The German government rejected claims by U.S. Health Secretary Robert F. Kennedy Jr. that Berlin prosecuted doctors and patients for refusing Covid-19 vaccinations or mask mandates. “The statements made by the U.S. Secretary of Health are completely unfounded, factually incorrect, and must be rejected,” German Health Minister Nina Warken said in a statement late Saturday. “I can happily explain this to him personally,” she said. “At no time during the coronavirus pandemic was there any obligation for doctors to carry out vaccines against Covid-19,” Warken added. “Anyone who did not wish to offer vaccines for medical, ethical or personal reasons were not criminally liable and did not have to fear penalties,” she said. Warken added that “criminal prosecution took place only in cases of fraud and forgery of documents, such as the issuing of false vaccine certificates” or exemption certificates for masks.  “Doctors [in Germany] decide independently and autonomously on the treatment of patients,” the minister stressed, adding that “patients are also free to decide which treatment they wish to receive.” Kennedy said in a video post on Saturday that he had written to Warken after receiving reports that Germany was restricting “people’s abilities to act on their own convictions” in medical decisions. He claimed that “more than a thousand German physicians and thousands of their patients” faced prosecution for issuing exemptions from mask-wearing or Covid-19 vaccination requirements during the pandemic. Kennedy did not provide specific examples or identify the reports he cited, but he said Germany was “targeting physicians who put their patients first” and was “punishing citizens for making their own medical choices.” He accused Berlin of undermining the doctor–patient relationship and replacing it with “a dangerous system that makes physicians enforcers of state policies.” Former German Health Minister Karl Lauterbach also pushed back on the claims, telling Kennedy on X to “take care of health problems in his own country.”

BRUSSELS — If European governments didn’t realize before that Donald Trump’s threats to seize Greenland were serious, they do now. Policymakers are no longer ignoring the U.S. president’s ramped-up rhetoric — and are desperately searching for a plan to stop him. “We must be ready for a direct confrontation with Trump,” said an EU diplomat briefed on ongoing discussions. “He is in an aggressive mode, and we need to be geared up.” U.S. Secretary of State Marco Rubio said Wednesday that he planned to discuss a U.S. acquisition of Greenland with Danish officials next week. The White House said Trump’s preference would be to acquire the territory through a negotiation and also that it would consider purchasing the island — but that a military takeover was possible. As diplomatic efforts intensified in Europe, French Foreign Minister Jean-Noël Barrot said he and his counterparts from Germany and Poland had discussed a joint European response to Trump’s threats. “What is at stake is the question of how Europe, the EU, can be strengthened to deter threats, attempts on its security and interests,” Barrot told reporters. “Greenland is not for sale, and it is not for taking … so the threats must stop.” POLITICO spoke with officials, diplomats, experts and NATO insiders to map out how Europe could deter the U.S. president from getting that far, and what its options are if he does. They were granted anonymity to speak freely. “Everyone is very stunned and unaware of what we actually have in the toolbox,” said a former Danish MP. “No one really knows what to do because the Americans can do whatever they want. But we need answers to these questions immediately. They can’t wait three or five or seven years.” On Wednesday, POLITICO set out the steps Trump could take to seize Greenland. Now here’s the flip side: What Europe does to stop him. OPTION 1: FIND A COMPROMISE Trump says Greenland is vital for U.S. security interests and accuses Denmark of not doing enough to protect it against increasing Chinese and Russian military activity in the Arctic.  A negotiated settlement that sees Trump come out of talks with something he can sell as a win and that allows Denmark and Greenland to save face is perhaps the fastest route out of trouble. A former senior NATO official suggested the alliance could mediate between Greenland, Denmark and the U.S., as it has done with alliance members Turkey and Greece over their disputes. U.S. NATO Ambassador Matthew Whitaker said on Wednesday that Trump and his advisers do not believe Greenland is properly secured. | Omar Havana/Getty Images U.S. NATO Ambassador Matthew Whitaker said on Wednesday that Trump and his advisers do not believe Greenland is properly secured. “As the ice thaws and as the routes in the Arctic and the High North open up … Greenland becomes a very serious security risk for the mainland of the United States of America.” NATO allies are also mulling fresh overtures to Trump that could bolster Greenland’s security, despite a widely held view that any direct threat from Russian and Chinese ships to the territory is overstated. Among other proposals, the alliance should consider accelerating defense spending on the Arctic, holding more military exercises in the region, and posting troops to secure Greenland and reassure the U.S. if necessary, according to three NATO diplomats.  The alliance should also be open to setting up an “Arctic Sentry” scheme — shifting its military assets to the region — similar to its Eastern Sentry and Baltic Sentry initiatives, two of the diplomats said. “Anything that can be done” to bolster the alliance’s presence near Greenland and meet Trump’s demands “should be maxed out,” said one of the NATO diplomats cited above. Trump also says he wants Greenland for its vast mineral deposits and potential oil and gas reserves. But there’s a reason Greenland has remained largely untapped: Extracting resources from its inhospitable terrain is difficult and very expensive, making them less competitive than Chinese imports. Denmark’s envoys say they tried for years to make the case for investment in Greenland, but their European counterparts weren’t receptive — though an EU diplomat familiar with the matter said there are signs that attitude is shifting. OPTION 2: GIVE GREENLAND A TON OF CASH The Trump administration has thrown its weight behind Greenland’s independence movement. The pitch is that if the Arctic territory leaves the Kingdom of Denmark and signs up to a deal with the U.S., it will be flooded with American cash.  While Trump has repeatedly refused to rule out using military force to take Greenland, he has also insisted he wants it to come willingly. The EU and Denmark are trying to convince Greenlanders that they can give them a better deal. Brussels is planning to more than double its spending on Greenland from 2028 under long-term budget plans drawn up after Trump started to make claims on the Danish-held territory, according to a draft proposal from the European Commission published in September. Under the plans, which are subject to further negotiations among member countries, the EU would almost double spending on Greenland to €530 million for a seven-year period starting in 2028.  That comes on top of the money Denmark sends Greenland as part of its agreement with the self-governing territory. Greenland would also be eligible to apply for an additional €44 million in EU funding for remote territories associated with European countries, per the same document. Danish and European support currently focuses mainly on welfare, health care, education and the territory’s green transition. Under the new spending plans, that focus would expand to developing the island’s ability to extract mineral resources. “We have many, many people below the poverty line, and the infrastructure in Greenland is lagging, and our resources are primarily taken out without good profit to Greenland but mostly profit to Danish companies,” said Kuno Fencker, a pro-independence Greenlandic opposition MP.  An attractive offer from Denmark and the EU could be enough to keep Greenlanders out of America’s grasp. OPTION 3: RETALIATE ECONOMICALLY Since Trump’s first term in office, “there’s been a lot of effort to try and think through how we ensure European security, Nordic security, Arctic security, without the U.S. actively involved,” said Thomas Crosbie, a U.S. military expert at the Royal Danish Defense College, which provides training and education for the Danish defense force. “That’s hard, but it’s possible. But I don’t know if anyone has seriously contemplated ensuring European security against America. It’s just crazy,” Crosbie said. The EU does have one strong political tool at its disposal, which it could use to deter Trump: the Anti-Coercion Instrument, the “trade bazooka” created after the first Trump administration, which allows the EU to retaliate against trade discrimination. The EU threatened to deploy it after Trump slapped tariffs on the bloc but shelved it in July after the two sides reached a deal. With the U.S. still imposing tariffs on the EU, Brussels could bring the bazooka back out. “We have exports to the United States a bit above €600 billion, and for around one-third of those goods we have a market share of more than 50 percent and it’s totally clear that this is also the power in our hands,” said Bernd Lange, chair of the European Parliament’s trade committee. But Trump would have to believe the EU was serious, given that all its tough talk amounted to nothing the last time around. OPTION 4: BOOTS ON THE GROUND If the U.S. does decide to take Greenland by military force, there’s little Europeans could do to prevent it.  “They are not going to preemptively attack Americans before they claim Greenland, because that would be done before an act of war,” said Crosbie, the Danish military educator. “But in terms of responding to the first move, it really depends. If the Americans have a very small group of people, you could try and arrest those people, because there’d be a criminal act.” It’s a different story if the U.S. goes in hard. Legally speaking, it’s possible Denmark would be forced to respond militarily. Under a 1952 standing order, troops should “immediately take up the fight without waiting for, or seeking orders” in “the event of an attack on Danish territory.” European countries should weigh the possibility of deploying troops to Greenland — if Denmark requests it — to increase the potential cost of U.S. military action, an EU diplomat said, echoing suggestions that Berlin and Paris could send forces to deter any incursion. While those forces are unlikely to be able to withstand a U.S. invasion, they would act as a deterrent. “You could have a tripwire effect where you have some groups of people who are physically in the way, like a Tiananmen Square-type situation, which would potentially force the [U.S.] military to use violence” or to back down, said Crosbie.  But that strategy comes at a high cost, he said. “This is completely unexplored territory, but it is quite possible that people’s lives will be lost in the attempt to reject the American claim over Greenland.” Gerardo Fortuna, Clea Caulcutt and Eli Stokols contributed reporting.

