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

Today, as the world reaches a critical juncture in the fight against HIV/AIDS, tuberculosis (TB) and malaria, the EU must choose: match scientific breakthroughs with political will and investment or retreat, putting two decades of hard-won progress at risk. Having saved over 70 million lives, the Global Fund to Fight AIDS, Tuberculosis, and Malaria (the Global Fund) has proven what smart, sustained investment can achieve.  But the impact of its work — the lives protected, the life expectancy prolonged, the systems strengthened, the innovations deployed — is now under threat due to declining international funding.  > The real question is no longer whether the EU can afford to invest in the > Global Fund, but whether it can afford to let these hard-won gains unravel. The real question is no longer whether the EU can afford to invest in the Global Fund, but whether it can afford to let these hard-won gains unravel. Declining international funding, climate change, conflict and drug resistance are reversing decades of progress. HIV prevention is hampered by rising criminalization and attacks on key populations, with 1.3 million new infections in 2024 — far above targets. TB remains the deadliest infectious disease, worsened by spreading multidrug resistance, even in Europe. Malaria faces growing resistance to insecticides and drugs, as well as the impacts of extreme weather. Without urgent action and sustained investment, these threats could result in a dangerous resurgence of all three diseases. The stakes could not be higher  The Global Fund’s latest results reveal extraordinary progress. In 2024 alone: * 25.6 million people received lifesaving antiretroviral therapy, yet 630,000 still died of AIDS-related causes; * 7.4 million people were treated for TB, with innovations like AI-powered diagnostics reaching frontline workers in Ukraine; and * malaria deaths, primarily among African children under five, have been halved over two decades, with 2.2 billion mosquito nets distributed and ten countries eliminating malaria since 2020. Yet one child still dies every minute from this treatable disease.  What makes this moment unprecedented is not just the scale of the challenge, but the scale of the opportunity. Thanks to extraordinary scientific breakthroughs, we now have the tools to turn the tide:  * lenacapavir, a long-acting antiretroviral, offers new hope for the possibility of HIV-free generations; * dual active ingredient mosquito nets combine physical protection with intelligent vector control, transforming malaria prevention; and  * AI-driven TB screening and diagnostics are revolutionizing early detection and treatment, even in the most fragile settings. Some of these breakthroughs reflect Europe’s continued research and development and the private sector’s leadership in global health. BASF’s dual-active-ingredient mosquito nets, recently distributed by the millions in Nigeria, are redefining malaria prevention by combining physical protection with intelligent vector control. Delft Imaging’s ultra-portable digital X-ray devices are enabling TB screening in remote and fragile settings, while Siemens Healthineers is helping deploy cutting-edge AI software to support TB triage and diagnosis.  But they must be deployed widely and equitably to reach those who need them most. That is precisely what the Global Fund enables: equitable access to cutting-edge solutions, delivered through community-led systems that reach those most often left behind. A defining moment for EU Leadership The EU has a unique chance to turn this crisis into an opportunity. The upcoming G20 summit and the Global Fund’s replenishment are pivotal moments.  President Ursula von der Leyen and Commissioner Síkela can send a clear, unequivocal signal: Europe will not stop at “almost”. It will lead until the world is free of AIDS, tuberculosis and malaria.  The Global Fund is a unique partnership that combines financial resources with technical expertise, community engagement and inclusive governance. It reaches those often left behind — those criminalized, marginalized or excluded from health systems.  > Even in Ukraine, amid the devastation of war, the Global Fund partnership has > ensured continuity of HIV and TB services — proof that smart investments > deliver impact, even in crisis. Its model of country ownership and transparency aligns with Africa’s agenda for health sovereignty and with the EU’s commitment to equity and human rights. Even in Ukraine, amid the devastation of war, the Global Fund partnership has ensured continuity of HIV and TB services — proof that smart investments deliver impact, even in crisis. The cost of inaction Some may point to constraints in the Multiannual Financial Framework. But history shows that the EU has consistently stepped up, even in difficult fiscal times. The instruments exist. What’s needed now is leadership to use them. Failure to act would unravel decades of progress. Resurgent epidemics would claim lives, destabilize economies and undermine global health security. The cost of inaction far exceeds the price of investment. For the EU, the risks are strategic as well as moral. Stepping back now would erode the EU’s credibility as champion of human rights and global responsibility. It would send the wrong message, at precisely the wrong time.  Ukraine demonstrates what is at stake: with Global Fund support, millions continue to receive HIV and TB services despite war. Cutting funding now would risk lives not only in Africa and Asia, but also in Europe’s own neighborhood. A call to action Ultimately, this isn’t a question of affordability, but one of foresight. Can the EU afford for the Global Fund not to be fully financed? The answer, for us, is a resounding no. We therefore urge the European Commission to announce a bold, multi-year financial commitment to the Global Fund at the G20.  This pledge would reaffirm the EU’s values and inspire other Team Europe partners to follow suit. It would also support ongoing reforms to further enhance the Global Fund’s efficiency, transparency and inclusivity. > Ultimately, this isn’t a question of affordability, but one of foresight. Can > the EU afford for the Global Fund not to be fully financed? The answer, for > us, is a resounding no. This is more than a funding decision. It is a moment to define the kind of world we choose to build: one where preventable diseases no longer claim lives, where health equity is a reality and where solidarity triumphs over short-termism. Now is the time to reaffirm Europe’s leadership. To prove that when it comes to global health, we will never stop until the fight is won.

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.”

Global health leaders are urging the European Union to step up to protect lifesaving health programs amid what they see as a “moment of reckoning” after the United States and other countries cut foreign aid spending. The U.S.’s cuts to international development threaten the lives of millions of people and decades of progress in disease prevention and treatments, the leaders warned in interviews with POLITICO. They also said they worry these funding cuts present a worrying trend among some of the world’s richest — and traditionally most generous — countries. “There are huge uncertainties,” said Peter Sands, CEO of the Global Fund to Fight AIDS, Tuberculosis and Malaria. “And the huge uncertainty is not just about the U.S., but about what other partners, what other donors, are going to do. And I think it comes down to a question of political will.” Shortly after his January inauguration, U.S. President Donald Trump moved to dismantle the U.S. Agency for International Development (USAID), scrapping over 80 percent of its programs and slashing funding for numerous initiatives including those focused on HIV, tuberculosis and malaria prevention. The U.S. administration is also reviewing foreign aid with its “America First” policy, leaving many organizations that depend on federal financial support anxious about their future. The trend extends beyond the U.S. In February, the U.K. announced it will cut international development spending and instead boost its defense budget, while the Netherlands also said it is cutting foreign aid by €2.4 billion. Germany and France rolled back foreign aid budgets last year amounting to another €3 billion cut. In this uncertain political landscape, global health leaders want the EU to step up. “As some countries of the world backtrack from development assistance, it would be very important for the EU to signal — to Africa in particular — that development is still a priority and that the EU is a reliable partner,” said Sania Nishtar, CEO of Gavi, the Vaccine Alliance. As Europe increases its defense expenditure, Nishtar said she recognizes security is an important priority. “But health security is a very important aspect of the security paradigm,” she added. “Both for the European Commission itself and for the EU as a whole, there is a real opportunity to demonstrate leadership (in global health).” The Global Fund and Gavi both have replenishment rounds this year — and U.S. contributions can make a large difference to their operations. | Simon