AGP Executive Report

West Nile Virus Alert: A potentially lethal West Nile virus outbreak is being reported across Europe, with the Netherlands adding cases after 56 infections and nine deaths; health officials warn symptoms can be flu-like but severe illness can include meningitis, encephalitis, and paralysis. Cross-Border Health Access Dispute: North Macedonia’s refusal to let Bulgarian MP/committee chair Angel Georgiev enter the country has been linked to the case of Iva Mihaylova, who says her health is deteriorating and she needs treatment in Bulgaria after a 2025 road accident left her unable to travel. Court Case Update (Mihaylova): A long hearing in Kočani included additional questioning of a forensic doctor and concerns raised about gaps in the investigation, with the next hearing set for November 9. Questionable Cancer Treatment Probe: Greek authorities have intervened after complaints about a Thessaloniki clinic allegedly offering expensive “alternative” cancer treatment claims using electrical energy to destroy cancer cells. US Pharma Tariff Exemption (Trade + Access): The US has exempted select specialty medicines and ingredients from a planned 100% tariff, including categories such as orphan drugs, fertility treatments, cell/gene therapies, and antibody-drug conjugates—covering North Macedonia among 20 eligible jurisdictions. Bee Health Risk: Experts in North Macedonia are discussing containment as the invasive Tropilaelaps mite reaches Turkey, raising fears for European honey bees.

Cross-border healthcare access dispute: North Macedonia denied entry to Bulgarian MP and committee chair Angel Georgiev to attend a Kočani hearing in the Iva Mihaylova case, where she says she needs treatment abroad after her documents were seized following a 2025 road crash. Court scrutiny in a medical-treatment case: The latest Mihaylova hearing ran for over 10 hours, with additional questioning of a forensic doctor and concerns raised about gaps in the investigation and whether key materials were properly examined. Public health warning: West Nile virus is being reported across 16 European countries, with serious illness and deaths noted in several; health authorities are urging mosquito-bite prevention. Cancer-treatment red flag abroad: A Thessaloniki-linked clinic is under investigation over claims of “cancer treatment” using alternative electrical-energy methods, with questions about the doctor’s registration and the evidence behind universal cancer claims. Tobacco cessation and warnings: Serbia is set to introduce graphic smoking-cessation and health-warning images on cigarette packs from June 1, 2027, including messages tied to lung cancer and other diseases. Pharma trade impact: The US exempted select specialty drugs and ingredients from a planned 100% tariff, listing North Macedonia among eligible jurisdictions for certain rare-disease and advanced therapies.

Cancer Care Scrutiny: A Skopje-linked clinic in Thessaloniki is under investigation after complaints that it offers “cancer treatment” using alternative electrical-energy claims, including promises to treat all cancer types; prosecutors have stepped in and the doctor is registered as a surgeon, not an oncologist. Forensic Case Update: In Kočani, the trial of Iva Mihaylova continued for over 10 hours with additional questioning of a forensic doctor and concerns raised about gaps in the investigation; the next hearing is set for November 9. Cross-Border Access to Treatment: Mihaylova says her health is deteriorating and she needs treatment in Bulgaria for spinal injuries, while a Bulgarian MP was reportedly denied entry to North Macedonia for the hearing. Infectious Disease Watch: West Nile virus is being reported across 16 European countries, with warnings that severe illness can occur in a small share of cases; health authorities urge mosquito-prevention measures. Tobacco Warning Labels (Regional): Serbia is moving to graphic smoking-cessation warnings on cigarette packs from June 1, 2027, including images tied to lung and mouth cancer. Pharma Trade Policy: The US has exempted certain specialty medicines and ingredients from a planned 100% tariff, listing North Macedonia among eligible jurisdictions for specific categories like rare-disease drugs, fertility treatments, and cell/gene therapies.

Forensic Case in Kočani: The latest hearing in the Iva Mihaylova road-accident trial in North Macedonia ran for over 10 hours, with prosecutors and defence disputing forensic findings, including claims that certain vehicle materials were not properly examined and that gaps may exist in the investigation. Cross-Border Medical Access: Bulgarian MPs say Mihaylova’s health is deteriorating and that she needs treatment abroad for spinal injuries; her documents were reportedly seized after the crash, limiting travel for care. Court Attendance Blocked: Vazrazhdane MP Angel Georgiev was reportedly denied entry to North Macedonia for the hearing, raising further concerns about access and process. Public Health Alert: West Nile virus is being reported across 16 European countries, with serious cases and deaths noted in several places; health authorities are urging mosquito-bite prevention. US Pharma Tariff Relief (Regional Impact): The US exempted certain specialty drugs and ingredients from a planned 100% tariff, including products for rare diseases, fertility, cell/gene therapies and antibody-drug conjugates, with North Macedonia listed among eligible jurisdictions.