LONDON — They’re young, full of ideas — and about to be given the vote. Britain’s government has committed to lowering the voting age from 18 to 16 years — a major extension of the electorate that could have big implications for the outcome of the next race, expected by 2029. It means Brits who are just 12 today are in line to vote in the next general election, which is expected to be a fierce battle between incumbent Keir Starmer and his right-wing challenger Nigel Farage. But what do these young people actually think? In a bid to start pinning down the views of this cohort, POLITICO commissioned pollster More in Common to hold an in-depth focus group, grilling eight youngsters from across the country on everything from social media disinformation to what they would do inside No. 10 Downing Street. To protect those taking part in the study, all names used below are pseudonymous. The group all showed an interest in politics, and had strong views on major topics such as immigration and climate change — but the majority were unaware they would get the chance to vote in 2029.  In a bid to prepare the country for the change, the Electoral Commission has recommended that the school curriculum be reformed to ensure compulsory teaching on democracy and government from an early age. GET YOUR ACT TOGETHER There are few better introductions to the weird world of British politics than prime minister’s questions, the weekly House of Commons clash between Prime Minister Keir Starmer and his Conservative opponent Kemi Badenoch. Our group of 12-13-year-olds was shown a clip of the clash and asked to rate what they saw. They came away distinctly unimpressed. Hanh, 13, from Surrey, said the pair seemed like children winding each other up. “It seems really disrespectful in how they’re talking to each other,” she commented. “It sounds like they’re actually kids bickering … They were just going at each other, which didn’t seem very professional in my opinion.” Sarah, 13, from Trowbridge in the west of England, said the leading politicians were “acting like a pack of wild animals.” | Clive Brunskill/Getty Images Sarah, 13, from Trowbridge in the west of England, said the leading politicians were “acting like a pack of wild animals.” In the clip, the Commons backbenches roar as Tory Leader Kemi Badenoch quips about Starmer’s MPs wanting a new leader for Christmas. In turn, the PM dismisses the Conservative chief’s performance as a “Muppet’s Christmas Carol.” Twelve-year-old Holly, from Lincolnshire, said the pair were being “really aggressive and really harsh on each other, which was definitely rude.” And she said of the PM: “It weren’t really working out for Keir Starmer.” None of the children knew who Badenoch was, but all knew Starmer — even if they didn’t have particularly high opinions of the prime minister, who is tanking in the polls and struggling to get his administration off the ground. Twelve-year-old Alex said the “promises” Starmer had made were just “lies” to get him into No. 10. Sophie, a 12-year-old from Worcester in the West Midlands, was equally withering, saying she thought the PM is doing a “bad job.” “He keeps making all these promises, but he’s probably not even doing any of them,” she added. “He just wants to show off and try to be cool, but he’s not being cool because he’s breaking all the promises. He just wants all the money and the job to make him look really good.” Sarah said: “I think that it’s quite hard to keep all of those promises, and he’s definitely bitten off more than he can chew with the fact that he’s only made those statements because he wants to be voted for and he wants to be in charge.”  While some of the young people referenced broken promises by Starmer, none offered specifics. THE FARAGE FACTOR Although they didn’t know Badenoch as leader of the opposition, the whole room nodded when asked if they knew who Nigel Farage was. Although they didn’t know Badenoch as leader of the opposition, the whole room nodded when asked if they knew who Nigel Farage was. | Dan Kitwood/Getty Images “He’s the leader of the Reform party,” said Alex, whose favorite subject is computing. “He promises lots of things and the opposite of what Starmer wants. Instead of helping immigrants, he wants to kick them out. He wants to lower taxes, wants to stop benefits.” Alex added: “I like him.” Sarah was much less taken. “I’ve heard that he’s the leader of the far right, or he’s part of the far right. I think he’s quite a racist man.” Farage has faced accusations in recent weeks of making racist remarks in his school days. The Reform UK leader replied that he had “never directly racially abused anybody.” Other participants said they’d only heard Farage’s name before. When asked who they would back if they were voting tomorrow, most children shrugged and looked bewildered. Only two of the group could name who they wanted to vote for — both Alex and Sam backed Farage. POLICY WORRIES Politicians have long tried to reach Britain’s youngsters through questionable TikTok videos and cringe memes — but there was much more going on in the minds of this group than simply staring at phones. Climate change, mental health and homelessness were dominant themes of the conversation. Climate change is “dangerous because the polar bears will die,” warned Chris, 13, from Manchester. Sophie, who enjoys horse riding, is worried about habitats being destroyed and animals having to find new homes as a result of climate change, while Sarah is concerned about rising sea levels. Thirteen-year-old Ravi from Liverpool said his main focus was homelessness. “I know [the government is] building houses, but maybe speed the process up and get homeless people off the streets as quick as they can because it’s not nice seeing them on the streets begging,” he said. Sam agreed, saying if he personally made it into No.10, he would make sure “everyone has food, water, all basic survival stuff.” Sarah’s main ask was for better mental health care amid a strained National Health Service. “The NHS is quite busy dealing with mental health, anxiety and things like that,” she said. “Maybe we should try and make an improvement with that so everyone gets a voice and everyone’s heard.” IMMIGRATION DIVISIONS When the conversation moved to the hot-button topic of immigration, views were more sharply divided. Imagining what he’d do in government, Alex said he’d focus on “lowering taxes and stopping illegal immigrants from coming over.” “Because we’re paying France billions just to stop them, but they’re not doing anything,” he said. “And also it’s spending all the tax money on them to give them home meals, stuff like that.” In July, Starmer and France’s Emmanuel Macron unveiled a “one in, one out” pilot program to tackle illegal migration, although it’s enjoyed limited success so far and has generated some embarrassing headlines for the British government. Hanh said she’d been taught at school that it’s important to show empathy, but noted some people are angry about taxes going to support asylum seekers. Chris and Sarah both said asylum seekers are fleeing war, and seemed uneasy at the thought of drawing a hard line. Holly said she wants “racism” — which she believes is tied to conversations about immigration — to end. “I often hear a lot of racism [at school] and prejudice-type stuff … I often hear the N word. People don’t understand how bad that word is and how it can affect people,” she said. “They [migrants] have moved away from something to get safer, and then they get more hate.” Hanh said she is seeing more anti-immigration messages on social media, such as “why are you in my country, get out,” she said. “Then that’s being dragged into school by students who are seeing this … it’s coming into school environment, which is not good for learning.” NEWS SNOOZE Look away now, journalists: The group largely agreed that the news is boring. Some listen in when their parents have the television or radio on, but all said they get most of their news from social media or the odd push alert. Asked why they think the news is so dull, Hanh — who plays field hockey and enjoys art at school — said: “It just looks really boring to look at, there are no cool pictures or any funny things or fun colors. It just doesn’t look like something I’d be interested in.” She said she prefers social media: “With TikTok, you can interact with stuff and look at comments and see other people’s views, [but with the news] you just see evidence and you see all these facts. Sometimes it can be about really disturbing stuff like murder and stuff like that. If it’s going to pop up with that, I don’t really want to watch that.” These children aren’t alone in pointing to social media as their preferred source of news. A 2025 report by communications watchdog Ofcom found that 57 percent of 12-15-year-olds consume news on social media, with TikTok being the most commonly used platform, followed by YouTube and then Instagram. Sophie isn’t convinced that the news is for her. “Sometimes if my parents put it on the TV and it’s about something that’s really bad that’s happened, then I’ll definitely look at it,” she said. “But otherwise, I think it would probably be more for older people because they would like to watch basically whatever’s on the TV because they can’t really be bothered to change the channel.”

