People who stop taking weight-loss drugs regain body mass four times faster than those who lost their excess pounds through diet and exercise, according to an analysis of the latest studies. The additional benefits from taking weight-loss drugs, such as improvements in cholesterol and blood pressure, were also reversed when patients quit the medications, the study found. The research, published in the British Medical Journal on Thursday, adds to a growing body of evidence that suggests life-long treatment of obesity is needed to maintain control of the condition. But the high cost of the latest drugs — as well as their side effects — present barriers to long-term use. “We know that obesity is a chronic relapsing condition. We know that when treatment stops, weight is regained. And so, some kind of treatment needs to be continued. What [that] treatment should be, I don’t know,” co-author Susan Jebb, professor of diet and population health at the Nuffield Department of Primary Care Health Sciences, University of Oxford, told journalists. Rates of obesity and overweight are growing rapidly on the continent, with around 51 percent of people in the EU aged 16 years or over being overweight in 2022. Obesity significantly increases the risk of chronic illnesses such as diabetes, heart disease and cancers, and health systems are struggling to cope. Researchers analyzed weight gain from 37 trials of multiple weight-loss drugs, including older medications and the newer GLP-1s. The latest drugs, including Novo Nordisk’s diabetes and weight-loss drugs Ozempic and Wegovy and Eli Lilly’s Mounjaro, saw the greatest weight loss and the fastest weight regain when treatment stopped. Compared with another analysis of behavioral weight management programs supporting low energy diets and exercise, weight regain was faster after ending medication than after ending behavioral programs. THE LONG-TERM DILEMMA The newer weight-loss drugs have seen a boom in uptake across Europe and America, despite their high prices. Ozempic, Wegovy and Mounjaro soared in popularity after demonstrating roughly 15 percent weight loss in trials, and were pounced on by celebrities and influencers. However, around half of people who take these drugs will stop them after one year. Side effects such as nausea and vomiting, costs or dissatisfaction with weight loss as it plateaus are driving decisions to halt treatment, lead author Sam West, a postdoctoral researcher also at the Nuffield department at the University of Oxford, told journalists during the briefing. Most people in the U.K. — around 90 percent — pay privately for their weight-loss medication, Jebb said. But those who access it through the National Health Service are subject to a two-year cap on access to the drugs, known as GLP-1s. Similar limits apply in other EU countries. Dimitris Koutoukidis, associate professor in diet, obesity and behavioral sciences at the University of Oxford, suggested the U.K. may not be getting the value for money it envisioned with these weight-loss drugs. The model used to assess whether Lilly and Novo’s medicines were cost-effective assumed people would regain their lost weight after two years, he told journalists — but their study shows weight is regained at around 1.5 years. “It is really hard to treat obesity and keep the weight off long-term,” Jebb said. “That should make us put even more effort into preventing weight gain in the first place. And if we could transform our food environment to make it easier for people to manage their weight it would stop them gaining weight in the first place and help people — after a successful weight loss attempt — to keep it off.” “These treatments are not a whole solution,” she added.

Faced with an ageing population and rising chronic disease rates, Europe wants to make its citizens healthier. It also needs to keep its most powerful industries happy. In the basket of health policies that EU lawmakers rushed to get across the line before Christmas, industry was the big winner: The pharmaceutical, food and drink sectors walked away with a set of major policy wins — and (potentially) healthier profits. While the pharma industry previously feared losing some of its monopoly rights on new drugs, the Commission this month offered it an extra year of patent protection for novel biotech drugs — among the most expensive treatments in the world. The food and drink sectors, meanwhile, successfully pushed back against proposals to tax ultra-processed foods and alcopops, for now. On Dec. 16 the Commission published its Biotech Act and Safe Hearts Plan, which landed just days after a long-awaited update of the pharmaceutical legislation. Taken together, they seek to incentivize industries to innovate and do business in Europe, improve access to medicines, and tackle the burden of cardiovascular disease. The pharma industry broadly celebrated the biotech proposal. The Biotech Act “reflects priorities we’ve intensively advocated to keep Europe globally competitive in life sciences,” Ognjenka Manojlovic, head of policy at European pharmaceutical company Sanofi, told POLITICO. That includes accelerating clinical trials, boosting intellectual property, and strengthening financing for Europe’s biotech ecosystem, Manojlovic said. The pharmaceutical sector had pushed for longer monopoly rights in the pharma legislation. In the end they were kept at the current standard eight years — instead of being cut by two years as the European Commission had initially proposed. For Europe’s public health insurers, who pay for drugs, the decisions taken to maintain and then extend market protections for medicines are hard to square. “We are puzzled by the Commission’s intentions,” said Yannis Natsis, director of the European Social Insurance Platform, a network of Europe’s social insurance organizations, warning that taxpayers will have to pick up the bill. Meanwhile, health campaigners are also unhappy at the Commission’s “missed opportunity” to tackle obesity and heart disease with junk food taxes — as proposed in an earlier draft of the Safe Hearts Plan. Samuele Tonello, at consumer organization BEUC, said the Safe Hearts Plan “lacks teeth” to better protect consumers from unhealthy foods, and flagged the “urgency of [cardiovascular diseases].”  