The message from Capitol Hill on both sides of the aisle is clear: Get ready for U.S. relations with China to spiral all over again in the new year. The one-year trade truce brokered in October between President Donald Trump and Chinese leader Xi Jinping is already looking shaky. And lawmakers are preparing to reup clashes over trade, Taiwan and cyber-intrusions when they return in January. “It’s like a heavyweight fight, and we’re in that short time period in-between rounds, but both sides need to be preparing for what is next after the truce,” Rep. Greg Stanton (D-Ariz.), a member of the House Select Committee on China, said in an interview. POLITICO talked to more than 25 lawmakers, including those on the House Select Committee on China, the House Foreign Affairs Committee’s East Asia subcommittee and the Congressional Executive Commission on China, for their views on the durability of the trade treaty. Both Republicans and Democrats warned of turbulence ahead. More than 20 of the lawmakers said they doubt Xi will deliver on key pledges the White House said he made in October, including reducing the flow of precursor chemicals to Mexico that cartels process into fentanyl and buying agreed volumes of U.S. agricultural goods. “China can never be trusted. They’re always looking for an angle,” Sen. Thom Tillis (R-N.C.) said. That pessimism comes despite an easing in U.S.-China tensions since the Trump-Xi meeting in South Korea. The bruising cycle of tit-for-tat tariffs that briefly hit triple digits earlier this year is currently on pause. Both countries have relaxed export restrictions on essential items (rare earths for the U.S., chip design software for China), while Beijing has committed to “expanding agricultural product trade” in an apparent reference to the suspension of imports of U.S. agricultural products it imposed earlier this year. This trend may continue, given that Trump is likely to want stability in the U.S.-China relationship ahead of a summit with Xi planned for April in Beijing. “We’re starting to see some movement now on some of their tariff issues and the fentanyl precursor issue,” Sen. Steve Daines (R-Mont.) said. But a series of issues have been brushed aside in negotiations or left in limbo — a status quo the Trump administration can only maintain for so long. The U.S.-China trade deal on rare earths that Bessent said the two countries would finalize by Thanksgiving remains unsettled. And the White House hasn’t confirmed reporting from earlier this month that Beijing-based ByteDance has finalized the sale of the TikTok social media app ahead of the Jan. 23 deadline for that agreement. “The idea that we’re in a period of stability with Beijing is simply not accurate,” said Sen. Jeanne Shaheen (D-N.H.), ranking member of the Senate Foreign Relations Committee. Shaheen has been sounding the alarm on China’s national security threats since she entered the Senate in 2009. But even some lawmakers who have been more open to engagement with Beijing — such as California Democratic Reps. Ro Khanna and Ami Bera — said that they don’t expect the armistice to last. The White House is more upbeat about the prospects for U.S.-China trade ties. “President Trump’s close relationship with President Xi is helping ensure that both countries are able to continue building on progress and continue resolving outstanding issues,” the White House said in a statement, adding that the administration “continues to monitor China’s compliance with our trade agreement.” It declined to comment on the TikTok deal. Still, the lawmakers POLITICO spoke with described four issues that could derail U.S.-China ties in the New Year: A SOYBEAN SPOILER U.S. soybean farmers’ reliance on the Chinese market gives Beijing a powerful non-tariff trade weapon — and China doesn’t appear to be following through on promises to renew purchases. The standoff over soybeans started in May, when China halted those purchases, raising the prospect of financial ruin across farming states including Illinois, Iowa, Minnesota, Nebraska and Indiana — key political constituencies for the GOP in the congressional midterm elections next year. The White House said last month that Xi committed to buying 12 million metric tons of U.S. soybeans in November and December. But so far, Beijing has only purchased a fraction of that agreed total, NBC reported this month. “What agitates Trump and causes him to react quickly are things that are more domestic and closer to home,” Rep. Jill Tokuda (D-Hawaii) said. China’s foot-dragging on soybean purchases “is the most triggering because it’s hurting American farmers and consumers, so that’s where we could see the most volatility in the relationship,” she said. That trigger could come on Feb. 28 — the new deadline for that 12 million metric ton purchase, which Treasury Secretary Scott Bessent announced earlier this month. The Chinese embassy in Washington declined to comment on whether Beijing plans to meet this deadline. The White House said one of the aspects of the trade deal it is monitoring is soybean purchases through this growing season. THE TAIWAN TINDERBOX Beijing’s threats to invade Taiwan are another near-term potential flashpoint, even though the U.S. hasn’t prioritized the issue in its national security strategy or talks between Xi and Trump. China has increased its preparations for a Taiwan invasion this year. In October, the Chinese military debuted a new military barge system that addresses some of the challenges of landing on the island’s beaches by deploying a bridge for cargo ships to unload tanks or trucks directly onto the shore. “China is tightening the noose around the island,” said Rep. Ro Khanna (D-Calif.), who joined a bipartisan congressional delegation to China in September and returned calling for better communications between the U.S. and Chinese militaries. Some of the tension around Taiwan is playing out in the wider region, as Beijing pushes to expand its military reach and its influence. Chinese fighter jets locked radar — a prelude to opening fire — on Japanese aircraft earlier this month in the East China Sea. “There is a real chance that Xi overplays his hand on antagonizing our allies, particularly Australia and Japan,” Rep. Seth Moulton (D-Mass.) said. “There is still a line [China] cannot cross without making this truce impossible to sustain.” The U.S. has a decades-long policy of “strategic ambiguity” under which it refuses to spell out how the U.S. would respond to Chinese aggression against Taiwan. Trump has also adhered to that policy. “You’ll find out if it happens,” Trump said in an interview with 60 Minutes in November. MORE EXPORT RESTRICTIONS ON THE WAY Beijing has eased its export restrictions on rare earths — metallic elements essential to both civilian and military applications — but could reimpose those blocks at any time. Ten of the 25 lawmakers who spoke to POLITICO said they suspect Beijing will reimpose those export curbs as a convenient pressure point in the coming months. “At the center of the crack in the truce is China’s ability to levy export restrictions, especially its chokehold on the global supply of rare earths and other critical minerals,” Rep. André Carson (D-Ind.) said. Others are worried China will choose to expand its export controls to another product category for which it has market dominance — pharmaceuticals. Beijing supplies 80 percent of the U.S. supply of active pharmaceutical ingredients — the foundations of common drugs to treat everything from high blood pressure to type 2 diabetes. “Overnight, China could turn off the spigot and many basic pharmaceuticals, including things like aspirin, go away from the supply chain in the United States,” Rep. Nathaniel Moran (R-Texas) said. China restarted exports of rare earths earlier this month, and its Commerce Ministry pledged “timely approval” of such exports under a new licensing system, state media reported. Beijing has not indicated its intent to restrict the export of pharmaceuticals or their components as a trade weapon. But the U.S.-China Economic and Security Review Commission urged the Food and Drug Administration to reduce U.S. reliance on Chinese sources of pharmaceuticals in its annual report last month. The Chinese embassy in Washington didn’t respond to a request for comment. GROWING CHINESE MILITARY MUSCLE China’s drive to develop a world-class military that can challenge traditional U.S. dominion of the Indo-Pacific could also derail relations between Washington and Beijing in 2026. China’s expanding navy — which, at more than 200 warships, is now the world’s largest — is helping Beijing show off its power across the region. The centerpiece of that effort in 2025 has been the addition of a third aircraft carrier, the Fujian, which entered into service last month. The Fujian is two-thirds the size of the USS Gerald R. Ford carrier. But like the Ford, it boasts state-of-the-art electromagnetic catapults to launch J-35 and J-15T fighter jets. The Trump administration sees that as a threat. The U.S. aims to insulate allies and partners in the Indo-Pacific from possible Chinese “sustained successful military aggression” powered by Beijing’s “historic military buildup,” Defense Secretary Pete Hegseth said earlier this month at the Reagan National Defense Forum. Five lawmakers said they see China’s increasingly aggressive regional military footprint as incompatible with U.S. efforts to maintain a stable relationship with Beijing in the months ahead. “We know the long-term goal of China is really economic and diplomatic and military domination around the world, and they see the United States as an adversary,” Moran said. Daniel Desrochers contributed to this report.