President Donald Trump has told his health secretary, Robert F. Kennedy Jr., to consider aligning the U.S. vaccination schedule with those in Europe, where many countries recommend fewer vaccines. Kennedy has taken up the charge with gusto and is considering advising parents to follow Denmark’s childhood schedule rather than America’s. Many who specialize in vaccination and public health say that would be a mistake. While wealthy European countries do health care comparatively well, they say, there are lots of reasons Americans are recommended more shots than Europeans, ranging from different levels of access to health care to different levels of disease. “If [Kennedy] would like to get us universal health care, then maybe we can have a conversation about having the schedule adjusted,” Demetre Daskalakis, who led the Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases before resigning in protest in August, told POLITICO. Children, especially those who live in poor and rural areas, would be at greater risk for severe disease and death if the U.S. were to drop shots from its schedule, Daskalakis said. Denmark, for instance, advises immunizing against only 10 of the 18 diseases American children were historically recommended immunizations against. It excludes shots for potentially serious infections, including hepatitis A and B, meningitis and respiratory syncytial virus. Under Kennedy, the government has already changed its hepatitis B vaccine recommendations for newborns this year, even as critics warned the new advice could lead to more chronic infections, liver problems and cancer. The health department points out that the new guidance on hepatitis B — that mothers who test negative for the virus may skip giving their newborn a shot in the hospital — now align more closely with most countries in Europe. Public health experts and others critical of the move say slimmer European vaccine schedules are a cost-saving measure and a privilege afforded to healthier societies, not a tactic to protect kids from vaccine injuries. Kennedy’s interest in modeling the U.S. vaccine schedule after Europe, they point out, is underpinned by his belief that some childhood vaccines are unsafe and that American kids get too many too young. Kennedy’s safety concerns don’t align with the rationale underpinning the approach in Europe, where the consensus is that childhood vaccines are safe. Wealthy European countries in many cases eschew vaccines based on a risk-benefit calculus that doesn’t hold in America. European kids often don’t get certain shots because it would prevent a very small number of cases — like hepatitis B — or because the disease is rarely serious for them, such as Covid-19 and chickenpox. But since the U.S. doesn’t have universal access to care, vaccinating provides more return on investment, experts say. “We just have a tradition to wait a little bit” before adding vaccines to government programs, said Johanna Rubin, a pediatrician and vaccine expert for Sweden’s health agency. Swedish children are advised to get vaccines for 11 diseases before they turn 18. Rubin cited the need to verify the shots’ efficacy and the high cost of new vaccines as reasons Sweden moves slowly to add to its schedule. “It has to go through the health economical model,” she said. VACCINE SAFETY’S NOT THE ISSUE Martin Kulldorff, a Swedish native and former Harvard Medical School professor who led Kennedy’s vaccine advisory panel until this month, pointed to that country’s approach to vaccination and public health in an interview with POLITICO earlier this year. Before the Centers for Disease Control and Prevention this month dropped its recommendation that children of mothers who test negative for hepatitis B receive a vaccine within a day of birth, Kulldorff cited Sweden’s policy. “In Sweden, the recommendation is that you only do that if the mother has the infection. That’s the case in most European countries,” he said. “You could have a discussion whether one or the other is more reasonable.” The U.S. policy, as of Dec. 16, more closely resembles Sweden’s, with hepatitis B-negative mothers no longer urged to vaccinate their newborns against the virus at birth. But Sweden’s public health agency recommends that all infants be vaccinated, and the country’s regional governments subsidize those doses, which are administered as combination shots targeting six diseases starting at 3 months. Public health experts warn that even children of hepatitis B-negative mothers could catch the virus from others via contact with caregivers who are positive or shared household items. The prevalence of chronic hepatitis B in the U.S. is 6.1 percent compared to 0.3 percent in Sweden, according to the Coalition for Global Hepatitis Elimination, a Georgia-based nonprofit which receives funding from pharmaceutical companies, the CDC and the National Institutes of Health, among others. Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said the U.S. has taken a more comprehensive approach to vaccination, in part because its population is sicker than that of some Western European countries, and the impact of contracting a disease could be more detrimental. Osterholm pointed to the Covid pandemic as an example. By May 2022, the U.S. had seen more than 1 million people die. Other high-income countries — though much smaller — had more success controlling mortality, he said. “People tried to attribute [the disparity] to social, political issues, but no, it was because [peer nations] had so many more people who were actually in low-risk categories for serious illness,” Osterholm said. Kennedy and his advisers also cited European views on Covid vaccination in the spring when the CDC dropped its universal recommendation, instead advising individuals to talk to their providers about whether to get the shot. Last month, the Food and Drug Administration’s top vaccine regulator, Vinay Prasad, linked the deaths of 10 children to Covid vaccination without providing more detailed information about the data behind his assertion. European countries years ago stopped recommending repeat Covid vaccination for children and other groups not considered at risk of becoming severely sick. Covid shots have been linked to rare heart conditions, primarily among young men. European vaccine experts say Covid boosters were not recommended routinely for healthy children in many countries — not because of safety concerns, but because it’s more cost-effective to give them to high-risk groups, such as elderly people or those with health conditions that Covid could make severely sick and put in the hospital. In the U.K., Covid-related hospitalizations and deaths declined significantly after the pandemic, and now are “mostly in the most frail in the population, which has led to more restricted use of the vaccines following the cost-effectiveness principles,” said Andrew Pollard, the director of the Oxford Vaccine Group in the United Kingdom, which works on developing vaccines and was behind AstraZeneca’s Covid-19 shot. Pollard led the Joint Committee on Vaccination and Immunization, which advises the U.K. government, for 12 years before stepping down in September. In the U.S., more moves to follow Europe are likely. At a meeting of Kennedy’s vaccine advisers earlier this month, Tracy Beth Høeg, now acting as the FDA’s top drug regulator, pointed to Denmark’s pediatric schedule, which vaccinates for 10 diseases, while questioning whether healthy American children should be subject to more vaccines than their Danish counterparts. Danish kids typically don’t get shots for chickenpox, the flu, hepatitis A and B, meningitis, respiratory syncytial virus and rotavirus, like American children do, though parents can privately pay for at least some of those vaccines. The country offers free Covid and flu vaccines to high-risk kids. After the vaccine advisory meeting wrapped, Trump said he was on board, directing Kennedy to “fast track” a review of the U.S. vaccine schedule and potentially align it with other developed nations. He cited Denmark, Germany and Japan as countries that recommend fewer shots. Last week, Kennedy came within hours of publicly promoting Denmark’s childhood vaccine schedule as an option for American parents. The announcement