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

BERLIN — The leaders of German Chancellor Friedrich Merz’s conservative-led coalition on Friday announced accords on key issues that had divided his government in recent weeks. The internal disagreements — over pension reforms and a phaseout of the combustion engine — had turned into a test of the viability of Merz’s relatively weak and ideologically divergent coalition government. The new agreements, reached after a night of long negotiations, may have staved off a larger crisis of confidence in Merz’s government. Members of Merz’s coalition sought to portray the agreements as evidence that the government is functioning smoothly. “Sometimes the image that people paint — saying that everything is stuck and so on — doesn’t match what I experienced yesterday,” said Lars Klingbeil, the leader of the center-left Social Democratic Party (SPD), which governs in coalition with Merz’s conservative alliance. “We really did push forward far-reaching changes for this country in constructive debates.” The agreements announced Friday revolve around a pension package lawmakers are set to vote on in December that a faction of Merz’s own conservatives had railed against, as well as a deal on Germany’s position on the EU’s push to phase out the combustion engine. In the case of the pension reform, Merz sought to placate conservative rebels by vowing to take on a second, more far-reaching set of pension system reforms that would involve implementing the recommendations of an expert commission as early as next year. Previously, the coalition had agreed on a lengthier timeframe. “There is now a firm agreement,” Merz said in view of the immediate pension reform package set to go for a vote. “We will come to a decision next week, and it is not just a gut feeling, but a well-founded hope, based on the discussions we had this morning, that our colleagues now see that we are really serious about these reforms and that we are now going down this path together.” With regard to EU plans to ban carbon-emitting engines from 2035, Merz said he would write a letter to European Commission President Ursula von der Leyen on Friday to urge Brussels to apply extensive exemptions — including on dual-motor vehicles, plug-in hybrids, electric vehicles with range extenders and “highly efficient” combustion engines. That announcement signaled that the SPD has effectively backed off its previous support for EU green regulations for cars. “We ask the Commission, in a comprehensive sense, to adapt and correct the regulations for mobility,” said Merz. “This concerns in particular the compatibility of competitiveness — the industrial competitiveness of the European automotive industry — with the demands we place on climate protection.” Merz’s coalition has a majority of just 12 votes in the Bundestag, making his government vulnerable to even modest defections in the ranks. Conservative Bavarian premier Markus Söder on Friday signaled satisfaction with the agreements. “Everything we did yesterday is good for Germany, good for the economy, and bad for radicals,” he said in view of the surging far-right Alternative for Germany (AfD) party. “They are waiting outside the door for us to fail together. That is their great hope, that we will fail.”

The mastermind of President Donald Trump’s effort to downsize the federal workforce, Russ Vought, promised to use the government shutdown to advance his goal of “shuttering the bureaucracy.” Presented with a layoff plan that would have moved in that direction, officials at the Department of Health and Human Services scaled it way back, POLITICO has learned. It was another example, like several during the layoffs led by Elon Musk’s Department of Government Efficiency this spring, in which Trump’s agency heads have pushed back successfully against top-down cuts they viewed as reckless. POLITICO obtained an HHS document from late September, the shutdown’s eve, that said the department wanted to cut nearly 8,000 jobs, based on guidance from Vought’s budget office. On Oct. 10, HHS only went ahead with 1,760. In the two weeks since, the number has dwindled to 954, as the department has rescinded nearly half of the total, blaming a coding error. The disorganized handling of the layoffs is reminiscent of Musk’s DOGE effort, in which employees were rehired after being fired, sometimes on court orders, sometimes because agency officials objected. In each case, the layoffs rattled agency managers and traumatized employees, as Vought wanted, but haven’t gone nearly as far in downsizing the government as forecast. While the nearly 8,000-person layoff plan this month was largely scuttled by top agency officials who intervened before the cuts could be made, the whiplash manner in which it was proposed and then scaled back shows that the administration is still following the DOGE playbook. “These appear to be leftovers from DOGE. I don’t know anyone — including in the White House — who supports such cuts,” a senior administration official told POLITICO in explaining the pullback from the promised mass layoffs. The official, granted anonymity to discuss confidential matters, pointed to the involvement of a staffer who was part of the DOGE effort in producing the administration document. That document came to its initial tally of 7,885 layoffs at HHS by adding employees who would be furloughed during the shutdown, as well as workers in divisions that would be shuttered if Congress passed Trump’s fiscal 2026 budget proposal. Trump’s May budget plan called for a 25 percent cut to HHS, but lawmakers have rejected it in the appropriations bills now in process. HHS spokesperson Emily Hilliard told POLITICO in a statement that HHS made its layoff list “based upon positions designated as non-essential prior to the Democrat-led government shutdown.” She added: “Due to a recent court order, HHS is not currently taking actions to implement or administer the reduction-in-force notices.” According to the document reviewed by POLITICO, the National Institutes of Health was to take the hardest hit among HHS agencies, 4,545 layoffs, or roughly a quarter of its workforce. It ended up firing no one. A federal judge in San Francisco blocked the firing of 362 of the 954 HHS employees who did receive the October layoff notices. More will be shielded after additional federal employee unions joined the lawsuit on Wednesday. In congressional testimony earlier this year, Health Secretary Robert F. Kennedy Jr. said he had downsized his department’s staff to 62,000 from 82,000 when he took office. He’s nowhere close. An HHS contingency plan produced in advance of the shutdown said the department still employed 79,717. Employees who took a Sept. 30 buyout offer from Musk would bring that lower, though the number who did is unknown because the White House has not released agency-by-agency totals and has stopped publishing agency employment updates. It’s unclear who within the Trump administration came up with the initial plan for the shutdown layoffs. Hilliard did not respond to POLITICO’s question about who within HHS was responsible. Thomas Nagy, the HHS deputy assistant secretary for human resources, has been the one updating the judge, Susan Illston of the U.S. District Court for the Northern District of California, about the layoffs. The experience of the fired 954, whose last work day is scheduled for early December, mirrors the chaos of DOGE’s spring layoffs, in which employees were left wondering whether they still had jobs amidst lawsuits and officials were forced to backtrack and rehire fired workers. In one such instance, Kennedy told a House panel in June that he had appealed directly to Vought to make sure Head Start funding was protected after the early education and health care program was left out of the president’s budget proposal. In another case, HHS fired and then rehired an award-winning Parkinson’s