Chronic diseases such as cancer, cardiovascular disease, diabetes and mental and neurological conditions are on the rise. New research shows that these non-communicable diseases (NCDs) are responsible for 75 percent of deaths worldwide. Today, one in three people around the world live with a NCD. In addition to the huge impact these diseases have on individuals, they place enormous strain on health systems and reduce economic productivity. So much so, that it is estimated these diseases cost economies globally $2 trillion every year.   > Today, one in three people around the world live with a NCD. In addition to > the huge impact these diseases have on individuals, they place enormous strain > on health systems and reduce economic productivity. The underrecognized link between chronic diseases and vaccine preventable illnesses  It is well understood that prevention is better than the cure, and immunization campaigns are at the heart of robust, preventative healthcare. But it is often thought that vaccines are only relevant in preventing infectious disease, and the role they play in protecting people with chronic diseases as well as preventing those conditions in the first place is less understood.  It’s been encouraging to see that under the Hungarian presidency, the European Council has urged more robust efforts to prevent cardiovascular diseases — explicitly recognizing that vaccines against influenza, pneumococcal infections, SARS-CoV-2 and respiratory syncytial virus (RSV) offer crucial protection for patients living with cardiovascular diseases. The presidency has also called for action to integrate systematic vaccination alongside screening, treatment and rehabilitation into cardiovascular health action framework.  Later this year, the UN will discuss a new political declaration aimed at tackling the rise of NCDs, providing a key opportunity to maximize the benefits from vaccines and ensuring adult immunization is at the core of essential NCD prevention and management. This will not only help reduce the burden of these diseases on individuals and healthcare systems while supporting economic growth, but it will also help build better health for future generations.  > Later this year, the UN will discuss a new political declaration aimed at > tackling the rise of NCDs, providing a key opportunity to maximize the > benefits from vaccines and ensuring adult immunization is at the core of > essential NCD prevention and management. Embedding adult immunization into NCD care pathways  Adult immunization offers a cost-effective way to protect people living with NCDs, particularly against common respiratory infections like COVID-19, influenza, pneumococcal disease and RSV. These infections can worsen chronic conditions, trigger complications and lead to preventable hospitalizations and death. For example, people living with diabetes are twice as likely to die from influenza than people with no underlying condition.  Immunizing people living with NCDs against respiratory diseases is a practical, evidence-based way to strengthen prevention, protect the vulnerable, and reduce the strain on health systems both in the short term during seasonal infection peaks and over the longer term as populations age and NCDs rise. Adult immunization programs also support productivity by enabling people to stay in education or employment for much longer.   For people living with cardiovascular disease, the flu vaccine may reduce the risk of death from stroke by 50 percent and from heart attack by 45 percent. For people living with a chronic respiratory disease — such as asthma or chronic obstructive pulmonary disease (COPD) — the COVID-19 vaccine can reduce the risk of hospitalization due to infection by around 80 percent.  Despite this, vaccine policies for adults with chronic illnesses remain limited, and when available they are not equitably implemented. Data shows that 58 percent of the World Health Organization’s member states report vaccination against flu for adults with chronic conditions, and only 23 percent against pneumococcal disease. The findings show persistent gaps in adult vaccination programs, with awareness and uptake remaining low in many parts of the world. This can also be observed in Europe, where meeting the target of 75 percent of people having had a flu vaccine has proven challenging. In 2022 half of people aged 65 years and over in the EU were vaccinated against influenza, with another global report showing that adult influenza vaccination rates ranged from a low of 6 percent to a high of 86 percent, highlighting huge disparities between countries. This is not just about statistics. It is about real people and their families. It is about missed opportunities to protect those most at risk.   Lowering the risks of developing cancer and dementia  Vaccines also play a critical role in lowering the risk of developing cancer. This is because some cancers are caused by viruses. By preventing these viral infections, vaccines can halt the rise in some types of cancer. For instance, the human papillomavirus (HPV) vaccine is highly effective in preventing HPV-related cancers. It has the potential to eliminate cervical cancer in certain countries during our lifetime and radically reduce the burden of other HPV-related cancers. Similarly, improving access to and uptake of highly effective vaccines against Hepatitis B is critical to reducing liver cancer. Together, vaccination against HPV and Hepatitis B could prevent over one million cancer cases worldwide every year.  > Together, vaccination against HPV and Hepatitis B could prevent over one > million cancer cases worldwide every year. In addition, emerging research suggests that vaccines, by helping to prevent infections and reducing inflammation, can help protect the brain from long-term damage, potentially lowering the risk of dementia. A recent study performed using the electronic health records of 280,0000 people in Wales demonstrated a 20 percent relative reduction of dementia risk after shingles vaccination. This finding highlights the importance of real-world evidence for understanding the full value of immunization, and how it prevents NCDs and promotes healthy aging.   Opportunity for action   This year, the UN will consider a political declaration aimed at addressing the rising number of people around the world living with NCDs. This presents a real opportunity to place vaccination at the heart of efforts to do so.   Recognizing the role of immunization as a central pillar of NCD prevention and management would be a significant step forward. To deploy lifelong routine immunization programs as fundamental components of NCD management, policy- and decision-makers should look to deliver decisive action across four policy priorities.  > Recognizing the role of immunization as a central pillar of NCD prevention and > management would be a significant step forward. Firstly, we must ensure that adult immunization is at the core of essential NCD care in health care systems all over the world. That includes immunization against respiratory infections in national strategies and access through innovative outreach and delivery models.   Secondly, this should include expanded access to vaccines for people living with NCDs. This can help prevent complications, reduce hospitalizations and support system resilience, and enable more efficient use of existing prevention budgets.   Thirdly, we need to build awareness of the importance of immunization among people living with NCDs, by providing clear, trusted information and equipping healthcare professionals with the right knowledge and skills to communicate effectively about vaccines.   And, finally, we must make sure there is a system to capture what is going well and what can be improved, by tracking immunization coverage for people living with NCDs so that there is clear accountability for driving further progress.   Investing in social and economic resilience  Integrating routine adult immunization into NCD prevention and management offers a cost-effective opportunity to bend the curve on NCDs, helping people stay healthier for longer, alleviating pressure on healthcare systems, and delivering substantial economic benefits.  Data shows that adult vaccination programs deliver socio-economic benefits of up to 19 times the initial investment through benefits to individuals, health care systems and wider society. As countries confront rising rates of chronic disease, aging populations, workforce shortages and increasingly constrained budgets, investing in prevention today is not just good health policy — it’s smart economics.

Patients taking weight-loss and diabetes drugs Wegovy and Ozempic have an increased risk of developing a rare eye condition that could lead to loss of vision, a European Medicines Agency (EMA) committee announced Friday. The EMA’s drug safety committee (PRAC) launched a review of medicines containing semaglutide — a GLP-1 agonist and the active ingredient in Novo Nordisk’s Ozempic, Wegovy and Rybelsus — in January, following concerns that the drugs could lead to an increased risk of developing non-arteritic anterior ischemic optic neuropathy (NAION). NAION is a disorder caused by reduced blood flow to the optic nerve in the eye, which can damage the nerve and lead to permanent vision loss. PRAC said it found that the condition is “a very rare side effect” of semaglutide, potentially affecting up to one in 10,000 people taking the drug. The EMA said that exposure to semaglutide in people with diabetes is linked to a twofold increase in the risk of developing NAION compared with people not taking the medicine. The regulator has requested that the product information for semaglutide medicines is updated to include NAION as a side effect with a frequency of “very rare.” The final decision needs sign off from the European Commission.