Maina/AFP via Getty Images The Commission didn’t immediately respond to a request for comment. Laurent Muschel, acting director general at the EU’s Health Emergency Preparedness and Response Authority (HERA), said at a recent event that the Commission is “committed to continue to support global health.” BRACING FOR IMPACT The Global Fund and Gavi both have replenishment rounds this year — and U.S. contributions can make a large difference to their operations. The U.S. has traditionally been The Global Fund’s largest donor, contributing $1.7 billion in 2024. The government also gave $300 million to Gavi in 2024, and former U.S. President Joe Biden made a five-year pledge of at least $1.58 billion last year. The potential impact of further foreign assistance cuts would be enormous. Gavi has vaccinated over 1.1 billion children over the past 25 years, saving nearly 19 million lives, according to its statistics. “Vaccination is one of the most cost-effective life-saving interventions on this planet,” Nishtar said. “Now more than ever, it’s very important that EU and countries in the EU step up and signal the importance of this life-saving intervention.” The Global Fund says it has contributed to cutting the combined death rate from AIDS, TB and malaria by 61 percent over the past two decades, saving 65 million lives. “We’re talking about disease programs that affect millions of people,” Sands said. There are roughly 25 million people on antiretroviral treatment in the countries where PEPFAR (the President’s Emergency Plan for AIDS Relief) and the Global Fund are investing, he said — “people whose health is potentially at risk from disruptions to programming.” These HIV funding cuts also come as the world has a “game changing opportunity” to bring forward the end of HIV as a public health threat, he added, thanks to the latest drugs. The World Health Organization (WHO) has already warned that the recent funding cuts will have a “devastating impact” on tuberculosis (TB) programs worldwide, given that the U.S. has historically been the largest donor. In some countries cuts are already causing severe disruptions, and the timing couldn’t be worse: The European region is experiencing a 10 percent surge in childhood TB cases. In malaria treatment and prevention, where progress had already stalled due to challenges such as climate change, drug resistance and ongoing conflicts, “now we run the risk that we go backwards,” Sands said. Health leaders are warning that these cuts will impact those living in the most vulnerable communities, including low- and middle-income countries and war zones. Andriy Klepikov, executive director of the Alliance for Public Health, one of the largest HIV- and TB-focused NGOs in Ukraine and Eastern Europe, said that rumors that the White House is considering shutting down the HIV prevention division of the Centers for Disease Control and Prevention (CDC) are “worrying.” The WHO has already warned that the recent funding cuts will have a “devastating impact” on tuberculosis programs worldwide. | Robert Hradil/Getty Images “It would be a disaster,” he told POLITICO. “We would be dealing with thousands of undiagnosed people, with all range of consequences, like spikes in HIV infections, but also health consequences and complications.” The alliance receives about one-third of its funding from the U.S. and its operations have already been disrupted, with USAID cuts threatening to halt one of their mobile clinics — delivering health care to people on the frontline and in rural areas. “We managed to find money but it’s a short-term solution,” Klepikov said.

Listen on * Spotify * Apple Music * Amazon Music Ekrem İmamoğlu, Istanbul’s mayor and the main political rival of Turkish President Recep Tayyip Erdoğan, has been arrested. So what is Europe doing about it? Staying pretty quiet, it seems. Mass protests are breaking out across Turkey but Brussels is keeping its counsel. In this episode Sarah Wheaton speaks with Aslı Aydıntaşbaş, a visiting fellow at the Brookings Institution and a former journalist in Turkey, about what’s really driving Erdoğan’s shift toward authoritarianism and how Europe is responding — especially with a view to Turkey’s growing importance for European security. But Europe’s focus isn’t all on defense. We also examine some of the EU’s overlooked policy changes, from food and textile waste to agriculture and medicine shortages. Sarah is joined by Politico’s experts on sustainability, agriculture and health — Marianne Gros, Bartosz Brzeziński and Rory O’Neill — for an insightful dive into what’s going on behind the scenes.