Tobacco Warnings: Serbia is set to require graphic health warnings on cigarette packs from June 1, 2027, including images such as a black toe, tongue cancer and coughing up blood, plus quit-smoking help lines—an approach already seen in North Macedonia and Turkey. Infectious Disease Alert: West Nile virus is being reported across 16 European countries, with six seeing higher case numbers in the past month and some deaths; most infections are mild or symptom-free, but a small share can lead to severe illness affecting the brain and nerves. US Drug Tariffs (North Macedonia Included): The US has exempted certain specialty medicines and their ingredients from a planned 100% tariff, with North Macedonia listed among 20 eligible jurisdictions; the zero-tariff applies only to specific categories like rare-disease drugs, fertility treatments, cell and gene therapies, and antibody-drug conjugates. Cross-Border Care Dispute: In the Iva Mihaylova road-accident case, Bulgarian MPs and Mihaylova’s side say she cannot access needed spinal treatment in North Macedonia and that her health is deteriorating; the next hearing is scheduled for November 9.

US Pharma Tariff Relief: The US Commerce Department says it will exempt certain speciality medicines and related ingredients from a planned 100% ad valorem tariff starting 29 September, with zero duty applying to categories like orphan drugs, fertility treatments, cell and gene therapies, and antibody-drug conjugates—plus some medical countermeasures and animal pharmaceuticals. North Macedonia in the List: North Macedonia is named among 20 eligible jurisdictions for the zero-tariff treatment, meaning qualifying products from the country could avoid the new import duties if they meet the specialty criteria. Court & Care Access: In the Iva Mihaylova case tied to a 2025 road crash near Kočani, Bulgarian MPs and Mihaylova’s side argue she must receive appropriate treatment abroad for spinal injuries, while the next hearing is set for 9 November. Public Health Watch: A West Nile virus outbreak is reported across 16 European countries, with warnings that while most infections are mild, a small share can become severe, including meningitis or encephalitis.

US Pharma Tariff Relief: The US Commerce Department says select specialty drugs and related ingredients imported from India and 19 other jurisdictions—including North Macedonia—will face 0% ad valorem tariffs as a 100% pharma tariff phase-in approaches on September 29. The exemption targets rare-disease medicines, fertility treatments, cell and gene therapies, antibody-drug conjugates (ADCs), and veterinary pharmaceuticals, with some manufacturing components also covered. Court & Access to Care: In Kočani, the trial of Bulgarian-North Macedonian citizen Iva Mihaylova continues; she says her health is worsening and that she needs treatment in Bulgaria for spinal injuries not available in North Macedonia, while Bulgarian MPs report disruptions to travel for hearings. Infectious Disease Watch: A West Nile virus outbreak is reported across 16 European countries, with Travel Health Pro warning that while most cases are mild, a small share can become severe, including meningitis or encephalitis.

US Drug Tariffs: The US Commerce Department says it will apply a 0% ad valorem tariff to certain specialty drugs and ingredients from India and 19 other jurisdictions—including North Macedonia—as a 100% tariff on some patented pharma imports is set to start on Sept. 29. Court & Care Access: In the ongoing Iva Mihaylova case in Kočani, Bulgarian MP Boyko Mladenov says she is entitled to appropriate treatment regardless of the trial outcome, while the latest hearing ran over 10 hours and the next session is set for Nov. 9. Travel Denial: Bulgarian MP Angel Georgiev was reportedly denied entry to North Macedonia for the hearing, citing unpaid court costs. Health Alert: A potentially lethal West Nile virus outbreak has been reported across 16 European countries, with warnings to take preventative measures against mosquito bites.

