Is Europe Building Phage Therapy or Funding Everyone Else? A Closer Look at Horizon Europe's €45.7 Million Investment

Horizon Europe has just funded three major clinical projects dedicated to phage therapy for antibiotic-resistant bacterial infections. Scientifically, this is excellent news. For years, bacteriophage therapy has suffered from a lack of large, randomized, multicenter clinical trials capable of convincing regulators, clinicians, hospitals and payers. The decision to support REPhRAME, P-PEAKS UTI and PHAGE4DAIR therefore marks a turning point. It signals that phage therapy is no longer being treated only as an emergency option, an academic curiosity or a compassionate-use intervention, but as a serious therapeutic field requiring robust clinical evidence.

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This article does not question the scientific quality of the selected projects. It does not question the competence of the institutions involved, nor the legitimacy of Canada, the United Kingdom, Switzerland, Israel or the United States as world-class contributors to biomedical research. Many of the laboratories, hospitals and companies involved in these projects have made important contributions to phage therapy, antimicrobial resistance research, clinical trial design, phage manufacturing and patient care. International cooperation is essential in infectious diseases, and antibiotic-resistant bacteria do not stop at borders.

But precisely because the science is important, the funding strategy deserves scrutiny.

The three projects were selected under the Horizon Europe topic “Testing safety and efficacy of phage therapy for the treatment of antibiotic-resistant bacterial infections.” Together, they represent €45,666,509.45 in European funding. The question is not whether phage therapy deserves this money. It clearly does. The question is whether the geographical distribution of this money reflects a coherent European strategy for building European capacity in one of the most promising fields against antimicrobial resistance.

The numbers are striking. Across the three projects, only €16,317,889.16 goes to institutions located inside the European Union. That represents 35.7 percent of the total. By contrast, €29,348,620.29 goes to institutions located outside the Union, representing 64.3 percent of all funding allocated across these three projects.

This is not a small statistical imbalance. It is the central fact of the call.

The United Kingdom receives €10,865,017.77, or 23.8 percent of the total. Canada receives €10,071,446.24, or 22.1 percent. Germany receives €7,084,319.14, or 15.5 percent. Switzerland receives €4,438,125.13, or 9.7 percent. The United States receives €2,618,299.13, or 5.7 percent. France receives €1,753,166.64, or only 3.8 percent.

This means that, in this European phage therapy call, Canada receives almost six times more funding than France. The United States receives more than France, Spain, Italy, Belgium, Denmark, Sweden, Austria, Hungary, Latvia or Greece individually. The United Kingdom alone receives more than all EU countries except Germany combined in several parts of the distribution. These figures do not prove wrongdoing. But they do raise a serious policy question: what exactly is Europe trying to build?

The imbalance becomes even clearer when the three projects are examined separately.

PHAGE4DAIR, focused on Staphylococcus aureus prosthetic joint infections treated with DAIR surgery, receives €14,869,038.73. Of that amount, only €2,379,546.01 goes to EU-based participants, while €12,489,492.72 goes outside the European Union. In other words, 84 percent of the funding in this project goes to non-EU participants. The coordinator is Qeen Biotechnologies in Canada, which alone receives €4,374,508.37. United Kingdom-based partners receive substantial amounts, including University College London with €1,979,119.00 and Micron Research Limited with €1,779,376.25. France participates through Hospices Civils de Lyon, Centre Hospitalier Universitaire de Nice and Université Claude Bernard Lyon 1, but the combined French amount remains far below the Canadian and British totals.

P-PEAKS UTI, dedicated to personalized phage therapy against recurrent Escherichia coli urinary tract infections, receives €15,597,531.54. Here again, the project is coordinated outside the European Union, by Unity Health Toronto in Canada, which receives €2,378,462.33. The project includes major non-EU beneficiaries, including Qeen Biotechnologies in Canada, Mayo Clinic, Baylor College of Medicine and the Regents of the University of California in the United States, as well as Hadassah Medical Organization and the Hebrew University of Jerusalem in Israel. In total, €11,566,272.44 goes outside the European Union, representing 74.2 percent of the project’s funding. EU-based participants receive €4,031,259.10, or 25.8 percent.

REPhRAME is the only one of the three projects where the balance is clearly more European. Coordinated by Johann Wolfgang Goethe University Frankfurt, it receives €15,199,939.18. Around €9,907,084.05 goes to EU-based participants, while €5,292,855.13 goes outside the EU. The project involves strong German participation, including Goethe University Frankfurt, University Hospital Cologne, Hannover Medical School, Fraunhofer-Gesellschaft, LINQ Management and the German Center for Infection Research. It also includes SNIPR Biome in Denmark, JAFRAL in Slovenia, Riga Stradiņš University in Latvia, HUN-REN Biological Research Centre in Hungary, Leiden University Medical Center in the Netherlands, and partners from Switzerland and the United Kingdom. This project appears more consistent with the idea of building European clinical and translational capacity, although significant funding still goes to non-EU countries.

