migration to work in Italian small and medium industries; 2) the need to improve access to food security in rural and poor urban areas where internal and cross-border migration flows are more intense; 3) strengthening the school system in Ivory Coast (the first nationality of irregular migrants in Italy according to the Mattei Plan); the intention to support job creation and sustainable agriculture in those regions of Tunisia where migration rank is high. The fact that migration seems to be a key goal of the Mattei Plan but is absent from its priorities might then imply that the six pillars are the means through which the Italian government aims to achieve its main objective.
At the same time, it is important to recall that key transit countries, such as those of the Sahel region, did not attend the Italy-Africa Summit of January 2024, thus questioning the relevance that partnership on migration management may play for strategic African states. Finally, although development cooperation could surely contribute to eradicating poverty and other plagues that trigger migration flows within and from Africa, this result crucially depends on how development cooperation is intended and pursued.[9] In this regard, it is undisputed that development cooperation in the so-called Global North is increasingly directed to deter migration, based on the simplistic assumption that improving the living conditions of communities in vulnerable third countries would result in reduced emigration.[10] Such a narrative, however, has already proven to be flawed.[11]
All in all, not only are actions towards climate change and migration superficially addressed, but the nexus between the two is not mentioned in the Mattei Plan. Whereas Italy's engagement in providing protection to people compelled to flee because of climate and environmental factors is strongly present at the legislative level and is able to capture different types of causes and migration movements linked to climate stressors, Italy's political actions under the Meloni government raise questions regarding their responsiveness to the challenges posed by climate change on migration movements as well as their effectiveness in fairly managing migration. As currently envisaged, the Mattei Plan seems to fit in the established political trend of using development cooperation in third countries as a means of governing migration flows.
Time is needed to evaluate the next steps of the Mattei Plan and its concrete potential in such delicate areas. The Italian government needs to frame the projects it intends to pursue under the Mattei Plan with reference to migration and to climate change more explicitly, as well as how multilateral initiatives may support national efforts. In particular, the Italian government still has the opportunity to acknowledge the intersections between climate stressors and migration movements by unveiling their interconnections in Africa and in strategic African countries. Adequately addressing rooted climate and environmental causes of migration in a way that is in line with international standards would bring Italy's political action closer to its laudable legislative level.Chiara Scissa is Researcher in the Energy, Climate and Resources Programme at the Istituto Affari Internazionali (IAI).[1] Italian Ministry of the Interior, I numeri dell'asilo. Confronto dati anno 2021-2022, http://www.libertaciviliimmigrazione.dlci.interno.gov.it/it/node/97.[2] Chiara Scissa, "The Weaponization of Natural Resources and Disasters during Conflict: The Refugee Convention's Relevance for Syria and Yemen", in Baker Institute Policy Briefs, May 2024, https://www.bakerinstitute.org/node/77231; David Cantor et al., "International Protection, Disasters and Climate Change", in International Journal of Refugee Law, Vol. 36, No. 1-2 (March/June 2024), p. 176-197, https://doi.org/10.1093/ijrl/eeae012.[3] Administrative and judicial authorities have recognised that returning claimants back to countries affected by sudden-onset events would be contrary to Art. 19 TUI and granted special protection. Chiara Scissa, "Human Mobility in the Context of Disasters, Climate Change and Environmental Degradation in the Euro-Mediterranean Region: Challenges and Insights", in EuroMed Rights Reports, February 2024, p. 31-32, https://reliefweb.int/node/4040562.[4] Among many, Walter Kälin and Hannah Entwisle Chapuisat, Protection of Persons Displaced across Borders in the Context of Disasters and the Adverse Effects of Climate Change. A Review of Literature, Legislation and Case Law to Support the Implementation of the Global Compact on Refugees, Geneva, UNHCR, June 2024, https://www.refworld.org/reference/lpprs/unhcr/2024/en/148128; Walter Kälin and Hannah Entwisle Chapuisat, Policy Brief: Protection of Persons Displaced across Borders in the Context of Disasters and the adverse Effects of Climate Change, Platform on Disaster Displacement and UNHCR, December 2023, https://www.preventionweb.net/quick/82217. For an in-depth analysis of pros and cons of Italian protection statuses concerning the climate change-migration nexus, see Chiara Scissa, "Populism and Environmental Migration: The Peculiar Italian Duo", in Lorenzo Figoni et al., Climate Change Knows No Borders. Addressing Protection Gaps and Enhancing Policy Responses to Climate Mobility featuring In-Depth Research from The Gambia, ActionAid International Italia, April 2024, p. 37-43, https://actionaid-it.imgix.net/uploads/2024/06/Report_Gambia_ENG.pdf.[5] Amnesty International, The Italy-Albania Agreement on Migration: Pushing Boundaries, Threatening Rights, 19 January 2024, https://www.amnesty.org/en/documents/eur30/7587/2024/en; Mathias Hatleskog Tjønn and Maria Gabrielsen Jumbert, "Migration across the Mediterranean: Shaping Italy-Libya Relations over Time", in Ricard Zapata-Barrero and Ibrahim Awad (eds), Migrations in the Mediterranean. IMISCOE Regional Reader, Cham, Springer, 2024, p. 53-69, https://doi.org/10.1007/978-3-031-42264-5_4; Vasja Badalič, "Tunisia's Role in the EU External Migration Policy: Crimmigration Law, Illegal Practices, and Their Impact on Human Rights", in Journal of International Migration and Integration, Vol. 20, No. 1 (February 2019), p. 85-100, https://doi.org/10.1007/s12134-018-0596-7.[6] Author's translation from Italian Government, Schema di decreto del Presidente del Consiglio dei ministri di adozione del Piano strategico Italia-Africa: Piano Mattei, 17 July 2024, p. 3, https://www.senato.it/service/PDF/PDFServer/BGT/1424398.pdf.[7] Daniele Fattibene and Stefano Manservisi, "The Mattei Plan for Africa: A Turning Point for Italy's Development Cooperation Policy?", in IAI Commentaries, No. 24|10 (March 2024), https://www.iai.it/en/node/18219; Filippo Simonelli, Maria Luisa Fantappié and Leo Goretti, "The Italy-Africa Summit 2024 and the Mattei Plan: Towards Cooperation between Equals?", in IAI Commentaries, No. 24|11 (March 2024), https://www.iai.it/en/node/18220.[8] Italian Government, Schema di decreto del Presidente del Consiglio dei ministri, cit., p. 5.[9] Matthew Scott, "Adapting to Climate-Related Human Mobility into Europe: Between the Protection Agenda and the Deterrence Paradigm, or Beyond?", in European Journal of Migration and Law, Vol. 25, No. 1 (March 2023), p. 54-82, https://brill.com/view/journals/emil/25/1/article-p54_3.xml; Stephanie Pope and Zina Weisner, "From Development to Deterrence? Migration Spending under the EU Neighbourhood Development and International Cooperation Instrument (NDICI)", in Oxfam Briefing Papers, September 2023, https://doi.org/10.21201/2023.621536; Estela Casajuana and Giorgia Jana Pintus, Beyond Borders, Beyond Boundaries. A Critical Analysis of EU Financial Support for Border Control in Tunisia and Libya, ARCI et al., November 2023, https://actionaid.org/node/729179.[10] Sarah Louise Nash, "The Developmentalisation of Climate Mobilities Policy in Denmark and Sweden", in Miriam Cullen and Matthew Scott (eds), Nordic Approaches to Climate‑Related Human Mobility, London/New York, Routledge, 2024, p. 68-84, https://doi.org/10.4324/9781003460985-5.[11] Michael Collyer, "Border Work: Frames, Barriers, and Disingenuous Development", in Tanja Bastia and Ronald Skeldon (eds), Routledge Handbook of Migration and Development, London/New York, Routledge, 2020, p. 63-73.

At the Africa Climate Summit held in Kenya in 2023, African heads of state and government produced the Nairobi Declaration,[1] which is now the basis for the continent's common position on global climate change – in line with Agenda 2063,[2] the African Union's development blueprint. The Nairobi Declaration calls on the international community to support an increase of Africa's renewable generation capacity to at least 300 GW by 2030 (from 56 GW in 2022) – to serve the double goal of alleviating its harsh energy poverty and increasing the supply of cost-effective clean energy for industry. The Declaration stresses the importance of climate-positive growth, green industrialisation, and local value creation, while recognising the cascading and multidimensional effects of climate change on African economies and calling, inter alia, for a debt moratorium so that the continent can prepare for a world of ever greater climate extremes. Grappling with the twin challenges of energy access and transition, Africa has the vision for its future. Yet, it lacks the adequate means. The good news is that this year's G7 under Italian Presidency might help.The investment issue
The debate in many African countries bears little resemblance to that in wealthy G7 countries. The continent faces a major energy access deficit – with around 570 million people in sub-Saharan Africa lacking access to electricity and almost 960 million to clean cooking. With its population expected to grow to 2.5 billion by 2050, Africa stands at a crucial crossroads in its developmental trajectory. Despite abundant renewable resources that could contribute to its own leapfrogging, in the past two decades only 2 per cent of global investments in renewables were made in Africa (and with significant regional disparities).
Unfair as it is, the African continent cannot behave like rich countries had the luxury to do, grounding their development on the unconstrained burning of unabated fossil fuels. Just as crucially, Africa needs to disproportionally deal with consequences of climate change that are not of its making – a key aspect guiding its demands in multilateral fora in line with the "common but differentiated responsibilities" principle that has been a staple of the international climate consensus since the Kyoto Protocol. Given the scale of the ambition as crystallised in the Agenda 2063, African countries need a varied energy portfolio composed of multiple technologies across different sectors. Although the most readily available solutions to energy poverty in Africa still involve the burning of fossil fuels, providing access through the cleanest possible mix is necessary but would require investment to more than double from today's 90 billion US dollars by 2030, at which point around two-thirds of spending would go to clean energy.[3] Multiple barriers hinder the development of bankable clean energy opportunities in Africa and deter private investments at the necessary scale. Borrowing costs across the continent have reached levels up to eight times higher than in the rich world[4] and debt servicing costs are now double the level of clean energy investment.[5] When poor countries are forced to default on their foreign debt (for example, Zambia),[6] spending on energy access and transition is anything but easy.The role of multilateral institutions and the G7
Shifting away from the current dysfunctional and unjust financial system is however a goal the G7 can help to achieve. First and foremost, G7 countries should increase their financial support to energy projects in Africa favouring those focusing on clean energy, including decentralised solutions, such as mini and off-grids, rather than fossil fuel export-oriented projects. Second, the G7 could follow up on the Global Expert Review on Debt, Nature and Climate launched at COP28 opening to a range of new capital sources and financing approaches addressing both debt and climate risks. Creative uses for debt relief, for example, where a portion of a nation's foreign debt is forgiven in exchange for local investments in climate action, should be considered. Third, G7 nations can help mobilise more money globally, imagining new and efficient taxes on polluting activities and on extreme wealth to fill the finance gap. Fourth, the G7 can serve as a bridge for critical discussions to be brought at the wider multilateral level: from an adequate refinancing of the World Bank's International Development Association (IDA),[7] to ambitious guidance towards the new climate finance target after 2025 (the NCQG).[8] This latter goal is expected to be the critical outcome of COP29 as it will introduce a fresh financial objective surpassing the current annual target of 100 billion US dollars in climate finance. Lastly, the G7 should push for consistent frameworks for transition plans in both the real economy and financial institutions – ultimately bringing relevant support for stronger multilateral outcomes, even more important given the work of the G20 Task Force on a Global Mobilization against Climate Change set up by Brazil that is addressing these issues.[9]
This year's G7, under Italian Presidency, may provide a window of opportunity. Indeed, Prime Minister Giorgia Meloni herself kicked off the year with 'the Italy-Africa summit' and showcased the 'Mattei Plan for Africa' as the crown jewel of her foreign policy.[10] Moreover, a bonanza of climate milestones is on the horizon in the run-up to the 2025 COP30 in Brazil, with the opening of many diplomatic channels to make sure the world delivers. The recent WB-IMF spring meetings in Washington have revolved around a finance reform agenda fit for climate safety; the Petersburg Climate Dialogue a few weeks later outlined the COP29 agenda – dubbed the "Finance COP" given the strong relevance of climate finance amongst the priorities in Baku. In April, the G7 Climate, Energy and Environment Ministerial in Turin was the first climate multilateral event with a publicly negotiated output following the COP28: on that occasion, G7 officials set the first steps to achieve the UAE Consensus originated at the COP28 while emphasising the central position of Africa in the endeavour.[11]
However, the main outcomes from the Stresa Communiqué, adopted by G7 Finance ministers in late May,[12] show mixed results on the abovementioned priorities. Despite support for the replenishment of IDA (on which donors will make their official pledges in December), there are no signs that the 120 billion US dollars expected by Africa will be met. Even worse, the Communiqué does not even mention the NCQG. As for debt-related issues, G7 leaders are looking forward to the G20 improving the implementation of the Common Framework for debt treatments; however, G7 ministers did not provide guiding principles for a new approach, not even referencing to Special Drawing Rights (SDRs) that were one discussed tool to deliver much-needed financial resources to vulnerable countries back at the COP28.[13] Encouraging commitments were instead reached on the reform of multilateral development banks, on international taxation and on transition plans. The Communiqué specifically supports initiatives targeting sustainable development in Africa, such as the Resilient and Inclusive Supply-chain Enhancement (RISE)[14] and the Alliance for Green Infrastructure in Africa (AGIA), committing to contribute 150 million US dollars in grants, concessional and commercial capital and to mobilise 3 billion US dollars of private sector investment in green infrastructures.[15] It is however not clear how these initiatives will leverage on synergies through the Partnership for Global Infrastructure and Investments (PGII) on which G7 public development banks and development finance institutions are working.[16] Lastly, while the quick ending of fossil fuel subsidies that do not address energy poverty or just transitions was one of the most interesting commitments of the Turin Ministerial, no further indication was given in Stresa. G7 leaders should clearly define how to efficiently coordinate between different initiatives and agree on concrete commitments to increase finance for climate.Rethinking partnerships
The G7 can also support renewed partnerships with African hydrocarbon exporting countries – that regained centrality in the aftermath of the energy crisis and Russia's war against Ukraine. In this sense, the Italian Presidency is keen to foster a stronger cooperative vision with the Mediterranean Basin. To complement this, however, Italy and G7 countries should promote new patterns for sustainable energy partnerships by addressing, for example, methane emissions of the energy sector in line with the Global Methane Pledge launched at COP26. Think of the capture of fugitive methane emissions along natural gas, LNG, and oil supply chains – recognised by the Turin Ministerial as a quick win in the race to net zero. Similarly, a common definition of Environmental Social Governance (ESG) and transparency criteria with non-G7 countries is a priority to align international emission measurement standards for low and zero-emissions supply chains – on hydrogen, for instance.
With effective cross-regional integration, North African countries could also establish economies of scale in the renewable energy sector and open new revenue streams.[17] Although North Africa leads the continent in new utility-scale wind and solar deployment,[18] renewables are a small share of the regional mix to date, which is still heavily dependent on fossil fuels. Almost all North African countries are looking to invest significantly in renewable energy in the coming years if adequate financing and competitively priced technology are available.
Given the great industrial and economic opportunities of the transition and the African socioeconomic needs, the continent's leaders are questioning what the global energy transition means for them in the medium to longer terms. On the bright side, the continent holds critical raw materials (CRMs) potential, which is fundamental for the development of clean technologies worldwide. Especially when it comes to the downstream aspects of the CRM value chain, however, the investment panorama is poor: relocating parts of the CRM value chains' processing and manufacturing to African countries presents a significant investment challenge, as there is a strong incentive to export raw materials to nations with established processing capabilities and lower governance and infrastructure risks.[19] Against this backdrop, this year's G7 should acknowledge the emerging assertiveness of several African countries in scaling green value chains and not positioning themselves as mere exporters of raw materials that would result in little local value addition. The G7 should provide a space for these conversations to happen and ensure adequate financial and technical support in the longer term for the development of green industries in the continent. This is important for G7 countries too: as they try to decarbonise, they are aiming for less dependence on those holding significant power in the clean-tech supply chains (read: China). Failure to reduce import dependencies along the entire value chain carries the risk of overreliance on single providers, wasting the dramatic lesson of the 2022 energy crisis.