Novo Nordisk’s CEO Lars Fruergaard Jørgensen will stand down as the chief of the Danish pharma giant following increased competition in the obesity drug market. A company statement said the decision was made “per mutual agreement” between Jørgensen and Novo Nordisk’s board. Under his eight-year tenure as CEO, the Danish company’s sales, profits and share price have almost tripled, as it emerged as the front-runner in the diabetes and obesity drug markets, thanks to the success of Ozempic and Wegovy. But the firm, until last year Europe’s most valuable, saw its share price tumble over the past year amid increased competition and disappointing trial results for its next-generation treatments. “The changes are, however, made in light of the recent market challenges Novo Nordisk has been facing, and the development of the company’s share price since mid-2024,” Novo Nordisk said in a statement. Novo sells the majority of its obesity drugs in the U.S. where President Donald Trump has bemoaned the high price charged there, recently contrasting this against a far lower price in the U.K. Trump signed an executive order this week to bring down drug costs. In Brussels, Jørgensen serves as the president of the European Federation of Pharmaceutical Industries and Associations (EFPIA), the pharma lobby group in the EU. Jørgensen, who has worked at the company since 1991, told POLITICO in an interview last year that he had no plans to leave the company. Novo said Jørgensen would remain in his post “for a period to support a smooth transition to new leadership.” It added that the search for his replacement was ongoing and an announcement would be made in due course. Last month, the pharma giant’s longtime head of commercial strategy and corporate affairs, Camilla Sylvest, also stood down.

President Donald Trump has spent the first three months of his second term imposing his will on the rest of the globe, telling long-time allies that they “don’t have the cards.” But in capitals across Europe and elsewhere, debates are raging over the hands they could play. Proposals under consideration range from minor irritants to extreme actions that could sever defense and economic relationships that have cemented alliances for nearly a century. Those include finding alternative suppliers of military equipment and munitions from U.S.-based defense contractors, enacting stronger counter-tariffs, rolling back intellectual property protections for U.S. companies and lessening their reliance on American tech giants, according to conversations with more than two dozen government officials in Europe and Canada, many of whom were granted anonymity to describe high-level discussions they’re not authorized to speak about publicly. “There’s a change in mindset. We’ve moved on from seduction to strategy,” one EU diplomat said about dealing with Trump. “We’ll take decisions to protect ourselves.” The diplomat added: “We need to strike a path that works without Washington.” Less than three months into Trump’s term, his pursuit of a transactional, mercantilist and imperialist foreign policy has rattled leaders across the globe. It started with the president’s persistence in talking about annexing Canada and Greenland, his eagerness to end the war in Ukraine largely on Russia’s terms and Vice President JD Vance’s caustic comments describing Europe as freeloaders. But Trump’s market-cratering move this month to impose massive tariffs on nearly all U.S. trading partners — based on a formula scores of economists found bizarre — caused many longtime allies to shed any last remnants of magical thinking that they could manage or contain this predictably unpredictable American president as they did during his first term. Leaders from London to Warsaw, Helsinki to Rome, are continuing efforts to de-escalate and maintain productive relationships with Washington — while considering how to “de-risk” by protecting themselves from Trump’s havoc. Their initial moves could be the first cracks in a dam that could break wide open, unleashing a torrent of increasingly punitive actions that, ultimately, could unravel a transatlantic alliance that has tied America to Europe for eight decades and refashion the global order. The White House, however, downplayed the potential for a rift, asserting that Trump’s efforts to end the war in Ukraine — which he has undertaken with little input from NATO allies — are aimed at making Europe more secure, even though many of the continent’s leaders fear that any potential concessions to Russian President Vladimir Putin will make their collective security even more precarious. “The President has led in an effort to bring the biggest conflict since WWII in Europe to a peaceful resolution, and he is helping restore international shipping lanes in the Red Sea that will also benefit European markets,” said national security council spokesperson Brian Hughes. “We will continue to work with our European allies on ways to improve security cooperation — be that through foreign military sales, encouraging our allies to increase their defense budgets, and holding our adversaries like the Houthis accountable.” Of course, private Signal messages during the attack on the Houthis laid bare how some of the president’s most senior aides view Europe as “free-loading,” with Vance lamenting that he “hated” bailing the continent out. Trump officials “seem to think Europe is this dying continent that has no future and is not capable of independent action, that Russia is the more formidable power,” said Minna Ålander, a fellow on transatlantic defense and security at the Center for European Policy Analysis. “They may soon find out that the opposite is true.” SHIFTING DEFENSE DOLLARS AWAY FROM AMERICA Few countries across Europe are more indebted or unconditionally loyal to the U.S. than Poland. And yet, posters are now showing up around Warsaw merging two silhouettes: Putin and Trump. It’s an indication of the extent to which two months of direct threats and challenges from Washington are rapidly changing public opinion — and the private calculations of government officials — in Warsaw and in other European capitals. Trump has been pushing NATO members to increase their spending on defense, saying that the alliance’s requirement that nations allocate 2 percent of GDP should be raised to 5 percent. But the result of his pressure may well be that NATO allies shift their defense investments away from American contracts, shrinking a lucrative financial arrangement upon which the U.S. relies. Poland, which borders Ukraine and Russia-aligned Belarus, is already spending 4.7 percent of its GDP on defense, the most of any NATO member. And it buys more American defense equipment than any other country in the world. Trump and Defense Secretary Pete Hegseth have praised Poland as an exemplary ally. But Warsaw is reconsidering that partnership. Prime Minister Donald Tusk has ruled out the cancellation of any existing contracts, but there are qualms in Warsaw about entering new ones. “Confidence in the USA has been severely shaken,” said Pawel Kowal, the Ukraine envoy in Tusk’s office. “I don’t think we will be placing any more major orders with the American arms industry for the time being after analyzing our experiences with what is happening now.” That’s no small statement given how much Poland’s procurement of American defense equipment, Kowal added, has helped to solidify relations with Washington, and the Trump administration in particular. Poland plans to spend $47.1 billion on defense in 2025, more than half of which will go to U.S. contractors. But Kowal says Poland now needs “to diversify our arms purchases” and “to buy in Europe or rely more on our own Polish arms industry.” Cezary Tomczyk, Poland’s deputy defense minister, said that maintaining strong ties to the U.S. remains important, noting that Trump has encouraged Europe to be more self-reliant and saying investing more in production in Poland is part of that. But Tomczyk offered a word of caution, noting that the U.S. has tangible interests in Poland as well. “If the U.S. alienates Poland, it would not be good for the U.S.,” he said. As Trump prepared to take office for the second time, European leaders strategized that they could keep him engaged with NATO by meeting his demand that they increase defense spending with commitments to direct most of their outlays to American companies. Now, they’re moving in the opposite direction. “Europe is now going to heavily increase its investments to defense. And it will be very logical that Europe is turning this money to its own economy,” said Estonian Foreign Minister Margus Tsahkna, who also referred to the sudden questions about the reliability of American-made weapons systems that arose after Trump abruptly halted defense aid to and intelligence sharing with Ukraine in March. “There must be a political trust that if you buy something, you must be sure that you can use them as well.” Many of the countries determined to boost defense spending are loath to invest in America’s defense industrial base — and newly aware that placating Trump isn’t as simple as it was during his first term. “In previous years, under Trump 1.0 and even afterward, we said, yes, we can appease him. He wants to make deals, he wants us to go on a big shopping spree from him: Buy F-35s, Patriots, liquified natural gas and all sorts of other things … and then he’ll be appeased,” said Peter Beyer, a member of Germany’s Bundestag from the conservative Christian Democrats, the party expected to lead Germany’s incoming government. “I think that’s a much too simplistic calculation. It all doesn’t add up, at least not today. It won’t work.” Trump’s willingness to use U.S.