researcher. Kennedy also told senators that he brought back hundreds of staffers at the National Institute for Occupational Safety and Health. That came after West Virginia Republican Sen. Shelley Moore Capito and others protested. Now many HHS employees are having déjà vu. The situation is reminiscent of the experience some former employees of the U.S. Agency for International Development had during the Trump administration dismantling of the foreign aid agency early this year. Some furloughed employees at HHS, for example, didn’t have access to their work emails to receive notices informing them they were laid off this month. “There were individuals who didn’t even know if they were in RIF status until they got the hard copy packet in the mail two days ago,” a laid-off employee at the Centers for Disease Control and Prevention said, using the acronym for “reduction-in-force.” A similar situation played out at HHS’ Office of Population Affairs, where nearly all of the roughly 50 employees were laid off two weeks ago, according to one person with knowledge of the situation speaking anonymously for fear of retribution. The office, which is congressionally mandated, manages hundreds of millions of dollars in funding for family planning and teen pregnancy prevention programs. Three fired employees from the Substance Abuse and Mental Health Services Administration — granted anonymity to provide details about the firings without fear of retribution — said that many of the roughly 170 employees cut from the agency earlier this month are getting physical copies of their termination notices mailed to them because they’re shut out of their email accounts. “DOGE never really left, it just looks different now,” one of the SAMHSA employees said. Amanda Friedman and Sophie Gardner contributed reporting. Tim Röhn is a global reporter at Axel Springer and head of investigations for WELT, POLITICO Germany and Business Insider Germany.

In an AI-first era, where AI is becoming an integral part of everything we do, its applications spanning across different sectors and facilitating various parts of our daily routines, healthcare should be no exception. In an ideal world, this is what healthcare should look like: a patient goes to an app to book an appointment, AI directs them to the doctor with the best expertise, knows which equipment is available, and which location makes most sense, and puts the appointment in their respective diaries. The complexity with healthcare is that this isn’t just a system, but three interconnected worlds that must work together seamlessly. Patients rightly want care when and where they need it. Clinicians want to ensure their expert resource is directed as impactfully and efficiently as possible. And medical assets, from MRI scanners to life-saving medications, must be available when and where required. This is where investing in technology becomes key. The good news is that the AI revolution in healthcare is already beginning, and the early results are encouraging. Some GP practices have cut waiting times by 73 percent using smart triaging systems, reducing waits from 11 to three days. AI can help tackle the dreaded ‘8am rush’ when phone lines jam with appointment requests. In the same study, GP practices using these systems reduced phone-based contacts from 88 percent to 18 percent and saw a 30 percent drop in missed appointments — potentially saving £350 million annually from reduced non-attendance. Through ServiceNow’s work with NHS Trusts, we’ve identified five areas where change can make an immediate difference, as outlined in ServiceNow’s NHS Digital Transformation white paper: * improving the staff experience; * joining up corporate services; * protecting against cyber threats; * streamlining patient journeys; and * harnessing AI. The reward for getting this right? We could see £35 billion in productivity savings by 2030. That’s money that could be reinvested directly into patient care. Better staff systems could save £750 million annually — not through cuts, but by giving critical NHS workers back the 29 million hours currently lost to bureaucracy. Right now, it takes up to 120 days to get a new NHS employee properly started. In some trusts we have cut that to 25-40 days. Imagine the impact if this was rolled out across the whole NHS. When you’re trying to grow the workforce from 1.5 to 2.4 million people by 2036, every day matters. Joining up corporate services could save another £1.6 billion each year. This is especially urgent given that Integrated Care Systems are facing combined deficits and have been told to slash running costs by 50 percent. The NHS 10 Year Health Plan for England talks about rebuilding the NHS in working-class communities; areas that currently get 10 percent less funding per person. Digital transformation isn’t just about efficiency; it’s about equity. When systems work properly, everyone benefits, but the biggest gains go to those who currently struggle most to access care. The problem is these parts barely speak to each other. The white paper reveals just how costly this disconnection has become: 13.5 million hours wasted annually due to inadequate IT, a 7.5 million case waiting list, and nearly £3 billion spent each year compensating for care failures. Behind every statistic is a person. Someone facing a delayed diagnosis, a cancelled operation or simply not receiving the care they deserve. This fragmentation isn’t just inefficient, it has a direct effect on patients and clinicians too. We’re spending £15.5 billion annually, 6.5 percent of the entire NHS budget, on corporate services that don’t talk to each other. Nurses are spending over a quarter of their time on paperwork instead of caring for patients. GP practices are drowning in 240 million calls annually from frustrated patients who can’t get through. We have a patchwork of systems where crucial information gets lost in translation.  When it takes 20 separate manual processes just to say goodbye to a leaving employee, you know there’s room for improvement. In addition to internal challenges, there’s the cyber threat affecting the NHS. Healthcare cyberattacks doubled between 2022 and 2023. A single ransomware attack forced over 10,000 patients to have their appointments cancelled at just two trusts. Without proper digital defenses and monitoring, we’re one attack away from regional healthcare paralysis. But here’s the thing, AI is only as good as the systems it connects to. That’s where we need to be honest about the infrastructure challenge. You can’t build tomorrow’s healthcare on yesterday’s technology. We need systems that talk to each other, share information securely and put the right information in the right hands at the right moment. The truth is, the NHS can’t do this transformation alone. The scale is too big, the timeline too tight and the technical challenges too complex. It’s about partnership — because the best outcomes happen when public sector insight combines with private sector innovation and speed. We need genuine partnerships focused on outcomes, not just products. At ServiceNow, we’ve seen what’s possible when this approach works: connected systems, freed-up time and better patient experiences. We’re at a crossroads, and the path we choose in the next two to three years will determine the NHS our children inherit. We can keep tinkering around the edges, managing decline through small improvements or we can be bold and build the digital foundation that healthcare needs. This isn’t a distant dream; it’s an immediate opportunity. Patients have waited long enough. NHS staff have endured enough frustration with systems that make their jobs harder, not easier. The cost of inaction isn’t just measured in pounds, it’s measured in lives. The technology exists, the knowledge is there and the legal framework is in place. What we need now is to act on what we already know works for this transformation to happen.