Bringing Africa's sustainable future to fruition is a formidable task, that won't happen overnight. Yet, today's multilateral decisions will determine the blueprint for Africa's energy systems for the coming decades. With a joint G7-Africa interest to collaborate and the clean energy transition irrevocably in motion, new sustainable pathways need to be shaped together more than ever, breaking the investment ceiling for clean technology deployment, and using a just energy transition approach to these shifts.Margherita Bianchi is Head of the Energy, Climate and Resources Programme of the Istituto Affari Internazionali (IAI). This commentary is part of a broader IAI project, "Climate mitigation, energy and food security goals within the Italian G7 Presidency", supported by the European Climate Foundation (ECF).[1] African Union, The African Leaders Nairobi Declaration on Climate Change and Call to Action, 8 September 2023, https://au.int/en/node/43124.[2] African Union, Agenda 2063: The Africa We Want, 2015, https://au.int/Agenda2063/popular_version.[3] In order for the continent to achieve by 2030, in full and on time, all of its energy and climate-related goals, including universal energy access and its Nationally Determined Contributions (NDCs), the International Energy Agency considers around 200 billion dollars annually should be mobilised. See more: International Energy Agency (IEA), Financing Clean Energy in Africa, November 2023, p. 17, https://www.iea.org/reports/financing-clean-energy-in-africa.[4] United Nations, Secretary-General's Remarks at the Paris Summit on a New Global Financing Pact, 22 June 2023, https://www.un.org/sg/en/node/267059.[5] IEA, Financing Clean Energy in Africa, cit., p. 17.[6] "Default-stricken Zambia's Debts Creep Higher", in Reuters, 29 March 2023, https://www.reuters.com/world/africa/default-stricken-zambias-debts-creep-higher-2023-03-29.[7] IDA lending operates on a three-year cycle and offers low interest rates loans to 75 developing nations around the world, half of them in Africa. See more in: World Bank website: IDA Impact in Africa, https://www.worldbank.org/en/region/afr/brief/ida-impact.[8] The New Collective Quantified Goal on Climate Finance (NCQG) is a new global climate finance goal that the Conference of the Parties shall set from a floor of 100 billion US dollars per year, prior to 2025. See more in: UNFCCC website: New Collective Quantified Goal on Climate Finance, https://unfccc.int/NCQG.[9] Beatrice Moro and Pietro Cesaro, "G7 Financial Ministerial: The Critical Role of Transition Plans and the Need for a Systemic Approach to Finance", in ECCO Policy Briefings, May 2024, p. 4, https://eccoclimate.org/?p=8344.[10] Daniele Fattibene and Stefano Manservisi, "The Mattei Plan for Africa: A Turning Point for Italy's Development Cooperation Policy?", in IAI Commentaries, No. 24|10 (March 2023), https://www.iai.it/en/node/18219.[11] G7, Climate, Energy and Environment Ministers' Meeting Communiqué, Turin, 29-30 April 2024, https://www.g7italy.it/wp-content/uploads/G7-Climate-Energy-Environment-Ministerial-Communique_Final.pdf.[12] G7, G7 Finance Ministers and Central Bank Governors' Communiqué, Stresa, 23-25 May 2024, https://www.g7italy.it/wp-content/uploads/Stresa-Communique-25-May-2024.pdf.[13] African Development Bank, COP28: International Support Grows for Channeling IMF Special Drawing Rights through Multilateral Development Banks, 8 December 2023, https://www.afdb.org/en/node/66663.[14] The purpose of this initiative is to strengthen global supply chain diversification of clean energy technologies (that has initiated country roadmaps on Malawi, Zambia, DRC and Burundi). See more in: World Bank, Resilient and Inclusive Supply-Chain Enhancement (RISE), 21 May 2024, https://www.worldbank.org/en/programs/egps/brief/resilient-and-inclusive-supply-chain-enhancement.[15] G7, G7 Finance Ministers and Central Bank Governors' Communiqué, cit., point 45-46.[16] Cassa Depositi e Prestiti et al., G7 Public Development Banks and Development Finance Institutions Statement of Intent. Leveraging the Role of G7 Development Finance in Addressing Global Challenges during the 2024 G7 Italian Presidency, 9 May 2024, https://www.cdp.it/resources/cms/documents/2024_G7_Development_Finance_Statement_of_Intent.pdf.[17] International Renewable Energy Agency (IRENA), North Africa: Policies and Finance for Renewable Energy Deployment, December 2023, https://www.irena.org/Publications/2023/Dec/North-Africa-policies-and-finance-for-renewable-energy.[18] IRENA, North Africa's Renewable Potential and Strategic Location Reinforce Its Role in Energy Transition, 26 February 2024, https://www.irena.org/News/articles/2024/Feb/North-Africa-Renewable-Potential-and-Strategic-Location-Reinforce-Its-Role-in-Energy-Transition.[19] Max Münchmeyer, Strategic Security and Critical Raw Materials: The Role of the European Investment Bank, Rome, IAI, July 2023, https://www.iai.it/en/node/17351.

After several months of significant increase in irregular migration from Tunisia to Europe, European Commission President Ursula von der Leyen and Italian Prime Minister Giorgia Meloni, along with several other European Union leaders, have set their sights on what they seem to believe is the best way to produce immediate results: increasing the provision of cash, equipment and training to the Tunisian security forces (TSF) to diminish the country's booming irregular migration industry.
In the last two months, the European Commission announced it wants to agree to "new anti-smuggling operational partnerships" with Tunisia[1] that would significantly scale up border controls, police and judicial cooperation, as well as cooperation with EU agencies (for example, Frontex). An "International Conference on a global alliance to counter migrant smuggling" was also convened in Brussels on 28 November.[2] As one top EU official in Tunis put it to Refugees International, "There is a strong desire by some in Europe to get the maximum amount of resources possible to the Tunisian government and security forces as soon as possible to stop the boats, now and in the future".[3]
The EU intended strategy, however, appears destined for failure, falling short of its narrow objective of suppressing irregular migration and lacking in the broader – and more important – criteria of adherence to legal commitments, human rights principles and effective overall migration policy. This approach is riddled with four primary deficiencies.Weak state control and oversight of security forces
First and foremost, unlike Turkey, which some EU leaders consider a successful model for preventing irregular migration, Tunisia is a weaker and more divided state that is growing even more fragile due to the increasing authoritarianism by President Kais Saied. Despite the urgent need for financial support to avert bankruptcy, Saied continues to undermine efforts to procure support from the most realistic source of support at scale, the International Monetary Fund.[4] At several points during 2023, Tunisia saw inflation increase to double-digits. Bread, sugar and basic essentials are now scarce and regularly rationed to customers.
At the same time, Saied has repeatedly undermined the stability and capacity of the state since he unilaterally suspended the Parliament in 2021, dismantled local institutions, and used the TSF to clamp down on political opposition and imprison prominent critics.[5] He has systematically degraded the (somewhat weak) judicial independence that existed before his rule,[6] closed the main anti-corruption authority,[7] and cracked down on Tunisian NGOs[8] and press freedom. One year after the 2022–23 parliamentary elections – which saw only 11 per cent of Tunisian voters casting their ballot – the country still does not have a fully active parliament.[9]
Less appreciated – but crucial for the EU's objectives – is the simultaneous weakening of the country's security sector. Already badly divided before Saied's presidency, the security sector appears riven by expanding fragmentation and internal conflicts. One leading Tunisian political analyst observed to Refugees International that the Ministry of Interior (MoI), which controls the Police, National Guard and Coast Guard, is experiencing additional centrifugal breakdown. "The general director of security has changed two times in the last two years, and there have been three MoI heads under [Saied during that time]. The fracturing within the security system has grown".[10]
When it comes to migration policy specifically, Saied's government and the TSF have responded not with professional migration management but with incoherent, ad hoc policies and abusive practices such as the illegal expulsions to desert and border areas of thousands of Black Africans over the 2023 summer. This resulted in dozens of deaths and widespread injury as well as hundreds of migrants remaining stranded with little or no aid. In another reflection of its incoherent and illegal approach, the TSF carried out renewed border expulsions in September 2023[11] while simultaneously bussing other migrants to known human smuggling locales,[12] apparently hoping that the migrants would take to the sea (which many did). In doing so, officials aided the human smuggling industry and publicly demonstrated – especially to European policymakers – that they would periodically "vent pressure" by facilitating embarkations if and when they deemed it necessary.
In this overall context of growing state fragility, poor governance and illegal measures, it is unlikely that the current Tunisian government will be able to effectively allocate a flood of new resources to the security sector while implementing the kinds of oversight and accountability reforms needed to reduce departures and improve humane and orderly migration management. The likelier outcome is the renewed abuse of migrants with little impact on departures to Europe.The corruption–smuggling nexus
This reality is further reinforced by a second obstacle to the EU's aims: more and more elements of the TSF are monetising smuggling operations for their own benefit even as they brutalise migrants. Our investigation conducted between August and October 2023 indicates broad recognition of this amongst Tunisians – the "biggest public secret", as one leading Tunisian academic expert put it. Elements of the TSF have long been involved in, and have profited from, the country's human smuggling industry.[13] Across dozens of interviews, including with ten current and recently retired security officials in southern Tunisia, it is also clear that the substantial profits available from the smuggling industry and weak state control have led to expanded collusion by the TSF as more migrants, refugees and asylum seekers transit and leave Tunisia – and as the Tunisian economy in southern areas shrinks.
While possible links between such collusion and higher-level TSF leadership remain unclear, there has been little evident accountability for such practices within the TSF at any level. Security sweeps targeting smugglers and migrants have yielded only one publicly reported arrest of a security official in the last several months despite the widely described involvement of elements of the TSF and other government officials.[14] This absence of investigation and accountability raises significant questions about how additional cash, hardware and training for the TSF would sustainably dent migration flows, especially since a strong profit motive for collusion will remain. Expanded EU support for migration crackdowns, paired with occasional security surges from the capital of Tunis, will more likely produce only temporary "gains" while building up even greater pressure for new waves of abuses as the government seeks to demonstrate that it has embarkations under control.More people on the move will continue to choose the Tunisia route
The third factor undermining Europe's efforts to deter irregular migration through Tunisia is that, despite the TSF's abusiveness, conditions will very likely remain relatively less dire than in neighbouring Libya or Algeria, where impunity and human rights abuses and risks for migrants are significantly worse. As one migrant from Guinea who arrived in Sfax after the expulsions in early July put it, "At least in Tunisia I can still smell the hint of freedom and rights… And that's enough to go on."[15]
This aspect, as well as Tunisia's convenient geography astride several European islands, is linked to a fourth main factor undercutting the primary focus on irregular migration and human smuggling: the number of people fleeing wars, poverty and instability across Africa won't simply abate given that the underlying conditions prompting more people to migrate are only projected to worsen.[16] The upshot then is that there will continue to be a large number of migrants, refugees and asylum seekers transiting through Tunisia specifically. As in so many other places in the world, the constant demand for smuggling services for dangerous journeys to European shores will very likely be met by an increasingly embedded industry; all the more so as the Tunisian state teeters and more officials submit to corruption.Reimagining EU–Tunisia migration cooperation
The short-term securitisation approach to Tunisia advanced by Team Europe is therefore likely to fail on at least two fronts: both on its own terms by failing to stem irregular migration, and on legal and ethical terms by tying EU support to the inevitability of grave human rights abuses by Tunisian authorities. As has been roundly cited by human rights advocates, the EU Ombudsman and some European officials,[17] the EU's failure to include meaningful oversight and accountability for past and future human rights abuses in Tunisia exposes the EU to further complicity with violence and abuse. This stands in direct contradiction to both EU law and oft-stated European values
If informal migration to Tunisia cannot be significantly deterred by current or planned EU and Tunisian policy, and if onward irregular migration from Tunisia cannot be significantly deterred due to corruption by security forces and general state weakness, what options are left for EU policymakers, especially those who want to prevent complicity in grave abuses of migrants? In the immediate term, the EU must be willing to place firm conditionality on any migration management deal with Tunis, even at the risk of blowing up the deal. This would, at a minimum, include halting the abuse of migrants by the TSF, particularly the practice of summarily detaining and expelling migrants to border areas; investigating and holding accountable TSF elements involved in human smuggling and abuses of migrants; and facilitating a major expansion of emergency aid services for migrants through the Tunisian Red Crescent and Tunisian and international aid organisations.
The present dynamic, however, of obvious EU desperation for a deal gives all negotiating leverage to Saied, to the detriment of securing a deal that could be plausibly humane or effective. In consultations with Refugees International, senior EU officials in Tunis and Brussels expressed deep reluctance to place any meaningful oversight or accountability measures on EU–Tunisia migration cooperation, for fear that Saied would walk away. But if that is the case, the EU has already lost the prospect of a viable deal. The default scenario based on Tunisia's practices to date is that a new deal would do little to address the corruption that is partially enabling the spike in irregular migration, but would strengthen the hand of the security forces that have been responsible for systematic abuses. The EU would achieve little meaningful progress on migration in such a scenario but would face severe reputational exposure.
Taking a harder line with Tunisia would have risks – Saied may walk away from a deal that entailed meaningful accountability for abuses and measures to mitigate collusion with smugglers. But the levels of out-migration may not look all that different in either case. And at least by raising the discussion of accountability and oversight, the EU would have a chance to empower more responsible voices within the Tunisian system who have been appalled by the abuse, corruption and state breakdown witnessed through 2023.
In the longer run, the EU should also reconsider the viability of a deterrence-based migration policy in the Mediterranean. Nearly a decade of deterrence and externalisation policy has merely shifted irregular migration to different points, fed the growth of criminal networks that can monetise the desperation of migrants and made it considerably more dangerous, especially for the tens of thousands who have ultimately drowned.
There is an urgent need for the EU to explore and implement expansive, humanitarian-focused legal migration pathways. This pivotal shift can stand as the most effective and likely primary solution for a sustainable, long-term policy addressing irregular migration.Refugees International (RI) is a US registered 501(c)3 not-for-profit organisation that advocates for lifesaving assistance, human rights and protection for displaced people and promotes solutions to displacement crises. Due to the sensitive nature of our research which involved interviews with security force members as well as disclosing corruption within the security forces themselves, and the expanding crackdown by the Tunisian authorities on critics, the article does not disclose the names of Refugees International consultants, the people interviewed or the authors of the report.[1] "EU Planning New Anti-Migration Deals with Egypt and Tunisia, Unrepentant in Support for Libya", in Statewatch, 16 November 2023, https://www.statewatch.org/news/2023/november/eu-planning-new-anti-migration-deals-with-egypt-and-tunisia-unrepentant-in-support-for-libya.[2] European Commission, Commission Launches a Global Alliance to Counter Migrant Smuggling and Proposes a Strengthened EU Legal Framework, 28 November 2023, https://ec.europa.eu/commission/presscorner/detail/en/IP_23_6081.[3] RI Interview with European Union official in Tunis, 1 September 2023.[4] "Tunisia President Sacks the Economy Minister over Statement about IMF", in Reuters, 17 October 2023, http://reut.rs/46AnLVB.[5] Aaron Y. Zelin, "Saied's Tunisia Is Politicizing Counterterrorism Again", in PolicyWatch, No. 3713 (9 March 2023), https://www.washingtoninstitute.org/policy-analysis/saieds-tunisia-politicizing-counterterrorism-again.[6] Human Rights Watch, Tunisia: President Intensifies Attacks on Judicial Independence, 27 February 2023, https://www.hrw.org/node/384171.[7] "Tunisia: Anti-Corruption Authority Staff Launch Protests", in Middle East Monitor, 10 February 2023, https://www.middleeastmonitor.com/20230210-tunisia-anti-corruption-authority-staff-launch-protests.[8] Rihab Boukhayatia, "Tunisia: Kais Saied Tightens His Grip on Civil Society", in Nawaat, 18 August 2023, https://wp.me/p16NIR-pQI.[9] As a result of the new 2022 constitution, the legislative function is exercised by two chambers: the Assembly of the People's Representatives and the National Council of the Regions. The latter is still to be formed after local elections were held at the end of 2023.[10] Refugees International, Abuse, Corruption, and Accountability: Time to Reassess EU & U.S. Migration Cooperation with Tunisia, 16 November 2023, https://www.refugeesinternational.org/?p=8298.[11] Human Rights Watch, Tunisia: African Migrants Intercepted at Sea, Expelled, 10 October 2023, https://www.hrw.org/node/386154.[12] Monia Ben Hamadi, "Migrants in Tunisia: 'It looks Like They're Pushing Them to Leave' for the Italian Coast", in Le Monde, 19 September 2023, https://www.lemonde.fr/en/le-monde-africa/article/2023/09/19/migrants-in-tunisia-it-looks-like-they-re-pushing-them-to-leave-for-the-italian-coast_6137709_124.html.[13] Refugees International, Abuse, Corruption, and Accountability, cit.[14] "Sfax: Un 'ômda' soupçonné de soutien aux traversées clandestines", in MosaïqueFM, 2 October 2023, https://www.mosaiquefm.net/fr/actualite-regional-tunisie/1195387/sfax-un-omda-soupconne-de-soutien-aux-traversees-clandestines.[15] Refugees International, Abuse, Corruption, and Accountability, cit.[16] Lorena Stella Martini and Tarek Megerisi, "Road to Nowhere: Why Europe's Border Externalisation Is a Dead End", in ECFR Policy Briefs, 14 December 2023, https://ecfr.eu/?p=115665.[17] European Ombudsman, How the European Commission Intends to Guarantee Respect for Human Rights in the Context of the EU-Tunisia Memorandum of Understanding (SI/5/2023/MHZ), 13 September 2023, https://www.ombudsman.europa.eu/en/case/en/64730; Mared Gwyn Jones, "EU Lawmakers Clash over Tunisia Migration Deal, Denounce Lack of Results", in Euronews, 12 September 2023, https://www.euronews.com/my-europe/2023/09/12/eu-lawmakers-clash-over-tunisia-migration-deal-denounce-lack-of-results.

