STRASBOURG — The European Parliament has voted today to set up an EU fund to expand access to abortion for women across the bloc, in a historic vote that divided lawmakers. The plan would establish a voluntary, opt-in financial mechanism to help countries provide abortion care to women who can’t access it in their own country and who choose to travel to one with more liberal laws. European citizens presented the plan in a petition — through the campaign group “My Voice, My Choice.” Lawmakers in Strasbourg voted 358 in favor and 202 against the proposal, and 79 MEPs abstained. The topic sparked animated discussions in the European Parliament plenary on Tuesday evening. MEPs with center-right and far-right groups tabled competing texts to the resolution put forward by Renew’s Abir Al-Sahlani on behalf of the women’s rights and gender equality committee. Supporters of the scheme argued it would help reduce unsafe abortions and ensure women across the bloc have equal rights; those who oppose it, mostly from conservative groups, dismissed it as an ideological push and EU overreach into national policy. Abortion laws vary greatly across the EU, from near-total bans in Poland and Malta to liberal rules in the Netherlands and the U.K. The fund could be a game changer for the thousands of European women who travel every year to another EU country to access abortion care. The European Commission now has until March 2026 to give a response. This story is being updated.

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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.

This article is presented by EFPIA with the support of AbbVie I made a trip back to Europe recently, where I spent the vast majority of my pharmaceutical career, to share my perspectives on competitiveness at the European Health Summit. Now that I work in a role responsible for supporting patient access to medicine globally, I view Europe, and how it compares internationally, through a new lens, and I have been reflecting further on why the choices made today will have such a critical impact on where medicines are developed tomorrow. Today, many patients around the world benefit from medicines built on European science and breakthroughs of the last 20 years. Europeans, like me, can be proud of this contribution. As I look forward, my concern is that we may not be able to make the same claim in the next 20 years. It’s clear that Europe has a choice. Investing in sustainable medicines growth and other enabling policies will, I believe, bring significant benefits. Not doing so risks diminishing global influence. > Today, many patients around the world benefit from medicines built on European > science and breakthroughs of the last 20 years I reflect on three important points: 1) investment in healthcare benefits individuals, healthcare and society, but the scale of this benefit remains underappreciated; 2) connected to this, the underpinning science for future innovation is increasingly happening elsewhere; and 3) this means the choices we make today must address both of these trends. First, let’s use the example of migraine. As I have heard a patient say, “Migraine will not kill you but neither [will they] let you live.”[1] Individuals can face being under a migraine attack for more than half of every month, unable to leave home, maintain a job and engage in society.[2] It is the second biggest cause of disability globally and the first among young women.[3] It affects the quality of life of millions of Europeans.[4] From 2011-21 the economic burden of migraine in Europe due to the loss of working days ranged from €35-557 billion, depending on the country, representing 1-2 percent of gross domestic product (GDP).[5]   Overall socioeconomic burden of migraine as percentage of the country’s GDP in 2021 Source: WifOR, The socioeconomic burden of migraine. The case of 6 European Countries.5 Access to effective therapies could radically improve individuals’ lives and their ability to return to work.[6] Yet, despite the staggering economic and personal impacts, in some member states the latest medicines are either not reimbursed or only available after several treatment failures.[7] Imagine if Europe shifted its perspective on these conditions, investing to improve not only health but unlocking the potential for workforce and economic productivity? Moving to my second point, against this backdrop of underinvestment, where are scientific advances now happening in our sector? In recent years it is impressive to see China has become the second-largest drug developer in the world,[8] and within five years it may lead the innovative antibodies therapeutics sector,[9] which is particularly promising for complex areas like oncology. Cancer is projected to become the leading cause of death in Europe by 2035,[10] yet the continent’s share of the number of oncology trials dropped from 41 percent in 2013 to 21 percent in 2023.10 Today, antibody-drug conjugates are bringing new hope in