Fewer Than Half Had a Plan: Europe's Deadly Heatwave and the Preparedness Gap That Widened It

The call lasted several hours. More than 130 people joined — health ministers, emergency management directors, public health officials from 41 of the 53 countries in the WHO European Region, alongside representatives from the European Commission and civil society. The agenda was blunt: what went wrong in the June heatwave, are we ready for what is coming next, and what does a real heat response system actually require? The answers that came back were, in the words of WHO's regional director, a mix of genuine progress and gaps "we cannot afford to ignore."

The next heatwave was already forming over the Atlantic when Dr. Hans Henri P. Kluge issued his statement on July 7. Portugal and southern Spain were forecast to reach 43°C within days. France and the Benelux were bracing for another surge. Parts of central Asia were already baking under 40°C. The continent had not finished responding to one crisis before the next one began to build.

The Deaths Behind the Number

By July 5, confirmed excess mortality data across Europe had already surpassed 5,600 deaths attributable to the June heatwave. That figure is a floor, not a ceiling. A preliminary continental modelling study — drawing on historical excess mortality patterns from prior heatwaves and applying them to the scale and geographic spread of the June event — puts the plausible total near 20,400 excess deaths for the entire wave. France, Germany, Spain, and Italy account for the largest share. These are not deaths from a new pathogen or an unpredicted disaster. They are deaths from heat — a hazard that is predictable, measurable, and for which clinical and public health interventions are well established.

The 2003 European heatwave, which killed an estimated 70,000 people over several weeks, triggered a generation of investment in heat-health preparedness across the continent. France built a national surveillance and alert system. Italy followed. Other countries began drafting plans. More than two decades later, those systems — where they exist — are performing. Where they do not, the gap is measured in lives.

What a Plan Actually Does

A national heat-health action plan is not a document. It is a system — one that links meteorological forecasts to public health responses before a heatwave arrives. Done well, it specifies which government agency is responsible for what at each temperature threshold, which populations are at highest risk, when health-service surge planning is activated, and how cross-sector coordination between health, housing, social care, occupational health, and urban planning authorities is triggered and sustained.

The emergency call on July 6 produced concrete illustrations of what that looks like in practice. Italy's mortality surveillance system, active across 45 cities, gives decision-makers near real-time data during a crisis — enabling response adjustments as conditions evolve, rather than after the fact. Spain worked directly with broadcast and print media partners to improve how heat-health risk is communicated, reducing the time between a warning being issued and the public understanding what it means for them personally. Austria activated its updated national plan, implemented workplace heat-protection regulations — a category of harm that is chronically underaddressed — and convened national and regional coordination structures at speed. Belgium triggered its highest heat alert level, only the second time since 2020. France demonstrated how early cross-sector coordination reduced pressure on health services during peak demand. North Macedonia partnered with Red Cross and Red Crescent teams to reach people without permanent housing — a group that formal health systems almost universally fail during heat emergencies because they are, by definition, outside them.

These are not experimental interventions. They are proven, replicable responses that exist in the evidence base and that require, above all, prior investment in coordination structures before any specific heatwave arrives. The countries that had those structures used them. The countries that did not faced the same heat with none of the same tools.

The Gap That Killed People

Fewer than half of the 53 WHO European Region member states have a national heat-health action plan in place. That is the most direct finding from the July 6 emergency call, stated plainly in Kluge's statement, and it is the clearest explanation for why the same heatwave produced such different outcomes across the continent.

Countries named specific gaps during the call. Many said their populations did not recognize they were personally at risk even as a Code Red alert was active — a failure of health communication, but also of trust built over repeated false alarms in prior seasons. Others identified acute shortages of cooling facilities, and critically, a lack of public information about where those facilities were and how to access them. Several flagged procedural delays in formally declaring a heatwave, a bureaucratic gap that can slow public health action by hours or days at the moment it matters most. Across the region, three groups were consistently not being reached: long-term care residents, homeless people, and socially isolated older adults — the populations who cannot self-protect, whose situations are not captured in real-time by standard health surveillance, and who die in private, in rooms without air conditioning, without anyone checking on them until it is too late.

What WHO Heard, and What Comes Next

Kluge's statement identified something that matters beyond the body count: a structural shift is beginning. Emergency management bodies are sitting down with health policy teams. Urban planners are at the same table as public health officials. Environment ministries and health ministries are in the same room. That cross-government coordination — built around the recognition that extreme heat is a health security threat, not a single-sector problem — is the foundation on which plans are built and the reason they work when they exist.

WHO Europe committed after the July 6 call to three concrete actions: synthesizing lessons from the current heatwave and sharing them with all 53 member states; providing direct technical support to countries with immediate implementation needs; and remaining available to any member state that wants help strengthening its plan, improving implementation, or building the cross-sector structures that turn a document into a functioning system. The next wave, as of the statement's publication, was already forming.

The tools exist. The evidence base is strong. A heat-health action plan, structured well and pre-positioned before a wave arrives, saves lives in measurable and attributable ways. The continent has known this since 2003. What has been missing, in more than half the countries that share the European Region, is the political decision to build one — and the sustained investment to maintain it through the years when the heat does not arrive and the urgency fades. The 20,400 figure is a preliminary estimate. The gap it represents is not.