La introducción de especies no nativas invasoras es de gran preocupación en el contexto del cambio global debido a los impactos ambientales y socioeconómicos (por ejemplo, sobre la salud humana, sobre infraestructuras, sobre agricultura y silvicultura) que pueden causar. Para las especies de plantas no nativas, la introducción deliberada de ornamentales es una de las vías de entrada más importantes. En el proceso de intoducción de plantas ornamentales, los valores estéticos y de utilidad son muy relevantes para seleccionar ciertos rasgos, pero también hay características que pueden ser seleccionadas para hacer frente a las condiciones climáticas del área de plantación. Por lo tanto, para evitar la introducción y propagación de las especies ornamentales más dañinas es importante identificar las especies que pueden causar mayores impactos, así como sus rasgos biológicos en relación con las características geográficas y socioeconómicas de las ciudades en que están plantadas. En esta tesis, analizamos los rasgos morfológicos y funcionales asociados con el uso de plantas ornamentales no nativas. También hemos evaluado el potencial invasor de estas especies y los impactos que pueden causar. Con esta información presente, hemos establecido listas para la priorización de especies para el manejo, que tienen como objetivo establecer protocolos para prevenir invasiones biológicas. Las especies del estudio fueron 914 especies de plantas comerciales de 21 grandes viveros, y 474 especies de plantas leñosas de 46 parques y jardines urbanos de España. Como resultado principal de nuestra evaluación, hemos agrupado las especies en seis listas, de la siguiente manera: Listas de Prioridad. Compuestas por ocho especies invasoras reguladas, que no deberían venderse en viveros, cuatro de ellas plantadas de manera irregular en parques urbanos. Destacamos una especie, Ailanthus altissima, debido a que aparece en casi la mitad de los parques y está disponible en el comercio, pero también está regulada como especie invasora tanto por la legislación española como europea. La presencia de estas especies a la venta en viveros o plantadas en parques urbanos indica que la regulación no se está aplicando con la suficiente eficiencia. Listas de Atención. Compuestas por especies invasoras y potencialmente invasoras con alto nivel de causar impactos potenciales, tanto ambientales como socioeconómicos. La lista de atención está compuesta por 68 especies vendidas en viveros y 47 especoes presentes en parques y jardines. Ambas listas de atención —la de los viveros y la de los parques— tienen especies en común, como Robinia pseudoacacia y Eucalyptus globulus, ambas especies con un elevado potencial de invasión. Listas de Vigilancia. Estas listas contienen especies invasoras y potencialmente invasoras con pocos o ningun impacto potencial. Las listas de vigilancia tienen 27 especies en viveros y 12 especies en parques. Ambas tienen especies en común. Listas Verdes. Formadas por especies que no tienen potencial invasor. Solo seis especies han sido identificadas, y solo una especie leñosa, Ficus benjamina, está en la lista verde de parques. El resto de las especies fueron incluidas, ya fuera en Listas de Incertidumbre (es decir, especies cuyo potencial de invasión no pudimos analizar, y que requieren de una revisión adicional una vez que se disponga de mejores datos) o en Listas de Datos Deficientes (es decir, especies para las que no había suficiente información que analizar). Además, para clasificar las especies de las listas de atención y vigilancia, proporcionamos un sistema novedo semicuantitativos denominado "Índice de Prioridad", basado en cuatro factores: los impactos ambientales y socioeconomicos que la especie puede causar, su potencialidad de invasion cuantificada por una evaluación de riesgos de malezas (WRA, por sus siglas en inglés 'Weed Risk Assessment') establecido por primera vez en Australia, y un indicador del interés de la especie para las personas, el valor de tendencia estándar (STV, por sus siglas en inglés 'Standard Trending Value') cuantificado mediante Google Trends. Hemos comprobado que para las especies de viveros, no existe relación entre su estado de invasion (es decir, invasora, naturalizada, subespontánea o aún ausente en la naturaleza) en España y su STV, ni con su puntuación de WRA, ni con la puntuación del Índice de Prioridad. Esto implica que el estado de una especie potencialmente invasora no influye en ninguno de los factores del Índice de Prioridad. Sin embargo, para las especies en los parques, encontramos que las especies con mayor STV tienen una mayor ocurrencia. Este resultado sugiere que la población puede realizar más búsquedas en línea de aquellas plantas que ven con mayor frecuencia en su entorno urbano. Las especies no nativas plantadas en parques urbanos pueden causar gran número de impactos en los ecosistemas naturales. Hemos documentado que la competencia y la modificación de los habitats pueden ser los impactos más comunes, seguido del daño a la salud humana. Cada especie con potencial de causar estos impactos están presentes, de media, en más de siete parques, y desafortunadamente, muchas especies pueden causar varios impactos a la vez. El grupo de impactos más relevante que puede causar una especie no nativa es la competencia, la toxicidad, la alteración de la sucesión natural y los daños en las estructuras del hábitat. También puede haber una alta correlación entre la toxicidad y la alelopatía, la agricultura y los daños a la salud humana. Hemos hallado que los parques con mayores temperaturas en el mes más frío tienen más plantas no nativas con flores conspicuas, lo que está relacionado con la polinización entomófila. Además, los parques con mayor rango de temperaturas anuales tienen menor tolerancia a la sombra y mayores valores de perfil de rusticidad. La rusticidad es un valor que cuantifica la habilidad para sobrevivir a la adversidad climática; menores valores de rusticidad implica supervivencia a menores temperaturas; el perfil de rusticidad de un parque es el valor mediano de la rusticidad de todas las especies de ese parque. Esas correlaciones muestran un posible sesgo de selección en la introducción de especies no nativas basada en sus rasgos, dependiendo de las condiciones climáticas de la ciudad en que han sido introducidas. Es probable que los rasgos de las plantas y los factores climáticos y socioeconómicos asociados con la introducción de las especies de plantas sean diferentes a los que se relacionan con el proceso de invasión. Por tanto, en esta tesis analizamos cómo la proporción de especies no nativas respecto al total de especies, y la proporción de especies establecidas (naturalizadas e invasoras) respecto al total de especies no nativas, se relacionan con las variables climáticas y socioeconómicas, y con los perfiles de rasgos de plantas de los parques. Hemos encontrado una menor proporción de especies no nativas en parques donde el rango mediano de rusticidad de las especies que los componen es mayor. Esto es probablemente debido a un sesgo en la introducción de especies, en el que la estética y otras características son más relevantes que la tolerancia climática. Además, hemos encontrado mayor proporción de especies no nativas en ciudades donde los hogares son mayores —relacionado con grupos familiares— y donde los habitantes sobre el medio ambiente. Sin embargo, el efecto de los grupos familiares es inverso, probablemente debido a la limitada cantidad de información, a una posible percepción positiva de la presencia de especies no nativas, o al hecho de que estas personas carezcan de voz directa en la toma de decisiones. Respecto a la proporción de especies establecidas, encontramos una correlación negativa con el rango de temperatura anual. Esto indica que las especies no nativas plantadas en ambientes poco continentales tienen una mayor propensión a establecerse, y por lo tanto, a invadir. Por lo tanto, se debe tener mucha precaución en los parques ubicados en áreas costeras y valles fluviales. En general, esta tesis destaca las dimensiones multivariantes que actúan cuando la sociedad selecciona especies ornamentales no nativas. Muchas de esas introducciones pueden terminar en invasiones y causar impactos. Esta tesis ha desarrollado una herramienta de base científica para evaluar estos riesgos. Esta herramienta puede ser utilizada por los administradores ambientales para priorizar y seleccionar qué especies de plantas no nativas se pueden plantar como ornamentales sin causar efectos nocivos a la sociedad y a los sistemas naturales ; The introduction of non-native invasive species is of great concern in the context of global change because the environmental and socioeconomic impacts (e.g. on human health, on infrastructures, on agriculture and forestry) they can cause. For non-native plant species, the deliberate introduction of ornamentals is one of the most important pathways of entry. In the process of introduction ornamental plants, aesthetic and utility values are very relevant to select for certain traits, but there are also traits that might be selected to cope with the climatic conditions of the planting area. Therefore, to prevent the introduction and spread of the most harming ornamental species it is important to identify the species that might cause the greatest impacts as well as their biological traits in relation to geographical and socioeconomic characteristics of the towns where they are planted. In this thesis, we have analyzed the morphological and functional traits associated with the use of ornamental non-native plants. We have also assessed the invasive potential of these species and the impacts they might cause. With this information in hand, we have established lists for prioritizate of species for management which aim to establish protocols to prevent biological invasions. The species of study were 914 commercial plant species from 21 large nurseries, and 474 woody plant species from 46 urban parks and gardens in Spain. As the main result of our assessment, we have grouped the species in six lists as follow: Priority lists. Composed by eight invasive regulated species, that should not be sold by nurseries, four of them undudly planted in urban parks. We highlight one species, Ailanthus altissima, because it appears in almost half of the parks and is available in commerce, but is also regulated as invasive species by both the Spanish and European legislation. The presence of these species sold in nurseries or planted in urban parks indicates that the regulation is not being applied efficiently enough. Attention lists. Composed by invasive and potential invasive species with high level of causing potential impacts, both environmental and socioeconomic. The attention list is composed by 68 species sold in nurseries and 47 species present in parks and gardens. Both attention lists —the one of nurseries and the one of parks— have species in common, such as Robinia pseudoacacia and Eucalyptus globulus, both species showing a high potential of invasion. Watch lists. This lists contains invasive and potential invasive species with few or no potential impacts. The watch lists have 27 species in nurseries and 12 species in parks. Both lists have species in common. Green lists. Formed by species with no invasion potential. Only six species in nurseries were identified, and only one woody species, Ficus benjamina, is in the green list of parks. The rest of species where included, either in uncertainty lists (i.e. species whose potential of invasion we were unable to analyze, and which require further review once better data becomes available) or in data deficient lists (i.e. species for which there was not enough information to analyze). Furthermore, to rank species from the attention and watch lists we provide a novel semi-quantitative system named Priority Index, based on four factors: the environmental and socioeconomic impacts the species can cause, their invasive potential quantified by a weed risk assessment (WRA) first stablished in Australia and an indicator of the interest of the species to people, the standard trending value (STV) quantified by Google Trends. We have shown that for nursery species, there is no relation between their invasion status (i.e. invasive, naturalized, casual or are yet not present in the wild) in Spain and STV, nor with the WRA score or the Priority Index score. This implies that the status of a potential invasive species does not influence on any of the factors of the priority index. However, for species in parks we found that species with higher STV have a higher occurrence. This result suggests that population can perform more online searches for those plants that they see most frequently in its urban environment. Non-native species planted in urban parks could cause many impacts in natural ecosystems. We documented that competition and modification of habitats could be the most common potential impacts, followed by harm to human health. Each species with potential to cause these impacts are present on average in more than seven parks and unfortunately many species could cause several impacts at a time. The most relevant cluster of impacts a non-native species can cause is competition, toxicity, alteration of natural succession, and damages on habitat structures. There can also be a high correlation between toxicity and allelopathy with agriculture, and with damages to human health. We found that parks with highest temperatures in the coldest month have more non-native plants with conspicuous flowers, which is related to entomophilic pollination. Moreover, parks with the highest range of annual temperatures have lower tolerance to shadow and higher values of hardiness profile. The hardiness is a value that quantifies the ability to survive to climatic adversity; lower values of hardiness implies survival at lower temperatures; the hardiness profile of a park is the median value of the hardiness of all the plant species of this park. These correlations show possible selection biases in the introduction of non-native species based on their traits depending on the climatic conditions of the town where they have been introduced. The plant traits and the climatic and socioeconomic factors associated with the introduction of plant species are likely to be different to those related to the invasion process. Therefore, in this thesis, we analyzed how the proportion of non-native species respect to the total of species, and the proportion of established (naturalized and invasive) species respect to the total of non-native species, is related to climatic and socioeconomic variables, and to the plant trait profile of the parks. We found lower proportion of non-native species in parks where the median hardiness range of the species that compose them is higher. It is probably due to a bias in the introduction of species, in which aesthetics and other characteristics are more relevant than climatic tolerance. Furthermore, we found higher proportion of non-native species in cities where households are larger —related to family groups— and where inhabitants are older, probably due to the fact that younger people have higher awareness about environment. However, the effect on family groups is the reverse, probably due to the limited amount of information, a positive view of the presence of non-native species, or the fact that these people lack a direct voice in decision-making. Regarding the proportion of established species, we found a negative correlation with the annual temperature range. This indicates that non-native species planted in low continental environments have higher propensity to establish and, therefore, to invade. Therefore, high caution should be taken in parks located in coastal areas and river valleys. Overall, this thesis highlights the multivariate dimensions acting when society select ornamental non-native species. Many of these introduced species could become invasive and cause impacts. The thesis has developed a scientific based tool to assess these risks. This tool can be used by environmental managers to prioritize and select which species on non-native plants can be planted as ornamental without causing harming effects to the society and to natural systems

The infant mortality rate in Ukraine has been progressively decreasing over the past decade, but remains very high compared with the countries of the European Union. The mortality rate of infants in the first year of life in Ukraine is 2.5–3 times higher than in the EU countries, while the mortality rate of newborns during the first month of life exceeds the average European level by 6.6 times. This indicates a significant backlog of our country in the implementation of modern standards of medical care for both pregnant women and newborns using modern diagnostic and treatment methodologies.One of the most effective way that allowed to reduce significantly infant mortality and disability rates in the developed countries of the world proved to be introduction of expanded newborn screening as a tool of early detection of wide spectrum of inherited metabolic disorders (IMD) – orphan diseases caused by genetic defects of particular enzymes leading to alterations in specific metabolic pathways. As a rule, IMDs occurrence cannot be established during medical examination of newborns due to the absence of clinical symptoms. Therefore, IMDs are diagnosed in two ways: (i) with clinical manifestation in the form of "neonatal catastrophes" and/or sudden infant death syndrome, (ii) according to the results of a biochemical examination of the blood of all (asymptomatic) newborns (i.e. screening). Delays or errors in the diagnosis of these diseases often lead to irreversible damage of many organs, first of all, the brain (neurological deficits, mental retardation, oligophrenia). Newborn screening – measurement in dried blood spots, sampled in asymptomatic newborns, concentrations of a specific set of substances which characterize key processes of protein, carbohydrate and lipid metabolism as a tool of early IMDs identification and prompt treatment initiation of affected children to prevent metabolic decompensation episodes and disability development was started in the 1960s in the United States with just one disease – phenylketonuria.By now, newborn screening programs have been implemented in more than 50 countries of the world and provide diagnostics of more than 45 IMDs. A significant (8–10 times) expanding the spectrum of IMDs that can be detected upon examination of dried blood spots on filter paper has been achieved by application of a high-throughput quantitative bioanalysis method – tandem mass spectrometry (TMS) in the late 1990s. Unlike routinely applied immunofluorimetric method allowing to measure just one biochemical agent in one blood sample, TMS allowed to analyze concentrations of several dozen substances in one dried blood spot.Currently, in Ukraine newborn screening is carried out for 4 diseases: phenylketonuria, congenital hypothyroidism, congenital adrenal hyperplasia, and cystic fibrosis using the low-throughput immunofluorimetric method. In some cases, expanded newborn screening using TMS method is performed on a commercial basis in foreign laboratories. At the same time, according to the Law of Ukraine No. 2461 "On ensuring the prevention and treatment of rare diseases" dated April 15, 2014, and the Orders of the Ministry of Health of Ukraine No. 778 dated 10.27.2014, No. 919 dated December 30, 2015, and No. 731 dated June 29, 2017, "The list of rare (orphan) diseases, that lead to a reduction of patient's lifespan or their disability, and for these diseases there are well-established methods of treatment" comprises more than 60 inherited metabolic disorders.This indicates a significant backlog of our country in the issue of not only ethical and medical significance, but great social and economic importance.The key issue of the expanded newborn screening implementation using high-throughput and accurate TMS method in Ukraine is the absence of modern analytical instruments and supplementary equipment in the state medico-genetic laboratories, as well as analysts with sufficient level of training. TMS is a technically complex method based on application of expensive vacuum and chromatographic equipment, special software, isotopic labeling reagents, high-purity gases, instruments maintenance with the aid of foreign experts, as well as qualified lab staff.Such private clinical diagnostic laboratory, where TMS-measurements are performed routinely at site and biomaterials are not transferred abroad exists in Ukraine. This laboratory is capable to perform the full range of measurements at the initial stage of newborn screening (TMS-analysis) and the secondary confirmatory testing using gas-chromatography/mass-spectrometry (GC/MS) and high performance liquid chromatography (HPLC) methods, as well as enzymes activity assessment and molecular-genetic studies. On the basis of reached agreement in September 2017 it was started the development of the Program of improving the diagnostics of inherited metabolic diseases in newborns and older children in Ukraine. This Program has been initiated by the National Academy of Medical Sciences of Ukraine with the participation of "Association of Pediatricians of Ukraine" and "Association of Neonatologists of Ukraine", as well as membership of the "Institute of Pediatrics, Obstetrics and Gynecology named after academician O.M. Lukyanova of NAMS of Ukraine", medical universities and regional health-care providers.The purpose of the Program is to expand up to 29 the list of inherited metabolic disorders to be diagnosed in newborns and older children that allows early start of treatment and follow-up of affected patients. Wide implementation of the Program allows reducing the levels of neonatal, infant and child mortality and disability.The Program is based on the following principles: (i) a clear distribution of the responsibilities between participants considering newborn screening procedures and processes; (ii) implementation of electronic document management system to register transferring of biomaterial from the moment of sampling to presentation of laboratory measurement results, it's expert evaluation and medical recommendations for further actions; (iii) documented customer feedback to report the results and it's expert evaluation; (iv) creation of the database for calculating the threshold concentrations of biochemical markers and its' ratios (cut-off) for the Ukrainian population in order to reduce the number of false-negative and false-positive results.Financing of the Program have relied on funding of regional budgets, extra-budgetary funds and own funds of parents.The implementation of the preparatory phase of the Program was launched in Spring, 2018. The launch of the pilot part of the Program in 5 regions: Kiev, Kiev Region, Lugansk and Donetsk Regions, and the city Chernivtsi is scheduled for April 2019. The program is planned to be expanded throughout Ukraine at the end of 2020. ; Уровень детской смертности в Украине прогрессивно снижается в течение последнего десятилетия, но остается очень высоким по сравнению со странами Европейского Союза. Показатель смертности младенцев первого года жизни в Украине в 2,5-3 раза выше, чем в странах ЕС, при этом уровень смертности новорожденных в течение первого месяца жизни превышает среднеевропейский в 6,6 раз. Это свидетельствует о существенном отставании нашей страны во внедрении современных стандартов оказания медицинской помощи, как беременным женщинам, так и новорожденным с использованием современных методологий диагностики и лечения.