hard-to-treat tumor types,[11] like ovarian,[12] lung[13] and colorectal[14] cancer, and we hope to see more of these advances in the future. Unfortunately, Europe is no longer at the forefront of the development of these innovations. This geographical shift could impact high-quality jobs, the vitality of Europe’s biotech sector and, most importantly, patients’ outcomes. [15] > This is why I encourage choices to be made that clearly signal the value > Europe attaches to medicines This is why I encourage choices to be made that clearly signal the value Europe attaches to medicines. This can be done by removing national cost-containment measures, like clawbacks, that are increasingly eroding the ability of companies to invest in European R&D. To provide a sense of their impact, between 2012 and 2023, clawbacks and price controls reduced manufacturer revenues by over €1.2 billion across five major EU markets, corresponding to a loss of 4.7 percent in countries like Spain.[16] Moreover, we should address health technology assessment approaches in Europe, or mandatory discount policies, which are simply not adequately accounting for the wider societal value of medicines, such as in the migraine example, and promoting a short-term approach to investment. By broadening horizons and choosing a long-term investment strategy for medicines and the life science sector, Europe will not only enable this strategic industry to drive global competitiveness but, more importantly, bring hope to Europeans suffering from health conditions. AbbVie SA/NV – BE-ABBV-250177 (V1.0) – December 2025 -------------------------------------------------------------------------------- [1] The Parliament Magazine, https://www.theparliamentmagazine.eu/partner/article/unmet-medical-needs-and-migraine-assessing-the-added-value-for-patients-and-society, Last accessed December 2025. [2] The Migraine Trust; https://migrainetrust.org/understand-migraine/types-of-migraine/chronic-migraine/, Last accessed December 2025. [3] Steiner TJ, et al; Lifting The Burden: the Global Campaign against Headache. Migraine remains second among the world’s causes of disability, and first among young women: findings from GBD2019. J Headache Pain. 2020 Dec 2;21(1):137 [4] Coppola G, Brown JD, Mercadante AR, Drakeley S, Sternbach N, Jenkins A, Blakeman KH, Gendolla A. The epidemiology and unmet need of migraine in five european countries: results from the national health and wellness survey. BMC Public Health. 2025 Jan 21;25(1):254. doi: 10.1186/s12889-024-21244-8. [5] WifOR. Calculating the Socioeconomic Burden of Migraine: The Case of 6 European Countries. Available at: [https://www.wifor.com/en/download/the-socioeconomic-burden-of-migraine-the-case-of-6-eu­ropean-countries/?wpdmdl=358249&refresh=687823f915e751752703993]. Accessed June 2025. [6] Seddik AH, Schiener C, Ostwald DA, Schramm S, Huels J, Katsarava Z. Social Impact of Prophylactic Migraine Treatments in Germany: A State-Transition and Open Cohort Approach. Value Health. 2021 Oct;24(10):1446-1453. doi: 10.1016/j.jval.2021.04.1281 [7] Moisset X, Demarquay G, et al., Migraine treatment: Position paper of the French Headache Society. Rev Neurol (Paris). 2024 Dec;180(10):1087-1099. doi: 10.1016/j.neurol.2024.09.008. [8] The Economist, https://www.economist.com/china/2025/11/23/chinese-pharma-is-on-the-cusp-of-going-global, Last accessed December 2025. [9] Crescioli S, Reichert JM. Innovative antibody therapeutic development in China compared with the USA and Europe. Nat Rev Drug Discov. Published online November 7, 2025. [10] Manzano A., Svedman C., Hofmarcher T., Wilking N.. Comparator Report on Cancer in Europe 2025 – Disease Burden, Costs and Access to Medicines and Molecular Diagnostics. EFPIA, 2025. [IHE REPORT 2025:2, page 20] [11] Armstrong GB, Graham H, Cheung A, Montaseri H, Burley GA, Karagiannis SN, Rattray Z. Antibody-drug conjugates as multimodal therapies against hard-to-treat cancers. Adv Drug Deliv Rev. 2025 Sep;224:115648. doi: 10.1016/j.addr.2025.115648. Epub 2025 Jul 11. PMID: 40653109.. [12] Narayana, R.V.L., Gupta, R. Exploring the therapeutic use and outcome of antibody-drug conjugates in ovarian cancer treatment. Oncogene 44, 2343–2356 (2025). https://doi.org/10.1038/s41388-025-03448-3 [13] Coleman, N., Yap, T.A., Heymach, J.V. et al. Antibody-drug conjugates in lung cancer: dawn of a new era?. npj Precis. Onc. 7, 5 (2023). https://doi.org/10.1038/s41698-022-00338-9 [14] Wang Y, Lu K, Xu Y, Xu S, Chu H, Fang X. Antibody-drug conjugates as immuno-oncology agents in colorectal cancer: targets, payloads, and therapeutic synergies. Front Immunol. 2025 Nov 3;16:1678907. doi: 10.3389/fimmu.2025.1678907. PMID: 41256852; PMCID: PMC12620403. [15] EFPIA, Improving EU Clinical Trials: Proposals to Overcome Current Challenges and Strengthen the Ecosystem, efpias-list-of-proposals-clinical-trials-15-apr-2025.pdf, Last accessed December 2025. [16] The EU General Pharmaceutical Legislation & Clawbacks, © Vital Transformation BVBA, 2024.