The U.K. has reported a “rare” human case of bird flu, the Health Security Agency (UKHSA) announced today, but the risk to the wider public remains “very low.” The case was detected in the West Midlands. The individual acquired the infection on a farm, after “close and prolonged contact” with infected birds, the agency said. The patient is currently well and authorities are tracing all individuals who have been in contact with the confirmed case. “The risk of avian flu to the general public remains very low despite this confirmed case,” Susan Hopkins, chief medical adviser at UKHSA, said. “We have robust systems in place to detect cases early and take necessary action, as we know that spillover infections from birds to humans may occur.” Bird-to-human transmission of H5N1 avian influenza is rare, but it has happened a few times before in the U.K., the agency said. In recent months, the country has stepped up its surveillance and control measures to contain the spread of bird flu after seeing a rise of cases in wild birds and several outbreaks in poultry farms.

ROME — When darkness descends and the stone pines are no longer visible through the windows of San Giovanni Addolorata Hospital, nighttime in the emergency wards reveals a health service verging on breakdown.  Trolleys bearing elderly patients spill out into the corridors. A nurse grows visibly exhausted as she is forced to juggle several wards by herself. With no beds available, a sickly twenty-something curls up to sleep on the floor. It looks like a scene out of the Covid-era — but four years later, San Giovanni Addolorata’s situation is typical of Italian hospitals.  In recent weeks, the stress on Italy’s health care system has come to the fore after the government’s latest budget proposal appeared to abandon major spending plans for the sector in the context of a broader fiscal squeeze, one of many across Europe. Enraged and overworked, thousands of health care workers are set to strike this Wednesday.  Many in the sector had hoped for measures to improve low pay, onerous conditions and staff shortages. Health Minister Orazio Schillaci had trumpeted an extra  €3.7 billion in health care spending in next year’s budget, and Prime Minister Giorgia Meloni had promised that ordinary Italians would be spared the worst effects of any cuts. But critics say the measures that made it into the final text were really worth just over €1.2 billion, well below what they argue is needed to keep the system afloat. The increase in funding in absolute terms is “flaunted as a great achievement, but is in reality a mere illusion,” Gimbe Foundation president Nino Cartabellotta told a parliamentary budget committee earlier this month.  He predicted that even the best run health authorities will have to cut services. The unions, meanwhile, have blasted the government for failing to budget for an increase in hospital hiring capacity, even after it was enshrined in law earlier this year. Lawmakers can still push for amendments until December. Schillaci, however, has defended the budget in parliament, saying his ministry inherited a system run down by years of cuts. Prime Minister Giorgia Meloni insisted last week that the proposed spending was an increase both in absolute terms and adjusted for inflation, adding that billions had been earmarked for wage increases until 2030.  “Creeping privatization” Watchdogs argue that the hole in resources is putting the nation’s health at risk, with some 4.3 million Italians reportedly renouncing treatment because of waiting lists (these can last up to 715 days in the case of ultrasound appointments). Elly Schlein, leader of the center-left Democratic Party, told POLITICO the government had broken its promises, condemning the “dangerous disinvestment” in public health care, and “creeping privatization.”  “The welfare state is in great crisis,” said Pierino Di Silverio, a Naples-based surgeon and the national secretary of medical union Anaao. “It’s a pillar of our social model — and it’s being progressively de-financed.” Certainly, the original aspiration underlying Italy’s National Health Fund — to provide universal coverage, funded by general taxation — is struggling to survive. Italy’s rapid population ageing — nearly a quarter of Italians are over 64 years old — means  that demand for services is growing much faster than the tax revenues needed to pay for them.  Against that backdrop, the share of services provided privately has grown steadily over the last decade, and now accounts for around a quarter of all health spending in the country. But the growth of a parallel private system has inevitably drawn away resources — including key staff — from the state sector. Workers in the state system are leaving, either to the private sector or abroad, at a pace of 14 a day, said Di Silverio.  