Donald Trump this spring dubbed himself the “fertilization president.” But some conservative family policy advocates say he’s done little so far to publicly back that up and are pushing to get the White House in the remaining months of the year to prioritize family policy — and help Americans make more babies. A top priority is a pronatalist or family policy summit that spotlights the U.S.’s declining fertility rate. Other asks, which typically run through the White House’s Domestic Policy Council, include loosening regulations on day cares and child car seats, further increasing the child tax credit and requiring insurers to cover birth as well as pre- and post-natal care at no out-of-pocket cost. While the Trump administration has advanced a handful of policies explicitly billed as “pro-family,” some conservative advocates are dismayed that the president has not done more on one of his campaign’s most animating issues. The lack of movement threatens to dampen enthusiasm among parts of the Republican Party’s big tent coalition, including New Right populists, who worry about the erosion of the U.S. workforce, and techno-natalists, who advocate using reproductive technology to boost population growth, as the GOP stares down a challenging midterm election. “I think there are people, including the [vice president] and people in the White House, who really want to push pro-family stuff,” said Tim Carney, a senior fellow at the American Enterprise Institute who recently wrote “Family Unfriendly,” a book that has become popular in conservative circles. But “it hasn’t risen to the forefront of the actual decision-making tree in the White House, the people who can put some velocity on things.” “It’s all nascent,” Carney added, but “it is going to be something that Republicans want to talk about in the midterms.” White House aides acknowledge advocates’ restlessness, but argue that even as it has yet to take action on the suite of explicitly pro-family proposals advocates want, they have taken a whole-of-government approach to family policy. Privately, the White House is deliberating its next moves now that the GOP’s tax and policy bill passed. It’s taking a two-pronged approach: addressing financial pressures and infertility issues that prevent people from having children; and helping couples raise kids in alignment with their values. That latter bucket includes bolstering school choice and parental rights, promoting kin- and faith-based child care, and other actions that can help with the costs of raising children, including health care and housing. “You saw what we were able to accomplish in 200 days. It was a lot. Just wait for the next three-and-a-half years,” said a White House official, who was granted anonymity to discuss internal strategy. “There’s a lot of opportunity to accomplish a lot through pure administrative action, through the bully pulpit and, of course, if we need to, through working with Congress.” The official couldn’t rule out a family policy event hosted by the White House in the future. “Look, the president loves to convene stakeholders and thought leaders and policy leaders,” the official added. While they understand the White House has had its attention fixed on other issues, like foreign policy, immigration, and trade, pronatalists are anxious for the administration to do something about the declining birth rate. They see it as, quite literally, an existential crisis. “Demographic collapse has become the global warming of the New Right,” said Malcolm Collins, who along with his wife Simone, are two of the most outspoken techno-natalists and have pitched the White House on several policies. “And this is true, not just for me, but for many individuals within the administration, and many individuals within the think tanks that are informing the administration.” The Trump administration has advanced a handful of policies that conservatives argue will support families and, they hope, encourage people to have children. The president’s so-called One Big Beautiful Bill made permanent the child tax credit first passed as part of Trump’s first-term Tax Cuts and Jobs Act, increased the rate and adjusted it for inflation on an ongoing basis. The legislation also established a one-time $1,000 so-called baby bonus for children born in 2025 through 2028. Transportation Secretary Sean Duffy instructed his agency to give preference in competitive grants to communities with higher-than-average birth and marriage rates. Critics of the administration note that the megalaw will make it harder for people to keep their Medicaid insurance, the president’s proposed 2026 budget eliminates childcare subsidies for parents in college, and Trump’s CDC eliminated a research team responsible for collecting national data on IVF success rates. But family policy advocates say on the whole they see progress, though not nearly enough to reverse the trend of declining birth rates. “From my conversations with folks in the administration, there is definitely interest in doing something visible on the family stuff. They feel like they’re going down the list — homelessness, crime, obviously immigration — of different things and families’ time will come,” said Patrick Brown, a fellow at the conservative Ethics and Public Policy Center who focuses on family policy. The U.S. birth rate has been declining since the Baby Boom ended in the early 1960s, falling from 3.65 births per woman in 1960 to 1.599 in 2024, according to the CDC’s National Center for Health Statistics. There are similar trends across high-income nations, in part the result of easier access to contraception, changing societal values favoring careers over having children and high costs of living. The issue came to the