LONDON — The American drugmaker Eli Lilly wants to see more changes to Britain’s medicine market before it pivots on its abandoned £279 million investment in a biotech incubator project. The U.K. government has drawn up proposals to increase the amount the state-funded National Health Service is allowed to pay pharmaceutical firms for drugs after intense discussions with officials from Donald Trump’s administration. The U.S. president has demanded lower drug prices for Americans, and suggested other developed countries should pay more. The British plans under consideration could increase the threshold at which the NHS pays firms for medicines by up to 25 percent. But for the U.S. pharmaceutical company — which shelved its planned facility meant to support early-stage life sciences businesses with lab space, mentorship and potential financial backing — the proposal alone is not enough. “I don’t think we have heard enough to say that we are willing to get the Lilly Gateway Lab started,” Patrik Jonsson, president of Lilly’s international business, which covers all markets outside the U.S., told POLITICO. “I think once we see the right signs from the U.K. government, we’re more than happy to restart those discussions, and we could move quite quickly,” Jonsson said. However, “we need to see some significant and sustainable change here.” The comments will be a blow to British negotiators, who are in advanced talks to agree their drug-pricing deal with the U.S. administration as part of wider trade negotiations. Officials are hoping to wrap up the pharma talks ahead of the U.K.’s budget in late November. Ministers last week granted a two-week extension to the deadline by which pharma firms must tell the government if they intend to leave the NHS’s voluntary drug pricing scheme. If Washington and London strike a deal — effectively committing the NHS to higher drug spending — Chancellor Rachel Reeves will face pressure to spell out how much the increase will cost taxpayers. ‘WE NEED THE RIGHT CONDITIONS’ Drugmakers have long called for changes to the U.K.’s tightly-controlled drug prices. Britain limits the annual cost for a year of good-quality life (QALY) for a patient at £30,000 for most drugs. Industry also pays an annual rebate to the NHS at 23 percent of their U.K. sales. These measures have contained the medicine bill for the U.K.’s publicly-funded health care system. While Jonsson acknowledged the U.K. is “well positioned to be a source of innovation” thanks to a “small but really impressive group of scientists,” he said the country needs to demonstrate sustained changes. The British plans under consideration could increase the threshold at which the NHS pays firms for medicines by up to 25 percent. | Anna Barclay/Getty Images “At the end of the day if you want us to research, develop and produce medicines in your country you need to put the right conditions in place so that your citizens can get access to those patients at least who need it most,” Jonsson said. An editorial in the Lancet medical journal last week said “the argument that paying more for medicines leads to more innovation is unfounded.” “If the U.K. Government wants to attract pharma investment, it should follow the evidence. Rather than handing over more money for medicines, it should invest in creating fertile conditions for attracting world-leading scientists, boosting public infrastructure for research and development, and facilitating clinical trials,” the article states. “Although the tangible outcomes of applied research might appeal to politicians, investing massively in a second-to-none basic science sector will allow scientific innovation to flourish.” Jonsson was speaking to POLITICO as the company announced a €2.6 billion new manufacturing facility in the Netherlands to produce oral medicines, including its first GLP-1 weight-loss pill. A Department of Health and Social Care spokesperson said: “We will always prioritise the needs of NHS patients. Investment in patient access to innovative medicines is critical to our NHS. “We are now in advanced discussions with the US Administration to secure the best outcome for the UK, reflecting our strong relationship and the opportunities from close partnership with our pharmaceutical industry,” the spokesperson added.