Health Minister Orazio Schillaci had pledged an extra  €3.7 billion in health care spending in next year’s budget. | Fabio Frustaci/EFE via EPA That is compounding historic problems with the uneven distribution of funding across the country, which has tended to entrench divisions between the rich north and the poor south.   The issue is especially severe, Di Silverio said, in emergency wards, which now have up to 100 patients per doctor. The system is “so underfunded and badly equipped that people spend days in the emergency room,” recalled one medic at a major hospital in northern Rome, speaking on condition of anonymity as she wasn’t permitted to speak to the press. With patients often consigned to little more than a chair, the staffer said, frustrated relatives are known to assault overworked doctors, promoting more staff departures and increasingly dire conditions. “Nobody wants to do emergency medicine,” she said. Dead on arrival  Part of the budget strain is thanks to tough EU fiscal rules, brought back this year in a new form after being suspended during the pandemic. As a result of its enormous debt (now standing at nearly €3 trillion, or 139 percent of GDP) and an uncontrolled surge in deficit spending, Italy — along with several other countries — must now cut its deficit by at least 0.5 percent of GDP annually for up to seven years or face sanctions. But while the rules offer some leeway for increased funding on defense and the green transition, they have little or nothing to say on health. That lack of protection, critics argue, is bringing the state health system closer to breaking point.  Italy isn’t alone among EU countries pushed into difficult public spending trade-offs to rein in debt, and the Organization for Economic Cooperation and Development (OECD) notes that the Italian health care system is not all bad, boasting the third highest healthy-life expectancy as well as above-average spending on prevention.  But fiscal constraints have ensured that overall spending on health has fallen as a share of GDP since 2009, in contrast to most European countries, which have done better in accommodating the needs of graying populations.   Analysis by the Gimbe Foundation, an independent watchdog, suggests spending on the National Health Fund, specifically,will now fall to 5.7 percent of GDP by 2029, from 6.1 percent this year and well below the 7 percent recommended by the authors of a recent study published in The Lancet.  Overall spending on health, at 9.0 percent of GDP, is more than two full percentage points below the level in France, Germany and the U.K, according to OECD data.   That’s partly because Italy has to spend so much more on servicing its existing debts.  Raffaele Nevi, an MP with the center-right Forza Italia party, part of Meloni’s government, insisted that it’s essential to stick to the rules, to rebuild Italy’s credibility with financial markets and keep its future borrowing costs low. Despite the huge budget gap, the infamous ‘spread’ between Italian and German bond yields is currently as low as at any time since the European Central Bank stopped its net buying of government debt.  Do not resuscitate  To opposition figures and union leaders in negotiations with the government, the disappointment marks a covert return to the kind of austerity policies that have left much of Italy’s infrastructure crumbling or broken in recent decades. In the latest budget draft, outlays for new parents, pensions and teachers were also much smaller than expected. Schlein, the opposition leader, blasted as “unacceptable” a pension increase that amounts to just €3 a month, while government departments and local councils are gearing up for several billion euros in cuts. “They say they’re constrained by the European Union,” grumbled Guido Quici, president of the doctors’ union Cimo, recalling conversations with government officials.  Quici also expressed frustration that sectors with more powerful lobbies — or EU mandates — were barely scratched by the budget. Banks and insurers will only suffer a temporary shortfall, the tobacco industry avoided long-called-for tax increases. Military spending, meanwhile, is set to rise by over €2 billion each year on average until 2039, after three decades of withering on the vine. Some argue that the Italian situation reflects a broader loss of interest in health care and welfare amid a growing push for investments in hotter sectors. An influential report authored by former Italian PM Mario Draghi earlier this year, seen in Brussels as an economic blueprint for the next decade, makes only passing reference to health, focusing on developing new technologies. A spokesman for the European Commission said it was “assessing Italy’s draft budget plan and medium-term fiscal plan” and will present its assessment before the end of November. “My feeling,” said Yannis Natsis, director of the European Social Insurance Platform, a Brussels-based industry group, “is the [EU-wide] health budget will be significantly reduced because of other competing priorities like defense, security, and the industrial agenda.” Rory O’Neill contributed to this report.

