Part I — Situation overview

Within one week three pieces of data appeared, all pointing in the same direction. On 28 October Portfolio processed the quarterly data of the National Centre for Public Health and Pharmacy (NNGYK), the institution that carries out national epidemiological data collection. According to these, the number of reported syphilis cases rose from 1,157 to 2,053 between 2023 and 2025, that is, by almost 80 per cent in two years. In the first half of 2026, 1,369 cases were reported, compared with 782 in the same period of the previous year. The share of women rose from under 30 per cent in 2023 to 46.4 per cent by the second quarter of 2026. The number of congenital syphilis cases was 74 in 2025 and 63 in the first half of this year. On 27 October 24.hu presented a study in the scientific journal Nature Health. Based on data from 854 European cities, the researchers estimated this summer’s heat-related mortality. According to the study, during the heatwaves of June and early August Hungary had the highest mortality per million inhabitants. On the evening of 28 October Viktória Lőrincz, Minister for Rural and Settlement Development, announced that in the Government’s 2027 budget proposal the fund helping to fill vacant GP practices will rise to HUF 1.75 billion.

The background is known. In August the Government tightened antenatal care: it introduced repeat syphilis screening in the second trimester and testing in the delivery room. In mid-September NNGYK issued a new national protocol. MIAK published several analyses on heat over the summer; among other things, the blog of 30 July proposed a weekly excess mortality report and a heat vulnerability map. On GP districts, the blog of 3 October called for a public district map and a numerical target. This analysis does not revisit these.

MIAK’s reading: the common root of the two signals is the invisibility of public health. Both the spread of the infection and heat deaths become news only when the data already show the damage. Until then, barriers to access, the missing post-assessment and the failure to reach vulnerable groups operate silently. The new tightening measures point in the right direction, but without measurable targets and a public data series it will not become clear whether they are enough.

Part II — Foundations in the literature

Three European professional sources provide a framework for interpreting the two signals. Bernd Rechel, Elke Jakubowski, Martin McKee and Ellen Nolte, authors at the European Observatory on Health Systems and Policies, warn in their volume on the organisation of public health services in Europe that this work is mostly invisible. It is therefore easily underfunded and comes into the spotlight only when an epidemic breaks out. The European Health Report 2024 of the World Health Organization (WHO) Regional Office for Europe describes heat as the deadliest climate-change-related extreme phenomenon in the region. According to the report, a heat–health action plan depends on reaching vulnerable groups, especially older people. The OECD and European Commission publication Health at a Glance: Europe 2024 shows with EU data that extreme temperatures cause the largest share of deaths among the oldest. The detailed discussion of the literature — by author, with quotations — can be found in section 6.4 Literature in detail.

Part III — MIAK’s concrete proposal

MIAK proposes three measurable measures. Two concern the spread of syphilis, and one concerns the retrospective assessment of heat mortality and reaching vulnerable older people.

3.1 Free and anonymous screening and treatment independent of insurance status (by 1 March 2027)

According to Válasz Online, as quoted by Portfolio, one of the main obstacles to rapid treatment is that care is tied to social security entitlement. At the end of 2025 about 5 per cent of the population, almost half a million people, did not have valid insurance. Anyone without a valid social security identification number (TAJ) has to pay for both the test and the medicine. MIAK proposes that, on the initiative of the Minister of Health, legislation should lay down that screening and treatment for syphilis and other sexually transmitted infections are free of charge regardless of insurance status and can also be used anonymously. If this requires an amendment to an act, the Government should submit a bill to Parliament. In the counties most affected relative to population (Heves, Jász-Nagykun-Szolnok, Szabolcs-Szatmár-Bereg, Bács-Kiskun) and in Budapest, NNGYK should launch mobile, field-based screening. This should also reach the clients of the social care system, homeless services and child protection institutions. At a targeted screening in Northern Hungary the positivity rate was 25 per cent, which indicates a large hidden infection burden. The case density in Heves county is three times the national average, and according to the press monitor these regions are also areas with a GP shortage. Screening should therefore not rely on the local surgery, but on its own outreach capacity. This is an application of the targeted, territorial screening principle of the E4 prevention data programme. According to Rechel and his co-authors (see 6.4.1), communicable disease control is the task of local-level public health services, with central support.