fore during the campaign when Trump promised government-funded in vitro fertilization in an effort to allay concerns over his anti-abortion stance. A few months later, then-Sen. JD Vance doubled down on controversial comments about the country being run by “a bunch of childless cat ladies” and argued for more babies in the U.S. Elon Musk, perhaps the most prominent pronatalist, was Trump’s biggest financial booster during the campaign and a key adviser in the early days of the administration. There is no agreed-upon solution to the problem of a declining birth rate. Hungary is held up as a model by pronatalists for its family friendly policies but its birth rate remains low, despite exempting women with four or more children from paying income tax, among other incentives. The birth rate also remains low in Nordic countries like Sweden, Norway and Finland that have generous paid parental leave and heavily subsidized childcare. Still, advocates in the U.S. have a list for the Trump administration they believe will make a difference, arguing that even if they fail to increase the birth rate, they would support families. Some policies that pronatalists hope the Trump administration will pursue are more typically associated with the left, such as expanding child tax credits, which Trump did in the GOP megalaw, and reducing the costs of child care. But others have a home in the libertarian wing of the GOP, such as cutting regulations on day care and curbing car seat rules. Some of these proposals, pronatalists acknowledge, come with more risk but would overall result in more births. For decades, social conservatives led the GOP’s charge on families, arguing in support of policies that promote two-parent, heterosexual families. But declining birth rates, coupled with a broadening of the GOP coalition, has broadened the lens to focus on increasing the birth rate, a new pronatalist tinge. In an effort to keep their nascent and fragile coalition unified, neither social conservatives nor the techno-natalists are pushing policies at the extremes — like banning IVF or creating genetically modified super soldiers. That helps explain why the president has not taken action on one of his most concrete promises, making IVF free, despite receiving a report on it in May. A second White House official, granted anonymity to discuss internal deliberations, said expanding IVF access for families remains “a key priority,” but declined to offer specifics on the status of any policy moves. “This issue is a winner for the Republican Party, it’s a winner for women, it’s a pro-life issue,” said Kaylen Silverberg, a fertility doctor in Texas who has consulted with the White House on IVF. “This will result in more babies, period.” But social conservatives are morally opposed to IVF both because of a belief life begins at conception and because they don’t think that science should interfere with the natural act of procreation. The proposal would also be quite costly. Instead, they want the White House to support something called reproductive restorative medicine, which can include supplements and hormone therapy, that they say will help women naturally improve their fertility. “The point of President Trump’s campaign pledge was to help couples with infertility have children. There’s a way to do that that’s cheaper, faster, less painful and more preferable to couples,” said Katelyn Shelton, a visiting fellow at the Ethics and Public Policy Center’s Bioethics, Technology and Human Flourishing Program who worked at the Department of Health and Human Services during the first Trump administration. While most of the family policy conversation has been concentrated on the right, it’s also starting to grow on the left, alongside the so-called “abundance” movement focused on reducing government bureaucracy. Both the National Conservative Conference and the Abundance Conference this week in Washington hosted panels on family policy. Reducing barriers to building housing is “good for families,” said Leah Libresco Sargeant, a senior policy analyst at the Niskanen Center, a think tank that describes itself as supporting free markets and effective government, who co-moderated the Abundance Conference’s family policy panel. “That’s not kind of a family centered policy per se, [but] it’s a good policy that’s good for families.” Ultimately, many conservative family policy advocates argue there is only so much government can do to address what they see as a fundamentally cultural and religious problem. It’s a posture that the GOP’s historically small-government contingent takes as it pushes back on their new populist bedfellows. “I do not think that the problem of people not having enough kids is a problem of economics. I think that is very often a line that is used in order to promote a larger government populism,” said conservative commentator Ben Shapiro. “This is a predominantly religious problem, it’s a cultural problem.” Pronatalists have a lot of hope in the future of the GOP in part because of Vance, the administration’s most prominent and ideologically committed proponent of family policies, to carry the mantle, either during Trump’s presidency or as part of his own 2028 presidential bid. They love that Vance brings his children on official trips and is open about carving out time during the day to spend with them. “Our political leaders are inherently cultural leaders,” Carney said. “Bringing his kids with him to Europe and at the inauguration — where the little one, she was sucking on her fingers, so they had put Band-Aids on some of them so she wasn’t sucking all of them at once — all of those things that show a loving family and that kind of stuff, I think that can be culturally really productive.”