was canceled at the last minute after the HHS Office of the General Counsel said it would invite a lawsuit the administration could lose, a senior department official told POLITICO. The notion that the U.S. would drop its vaccine schedule in favor of a European one struck health experts there as odd. Each country’s schedule is based on “the local situation, so the local epidemiology, structure of health care services, available resources, and inevitably, there’s a little bit of political aspect to it as well,” said Erika Duffell, a principal expert on communicable disease prevention and control at the European Centre for Disease Prevention and Control, an EU agency that monitors vaccine schedules across 30 European countries. Vaccine safety isn’t the issue, she said. For example, even though most Europeans don’t get a hepatitis B shot within 24 hours of birth, the previous U.S. recommendation, “there is a consensus that the effectiveness and safety of the vaccine has been confirmed through decades of research” and continuous monitoring, she said. European nations like Denmark and the U.K. have kept new cases of hepatitis B low. Denmark recorded no cases of mother-to-child transmission in 2023, and Britain’s rate of such spread is less than 0.1 percent — though the latter does routinely recommend vaccinating low-risk infants beginning at 2 months of age. European experts point to high levels of testing of pregnant women for hepatitis B and most women having access to prenatal care as the reasons for success in keeping cases low while not vaccinating all newborns. The major differences between the U.S. and the U.K. in their approach to hepatitis B vaccination are lower infection rates and high screening uptake in Britain, plus “a national health system which is able to identify and deliver vaccines to almost all affected pregnancies selectively,” Pollard said. The CDC, when explaining the change in the universal birth dose recommendation, argued the U.S. has the ability to identify nearly all hepatitis B infections during pregnancy because of ”high reliability of prenatal hepatitis B screening,” which some European experts doubt. “If we change a program, we need to prepare the public, we need to prepare the parents and the health care providers, and say where the evidence comes from,” said Pierre Van Damme, the director of the Centre for the Evaluation of Vaccination at the University of Antwerp in Belgium. He suggested that, if there was convincing evidence, U.S. health authorities could have run a pilot study before changing the recommendation to evaluate screening and the availability of testing at birth in one U.S. state, for example. WHERE EUROPEANS HAVE MORE DISEASE In some cases, European vaccination policies have, despite universal health care, led to more disease. France, Germany and Italy moved from recommending to requiring measles vaccination over the last decade after outbreaks on the continent. The U.S., until recently, had all but eradicated measles through a universal recommendation and school requirements. That’s starting to change. The U.S. is at risk of losing its “measles-elimination” status due to around 2,000 cases this year that originated in a Texas religious community where vaccine uptake is low. The 30 countries in the European Union and the European Economic Area, which have a population of some 450 million people combined, reported more than 35,000 measles cases last year, concentrated in Romania, Austria, Belgium and Ireland. Europe’s comparatively high rate is linked to lower vaccination coverage than the level needed to prevent outbreaks: Only four of the 30 countries reached the 95-percent threshold for the second measles dose in 2024, according to the European Centre for Disease Prevention and Control. Kennedy touted the U.S.’s lower measles rate as a successful effort at containing the sometimes-deadly disease, but experts say the country could soon see a resurgence of infectious diseases due to the vaccine skepticism that grew during the pandemic and that they say Kennedy has fomented. Among kindergarteners, measles vaccine coverage is down 2.7 percentage points as of the 2024-2025 school year, from a peak of 95.2 percent prior to the pandemic, according to CDC data. That drop occurred before Kennedy became health secretary. Kennedy and his advisers blame it on distrust engendered by Covid vaccine mandates imposed by states and President Joe Biden. But Kennedy led an anti-vaccine movement for years before joining the Trump administration, linking shots to autism and other conditions despite scientific evidence to the contrary, and he has continued to question vaccine safety as secretary. In some EU nations, vaccines aren’t compulsory for school entry. Swedish law guarantees the right to education and promotes close consultation between providers and patients. Some governments fear mandates could push away vaccine-hesitant parents who want to talk the recommended shots over with their doctor before giving the vaccines to their children, Rubin explained. In the U.S., states, which have the authority to implement vaccine mandates for school entry, rely on the CDC’s guidance to decide which to require. Vaccine skeptics have pushed the agency to relax some of its recommendations with an eye toward making it easier for American parents to opt out of routine shots. Scandinavian nations maintain high vaccine uptake without mandates thanks to “high trust” in public health systems, Rubin said. In Sweden, she added, nurses typically vaccinate young children at local clinics and provide care for them until they reach school age, which helps build trust among parents. CHICKENPOX Another example of where the U.S. and Europe differ is the chickenpox vaccine. The U.S. was the first country to begin universal vaccination against the common childhood illness in 1995; meanwhile, 13 EU nations broadly recommend the shot. Denmark doesn’t officially track chickenpox — the vaccine isn’t included on its schedule — but estimates 60,000 cases annually in its population of 6 million. The vastly larger U.S. sees fewer than 150,000 cases per year, according to the CDC. Many European countries perceive chickenpox as a benign disease, Van Damme said. “If you have a limited budget for prevention, you will spend usually the money in other preventative interventions, other vaccines than varicella,” he said, referring to the scientific term for chickenpox. But there’s another risk if countries decide to recommend chickenpox vaccination, he explained. If the vaccination level is low, people remain susceptible to the disease, which poses serious risks to unborn babies. If it’s contracted in early pregnancy, chickenpox could trigger congenital varicella syndrome, a rare disorder that causes birth defects. If children aren’t vaccinated against chickenpox, almost all would get the disease by age 10, Van Damme explained. If countries opt for vaccination, they have to ensure robust uptake: vaccinate virtually all children by 10, or risk having big pockets of unvaccinated kids who could contract higher-risk infections later. Europe’s stance toward chickenpox could change soon. Several countries are calculating that widely offering chickenpox vaccines would provide both public health and economic benefits. Britain is adding the shot to its childhood schedule next month. Sweden is expected to green-light it as part of its national program in the coming months. While the public doesn’t see it as a serious disease, pediatricians who see serious cases of chickenpox are advocating for the vaccine, Rubin told POLITICO. “It is very contagious,” she said. “It fulfills all our criteria.” The U.K. change comes after its vaccine advisory committee reviewed new data on disease burden and cost-effectiveness — including a 2022 CDC study of the U.S. program’s first 25 years that also examined the vaccine’s impact on shingles, a painful rash that can occur when the chickenpox virus reactivates years later. Scientists had theorized for years that limiting the virus’ circulation among children could increase the incidence of shingles in older adults by eliminating the “booster” effect of natural exposure, but the U.S. study found that real-world evidence didn’t support that hypothesis.