European lawmakers have delayed their decision on whether to sign off Hungary’s choice for EU commissioner, Olivér Várhelyi, until Wednesday, five Parliament officials told POLITICO. Coordinators from the Parliament’s public health (ENVI) and agriculture (AGRI) committees met on Monday to decide whether to approve Várhelyi’s nomination as the next EU health and animal welfare commissioner. They agreed to delay the decision until the final commissioner hearings have finished. Várhelyi is so far the only candidate to face a second round of written questions after failing to impress lawmakers in his oral hearing last week. Committee coordinators met on Monday to discuss his answers to their follow-up questions. “We just decided to postpone the decision on the Fidesz Commissioner,” MEP Pascal Canfin, the group coordinator for the centrists Renew in the ENVI committee, wrote on X.  He told POLITICO that his group and the Socialists and Democrats (S&D) are “not happy” with the choice and have not yet decided whether they can vote for him or not. It would be “impossible,” he said, “to support a commissioner coming from Fidesz in charge of anything related to preparedness,” he said, referring to Hungarian Prime Minister Viktor Orbán’s right-wing party. While Várhelyi praised the European Medicines Agency (EMA) in his hearing last week, MEPs are still pointing to Budapest’s approach to the Covid-19 pandemic — when it was the only EU country to distribute non-EU approved vaccines from Russia and China — as a reason to reject the Hungarian candidate. They are also stalling at approving a portfolio that would include reproductive rights, Canfin said. The Greens and the Left Group have also opposed Várhelyi’s nomination so far, meaning the Hungarian lacks the numbers to get the green light. Only far-right groups and the European Conservatives and Reformists supported him after the initial hearing. One idea floated by S&D and Renew had been to approve Várhelyi in exchange for stripping competencies from his portfolio, such as reproductive rights, animal welfare and vaccines, and giving them to another commissioner. The far-right Patriots’ chief whip sees that as playing games. “It is of course unacceptable to see the groups play their games regarding the commissioner hearings,” Patriots chief whip, Danish MEP Anders Vistisen, told POLITICO.  “But it only shows the helplessness of the liberals, socialists and greens. They don’t hold any other real power in the parliament than EPP wants to grant them. The sole responsibility for the wrong direction Europe is heading now lies on the shoulders of EPP — they have a conservative parliament but refuses to use it.” Last week, a decision on Belgium’s Hadja Lahbib was also held hostage after a poor performance by Jessika Roswall. In the end, the the green light for Lahbib and Roswall was part of a deal between the EPP, the Renew group and the Socialists & Democrats. Similarly, the delay on Várhelyi means his fate can be used as a bargaining chip among the groups, who still have to sign off on the most high-profile of nominations on Tuesday, when the six executive vice presidents proposed by European Commission President Ursula von der Leyen will be quizzed by MEPs.

LONDON — Of all the horrors that Manchester-based surgeon Ammar Darwish has seen in Gaza, one of the very worst is the trauma a year of Israeli bombardment has inflicted on the children. “It will go to their kids and to their grandkids … it does not go away,” he told POLITICO. On the wards of Gaza’s hospitals, Darwish saw children shivering at the sound of jets overhead. They know what that sound means. Gaza is a city of children — they make up nearly half of its population — and for more than a year, Israel has bombed it relentlessly.  Visiting health workers are among the few outsiders who are able to offer eyewitness testimony from Gaza. Israel has mostly shut foreign press out of Gaza and carefully controls film crews and foreign correspondents allowed entry embedded with the Israel Defense Forces (IDF) for brief tours. Shortly after the publication of a United Nations-backed investigation, which accused the Israeli military of war crimes in Gaza, POLITICO spoke with four United Kingdom-based health workers who had recently returned from trips to Nasser Hospital in southern Gaza organized by British charity Medical Aid for Palestinians (MAP). They all highlighted the resilience of Gazans and the local medical staff, but underlined the deepening of exhaustion and desperation. On Oct. 30, the U.N. Independent Commission presented its report to the U.N. General Assembly on human rights abuses in Israel and Palestine. The