Medical Access & Justice: Iva Mihaylova, charged after a 2025 crash near Kocani, says her health is worsening and she urgently needs spinal treatment abroad because the procedure isn’t available in North Macedonia; she claims she can’t travel to Bulgaria due to document confiscation tied to her court case. Human Rights Spotlight: Bulgarian President Iliana Iotova raised Mihaylova’s case at the UN, saying Bulgaria offered treatment options or a medical team, but Skopje did not agree—adding pressure on how medical care is handled during legal proceedings. Antibiotic Stewardship (Regional): Bulgaria reports a sustained drop in antibiotic use after mandatory digital prescriptions introduced in 2024, with outpatient use down further in 2025–2026—an example of how tighter prescribing rules can reduce consumption. Healthcare Workforce Context: A rural doctor story from the region highlights how ageing medical staff and shortages of younger doctors keep care running in remote communities. Pharma Policy (Global, Includes North Macedonia): The US Commerce Department clarified specialty-drug tariff exemptions ahead of September 29, listing North Macedonia among eligible jurisdictions for zero tariffs on specified medicines and ingredients under trade/security frameworks.

Rural Health & Access: North Macedonia’s shrinking school network is closing more rural facilities, with communities like Struga’s villages left without local primary schools and children pushed to larger centers—an indirect hit to everyday access and social support for families. Sports Medicine Spotlight: Scott McTominay says he’s back in individual training after a heart operation for a benign arrhythmia, with Napoli confirming his recovery plan. Injury Watch (Regional): Benjamin Sesko has withdrawn from Slovenia’s Nations League squad due to a recurring shin injury, with medical tests planned—he’s expected to miss matches including against North Macedonia. Public Health Policy (Regional): Bulgaria reports a sustained drop in antibiotic use after mandatory digital prescriptions introduced in 2024, cutting outpatient antibiotic consumption further in 2025–2026. Health Rights & Care Access: Bulgaria’s President Iliana Iotova raised concerns at the UN about alleged discrimination and a case involving Iva Mihaylova, who reportedly was denied medical treatment in Bulgaria due to legal proceedings in North Macedonia.

Rural Health & Access: North Macedonia’s shrinking school network is closing rural primary schools as birth rates and emigration cut student numbers, with families forced to commute to larger towns—an indirect pressure on local community life and access to services. Cross-Border Care Dispute: Bulgaria’s President Iliana Iotova raised concerns at the UN about Iva Mihaylova, saying she has been blocked from receiving medical treatment in Bulgaria while legal proceedings continue in North Macedonia. Antibiotic Stewardship (Regional): Bulgaria reports a sustained drop in antibiotic use after mandatory digital prescriptions introduced in 2024, cutting outpatient antibiotic consumption by about 20% in 2025 and a further 10–15% in 2026—relevant for regional antimicrobial resistance efforts. Healthcare Policy Watch (US): The US Senate HELP committee is set to consider key health leadership nominations (FDA commissioner, surgeon general, mental health and aging roles), alongside ongoing scrutiny of healthcare affordability and public health preparedness. Medical Workforce Context (Regional): A report highlights how ageing rural doctors in the region keep clinics running due to too few younger replacements, underscoring staffing pressures that North Macedonia also faces.

Rural Health & Access: North Macedonia’s shrinking school network is closing more rural schools as student numbers fall, with parents worried about safety and longer commutes—an indirect hit to child wellbeing and access to services. Cross-Border Rights & Care: Bulgaria’s President Iliana Iotova briefed UN High Commissioner Volker Turk over alleged pressure on Bulgarians in North Macedonia and the case of Iva Mihaylova, who says she was denied medical treatment in Bulgaria amid legal proceedings in Kocani. Antibiotic Stewardship (Regional signal): Bulgaria reports a sustained drop in antibiotic use after mandatory digital prescriptions introduced in 2024, cutting outpatient use by about 20% in 2025 and a further 10–15% in 2026—useful context for North Macedonia’s antimicrobial resistance efforts. Health Policy Watch (Global): The U.S. clarified specialty drug exemptions under Section 232 tariffs, including a narrower “urgent U.S. health need” pathway that requires product-level requests before the Sept. 29 deadline.