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Disclaimer POLITICAL ADVERTISEMENT * This is sponsored content from AstraZeneca. * The advertisement is linked to public policy debates on the future of cancer care in the EU. More information here. Europe has made huge strides in the fight against cancer.[1] Survival rates have climbed, detection has improved and the continent has become home to some of the world’s most respected research hubs.[2],[3] None of that progress came easy — it was built on years of political attention and cooperation across borders. However, as we look to 2026 and beyond, that progress stands at a crossroads. Budget pressures and tougher global competition threaten to push cancer and health care down the EU agenda. Europe’s Beating Cancer Plan — a flagship initiative aimed at expanding screening, improving early detection and boosting collaboration — is set to expire in 2027, with no clear plan to secure or extend its gains.[4],[5] “My [hope is that we can continue] the work started with Europe’s Beating Cancer Plan and make it sustainable… [and] build on the lessons learned, [for other disease areas] ” says Antonella Cardone, CEO of Cancer Patients Europe. A new era in cancer treatment Concern about the lapsing initiative is compounded by two significant shifts in health care: declining investment and increasing scientific advancement. Firstly, Europe has seen the increased adoption of cost-containment policies by some member states. Under-investment in Europe in cancer medicines has been a challenge — specifically with late and uneven funding, and at lower levels than international peers such as the US — potentially leaving patients with slower and more limited access to life-saving therapies.[6],[7],[8] Meanwhile, the U.S., which pays on average double for medicines per capita than the EU,[9] is actively working to rebalance its relationship with pharmaceuticals to secure better pricing (“fair market value”) through policies across consecutive administrations.[10] All the while, China is rapidly scaling investment in biotech and clinical research, determined to capture the trials, talent, and capital that once flowed naturally to Europe.[11] The rebalancing of health and life-science investment can have significant consequences. If Europe does not stay attractive for life-sciences investment, the impact will extend beyond cancer patient outcomes. Jobs, tax revenues, advanced manufacturing, and Europe’s leadership in strategic industries are all at stake.[12] Secondly, medical science has never looked more promising.[7] Artificial intelligence is accelerating drug discovery, clinical trials, and diagnostics, and the number of approved medicines for patients across Europe has jumped from an average of one per year between 1995 and 2000 to 14 per year between 2021 and 2024.[13],[14],[15], [7] Digital health tools and innovative medtech startups are multiplying, increasing competitiveness and lowering costs — guiding care toward a future that is more personalized and precise.[16],[17] Europe stands at the threshold of a new era in cancer treatment. But if policymakers ease up now, progress could stall — and other regions, especially the U.S. and China, are more than ready to widen the innovation gap. Recognizing the strategic investment Health spending is generally treated as a budget item to be contained. Yet investment in cancer care has been one of Europe’s smartest economic bets.[18],[19] The sector anchors millions of high-skilled jobs (it employs around 29 million people in the EU[11]) and attracts global life sciences investment. According to the European Commission, the sector contributes nearly €1.5 trillion to the EU economy.[12] Studies from the Institute of Health Economics confirm that money put into research directly translates into better survival outcomes.[20] The same report shows that although the overall spend on cancer is increasing, the cost per patient has actually decreased since 1995, suggesting that innovative treatments are increasing efficiency.[20] Those gains matter not only to patients and families, but to Europe’s long-term stability: healthier populations mean fewer costs down the line, stronger productivity, and more sustainable public finances.[20] Fixing Europe’s access gap Cancer medicines bring transformative value — to patients, to society and to the wider economy. [21] However, even as oncology therapies advance, patients across Europe are not benefiting equally. EFPIA’s 2024 Patients W.A.I.T. indicator shows that, on average, just 46 percent of innovative medicines approved between 2020 and 2023 were available to patients in 2024.[22] On average, it takes 578 days for a new oncology medicine to reach European patients, and only 29 percent of drugs are fully available in all member states.[23] This is not caused by a lack of breakthrough medicines, but by national policy mechanisms that undervalue innovation. OECD and the Institute for Health Economics data show that divergent HTA requirements, rigid cost-effectiveness thresholds, price-volume clawbacks, ad hoc taxes on pharmaceutical revenues and slow national reimbursement decisions collectively suppress timely access to new cancer medicines across the EU.[24] These disparities cut against Europe’s long-standing reputation as a collection of societies that values equitable, high-quality care for all of its citizens. It risks eroding one of the EU’s defining strengths: the commitment to fairness and collective progress. Cancer policy solutions for the EU Although this is ultimately a matter for member states, embedding cancer as a permanent EU priority — backed by funding, coordination, and accountability — could give national systems the incentives and strategic direction to buck these trends. These actions will reassure pharmaceutical companies that Europe is serious about attracting clinical trials and the launch of new medicines, ensuring that its citizens, societies and economies enjoy the benefits this brings. Europe’s Beating Cancer Plan delivered progress, but its expiry presents a pivotal moment. 2026 and beyond bring a significant opportunity for the EU to build on this by ensuring that member states implement National Cancer Control Plans and have clear targets and accountability on their national performance, including on investment and access. To do this, EU policymakers should consider three actions as an immediate priority with lasting impact: * Embed cancer and investment within EU governance. Build it into the European Semester on health with mandatory indicators, regular reviews, and accountability frameworks to ensure continuity. This model worked well during Covid-19 and should be adapted for non-communicable diseases starting with cancer as a pilot. * Secure stable and sufficient funding. The Multiannual Financial Framework must ensure adequate funding for health and cancer to encourage coordinated initiatives across member states. * Strengthen EU-level coordination. Ensure that pan-EU structures such as the Comprehensive Cancer Centres and Cancer Mission Hubs are adequately funded and empowered. These are the building blocks of a lasting European commitment to cancer. With action, Europe can secure a sustainable foundation for patients, resilience and continued scientific excellence. -------------------------------------------------------------------------------- [1] European Commission, OECD/European Observatory on Health Systems and Policies. 2023. State of Health in the EU: Synthesis Report 2023. Available at: https://health.ec.europa.eu/system/files/2023-12/state_2023_synthesis-report_en.pdf [Accessed December 2025] [2] Efpia. 2025. Cancer care 2025: an overview of cancer outcomes data across Europe. Available at: https://www.efpia.eu/news-events/the-efpia-view/statements-press-releases/ihe-cancer-comparator-report-2025/ [Accessed December 2025] [3] Cancer Core Europe. 2024. Cancer Core Europe: Advancing Cancer Care Through Collaboration. Available at: https://www.cancercoreeurope.eu/cce-advancing-cancer-care-collaboration/ [Accessed December 2025] [4] European Commission. 2021. Europe’s Beating Cancer Plan. Available at:https://health.ec.europa.eu/system/files/2022-02/eu_cancer-plan_en_0.pdf [Accessed December 2025] [5] European Parliament. 