Taken together, these three projects reveal a paradox. Horizon Europe is Europe’s flagship research and innovation programme. Its stated purpose is not only to fund excellent science, but also to strengthen European research, innovation, competitiveness, technological leadership and resilience. Yet in this phage therapy call, nearly two thirds of the money flows outside the European Union.

Again, this is not an argument against international science. It is not a criticism of Canadian phage centres, British clinical trial units, Swiss bioinformatics teams, Israeli hospitals or American academic institutions. Many of them are outstanding. Some possess expertise that Europe may genuinely need. The criticism is directed primarily at the European system itself. If Europe needs to outsource such a large fraction of one of its most strategic antimicrobial resistance calls, then this reveals either a weakness in European capacity, a failure to support existing European expertise, or a lack of political will to build durable industrial and clinical infrastructure within the Union.

The issue is even more sensitive because phage therapy is not a field where Europe starts from nothing. Europe has a long and complex history with bacteriophages. France, Belgium, Poland, Georgia, Germany, the Netherlands and several Central and Eastern European countries have contributed to phage science for decades. European hospitals have treated patients under compassionate-use frameworks. European companies are developing phage products. European laboratories work on phage biology, manufacturing, biofilms, pharmacology, microbiome interactions, resistance mechanisms and regulatory science.

If a major European clinical funding call still ends up sending most of its resources outside the Union, the explanation cannot simply be that Europe lacks expertise. The question is more uncomfortable: why has European expertise not been organized, financed and politically supported strongly enough to lead more of these projects?

The geographical distribution inside Europe also deserves attention. Germany emerges as the main EU beneficiary, receiving more than €7 million across the three projects. France receives around €1.75 million. Slovenia receives €1.65 million, largely through JAFRAL in REPhRAME. Estonia receives €1.42 million, mostly through P-PEAKS UTI. Italy receives €615,756.16. Belgium receives €602,628.29. Spain receives €406,948.60. Hungary receives €377,000. Latvia receives €350,000. Denmark receives €297,769.50. Sweden receives €145,375.

This distribution is not random. It reflects the unequal capacity of European institutions to build successful consortia, attract leadership roles and capture high-value tasks such as coordination, manufacturing, trial management, data analysis and regulatory strategy. But it also illustrates a broader structural problem in European research funding: excellence-based competition often reinforces existing power centres. Countries and institutions already well connected to major networks tend to obtain more funding, while less connected regions struggle to become central players, even when they possess relevant expertise.

This matters particularly for phage therapy. Some of the most historically important phage traditions in Europe come from regions that do not necessarily dominate Horizon Europe funding. If Europe wants to build a serious phage therapy ecosystem, it cannot rely only on the same narrow circle of countries and institutions. It must also integrate clinical, microbiological and manufacturing capacities across Eastern, Central and Southern Europe, where phage therapy has often been more culturally and scientifically familiar than in Western regulatory systems.

The role of associated and third countries complicates the picture. The United Kingdom, Switzerland, Israel and Canada have specific relationships with Horizon Europe. Associated countries contribute financially to the programme and can participate under conditions that are often close to those of EU Member States. Their participation is therefore not simply “free access” to European funds. In principle, there are financial contributions, correction mechanisms and negotiated agreements.

However, this does not fully resolve the transparency problem. While the European Commission publishes detailed data on who receives Horizon Europe grants, it is much harder for ordinary citizens to find a simple, official and regularly updated table showing how much each associated country contributes annually and how much it receives back. The absence of an easily accessible “paid versus received” dashboard weakens public accountability. If the system is fair, balanced and mutually beneficial, then the numbers should be easy to publish and easy to compare.

The United States is a different case. It is not an associated country to Horizon Europe. Yet American institutions receive more than €2.6 million across these three phage therapy projects. Their involvement may be scientifically justified, particularly when they bring unique clinical expertise, patient cohorts, regulatory experience or phage therapy infrastructure. But from a European sovereignty perspective, the question remains legitimate. If American institutions can receive millions from a European programme in a strategic biomedical field, what exactly is the threshold for deciding that non-European participation is essential? Who evaluates that necessity? And how is the long-term return for Europe measured?

This is where the debate becomes political rather than technical.

Europe has repeatedly declared its ambition to strengthen its strategic autonomy in health, biotechnology, pharmaceutical production and antimicrobial resistance preparedness. The COVID-19 pandemic exposed the fragility of supply chains. Antibiotic resistance is widely recognized as a major public health threat. Phage therapy sits at the intersection of several strategic priorities: infectious disease control, biological manufacturing, personalized medicine, microbiome science, synthetic biology and regulatory innovation.

If Europe wants to become a leader in these areas, funding excellent international projects is not enough. It must ensure that public money builds lasting capacity inside Europe: GMP phage manufacturing, hospital-based phage therapy units, standardized susceptibility testing platforms, clinical trial networks, biobanks, regulatory expertise, data infrastructure, and companies capable of bringing products to market.

Otherwise, Europe risks paying for science without building sovereignty.

