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

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

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

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

Taking Ozempic or Wegovy once-a-week has shown to reduce heavy drinking and cravings in a small study of people with alcohol-use disorder. The U.S.-based trial involving 48 people with moderate alcohol-use disorder found that semaglutide, the diabetes and obesity medication, “significantly reduced alcohol craving and drinks per drinking day.” Recent reports linking semaglutide or drugs of the same class to alcohol-related outcomes have previously relied on “observational or anecdotal data,” the study said. The U.S. researchers said the results justify larger clinical trials to evaluate this class of drugs — known as glucagon-like peptide 1 (GLP-1) receptor agonists — for alcohol use disorder. The study is published today in the Journal of the American Medical Association. “We hoped to see a reduction in drinking and craving,” said Christian Hendershot, lead author of the study from the University of Southern California. “What I didn’t expect was the magnitude of the effects looks fairly good … compared to other alcohol-use disorder medications.” Stephen Burgess from Cambridge university said the study was a small “but an exciting one.”  “This study serves as an initial indication that semaglutide and similar weight-loss drugs may be beneficial for treating alcohol use disorder, at least in the short term,” he said. But he added that larger and longer studies would be needed to understand whether people who stop the treatment can still maintain a healthy alcohol status post-treatment.