Europe spends more on tackling mental health conditions that any other region in the world, but with rates of illness at high levels, it still needs to urgently invest more. That’s one of the warnings from the World Health Organization in two reports released Tuesday — one on governments’ mental health policies and another on mental wellbeing. Together, the reports, which collate rates of mental health conditions and policies from 2021 and 2024, respectively, point to countries playing catch-up as mental health disorders weigh down national health budgets and contribute significantly to disability. Governments in WHO’s Europe region spent $51.76 per capita in 2024 on mental health, far more than any other region globally. The next-highest-spending region is the Americas, with $6.86 per capita. European countries also spend a higher proportion of their overall budget on mental wellbeing, with 4.5 percent compared to the global median figure of 2.1 percent. The 2.1 percent figure is stuck at the same level as in 2017 and 2020, with no evidence of greater spending at any income level, WHO officials told reporters Monday. High-income countries in general greatly outspend lower- and middle income countries on mental health. In all WHO regions, the estimated prevalence of mental disorders has increased since 2001, with the greatest increases taking place in WHO’s Americas region (rising from 15.3 percent to 17.1 percent in 2021) and European region (from 14 percent to 15.4 percent). Globally, there were more than 1 billion people living with a mental health disorder, according to 2021 data. The prevalence of mental health disorders is generally evenly distributed by region, although Europe has lower rates of anxiety disorders than elsewhere in the world, with 3.7 percent of the population compared with 4.4 percent globally. Europe and Southeast Asia both have higher rates of intellectual development disorders than the global rate of 1.2 percent, with 1.8 and 2.7 percent. Underspending on mental health is costing people access to the services they need, the WHO told reporters Monday. Just 9 percent of people with depression, and 40 percent of people with psychosis, get treatment. “Those are the numbers to be worried about,” said Dévora Kestel, a director at the WHO’s department for non-communicable diseases and mental health.

Lawmakers and activists are warning that nationalist candidate Karol Nawrocki’s win in the Polish presidential election represents a “defeat” for women’s rights and further threatens abortion access in Poland. Nawrocki, a self-described football hooligan backed by the right-wing nationalist Law and Justice (PiS) party — and by U.S. President Donald Trump’s administration — won Poland’s presidential election last weekend, narrowly beating centrist Rafał Trzaskowski. His victory deals a significant loss to the current government, led by centrist Donald Tusk, and represents “a devastating blow to anyone fighting for reproductive freedom,” said Nika Kovač, coordinator for the My Voice, My Choice campaign, which is working to improve access to abortion across the EU. “As a staunch conservative with strong nationalist backing, Nawrocki is expected not only to uphold but potentially tighten Poland’s already draconian abortion laws,” Kovač said in a written statement. “His win slams the door on hope for political reform in the near future — and locks in a future where women’s lives remain expendable.” Poland has some of the strictest abortion rules in Europe. The PiS party tightened the country’s abortion laws to a near-total ban in 2020, making the procedure allowed only in cases of rape or incest, or if the life of the woman is endangered. Nawrocki has said he would not sign any bills expanding the right to abortion. Tusk’s 2023 campaign, which pushed out PiS from government after eight years of rule, heavily relied on his commitment to liberalize abortion laws. But activists said they have become embittered with his promises, after attempts to ease the strict regulations hit a political wall as the opposition and incumbent President Andrzej Duda blocked several of his efforts. A bill to decriminalize abortion up to the 12th week of pregnancy narrowly failed to pass in the parliament and a parliamentary vote to stop prosecuting people who assist with abortions failed because of conservatives within his ruling coalition.  “We are quite disillusioned and disappointed,” said Kinga Jelinska, an activist from women’s rights and abortion group Abortion Dream Team and co-founder of Women Help Women. “I am not surprised that many people did not go to vote in this election … These are the votes that were missing in comparison to 2023, because people are disillusioned and they don’t want to go and vote and then have nothing delivered.” Now, Nawrocki’s win means that “there is no chance to change the abortion laws in Poland,” said Polish Member of the European Parliament Joanna Scheuring-Wielgus, from the Socialists and Democrats group.  