-controlled weapons systems as leverage over Ukraine in the midst of a war has given rise to new worries. Canada, Portugal, Denmark and Germany have publicly expressed reservations about continuing to purchase F-35 fighter jets from the U.S. given that Trump, in the event of a political disagreement, could block access to spare parts and software upgrades needed to keep the aircraft flying and combat-ready. German Defense Minister Boris Pistorius has asserted that Berlin will continue to honor its F-35 contracts, calling the U.S. “an important ally for us.” But he has also made clear that’s at least partly due to a lack of other options when it comes to upgrading a current fleet that is about to age out. Beyer, a former transatlantic coordinator for the German government, said that even if concerns about an F-35 “kill switch” aren’t reality-based, it would be “daft” for Berlin to continue relying so heavily on America’s security backing given the administration’s approach. “If we purchase weapons systems, be it Patriot, F-35 or whatever, Lockheed Martin, Northrop Grumman, Raytheon, we have to be aware that it’s like a Damocles sword that a shutdown could occur,” Beyer said. “This thought is now there in people’s minds, also in connection with Starlink, Elon Musk and the data for Ukraine — this discussion is in full swing.” Given that Europe is so integrated into America’s defense industrial base after decades of procurement, finding European alternatives to U.S. systems won’t happen overnight. But even the U.S.-made Patriot system has its challengers. The French-Italian SAMP/T, which takes only two years to produce, is now going through upgrades to put its range on par with Patriots. And confidence about it being a viable alternative has grown after its widespread usage by Ukraine over the last few years. TAKING COUNTER-TARIFFS TO THE EXTREME On April 2, Trump levied 20 percent tariffs on the EU as part of a sweeping policy shift aimed at erasing trade deficits, only to abruptly hit the pause button less than a week later to halt a global economic panic that was starting to affect even America’s bond market. Even if the detente holds, allies still reeling from the whiplash still face a new reality of chronic uncertainty. Hours before Trump announced he was pausing all tariffs except those on China, the EU voted to hit back with counter-tariffs on nearly €21 billion of U.S. products — soybeans, motorcycles and orange juice — but stopped short of retaliating on the 20 percent “reciprocal” tariff Trump had imposed on all EU exports to the U.S. “Right now, Europe is focusing on customs duties in response to the duties announced by the U.S., and we aren’t looking for escalation. We don’t want to fuel confrontation, but we do want to be very clear,” one senior European diplomat said. The EU quickly put its retaliatory measures on hold after Trump announced his 90-day pause. But if the tit-for-tat on trade ratchets back up, Europe could go even further. There has been some talk already about deploying the EU’s Anti-Coercion Instrument, adopted in 2023 in response to China’s attempted political blackmailing of Lithuania over its position on Taiwan. The ACI, dubbed by some EU officials the “bazooka,” sets out a step-by-step procedure if and when coercion is identified, starting with talks with the country involved to determine the best way to resolve the matter. If the economic coercion continues, the EU is then empowered to ratchet up its response with countermeasures ranging from tariffs increases and exclusion from public procurement to restrictions on intellectual property rights protection. Although Trump’s initial rationale for the tariffs — boosting American manufacturing — is not ostensibly coercive, the EU Commission is considering and discussing with member states whether the ACI could be a weapon in a prolonged trade war with the U.S., according to one EU official. “It has been discussed at the European Commission level, but it’s really the nuclear option,” the European official said. “It was devised against a systemic rival [China]. You start hitting data, services, it’s a lot more imposing, you really are widening the scope. The decision is not taken, but it’s been more than just mentioned at the Commission, it’s being discussed as a possibility.” There is hope that such a move won’t be necessary. “The brake [on Trump] could well come from the markets,” another senior European diplomat said. “Europe is not defenseless.” TARGETING SPECIFIC PRODUCTS Some countries — and their citizens — are also looking at how to hit back at individual companies or industries to cause pain or grab headlines in the United States. Some EU governments are considering weaponizing agricultural and environmental standards to discriminate against American products. They could ban specific products from certain Trump-supporting states, like Kentucky bourbon or Florida orange juice. As boycotts of Tesla have already shown — European sales were down 45 percent in January — public sentiment alone could drive people to stop buying American products on their own. Across the continent, Facebook groups devoted to organizing boycotts of American products have amassed tens of thousands of followers. In Denmark, a survey showed that roughly half the population has avoided buying American products since Trump’s inauguration. And the country’s largest grocery store operator now marks whether products sold are from European companies on its electronic price tags. There’s also tourism. Canada is among a handful of countries that have issued advisories warning about traveling to the U.S., going as far as to ask citizens to “reconsider” visiting the States. Passenger bookings on airline routes between the U.S. and Canada are down 70 percent compared to the same period a year ago, a shift that industry analysts believe will cost $2 billion in lost travel and business revenue. Similarly, travel from Europe to the U.S. has dropped by 35 percent in the last two months. If Trump imposes tariffs he is weighing on pharmaceuticals coming into the country, the EU might decide to add export controls on top of that — making Americans pay even more for popular drugs like Ozempic, Novo Nordisk’s obesity and diabetes drug, which is largely produced in Denmark. DISRUPTING SUPPLY CHAINS Some countries are also looking at ways to limit — or make more costly — essential products or services the U.S. depends on. The EU could impose export tariffs on EU-produced machinery, electrical equipment or pharmaceuticals — creating immediate price pressure on U.S. supply chains. That would come at a high cost for European countries, but some officials and analysts aren’t ruling it out. “Europe can have some chokepoints vis à vis America. Europe trades in machinery and optical equipment, we can effect a standstill of American production,” Swedish economist Fredrik Erixon said. “These products are not easily substitutable.” For instance, Europe could impose export controls on products made by Dutch company ASML, the world’s biggest provider of photolithography machines which are used to produce computer chips. This would force U.S. manufacturers that use ASML technology — American consumers — to pay more. Other choke points could be highly advanced technology products made by Nokia and Ericsson that are essential to network operators. Erixon described such moves as “the nuclear option” in a transatlantic trade war, given how intertwined their supply chains are. But, he said, “America is in a predicament because it wants to impose general tariffs, whereas the EU has the possibility of rearranging trade flows.” Some European companies have taken to disrupting supply lines on their own. A Norwegian fuel supplier refused to refuel the U.S. Navy warships and submarines after Trump and Vance berated Ukraine’s president in the Oval Office. It was an isolated incident, but illuminated how much American interests rely on and benefit from strong alliances — and what stands to be lost if relationships deteriorate. And allies closer to home have other levers to pull. Canada supplied 27,220,531 megawatt hours of electricity to the U.S. last year, not to mention 59 percent of the crude oil America imports — a point of leverage, some leaders have noted, in the event of a protracted trade war. The premier of Canada’s largest province threatened last month to