Одним из наиболее эффективных направлений деятельности, которая обеспечила существенное снижение уровня детской смертности и инвалидности в развитых странах мира, стало внедрение расширенного массового скрининга новорожденных с целью выявления наследственных болезней обмена веществ (НБО) – орфанных заболеваний, которые возникают вследствие генетических дефектов ферментов. Наличие НБО, как правило, не удается установить при врачебном осмотре новорожденных из-за отсутствия клинических симптомов. Диагностируют НБО двумя способами: (i) по клиническим проявлениям в форме «катастроф неонатального периода» и синдрома внезапной смерти младенцев, (ii) по результатам биохимического обследования крови новорожденных (скрининга). Задержка или ошибки в диагностике этих заболеваний часто приводят к необратимым повреждениям многих органов и, в первую очередь, головного мозга (неврологические нарушения, психическое регресс, слабоумие).Неонатальный скрининг – измерение в крови новорожденных концентраций определенного набора веществ, характеризующих ключевые процессы белкового, углеводного и липидного обмена с целью раннего выявления и начала лечения детей с НБО и предотвращения их инвалидизации было начато в 60-х годах прошлого века в США с одной болезни – фенилкетонурии. Сегодня программы неонатального скрининга внедрены более, чем в 50 странах мира и обеспечивают диагностику более 45 НБО. Значительное (в 8-10 раз) расширение количества НБО, которые могут быть обнаружены при исследовании высушенных на фильтровальной бумаге пятен крови, стало возможным благодаря внедрению высокопроизводительного метода тандемной масс-спектрометрии (ТМС) в конце 90-х годов прошлого века. В отличие от иммунофлуориметрического метода, который позволяет определять один показатель в одной пробе крови, ТМС позволяет измерять концентрации нескольких десятков веществ в одной пробе крови.В настоящее время в Украине скрининг новорожденных ведется по 4-м заболеваниям: фенилкетонурии, врожденному гипотиреозу, адреногенитальному синдрому и муковисцидозу с использованием низкопродуктивного иммунофлуориметрического метода. В отдельных случаях расширенный скрининг новорожденных с использованием метода ТМС выполняется на коммерческой основе в зарубежных лабораториях. При этом, согласно Закону Украины № 2461 «Об обеспечении профилактики и лечения редких заболеваний» от 15.04.2014, и Приказов МОЗ Украины № 778 от 27.10.2014, № 919 от 30.12.2015 и № 731 от 29.06.2017, «Перечень редких (орфанных) заболеваний, приводящих к сокращению продолжительности жизни больных или их инвалидизации и для которых существуют признанные методы лечения» включает более 60 наследственных болезней обмена веществ. Это свидетельствует о значительном отставании нашей страны в вопросе, который, кроме этического и медицинского, имеет важное социальное и экономическое значение.Ключевым вопросом внедрения расширенного скрининга новорожденных с использованием высокопроизводительного и точного метода ТМС в Украине является отсутствие в государственных медико-генетических лабораториях современного аналитического оборудования и вспомогательной инфраструктуры, а также специалистов-аналитиков с достаточным уровнем подготовки. ТМС – технически сложный метод, требующий использования дорогостоящего вакуумного и хроматографического оборудования, специального программного обеспечения, реагентов с изотопными метками, высокочистых газов, сервисного обслуживания с привлечением иностранных специалистов, а также квалифицированного персонала.Учитывая наличие частной клинико-диагностической лаборатории, выполняющей ТМС-анализы в Украине, а не транспортирующей биоматериал в зарубежные лаборатории, способной выполнять весь комплекс исследований первого (массового) этапа скрининга, а также уточняющую диагностику НБО с использованием методов газовой хроматографии/масс-спектрометрии, высокоэффективной жидкостной хроматографии, определение активности ферментов и молекулярно-генетические исследования, в сентябре 2017 была начата разработка Программы усовершенствования диагностики наследственных болезней обмена веществ у новорожденных и детей старшего возраста в Украине. Инициаторами этой Программы являются Национальная академия медицинских наук Украины, ВОО «Ассоциация педиатров Украины», ВОО «Ассоциация неонатологов Украины», ГУ «ИПАГ имени академика О.М. Лукьяновой НАМН Украины», медицинские университеты и региональные лечебно-профилактические учреждения.Цель Программы – расширение до 29 нозологий перечня наследственных болезней обмена веществ, диагностируемых у новорожденных и детей старшего возраста, обеспечение своевременного медицинского сопровождения и лечения выявленных больных, что позволит снизить уровень неонатальной, младенческой и детской смертности и инвалидности. Программа базируется на следующих принципах: (i) четкое распределение сфер ответственности исполнителей, регламентированных рабочими процессами и процедурами скрининга; (ii) электронный документооборот с фиксацией движения биоматериала от момента отбора до выдачи результатов лабораторных измерений, документирование результатов их экспертной оценки и принятого решения относительно дальнейших действий; (iii) документированная обратная связь с заказчиком исследований с целью сообщения результатов и их экспертной оценки; (iv) создание информационной базы данных для расчета предельных уровней концентраций маркерных соединений (cut-off) для украинской популяции с целью снижения количества ложноотрицательных и ложноположительных результатов.Финансирование Программы планируется осуществлять за счет средств региональных бюджетов, внебюджетных фондов, собственных средств родителей.Выполнение подготовительного этапа Программы было начато весной 2018 года. Запуск пилотной части Программы в 5 регионах: Киев, Киевская область, Луганская и Донецкая области и г. Черновцы, - запланирован в апреле 2019. Расширение Программы по всей территории Украины планируется завершить в конце 2020 года. ; Рівень дитячої смертності в Україні прогресивно знижується протягом останнього десятиріччя, але лишається дуже високим у порівнянні з країнами Європейського Союзу. Показник смертності немовлят першого року життя в Україні у 2,5-3 рази вищий, ніж у країнах ЄС, при цьому рівень смертності новонароджених протягом першого місяця життя перевищує середньоєвропейський у 6,6 разів. Це свідчить про суттєве відставання нашої країни у впровадженні сучасних стандартів надання медичної допомоги як вагітним жінкам, так і новонародженим з використанням сучасних методологій діагностики та лікування.Одним з найбільш ефективних напрямків діяльності, яка забезпечила суттєве зниження рівня дитячої смертності та інвалідності у розвинутих країнах світу стало впровадження розширеного масового скринінгу новонароджених з метою виявлення спадкових хвороб обміну речовин (СХОР) – орфанних захворювань, які виникають внаслідок генетичних дефектів ферментів. Наявність СХОР, зазвичай, не вдається встановити при лікарському огляді новонароджених через відсутність клінічних симптомів. Діагностують СХОР двома способами: (і) по клінічним проявам у формі «катастроф неонатального періоду» та синдрому раптової смерті немовлят, (іі) по результатам біохімічного обстеження крові новонароджених (скринінгу). Затримка або помилки в діагностиці цих захворювань часто призводять до незворотних пошкоджень багатьох органів і, в першу чергу, головного мозку (неврологічні порушення, психічний регрес, слабоумство).Неонатальний скринінг – вимірювання у крові новонароджених концентрацій певного набору речовин, які характеризують ключові процеси білкового, вуглеводного та ліпідного обміну з метою раннього виявлення і початку лікування дітей зі СХОР та запобігання їх інвалідизації було розпочато у 60-х роках минулого століття у США з однієї хвороби – фенілкетонурії. Сьогодні програми неонатального скринінгу впроваджені більш, ніж в 50 країнах світу та забезпечують діагностику понад 45 СХОР. Значне (у 8-10 разів) розширення кількості СХОР, що можуть бути виявлені при дослідженні висушених на фільтрувальному папері плям крові, стало можливим завдяки впровадженню високопродуктивного методу тандемної мас-спектрометрії (ТМС) наприкінці 90-х років минулого століття. На відміну від імунофлюорометричного методу, який дозволяє визначати один показник в одній пробі крові, ТМС дозволяє вимірювати концентрації декількох десятків речовин в одній пробі крові.На теперішній час в Україні скринінг новонароджених впроваджено лише для 4 захворювань: фенілкетонурії, вродженого гіпотиреозу, адреногенітального синдрому та муковісцидозу, який проводиться з використанням низькопродуктивного імунофлюорометричного методу. В окремих випадках розширений скринінг новонароджених з використанням методу ТМС виконується на комерційній основі в зарубіжних лабораторіях. При цьому, згідно з Законом України № 2461 «Про забезпечення профілактики та лікування рідкісних захворювань» від 15.04.2014 та Наказами МОЗУ № 778 від 27.10.2014, № 919 від 30.12.2015 та № 731 від 29.06.2017, «Перелік рідкісних (орфанних) захворювань, що призводять до скорочення тривалості життя хворих або їх інвалідизації та для яких існують визнані методи лікування» включає більше, ніж 60 спадкових хвороб обміну речовин. Це свідчить про значне відставання нашої країни в питанні, яке, крім етичного та медичного, має важливе соціальне та економічне значення.Ключовим питанням впровадження розширеного скринінгу новонароджених з використанням високопродуктивного і точного методу ТМС в Україні є відсутність у державних медико-генетичних лабораторіях сучасного аналітичного обладнання та допоміжної інфраструктури, а також фахівців-аналітиків з певним рівнем підготовки. ТМС – технічно складний метод, який вимагає використання коштовного вакуумного та хроматографічного обладнання, спеціального програмного забезпечення, реагентів з ізотопними мітками, високочистих газів, сервісного обслуговування з залученням закордонних фахівців, а також кваліфікованого персоналу.З огляду на наявність приватної клініко-діагностичної лабораторії, яка виконує ТМС-аналізи в Україні, а не транспортує біоматеріал в закордонні лабораторії та здатна виконувати весь комплекс досліджень першого (масового) етапу скринінгу, а також уточнюючу діагностику СХОР з використанням методів газової хроматографії/мас-спектрометрії, високоефективної рідинної хроматографії, визначення активності ферментів та молекулярно-генетичні дослідження, у вересні 2017 р. було розпочато розробку Програми удосконалення діагностики спадкових хвороб обміну речовин у новонароджених і дітей старшого віку в Україні. Ініціаторами цієї Програми є Національна академія медичних наук України, ВГО «Асоціація педіатрів України», ВГО «Асоціація неонатологів України», ДУ «ІПАГ імені академіка О.М. Лук'янової НАМН України», медичні університети та регіональні лікувально-профілактичні заклади.Мета Програми – розширення до 29 нозологій переліку спадкових хвороб обміну речовин, які виявляються у новонароджених та дітей старшого віку, забезпечення своєчасного медичного супроводу та лікування виявлених хворих, що дозволить знизити рівень неонатальної, малюкової й дитячої смертності та інвалідності. Програма базується на наступних принципах: (і) чіткий розподіл відповідальності виконавців, регламентований робочими процесами та процедурами скринінгу; (іі) електронний документообіг з фіксацією руху біоматеріалу від моменту відбору до видачі результатів лабораторних визначень, документування результатів їх експертної оцінки та прийнятого рішення стосовно подальших дій; (ііі) документований зворотній зв'язок з замовником досліджень з повідомленням результатів та їх експертної оцінки; (iv) створення інформаційної бази даних для розрахунку граничних рівнів концентрацій маркерних сполук (cut-off) для української популяції з метою зниження кількості хибно-негативних та хибно-позитивних визначень.Фінансування Програми планується здійснювати за рахунок коштів регіональних бюджетів, позабюджетних фондів, власних коштів батьків.Виконання підготовчого етапу Програми було розпочато на весні 2018 року. Запуск пілотної частини Програми у 5 регіонах: м. Київ, Київська область, Луганська та Донецька області та м. Чернівці, – запланований у квітні 2019 р. Розширення Програми по всій території України планується завершити наприкінці 2020 року.

The infant mortality rate in Ukraine has been progressively decreasing over the past decade, but remains very high compared with the countries of the European Union. The mortality rate of infants in the first year of life in Ukraine is 2.5–3 times higher than in the EU countries, while the mortality rate of newborns during the first month of life exceeds the average European level by 6.6 times. This indicates a significant backlog of our country in the implementation of modern standards of medical care for both pregnant women and newborns using modern diagnostic and treatment methodologies.One of the most effective way that allowed to reduce significantly infant mortality and disability rates in the developed countries of the world proved to be introduction of expanded newborn screening as a tool of early detection of wide spectrum of inherited metabolic disorders (IMD) – orphan diseases caused by genetic defects of particular enzymes leading to alterations in specific metabolic pathways. As a rule, IMDs occurrence cannot be established during medical examination of newborns due to the absence of clinical symptoms. Therefore, IMDs are diagnosed in two ways: (i) with clinical manifestation in the form of "neonatal catastrophes" and/or sudden infant death syndrome, (ii) according to the results of a biochemical examination of the blood of all (asymptomatic) newborns (i.e. screening). Delays or errors in the diagnosis of these diseases often lead to irreversible damage of many organs, first of all, the brain (neurological deficits, mental retardation, oligophrenia). Newborn screening – measurement in dried blood spots, sampled in asymptomatic newborns, concentrations of a specific set of substances which characterize key processes of protein, carbohydrate and lipid metabolism as a tool of early IMDs identification and prompt treatment initiation of affected children to prevent metabolic decompensation episodes and disability development was started in the 1960s in the United States with just one disease – phenylketonuria.By now, newborn screening programs have been implemented in more than 50 countries of the world and provide diagnostics of more than 45 IMDs. A significant (8–10 times) expanding the spectrum of IMDs that can be detected upon examination of dried blood spots on filter paper has been achieved by application of a high-throughput quantitative bioanalysis method – tandem mass spectrometry (TMS) in the late 1990s. Unlike routinely applied immunofluorimetric method allowing to measure just one biochemical agent in one blood sample, TMS allowed to analyze concentrations of several dozen substances in one dried blood spot.Currently, in Ukraine newborn screening is carried out for 4 diseases: phenylketonuria, congenital hypothyroidism, congenital adrenal hyperplasia, and cystic fibrosis using the low-throughput immunofluorimetric method. In some cases, expanded newborn screening using TMS method is performed on a commercial basis in foreign laboratories. At the same time, according to the Law of Ukraine No. 2461 "On ensuring the prevention and treatment of rare diseases" dated April 15, 2014, and the Orders of the Ministry of Health of Ukraine No. 778 dated 10.27.2014, No. 919 dated December 30, 2015, and No. 731 dated June 29, 2017, "The list of rare (orphan) diseases, that lead to a reduction of patient's lifespan or their disability, and for these diseases there are well-established methods of treatment" comprises more than 60 inherited metabolic disorders.This indicates a significant backlog of our country in the issue of not only ethical and medical significance, but great social and economic importance.The key issue of the expanded newborn screening implementation using high-throughput and accurate TMS method in Ukraine is the absence of modern analytical instruments and supplementary equipment in the state medico-genetic laboratories, as well as analysts with sufficient level of training. TMS is a technically complex method based on application of expensive vacuum and chromatographic equipment, special software, isotopic labeling reagents, high-purity gases, instruments maintenance with the aid of foreign experts, as well as qualified lab staff.Such private clinical diagnostic laboratory, where TMS-measurements are performed routinely at site and biomaterials are not transferred abroad exists in Ukraine. This laboratory is capable to perform the full range of measurements at the initial stage of newborn screening (TMS-analysis) and the secondary confirmatory testing using gas-chromatography/mass-spectrometry (GC/MS) and high performance liquid chromatography (HPLC) methods, as well as enzymes activity assessment and molecular-genetic studies. On the basis of reached agreement in September 2017 it was started the development of the Program of improving the diagnostics of inherited metabolic diseases in newborns and older children in Ukraine. This Program has been initiated by the National Academy of Medical Sciences of Ukraine with the participation of "Association of Pediatricians of Ukraine" and "Association of Neonatologists of Ukraine", as well as membership of the "Institute of Pediatrics, Obstetrics and Gynecology named after academician O.M. Lukyanova of NAMS of Ukraine", medical universities and regional health-care providers.The purpose of the Program is to expand up to 29 the list of inherited metabolic disorders to be diagnosed in newborns and older children that allows early start of treatment and follow-up of affected patients. Wide implementation of the Program allows reducing the levels of neonatal, infant and child mortality and disability.The Program is based on the following principles: (i) a clear distribution of the responsibilities between participants considering newborn screening procedures and processes; (ii) implementation of electronic document management system to register transferring of biomaterial from the moment of sampling to presentation of laboratory measurement results, it's expert evaluation and medical recommendations for further actions; (iii) documented customer feedback to report the results and it's expert evaluation; (iv) creation of the database for calculating the threshold concentrations of biochemical markers and its' ratios (cut-off) for the Ukrainian population in order to reduce the number of false-negative and false-positive results.Financing of the Program have relied on funding of regional budgets, extra-budgetary funds and own funds of parents.The implementation of the preparatory phase of the Program was launched in Spring, 2018. The launch of the pilot part of the Program in 5 regions: Kiev, Kiev Region, Lugansk and Donetsk Regions, and the city Chernivtsi is scheduled for April 2019. The program is planned to be expanded throughout Ukraine at the end of 2020. ; Уровень детской смертности в Украине прогрессивно снижается в течение последнего десятилетия, но остается очень высоким по сравнению со странами Европейского Союза. Показатель смертности младенцев первого года жизни в Украине в 2,5-3 раза выше, чем в странах ЕС, при этом уровень смертности новорожденных в течение первого месяца жизни превышает среднеевропейский в 6,6 раз. Это свидетельствует о существенном отставании нашей страны во внедрении современных стандартов оказания медицинской помощи, как беременным женщинам, так и новорожденным с использованием современных методологий диагностики и лечения.