LONDON — Unions founded Britain’s governing Labour Party. But that doesn’t mean they’ll always have its back. A year into Keir Starmer’s government, union reps can point to some big wins, including a dedicated workers’ rights bill and the cooling of several pay disputes that had simmered under the previous Conservative government. Yet unions are still pressing Labour for more, and ministers are quickly discovering that a flurry of above-inflation pay hikes is not enough to satiate them. A Labour MP on the left of the party, granted anonymity to speak candidly, said relations between Labour and the unions were now “strained to a degree” because of the stagnant state of the British economy. “There’s a fairly widespread sense of unhappiness about the direction of the country, and that obviously reads on to the Labour Party,” they said of the current union mood. STRIKING A BARGAIN  Labour won the July 2024 elections by a landslide, running on a ticket of “change”. On labor relations, the need for a shift was obvious. Under the Conservatives, millions of working days were lost as train drivers, doctors and teachers all walked out over pay and terms, while the government, citing concerns about Britain’s shaky public finances, resisted. Labour wanted to show swift action — and a jolt to straining public services — by settling pay claims with numerous public sector workers who were demanding the restoration of their pay to historic levels. Teachers received a 5.5 percent pay award, train drivers were handed a 15 percent multi-year uplift, and resident doctors got a 22.3 percent rise over two years on average. “It was an important signal of intent from the government,” reflects Trades Union Congress General Secretary Paul Nowak. His body represents 48 affiliated unions and roughly 5.5 million workers. “It was good for our members, but more importantly, it was good for public services and the people that rely on them.” A much-hyped Employment Rights Bill is also going through parliament. It promises to end some of the more insecure forms of work, ban “fire and rehire” schemes, and grant workers the right to challenge unfair dismissal from the day they start employment. Unions have welcomed involvement with the legislation, although some critics remain. The Labour MP cited above said the bill was far from perfect: “It doesn’t really deal with the collective rights which workers need to protect themselves fully.” TIGHTEN THE PURSE STRINGS  Union reps say that Labour has been much better at communicating with unions than its predecessors, although they argue this was a low bar to clear. “It’s been night and day in comparison to our relationship with the previous Conservative governments,” says Nowak. “This is clearly a government that actually sees a positive role for unions in a modern economy and sees us as part of the solution.”  Yet consulting is not the same as acting, and last year’s pay settlements may have already set a precedent. Chancellor Rachel Reeves’ tight fiscal rules mean this is an expectation the government is unlikely to meet. “We know how tight the fiscal position is, but we also know we’ve got a crisis in our public services that have been underfunded,” argues Nowak, who points to problems in recruiting and retaining staff. Britain has a series of independent pay review bodies tasked with examining the economic picture and recommending salary hikes for many public sector workers. Still, it is ministers who ultimately decide who receives the increases. This year, the body for resident doctors recommended a far more modest 5.4 percent increase for 2025-2026. Health Secretary Wes Streeting backed that call — and faced an immediate backlash. The British Medical Association, which represents doctors, branded the hike inadequate as it did not restore real-terms pay to 2008 levels. They’re already balloting members for strike action that could last at least six months, at a time when the government doesn’t need the headache. “The bedside manner is much better, but the NHS is still really sick,” says Emma Runswick, deputy chair of council at the BMA. “We have an NHS which is hemorrhaging staff because it’s eroded their pay so badly and it treats them so poorly.” Streeting, who is expected to unveil a 10-year reform plan for the publicly funded National Health Service this week, is urging doctors not to strike and instead to “work with the government.” But unions shouldn’t expect much. Although the health secretary says his door is open, Streeting has stressed there are no further funds for pay increases. “If you’re going to base yourself as the party who founded the NHS … where’s the action to back that up?” Runswick asks. A summer of strikes could make the growth Reeves desperately covets even harder to achieve. | Andy Rain/EPA-EFE For Labour MPs with a union background, this kind of punchy approach isn’t too surprising. “I don’t think that kind of rhetoric is uncommon in the trade union movement,” says Labour MP Steve Witherden, a former teacher who remains in a teaching union. “They’re obviously setting themselves up for a negotiating position.” “Even a trade union leader [who] might want to be able to be favorable to the Labour government … will be feeling the breath of their members down their necks,” says the Labour MP quoted at the top of this article. The Labour government, by standing firm against union demands, is betting that public opinion has shifted since past disputes. A YouGov poll of 4,100 adults in May found that 48 percent somewhat or strongly opposed resident doctors striking, compared to 39 percent somewhat or strongly supporting them. That’s a fall in support since a comparable YouGov poll was conducted last year. “If it’s a profession they admire and like and think makes a significant contribution, they tend to be favorable toward strike action,” says YouGov’s Head of European Political and Social Research Anthony Wells. But he adds: “While people hugely value doctors, doctors are also already seen as being relatively well paid, so they get far less support for strikes than nurses do.” “There’s an awful lot more that needs to be done,” said left-wing Labour MP Ian Lavery, a former National Union of Mineworkers president, regarding union discontent. “They’ve got to get their heads together.” It’s not just healthcare staff getting antsy. Refuse workers in the city of Birmingham have been on strike for over 100 days due to pay disputes, and the Unite union recently extended that strike mandate until December. National Education Union members also rejected the government’s 2.8 percent pay offer for teachers and leaders in April, with 83.4 percent of respondents saying they would be willing to take strike action. Labour is also treading a fine line with its workers’ rights package, as firms that are already smarting from increased taxes warn the bill’s measures could further dent the government’s growth agenda. The opposition Tories have promised to scrap the package if they return to power in the next election. SUMMER OF DISCONTENT? A summer of strikes could make the growth Reeves desperately covets even harder to achieve — and draw unfavorable historical comparisons. In the 1970s, Labour was effectively toppled for a generation by what became known as the “Winter of Discontent.” Garbage piled up on the streets, bodies weren’t buried, and health, rail and haulage workers made their anger known.  To avert a similar fate, some in the party say keeping unions on side is essential. “The most important thing about relations is that you always keep those channels of dialogue open,” Witherden argues. Garbage workers in Birmingham have been on strike for over 100 days due to pay disputes. | Andy Rain/EPA-EFE Nowak, who has been publicly supportive of much of the government’s agenda, argues that sorting out pay won’t be enough, particularly in the public sector. “There needs to be a longer-term, more strategic discussion … about what’s the future of the public sector workforce” on issues like flexible working and artificial intelligence, he says. “That’s the missing piece of the jigsaw for me.”  However, for a government already struggling to put out multiple fires, keeping the unions sweet will be easier said than done. “The fiscal framework which the government’s working to is incredibly tight,” said the anonymous Labour MP. “It’s difficult to see how they’re going to fund further pay rises that can meet people’s expectations.”