shut off the electricity that powers much of New England the Great Lakes states, vowing that Americans “need to feel the pain” from Trump’s trade war. At the same time, the premier of Nova Scotia said American companies would no longer be able to bid on provincial procurement contracts and could see their existing contracts canceled, remarking that “some people need to touch the hot stove to learn.” STICKING IT TO SILICON VALLEY Musk’s involvement with the Department of Government Efficiency and the presence of a raft of tech CEOs at Trump’s inauguration have highlighted the extent to which U.S. tech leaders are increasingly in league with Trump. The EU had already been in the lead on regulating tech companies and attempting to curb the spread of misinformation on privately owned platforms like Musk’s X. But there had been a sense of wanting to work together with the U.S. on policies and standards. That’s changing. In the Netherlands, lawmakers last month approved funding for a new Dutch-controlled cloud services platform to reduce the country’s reliance on U.S. tech companies. That followed a call from then-Belgian Prime Minister Alexander De Croo for the EU to “take action” in response to Musk’s involvement in recent European elections where he advocated for far-right candidates. The EU has been investigating X, the social media platform Musk owns, for nearly a year and a half over suspected breaches of Europe’s Digital Services Act, which requires platforms with over 45 million monthly users to comply with a raft of stringent rules designed to keep users safe and curb the spread of illegal, harmful content. Cutting against the grain, Britain is considering a cut to the digital services tax levied on tech giants, although the optics of doing so would be extremely uncomfortable at a time when the government is also drawing up plans to reduce welfare payments for disabled people. In a sign of how countries can leverage their own tech markets and companies that are important to the U.S., China is harnessing its control over TikTok’s future in the U.S. Trump has been forced to delay the enforcement of a law requiring that TikTok find a new owner in the U.S. or be banned over security concerns. That’s because Beijing, upset about being hit with additional tariffs, scuttled a tentative deal giving a group of American investors a 50 percent stake in the company. GOING IT ALONE Whether allies in Europe or the Americas end up implementing some of the more aggressive responses they’re now discussing, Trump’s unilateral approach and disregard for the interwoven economic and security interests at the core of longstanding alliances has heightened the urgency of lessening their dependence on Washington. No one put it in more stark terms than Canada’s new prime minister, Mark Carney, responding to Trump’s tariffs: “The old relationship we had with the United States, based on deepening integration of our economies and tight security and military cooperation, is over,” he said in late March. Increasingly, Europe’s sudden seriousness about defense spending isn’t driven by the idea that placating Trump will help maintain American hard power as a backstop for the continent’s defense — but by the realization that in many ways Europe is already on its own. That’s a message Hegseth and Vance have conveyed directly both in private meetings and public statements. Following his election two months ago, Germany’s new chancellor, Friedrich Merz, declared his top priority to be strengthening Europe to “achieve independence from the USA,” lamenting that Trump has made clear that “the Americans … are largely indifferent to the fate of Europe.” To that end, Merz succeeded in winning the Bundeswehr’s approval to skirt Germany’s “debt brake” and dramatically boost defense spending, a striking about-face for a country that has been wary of greater militarization since the end of World War II. And as more countries follow suit, there is growing interest in forming new coalitions. Several countries in Europe’s north and east appear interested in joining the six-member Organisation for Joint Armament Cooperation, or OCCAR, which manages armament programs on behalf of France, Germany, Italy, Spain, the United Kingdom and Belgium. Denmark, which has long contributed more to NATO defenses than many larger member countries, has joined the European Sky Shield Initiative to create a multi-layered air defense system in Europe. “In three to five years, we need to be totally able to defend ourselves in Europe,” Danish Prime Minister Mette Frederiksen told POLITICO last month. Similarly on the trade front, allies are eager to insulate themselves from Trump’s erratic approach by replacing trade with the U.S. with new partners. French Trade Minister Laurent Saint-Martin said last month that Paris was suddenly rethinking its opposition to a massive EU trade pact with several South American nations, calling on leaders in Brussels to address French concerns so that the “Mercosur” deal could be finalized. Trump’s “Liberation Day” announcement, Saint-Martin said, was “a wake-up call.” After Trump’s reversal on tariffs left China as his primary target under an increased 145 percent tariff, Beijing opened negotiations with the EU to abolish the bloc’s tariffs on imported vehicles from China. Those discussions, if successful, could dramatically reduce the volume of American-made vehicles sold in the European market. In the long run, Trump’s belief that he has better cards could weaken America’s hand, reducing its leverage over longtime allies once they’re more independent from Washington. “We need to take advantage of the crisis with the U.S., to rebuild our economic, defense and energy sovereignty,” said a former French minister. “And we need to carry on hitting back.” This text is a collaboration of the Axel Springer Global Reporters Network. Eli Stokols reported from Washington, WELT’s Philipp Fritz reported from Warsaw, Clea Caulcutt reported from Paris and Emily Schultheis reported from Los Angeles. Nicholas Vinocur in Brussels and Esther Webber in London contributed to this report.

Europeans face “lifelong health crises” as the region grapples with a growing mental health crisis among young people, stagnating immunization coverage and high rates of chronic diseases such as obesity and heart disease, according to a World Health Organization report published Tuesday. At the same time, health systems are not ready for future health emergencies, strained under the growing threat of climate change and facing an aging population amid ongoing workforce shortages.   The WHO’s European Health Report, published every three years, looks at the state of health across the European region, which includes 53 countries in Europe, the Caucasus and Central Asia. It found that one in six people in the region die before their 70th birthday from non-communicable diseases (NCDs), such as cardiovascular diseases, cancer, diabetes or chronic respiratory diseases.  “The entire region must confront the root causes of chronic disease, from tobacco and alcohol use to poor access to healthy and nutritious food, to air pollution, to a lack of physical activity,” said WHO Regional Director for Europe Hans Henri Kluge in a statement. The European region has the world’s highest alcohol intake, averaging 8.8 liters of pure alcohol per adult per year, with the EU recording the highest intake. Tobacco use remains “unacceptably high” at 25.3 percent and obesity, currently affecting a quarter of adults, is rising.   The report also found that infant mortality, though overall low in the region, varies greatly among countries and nearly 76,000 children die before their fifth birthday every year, usually due to preterm birth complications, birth asphyxia, congenital heart anomalies, lower respiratory infections, neonatal sepsis or other infections. On top of this, routine vaccination rates are stagnating, which is leading to a resurgence of preventable diseases. For example, measles cases across 41 WHO Europe member countries saw a 30-fold increase in 2023 compared with the previous year, with 58,000 measles cases. Poor mental health is also a growing trend among children and teenagers. One in five teenagers in the region grapples with a mental health condition, with suicide being the leading cause of death among 15 to 29-year-olds. Cyberbullying has also become a significant concern, affecting 15 percent of adolescents. Unhealthy lifestyles are also a worrying trend, according to the report, with nearly one in three school-aged children overweight and one in eight living with obesity. And about 11 percent of teenagers used some form of tobacco products in 2022, including e-cigarettes. The report shows “health linkages across the entire life cycle,” Kluge said. “A healthy child is more likely to grow into a healthy adolescent, a healthy adult and a healthy older person. This couldn’t be more crucial because for the first time ever, there are more people aged over 65 years than under 15 years in the European Region.” 