Одним из наиболее эффективных направлений деятельности, которая обеспечила существенное снижение уровня детской смертности и инвалидности в развитых странах мира, стало внедрение расширенного массового скрининга новорожденных с целью выявления наследственных болезней обмена веществ (НБО) – орфанных заболеваний, которые возникают вследствие генетических дефектов ферментов. Наличие НБО, как правило, не удается установить при врачебном осмотре новорожденных из-за отсутствия клинических симптомов. Диагностируют НБО двумя способами: (i) по клиническим проявлениям в форме «катастроф неонатального периода» и синдрома внезапной смерти младенцев, (ii) по результатам биохимического обследования крови новорожденных (скрининга). Задержка или ошибки в диагностике этих заболеваний часто приводят к необратимым повреждениям многих органов и, в первую очередь, головного мозга (неврологические нарушения, психическое регресс, слабоумие).Неонатальный скрининг – измерение в крови новорожденных концентраций определенного набора веществ, характеризующих ключевые процессы белкового, углеводного и липидного обмена с целью раннего выявления и начала лечения детей с НБО и предотвращения их инвалидизации было начато в 60-х годах прошлого века в США с одной болезни – фенилкетонурии. Сегодня программы неонатального скрининга внедрены более, чем в 50 странах мира и обеспечивают диагностику более 45 НБО. Значительное (в 8-10 раз) расширение количества НБО, которые могут быть обнаружены при исследовании высушенных на фильтровальной бумаге пятен крови, стало возможным благодаря внедрению высокопроизводительного метода тандемной масс-спектрометрии (ТМС) в конце 90-х годов прошлого века. В отличие от иммунофлуориметрического метода, который позволяет определять один показатель в одной пробе крови, ТМС позволяет измерять концентрации нескольких десятков веществ в одной пробе крови.В настоящее время в Украине скрининг новорожденных ведется по 4-м заболеваниям: фенилкетонурии, врожденному гипотиреозу, адреногенитальному синдрому и муковисцидозу с использованием низкопродуктивного иммунофлуориметрического метода. В отдельных случаях расширенный скрининг новорожденных с использованием метода ТМС выполняется на коммерческой основе в зарубежных лабораториях. При этом, согласно Закону Украины № 2461 «Об обеспечении профилактики и лечения редких заболеваний» от 15.04.2014, и Приказов МОЗ Украины № 778 от 27.10.2014, № 919 от 30.12.2015 и № 731 от 29.06.2017, «Перечень редких (орфанных) заболеваний, приводящих к сокращению продолжительности жизни больных или их инвалидизации и для которых существуют признанные методы лечения» включает более 60 наследственных болезней обмена веществ. Это свидетельствует о значительном отставании нашей страны в вопросе, который, кроме этического и медицинского, имеет важное социальное и экономическое значение.Ключевым вопросом внедрения расширенного скрининга новорожденных с использованием высокопроизводительного и точного метода ТМС в Украине является отсутствие в государственных медико-генетических лабораториях современного аналитического оборудования и вспомогательной инфраструктуры, а также специалистов-аналитиков с достаточным уровнем подготовки. ТМС – технически сложный метод, требующий использования дорогостоящего вакуумного и хроматографического оборудования, специального программного обеспечения, реагентов с изотопными метками, высокочистых газов, сервисного обслуживания с привлечением иностранных специалистов, а также квалифицированного персонала.Учитывая наличие частной клинико-диагностической лаборатории, выполняющей ТМС-анализы в Украине, а не транспортирующей биоматериал в зарубежные лаборатории, способной выполнять весь комплекс исследований первого (массового) этапа скрининга, а также уточняющую диагностику НБО с использованием методов газовой хроматографии/масс-спектрометрии, высокоэффективной жидкостной хроматографии, определение активности ферментов и молекулярно-генетические исследования, в сентябре 2017 была начата разработка Программы усовершенствования диагностики наследственных болезней обмена веществ у новорожденных и детей старшего возраста в Украине. Инициаторами этой Программы являются Национальная академия медицинских наук Украины, ВОО «Ассоциация педиатров Украины», ВОО «Ассоциация неонатологов Украины», ГУ «ИПАГ имени академика О.М. Лукьяновой НАМН Украины», медицинские университеты и региональные лечебно-профилактические учреждения.Цель Программы – расширение до 29 нозологий перечня наследственных болезней обмена веществ, диагностируемых у новорожденных и детей старшего возраста, обеспечение своевременного медицинского сопровождения и лечения выявленных больных, что позволит снизить уровень неонатальной, младенческой и детской смертности и инвалидности. Программа базируется на следующих принципах: (i) четкое распределение сфер ответственности исполнителей, регламентированных рабочими процессами и процедурами скрининга; (ii) электронный документооборот с фиксацией движения биоматериала от момента отбора до выдачи результатов лабораторных измерений, документирование результатов их экспертной оценки и принятого решения относительно дальнейших действий; (iii) документированная обратная связь с заказчиком исследований с целью сообщения результатов и их экспертной оценки; (iv) создание информационной базы данных для расчета предельных уровней концентраций маркерных соединений (cut-off) для украинской популяции с целью снижения количества ложноотрицательных и ложноположительных результатов.Финансирование Программы планируется осуществлять за счет средств региональных бюджетов, внебюджетных фондов, собственных средств родителей.Выполнение подготовительного этапа Программы было начато весной 2018 года. Запуск пилотной части Программы в 5 регионах: Киев, Киевская область, Луганская и Донецкая области и г. Черновцы, - запланирован в апреле 2019. Расширение Программы по всей территории Украины планируется завершить в конце 2020 года. ; Рівень дитячої смертності в Україні прогресивно знижується протягом останнього десятиріччя, але лишається дуже високим у порівнянні з країнами Європейського Союзу. Показник смертності немовлят першого року життя в Україні у 2,5-3 рази вищий, ніж у країнах ЄС, при цьому рівень смертності новонароджених протягом першого місяця життя перевищує середньоєвропейський у 6,6 разів. Це свідчить про суттєве відставання нашої країни у впровадженні сучасних стандартів надання медичної допомоги як вагітним жінкам, так і новонародженим з використанням сучасних методологій діагностики та лікування.Одним з найбільш ефективних напрямків діяльності, яка забезпечила суттєве зниження рівня дитячої смертності та інвалідності у розвинутих країнах світу стало впровадження розширеного масового скринінгу новонароджених з метою виявлення спадкових хвороб обміну речовин (СХОР) – орфанних захворювань, які виникають внаслідок генетичних дефектів ферментів. Наявність СХОР, зазвичай, не вдається встановити при лікарському огляді новонароджених через відсутність клінічних симптомів. Діагностують СХОР двома способами: (і) по клінічним проявам у формі «катастроф неонатального періоду» та синдрому раптової смерті немовлят, (іі) по результатам біохімічного обстеження крові новонароджених (скринінгу). Затримка або помилки в діагностиці цих захворювань часто призводять до незворотних пошкоджень багатьох органів і, в першу чергу, головного мозку (неврологічні порушення, психічний регрес, слабоумство).Неонатальний скринінг – вимірювання у крові новонароджених концентрацій певного набору речовин, які характеризують ключові процеси білкового, вуглеводного та ліпідного обміну з метою раннього виявлення і початку лікування дітей зі СХОР та запобігання їх інвалідизації було розпочато у 60-х роках минулого століття у США з однієї хвороби – фенілкетонурії. Сьогодні програми неонатального скринінгу впроваджені більш, ніж в 50 країнах світу та забезпечують діагностику понад 45 СХОР. Значне (у 8-10 разів) розширення кількості СХОР, що можуть бути виявлені при дослідженні висушених на фільтрувальному папері плям крові, стало можливим завдяки впровадженню високопродуктивного методу тандемної мас-спектрометрії (ТМС) наприкінці 90-х років минулого століття. На відміну від імунофлюорометричного методу, який дозволяє визначати один показник в одній пробі крові, ТМС дозволяє вимірювати концентрації декількох десятків речовин в одній пробі крові.На теперішній час в Україні скринінг новонароджених впроваджено лише для 4 захворювань: фенілкетонурії, вродженого гіпотиреозу, адреногенітального синдрому та муковісцидозу, який проводиться з використанням низькопродуктивного імунофлюорометричного методу. В окремих випадках розширений скринінг новонароджених з використанням методу ТМС виконується на комерційній основі в зарубіжних лабораторіях. При цьому, згідно з Законом України № 2461 «Про забезпечення профілактики та лікування рідкісних захворювань» від 15.04.2014 та Наказами МОЗУ № 778 від 27.10.2014, № 919 від 30.12.2015 та № 731 від 29.06.2017, «Перелік рідкісних (орфанних) захворювань, що призводять до скорочення тривалості життя хворих або їх інвалідизації та для яких існують визнані методи лікування» включає більше, ніж 60 спадкових хвороб обміну речовин. Це свідчить про значне відставання нашої країни в питанні, яке, крім етичного та медичного, має важливе соціальне та економічне значення.Ключовим питанням впровадження розширеного скринінгу новонароджених з використанням високопродуктивного і точного методу ТМС в Україні є відсутність у державних медико-генетичних лабораторіях сучасного аналітичного обладнання та допоміжної інфраструктури, а також фахівців-аналітиків з певним рівнем підготовки. ТМС – технічно складний метод, який вимагає використання коштовного вакуумного та хроматографічного обладнання, спеціального програмного забезпечення, реагентів з ізотопними мітками, високочистих газів, сервісного обслуговування з залученням закордонних фахівців, а також кваліфікованого персоналу.З огляду на наявність приватної клініко-діагностичної лабораторії, яка виконує ТМС-аналізи в Україні, а не транспортує біоматеріал в закордонні лабораторії та здатна виконувати весь комплекс досліджень першого (масового) етапу скринінгу, а також уточнюючу діагностику СХОР з використанням методів газової хроматографії/мас-спектрометрії, високоефективної рідинної хроматографії, визначення активності ферментів та молекулярно-генетичні дослідження, у вересні 2017 р. було розпочато розробку Програми удосконалення діагностики спадкових хвороб обміну речовин у новонароджених і дітей старшого віку в Україні. Ініціаторами цієї Програми є Національна академія медичних наук України, ВГО «Асоціація педіатрів України», ВГО «Асоціація неонатологів України», ДУ «ІПАГ імені академіка О.М. Лук'янової НАМН України», медичні університети та регіональні лікувально-профілактичні заклади.Мета Програми – розширення до 29 нозологій переліку спадкових хвороб обміну речовин, які виявляються у новонароджених та дітей старшого віку, забезпечення своєчасного медичного супроводу та лікування виявлених хворих, що дозволить знизити рівень неонатальної, малюкової й дитячої смертності та інвалідності. Програма базується на наступних принципах: (і) чіткий розподіл відповідальності виконавців, регламентований робочими процесами та процедурами скринінгу; (іі) електронний документообіг з фіксацією руху біоматеріалу від моменту відбору до видачі результатів лабораторних визначень, документування результатів їх експертної оцінки та прийнятого рішення стосовно подальших дій; (ііі) документований зворотній зв'язок з замовником досліджень з повідомленням результатів та їх експертної оцінки; (iv) створення інформаційної бази даних для розрахунку граничних рівнів концентрацій маркерних сполук (cut-off) для української популяції з метою зниження кількості хибно-негативних та хибно-позитивних визначень.Фінансування Програми планується здійснювати за рахунок коштів регіональних бюджетів, позабюджетних фондів, власних коштів батьків.Виконання підготовчого етапу Програми було розпочато на весні 2018 року. Запуск пілотної частини Програми у 5 регіонах: м. Київ, Київська область, Луганська та Донецька області та м. Чернівці, – запланований у квітні 2019 р. Розширення Програми по всій території України планується завершити наприкінці 2020 року.

The infant mortality rate in Ukraine has been progressively decreasing over the past decade, but remains very high compared with the countries of the European Union. The mortality rate of infants in the first year of life in Ukraine is 2.5–3 times higher than in the EU countries, while the mortality rate of newborns during the first month of life exceeds the average European level by 6.6 times. This indicates a significant backlog of our country in the implementation of modern standards of medical care for both pregnant women and newborns using modern diagnostic and treatment methodologies.One of the most effective way that allowed to reduce significantly infant mortality and disability rates in the developed countries of the world proved to be introduction of expanded newborn screening as a tool of early detection of wide spectrum of inherited metabolic disorders (IMD) – orphan diseases caused by genetic defects of particular enzymes leading to alterations in specific metabolic pathways. As a rule, IMDs occurrence cannot be established during medical examination of newborns due to the absence of clinical symptoms. Therefore, IMDs are diagnosed in two ways: (i) with clinical manifestation in the form of "neonatal catastrophes" and/or sudden infant death syndrome, (ii) according to the results of a biochemical examination of the blood of all (asymptomatic) newborns (i.e. screening). Delays or errors in the diagnosis of these diseases often lead to irreversible damage of many organs, first of all, the brain (neurological deficits, mental retardation, oligophrenia). Newborn screening – measurement in dried blood spots, sampled in asymptomatic newborns, concentrations of a specific set of substances which characterize key processes of protein, carbohydrate and lipid metabolism as a tool of early IMDs identification and prompt treatment initiation of affected children to prevent metabolic decompensation episodes and disability development was started in the 1960s in the United States with just one disease – phenylketonuria.By now, newborn screening programs have been implemented in more than 50 countries of the world and provide diagnostics of more than 45 IMDs. A significant (8–10 times) expanding the spectrum of IMDs that can be detected upon examination of dried blood spots on filter paper has been achieved by application of a high-throughput quantitative bioanalysis method – tandem mass spectrometry (TMS) in the late 1990s. Unlike routinely applied immunofluorimetric method allowing to measure just one biochemical agent in one blood sample, TMS allowed to analyze concentrations of several dozen substances in one dried blood spot.Currently, in Ukraine newborn screening is carried out for 4 diseases: phenylketonuria, congenital hypothyroidism, congenital adrenal hyperplasia, and cystic fibrosis using the low-throughput immunofluorimetric method. In some cases, expanded newborn screening using TMS method is performed on a commercial basis in foreign laboratories. At the same time, according to the Law of Ukraine No. 2461 "On ensuring the prevention and treatment of rare diseases" dated April 15, 2014, and the Orders of the Ministry of Health of Ukraine No. 778 dated 10.27.2014, No. 919 dated December 30, 2015, and No. 731 dated June 29, 2017, "The list of rare (orphan) diseases, that lead to a reduction of patient's lifespan or their disability, and for these diseases there are well-established methods of treatment" comprises more than 60 inherited metabolic disorders.This indicates a significant backlog of our country in the issue of not only ethical and medical significance, but great social and economic importance.The key issue of the expanded newborn screening implementation using high-throughput and accurate TMS method in Ukraine is the absence of modern analytical instruments and supplementary equipment in the state medico-genetic laboratories, as well as analysts with sufficient level of training. TMS is a technically complex method based on application of expensive vacuum and chromatographic equipment, special software, isotopic labeling reagents, high-purity gases, instruments maintenance with the aid of foreign experts, as well as qualified lab staff.Such private clinical diagnostic laboratory, where TMS-measurements are performed routinely at site and biomaterials are not transferred abroad exists in Ukraine. This laboratory is capable to perform the full range of measurements at the initial stage of newborn screening (TMS-analysis) and the secondary confirmatory testing using gas-chromatography/mass-spectrometry (GC/MS) and high performance liquid chromatography (HPLC) methods, as well as enzymes activity assessment and molecular-genetic studies. On the basis of reached agreement in September 2017 it was started the development of the Program of improving the diagnostics of inherited metabolic diseases in newborns and older children in Ukraine. This Program has been initiated by the National Academy of Medical Sciences of Ukraine with the participation of "Association of Pediatricians of Ukraine" and "Association of Neonatologists of Ukraine", as well as membership of the "Institute of Pediatrics, Obstetrics and Gynecology named after academician O.M. Lukyanova of NAMS of Ukraine", medical universities and regional health-care providers.The purpose of the Program is to expand up to 29 the list of inherited metabolic disorders to be diagnosed in newborns and older children that allows early start of treatment and follow-up of affected patients. Wide implementation of the Program allows reducing the levels of neonatal, infant and child mortality and disability.The Program is based on the following principles: (i) a clear distribution of the responsibilities between participants considering newborn screening procedures and processes; (ii) implementation of electronic document management system to register transferring of biomaterial from the moment of sampling to presentation of laboratory measurement results, it's expert evaluation and medical recommendations for further actions; (iii) documented customer feedback to report the results and it's expert evaluation; (iv) creation of the database for calculating the threshold concentrations of biochemical markers and its' ratios (cut-off) for the Ukrainian population in order to reduce the number of false-negative and false-positive results.Financing of the Program have relied on funding of regional budgets, extra-budgetary funds and own funds of parents.The implementation of the preparatory phase of the Program was launched in Spring, 2018. The launch of the pilot part of the Program in 5 regions: Kiev, Kiev Region, Lugansk and Donetsk Regions, and the city Chernivtsi is scheduled for April 2019. The program is planned to be expanded throughout Ukraine at the end of 2020. ; Уровень детской смертности в Украине прогрессивно снижается в течение последнего десятилетия, но остается очень высоким по сравнению со странами Европейского Союза. Показатель смертности младенцев первого года жизни в Украине в 2,5-3 раза выше, чем в странах ЕС, при этом уровень смертности новорожденных в течение первого месяца жизни превышает среднеевропейский в 6,6 раз. Это свидетельствует о существенном отставании нашей страны во внедрении современных стандартов оказания медицинской помощи, как беременным женщинам, так и новорожденным с использованием современных методологий диагностики и лечения.