commission told the assembly that Israel has pursued a concerted policy to wreck Gaza’s health care system: a war crime. The report itself concluded that Israeli security forces have deliberately killed, wounded, arrested, detained, mistreated and tortured health workers, alleging war crimes and the crime against humanity of extermination. The commission also investigated the treatment of Israeli hostages held in Gaza since Oct. 7, 2023, and alleged both Israeli and Palestinian armed groups have been responsible for torture, sexual- and gender-based violence. Israel said the findings were “outrageous,” accusing U.N. investigators of bias and seeking to “delegitimize the very existence of the State of Israel and obstruct its right to protect its population.” Israel has consistently claimed that the Palestinian armed group Hamas uses hospitals for military purposes, which Hamas and visiting doctors speaking to POLITICO denied. The IDF published videos of what Israeli intelligence says are Hamas tunnels dug underneath Al-Shifa Hospital. The IDF told POLITICO the evidence of Hamas using medical infrastructure was “overwhelming and irrefutable.” It cited videos purporting to be confessions by captured militants and photos of guns found in medical facilities. Some media have challenged the veracity of Israeli claims on the matter, suggesting Israeli military may have manipulated the scene at Al-Shifa hours before journalists were allowed in. Israel has denied it. Observers, meanwhile, point to the civilian death toll of Israel’s strikes. Oxfam said Israel had killed more women and children in Gaza in a year than any other conflict in the past two decades. “There’s this methodical destruction of the population on so many levels,” Tahseen Qureshi, a consultant surgeon at University Hospitals Dorset who has been to Gaza twice this year, told POLITICO. ‘EVERYONE … IS MALNOURISHED’ Ana Jeelani, an orthopedic surgeon in Liverpool, first went to Gaza in March via the Rafah Crossing with Egypt. During her first trip, Rafah was crowded, its population swollen by Palestinians displaced from other parts of the Gaza Strip. “There were lights, there were buildings, there was life. I saw children on a little swing outside,” Jeelani recalls.  On her return in September, there was little remaining of the town she said. “I didn’t even recognize Rafah. It was silent … it was just a lot of rubble, a lot of dust, there were no people.” Jeelani spent her second mission at Nasser Hospital from Sep. 13 to Oct. 8, working alongside Qureshi. Like all of the doctors POLITICO spoke to, she said basic necessities — even sterile gloves, gauzes, gowns — were unavailable. Israel has starved Gaza’s health system of basic health supplies, they said. All four health workers said they were under tight restrictions on what they could take and were allowed to bring only enough food and supplies — even soap — for personal use. The report itself concluded that Israeli security forces have deliberately killed, wounded, arrested, detained, mistreated and tortured health workers. | AFP/Getty Images Israel’s office for the Coordination of Government Activities in the Territories (COGAT) told POLITICO it was “false” to claim Israel restricted medical aid and that 27,257 metric tons of medical equipment had entered Gaza since the war began. COGAT also said it allowed the entry of “dual-use equipment” pending security approval. U.N. agencies, nongovernmental organizations, and Israel’s allies such as the U.K. state, however, that Gaza faces critical shortages of medical supplies while growing numbers of aid trucks are refused entry. Nizam Mamode, a London-based transplant surgeon, worked at Nasser Hospital from Aug. 13 to Sep. 10. Mamode described the scene inside the hospital as “beyond comprehension;” the staff overwhelmed by one to two mass-casualty incidents a day. Little around the site is left standing, he said. There’s a school next door sheltering thousands of displaced people. “Every time I hear of a school that’s been bombed, I just hope it’s not that school,” Mamode said. Schools, like other types of civilian infrastructure, are frequent Israeli targets, the U.N. says. UNICEF estimated in August that more than 76 percent of schools in Gaza required full or near-total reconstruction. Israel consistently says it has to target schools because Hamas uses them as hubs and command centers — a claim denied by Hamas. Mamode said most of the victims he treated were women and children. Qureshi estimated the number of women and children they treated to be between 70 and 80 percent. Without the most basic and sterile equipment, there was little these highly specialized doctors could do for many of the wounded. “It was overwhelming, the number we couldn’t help,” regrets Mamode.  