2025. Europe’s Beating Cancer Plan: Implementation findings. https://www.europarl.europa.eu/RegData/etudes/STUD/2025/765809/EPRS_STU(2025)765809_EN.pdf [Accessed December 2025] [6] Hofmarcher, T., et al. 2024. Access to Oncology Medicines in EU and OECD Countries (OECD Health Working Papers, No.170). OECD Publishing. Available at: https://www.oecd.org/content/dam/oecd/en/publications/reports/2024/09/access-to-oncology-medicines-in-eu-and-oecd-countries_6cf189fe/c263c014-en.pdf [Accessed December 2025] [7] Manzano, A., et al. 2025. Comparator Report on Cancer in Europe 2025 – Disease Burden, Costs and Access to Medicines and Molecular Diagnostics (IHE). Available at: https://ihe.se/app/uploads/2025/03/IHE-REPORT-2025_2_.pdf [Accessed December 2025] [8] Efpia. [no date]. Europe’s choice. Available at: https://www.efpia.eu/europes-choice/ [Accessed December 2025] [9] OECD. 2024. Prescription Drug Expenditure per Capita. https://data-explorer.oecd.org/vis?lc=en&pg=0&snb=1&vw=tb&df[ds]=dsDisseminateFinalDMZ&df[id]=DSD_SHA%40DF_SHA&df[ag]=OECD.ELS.HD&df[vs]=&pd=2015%2C&dq=.A.EXP_HEALTH.USD_PPP_PS%2BPT_EXP_HLTH._T..HC51%2BHC3.._T…&to[TIME_PERIOD]=false&lb=bt [Accessed December 2025] [10] The White House. 2025. Delivering most favored-nation prescription drug pricing to American patients. Available at: https://www.whitehouse.gov/presidential-actions/2025/05/delivering-most-favored-nation-prescription-drug-pricing-to-american-patients/ [Accessed December 2025] [11] Eleanor Olcott, Haohsiang Ko and William Sandlund. 2025. The relentless rise of China’s Biotechs. Financial Times. Available at: https://www.ft.com/content/c0a1b15b-84ee-4549-85eb-ed3341112ce5 [Accessed December 2025] [12] European Commission, Directorate-General for Communication. 2025. Making Europe a Global Leader in Life Sciences. Available at: https://commission.europa.eu/news-and-media/news/making-europe-global-leader-life-sciences-2025-07-02_en [Accessed December 2025] [13] Financial Times. 2025. How AI is reshaping drug discovery. Available at: https://www.ft.com/content/8c8f3c10-9c26-4e27-bc1a-b7c3defb3d95 [Accessed December 2025] [14] Seedblink. 2025. Europe’s HealthTech investment landscape in 2025: A deep dive. https://seedblink.com/blog/2025-05-30-europes-healthtech-investment-landscape-in-2025-a-deep-dive [15] European Commission. [No date]. Artificial Intelligence in healthcare. Available at: https://health.ec.europa.eu/ehealth-digital-health-and-care/artificial-intelligence-healthcare_en [Accessed December 2025] [16] Codina, O. 2025. Code meets care: 20 European HealthTech startups to watch in 2025 and beyond. EU-Startups. Available at: https://www.eu-startups.com/2025/06/code-meets-care-20-european-healthtech-startups-to-watch-in-2025-and-beyond [Accessed December 2025] [17] Protogiros et al. 2025. Achieving digital transformation in cancer care across Europe: Practical recommendations from the TRANSiTION project. Journal of Cancer Policy. Available at: https://www.sciencedirect.com/science/article/pii/S2213538325000281 [Accessed December 2025] [18] R-Health Consult. [no date]. The case for investing in a healthier future for the European Union. EFPIA. Available at: https://www.efpia.eu/media/xpkbiap5/the-case-for-investing-in-a-healthier-future-for-the-european-union.pdf [Accessed December 2025] [19] Pousette A., Hofmarcher T. 2024.Tackling inequalities in cancer care in the European Union. Available at: https://ihe.se/en/rapport/tackling-inequalities-in-cancer-care-in-the-european-union-2/ [Accessed December 2025] [20] Efpia. 2025. Comparator Report Cancer in Europe 2025. Available at: https://www.efpia.eu/media/0fbdi3hh/infographic-comparator-report-cancer-in-europe.pdf [Accessed December 2025] [21] Garau, E. et al. 2025. The Transformative Value of Cancer Medicines in Europe. Dolon Ltd. Available at: https://dolon.com/wp-content/uploads/2025/09/EOP_Investment-Value-of-Oncology-Medicines-White-Paper_2025-09-19-vF.pdf?x16809 [Accessed December 2025] [22] IQVIA. 2025. EFPIA Patients W.A.I.T. Indicator 2024 Survey. Available at: https://www.efpia.eu/media/oeganukm/efpia-patients-wait-indicator-2024-final-110425.pdf [Accessed December 2025] [23] Visentin M. 2025. Improving equitable access to medicines in Europe must remain a priority. The Parliament. Available at: https://www.theparliamentmagazine.eu/partner/article/improving-equitable-access-to-medicines-in-europe-must-remain-a-priority [Accessed December 2025] [24] Hofmarcher, T. et al. 2025. Access to novel cancer medicines in Europe: inequities across countries and their drivers. ESMO Open. Available at: https://www.esmoopen.com/action/showPdf?pii=S2059-7029%2825%2901679-5 [Accessed December 2025]

On its current trajectory, Europe’s target for ending HIV as a public health threat by 2030 — a key UN goal — will not be met. Whereas once we talked of this being realized, we now find ourselves discussing the need to adjust our approach and accelerate action if we are to get back on track. This is not where we want, or can afford, to be. But it is where we are. > While the global incidence of HIV has declined by 39 percent since 2010, parts > of Europe are now seeing infections rise.1 A key concern is that over half of those diagnosed in the World Health Organization’s (WHO) European region in 2023 were identified at a late stage. Late diagnoses lead to higher mortality and morbidity, and significantly increase healthcare costs, adding a considerable burden to European governments, reaching billions of euros annually. Mortality risk is estimated to be nine times higher in those diagnosed late, while medical costs in the first year are nearly double those of early diagnosed patients.2,3,4 A broader concern is that a failure to provide timely prevention and treatment exacerbates the epidemic by enabling continued transmission. Altering the Trajectory of HIV In Europe, a report by the Office for Health Economics (OHE) and commissioned by ViiV Healthcare, clearly demonstrates the significant consequences of a failure to effectively prevent and treat HIV for patients, healthcare professionals and governments.5 European governments must also manage the complex and evolving healthcare needs of an increasingly elderly HIV community.6 Based on observed trends in prevalence across eight European countries, the report suggests there could be ~100,000 new diagnoses by 2030. > The total estimated cost of new diagnoses alone could reach €4.4 > billion between 2025 and 2030 across seven European countries. This figure, > however, represents only a fraction of the overall financial burden – the > total estimated cost of all HIV care in just five European countries for the > same period is projected to be €56.7 billion. Given the substantial financial implications, an urgent reality check is needed. Europe cannot afford to be complacent when it comes to its HIV response. Failure to act decisively now will result in significant long-term financial and societal burdens. How, then, should we move forward? Ultimately, what the OHE report delivered was recognition of the urgent need for a coordinated effort, one that addresses the challenges facing the European HIV community while acknowledging the consequences if we fail to do so. This is also reinforced by a powerful consensus statement published last year urging the European Commission to address pressing issues related to HIV’s threat in Europe. Signed by multiple stakeholders in the HIV community, including ViiV Healthcare, it sets out a series of recommendations for how Europe should move forward. These include: * Increasing access and adherence to antiretroviral therapies; * Adopting the latest European AIDS Clinical Society guidelines; * Advancing research into new and accessible medicines to enhance the HIV response in Europe; and * Ensuring that underserved populations, including migrants and refugees, have access to healthcare. In addition, the statement calls for community, health organizations, governments and other stakeholders to play a greater role in policy shaping, and for Europe’s institutions to recognize the crucial role civil society can play in reaching key populations. Other goals should include: * Scaling up testing among key populations, particularly hard-to-reach migrant and refugee groups; * Promoting early diagnosis; * Strengthening primary prevention by expanding access to condoms, PrEP (pre-exposure prophylaxis), PEP (post-exposure prophylaxis) and ART (antiretroviral treatment); and * Improving data monitoring and collection by developing closer relationships with partner organizations such as the European Centre for Disease Prevention and Control and WHO Europe. > However, these goals will only have real impact if they are pursued in an > environment that supports and incentivizes new patient-centric medicines and > solutions, which will be key to driving positive change in HIV treatment and > prevention. For example, while oral pills for HIV