Одним из наиболее эффективных направлений деятельности, которая обеспечила существенное снижение уровня детской смертности и инвалидности в развитых странах мира, стало внедрение расширенного массового скрининга новорожденных с целью выявления наследственных болезней обмена веществ (НБО) – орфанных заболеваний, которые возникают вследствие генетических дефектов ферментов. Наличие НБО, как правило, не удается установить при врачебном осмотре новорожденных из-за отсутствия клинических симптомов. Диагностируют НБО двумя способами: (i) по клиническим проявлениям в форме «катастроф неонатального периода» и синдрома внезапной смерти младенцев, (ii) по результатам биохимического обследования крови новорожденных (скрининга). Задержка или ошибки в диагностике этих заболеваний часто приводят к необратимым повреждениям многих органов и, в первую очередь, головного мозга (неврологические нарушения, психическое регресс, слабоумие).Неонатальный скрининг – измерение в крови новорожденных концентраций определенного набора веществ, характеризующих ключевые процессы белкового, углеводного и липидного обмена с целью раннего выявления и начала лечения детей с НБО и предотвращения их инвалидизации было начато в 60-х годах прошлого века в США с одной болезни – фенилкетонурии. Сегодня программы неонатального скрининга внедрены более, чем в 50 странах мира и обеспечивают диагностику более 45 НБО. Значительное (в 8-10 раз) расширение количества НБО, которые могут быть обнаружены при исследовании высушенных на фильтровальной бумаге пятен крови, стало возможным благодаря внедрению высокопроизводительного метода тандемной масс-спектрометрии (ТМС) в конце 90-х годов прошлого века. В отличие от иммунофлуориметрического метода, который позволяет определять один показатель в одной пробе крови, ТМС позволяет измерять концентрации нескольких десятков веществ в одной пробе крови.В настоящее время в Украине скрининг новорожденных ведется по 4-м заболеваниям: фенилкетонурии, врожденному гипотиреозу, адреногенитальному синдрому и муковисцидозу с использованием низкопродуктивного иммунофлуориметрического метода. В отдельных случаях расширенный скрининг новорожденных с использованием метода ТМС выполняется на коммерческой основе в зарубежных лабораториях. При этом, согласно Закону Украины № 2461 «Об обеспечении профилактики и лечения редких заболеваний» от 15.04.2014, и Приказов МОЗ Украины № 778 от 27.10.2014, № 919 от 30.12.2015 и № 731 от 29.06.2017, «Перечень редких (орфанных) заболеваний, приводящих к сокращению продолжительности жизни больных или их инвалидизации и для которых существуют признанные методы лечения» включает более 60 наследственных болезней обмена веществ. Это свидетельствует о значительном отставании нашей страны в вопросе, который, кроме этического и медицинского, имеет важное социальное и экономическое значение.Ключевым вопросом внедрения расширенного скрининга новорожденных с использованием высокопроизводительного и точного метода ТМС в Украине является отсутствие в государственных медико-генетических лабораториях современного аналитического оборудования и вспомогательной инфраструктуры, а также специалистов-аналитиков с достаточным уровнем подготовки. ТМС – технически сложный метод, требующий использования дорогостоящего вакуумного и хроматографического оборудования, специального программного обеспечения, реагентов с изотопными метками, высокочистых газов, сервисного обслуживания с привлечением иностранных специалистов, а также квалифицированного персонала.Учитывая наличие частной клинико-диагностической лаборатории, выполняющей ТМС-анализы в Украине, а не транспортирующей биоматериал в зарубежные лаборатории, способной выполнять весь комплекс исследований первого (массового) этапа скрининга, а также уточняющую диагностику НБО с использованием методов газовой хроматографии/масс-спектрометрии, высокоэффективной жидкостной хроматографии, определение активности ферментов и молекулярно-генетические исследования, в сентябре 2017 была начата разработка Программы усовершенствования диагностики наследственных болезней обмена веществ у новорожденных и детей старшего возраста в Украине. Инициаторами этой Программы являются Национальная академия медицинских наук Украины, ВОО «Ассоциация педиатров Украины», ВОО «Ассоциация неонатологов Украины», ГУ «ИПАГ имени академика О.М. Лукьяновой НАМН Украины», медицинские университеты и региональные лечебно-профилактические учреждения.Цель Программы – расширение до 29 нозологий перечня наследственных болезней обмена веществ, диагностируемых у новорожденных и детей старшего возраста, обеспечение своевременного медицинского сопровождения и лечения выявленных больных, что позволит снизить уровень неонатальной, младенческой и детской смертности и инвалидности. Программа базируется на следующих принципах: (i) четкое распределение сфер ответственности исполнителей, регламентированных рабочими процессами и процедурами скрининга; (ii) электронный документооборот с фиксацией движения биоматериала от момента отбора до выдачи результатов лабораторных измерений, документирование результатов их экспертной оценки и принятого решения относительно дальнейших действий; (iii) документированная обратная связь с заказчиком исследований с целью сообщения результатов и их экспертной оценки; (iv) создание информационной базы данных для расчета предельных уровней концентраций маркерных соединений (cut-off) для украинской популяции с целью снижения количества ложноотрицательных и ложноположительных результатов.Финансирование Программы планируется осуществлять за счет средств региональных бюджетов, внебюджетных фондов, собственных средств родителей.Выполнение подготовительного этапа Программы было начато весной 2018 года. Запуск пилотной части Программы в 5 регионах: Киев, Киевская область, Луганская и Донецкая области и г. Черновцы, - запланирован в апреле 2019. Расширение Программы по всей территории Украины планируется завершить в конце 2020 года. ; Рівень дитячої смертності в Україні прогресивно знижується протягом останнього десятиріччя, але лишається дуже високим у порівнянні з країнами Європейського Союзу. Показник смертності немовлят першого року життя в Україні у 2,5-3 рази вищий, ніж у країнах ЄС, при цьому рівень смертності новонароджених протягом першого місяця життя перевищує середньоєвропейський у 6,6 разів. Це свідчить про суттєве відставання нашої країни у впровадженні сучасних стандартів надання медичної допомоги як вагітним жінкам, так і новонародженим з використанням сучасних методологій діагностики та лікування.Одним з найбільш ефективних напрямків діяльності, яка забезпечила суттєве зниження рівня дитячої смертності та інвалідності у розвинутих країнах світу стало впровадження розширеного масового скринінгу новонароджених з метою виявлення спадкових хвороб обміну речовин (СХОР) – орфанних захворювань, які виникають внаслідок генетичних дефектів ферментів. Наявність СХОР, зазвичай, не вдається встановити при лікарському огляді новонароджених через відсутність клінічних симптомів. Діагностують СХОР двома способами: (і) по клінічним проявам у формі «катастроф неонатального періоду» та синдрому раптової смерті немовлят, (іі) по результатам біохімічного обстеження крові новонароджених (скринінгу). Затримка або помилки в діагностиці цих захворювань часто призводять до незворотних пошкоджень багатьох органів і, в першу чергу, головного мозку (неврологічні порушення, психічний регрес, слабоумство).Неонатальний скринінг – вимірювання у крові новонароджених концентрацій певного набору речовин, які характеризують ключові процеси білкового, вуглеводного та ліпідного обміну з метою раннього виявлення і початку лікування дітей зі СХОР та запобігання їх інвалідизації було розпочато у 60-х роках минулого століття у США з однієї хвороби – фенілкетонурії. Сьогодні програми неонатального скринінгу впроваджені більш, ніж в 50 країнах світу та забезпечують діагностику понад 45 СХОР. Значне (у 8-10 разів) розширення кількості СХОР, що можуть бути виявлені при дослідженні висушених на фільтрувальному папері плям крові, стало можливим завдяки впровадженню високопродуктивного методу тандемної мас-спектрометрії (ТМС) наприкінці 90-х років минулого століття. На відміну від імунофлюорометричного методу, який дозволяє визначати один показник в одній пробі крові, ТМС дозволяє вимірювати концентрації декількох десятків речовин в одній пробі крові.На теперішній час в Україні скринінг новонароджених впроваджено лише для 4 захворювань: фенілкетонурії, вродженого гіпотиреозу, адреногенітального синдрому та муковісцидозу, який проводиться з використанням низькопродуктивного імунофлюорометричного методу. В окремих випадках розширений скринінг новонароджених з використанням методу ТМС виконується на комерційній основі в зарубіжних лабораторіях. При цьому, згідно з Законом України № 2461 «Про забезпечення профілактики та лікування рідкісних захворювань» від 15.04.2014 та Наказами МОЗУ № 778 від 27.10.2014, № 919 від 30.12.2015 та № 731 від 29.06.2017, «Перелік рідкісних (орфанних) захворювань, що призводять до скорочення тривалості життя хворих або їх інвалідизації та для яких існують визнані методи лікування» включає більше, ніж 60 спадкових хвороб обміну речовин. Це свідчить про значне відставання нашої країни в питанні, яке, крім етичного та медичного, має важливе соціальне та економічне значення.Ключовим питанням впровадження розширеного скринінгу новонароджених з використанням високопродуктивного і точного методу ТМС в Україні є відсутність у державних медико-генетичних лабораторіях сучасного аналітичного обладнання та допоміжної інфраструктури, а також фахівців-аналітиків з певним рівнем підготовки. ТМС – технічно складний метод, який вимагає використання коштовного вакуумного та хроматографічного обладнання, спеціального програмного забезпечення, реагентів з ізотопними мітками, високочистих газів, сервісного обслуговування з залученням закордонних фахівців, а також кваліфікованого персоналу.З огляду на наявність приватної клініко-діагностичної лабораторії, яка виконує ТМС-аналізи в Україні, а не транспортує біоматеріал в закордонні лабораторії та здатна виконувати весь комплекс досліджень першого (масового) етапу скринінгу, а також уточнюючу діагностику СХОР з використанням методів газової хроматографії/мас-спектрометрії, високоефективної рідинної хроматографії, визначення активності ферментів та молекулярно-генетичні дослідження, у вересні 2017 р. було розпочато розробку Програми удосконалення діагностики спадкових хвороб обміну речовин у новонароджених і дітей старшого віку в Україні. Ініціаторами цієї Програми є Національна академія медичних наук України, ВГО «Асоціація педіатрів України», ВГО «Асоціація неонатологів України», ДУ «ІПАГ імені академіка О.М. Лук'янової НАМН України», медичні університети та регіональні лікувально-профілактичні заклади.Мета Програми – розширення до 29 нозологій переліку спадкових хвороб обміну речовин, які виявляються у новонароджених та дітей старшого віку, забезпечення своєчасного медичного супроводу та лікування виявлених хворих, що дозволить знизити рівень неонатальної, малюкової й дитячої смертності та інвалідності. Програма базується на наступних принципах: (і) чіткий розподіл відповідальності виконавців, регламентований робочими процесами та процедурами скринінгу; (іі) електронний документообіг з фіксацією руху біоматеріалу від моменту відбору до видачі результатів лабораторних визначень, документування результатів їх експертної оцінки та прийнятого рішення стосовно подальших дій; (ііі) документований зворотній зв'язок з замовником досліджень з повідомленням результатів та їх експертної оцінки; (iv) створення інформаційної бази даних для розрахунку граничних рівнів концентрацій маркерних сполук (cut-off) для української популяції з метою зниження кількості хибно-негативних та хибно-позитивних визначень.Фінансування Програми планується здійснювати за рахунок коштів регіональних бюджетів, позабюджетних фондів, власних коштів батьків.Виконання підготовчого етапу Програми було розпочато на весні 2018 року. Запуск пілотної частини Програми у 5 регіонах: м. Київ, Київська область, Луганська та Донецька області та м. Чернівці, – запланований у квітні 2019 р. Розширення Програми по всій території України планується завершити наприкінці 2020 року.

The PGC was funded by National Institute of Mental Health (NIMH) Grant Nos. MH085520 (to PFS) and MH080403. Statistical analyses were carried out on the Genetic Cluster Computer (http://www. geneticcluster.org) hosted by SURFsara and financially supported by the Netherlands Scientific Organization Grant No. NWO 480-05-003 (to D. Posthuma) and the department of Psychology, Vrije Universiteit Amsterdam along with a supplement from the Dutch Brain Foundation. The Bonn/Mannheim GWAS was supported by the German Federal Ministry of Education and Research (BMBF) through the Integrated Genome Research Network Systematic Investigation of the Molecular Causes of Major Mood Disorders and Schizophrenia Grant Nos. 01GS08144 and 01GS08147, under the auspices of the National Genome Research Network plus, and through the Integrated Network Integrated Understanding of Causes and Mechanisms in Mental Disorders, under the auspices of the e:Med Programme Grant Nos. 01ZX1314A and 01ZX1314G. The Bonn/Mannheim GWAS was also supported by the German Research Foundation (DFG) Grant Nos. FOR2107, RI908/11-1, and NO246/10-1. The GenRED GWAS project was supported by NIMH R01 Grant Nos. MH061686 (to DFL), MH059542 (to W.H. Coryell), MH075131 (W.B. Lawson), MH059552 (JBP), MH059541 (W.A. Scheftner), and MH060912 (MMW). Max Planck Institute of Psychiatry MARS study was supported by the BMBF Program Molecular Diagnostics: Validation of Biomarkers for Diagnosis and Outcome in Major Depression by Grant No. 01ES0811. Genotyping was supported by the Bavarian Ministry of Commerce, and the BMBF in the framework of the National Genome Research Network by Grant Nos. NGFN2 and NGFN-Plus, FKZ 01GS0481 and 01GS08145. The Netherlands Study of Depression and Anxiety and the Netherlands Twin Register contributed to Genetic Association Information Network (GAIN)-MDD and to MDD2000. Funding for NTR/NESDA was from the following: the Netherlands Organization for Scientific Research (MagW/ZonMW Grant Nos. 904-61-090, 985-10-002, 904-61-193, 480-04004, 400-05-717, 912-100-20; Spinozapremie Grant No. 56-464-14192; Geestkracht program Grant No. 10-000-1002); the Center for Medical Systems Biology (NWO Genomics), Biobanking and Biomolecular Resources Research Infrastructure, Vrije Universiteit's Institutes for Health and Care Research and Neuroscience Campus Amsterdam, BIC/BioAssist/RK (Grant No. 2008.024); the European Science Foundation (Grant No. EU/QLRT-200101254); the European Community's Seventh Framework Program (Grant No. FP7/2007-2013); ENGAGE (Grant No. HEALTH-F4-2007-201413); and the European Science Council (Grant No. ERC 230374). Genotyping was funded in part by the GAIN of the Foundation for the US National Institutes of Health, and analysis was supported by grants from GAIN and the NIMH (Grant No. MH081802). Funding for the QIMR samples was provided by the Australian National Health and Medical Research Council (Grant Nos. 241944, 339462, 389927, 389875, 389891, 389892, 389938, 442915, 442981, 496675, 496739, 552485, 552498, 613602, 613608, 613674, 619667), the Australian Research Council (Grant Nos. FT0991360, FT0991022), the FP-5 GenomEUtwin Project (Grant No. QLG2-CT-2002-01254), and the US National Institutes of Health (Grant Nos. AA07535, AA10248, AA13320, AA13321, AA13326, AA14041, MH66206, DA12854, DA019951), and the Center for Inherited Disease Research (Baltimore, MD). RADIANT was funded by the following: a joint grant from the UK Medical Research Council and GlaxoSmithKline (Grant No. r G0701420); the National Institute for Health Research Specialist Biomedical Research Centre for Mental Health at the South London and Maudsley National Health Service Foundation Trust and the Institute of Psychiatry, King's College London; the UK Medical Research Council (Grant No. G0000647), and the Marie Curie Industry-Academia Partnership and Pathways (Grant No. 286213). The GENDEP study was funded by a European Commission Framework 6 grant (EC Contract Ref.: LSHB-CT2003- 503428). Genotyping of STAR* D was supported by NIMH Grant No. MH072802 (to SPH). STAR* D was funded by NIMH Grant No. N01MH90003 to the University of Texas Southwestern Medical Center at Dallas (to A.J. Rush). The CoLaus/PsyCoLaus study was supported by research grants from GlaxoSmithKline, the Faculty of Biology and Medicine of Lausanne, and the Swiss National Science Foundation (Grant Nos. 3200B0-105993, 3200B0-118308, 33CSCO-122661, 33CS30-139468, 33CS30-148401) and two grants from GlaxoSmithKline Clinical Genetics. SHIP is part of the Community Medicine Research net of the University of Greifswald, Germany, which is funded by the Federal Ministry of Education and Research (Grant Nos. 01ZZ9603, 01ZZ0103, 01ZZ0403), the Ministry of Cultural Affairs, and the Social Ministry of the Federal State of Mecklenburg-West Pomerania. Genome-wide data have been supported by the Federal Ministry of Education and Research (Grant No. 03ZIK012) and a joint grant from Siemens Healthcare, Erlangen, Germany, and the Federal State of Mecklenburg-West Pomerania. SHIP-LEGEND is funded by the DFG (Grant No. GR 1912/5-1). The TwinGene study was supported by the Swedish Ministry for Higher Education, the Swedish Research Council (Grant No. M-2005-1112), GenomEUtwin (Grant Nos. EU/QLRT2001-01254,QLG2-CT-2002-01254), the Swedish Foundation for Strategic Research and the US National Institutes of Health (Grant No. U01 DK066134). The collection of PRISME control subjects and genotyping of the 883 Danish control subjects was supported by grants from The Danish Strategic Research Council, The Stanley Research Foundation, and H. Lundbeck A/S. The Muenster Depression cohorts were supported by the European Union (Grant No. N Health-F2-2008-222963) and by grants from the DFG (Grant Nos. FOR 2107 and DA1151/5-1 [ to UD]), Innovative Medizinische Forschung of the Medical Faculty of Munster (Grant Nos. DA120903, DA111107, and DA211012 [ all to UD]). Generation Scotland is supported by a Wellcome Trust Strategic Award "Stratifying Resilience and Depression Longitudinally" (Reference No.: 104036/Z/14/Z) and core support from the Chief Scientist Office of the Scottish Government Health Directorates (Grant No. CZD/16/6) and the Scottish Funding Council (Grant No. HR03006).r The NIMH Cell Repository at Rutgers University and the NIMH Center for Collaborative Genetic Studies on Mental Disorders made essential contributions to this project. Genotyping was carried out by the Broad Institute Center for Genotyping and Analysis with support from Grant No. U54 RR020278 (which partially subsidized the genotyping of the GenRED cases). Collection and quality control analyses of the control dataset were supported by grants from NIMH and the National Alliance for Research on Schizophrenia and Depression.r We acknowledge the contributions of Dr. George S Zubenko and Dr. Wendy N Zubenko, Department of Psychiatry, University of Pittsburgh School of Medicine, to the GenRED I project. We are grateful to Knowledge Networks (Menlo Park, CA) for assistance in collecting the control dataset. We express our profound appreciation to the families who participated in this project, and to the many clinicians who facilitated the referral of participants to the study. We thank the twins and their families registered at the Australian Twin Registry for their participation in the many studies that have contributed to this research. We thank V. Mooser, G. Weaber, and P. Vollenweider who initiated the CoLaus project. We express our gratitude to the Lausanne inhabitants who volunteered to participate in the PsyCoLaus study. We would like to acknowledge the PRISME-study group, Denmark, for collection of the PRISME samples. We thank David M. Hougaard, Section of Neonatal Screening and Hormones, Statens Serum Institute, Copenhagen, Denmark; Preben Bo Mortensen, National Centre for Register-based Research, Aarhus University, Denmark; Merete Nordentoft, Mental Health Centre, Copenhagen, Denmark; and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark. Funding from the BBSRC and MRC is gratefully acknowledged.r Data used in the preparation of this article were obtained from the Genetic and Environmental Risk for Alzheimer's disease (GERAD1) Consortium. As such, the investigators within the GERAD1 consortia contributed to the design and implementation of GERAD1 and/or provided data but did not participate in analysis or writing of this report.r SS, HS, KS, and TET are employees of deCODE Genetics/Amgen. VA received funds from the German Federal Ministry of Education and Research, from the European Union (FP 7), and from the Interdisciplinary Center for Clinical Research Munster, and he has served on the advisory boards of, or has given presentations on behalf of the following companies: Astra-Zeneca, Janssen-Organon, Lilly, Lundbeck, Servier, Pfizer, Otsuka, and Trommsdorff. BTB has received funding from the National Health and Medical Research Council Australia and honoraria from Lundbeck, BristolMeyers Squibb, Sanofi, Servier, Astra-Zeneca, Pfizer. IJD is supported by the MRC-BBSRC, Centre for Cognitive Ageing and Cognitive Epidemiology, part of the cross council