Tusk’s efforts have been “effectively paralyzed,” added Kovač. “Even a supportive parliament cannot bypass a president who holds veto power — and Nawrocki has made it clear where he stands (on abortion).” This does not mean that Polish women will stop fighting for these rights, Scheuring-Wielgus said. “Sooner or later the discussion in Poland on this topic will erupt again. I am convinced of this.” HOSTILE ENVIRONMENT It’s not just the failed legislative efforts that anger activists; Jelinska said the current government has repeatedly failed to protect women seeking abortion and doctors performing the procedure from harassment, including at the newly opened Abotak center. Activists from Abortion Dream Team opened the center in March, right opposite the Polish parliament — the first place in Poland where women can go to access and take abortion pills. But the center has been the target of ongoing attacks and steady harassment since its opening, Jelinska said, and Tusk and Trzaskowski (Warsaw’s mayor) have done nothing about it, she claimed. “We have not seen any support for our center, even though this is a situation where we actually risk our health to be there,” she said. “It is fake promises, and people are not stupid.” Doctors and organizations assisting with abortion face constant harassment in Poland. The U.N. Committee on the Elimination of Discrimination against Women concluded last year that women in Poland are facing severe human rights violations due to restrictive abortion laws, with many forced to carry unwanted pregnancies to term, seek unsafe clandestine procedures or travel abroad for legal abortions. The case of Justyna Wydrzyńska, an activist who was sentenced to eight months of community service for facilitating an abortion in 2023, made international headlines. And in April, Polish MEP Grzegorz Braun stormed a hospital in Poland and threatened a doctor with a citizen’s arrest for performing a legal late-term abortion. “We also can expect that in the future, there will be more prosecution and more attacks, because this kind of voice gets legitimized in the presidential seat,” Jelinska said. Amid ongoing challenges, the EU should step up and show solidarity to women in Poland, Left MEP Manon Aubry said. Last month, Aubry was one of the MEPs that traveled to Poland to deliver abortion pills to the Abotak center. She said she is planning to do it again soon. “It’s part of the role of the European Union,” she said. “When fundamental values of the European Union are under threat — like it is the case in Poland when it comes to women’s rights or to rule of law in general — then it’s our responsibility to stand up and act in solidarity.” The My Voice, My Choice campaign wants the European Commission to establish a fund to help women who can’t access abortion care in their own country to travel to another with more liberal abortion laws. It successfully gathered the 1 million signatures needed to be considered by the Commission earlier this year.  The Polish election shows why the campaign is “more essential than ever,” Kovač said. “When the political system fails us, it is movements like ours that must lead the fight.”

Ukrainian HIV patients are worried their life-saving drugs will run out amid uncertainty over U.S. funding. President Donald Trump’s massive ax in January to projects funded by its international development agency USAID hit NGOs and government-run projects in Ukraine working to tackle one of the largest HIV epidemics in Europe.  The U.S. administration later reversed cuts to life-saving humanitarian assistance for 90 days — while it conducts a review of foreign aid — bringing a reprieve to these Ukrainian services. But with no long-term funding decision in sight, and with supplies of medicines only sufficient until November, health staff and patients are fearful they will have no means to control the deadly infectious disease. “We’ve never had such an apocalypse before,” said Anzhela Moiseyenko, who heads the Chernihiv Network, a Ukrainian organization of people living with HIV.  Ukrainian services have already had a bitter taste of what might come. The temporary pause left the country scrambling to maintain treatment for over 116,000 people with HIV, while some testing and prevention services have scaled down and may close, as urgent treatment needs take priority.  The Chernihiv Network ran an HIV testing service through three years of war. But at the end of January the USAID-funded project abruptly stopped for two months as funds ceased, Moiseyenko said.   Deliveries of antiretroviral therapy (ART) to Ukraine were stranded en route by the stop-work order, said Dmytro Sherembey, who heads NGO 100% Life. Some stocks, including for children, are now running short, he said. Contracts with pharmaceutical companies had to be cancelled then restarted, while funding uncertainty affects procurement, which has to be planned months in advance. “We have no guarantee they won’t announce a halt again. There is no system through which we can plan for the future,” said Sherembey, who was among the first 100 people in Ukraine to start ART in 2002 with U.S. funding. The therapy has to be taken daily for life.  “You can’t put life on hold,” he said.  JEOPARDIZING PROGRESS Before the war, the story was quite different. While Ukraine has the largest HIV epidemic in the European region after Russia, by 2022, nationwide testing, prevention and treatment were on track to control the infection. New cases were dropping and many people’s disease was controlled with medicines.  But after Russia’s full-scale invasion more than 50 percent of the country’s budget was allocated to defense. International funding kept health systems afloat. Ukraine registered over 10,000 new cases of HIV in 2024. | Kseniia Tomchyk/AFP via Getty Images “Because the country is at war, there is no other source of financing,” Moiseyenko said. The U.S. president’s Emergency Plan for AIDS Relief (PEPFAR) took over the purchase of all antiretroviral therapy for people with HIV — previously 80 percent funded by Ukraine — contributing close to $16 million for medication and test kits in 2023-2024.  Following the blanket stop-work order, all national HIV services were interrupted for at least two to four weeks. Now care providers are trying to second-guess why U.S. funding for most projects has been resumed — and, critically, for how long.  “It’s not finally clear, and we are not asking — it got released, so we just keep working,” said Andriy Klepikov, executive director of the Ukrainian NGO Alliance for Public Health which, together with 100% Life, manages prevention and support services through local partners. The 90-day review period has been extended for another 30 days, Devex reported, which ends May 20. The U.S. State Department told POLITICO in an email: “While the Department has acted swiftly, and finished a comprehensive review of all of its existing awards, this process remains ongoing.” The Office of Management and Budget is conducting a review. The department referred to statements from Secretary of State Marco Rubio that PEPFAR is an important and life-saving program that will continue, but which should be reduced over time. ADAPTING SERVICES In the meantime, Ukrainian health authorities have reallocated drugs to regions with the most need and prioritized combinations of available medications in order to prevent treatment interruptions. According to the Ukrainian Health Ministry’s Public Health Centre, Ukraine can continue providing ART for all current and new patients until at least the end of November.   “The policy is to preserve the whole range of life-saving services without reduction or suspension, even under conditions of martial law or unstable external financing. The ministry, [the Public Health Centre] and [its] partners are all working to find a stable solution and source of support to continue HIV services in full,” the Centre wrote in a response to POLITICO. The future of testing and prevention programs is even less certain. They are affected not only by dwindling commodities such as rapid test kits but also by new U.S. rules on diversity, equity, and inclusion and reproductive health.  The Chernihiv testing service worked with HIV-vulnerable groups like men who have sex with men and people involved in sex work, who fall into new exclusions. In early April the service restarted on a smaller scale and with a new policy. “Now we don’t highlight the groups that raise concerns,” Moiseyenko said. Although planned to run until 2026, the service’s funding has resumed only until the end of September. 100% Life has laid off a quarter of its staff from reduced or halted projects. The future of testing and prevention programs is even less certain. | Vyacheslav Madiyevskyi/ Ukrinform/Future Publishing via Getty Images Over the last two decades, seasoned Ukrainian NGOs have weathered several U.S. policy changes affecting HIV funding priorities, while keeping services running. “It’s important to acknowledge how massive and critical U.S. support has been,” said Klepikov of the Alliance for Public Health. The reach of the current cuts, however, is unprecedented. The second major donor for HIV and TB response in Ukraine is the Global Fund, an international financing and partnership organization. A third of its financing comes from the U.S. and is unlikely to be replaced from elsewhere, according to Klepikov, who warned this cash may be reallocated to medicines at the cost of prevention.  Meanwhile, WHO’s Ukraine mission is 17 percent U.S.-funded and has already seen a $8 million reduction, said WHO Ukraine representative Jarno Habicht. The mission has cut staffing, training and technical support that had been building Ukraine’s capacity to respond. Habicht suggested that Ukraine and its partners can balance other international funding streams to protect crucial services. But many countries are cutting support as they bolster defense and security. Klepikov hopes countries will see that stopping the spread of diseases like HIV is in line with these new priorities. “The programs we implement are contributing to global security and economic stability,” he said. UNCERTAINTY AND APATHY The funding uncertainty is compounding the negative health impact of the war in Ukraine.  