3.2 Repeat antenatal screening at the end of pregnancy and a monthly public data series (within 90 days)

The Hungarian tightening in August repeats the screening in the second trimester. However, the standards of care issued in September by the European Centre for Disease Prevention and Control (ECDC), the EU’s specialised epidemiological agency, expect repeat screening in the third trimester as well in cases of increased risk. MIAK proposes that the Minister of Health also introduce this by reviewing the professional guideline within 90 days. The risk group should be determined by the antenatal care physician and the health visitor, based on a simple, public checklist. The data are just as important. According to Portfolio, NNGYK’s 2026 tables do not include laboratory-confirmed foetal deaths due to the infection, so the actual burden may be greater than published. MIAK’s proposal: NNGYK should publish monthly, broken down by county, in machine-readable form, the reported syphilis cases by sex, the congenital cases and, on a separate line, foetal deaths. This is a practical application of the E2 digital healthcare programme point and the G1 data-driven decision-making principle. Within a few months the monthly data series will show whether the August tightening is having an effect.

3.3 Official heat post-assessment and Gondosóra call-backs during heat alerts (by 31 March 2027)

The Nature Health study is an international estimate based on an urban sample. The authors themselves note that the urban population makes up about 40 per cent of the population, so the total burden may be greater. Hungarian decision-makers need an official assessment based on domestic data. MIAK proposes that the Hungarian Central Statistical Office (KSH), the institution that publishes official statistical data, and NNGYK jointly publish an excess mortality analysis of the 2026 heat summer by 31 March 2027. It should include a breakdown by county and age group, as well as which measures came into force on heat alert days. The analysis should be the starting data for planning the next heat season. According to the WHO (see 6.4.2), the essence of a heat–health plan is reaching the vulnerable. In Hungary a ready-made tool is available for this. From 1 January 2027 the emergency call devices issued to older people under Gondosóra will be operated by state companies within the portfolio of the Ministry of Science and Technology (TTM). MIAK proposes that the restructuring should include a heat alert module. During a third-level alert, the dispatch centre should call back users who live alone and have voluntarily signed up, and if necessary notify a relative or the home help service. This is the social implementation of the heat alert protocol linked to the K1 measurable climate targets programme point, and it is also in line with the TE4 minimum rural public service standard.

The three proposals are linked by one principle: public health intervention should start where the risk is, not where the care system is conveniently accessible. Syphilis screening must reach the uninsured and the shortage areas, and heat protection must reach older people living alone. In both cases, public, regular data show whether the intervention is working.

Part IV — Expected effects and risks

Dimension Expected effect Risk
Healthcare Earlier diagnosis and treatment, fewer newborns born infected; the causes of heat mortality can be identified with domestic data The staffing needs of mobile screening may draw capacity away from dermatology and STI care centres
Budget Free screening and treatment are cheap; the long-term care cost of one avoided congenital infection is an order of magnitude greater Free care for the uninsured may set a precedent for other services, so the legislation must define it precisely
Society Anonymity reduces the fear of stigma; call-backs during heat alerts reach older people living alone Gondosóra’s data processing is currently under review; call-backs are acceptable only with voluntary sign-up and data processing tied to a narrow purpose
Public administration A joint NNGYK–KSH analysis provides uniform heat statistics With monthly data publication, individuals may become identifiable in counties with small case numbers, so values below a threshold must be aggregated

The main question to weigh is the targeting of screening. If mobile screening starts only from hospital centres, precisely the hardest-to-reach groups will be left out. If, however, it is too scattered, it is expensive and yields few results. It is therefore worth evaluating the positivity rate and the groups reached publicly every quarter, and adjusting the locations accordingly. Gondosóra call-backs only work if the devices are actually active after the takeover. According to Portfolio, of the one million devices issued, 600–640 thousand have been switched on for at least nine months. The heat module should therefore be planned together with the collection and redistribution of inactive devices. Finally: the HUF 1.75 billion practice-filling fund is a good step. Compared with the support for filling a single practice, however, according to the estimate of MIAK’s press monitor the fund is enough for roughly a few dozen districts, so screening in GP-shortage regions cannot rely on the local surgery in the coming years either.