A MAN ON A MISSION Health Commissioner Olivér Várhelyi has made no secret of his support for industry, and has championed the Commission’s competitiveness mantra since taking office in late 2024. Health Commissioner Olivér Várhelyi has made no secret of his support for industry, and has championed the Commission’s competitiveness mantra since taking office in late 2024. | Thierry Monasse/Getty Images The standout feature of his end-of-year bonanza was the 12-month patent extension in the Biotech Act I — legislation that was split in two late in the day, allowing Várhelyi to meet his end-of-year deadline for the pharma component. The proposal came just a week after the Commission, countries and MEPs clinched a deal to reform Europe’s pharmaceutical laws, in which IP rights were among the last issues to be settled. Updates to the pharma laws were a legacy of the last Commission, whereas the Biotech Act became something of a personal mission for Várhelyi. He repeatedly stressed that there was “no time to lose” in delivering a targeted policy aimed at revitalizing Europe’s flagging biotech industry, which risks being overtaken by competition from China and the U.S. Few commissioners are more vocal than Várhelyi about the premium they place on the competitiveness of European industry.  Industry insiders had heard whispers of his plans to expand IP incentives for the biotech sector, even if Council representatives were dismayed not to have been informed in advance — especially with the ink barely dry on the Pharma Package. That’s not to say pharma is happy with its lot. Industry lobby group the European Federation of Pharmaceutical Industries and Associations (EFPIA) tempered its praise of the Biotech Act, lamenting that the extra year of monopoly rights would only apply to a “limited subset of products.”  The extra year of protection is tied to the Commission’s efforts to locate more pharma research and manufacturing in Europe. It would apply only to new products, tested and at least partially made in Europe.  But the generics sector, which makes cheaper, off-patent drugs to compete with branded medicines, sees the Biotech Act as a further sweetening of what is already one of the world’s most generous IP systems. Lobby group Medicines for Europe claims each year of delayed competition for the top three biologic drugs would cost countries €7.7 billion. Longer IP “will have a dramatic impact on healthcare budgets and delayed patients’ access to essential medicines,” said Adrian van den Hoven, head of the lobby. These kinds of estimates would normally be included in an impact assessment published alongside the proposal, but in its haste to get the Biotech Act out the Commission didn’t do one. POLITICO asked the Commission for an estimate of what the extra year of patent protection would cost. A Commission spokesperson would not give a figure but said they had used the impact assessment for the pharma legislation as a reference. “It is also important to stress that the number of products eligible for an additional year of SPC will be limited to only those that are truly innovative and tested and manufactured in the EU. The approach is deliberately targeted to incentivise genuinely innovative therapies that deliver a clear added value for patients and support European innovation,” the spokesperson said. LUCKY ESCAPE FOR UPFS The big food and drink sectors are on shakier ground with Várhelyi. The commissioner has repeatedly made known his distaste for ultra-processed food, and an early leaked version of the Safe Hearts Plan included new taxes on unhealthy highly processed foods and alcopops. But the final proposal showed the Commission had undertaken a significant climbdown. Concrete targets to tax unhealthy food and drink in 2026 were gone, replaced with a much woollier commitment to “work towards” such a levy. Alcopops were excluded altogether.  Industry lobby FoodDrinkEurope took a far more measured tone on the final plan than its explosive reactions to the earlier leaks, but that may well ramp up again if and when health tax proposals emerge. The text suggests the soft drinks industry may be the Commission’s first target if it does decide to pursue new levies, while UPFs remain in Várhelyi’s sights. “In the next couple of years, we will need to tackle the issue of ultra-processed food much more,” he told MEPs in December. For now, though, the plan seems to have let industry off easy. Health NGOs saw it as a disappointment, given its lack of hard-hitting policies to reduce consumption of UPFs and other unhealthy products. While the pharma legislation is all wrapped up, the Biotech Act still needs to win the approval of EU countries and the European Parliament. For the food and pharma sectors, the proposals set out this month are confirmation they have allies in the Berlaymont.