prevention treatment are highly effective, we know that some people find it unsuitable and difficult to adhere to, a reticence that affects both health outcomes and overall wellbeing. Long-acting injectables (LAIs) will ultimately enhance adherence7 rates and help reduce the stigma that some users may face through daily pill intake.8 ViiV Healthcare, as the sole global company entirely dedicated to HIV, has been at the forefront of this scientific advancement, pioneering the world’s first long-acting injectables for both treatment and prevention. Our extensive research and development of LAIs underscore our conviction that they are set to play a vital role in ending the HIV epidemic. To drive impact at scale, these transformative solutions must be delivered, and adequately funded, in partnership with governments and other key stakeholders. Now is not the time for complacency or cutbacks; too much is at stake. > We stand at a critical juncture, and it is imperative we recognize that > prioritizing HIV is not merely a public health imperative, but an economic and > social necessity demanding a collective effort. With a new European Parliament in place, politicians committed to Europe meeting the UNAIDS’ target of ending the HIV epidemic as a public health threat by 2030 have the opportunity to advocate for this. This leadership is essential, particularly as global political attention to HIV challenges appears to be diminishing. While some may argue Europe cannot afford to address these challenges, the reality is that the cost of complacency is far greater. The clock is ticking. But there is still time and, by coming together, we can change the trajectory of this epidemic. -------------------------------------------------------------------------------- References: 1 The urgency of now: AIDS at a crossroads. Geneva: Joint United Nations Programme on HIV/AIDS (2024). Available at: https://www.unaids.org/sites/default/files/media_asset/2024-unaids-global-aids-update_en.pdf. 2 Boardman E, Boffito M, Chadwick DR, Cheserem E, Kabagambe S, Kasadha B, Elliott C. Tackling late HIV diagnosis: Lessons from the UK in the COVID-19 era. International journal of STD & AIDS. 2024 Mar;35(4):244-53. 3 Guaraldi G, Zona S, Menozzi M, Brothers TD, Carli F, Stentarelli C, Dolci G, Santoro A, Da Silva AR, Rossi E, Falutz J. Late presentation increases risk and costs of non-infectious comorbidities in people with HIV: an Italian cost impact study. AIDS research and therapy. 2017 Feb 16;14(1):8. 4 The Late Presentation Working Groups in EuroSIDA and COHERE. Estimating the burden of HIV late presentation and its attributable morbidity and mortality across Europe 2010–2016. BMC Infect Dis 20, 728 (2020). https://doi.org/10.1186/s12879-020-05261-7 5 Radu P, Hayes H, Tunnicliffe E, Mott D, Hampson G. Altering the Trajectory of HIV in Europe. OHE Contract Research Report, London: Office of Health Economics. Available at: https://www.ohe.org/publications/altering-the-trajectory-of-hiv-in-europe/. 6 Kiplagat J, Tran DN, Barber T, Njuguna B, Vedanthan R, Triant VA, Pastakia SD. How health systems can adapt to a population ageing with HIV and comorbid disease. The Lancet HIV. 2022 Apr 1;9(4):e281-92. 7 Zhang C, Liu Y. Understanding the association between PrEP stigma and PrEP cascade moderated by the intensity of HIV testing. Tropical Medicine and Infectious Disease. 2022 May 16;7(5):74. 8 Brooks RA, Cabral A, Nieto O, Fehrenbacher A, Landrian A. Experiences of pre-exposure prophylaxis stigma, social support, and information dissemination among Black and Latina transgender women who are using pre-exposure prophylaxis. Transgender health. 2019 Aug 1;4(1):188-96. -------------------------------------------------------------------------------- Disclaimer POLITICAL ADVERTISEMENT * The sponsor is ViiV Healthcare * The ultimate controlling entity is GSK Plc * The advertisement is linked to policy advocacy regarding the progress of HIV response in Europe and actions to end HIV as a public health threat by 2030 More information here.

Thirty-six million Europeans — including more than one million in the Nordics[1] — live with a rare disease.[2] For patients and their families, this is not just a medical challenge; it is a human rights issue. Diagnostic delays mean years of worsening health and needless suffering. Where treatments exist, access is far from guaranteed. Meanwhile, breakthroughs in genomics, AI and targeted therapies are transforming what is possible in health care. But without streamlined systems, innovations risk piling up at the gates of regulators, leaving patients waiting. Even the Nordics, which have some of the strongest health systems in the world, struggle to provide fair and consistent access for rare-disease patients. Expectations should be higher. THE BURDEN OF DELAY The toll of rare diseases is profound. People living with them report health-related quality-of-life scores 32 percent lower than those without. Economically, the annual cost per patient in Europe — including caregivers — is around €121,900.[3] > Across Europe, the average time for diagnosis is six to eight years, and > patients continue to face long waits and uneven access to medications. In Sweden, the figure is slightly lower at €118,000, but this is still six times higher than for patients without a rare disease. Most of this burden (65 percent) is direct medical costs, although non-medical expenses and lost productivity also weigh heavily. Caregivers, for instance, lose almost 10 times more work hours than peers supporting patients without a rare disease.[4] This burden can be reduced. European patients with access to an approved medicine face average annual costs of €107,000.[5] Yet delays remain the norm. Across Europe, the average time for diagnosis is six to eight years, and patients continue to face long waits and uneven access to medications. With health innovation accelerating, each new therapy risks compounding inequity unless access pathways are modernized. PROGRESS AND REMAINING BARRIERS Patients today have a better chance than ever of receiving a diagnosis — and in some cases, life-changing therapies. The Nordics in particular are leaders in integrated research and clinical models, building world-class diagnostics and centers of excellence. > Without reform, patients risk being left behind. But advances are not reaching everyone who needs them. Systemic barriers persist: * Disparities across Europe: Less than 10 percent of rare-disease patients have access to an approved treatment.[6] According to the Patients W.A.I.T. Indicator (2025), there are stark differences in access to new orphan medicines (or drugs that target rare diseases).[7] Of the 66 orphan medicines approved between 2020 and 2023, the average number available across Europe was 28. Among the Nordics, only Denmark exceeded this with 34. * Fragmented decision-making: Lengthy health technology assessments, regional variation and shifting political priorities often delay or restrict access. Across Europe, patients wait a median of 531 days from marketing authorization to actual availability. For many orphan drugs, the wait is even longer. In some countries, such as Norway and Poland, reimbursement decisions take more than two years, leaving patients without treatment while the burden of disease grows.[8] * Funding gaps: Despite more therapies on the market and greater technology to develop them, orphan medicines account for just 6.6 percent of pharmaceutical budgets and 1.2 percent of health budgets in Europe. Nordic countries — Sweden, Norway and Finland — spend a smaller share than peers such as France or Belgium. This reflects policy choices, not financial capacity.