Lifelong Health and Wellbeing Initiative (Grant No. MR/K026992/1). HJG has received funding from German Research Foundation and Federal Ministry of Education and Research Germany and speakers honoraria from Eli Lilly and Servier. CH acknowledges support from the Medical Research Council (MRC) and the Biotechnology and Biological Sciences Research Council (BBSRC). DJM is supported by an , funded by the Chief Scientist Office. AMM is supported by a Scottish Funding Council Senior Clinical Fellowship and by the Dame Theresa and Mortimer Sackler Foundation and has received research support from Pfizer, Janssen, and Lilly. CMM was supported by the Netherlands Organization for Scientific Research (Grant No. NOW VENI 916-76-125). BM- M has consulted for Affectis Pharmaceuticals. MP has served on the advisory boards of Lundbeck and Eli Lilly ; BACKGROUND: Major depressive disorder (MDD) is a disabling mood disorder, and despite a known heritable component, a large meta-analysis of genome-wide association studies revealed no replicable genetic risk variants. Given prior evidence of heterogeneity by age at onset in MDD, we tested whether genome-wide significant risk variants for MDD could be identified in cases subdivided by age at onset. METHODS: Discovery case-control genome-wide association studies were performed where cases were stratified using increasing/decreasing age-at-onset cutoffs; significant single nucleotide polymorphisms were tested in nine independent replication samples, giving a total sample of 22,158 cases and 133,749 control subjects for subsetting. Polygenic score analysis was used to examine whether differences in shared genetic risk exists between earlier and adult-onset MDD with commonly comorbid disorders of schizophrenia, bipolar disorder, Alzheimer's disease, and coronary artery disease. RESULTS: We identified one replicated genome-wide significant locus associated with adult-onset (.27 years) MDD (rs7647854, odds ratio: 1.16, 95% confidence interval: 1.11–1.21, p 5 5.2 3 10-11). Using polygenic score analyses, we show that earlier-onset MDD is genetically more similar to schizophrenia and bipolar disorder than adult-onset MDD. CONCLUSIONS: We demonstrate that using additional phenotype data previously collected by genetic studies to tackle phenotypic heterogeneity in MDD can successfully lead to the discovery of genetic risk factor despite reduced sample size. Furthermore, our results suggest that the genetic susceptibility to MDD differs between adult- and earlier-onset MDD, with earlier-onset cases having a greater genetic overlap with schizophrenia and bipolar disorder. ; United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Institute of Mental Health (NIMH) MH085520 MH080403 ; SURFsara ; Netherlands Scientific Organization NWO 480-05-003 ; Department of Psychology, Vrije Universiteit Amsterdam ; Dutch Brain Foundation ; Federal Ministry of Education & Research (BMBF) 01GS08144 01GS08147 ; National Genome Research Network plus, and through the Integrated Network Integrated Understanding of Causes and Mechanisms in Mental Disorders ; e:Med Programme 01ZX1314A 01ZX1314G ; German Research Foundation (DFG) FOR2107 RI908/11-1 NO246/10-1 ; United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Institute of Mental Health (NIMH) MH061686 MH059542 MH075131 MH059552 MH059541 MH060912 ; Federal Ministry of Education & Research (BMBF) 01ES0811 ; Bavarian Ministry of Commerce ; Federal Ministry of Education & Research (BMBF) NGFN2 NGFN-Plus FKZ 01GS0481 01GS08145 ; Netherlands Organization for Scientific Research (MagW/ZonMW) 904-61-090 985-10-002 904-61-193 480-04004 400-05-717 912-100-20 ; Spinozapremie 56-464-14192 ; Geestkracht program 10-000-1002 ; Center for Medical Systems Biology (NWO Genomics) ; Biobanking and Biomolecular Resources Research Infrastructure ; Vrije Universiteit's Institutes for Health and Care Research and Neuroscience Campus Amsterdam ; BIC/BioAssist/RK 2008.024 ; European Science Foundation (ESF) EU/QLRT-200101254 ; European Union (EU) FP7/2007-2013 ; ENGAGE HEALTH-F4-2007-201413 ; European Science Council ERC 230374 ; United States Department of Health & Human Services National Institutes of Health (NIH) - USA ; GAIN ; United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Institute of Mental Health (NIMH) MH081802 MH072802 N01MH90003 ; National Health and Medical Research Council of Australia 241944 339462 389927 389875 389891 389892 389938 442915 442981 496675 496739 552485 552498 613602 613608 613674 619667 ; Australian Research Council FT0991360 FT0991022 ; FP-5 GenomEUtwin Project QLG2-CT-2002-01254 ; United States Department of Health & Human Services National Institutes of Health (NIH) - USA AA07535 AA10248 AA13320 AA13321 AA13326 AA14041 MH66206 DA12854 DA019951 U01 DK066134 ; Center for Inherited Disease Research (Baltimore, MD) ; UK Medical Research Council and GlaxoSmithKline G0701420 ; National Institute for Health Research (NIHR) ; Maudsley National Health Service Foundation Trust ; Institute of Psychiatry, King's College London ; Medical Research Council UK (MRC) G0000647 ; European Union (EU) 286213 ; European Commission Framework 6 grant (EC) LSHB-CT2003- 503428 ; GlaxoSmithKline ; Faculty of Biology and Medicine of Lausanne ; Swiss National Science Foundation (SNSF) 3200B0-105993 3200B0-118308 33CSCO-122661 33CS30-139468 33CS30-148401 ; GlaxoSmithKline Clinical Genetics ; Federal Ministry of Education & Research (BMBF) 01ZZ9603 01ZZ0103 01ZZ0403 03ZIK012 ; Ministry of Cultural Affairs ; Social Ministry of the Federal State of Mecklenburg-West Pomerania ; Siemens Healthcare, Erlangen, Germany ; German Research Foundation (DFG) GR 1912/5-1 FOR 2107 DA1151/5-1 ; Swedish Ministry for Higher Education ; Swedish Research Council M-2005-1112 ; GenomEUtwin QLG2-CT-2002-01254 EU/QLRT2001-01254 ; Swedish Foundation for Strategic Research ; Danske Strategiske Forskningsrad (DSF) ; Stanley Research Foundation ; European Union (EU) N Health-F2-2008-222963 ; Innovative Medizinische Forschung of the Medical Faculty of Munster DA120903 DA111107 DA211012 ; Wellcome Trust Strategic Award "Stratifying Resilience and Depression Longitudinally" 104036/Z/14/Z ; Chief Scientist Office of the Scottish Government Health Directorates CZD/16/6 ; Scottish Funding Council HR03006 ; Broad Institute Center for Genotyping and Analysis U54 RR020278 ; NARSAD ; Biotechnology and Biological Sciences Research Council (BBSRC) ; Medical Research Council UK (MRC) ; Federal Ministry of Education & Research (BMBF) ; Interdisciplinary Center for Clinical Research Munster ; National Health and Medical Research Council of Australia ; MRC-BBSRC, Centre for Cognitive Ageing and Cognitive Epidemiology, part of the cross council Lifelong Health and Wellbeing Initiative MR/K026992/1 ; German Research Foundation (DFG) ; Federal Ministry of Education ; Research Germany and speakers honoraria from Eli Lilly and Servier ; Medical Research Council UK (MRC) ; Biotechnology and Biological Sciences Research Council (BBSRC) ; NRS Career Fellowship - Chief Scientist Office ; Scottish Funding Council Senior Clinical Fellowship ; Dame Theresa and Mortimer Sackler Foundation ; Netherlands Organization for Scientific Research (NWO) NOW VENI 916-76-125 ; Lundbeckfonden R155-2014-1724 ; Medical Research Council UK (MRC) MR/K026992/1 MC_PC_U127561128 1292844 ; Chief Scientist Office CZD/16/6/4

The revival of the EU's enlargement policy as a geostrategic imperative following Russia's 2022 invasion of Ukraine[1] has sparked discussions about the Union's internal readiness to welcome additional members. The potential accession of up to nine countries from the post-Soviet space and the Western Balkans[2] has been widely associated with the urgent need to reform the Union.[3] The European Council and the Commission have also acknowledged this necessity, formally starting a process of internal revision of EU's institutions, policies and budget.[4] Yet fundamental uncertainties remain regarding how enlargement will influence this process and whether it will contribute to substantial changes.
In this context, and particularly considering the current security situation, further European integration could develop as a result of leaders' hopes for internal reforms through enlargement; a willingness to expand in view of existing interdependencies; and the necessity to adapt to long-term dynamics. Each of these dynamics offers different pathways for deepening and widening the EU, as well as shaping its broader system of regional integration.
To move past current challenges and overly optimistic expectations, the EU could continue to integrate effectively by drawing on the benefits of its differentiated nature and porous boundaries, as far as it combines them with the pursuit of clear strategic objectives. The latter could include the consolidation of EU integration in crucial sectors, such as industrial, technological and defence policies, as well as the gradual expansion of the EU integration project to candidate countries, up to full membership. Yet these outcomes are by no means certain: they require the EU leadership's determination to find a delicate balance between advancing EU policies and decision-making while providing viable solutions to controversies surrounding the EU budget.Leaders' hopes and preferences
Some European leaders hope that enlargement could drive further integration by helping to balance member states' diverse preferences regarding the functioning of the EU. Germany is the main advocate of using enlargement to revive the stalled process of institutional reform. Chancellor Olaf Scholz has rekindled hopes for stronger supranational governance, framing it as essential for enlargement and suggesting that EU treaty changes may be needed.[5] These views are shared by key figures like the European Commission President Ursula von der Leyen, who believe that reforming the EU is a necessary prerequisite of enlargement.[6] The envisaged reforms, echoed in the 2023 Franco-German experts' report, include a shift from unanimity to qualified majority voting (QMV) in areas like the Common Foreign and Security Policy (CFSP) and taxation, as well as restructuring the European Parliament and Commission.[7]
Yet, these leaders will have a hard time convincing other member states to agree to such reforms. Germany hopes that the new eastward-looking enlargement perspective could push some Central-Eastern European (CEE) countries, which are interested in shifting the Union's balance to the East, to overcome or soften their traditional opposition to institutional reforms. CEE states remain reluctant to cede further sovereignty, particularly in strategic areas. Czechia,[8] Croatia and Hungary,[9] for instance, openly oppose any move towards QMV in the CFSP. To promote its goal, Germany launched the 'Group of Friends on QMV in EU CFSP' gathering a group of states such as Belgium, Finland, France, Germany, Italy, Luxembourg, Netherlands, Slovenia and Spain, that aims to foster QMV in this policy field under the current treaties.[10] However, Germany's intentions hardly will succeed if some of these states do not actively pursue the same goal, like Italy. Overall, the fear of losing sovereignty is shared by 17 member states, who oppose treaty changes necessary to introduce QMV.[11]
Without formal treaty revisions, institutional reforms will remain limited. Even adjustments short of treaty amendments, like using the passerelle clause[12] to move to QMV, reducing the overall number of MEPs or increasing the hierarchical structure of the Commission, are unlikely to achieve a consensus as they require adjusting the relative weight of member states in the Parliament, Council and Commission.Interdependencies matter
When addressing the EU enlargement, member states' have also been willing to pragmatically tackle the evolving interdependencies stemming from the war in Ukraine, regardless of their overall preferences for EU integration. The negative externalities generated by the war in Ukraine have affected several sectors, from defence and technology, to energy, migration and food security, and may serve as catalysts for change. As such, directly addressing costs deriving from war-induced shocks in these sectors could be an opportunity to both modernise connected EU policies while increasing support to candidate countries by gradually allowing access to these policy areas. Indeed, some EU leaders might find it more feasible to support enlargement and key EU policies' reforms rather than modifying the Union's complex institutional settings and decision-making procedures.
Different actors are echoing this view. The outgoing Commission has outlined key reforms in core policies such as the Common Agricultural Policy (CAP)[13] and cohesion policy[14] to make them more efficient and prepare for the inclusion of enlargement countries. Also, it is no surprise that Enrico Letta's report on the Single Market – which calls for the completion of the Capital Market Union together with upgrading the Single Market to include defence, telecommunications and energy infrastructure – also deals with the external dimension of EU Single Market and policies.[15] Addressing common interdependencies could, at the same time, encourage the deepening of the Single Market while supporting gradual integration of candidate countries in the EU, especially in light of current security dynamics.
The willingness to address current interdependencies through various forms of enhanced cooperation within a multi-speed Europe is clearly reflected in Emmanuel Macron's 2023 speech in Bratislava, where he revised France's traditional stance on enlargement, revealing a change of mind – if not of heart.[16] Europe's strategic awakening, as proposed by the French President, encompasses a profound revision of EU industrial, technological and defence policies, while relying on flexible organisation and formats. These also include greater support for enlargement countries, which should be allowed to benefit from EU policies and budget even before fully-fledged membership.[17]
However, divergencies among member states about how to reform policies are as profound as those impeding the success of institutional reforms. There is a range of different views on such issues as the future of the CAP, how the cohesion policy is funded, as well as Macron's complaints about member states buying non-European weapons after February 2022. Even the Letta report, which rightly notes how persisting fragmentation is damaging the Single Market,[18] does not provide detailed recommendations about how to harmonise its economic and financial rules or develop concrete mechanisms for increasing the inclusion of third countries. That said, while war might have raised EU leaders' awareness of common challenges and costs of non-integration, this consensus does not necessarily translate into action. On the contrary, any change of the status quo in any of the above-mentioned policy areas implies a number of distributive conflicts among the member states which will be difficult to resolve within current decision-making structures.EU long-term challenges
Other policymakers recognise that enlargement will do little to address the EU's urgent need to reform and avoid decline and that, thus, the EU should focus on its long-term challenges to foster integration. This point is illustrated by Mario Draghi's report on EU competitiveness, which overlooks enlargement and focuses instead on the need of EU leaders to act decisively to avoid long-term stagnation.[19] The Draghi report outlines serious concerns about the EU's declining growth, innovation and competitiveness in the face of Chinese competition, geopolitical tensions, energy dependencies and negative demographic trends. According to proponents like Draghi, the potential of the EU budget must be scaled up to address the around 800 billion-euro-gap in annual public and private investment in order to improve productivity and boost competitiveness. These discussions highlight that the future of EU integration rests on the capacity of EU economic governance to support this process in light of increasing challenges.
The budget considerations demonstrate that the future of EU integration goes beyond the specific challenges of EU enlargement to include broader financial reforms. For instance, the EU's financial efforts linked to enlargement pale in comparison to Draghi's suggestions about the EU budget. According to a study by Bruegel, for example, Ukraine's EU membership is expected to cost 136 billion euros over 7 years,[20] far below Draghi's annual budget forecast. The ability of the budget to support integration will also determine the success of enlargement. In this way, reforms of the EU budget are pivotal and remain interlinked with the enlargement process especially at a time when candidate states are under pressure to reform and prepare for accession. For this reason, the EU's response to long-term challenges will need to ensure not only that integration continues but also a successful enlargement process.
Change through necessity faces obstacles, however, due to member states' reluctance to adapt to new circumstances. For instance, German representatives publicly rejected the Draghi report because it contains proposals about joint decision-making in economic matters.[21] This mirrors the lack of support that previous efforts to increase the EU's own resources received. EU bonds, often proposed as an option, have raised concerns over debt costs, with Nordic countries opposing them.[22] Opposition to the idea of an EU common debt is linked to the overall debate about the model of growth the Union should pursue. With many frugal member states still relying on an export-led growth model, Next Generation EU funds running out by 2026, and the new Stability Pact having just entered into force, fiscal rules are likely to tighten in the years to come. Like the North-South divisions during the EU debt crisis, these restrictions will negatively affect internal demands and fuel intra-EU animosities, impacting on both enlargement, further integration and weakening the EU as a whole.Looking ahead
The role of the EU enlargement in the integration process relates to the different hopes, wills and needs of member states to reform the EU, which push the integration process in different directions while being intrinsically connected. The reform of the integration process cannot ignore divergent preferences and interdependencies among member states. Approaches based on transforming the EU's fundamental architecture or proposing a grand vision is unlikely to be accepted by all member states.
Against this backdrop, differentiation, whether internal or external, remains key for member states that want to pursue integration in areas of their major interests and contributes to enhancing cooperation with partners and future members. However, EU leaders should carefully evaluate the best way to take advantage of differentiation, or they risk pushing the EU in contrasting directions. Agreeing on a tangible set of concrete objectives to pursue could help overcome deadlock, facilitate compromises in negotiations and enable compensations and side-payments across various areas. This, in turn, would help build trust and credibility in the overall reform process, potentially attracting greater political investment from EU leaders, who could ultimately become more willing to also overcome entrenched positions concerning the reform of EU governance.
The EU's porous boundaries also provide a path to foster integration in light of the current challenges. EU policies entail a degree of porosity, which consists in the access to policies an organisation can provide to non-member states[23] that enhances the ability to cooperate with candidate states. This porosity enables both the enlargement process itself or participation in Common Security and Defence Policy (CSDP) missions to become vehicles for increased cooperation and smoothen the integration process of candidate states as they become increasingly involved in EU policies. This, in turn, allows the EU to increase its engagement with candidate states, reinforce and improve the efficiency of its policies especially in light of future accessions, and maintain cooperation with its partners active and kicking. This is crucial in times of war and considering the current security dynamics, but requires the Union and acceding countries to remain committed to cooperation.
An approach to reforms that considers the potential of differentiation and porosity could ultimately also contribute to change the dynamics of the EU economic governance in what is likely to be the most challenging negotiation: that concerning the EU's budget. A productive path forward involves moving away from zero-sum-game logic and a 'fair reward' approach to focus on European public goods and how to finance and govern them. To this end, security imperatives brought about by the war in Ukraine could be instrumental and reveal new ways to overcome long-standing deadlocks.