Approximately, one in every 10 adults in Europe is affected by chronic kidney disease , yet most are unaware they have it. Many might find out too late.(1) If caught early, CKD can be manageable. Left untreated, it progresses toward kidney failure — a complex, life-threatening condition that cannot be reversed.(2) Despite the severity of the disease, it is underdiagnosed and often overlooked in European public health policies.(2) > If caught early, CKD can be manageable. Left untreated, it progresses toward > kidney failure. Even so, there is hope that Europe can change the course of the growing CKD epidemic. The solution is simple and cost-effective: Implement policies prioritizing early screening for high-risk patients and treatments according to guidelines.(3,4) CKD’s extensive impact CKD involves the gradual loss of kidney function, which disrupts the body’s critical systems. It often progresses without symptoms until the later stages — at which point it may be that only a third or less of kidney function remains.(2,5,6) > In Europe, an estimated 100 million adults live with CKD, with another 300 > million at risk. Reduced kidney function can be detected early with simple urine and blood tests.(7) But these tests are underutilized, even for high-risk CKD patients — such as those with diabetes. This may be partly because kidney health is not prioritized in public health policies.(8) For instance, despite kidney disease affecting an estimated 850 million people globally(9) and CKD being projected as the fifth leading cause of death by 2040,(3) CKD is still not recognized by the World Health Organization as a priority non-communicable disease, neither is it highlighted in the 2022-2027 EU Non-Communicable Diseases Initiative ”Healthier Together”.(10,11) In Europe, an estimated 100 million adults live with CKD, with another 300 million at risk.(12) Alarmingly, global stats estimate fewer than 10 percent of the affected know they have the disease.(13) The impact of CKD extends beyond physical health. Nearly a third of CKD patients in stage 3 to 5 experience anxiety or depression, and treatments such as dialysis and kidney transplants are invasive and life-altering.(14,15) Later stages of the disease can also take a heavy toll on families, who often face financial strain and disruptions to daily life while caring for loved ones.(2) For health care systems, the costs are staggering. Europe allocates approximately €140 billion annually to CKD and kidney failure.(4) In many high-income countries, end-stage CKD accounts for 2 to 3 percent of health care budgets, despite affecting just 0.03 percent of the population.(16) But there is also an environmental price we pay for the treatment of late stage CKD, with dialysis being one of the most resource-intensive medical fields.(17) If current trends persist, projections indicate that by 2032, CKD-related environmental burden in Germany alone could generate approximately 1.24 billion kilograms of carbon emissions — equivalent to the annual carbon footprint of 737,000 cars.(18) As Europe’s population ages, the prevalence of CKD is expected to rise dramatically, placing even greater pressure on health care systems.(19) Dr Navdeep Tangri, chair of the Medical Advisory Council for the Global Patient Alliance for Kidney Health, a professor of medicine at the University of Manitoba and senior scientist at the Chronic Disease Innovation Centre, warns of the dire consequences of inaction. “We know, even counting in today’s standards, that globally there has been a 33 percent rise in the prevalence of CKD from 1990 to now(20), and there is a projected 116 percent rise in mortality from chronic kidney disease between 2019 and 2040,” he says. (21,22) “Those numbers tell the story of a billion-person, trillion-dollar disease.” The case for early detection Despite CKD’s widespread impact, it can be a solvable problem — if caught early. The health benefits optimized treatment according to guidelines are clear.(23) Preliminary results from a recent study found that CKD patients (the majority of whom were in mid-to-late stages of the disease) who were prescribed and adhered to guideline-recommended therapies (kidney-protective medication) lowered their risk of death by 67 percent and hospitalization by 20 percent.(23) And, economically, early detection and treatment are particularly cost-effective because treatments and procedures become more expensive as the disease advances.(3) Around 250,000 Europeans rely on dialysis to survive — a number rising by 5 to 8 percent annually.(24) The cost of haemodialysis to health care systems can reach an eye-watering €80,000 per patient per year.(25) By contrast, early diagnosis and treatment allow for lower-cost interventions that can slow progression, reduce complications, preserve quality of life and significantly ease the burden on health systems.(2) A need for more efficient programs and policies Although international guidelines recommend regular CKD screening for at-risk individuals (those with diabetes and hypertension),(26) few European countries have adopted targeted screening programs. Among those that do have them, their implementation remains inconsistent, and many patients do not receive immediate access to guideline-recommended therapy even when diagnosed.(2) A lack of CKD-specific training for primary care providers and inadequate referral pathways further hinder Europe’s patient outcomes.(2) Take Germany: while it can be applauded for incorporating international CKD guidelines into its national health care system, the reality is that adherence to recommended testing and care pathways remains low.(27) And in France, where the care of patients with end-stage-kidney disease is estimated to cost €5 billion by 2025,(28) significant gaps persist between clinical guidelines and actual practice.(29) “France recommended screening for people over 60 since 2012.(30) That was adjusted in 2021 to include individuals of any age at risk,”(31) explains Yvanie Caillé, Founder of the French patient advocacy group Renaloo. “But uptake is still low.”(32) Political momentum is building These shortcomings in testing and care pathways leave significant room for policy to make improvements. Caillé remains hopeful, pointing to recent policies that might encourage more testing. “The French Health Insurance has made CKD one of its strategic priorities. Consequently, it will inform general practitioners about CKD screening and offer them financial incentives for meeting annual screening targets among their at-risk patients.”(33,34) > Integrating CKD screening into routine health checks is one solution that can > make a significant difference. Encouragingly, recent developments at the EU level suggest policymakers are catching on to the benefits of early detection. The Council’s conclusions on improving cardiovascular health in the EU, published in December under the Hungarian Presidency, acknowledge CKD’s strong link to cardiovascular disease. It also urges member countries to introduce joint health checks for cardiovascular disease and diabetes that include kidney function assessment.(35) The path forward International guidelines for CKD detection are well-researched and ready for implementation. Policymakers have the tools and knowledge to act — now they need to prioritize early detection and equitable access to care. Integrating CKD screening into routine health checks is one solution that can make a significant difference, particularly for at-risk patients such as those with diabetes, hypertension and cardiovascular conditions. Simple, scalable tests such as blood and urine analysis make early CKD detection accessible, enabling interventions when the disease is easier and less costly to manage.(3) “Nobody should face the need to receive dialysis or transplantation in the last part of the 21st century. If all European countries would include CKD as part of joint health checks at the primary care level it would have massive positive impacts on health care systems and give hope for patients. We urge all countries to follow suit,” says Daniel Gallego, president of the European Kidney Patients´ Federation. Given CKD’s strong ties to other major conditions such as diabetes, heart disease and hypertension, incorporating CKD into existing NCD policies is essential for a robust and effective approach to managing Europe’s growing health challenges.(8) For too long, CKD has been an afterthought — it’s time for policymakers to correct this life-threatening oversight. To achieve this, key actions for policymakers include: * Integrate CKD screening into routine health checks, using simple, cost-effective tools such as blood and urine tests. * Embed CKD into national NCD strategies and frameworks, ensuring kidney health is part of a comprehensive public health response. * Ensure diagnosed patients receive guideline-directed treatment, following international standards such as the KDIGO guidelines, to help slow disease progression. * Prioritize equitable access to CKD care, ensuring early intervention for at-risk populations, particularly those with comorbid conditions. Finally, these efforts must extend beyond Europe. The WHO should formally recognize CKD as a priority NCD and include it in global health frameworks, such as the WHO Global Monitoring Framework for NCD Prevention and WHO NCD “best buys.” This would provide policymakers worldwide with a roadmap to reduce the burden of CKD and drive coordinated international action. Now is the time Europe stands at a critical juncture. With the tools, guidelines and policy frameworks already within reach, there is a clear opportunity to address CKD through early detection, integrated health checks and access to treatment. However, failing to act now will likely escalate costs, strain health care systems, increase the environmental impact and worsen patient outcomes across Europe and beyond.  