EUROPE’S FRONTIER COUNTRIES READY THEIR HOSPITALS FOR WAR From stockpiling trauma kits for mass casualties to kitting out medics with body armor, wartime health planning is no longer hypothetical on NATO’s eastern flank. By GIEDRĖ PESECKYTĖ Illustration by Wayne Brezinka for POLITICO Speeding along Fabriko Street in an ambulance toward Lietavos school, Martyna Veronika Noreikaitė felt unprepared. She could feel her heart pounding. It was a sunny Tuesday morning in mid-May when Noreikaitė was radioed about an explosion in Jonava, a city of 30,000 people in central Lithuania. In her three years as a paramedic, her calls would, on a normal day, involve high blood pressure or chest pains. This was Noreikaitė’s first mass casualty event. As they pulled up to the school, sirens wailing, the building was obscured by smoke. “People were running around, lying on the ground, screaming,” Noreikaitė said, recalling the chaos at the school’s stadium. Police, firefighters and military personnel were already on site. Noreikaitė and her colleague were the first paramedics to arrive.“When you see what happened — the panic, the screams — you don’t know what to do, or where to go. You forget everything. It throws you off balance.” The novelty of such a disaster in a peaceful European state was precisely why the Lithuanian authorities had set up the two-day “Iron Wolf” (“Geležinis Vilkas”) military exercises. The goal was to steel the military, police, firefighters, hospitals and paramedics to operate under exceptional circumstances — as Lithuania braces for the worst-case scenario: an attack on NATO’s eastern flank. Since Russia’s full-scale invasion of Ukraine, the threat of military conflict has loomed large. “When the media reported the war had started in Ukraine, it was terrifying,” Noreikaitė said. “It was frightening at work because we didn’t know if we had enough resources or if we were prepared if it happened here.”  Noreikaitė now feels calmer. She focuses on training and mastering triage protocols. Exercises, like the one in Jonava, help. Indeed, she believes they “should happen more often.” Lithuania is no outlier: All NATO’s eastern flank countries are revisiting crisis response protocols for health-care facilities, organizing training exercises, investing in ballistic helmets and vests, and shifting operating theaters underground. Since the conflict in Ukraine has shattered the illusion that Europe is safe from war. “It’s not a question of if [Russia] will attack,” said Ragnar Vaiknemets, deputy director general of the Estonian Health Board, which oversees preparedness for crises from pandemics to war. “It’s a question about when.” Ukrainian medical personnel transport a wounded soldier to a medical evacuation (Medevac) airplane, in Rzeszow, Poland. | Petter Bernsten/AFP via Getty Images Formerly under Soviet occupation, the countries on Europe’s eastern frontier know only too well how quickly troops can arrive. “We have bad neighbors here: Russia and Belarus,” Daniel Naumovas, Lithuania’s deputy health minister, said at an event in February. His country links NATO to the Baltics via the Suwałki Gap — a narrow, vulnerable corridor seen as one of the likeliest targets of a future Russian attack. While all EU countries are “in the same boat,” some are in the vanguard “where the water is cold,” Naumovas said. “Water is splashing on our face; water of war.” For countries on NATO’s east, war readiness isn’t optional — it’s urgent. “Few EU countries are frontline countries,” said Katarzyna Kacperczyk, undersecretary of state at Poland’s health ministry. “For them the issue is more pertinent.”  Poland has elevated the issue of health security during times of conflict throughout its rotating presidency of the Council of the EU, where Europe’s security has been the central theme. “We cannot prepare a contingency or strategic plan for the military sector or economic sector or energy sector, and exclude the health sector,” Kacperczyk said.  HOSPITALS UNDER FIRE Russia’s invasion of Ukraine has shown that modern conflicts no longer spare health services — or the civilians they serve. Eastern European countries are taking note. Located just 50 kilometers from the EU’s external border with Belarus, Vilnius University Hospital Santaros Clinics is developing underground infrastructure, shelters, helicopter landing sites and autonomous systems that would allow it to function even if electricity or water supplies were cut off. Santaros is not unusual. In Estonia, in addition to body armor for ambulance crews, satellite phones would be distributed to maintain communications if traditional networks fail. Plans are even in place to generate an independent internet network if necessary. European countries average 11.5 intensive care beds per 100,000 population. | Omar Marques/Getty Images Electrical generators are being installed across the health-care system, following Ukraine’s experience with Russian strikes that routinely cut off civilian power. “We know for certain that Russia targets the civilian infrastructure and energy structures, and that means that you cannot have these kinds of situations where the hospital doesn’t work because there are some power plant problems,” Vaiknemets said. Many hospitals in Eastern Europe — relics of the Soviet era — are particularly vulnerable. “We have high buildings, we have large buildings. They are in one complex, one area,” Vaiknemets said. Hospitals are now looking at how to repurpose basements to be operating theaters in case of need. “I can’t imagine working on a top level … of the hospital just waiting to get hit,” he said.  Estonia is procuring mobile medical units — pop-up treatment facilities deployable in emergencies — which should help address the currently limited critical care capacity in Europe. While European countries average 11.5 intensive care beds per 100,000 population, “wartime needs could require three to five times this capacity,” said Bjørn Guldvog, special adviser at the Norwegian Directorate of Health, at a health security event in April. Sustaining a high volume of operations for weeks or months would also be challenging: “Most facilities can sustain maybe 120-150 percent of normal surgical volume for 24 to 48 hours,” he said. Blood and oxygen supplies would also become critical. STOCKPILES AND SUPPLY CHAINS Even the best-prepared hospitals can’t function without medicines, supplies and equipment, and the Baltic countries are stocking up in preparation for mass casualties. Estonia, for example, has allocated €25 million for mass casualty supplies, including orthopedic gear, tourniquets and trauma kits — “the only heavy investment we have made,” Health Minister Riina Sikkut said at an event in February. Stockpiles would ensure that hospitals can run until supplies from allies reach them, Vaiknemets said, adding that NATO is crucial to securing supply routes.  