The World Health Organization has recommended the use of novel weight-loss drugs to curb soaring obesity rates, and urged pharma companies to lower their prices and expand production so that lower-income countries can also benefit. The WHO’s new treatment guideline includes a conditional recommendation to use the so-called GLP-1s — such as Wegovy, Ozempic and Mounjaro — as part of a wider approach that includes healthy diet, exercise and support from doctors. The WHO described its recommendation as “conditional” due to limited data on the long-term efficacy and safety of GLP-1s. The recommendation excludes pregnant women. While GLP-1s are a now well-established treatment in high-income countries, the WHO warns they could reach fewer than 10 percent of people who could benefit by 2030. Among the countries with the highest rates of obesity are those in the Middle East, Latin America and Pacific islands. Meanwhile, Wegovy was only available in around 15 countries as of the start of this year. The WHO wants pharma companies to consider tiered pricing (lower prices in lower-income countries) and voluntary licensing of patents and technology to allow other producers around the word to manufacture GLP-1s, to help expand access to these drugs. Jeremy Farrar, an assistant director general at the WHO, told POLITICO the guidelines would also give an “amber and green light” to generic drugmakers to produce cheaper versions of GLP-1s when the patents expire. Francesca Celletti, a senior adviser on obesity at the WHO, told POLITICO “decisive action” was needed to expand access to GLP-1s, citing the example of antiretroviral HIV drugs earlier this century. “We all thought it was impossible … and then the price went down,” she said.  Key patents on semaglutide, the ingredient in Novo Nordisk’s diabetes and weight-loss drugs Ozempic and Wegovy, will lift in some countries next year, including India, Brazil and China. Indian generics giant Dr. Reddy’s plans to launch a generic semaglutide-based weight-loss drug in 87 countries in 2026, its CEO Erez Israeli said earlier this year, reported Reuters. “U.S. and Europe will open later … (and) all the other Western markets will be open between 2029 to 2033,” Israeli told reporters after the release of quarterly earnings in July. Prices should fall once generics are on the market, but that isn’t the only barrier. Injectable drugs, for example, need cold chain storage. And health systems need to be equipped to roll out the drug once it’s affordable, Celletti said. 

Ozempic-maker Novo Nordisk is to lay off 9,000 of its staff, with 5,000 of those coming from its sites in Denmark, the company announced today. The firm has around 78,400 staff worldwide; the redundancies account for 11.5 percent of its workforce. “It is always difficult to see talented and valued colleagues go, but we are convinced that this is the right thing to do for the long-term success of Novo Nordisk,” CEO Mike Doustdar said.  “By realigning our resources now, we will be able to prioritise investments to drive sustainable growth and future innovation for the millions of patients with chronic diseases globally, particularly in diabetes and obesity.” It’s one of Doustdar’s first moves as head of the company after he replaced Lars Fruergaard Jørgensen earlier this year. Jørgensen, who had helmed the Danish drugmaker for eight years, saw Novo become Europe’s most valuable company under his leadership. But the firm saw its share price tumble over the past year amid increased competition in the weight-loss drug market from Eli Lilly’s Mounjaro, and disappointing trial results for its next-generation treatments. “Our markets are evolving, particularly in obesity, as it has become more competitive and consumer-driven. Our company must evolve as well,” Doustdar said. The company said the layoffs would mean a one-off cost of 8 billion danish krone (€1.07 billion) It now expects full-year operating profit growth of 4 percent to 10 percent, down from the 10 percent to 16 percent outlined in August.

Fake weight-loss drugs are increasingly being advertised and sold across the EU, posing a serious public health threat, the bloc’s drugs regulator warned today. The European Medicines Agency said there has been a “sharp rise” in the number of illegal medicines marketed and sold as GLP-1 agonists, such as the popular semaglutide, liraglutide and tirzepatide, in recent months. Authorities have identified hundreds of sham Facebook profiles, advertisements and e-commerce listings promoting the fake drugs. These websites often mislead customers by using official logos and false endorsements, the EMA said. While genuine versions under the brand names Wegovy, Ozempic, Saxenda and Mounjaro are available through legitimate health services and with a prescription, the fake versions are “not authorised and do not meet necessary standards of quality, safety and efficacy,” the agency said. “Such illegal products pose a serious risk to public health. They may not contain the claimed active substance at all and may contain harmful levels of other substances,” the EMA warned. “People who use these products are therefore at a very high risk of treatment failure, unexpected and serious health problems and dangerous interactions with other medicines.”

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.