The steps we take today will determine the future trajectory of this silent yet devastating disease. It’s time for Europe — and the world — to make CKD a priority and potentially spare millions from the burden of kidney failure. Veeva ID: Z4-70462 Date of Prep: December 2024 References: 1. Sundström J, et al. Prevalence, outcomes, and cost of chronic kidney disease in a contemporary population of 2·4 million patients from 11 countries: the CaReMe CKD study. The Lancet Regional Health – Europe. 2022; 20:100438. https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(22)00132-6/fulltext  [Last accessed 6 December 2024] 2. Economist Impact. Chronic kidney disease. Driving change to address the urgent and silent epidemic in Europe. 2023. https://impact.economist.com/perspectives/sites/default/files/chronickidneydisease_economistimpact_mar2023_final.pdf [Last accessed 6 December 2024] 3. International Society of Nephrology. Early diagnosis of chronic kidney disease: A discussion paper for building resilience and sustainability of healthcare systems. Published March 2021: https://www3.weforum.org/docs/WEF_CKD_discussion_paper_PHSSR.pdf  [Last accessed 6 December 2024] 4. van Mil D, et al. Cost-effectiveness of screening for chronic kidney disease: existing evidence and knowledge gaps. Clin Kidney J. 2024; 17(1):1–5. https://pmc.ncbi.nlm.nih.gov/articles/PMC10783263/ [Last accessed 6 December 2024] 5. American Kidney Fund. Stages of kidney disease. https://www.kidneyfund.org/all-about-kidneys/stages-kidney-disease [Last accessed 6 December 2024] 6. National Kidney Foundation. Stage 4 Chronic Kidney Disease (CKD). https://www.kidney.org/kidney-topics/stage-4-chronic-kidney-disease-ckd. [Last accessed 6 December 2024] 7. Cleveland Clinic. Kidney Function Tests.  https://my.clevelandclinic.org/health/diagnostics/21659-kidney-function-tests [Last accessed 6 December 2024] 8. Neuen BL, et al. National health policies and strategies for addressing chronic kidney disease: Data from the International Society of Nephrology Global Kidney Health Atlas. PLOS. Global Public Health. 2023; 3(2): e0001467. https://pmc.ncbi.nlm.nih.gov/articles/PMC10021302/pdf/pgph.0001467.pdf [Last accessed 6 December 2024] 9. Jager KJ,  et al.  A single number for advocacy and communication – worldwide more than 850 million individuals have kidney diseases. Nephrol Dial Transplant. 2019; 34:1803–1805: https://academic.oup.com/ndt/article/34/11/1803/5574389   [Last accessed 6 December 2024] 10. WHO. Noncommunicable diseases. 16 September 2023. https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases [Last accessed 6 December 2024] 11. European Commission. Heathier Together. EU Non-Communicable Diseases Initiative. June 2022. https://health.ec.europa.eu/system/files/2022-06/eu-ncd-initiative_publication_en_0.pdf [Last accessed 9 December 2024] 12. Vanholder R, et al.  Fighting the unbearable lightness of neglecting kidney health: the decade of the kidney. Clinical Kidney Journal, Volume 14, Issue 7, July 2021, Pages 1719–1730. Published 20 April 2021: https://academic.oup.com/ckj/article/14/7/1719/6243030 [Last accessed 6 December 2024] 13. Bikbov B, et al. Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2020;395(10225):709-733. 14. Kidney Care UK. Facts about kidneys [Internet]. Alton: Kidney Care UK. May 2024.  https://www.kidneycareuk.org/news-and-campaigns/facts-and-stats/ [Last accessed 6 December 2024] 15. Krishnan A, et al. Health-related quality of life in people across the spectrum of CKD. Kidney Int Rep. 2020;5(12):2264-74. [Last accessed 6 December 2024] 16. Couser et al.. The contribution of chronic kidney disease to the global burden of major noncommunicable diseases. Kidney International. 2011; 80:1258–1270. Available from: https://www.kidney-international.org/article/S0085-2538(15)55004-7/fulltext [Last accessed 6 December 2024] 17. Wieliczko et al.. Eco-dialysis: fashion or necessity. International Urology and Nephrology. 2020; 52:519-523. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7060957/ [Last accessed 6 December 2024] 18. Rao N, et al. Multidimensional Burden of Chronic Kidney Disease in Eight Countries: Insights from the IMPACT CKD Study. Presented at: WCN 2024, 13-16 April 2024, Buenos Aires, Argentina. https://events.theisn.org/user/form/view/1452?response=1204:44781  19. Chesnaye, N.C. et al. The impact of population ageing on the burden of chronic kidney disease. Nat Rev Nephrol 20, 569–585 (2024). https://doi.org/10.1038/s41581-024-00863-9 [Last accessed 6 December 2024] 20. Francis, A., Harhay, M.N., Ong, A.C.M. et al. Chronic kidney disease and the global public health agenda: an international consensus. Nat Rev Nephrol 20, 473–485 (2024). https://doi.org/10.1038/s41581-024-00820-6 [Last accessed 11 December 2024] 21. Dong, B., Zhao, Y., Wang, J., Lu, C., Chen, Z., Ma, R., … Li, Y. (2024). Epidemiological analysis of chronic kidney disease from 1990 to 2019 and predictions to 2030 by Bayesian age-period-cohort analysis. Renal Failure, 46(2). https://doi.org/10.1080/0886022X.2024.2403645 [Last accessed 11 December 2024] 22. Foreman et al.. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016-40 for 195 countries and territories. 2018.Available from: https://pubmed.ncbi.nlm.nih.gov/30340847/ [Last accessed 11 December 2024] 23. Pecoits-Filho R, et al. Kidney-protective medication and risk of adverse clinical outcomes in patients with chronic kidney disease: preliminary findings from DISCOVER CKD. Abstract presented at: Annual Congress of the European Renal Association (ERA); Stockholm, Sweden; 2024. https://oa.mg/work/10.1093/ndt/gfae069.713 [Last accessed 6 December 2024] 24. Biebuyck GKM, et al. Impact of telehealth interventions added to peritoneal dialysis-care: a systematic review. BMC Nephrology. 2022; 23:292. https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-022-02869-6  [Last accessed 6 December 2024] 25. EKHA. Recommendations for sustainable kidney care [Internet]. Brussels: European Kidney Alliance. August 2015. https://ekha.eu/wp-content/uploads/2016/01/EKHA-Recs-for-Sustainable-Kidney-Care-25.08.2015.pdf [Last accessed 6 December 2024] 26. KDIGO. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Disease Improving Global Outcomes, 2024. Available from: https://kdigo.org/wp-content/uploads/2024/03/KDIGO-2024-CKD-Guideline.pdf [Last accessed 6 December 2024] 27. Stengel B, et al. Adherence to the kidney disease: improving global outcomes CKD guideline in nephrology practice across countries. Kidney Int Rep(2021) 6, 437–448. https://pmc.ncbi.nlm.nih.gov/articles/PMC7879121/pdf/main.pdf [Last accessed 6 December 2024] 28. High Authority of Health. Medico-economic evaluation of strategies for the management of terminal chronic renal failure in France. https://has-sante.fr/upload/docs/application/pdf/2012-09/argu_irct_volet_greffe_vf.pdf [Last accessed 6 December 2024] 29. Economist Impact. Chronic kidney disease. Country profile: France. https://impact.economist.com/projects/chronic-kidney-disease/images/countries/ECO072_AZ_Profile_France_1505.pdf [Last accessed 6 December 2024] 30. High Authority for Health. Care pathway guide– Chronic kidney disease in adults (CKD). February 2012.Guide_Parcours_de_soins_MRC_Final3 [Last accessed 11 December 2024] 31. High Authority for Health. Care pathway guide– Chronic kidney disease in adults (CKD). Update September 2023. Guide du parcours de soins – Maladie rénale chronique de l’adulte (MRC) [Last accessed 11 December 2024] 32. France Rein. Chronic Kidney Disease. Prevent. Better care. Generate savings. optimrc-livre-blanc.pdf [Last accessed 11 December 2024] 33. Health Insurance. Medical Convention. PPT MEDECINS, page 26 https://www.ameli.fr/sites/default/files/Documents/Pr%C3%A9sentation%20synth%C3%A9tique%20Convention%20M%C3%A9dicale%20vdef.pdf [Last accessed 6 December 2024] 34. 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Call it the evaluation before the job interview. Ahead of the aspiring commissioners facing a grilling from the European Parliament in early November, they must respond to lawmakers’ written questions. And the answers are in. Many of the incoming top brass are new to the Brussels’ policymaking machine. The written answers, in theory at least, are an opportunity to share their vision of their upcoming roles. Don’t get too excited though.  The majority of commissioner nominees rehashed previous statements from various Brussels institutions, whether from the political guidelines of European Commission President Ursula von der Leyen or the so-called mission letters that she sent to her future commissioners. The answers were also partly written by the Commission’s civil servants, who have crafted and executed EU policies for decades.  The real test will be facing unexpected questions from European lawmakers when commissioner nominees can no longer rely on advisers to whisper the answers.  Still, the written answers give some indications to how the newcomers want to set the tone or change direction — which makes them worth combing through.  And POLITICO got stuck into more than 400 pages of written answers so you don’t have to. Here are our key takeaways.  