In Latvia, health-care institutions have been required since Covid-19 to maintain a three-month supply of medicines. “I have never thought that I would say thanks to Covid, but thanks to Covid … we found financial resources,” said Agnese Vaļuliene, health ministry state secretary. The country is also working on national stockpiles. But the Baltics are too close to the front lines to keep emergency supplies safe, said Jos Joosten, a medical adviser at the European External Action Service, the EU’s diplomatic corps. As a result, other EU countries must “identify the things that are scarce, that are very difficult to organize, specifically for the small nations,” Joosten said. “And then we should give [up] some sovereignty, give it to the European Union to make decisions” on distributing what is needed. Stockpiles from the Red Cross, national reserves and rescEU, the EU’s emergency service, must all be ready to reach the front line — and civilian patients. “We have to have good crisis plans,” Sikkut said. STAFFING THE WAR EFFORT War readiness goes beyond policy — it needs people. Workforce shortages are a fundamental challenge for the Baltics, where day-to-day health staff are already stretched thin. Estonia, with a population of 1.3 million, has nearly half the health-care workforce per capita of Germany.  A Lithuanian survey found that over a quarter of health workers would likely flee during war, while fewer than 40 percent would stay and a third were unsure. | Mykhailov Dmytro/Global Images Ukraine via Getty Images As a result, patients “from the front lines” cannot expect the same care they would receive in times of peace, Vaiknemets said, which is “the main and underlying principle of our crisis-measure planning.”  But there’s another problem: Not everyone is prepared to stay. When Russia invaded Ukraine, Noreikaitė, like all paramedics, had to sign a declaration saying if war broke out in Lithuania she would stay on and work. “But how it would really be — who would come and who wouldn’t — I don’t know. Personally, I don’t have children or a family yet, so I think I would stay,” she said.  A Lithuanian survey found that over a quarter of health workers would likely flee during war, while fewer than 40 percent would stay and a third were unsure. Estonia anticipates similar patterns: “There are patriots, the first responders, the people that we know without question will stay,” Vaiknemets said. “Of course, there are naysayers that talk about going to Spain straight away.” He said around 50 percent to 60 percent of the population don’t yet know how they would respond. While he’s confident that most doctors and nurses would remain, Estonia’s authorities are working to ease concerns, especially about family safety. “It is very human: If I don’t feel safe, if I don’t have the confidence that my family is safe, I will not do it,” Vaiknemets said. In Latvia, pulmonologist Rūdolfs Vilde said some doctors he spoke to were considering fleeing if war breaks out — especially parents who “don’t see how it would be suitable for them to ditch the children somewhere and be in the hospital in times of military crisis,” he said.  Just a week before the interview, Vilde and his colleagues at Pauls Stradiņš Clinical University Hospital were also asked to sign a document acknowledging they are critical personnel required to report to work if sirens sound.    Vilde himself plans to stay but stressed that he needs more information to feel confident should the worst happen.  “Should I be prepared … to provide some kind of military medicine, or should I be just prepared to come into my regular work and just have a bigger flow of patients?” Vilde asked. “Because those are two very different things and probably both of them would have to function during the wartime.” And Vilde doesn’t mind spending extra hours on top of his doctors’ job for training “because … I see this as a way to keep things the way they are.” A Ukrainian soldier being evacuated to Poland. | Petter Bernsten/AFP via Getty Images “If I want to be able to do my pulmonology job and maybe to try to develop things in Latvia, then there should be Latvian existence, right?” His hospital in Riga has also begun war-training sessions, Vilde said. Other hospitals and countries have begun ramping up war-readiness drills, too. Estonia is reinforcing its system-wide training. Hospitals, ambulance crews and health workers are instructed on how to switch to “crisis mode,” in which they must deal with large influxes of patients and treat wartime injuries — including blast wounds, gunshot trauma, burns, amputations and spinal or head injuries — that are rare in civilian settings. At Lithuania’s Vilnius University Hospital, “evacuation drills and preparedness exercises for receiving a large number of casualties are conducted for hospital staff” alongside the Lithuanian Armed Forces and Riflemen’s Union, hospital chief Tomas Jovaiša said. This year alone, Lithuania is planning seven exercises with the army and over 10 civil-security drills for medical professionals, according to health ministry spokesperson Julijanas Gališanskis. Lithuania is also forming an emergency medical team, and junior doctors last month hosted a forum dedicated to wartime health-care readiness. Some medics travel to Ukraine to learn firsthand how hospitals deal with missile strikes, mass casualties and power outages.  Vaiva Jankienė, a nurse and coordinator at Blue/Yellow Medical, which provides medical care to civilians close to Ukraine’s front line with Russia, has volunteered over 20 times in Ukraine since April 2022 — including in the atrocity-stricken town of Bucha shortly after its liberation. She said the best way to prepare health-care specialists is by volunteering in Ukraine.  