When United States President Donald Trump announced he would tariff Denmark if the country didn’t relinquish control of Greenland, Danish Prime Minister Mette Frederiksen turned to a coterie of CEOs for advice. But rather than the fist-pumping tech bros or mixed martial arts fighters that made up Trump’s circle at his inauguration, Frederiksen went instead to a rather more reserved character: a softly spoken 58-year old, Lars Fruergaard Jørgensen. In person the Dane is quiet, polite and understated. But he inspires enough fear in fast food giants that they call him up in a panic about the threat he poses to their businesses. He’s the CEO of Danish pharmaceutical firm Novo Nordisk — best known as the maker of Ozempic and Wegovy, the blockbuster diabetes and weight-loss drugs-turned-cultural phenomena that have single-handedly prevented Denmark from falling into a recession. But how did the self-confessed introvert who “needs his quiet time” become the man to advise Denmark on how to handle the American president? THE AMBIVALENT BOFFIN In the helix-shaped headquarters half an hour from central Copenhagen, Jørgensen was at pains to explain to POLITICO his rise to the top of Novo Nordisk — until recently, Europe’s most valuable firm — was never his intention. As a young graduate he applied to four companies — and accepted the first offer he got. Joining Novo Nordisk as an economist in 1991, Jørgensen said he had “no ambition, no clue.”  From the company’s offices overlooking the city, Jørgensen spoke in December about his anxiety from that time.“In the early years of my career I did not talk a lot about that I grew up on a farm, that I’m the first one to go to high school and business school … because I felt I was less good,” he said. “Others came from academic families and I felt they were better.” He had no great desire to one day run the company — “I think nobody saw that early on” — but Novo put all the levers in place for a young Jørgensen to learn and succeed. He said he just made the most of them. “[They] kind of threw me into stuff I had no clue about. You learn the art of quickly trying to assess: ‘OK, what is actually the problem? What’s going on? What am I supposed to do?’” It took him a while to feel fully comfortable; being more open about his farming roots was a big part of it, he said. “I think that has made me more authentic and also it resonates with many other people who have the same upbringing.” Jørgensen didn’t fully shed that insecurity until he was made CEO, he said, a role which has thrust him blinking into the spotlight — and now sees him having to reassure a panicked prime minister. Frederiksen summoned Danish business leaders, including Jørgensen, for crisis talks in January after Trump refused to rule out military or economic action to take control of Greenland, a semi-autonomous territory of Denmark. Danish Prime Minister Mette Frederiksen turned to a coterie of CEOs for advice. | Johannes Simon/Getty Images The United States president has also suggested he would impose tariffs on Danish goods if Copenhagen turns down his offer to buy the Arctic island — no empty threat given he’s already following through with tariffs on goods from Canada, China and Mexico. NOVO’S RISE It’s difficult to overstate the recent success of Novo Nordisk, which boasted a turnover of €38.9 billion in 2024 — of which €13.5 billion was profit — and accounts for nearly half of Denmark’s gross domestic product growth. The Scandinavian company has long been a leader in diabetes medicine but hit the jackpot with its GLP-1 class of drug for diabetes that also caused weight loss. Although Ozempic has become synonymous with a shrinking waistband, it’s Novo’s drug Wegovy, which is licensed for weight loss and clinical trials showed patients lost on average 15 to 16 percent of their body weight after just over a year. Both drugs contain semaglutide, which mimics a hormone released after eating, tricking the brain into feeling full. Wegovy’s approval — in 2021 in the U.S. and 2022 in Europe — was a game changer for the company.  Celebrities including Oprah Winfrey and Trump’s “efficiency czar” Elon Musk have boosted its profile (the latter describing himself as an “Ozempic Santa”), while Senator Bernie Sanders — who hauled Jørgensen in front of his U.S. Senate health committee last year — said semaglutide “may end up being one of the bestselling pharmaceutical products in the history of humanity.” One in eight people have taken Ozempic, Wegovy or one of its competitors in the U.S. Scientists are already questioning whether their rapid adoption is causing obesity rates to fall in America. That stratospheric rise in profile has come during Jørgensen’s reign as CEO, a position he has held since 2017, when he became only the fifth person to lead the company in its 100-year history. It also makes Novo a rare European success story at a time when businesses and investors pivot to the U.S. and China. Despite that success, Jørgensen doesn’t have a reputation as a ball-breaker, nor a political animal in his home country. “He’s seen more as a civil servant than a CEO,” one Danish diplomat, granted anonymity like others in this article to speak candidly, said.  