[9] If Europe struggles with access today, it risks being overwhelmed tomorrow. Rare-disease patients — already facing some of the longest delays — cannot afford for systems to fall farther behind. EASING THE BOTTLENECKS Policymakers, clinicians and patient advocates across the Nordics agree: the science is moving faster than the systems built to deliver it. Without reform, patients risk being left behind just as innovation is finally catching up to their needs. So what’s required? * Governance and reforms: Across the Nordics, rare-disease policy remains fragmented and time-limited. National strategies often expire before implementation, and responsibilities are divided among ministries, agencies and regional authorities. Experts stress that governments must move beyond pilot projects to create permanent frameworks — with ring-fenced funding, transparent accountability and clear leadership within ministries of health — to ensure sustained progress. * Patient organizations: Patient groups remain a driving force behind awareness, diagnosis and access, yet most operate on short-term or volunteer-based funding. Advocates argue that stable, structural support — including inclusion in formal policy processes and predictable financing — is critical to ensure patient perspectives shape decision-making on access, research and care pathways. * Health care pathways: Ann Nordgren, chair of the Rare Disease Fund and professor at Karolinska Institutet, notes that although Sweden has built a strong foundation — including Centers for Rare Diseases, Advanced Therapy (ATMP) and Precision Medicine Centers, and membership in all European Reference Networks — front-line capacity remains underfunded. “Government and hospital managements are not providing  resources to enable health care professionals to work hands-on with diagnostics, care and education,” she explains. “This is a big problem.” She adds that comprehensive rare-disease centers, where paid patient representatives collaborate directly with clinicians and researchers, would help bridge the gap between care and lived experience. * Research and diagnostics: Nordgren also points to the need for better long-term investment in genomic medicine and data infrastructure. Sweden is a leader in diagnostics through Genomic Medicine Sweden and SciLifeLab, but funding for advanced genomic testing, especially for adults, remains limited. “Many rare diseases still lack sufficient funding for basic and translational research,” she says, leading to delays in identifying genetic causes and developing targeted therapies. She argues for a national health care data platform integrating electronic records, omics (biological) data and patient-reported outcomes — built with semantic standards such as openEHR and SNOMED CT — to enable secure sharing, AI-driven discovery and patient access to their own data DELIVERING BREAKTHROUGHS Breakthroughs are coming. The question is whether Europe will be ready to deliver them equitably and at speed, or whether patients will continue to wait while therapies sit on the shelf. There is reason for optimism. The Nordic region has the talent, infrastructure and tradition of fairness to set the European benchmark on rare-disease care. But leadership requires urgency, and collaboration across the EU will be essential to ensure solutions are shared and implemented across borders. The need for action is clear: * Establish long-term governance and funding for rare-disease infrastructure. * Provide stable, structural support for patient organizations. * Create clearer, better-coordinated care pathways. * Invest more in research, diagnostics and equitable access to innovative treatments. Early access is not only fair — it is cost-saving. Patients treated earlier incur lower indirect and non-medical costs over time.[10] Inaction, by contrast, compounds the burden for patients, families and health systems alike. Science will forge ahead. The task now is to sustain momentum and reform systems so that no rare-disease patient in the Nordics, or anywhere in Europe, is left waiting. -------------------------------------------------------------------------------- [1] https://nordicrarediseasesummit.org/wp-content/uploads/2025/02/25.02-Nordic-Roadmap-for-Rare-Diseases.pdf [2] https://nordicrarediseasesummit.org/wp-content/uploads/2025/02/25.02-Nordic-Roadmap-for-Rare-Diseases.pdf [3] https://media.crai.com/wp-content/uploads/2024/10/28114611/CRA-Alexion-Quantifying-the-Burden-of-RD-in-Europe-Full-report-October2024.pdf [4] https://media.crai.com/wp-content/uploads/2024/10/28114611/CRA-Alexion-Quantifying-the-Burden-of-RD-in-Europe-Full-report-October2024.pdf [5] https://media.crai.com/wp-content/uploads/2024/10/28114611/CRA-Alexion-Quantifying-the-Burden-of-RD-in-Europe-Full-report-October2024.pdf [6] https://www.theparliamentmagazine.eu/partner/article/a-competitive-and-innovationled-europe-starts-with-rare-diseases? [7] https://www.iqvia.com/-/media/iqvia/pdfs/library/publications/efpia-patients-wait-indicator-2024.pdf [8] https://www.iqvia.com/-/media/iqvia/pdfs/library/publications/efpia-patients-wait-indicator-2024.pdf [9] https://copenhageneconomics.com/wp-content/uploads/2025/09/Copenhagen-Economics_Spending-on-OMPs-across-Europe.pdf [10] https://media.crai.com/wp-content/uploads/2024/10/28114611/CRA-Alexion-Quantifying-the-Burden-of-RD-in-Europe-Full-report-October2024.pdf Disclaimer POLITICAL ADVERTISEMENT * The sponsor is Alexion Pharmaceuticals * The entity ultimately controlling the sponsor: AstraZeneca plc * The political advertisement is linked to policy advocacy around rare disease governance, funding, and equitable access to diagnosis and treatment across Europe More information here.

PARIS — How do you celebrate a major anniversary of the world’s most significant climate treaty while deprioritizing the fight against climate change?   That’s the quandary in Paris heading into Friday, when the landmark Paris Agreement turns 10.   With budgets strapped and the fight against climate change losing political momentum, the only major celebration planned by the French government consists of a reception inside the Ministry of Ecological Transition hosted by the minister, Monique Barbut, according to the invitation card seen by POLITICO.  Prime Minister Sébastien Lecornu won’t be there, and it’s unclear if President Emmanuel Macron will attend.  Lecornu will be talking about health care in the region of Eure, where he’s from. Macron’s plans for Friday are not yet public, but the day before he’ll address the “consequences of misinformation on climate change” as part of a nationwide tour to speak with French citizens about technology and misinformation.  According to two ministerial advisers, the Elysée Palace had initially planned to organize an event, details of which were not released, but it was canceled at the last minute. When contacted about the plans, the Elysée did not respond.  Even if Macron ends up attending the ministerial event, the muted nature of the celebration is both a symptom of the political backlash against Europe’s green push and a metaphor for the Paris Agreement’s increasingly imperiled legacy — sometimes at the hands of France itself, which had been supposed to act as guarantor of the accord.  “France wants to be the guardian of the Paris Agreement, [but] it also needs to implement it,” said Lorelei Limousin, a climate campaigner at Greenpeace. “That means really putting the resources in place, particularly financial resources, to move away from fossil fuels, both in France and internationally.”  PARIS AGREEMENT’S BIRTHDAY PLANNER  Before being appointed to government, Barbut was Macron’s special climate envoy and had been tasked with organizing the treaty’s celebration. She told POLITICO in June that she hoped to use the annual Paris Peace Forum to celebrate the anniversary, then bring together hundreds of the world’s leading climate scientists in late November and welcome them at the Elysée.   Those events, which have already come and gone, were supposed to be followed by a grand finale on Friday.   According to one of the ministerial advisers previously cited, the moratorium on government communications spending introduced in October by the prime minister threw a wrench in those plans.   “We’d like to do something more festive, but the problem is that we have no money,” the adviser said.   Environmentalists say the muted plans point to a government that remains mired in crisis and shows little interest in prioritizing climate change. Lecornu is laser-focused on getting a budget passed before the end of the year, whereas Macron’s packed agenda sees him hopscotching across the globe to tackle geopolitical crises and touring France to talk about his push to regulate social media.  Anne Bringault, program director at the Climate Action Network, accused the government of trying to minimize the anniversary of the treaty “on the sly” because there “is no political support” for a celebration. Some hope the government will use the occasion to present an update of its climate roadmap, the national low-carbon strategy, which is more than two years overdue.  They also still hope that Lecornu will change his plans and show up to mark the occasion. Apart from his trip to his fiefdom in the Eure, the prime minister’s schedule shows no appointments. His office told POLITICO that Lecornu has no plans to change his schedule for the time being.  As for Macron, it’s still unclear what he’ll be doing on Friday. This story is adapted from an article published by POLITICO in French.