In spring 2022, when Chernihiv was surrounded by Russian troops, Moiseyenko recalled how patients would travel long distances, risking shelling and capture, to get their HIV medication. Now, apathy is setting in, and people are more likely to miss treatment doses. Ukraine registered over 10,000 new cases of HIV in 2024. In the last two years, 75 percent of new cases in the Chernihiv region were in late stages of the infection — making it harder to treat and easier to pass on.  Late diagnosis and less adherence to treatment will only increase, according to Moiseyenko. “It’s already hard to motivate someone, when after three years of war they can’t see any future,” she said. “Cutting programs will lead to more deaths.” For the moment, patients and health care providers are awaiting a final U.S. decision — and watching as the U.S. attempts to end the war. “For 20 years there was this huge effort to stop HIV,” Sherembey at 100% Life said. “If you put this on hold it means that 20 years of effort went for nothing, and very quickly we’ll be back where we started.” Correction: This story has been updated to correct the amount of funds the WHO Ukraine mission receives from the U.S.

The United Kingdom’s recent vote to move toward the legalization of assisted dying represented a historic moment for the country — but it also mirrors a wider trend in Europe. Countries are on a path to liberalize their laws to expand end-of-life options to include euthanasia and assisted suicide. To some experts, the latest position in the U.K. reflects what is a growing and inevitable trend among Western European countries. Various forms of assisted dying are already legal in Austria, Belgium, Luxembourg, the Netherlands, Spain and Switzerland. “It will not happen in all countries at once, but especially in Western Europe and Northern Europe, if there are no laws available yet, there will be an urge to have such laws,” said Martin Buijsen, professor of health law at the Erasmus University Rotterdam. “I think that’s inevitable.” But to others, there are concerns that existing laws are already being pushed beyond their intended purpose, and fears that this slow trudge toward assisted dying being the norm could lead to harm — especially to vulnerable people. In Switzerland, for example, the recent use of a suicide pod stirred controversy and led to several arrests, while in the Netherlands, young people with mental health conditions are also legally taking their own lives with help from the state. “I have seen no jurisdiction in which the practice has not expanded, not one single jurisdiction,” said Theo Boer, professor of health care ethics at Protestant Theological University. “By imposing really strict criteria we can slow down the expansion … but they will not prevent the expansion.” For the U.K. this was the country’s second attempt to pursue such a law. This time it heeded lessons from its first failed attempt (making the conditions more restrictive) — and perhaps from stories from across the Channel. LEARNING THE LESSONS Assisted dying can refer to both euthanasia and assisted suicide. In euthanasia, a physician or provider administers a patient a fatal drug to deliberately end their life; while for assisted suicide the patient is legally prescribed lethal drugs they must take themselves to end their own life. In several of the countries that have legalized assisted dying, the number of people using it to end their lives is increasing. In 2023, 9,068 people died from assisted dying in the Netherlands — 5.4 percent of deaths that year. This is up 4 percent compared with 2022 and up 87 percent from 2013. Similarly, in Belgium there were 3,423 cases of euthanasia in 2023, up 15 percent compared with the previous year and comprising 3.1 percent of total deaths in the country. The Netherlands and Belgium were the first European countries to legalize euthanasia in 2002. Some have raised the alarm at the increasing number of people choosing to end their lives, warning governments debating similar laws to be aware of this phenomenon. “What I saw was not only the increase in the numbers — which for me was a sign that it was no longer the last exception, the last resort — but it became more and more a default way to die,” said Boer. “In addition to the numbers, we saw an expansion of the pathologies underlying euthanasia requests.” Boer had initially supported the Dutch euthanasia law and was a member of the Dutch euthanasia review committee. But he has since become an outspoken critic of this law and has warned other governments debating similar bills of the possible “side effects.” The rising number of patients — especially young people — with mental health disorders dying by euthanasia has also spurred fierce debate in the Netherlands, Buijsen said. The number of euthanasias for patients with psychiatric disorders doubled over the last five years, from 68 to 138. Similar debates arise