Part V — Measurability and summary

5.1 What is worth tracking? (proposed KPIs)

MIAK proposes tracking the following key performance indicators (KPIs):

  • Number of congenital syphilis cases: compared with the 74 cases in 2025, it is worth setting as a target a value that at least halves in 2027, and tracking this monthly and publicly.
  • Coverage of repeat third-trimester screening among pregnant women classified in the risk group: at least 90 per cent by the end of 2027.
  • Number and positivity rate of mobile screenings in the four most affected counties: quarterly publication from the second quarter of 2027.
  • Publication of the heat post-assessment by 31 March 2027, and in the next heat season the number of users reached by Gondosóra call-backs on third-level alert days.

5.2 Summary

MIAK asks the Minister of Health to make syphilis screening and treatment free of charge regardless of insurance status, and to have it repeated at the end of pregnancy in the risk group. It asks NNGYK to publish the data monthly, broken down by county. On heat, an official assessment based on domestic data should be prepared before next summer, and call-backs during heat alerts should be given a place in the restructuring of Gondosóra. The proposal concerns two MIAK foundational values. Data-drivenness, because today the scale of the problem is revealed by an international study and a news portal’s data processing. Universal representation, because both the infection and the heat hit hardest those who make their voices heard the least: the uninsured, those living in shortage areas and older people living alone.

Part VI — Reasoning and further sources

6.1 Press framing by spectrum

Business press. Portfolio’s article “Országos szifiliszjárvány bontakozott ki Magyarországon” (A nationwide syphilis epidemic has unfolded in Hungary) chooses a data-driven, epidemiological frame. The emphasis is on the time series, the county breakdown and the EU comparison, and the outlet also names the limitations of the data, for example the absence of foetal deaths from the tables. It assesses the government tightening as a targeted intervention, and also notes that the timing differs from the ECDC recommendation.

Public-affairs press. 24.hu presents the heat mortality study as science news, as a European record summer. It does not politicise the Hungarian figure and does not raise the question of government responsibility either. The 24.hu and Index articles on the Gondosóra takeover write from a service and business (4iG stock market) perspective; the heat protection opportunity does not come up in either.

Left-liberal press. Telex and HVG report the practice-filling fund following the minister’s announcement. Telex frames the scale of the shortage with July data from GKI Economic Research, while HVG also quotes the minister’s indication of the funding source (“by cutting back excessive government propaganda and expensive events”). In these articles the syphilis and heat data are not linked to primary care. Material from 444.hu and Népszava was not included in the sample collected by the press monitor for this topic.

Conservative press. As its public health topic of the day, Magyar Nemzet ran the European risk of the African Ebola epidemic, linking it to illegal migration routes. The conservative outlets in the sample did not put the domestic syphilis and heat data in focus on this day. Material from Mandiner was not included in the sample.