She described the scale of injuries and illnesses in Ukraine as “difficult to comprehend” — many wounds are unlike anything seen before, owing to new wartime tactics. “After the drone attacks, the consequences are hard to imagine,” Jankienė said. “Injuries like these,” she sighed, “every single medical professional who saw them said the same thing: We couldn’t have imagined it would look like this.” While a trauma doctor in Lithuania might perform one amputation a year, in Ukraine, entire hospital wards are filled with patients suffering amputations of one, two, three, or even four limbs — plus a range of other severe injuries. “We have very little experience treating such complex, multiple traumas,” she said.  THE REFUGEE SURGE RISK The impact of war wouldn’t stop at national borders. Because of the use of advanced weaponry in Ukraine — including long-range missiles and military drones — the front line is no longer a fixed boundary. Attacks can now reach targets hundreds of kilometers away, endangering hospitals and civilian infrastructure far from combat zones and making evacuation plans essential.  Illustration by Wayne Brezinka for POLITICO As a result, countries further from the front lines must prepare to receive patients and refugees, Joosten said, warning that EU solidarity will be tested. “If Lithuania is overrun, who’s responsible for Lithuanians, because there’s no Lithuania anymore? But the European Union is (still there),” he said.  Joosten urged EU institutions to create funds to handle civilian and military casualties, as well as displaced populations. He added that casualties could be dramatically higher than in Ukraine. “Those 4,000 patients we moved away from Ukraine, that’s nothing, 4,000 in three years,” he said. “Let’s talk about 4,000 in two weeks, and then the next two weeks again, and the next two weeks … the numbers are so different when the real war starts.” No one knows when — or if — war will come. But as Vaiknemets put it: “Crisis never shouts when it’s coming.” That’s why the Poles and the Baltics “have to prepare for the worst,” Vaļuliene said. “But we hope it will not come.”

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.

BRUSSELS — The European Parliament is bracing for cuts within the institution’s sprawling communications department as some staffers now fear their jobs are in danger. The Parliament has for years contained one of the biggest communications departments in Brussels, essentially acting as the body’s in-house public relations agency. But the years of abundance — and an annual budget that reached €127 million in 2025 — appear to be coming to an end as the institution reallocates resources to focus on what Parliament leaders perceive as their central mission: legislating and democratic oversight. “It is known they want to cut. That is a fact,” said one Parliament official, who, like others in this story, spoke on condition of anonymity to freely discuss internal matters. “There are people scared for their jobs.” Alessandro Chiocchetti, the Parliament’s secretary-general, a powerful post overseeing the institution’s expansive bureaucracy, has vowed to reallocate the institution’s resources to what he considers core parliamentary work since beginning his mandate in 2023. One of his measures has been to create four new departments to help MEPs draft legislation, requiring new personnel and resources. But because the Parliament’s annual budget of around €2 billion, despite adjustments for inflation, is fixed, other departments need to be trimmed in order to find the funds. Delphine Colard, a Parliament spokesperson, confirmed to POLITICO that Director General for Communication Christian Mangold is working with Chiocchetti to “review” his department’s activities. With a plan to restructure the communications department expected to come by the summer recess, many staff members say they are unnerved by the uncertainty. “The process is not transparent,” said a second Parliament staffer, speaking to POLITICO. Another said the situation has caused “a morale issue” in the department’s ranks. The directorate general for communications had 761 staff members in 2022, according to data from its annual report. “They’re looking at the overall numbers and they’re saying, oh, it’s a big directorate general, so it needs to be trimmed,” said one of the officials, referring to the communications department. Another official, however, cautioned the restructuring will likely not be a “major reform” but rather a “readjustment” of resources. WHAT’S ON THE CHOPPING BLOCK The Parliament’s leadership intends to gradually reassign existing staff members to jobs in other departments or to reallocate posts after employees retire. Less clear is what happens with subcontracted temporary positions — so-called externals — who often work in areas such as audiovisual services, website maintenance and event organization. Specifically, the administration is considering withdrawing funding for events such as the Brussels 20-kilometer race. | Dursun Aydemir/Anadolu via Getty Images At first, senior leadership planned to discontinue up to 50 percent of external contracts, according to the minutes of an internal meeting seen by POLITICO. But those cuts are likely to be less drastic, according to one of the three officials. (Colard refused to provide the number of externals currently employed in the communications department.) Overall, the Parliament’s outreach and campaign activities are likely to be most affected. Specifically, the administration is considering withdrawing funding for events such as the Brussels 20-kilometer race, grants for organizations at the regional and local level, and art exhibitions, according to a draft plan seen by POLITICO. It may also slash part of its budget for awards, according to the three Parliament officials, including the LUX Audience Award for films, the European Citizen’s Prize and the European Charlemagne Youth Prize for youth projects promoting democracy. The Europa Experience initiative, a project to establish EU-themed spaces across all 27 member countries, has already suffered cuts because of soaring costs and lackluster visitor numbers. The uncertainty has caused some staffers to look elsewhere to build their careers, especially in the newly created legislative directorates, according to two of the officials POLITICO spoke to. “The feeling now is that the future is in the new directorates if you want to grow professionally,” one of them said.