MARIA LUÍS ALBUQUERQUE Portugal’s Maria Luís Albuquerque, the commissioner candidate for financial services and the Savings and Investments Union, said the bloc must “not roll back” global bank capital standards — the so-called Basel III accords, which aimed to make the financial system safer following the 2008 global financial crisis — and “must implement the rules,” pushing back against calls from EU countries to scrap some elements of existing regulation. Albuquerque, who will answer questions from European Parliament lawmakers at her confirmation hearing on Nov. 6, said in written responses to MEPs’ questions that the EU is “giving banks ample time to adapt to the new rules.” VALDIS DOMBROVSKIS Latvia’s Valdis Dombrovskis, the commissioner candidate for economy, productivity, implementation and simplification, gave his strongest support yet for conditions to be attached to European Union funding in the next budget, saying the bloc may draw inspiration from the successful linking of investment and reform within its pandemic recovery fund. His remarks formed part of his written answers to European lawmakers ahead of his Nov. 7 confirmation hearing in the European Parliament, and follow a similar push from von der Leyen. The remarks of Valdis Dombrovskis formed part of his written answers to European lawmakers ahead of his Nov. 7 confirmation hearing in the European Parliament, and follow a similar push from von der Leyen. | Sajjad Hussain/AFP via Getty Images CHRISTOPHE HANSEN Luxembourg’s Christophe Hansen, the commissioner candidate for agriculture and food, said the European Commission won’t publish a flagship framework law on sustainable food systems, in written answers ahead of his grilling by lawmakers on Nov. 4. “Rather than new legislative proposals, we can achieve our objectives by better implementing and enforcing existing legislation while using incentives and new market-based tools to promote change,” Hansen said in reply to a question on whether the EU’s executive would propose the framework next year. COSTAS KADIS Cyprus’ Costas Kadis, the commissioner candidate for fisheries and oceans, made it clear he won’t compromise on environmental protection ahead of his Nov. 6 confirmation hearing. In his role, Kadis will have the delicate task of balancing the interests of the EU’s fishing industry with those of imperiled ocean biodiversity — which are often diametrically opposed. Kadis, who has a background in biology, said his “top priority” was to “ensure that the fishing and aquaculture sectors remain sustainable, competitive and resilient.” HADJA LAHBIB Belgium’s Hadja Lahbib, the commissioner candidate for preparedness, crisis management and equality, dodged MEPs’ questions over the future of the Health Emergency and Response Authority (HERA) and hinted funding for health crisis planning could be hard to come by, ahead of her hearing on Nov. 6. MEPs asked whether she foresaw an expansion of HERA’s capacity and how she would manage financing issues that have already affected its work. In her statement Lahbib didn’t answer directly but said she would draw on HERA’s expertise for the EU preparedness strategy and for the Critical Medicines Act. TERESA RIBERA Spain’s Teresa Ribera, the executive vice president candidate for the clean, just and competitive transition, promised “swift and effective state aid” to back the EU’s Clean Industrial Deal, pitching public funds as a way to unlock private sector investments in “considerable” decarbonization costs, she told the European Parliament ahead of her Nov. 12 confirmation hearing. The Clean Industrial Deal — a bill to help companies meet the EU’s ambitious carbon-cutting targets and boost climate-friendly technologies — is one of Ribera’s top agenda items. The EU has vowed to release the legislation within 100 days of Ribera taking office. Spain’s Teresa Ribera, the executive vice president candidate for the clean, just and competitive transition, promised “swift and effective state aid” to back the EU’s Clean Industrial Deal. | Javier Soriano/AFP via Getty Images JESSIKA ROSWALL Sweden’s Jessika Roswall, the commissioner candidate for environment, water resilience and a competitive circular economy, stressed her commitment to the farming, forestry and bioeconomy industries ahead of her hearing on Nov. 5. In doing so, the lawyer-by-trade and former European affairs minister made it clear the European Commission’s green agenda will no longer take priority over support for the agricultural sector — addressing what became one of the biggest controversies of the last mandate. STÉPHANE SÉJOURNÉ France’s Stéphane Séjourné, the executive vice president candidate for prosperity and industrial strategy, said that the European Commission will thoroughly assess the way it scrutinizes foreign subsidies impacting takeover deals and public procurement in the EU. He commits to a review of the implementation of the rules in responses submitted ahead of his confirmation hearing on Nov. 12 and highlights the “appropriateness of the level of the notification thresholds.” He also says that Brussels will come up with a possible legislative proposal depending on the outcome of this review, as planned in the text of the regulation. OLIVÉR VÁRHELYI Hungary’s Olivér Várhelyi, the commissioner candidate for health and animal welfare, was opaque on pushing ahead with front-of-pack labels in written answers to MEPs on how to tackle ever-rising rates of noncommunicable diseases such as diabetes, cancer and cardiovascular disease, ahead of his hearing on Nov. 6. While he acknowledged that mandatory food information “can help consumers to make healthier consumer choices,” he nonetheless favors a “comprehensive approach” (EU-speak for nonlegislative measures). This could signal a line in the sand over stalled European Commission proposals to introduce front-of-pack health labels for all foods in Europe, as well as for alcoholic drinks. Hungary’s Olivér Várhelyi, the commissioner candidate for health and animal welfare, was opaque on pushing ahead with front-of-pack labels in written answers to MEPs. | Joe Klamar/AFP via Getty Images EKATERINA ZAHARIEVA Bulgaria’s Ekaterina Zaharieva, the commissioner candidate for startups, research and innovation — who is also tasked with leading the EU life sciences strategy — only briefly mentioned the hotly anticipated proposal ahead of her hearing on Nov. 5. But in her nine-page replies to the questions posed by MEPs, published Tuesday night, Zaharieva only said she will “engage with the relevant players to develop a Strategy for European Life Sciences, which will cover also biotechnology … (to) support a faster green and digital transition.” Helen Collis, Rory O’Neill, Claudia Chiappa, Aude van den Hove, Francesca Micheletti, Camille Gijs, Leonie Cater, Marianne Gros and Louise Guillot contributed to this report.

Weight-loss and diabetes drugs like Ozempic and Mounjaro could be used to treat drug and alcohol addiction in the future — according to the first large-scale study — but more research is needed. An analysis of 1.3 million health records found these types of drugs reduced the instances of drug or alcohol overdoses. In people with alcoholism, rates of alcohol intoxication were 50 percent lower in those taking these types of medicines than for people who didn’t, while among people with opioid addiction, overdose rates were 40 percent lower in those taking these drugs versus those who didn’t. The study, published in the journal Addiction on Thursday, saw researchers trawl a United States database of electronic health records to look for people with either an addiction to opioids or alcohol and who were also prescribed treatment for obesity or diabetes. They found 8,103 people with a history of opioid use disorder who also had a prescription for obesity or diabetes drugs. The study also included more than 817,000 people with a history of alcohol use disorder, 5,621 of whom had a similar prescription. The medicines analyzed in the study included drugs such as Novo Nordisk’s Wegovy and Ozempic and Lilly’s Mounjaro. The results reveal “the possibilities of a novel therapeutic pathway in substance use treatment,” the authors, from Loyola University Chicago, state. But they caution that while the results are “promising,” they highlight the need for further research, particularly prospective clinical trials. A WORD OF CAUTION Until now, most of the existing research into using these types of drugs — known as GLP-1s and GIPs — to treat substance use disorders looked at its effects on animals, or were only small clinical trials.  But despite the promising results, Matt Field, a professor of psychology at the University of Sheffield, issued a note of caution over the study. He said its findings relate largely to “very extreme instances of substance intoxication,” like overdoses. “Those outcomes are very different from the outcomes used when researchers test new treatments for addiction, in which case we might look at whether the treatment helps people to stop taking the substance altogether (complete abstinence), or if it helps people to reduce the amount of substance they consume, or how often they consume it,” he said. “Those things could not be measured in this study.” This leaves open the possibility that while Ozempic may (for reasons currently unknown) prevent people from taking so much alcohol or heroin that they overdose and end up in hospital, “it may not actually help them to reduce their substance use, or to abstain altogether,” he said. He goes on to say that one of the trials mentioned in the paper reported that a similar medication “did not reduce the number of heavy drinking days compared with placebo.” Early this year, Ozempic-maker Novo Nordisk said it will start assessing the effects of semaglutide, the active ingredient in the drug, on alcohol consumption.