6.2 Facts and data

Indicator Value Source
Reported syphilis cases 2023: 1,157; 2024: 1,503; 2025: 2,053 NNGYK preliminary data (Portfolio, 28 October 2026)
First half of 2026 1,369 cases (first half of 2025: 782) NNGYK (Portfolio)
Share of women 2023: under 30%; Q1 2026: 42.3%; Q2: 46.4% NNGYK (Portfolio)
County case density, first half of 2026 Heves 44.2; Jász-Nagykun-Szolnok 30.3; Szabolcs-Szatmár-Bereg 30.0; Bács-Kiskun 25.7 /100,000 inhabitants (national average 14.4); Budapest 429 cases in absolute terms NNGYK (Portfolio)
Congenital syphilis 2025: 74; first half of 2026: 63; 100 identified cases by August NNGYK (Portfolio); official statement (Válasz Online, as quoted by Portfolio)
EU/EEA confirmed syphilis cases 45,577 (2024, a decade high) ECDC, 21 May 2026 (Portfolio)
Congenital syphilis in Europe 140 cases in 14 countries (2024; 78 in 2023); Bulgaria, Hungary and Portugal together account for 62% of cases ECDC (Portfolio)
Uninsured about 5% of the population, almost half a million people (end of 2025) Válasz Online (as quoted by Portfolio)
Heat-related mortality, summer 2026 50,391 deaths in 854 cities in 30 countries; of these about 22,500 among those over 85; mortality relative to population was highest in Hungary in the late June and early August period Nature Health (24.hu, 27 October 2026)
GP care more than a thousand districts have no permanent doctor, affecting 1.4 million people; the practice-filling fund is HUF 1.75 billion in 2027 Announcement by Viktória Lőrincz (Telex, HVG, 28–29 October 2026)
Number of GPs 15% decrease since 2010; more than 760 vacant practices, more than 700 settlements without a permanent GP GKI, July 2026 (Telex)
Gondosóra about one million devices issued, of which 600–640 thousand have been switched on for at least nine months; state operation from 1 January 2027 TTM announcement (Portfolio, 24.hu, 28 October 2026)

The sources differ on two points. The minister puts the number of vacant districts at “more than a thousand”, while GKI’s July analysis mentions “more than 760” vacant practices. The difference probably stems from different dates and terminology (district or practice, long-term substitution or vacancy). For European heat mortality in 2022, the urban estimate presented by 24.hu gives 29,480 people, while the WHO report’s estimate for 35 member states gives more than 61,000. The two have different coverage and are therefore not comparable.

6.3 Policy dimensions

  • Healthcare (programme points) — the targeted screening principle of the prevention data programme and epidemiological data publication built on the digital healthcare system (E4, E2);
  • Environment and climate (programme points) — the heat alert protocol as the health implementation of climate adaptation (K1);
  • Territorial inequality and rural policy (programme points) — the most affected counties are also primary care shortage areas, and screening and heat protection capacity must reach them (TE4);
  • Social policy (background material) — reaching the uninsured and the clients of homeless services and child protection, as well as the heat protection of older people living alone.

6.4 Literature in detail

6.4.1 Rechel and co-authors: Organization and Financing of Public Health Services in Europe

The volume by Bernd Rechel, Elke Jakubowski, Martin McKee and Ellen Nolte compares the organisation and financing of public health services in Europe. Their starting point is that the success of public health work is rarely visible. In the authors’ words:

“Sometimes this is highly visible, as when they intervene to prevent the spread of an epidemic. More often it is largely invisible, taking place outside the public gaze, but equally important for safeguarding health.”

In other words, the result of prevention is the illness that did not occur, which is why it is easily pushed into the background in budget debates. Among the volume’s country examples is that in the Netherlands, for instance, the surveillance and control of communicable diseases is the task of municipal public health services. According to the authors, tasks placed at local level need a national or regional support structure. According to the chapter on financing, Hungary is one of the three countries where the share of private sources in public health expenditure is the highest (although most of this does not come from households). In the case of the syphilis epidemic, the lesson is that prevention is a public task that must not depend on the patient’s insurance status or ability to pay. Free screening independent of insurance status makes this task unambiguous.

📖 Source: Bernd Rechel, Elke Jakubowski, Martin McKee, Ellen Nolte (eds.): Organization and Financing of Public Health Services in Europe

6.4.2 WHO Regional Office for Europe: European Health Report 2024

The report of the WHO Regional Office for Europe, published every three years, discusses heat-related mortality in a separate chapter. According to the report, heat and heatwaves are the deadliest climate-change-related extreme phenomena in the region. Heat-related mortality among those over 65 increased significantly in the 2018–2022 period compared with the early 2000s, and the largest increase was in Southern and Eastern Europe. The report puts it this way regarding heat–health action plans:

“Developing heat–health action plans is a crucial adaptation process that makes communities more resilient to heatwaves.”