And he remained diplomatic when POLITICO asked him at the end of last year about Trump’s controversial picks for top jobs, such as vaccine-skeptic Robert F. Kennedy Jr. for health secretary. “Let’s just see how they play out,” he said. That kind of response is typical of Denmark’s approach to diplomacy, said Lars Sandahl Sørensen, head of the Confederation of Danish Industry and former deputy CEO of Scandinavian Airlines, who has known Jørgensen for years. It’s difficult to overstate the recent success of Novo Nordisk, which boasted a turnover of €38.9 billion in 2024. | Claus Rasmussen and Ritzau Scanpix/Getty Images “Standing up and shouting contests is not our style,” Sørensen told POLITICO over the phone last year. Nor is it to be “very flamboyant or show off, or show strength,” he said. “I understand that’s part of other cultures and that works there, but here it would work negatively.” Jørgensen is also unfazed by the success of Mounjaro, a drug produced by Novo’s U.S. rival Eli Lilly, which has demonstrated greater weight loss compared with Wegovy. “I welcome competition,” he said. “We have a 100-year history of competing with Eli Lilly and we tend to take turns about who has a product that’s ahead.” CRISIS MODE Trump’s threat of tariffs against Denmark is perhaps the biggest headache the CEO has had to deal with in his time as head of the organization. Last year, 58 percent of Novo’s sales came from the U.S. — 79 percent of Wegovy and 70 percent Ozempic sales. Asked about tariffs at a press conference in February, Jørgensen said Novo was “not immune, but we are confident our business is in a good position to meet the demands of the new [U.S.] administration.” The other major crisis was the Covid-19 pandemic; though not a vaccine-maker the company still had to navigate disrupted supply chains. His instinct was to let other people take over. “If I have to solve the problems, that’s a problem,” Jørgensen told Bloomberg last year. The company set up a crisis response team but Jørgensen didn’t initially attend and let others lead it. “I knew if I put myself into that I’d become a bottleneck,” he said. His attitude to leadership is one of consensus. “I was born with a big nose and big ears and I use the attributes of that each day to collect opinions from the company. Then it’s my role to combine it into an opinion together with my team,” he said. That goes as far as taking advice on running the company from his two environmentally conscious kids, who encouraged him to reevaluate Novo’s policy on flights. But that approach means that when the spotlight is on him, he’s out of his comfort zone. His reticence hasn’t always gone down well with policymakers.Senator Sanders said his committee “reached out time and time again” to schedule Novo Nordisk’s voluntary appearance at a hearing, without success. It wasn’t until he threatened the Dane with a subpoena that he turned up in person. Donald Trump’s threat of tariffs against Denmark is perhaps the biggest headache the CEO has had to deal with in his time as head of the organization. | Tierney L. Cross/Getty Images When he did, the Senate report into Novo’s pricing accused the company of “greed, greed, greed.” Jørgensen nonetheless was accommodating, promising to sit down with pharmacy benefit managers — middlemen who negotiate medicine rebates with manufacturers on behalf of insurers — to “collaborate on anything that helps patients get access and affordability.” SOFT POWER Jørgensen is not someone who schmoozes in Brussels either, preferring to spend his time in Denmark, ideally in the garden or on the tennis court, he said. Despite being current president of Europe’s pharma lobby EFPIA, he goes to the European Union capital only two or three times a year in that capacity, his press secretary told POLITICO. Nonetheless, Novo’s presence looms large over discussions on a major overhaul of European laws for the pharmaceutical industry — because of the ferocious loyalty Denmark and its lawmakers show to Novo in Brussels.  The country is the most vocal supporter of the pharma industry in the EU, where countries are currently negotiating their position on the legislative reform. One European Parliament official said that Novo is practically “in the room” during these talks, such is the extent Denmark mirrors the pharma position. Assistants for Danish members of the European Parliament had tried to insert amendments into the Parliament’s text to make it more favorable to the industry, the official said, adding that the company’s lobbyists would be “welcoming the new MEPs off the train in Strasbourg,” the seat of the Parliament. Nevertheless, those who have met Jørgensen in such a capacity say he is thoughtful and respectful. “Polite and quiet, like he had a genuine interest in what his staff and I were saying rather than in hearing himself talk,” said another Parliament official. “He appeared very knowledgable.” That’s a very Danish approach to leadership, pointed out Sørensen. “We like to be fact-based. We like to be honest. We like to be trustworthy,” he said. It’s a style that will surely go down well with the U.S. president, who calls himself “perhaps the most honest human being” God ever created. Right? This article has been updated to clarify the effect of GLP-1s on weight.

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.”