Darwish, who has considerable experience working in war zones, told POLITICO postoperative recovery is hampered by high levels of malnutrition. “Everyone there has either lost weight or [is] malnourished,” including local doctors, he said. Adults tend to be the most malnourished, Darwish adds. What little food they secure, they give to their children. Earlier this month, U.N. food rights expert Michael Fakhri told governments they had failed to act on warnings of famine and genocide against the Palestinians. For many of the victims, the most the doctors could do for their patients was to be attentive and show solidarity. “A large part of the reason for being there was really about standing next to the Palestinians,” Mamode said. “I think it was really important for them to see that people actually cared.” THE SIEGE OF NASSER Nasser is one of the most important hospitals in Gaza. “We cannot lose that hospital,” Rik Peeperkorn, the World Health Organization’s (WHO) envoy for the Palestinian territories, warned ahead of an Israeli strike that put the hospital out of operation in February. Israel claimed it apprehended more than 100 Hamas soldiers and avoided harm to medical staff or patients. Qureshi stayed there “24/7” on his first trip in January with Darwish, weeks before Israeli troops entered. Neither witnessed any signs of Hamas military activity at Nasser, nor did Jeelani and Mamode on their later visits. Qureshi and his team were forced to flee Nasser in January, after a night of intense fighting around the site that he described as “probably the scariest” of his life. The next day, for the first time on their visit, the MAP team availed themselves of a safe house on the edge of town. “We said we need to go back … just to gather our thoughts and refresh ourselves,” Qureshi said. The safe house was carefully selected — a residential compound built on sand, with no tunnels underneath, Qureshi said. It housed the staff of MAP and the International Rescue Committee, who provided the coordinates to the Israeli military. At 6 a.m. the following morning, an Israeli airstrike hit the safe house. “The ceiling fell in, the windows came off the panes,” Qureshi said. There were no fatalities, with one of the doctors sustaining only minor injuries — the team was mostly concerned for two children who were staying in the house, he added. Israeli troops occupied Nasser Hospital until April. | AFP/Getty Images) Israel has provided multiple and contradictory explanations for what happened, alternatively denying responsibility and admitting a mistake. The IDF told POLITICO it didn’t have enough details to comment on the strike. Israeli troops occupied Nasser Hospital until April. After they left, Palestinian authorities reported the discovery of a mass grave outside Nasser containing more than 300 bodies. Jeelani shared a photograph of the site taken from a balcony at the back of the hospital. Palestinian officials say hospital staff buried at least 150 people in two burial pits on the grounds in January out of necessity and accused Israel of being behind a third grave discovered after their forces left. Israel has denied digging new graves, saying it only exhumed and reburied the remains of people already buried on the hospital grounds before they arrived. But U.N. authorities and NGOs, including MAP, have called for an independent investigation into potential Israeli war crimes. The bodies reportedly included those of women, children and the elderly; others had their hands tied. All four of the doctors said they hope to return to Gaza. It’s unclear yet whether that will be possible. According to the WHO, Israel has blocked further access to eight health NGOs providing emergency medical care in Gaza. MAP is not among them. COGAT told POLITICO it had allowed 1,000 doctors and aid workers into Gaza in recent months. The most difficult feelings arose when it was time to leave, Jeelani said. “I get to England, I switch on the news and I don’t know how this doesn’t remain top of the agenda. What is happening is a full-blown ethnic cleansing,” she said. U.N. leaders and experts have warned Israel’s actions amount to genocide and ethnic cleansing against the Palestinians. Israel and the IDF deny a deliberate policy of eliminating the Palestinian population. Senior Israeli leaders, however, have called for the settlement of Gaza and Palestinian emigration. “[The Palestinians in Gaza] have a sadness and trauma that is so deep within them,” Jeelani said. “I don’t know how they heal from it. I don’t know how we heal from it.”