According to the report, these plans are based on identifying risks, vulnerable groups and available resources, and call for special attention to those who live in care institutions or have no access to cooling. The report also mentions the 2022–2030 regional action plans on ending sexually transmitted infections among the region’s commitments. Applied to the Hungarian heat summer, an alert on its own is not enough. Actively reaching the vulnerable, for example through Gondosóra call-backs, and the retrospective assessment make the plan complete.

📖 Source: WHO Regional Office for Europe: European Health Report 2024

6.4.3 OECD and European Commission: Health at a Glance: Europe 2024

The joint publication of the OECD and the European Commission works with EU comparative data. According to it, in 2021 the deaths of about 165 thousand people over 65 in the EU were attributable to extreme cold or heat. The share of deaths linked to extreme temperatures rises from 2 per cent among 65–69-year-olds to 4 per cent among those over 80. The publication explains this with physiological causes: older people cool their bodies less efficiently, certain medicines and chronic diseases impair thermoregulation, and heat aggravates heart, lung and kidney diseases. Regarding the estimated more than 60 thousand heat deaths in Europe in the summer of 2022, the publication writes that about 85 per cent of them were over 65. Applied to the Hungarian data, the target group of heat protection is clearly defined: chronically ill older people living alone. It is therefore reasonable to build on an existing tool that already reaches this group.

📖 Source: OECD and European Commission: Health at a Glance: Europe 2024

6.5 International comparison

Antenatal screening according to the European standard. The standards of care published by the ECDC in September 2026 fit the WHO triple elimination framework, which aims to curb mother-to-child transmission of HIV, hepatitis B and syphilis. The standard expects universal, free first-trimester screening, a third-trimester repeat in cases of increased risk, and a rapid test at delivery if status is unknown. The Hungarian second-trimester repeat points in this direction, but the timing differs.

Heat–health plans. According to the WHO report, more than 20 countries in the region have a heat–health action plan. According to the report, this is encouraging, but not enough to protect every community. A well-known element of the system developed in France after the 2003 heatwave is the voluntary register of vulnerable older people living alone and calling them during heat alerts. The Gondosóra module proposed by MIAK is a Hungarian version of this, built on existing infrastructure.

European syphilis trend. According to ECDC data, the increase since 2021 has been persistent among heterosexual adults as well. More than 60 per cent of congenital cases in 2024 came from three countries, including Hungary. The Hungarian situation is therefore not isolated, but it stands out in the European comparison.

Healthcare

  • E4 — Prevention data programme
  • E2 — Digital healthcare system

Environment and climate

  • K1 — Measurable climate targets

Territorial inequality and rural policy

  • TE4 — Minimum rural public service standard

Economy

  • G1 — Data-driven budget

Proposed new programme point: Free screening and treatment for sexually transmitted infections independent of insurance status — for the Healthcare area.

6.7 List of sources

Press sources (MIAK press monitor, 29 October 2026 — top 10 topics):

Knowledge-base references (books):

  • 📖 Bernd Rechel, Elke Jakubowski, Martin McKee, Ellen Nolte (eds.): Organization and Financing of Public Health Services in Europe
  • 📖 WHO Regional Office for Europe: European Health Report 2024
  • 📖 OECD and European Commission: Health at a Glance: Europe 2024

MIAK internal materials:

  • MIAK policy area: Healthcare (programme points; programme point ID: E4, E2)
  • MIAK policy area: Environment and climate (programme points; programme point ID: K1)
  • MIAK policy area: Territorial inequality and rural policy (programme points; programme point ID: TE4)
  • MIAK policy area: Economy (programme points; programme point ID: G1)
  • MIAK policy area: Social policy (background material)
  • MIAK press monitor, 29 October 2026 — topic 6, score: 82/100

Supplementary public data sources (via the press sources):

  • NNGYK quarterly epidemiological data (as processed by Portfolio)
  • ECDC syphilis report (21 May 2026) and standards of care for antenatal screening (September 2026)
  • Nature Health, 2026 — heat-related mortality in 854 European cities (as presented by 24.hu)
  • GKI Economic Research Co., July 2026 — GP care (as quoted by Telex)

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