This does not mean closing the door to international partners. That would be scientifically foolish. Phage therapy needs global collaboration. Resistant infections are global. Clinical trials require patients, diversity of strains, standardized methods and international regulatory dialogue. Canada, the United Kingdom, Switzerland, Israel and the United States all have valuable contributions to make.

But collaboration should not become dependency. International excellence should strengthen European capacity, not replace it. If European funding systematically relies on non-EU coordinators, non-EU production centres, non-EU trial infrastructure and non-EU commercial actors, then Europe may end up financing the future market without controlling enough of the future value chain.

This is especially important because clinical trials are not neutral scientific objects. They shape standards. They define endpoints. They validate products. They create regulatory precedents. They build industrial credibility. The institutions that coordinate them gain visibility, authority and strategic advantage. In emerging fields, early leadership matters. The actors who run the first major randomized trials often shape the field for years.

That is why the allocation of these funds matters beyond the immediate amounts. The issue is not simply that Canada receives €10 million, or that the United States receives €2.6 million, or that the United Kingdom receives €10.8 million. The issue is what these numbers reveal about the balance of power in the emerging phage therapy ecosystem.

A fair defense of Horizon Europe would argue that these consortia were selected because they were scientifically excellent, clinically credible and capable of delivering results. That may be true. But if the best proposals in a European phage therapy call are so heavily dependent on non-EU partners, then Europe should ask itself why. Did European institutions lack comparable infrastructure? Were European companies insufficiently supported before the call? Were hospital networks fragmented? Were regulatory pathways too unclear? Did European phage actors fail to coordinate? Or did the call design itself favor large international consortia with established Anglo-American clinical research infrastructure?

These questions are not anti-science. They are pro-strategy.

The goal should not be to exclude non-European partners. The goal should be to ensure that European public funding produces a European return: scientific, clinical, industrial and societal. Patients in Europe should benefit from faster access to phage therapy. European hospitals should gain expertise. European regulators should receive better data. European companies should be able to grow. European manufacturing capacity should expand. European citizens should be able to see where their money goes and what it builds.

At present, the available figures suggest a mixed picture. The call is scientifically ambitious and potentially transformative. It may generate crucial evidence for phage therapy. It may help patients with recurrent urinary tract infections and prosthetic joint infections. It may accelerate the regulatory normalization of bacteriophage-based treatments.

But it also reveals a troubling imbalance. In a €45.7 million European funding effort for phage therapy, less than 36 percent of the money goes to EU-based institutions. Two of the three projects are coordinated from Canada. The United States, although not associated with Horizon Europe, receives more funding than most EU Member States in this call. France, despite its active phage therapy landscape and recent institutional progress, receives less than 4 percent of the total. Several European countries with historical or emerging phage expertise remain marginal.

That should not be dismissed as a technical detail. It is a political signal.

Europe can and should cooperate with the world. But cooperation must not become a substitute for ambition. If the European Union wants to lead in phage therapy, antimicrobial resistance and next-generation biological medicines, it must not only fund trials. It must build an ecosystem. It must support its own hospitals, companies, manufacturing platforms, regulatory science and clinical networks with the same intensity that it supports international excellence.

The real question raised by these grants is therefore not whether Canada, the United Kingdom, Switzerland, Israel or the United States deserve to participate. Many of their teams clearly do. The real question is why Europe, with its scientific history, clinical needs, public money and stated ambitions, still appears unable to keep the majority of a strategic phage therapy call within its own borders.

That is not an accusation. It is a warning.

Sources : 

1) CORDIS, PHAGE4DAIR, Grant agreement ID 101287116, European Union contribution: €14,869,038.73. https://cordis.europa.eu/project/id/101287116

2) CORDIS, REPhRAME, Grant agreement ID 101287159, European Union contribution: €15,199,939.18. https://cordis.europa.eu/project/id/101287159

3) CORDIS, P-PEAKS UTI, Grant agreement ID 101289070, European Union contribution: €15,597,531.54. https://cordis.europa.eu/project/id/101289070

4) European Commission, Horizon Europe association policy and rules for associated countries. https://ec.europa.eu/info/funding-tenders/opportunities/docs/2021-2027/common/guidance/list-3rd-country-participation_horizon-euratom_en.pdf

5) European Commission, Horizon Europe country profiles and public funding data. https://research-and-innovation.ec.europa.eu/statistics/framework-programme-facts-and-figures/horizon-europe-country-profiles_en

6) Unity Health Toronto, “Unity Health to lead $25M international trial using viruses to treat drug-resistant infections,” 26 June 2026.https://unityhealth.to/2026/06/international-trial-using-viruses-to-treat-drug-resistant-infections/

7) Universitätsmedizin Frankfurt / REPhRAME public project communication, “Using Viruses Against Bacteria: €15 Million for Phage Therapy.”https://www.uni-frankfurt.de/en/newsroom/meldungen/pressemitteilungen/2026/mit-viren-gegen-bakterien-15-millionen-fuer-phagentherapie