EU Integration: MEP Kristian Vigenin said North Macedonia’s EU accession talks are not a bilateral issue with Bulgaria, urging Skopje to speed up reforms and the EU to respond once conditions are met. Rural Health & Access: A report on North Macedonia’s shrinking school network highlights how closures and mergers are reshaping rural communities—an indirect pressure point for long-term access to services, including healthcare, as families move toward larger towns. Healthcare Policy (Regional): Bulgaria reported a sustained drop in antibiotic use after mandatory digital prescriptions introduced in 2024, with outpatient antibiotic use down about 20% in 2025 and a further 10–15% in 2026—showing how prescribing rules can curb misuse. Medical Care & Rights: Bulgarian President Iliana Iotova briefed UN High Commissioner Volker Turk on alleged rights violations in North Macedonia, including the case of Iva Mihaylova, who says she was denied medical treatment in Bulgaria while facing legal proceedings in North Macedonia. Public Health Compliance: Swiss prosecutors opened an investigation into Granit Xhaka over an alleged forged COVID-19 vaccination certificate; he admitted the decision was a mistake and apologized, underscoring ongoing scrutiny of health documentation.

EU Accession & Rights: Bulgarian MEP Kristian Vigenin says North Macedonia’s EU integration is not a “bilateral matter” and urges faster reforms, while UN General Assembly briefings also spotlight alleged discrimination and access-to-care issues affecting Bulgarians in North Macedonia, including the Iva Mihaylova case. Rural Health & Care Access: A report on shrinking rural school networks in North Macedonia underlines how depopulation and service closures can worsen access to support for families—an issue that often overlaps with broader healthcare access challenges. Medical Workforce Context (Regional): A profile of a 90-year-old rural doctor in Bulgaria treating 1,500+ patients highlights the wider regional strain of ageing healthcare staff and the difficulty of replacing them in remote areas. Public Health Policy (Regional): Bulgaria’s antibiotic use is reported to be down at least one-third after mandatory digital prescriptions introduced in 2024, with officials pointing to the need to shift toward narrower-spectrum options. Health & Safety Tech Debate (Europe): On World Patient Safety Day, a European network discusses how smart home monitoring for older people could help after falls or illness—while raising privacy concerns about cameras and microphones.

Health diplomacy & rights: Bulgaria’s President Iliana Iotova briefed UN High Commissioner Volker Turk on alleged rights violations against Bulgarians in North Macedonia, including claims of people losing jobs, being denied university access, and a case involving Iva Mihaylova reportedly not allowed to get medical treatment in Bulgaria while facing proceedings in Kocani. Access to care: The briefing says Bulgaria offered either treatment in Bulgaria or a Bulgarian medical team consultation, but Skopje did not agree. Rural healthcare workforce: A report highlights 90-year-old GP Dr Kiril Apostolov in Bulgaria’s Skrat, still seeing 1,500+ patients across villages—an example of aging medical staffing and the shortage of younger doctors willing to work rurally near North Macedonia. Older adults & privacy: A European network (COST Action GoodBrother) discusses smart home support for seniors—cameras and microphones that can detect falls or alert carers—while warning about privacy and surveillance concerns. Antibiotic stewardship (regional lesson): Bulgaria reports a sustained drop in antibiotic use after mandatory digital prescriptions in 2024, with authorities urging a shift toward narrower-spectrum options in outpatient care.

Heart Health & Return to Play: Napoli says Scotland forward Scott McTominay has resumed individual training after heart surgery for a benign arrhythmia, with a possible comeback targeted after the international break. Public Health & Antibiotics: Bulgaria reports a sustained drop in antibiotic use in human medicine after mandatory digital prescriptions were introduced in 2024, with authorities citing at least a one-third decline and urging more use of narrower-spectrum options. Patient Access & Rights: Bulgaria’s President Iliana Iotova briefed the UN human rights chief on alleged rights violations tied to Iva Mihaylova, including claims she was blocked from medical treatment in Bulgaria. Rural Healthcare Workforce: A 90-year-old GP in a Bulgarian mountain village continues seeing 1,500+ patients, highlighting the strain of an ageing rural doctor workforce and shortages of younger replacements. Privacy-Aware Tech for Seniors: A European network discusses how cameras and microphones could help older people live independently while protecting privacy and limiting surveillance fears. Healthcare Integrity: Swiss prosecutors are investigating Granit Xhaka over alleged forged COVID-19 vaccination documentation, as he publicly admits the decision was a mistake. Regional Medical Readiness: Montenegro hosted Common Challenge 2026, a multi-country mountain training exercise that included medical and rescue care in hard-to-reach terrain with participation from North Macedonia.