around cases of minors and patients with dementia, he said. But it’s not a one-size-fit-all. According to researchers at the University of Bologna, the proportion of euthanasia and assisted suicide on overall deaths “continues to vary widely” in countries where the practice has been legalized for years, “mainly due to the circumstances under which [they] were adopted into law and the different practices approved.” Switzerland, for example, is one of the most popular destinations for foreigners looking to access assisted dying, and has been offering legal assisted suicide since 1942. POLITICAL AND SOCIAL BARRIERS It has taken some countries several years to push their assisted dying laws over the finish line, amid opposition from conservative parties, religious institutions and highly emotive debates. The Portuguese parliament approved an euthanasia bill four times over three years, but conservative President Marcelo Rebelo de Sousa vetoed all drafts. Eventually, the parliament overturned his veto in 2023 and forced him to sign the bill. But even today, the legislation has not been published in the country’s official journal, meaning it’s not in effect. While in countries such as Italy and Ireland, the powerful presence of the Catholic Church has historically steered the conversation away from legalization for years. It’s only recently, however, that things are changing. In Italy, the country’s Constitutional Court ruled in 2019 that assisted suicide was permissible when patients are able to make decisions and are in overwhelming pain. This led to Italy’s first case of assisted suicide in 2022 — despite there being no law to allow it. While in Ireland, progress on the debate shows the Church’s influence on policy may be weakening. Irish MPs earlier this year endorsed a parliamentary report calling for assisted dying and presented a “Voluntary Assisted Dying Bill 2024” to the lower house in June. But Ireland is also among a group of countries impacted by political upheaval. The Irish bill lapsed with a snap election and the dissolution of the Dáil. Similarly, France was debating an assisted dying bill earlier this year, but the process was interrupted by the dissolution of the government and subsequent snap election. And in Iceland, MPs presented a bill on euthanasia in March 2024, but the government fell in October, leading to a parliamentary election in November. TIMING IS EVERYTHING Timing and a country’s political landscape play a crucial role in determining the success of such proposals. And while the issue does not fall neatly along party lines — some Labour MPs in the U.K. were very vocal in criticizing the change of law — a left-leaning government or parliament are much more likely to pass similar bills. At the same time, conservative figures such as Boris Johnson and Marine Le Pen have spoken against euthanasia. In Spain, far-right party Vox challenged the country’s euthanasia law in 2023, but failed. Spain passed its law to legalize assisted dying in 2021. “If the [U.K.] vote had been taken before general elections, the outcome might have been somewhat different,” said Buijsen. “You will need, in some way, a kind of a progressive majority in parliament in order to have these laws passed.” The requirements of accessing assisted dying also vary greatly. While some countries, like the British bill, require the patient to have a terminal illness, others such as Belgium and the Netherlands only require that the patient is experiencing constant and unbearable suffering with no cure or prospect of improvement, including psychological suffering. Other Western European countries to have approved assisted dying include Luxembourg in 2009 and Austria from 2022. Countries including Scotland, Jersey and the Isle of Man have started the debate and made attempts to introduce legislation in recent years. In Germany, assisted dying falls into a gray area. The practice is illegal but the Federal Constitutional Court decriminalized it in 2020. A GEOGRAPHICAL DIVIDE While Western European countries are increasingly entertaining the assisted dying debate, Eastern and Central Europe are moving at a much slower pace. No countries in Eastern Europe have legalized assisted dying or are currently entertaining legislative proposals. But that doesn’t mean the topic is not entering public discussions. Veljko M. Turanjanin, law professor at the University of Kragujevac, in Serbia, said the country has seen several discussions to legalize euthanasia, as the public opinion and many medical professionals seem to be in favor. But the strong influence of the Orthodox Church has slowed progress, he said. “I think in the state where the government and the Church are linked close, it will not be an easy task for the government to pass such kind of legislations,” Turanjanin said. But when countries in the region do eventually move toward legalization, surrounding countries are likely to follow suit, he said. “I think when [Serbia and Croatia] legalize euthanasia or assisted suicide, the other countries will do the same.”