Overall, the challenge for the EU political leadership is to ensure that member states stay committed to integration. Enlargement plays important role since it brings our attention to the differentiated and porous nature of the EU as a way to find political solutions. This could certainly help to address divergent hopes, wills and needs that, until today, have caused uncertainty and deadlocks in the integration process.Matteo Bonomi is a Senior Fellow in the "EU, politics and institutions" Programme at the Istituto Affari Internazionali (IAI). Raffaele Mastrorocco is a PhD Researcher in the Department of Political and Social Sciences at the European University Institute (EUI).[1] Nathalie Tocci, "How the EU Can Enlarge", in Politico Europe, 24 July 2023, https://www.politico.eu/?p=3378024.[2] Namely Albania, Bosnia and Herzegovina, Georgia, North Macedonia, Moldova, Montenegro, Kosovo, Serbia and Ukraine.[3] Ursula von der Leyen, Europe's Choice. Political Guidelines for the Next European Commission, 2024−2029, 18 July 2024, https://commission.europa.eu/media/58570_en.[4] European Commission, Pre-Enlargement Reforms and Policy Reviews (COM/2024/146), 20 March 2024, https://eur-lex.europa.eu/legal-content/en/TXT/?uri=celex:52024DC0146. See also the European Council website: Internal Reforms of the EU, last reviewed on 1 August 2024, https://europa.eu/!NBDMck.[5] German Federal Government, Speech by Federal Chancellor Olaf Scholz at the Charles University in Prague on Monday, 29 August 2022, https://www.bundesregierung.de/breg-en/news/scholz-speech-prague-charles-university-2080752.[6] Ursula von der Leyen, Europe's Choice, cit., p. 25-26.[7] Franco-German Working Group, Sailing on High Seas: Reforming and Enlarging the EU for the 21st Century, 18 September 2023, https://institutdelors.eu/en/publications/sailing-on-high-seas-reforming-and-enlarging-the-eu-for-the-21st-century.[8] Daniela Lazarová, "PM Fiala: Czechia Not in Favour of Qualified Majority Voting in EU", in Radio Prague International, 7 October 2023, https://english.radio.cz/node/8796468.[9] OSW Team, "The EU Debate on Qualified Majority Voting in the Common Foreign and Security Policy. Reform and Enlargement", in OSW Commentaries, No. 545 (12 October 2023), https://www.osw.waw.pl/en/node/31931.[10] Group of Friends on QMV, Joint Statement of the Foreign Ministries on the Launch of the Group of Friends on Qualified Majority Voting in EU Common Foreign and Security Policy, 4 May 2023, https://www.auswaertiges-amt.de/en/newsroom/news/-/2595304.[11] Nicole Koenig, "Towards QMV in EU Foreign Policy. Different Paths at Multiple Speeds", in Jacques Delors Centre Policy Briefs, 14 October 2022, https://www.delorscentre.eu/en/publications/towards-qmv-in-eu-foreign-policy.[12] The passerelle clause is a provision in EU treaties that permits changes to a legislative process without requiring a formal treaty modification.[13] European Commission DG for Agriculture website: The Common Agricultural Policy: 2023-27, https://agriculture.ec.europa.eu/node/47_en.[14] High-level Group on the Future of Cohesion Policy, Forging a Sustainable Future Together: Cohesion for a Competitive and Inclusive Europe, February 2024, https://doi.org/10.2776/974536.[15] Enrico Letta, Much More than a Market, April 2024, https://www.consilium.europa.eu/media/ny3j24sm/much-more-than-a-market-report-by-enrico-letta.pdf.[16] French Presidency, Globsec Summit in Bratislava. Closing speech by the President of the French Republic, 31 May 2023, https://www.elysee.fr/en/emmanuel-macron/2023/06/01/globsec-summit-in-bratislava.[17] Pierre Vimont, "Macron in Eastern Europe: Reassure, Shore Up, Move Forward", in Strategic Europe, 6 June 2023, https://carnegieendowment.org/europe/strategic-europe/2023/06/macron-in-eastern-europe-reassure-shore-up-move-forward.[18] Hung Tran, "The Enrico Letta Report and the State of the EU's Capital Market Union", in Econographics, 7 May 2024, https://www.atlanticcouncil.org/?p=763030.[19] Mario Draghi, The Future of European Competitiveness, September 2024, https://commission.europa.eu/node/32880_en.[20] Zsolt Darvas et al., "Ukraine's Path to European Union Membership and Its Long-Term Implications", in Bruegel Policy Briefs, No. 5/24 (March 2024), p. 16, https://www.bruegel.org/node/9789.[21] Giovanna Faggionato and Hans von der Burchard, "Germany's Lindner Rejects Draghi's Common Borrowing Proposal", in Politico Europe, 9 September 2024, https://www.politico.eu/?p=5343717.[22] Iain Begg, "Dilemmas and Challenges around the EU Budget", in CER Insights, 8 April 2024, https://www.cer.eu/node/10855.[23] Stephanie C. Hofmann et al., "Porous Organizational Boundaries and Associated States: Introducing Memberness in International Organizations", in European Journal of International Relations, Vol. 29, No. 4 (December 2023), p. 929-959, https://doi.org/10.1177/13540661231163988.

The energy transition from fossil fuels to renewable energy sources is the next great challenge that the EU will face. One key concern is the transformation of the labour market. As we move away from fossil fuels, some polluting "brown" sectors, such as coal mining, will decline, affecting 3-10 per cent of jobs across the EU, but more than 20 per cent of jobs in certain regions.[1] The green transition will also be a source of new jobs: delivering on the EU's 2030 climate pledges could lead to a net increase of up to 884,000 jobs in climate-friendly and neutral sectors.[2] Other brown sectors, such as automotive, will transform.[3] The working-age population, however, will need training to tailor their existing skills to the requirements of the new or transformed jobs. According to a 2022 Special Eurobarometer, 38 per cent of respondents believe they lack the skills to support the green transition.[4] Reskilling and upskilling will thus be needed to prevent labour shortages in the future.
To bridge the gap between employers grappling with skill shortages and workers facing displacement, we propose to create training programs tailored to equip working-age citizens with the skills demanded by emerging sectors, which will help ensure a smooth transition. Policy action will be necessary to navigate this process effectively, fostering a fair transition and preventing potential political backlash. Proactively managing this transformation towards a green economy will contribute not only to creating pathways to employment but also to cultivating a more resilient and sustainable future for all EU citizens.The EU's Skills Agenda for 2025
In the face of these challenges, the EU is currently developing a framework to promote life-long learning and skills adaptation for the green transition. In 2020, the Commission announced a new Skills Agenda for 2020-2025,[5] which aimed to (i) obilise stakeholders to collaborate through a Pact for Skills; (ii) design a strategy to improve the matching of skills to jobs; (iii) support lifelong learning by promoting national actions and vocational and education training (VET); and (iv) foster financial investment. The targets set by the Skills Agenda for 2025 are summed up in Table 1. The Skills Agenda aligns with the European Pillar of Social Rights objectives and builds on the initiative to create an inclusive and resilient European Education Area. It has recently gained visibility following the European Year of Skills (EYS) 2023-2024, which raised awareness regarding lifelong learning.[6]

Table 1 | Skills Agenda for 2025 targets



Source: European Commission, European Skills Agenda for Sustainable Competitiveness, Social Fairness and Resilience, cit., p. 20.



Against this backdrop, the policies we recommend in the following could help reach the 2025 targets as well as unlock progress for the next Skills Pact to be drafted after the 2024 EU elections.Strengthening the EU's strategy for training: The Green Energy Erasmus Programme
The future workforce will face many challenges in these new employment conditions and therefore needs decisive support. To this end, the new Commission could propose a Green Energy Erasmus Programme (GEEP). This would entail mobility programmes tailored to apprentices in the energy sector so that young Europeans can be specifically trained for upcoming energy jobs.[7] In direct partnership with small and medium enterprises and other stakeholders, the GEEP would in parallel support transitioning industries in acquiring qualified workers. To make it profitable to all, a guaranteed minimum salary would be provided for apprentices, and organisations hosting them will benefit from tax breaks.
These new Erasmus opportunities should be available and tailored to students in VET programmes, which represented 8.5 million students in the EU in 2019.[8] As emphasised in the Council recommendation of 2020, VET is a key pillar of education and skills for the green transition.[9] However, research shows that students in VET programmes perform relatively worse than others in the skills needed for green jobs.[10] Therefore, the opportunity to complete work-based training abroad in the green sector through the GEEP would highly benefit their education.
To fund the GEEP, those public-private partnerships (PPPs) may be leveraged that, according to the European Training Foundation, already provide key support for VET centres. These types of partnerships enable all actors involved to contribute to the design of programmes and finance their development. PPPs for VET programmes are not only beneficial for students and training centres but also for private actors who have strong incentives to invest financially in them as they generate opportunities for growth.[11] Such instruments could be encouraged to fund the GEEP and ensure high-stakes collaboration between training centres and private actors in successfully teaching young generations green skills.Creating training opportunities that are accessible to all and for all
The EU's training programmes must be as inclusive as possible. The opportunities of the green transition must be shared more fairly by ensuring that groups currently underrepresented in green jobs, such as women and older adults, also take part in training.[12] In close collaboration with stakeholders defending the interests of these groups, more steps need to be taken to promote inclusivity. A few ideas to steer a more inclusive transition may include:
• Provide childcare services during training hours and minimum quotas. Women are underrepresented in energy-intensive industries. They account for 27.7 per cent of the workforce in the electricity sector and 22.2 per cent in transport.[13] The Skills Pact aims to increase women's participation in STEM fields by raising awareness, but the structural constraints that hinder women's participation in these sectors need to be addressed with concrete measures, such as free childcare services and minimum quotas for women.
• Remove barriers to entry through financial compensation for programme completion and flexible schedules. Whilst demand for skills training is increasing, studies show that worker participation in such programmes is below average, and low-skilled workers are more likely to find participation difficult.[14] Financial compensation would allow easier programme access to all working-age individuals by ensuring that time away from paid work does not pose a barrier to entry and compensates for potential wage gaps. Flexible schedules allow workers to train whilst continuing their current profession, hence making programmes more accessible to workers.
• Open up specific training programmes for adult and older workers. Adult workers require training focusing on particular skills, rather than participating in 'complete programmes'.[15] Specific training programmes tailored to their skills gap and oriented towards career guidance must be created in collaboration with businesses that know what skills are required. These programmes would optimally evaluate the green sectors where workers can most easily relocate with their existing skills, and provide focused training for those they still require.Targeting the right sectors and regions
The effectiveness of the proposed measures depends on the EU's ability to discern strategic sectors that will grow during the green transition. A study by the Clean Energy Technology Observatory (CETO) indicates that sectors such as heat pumps, biofuels, solar and wind energy are the most promising.[16]
More specifically, it is expected that most jobs in the solar industry will be created by the deployment of solar infrastructure and its installation.[17] For wind energy, manufacturing accounts for a greater share of new employment opportunities. Hence, training programmes and related measures must be focused first and foremost on these rapidly developing sectors and on the segments of the value chain most in need of a labour force.
A different but related issue is the relocation of jobs. Indeed, the impact of the energy transition on the labour market does and will vary across regions depending on the share of employment in brown industries and other dimensions of vulnerability and adaptability.[18] The loss of jobs could lead to emigration from the most affected regions, which in turn would exacerbate the regional differences within countries and the EU at large.
To prevent the decline of carbon-intensive regions and the mass relocation of working-age population, as well as potential political backlash, provisions must be introduced to ensure that new green jobs are created in the same areas where brown jobs are lost. In some of the most affected regions, the jobs lost in the coal mining sector could be replaced by new jobs in renewable energy production. One of the most affected regions, for example, is Greece's Western Macedonia region, where the coal mining industry employs an important share of workers.[19] This region is suitable for renewable energy production, and has already signed off on solar photovoltaic projects co-financed by the EU's Recovery and Resilience Facility to be implemented by the end of 2024.[20]
In those regions that are not similarly suitable for renewable production, the accompanying service industries could provide new jobs. This could be ensured through financial incentives, such as power purchasing agreements, infrastructure development, an enabling policy environment and support for R&D and innovation.Monitoring the programmes and assessing their performance
Continuous performance assessment is quintessential for green skills training since the employment market is set to evolve over time. Whilst some sectors require high-skilled workers today, they will need lower-skilled workers as they progress from the innovation and installation stages to maintenance. The success of any measures taken at the EU level is dependent on effective performance assessment to adapt programmes to the changes in skills requirements.
To this end, the Commission should be tasked with monitoring and evaluating the effects of these policies and present a report following their implementation to the European Parliament and the Council. This could happen in parallel with the report that the Commission is already responsible for regarding the assessment of the EYS.[21] The Commission's report should also be based on interviews and surveys with participants in training programmes and their employers.Funding the EU's reskilling programmes
When discussing the costs of reskilling programmes, it must be borne in mind that, as older workers are overrepresented in brown sectors, the main alternative to reskilling programmes is early retirement. However, early retirement raises significant financial issues for workers who will often not have saved up enough money to support themselves in retirement. The replacement rate of pensions, which expresses the percentage of income that is replaced by pensions upon retirement, is 68 per cent on average in the EU, but only 40 per cent and 59 per cent in Poland and Croatia respectively,[22] two of the countries with the highest rates of employment in brown industries in the EU.[23] These sudden drops in income would have severe consequences for the affected older workers.
Furthermore, a sudden increase in the number of pensioners would put a strain on the economy: due to the ageing of European societies, pension systems are already unsustainable in many EU countries, and the issue would be only aggravated by mass early retirement.[24] On the contrary, studies suggest that the majority of the skill characteristics of jobs in brown sectors could be transferred to green sector jobs:[25] therefore reskilled workers could reintegrate into the workforce relatively easily.
To be sure, the creation of training programmes will incur costs. The EU Skills Agenda, however, already outlines several funding opportunities.[26] Next Generation EU, the Recovery and Resilience Facility, the European Social Fund Plus, Erasmus+, as well as the European Regional Development Fund can support new measures for up- and reskilling programmes. Furthermore, the savings achieved through reskilling rather than relying heavily on early retirement could free up new funds previously allocated to pension systems, which could be redirected towards funding skill programmes as well.The manifold benefits of reskilling and upskilling
Our proposal aims to prevent political backlash against the green transition by ensuring a smooth and fair transition towards a green economy. Without policies to provide the working-age population with reskilling and upskilling training programmes, disruptions in the labour market, labour shortages in certain sectors and rising unemployment can be expected. These outcomes, in turn, would lead many citizens to lose trust in institutions and turn against the green transition.[27]
The up- and reskilling programmes outlined here would instead help displaced workers from brown industries reintegrate into the labour market. Through a Green Energy Erasmus Programme and inclusive training programmes targeting women, low-skilled and older workers, we would allow the most affected segments of the population to find employment in emerging sectors. This would serve the twin objectives of strengthening the EU's economy, preventing political backlash against the green transition and propelling the green transition forward.Marion Beaulieu is a Master student in European Affairs, specialised in Energy, Environment and Sustainability at Sciences Po Paris. Sára Kende is a Master student in a double degree between Sciences Po Paris (European Affairs, specialised in Energy, Environment and Sustainability) and Bocconi University (Politics and Policy Analysis).
This commentary is an updated version of the winning brief from the futurEU Competition 2024, hosted by the futurEU Initiative at the Hertie School and supported by the CIVICA Alliance.[1] Anneleen Vandeplas et al., "The Possible Implications of the Green Transition for the EU Labour Market", in European Economy Discussion Papers, No. 176 (December 2022), p. 15, https://data.europa.eu/doi/10.2765/583043.[2] Bertrand Piccard and Maroš Šefčovič, "Green Jobs and the Green Transition: A Long, Bumpy but Exciting Journey", in Euractiv, 17 November 2021, https://www.euractiv.com/?p=1674933.[3] Oya Celasun et al., "Cars and the Green Transition: Challenges and Opportunities for European Workers", in IMF Working Papers, No. 2023/116 (June 2023), https://www.imf.org/en/Publications/WP/Issues/2023/06/02/Cars-and-the-Green-Transition-Challenges-and-Opportunities-for-European-Workers-534091.[4] European Commission, Special Eurobarometer 527: Fairness Perceptions of the Green Transition. Report, 2022, p. 27, https://europa.eu/eurobarometer/surveys/detail/2672.[5] European Commission, European Skills Agenda for Sustainable Competitiveness, Social Fairness and Resilience (COM/2020/274), 1 July 2020, https://eur-lex.europa.eu/legal-content/en/TXT/?uri=celex:52020DC0274.[6] European Parliament, Report on the Proposal for a Decision of the European Parliament and of the Council on a European Year of Skills 2023, 9 February 2023, https://www.europarl.europa.eu/doceo/document/A-9-2023-0028_EN.html.[7] Sofia Fernandes, "A Social Pact for the Energy Transition", in Thomas Pellerin-Carlin et al., Making the Energy Transition a European Success, Jacques Delors Institute Reports, September 2017, p. 148-211, https://institutdelors.eu/en/publications/making-the-energy-transition-a-european-success.[8] Javier Sanchez-Reaza et al., Making the European Green Deal Work for People. The Role of Human Development in the Green Transition, Washington, World Bank, 2023, http://hdl.handle.net/10986/39729.[9] Council of the European Union, Council Recommendation of 24 November 2020 on Vocational Education and Training (VET) for Sustainable Competitiveness, Social Fairness and Resilience, https://eur-lex.europa.eu/legal-content/en/TXT/?uri=celex:32020H1202(1).[10] Javier Sanchez-Reaza et al., Making the European Green Deal Work for People, cit., p. 63.[11] Veronica Vecchi, "Introduction", in European Training Foundation, Public-Private Partnerships for Skills Development: A Governance Perspective. Volume I: Thematic Overview, Publications Office of the EU, 2020, p. 9, https://data.europa.eu/doi/10.2816/422369.[12] Barbara Janta, Eliza Kritikos and Thibault Clack, "The Green Transition in the Labour Market: How to Ensure Equal Access to Green Skills across Education and Training Systems", in EENEE Analytical Reports, No. AR02/2022, https://data.europa.eu/doi/10.2766/563345.[13] European Commission, Employment and Social Developments in Europe 2023, Publications Office of the EU, July 2023, p. 54, https://data.europa.eu/doi/10.2767/089698.[14] Anneleen Vandeplas et al., "The Possible Implications of the Green Transition for the EU Labour Market", cit., p. 19-20.[15] Javier Sanchez-Reaza et al., Making the European Green Deal Work for People, cit., p. 115.[16] Aliki Georgakaki et al., "Clean Energy Technology Observatory: Overall Strategic Analysis of Clean Energy Technology in the European Union. 2023 Status Report", in JRC Technical Reports, 2023, https://data.europa.eu/doi/10.2760/150096.[17] Jannik Jansen, "When Europe Talks Climate, It Needs to Think Jobs", in Hertie School Policy Briefs, 6 December 2023, https://www.delorscentre.eu/en/publications/skilled-workers-in-the-green-transition.[18] Will McDowall et al., "Mapping Regional Vulnerability in Europe's Energy Transition: Development and Application of an Indicator to Assess Declining Employment in Four Carbon-Intensive Industries", in Climatic Change, Vol. 176, No. 2 (February 2023), Article 7, https://doi.org/10.1007/s10584-022-03478-w.[19] Ibid.[20] RWE, RWE and PPC to Build Solar Projects with More than 200 Megawatts in Greece, 26 January 2023, https://www.rwe.com/en/press/rwe-renewables/2023-01-26-rwe-and-ppc-to-build-solar-projects-with-more-than-200-megawatts-in-greece.[21] European Commission, Proposal for a Decision of the European Parliament and of the Council on a European Year of Skills 2023 (COM/2022/526), 12 October 2022, p. 18, https://eur-lex.europa.eu/legal-content/en/TXT/?uri=celex:52022PC0526.[22] OECD, Pensions at a Glance 2023. OECD and G20 Indicators, 2023, https://doi.org/10.1787/678055dd-en.[23] Anneleen Vandeplas et al., "The Possible Implications of the Green Transition for the EU Labour Market", cit.[24] Vincenzo Galasso, "Postponing Retirement: The Political Effect of Aging", in Journal of Public Economics, Vol. 92, No. 10-11 (October 2008), p. 2157-2169, DOI 10.1016/j.jpubeco.2008.04.012.[25] Anneleen Vandeplas et al., "The Possible Implications of the Green Transition for the EU Labour Market", cit.[26] European Commission, European Skills Agenda for Sustainable Competitiveness, Social Fairness and Resilience, cit.[27] Anneleen Vandeplas et al., "The Possible Implications of the Green Transition for the EU Labour Market", cit., p. 28.