Listen on * Spotify * Apple Music * Amazon Music Wer regiert die Welt – und was treibt sie an? In unserem regelmäßigen Machthaber-Spezial geht es um die mächtigsten und umstrittensten Politikerinnen und Politiker unserer Zeit. Wir zeigen, wie sie denken, entscheiden – und was das für uns bedeutet. Eine Politikerin oder Politiker, alle zwei Wochen, ein Blick hinter die Kulissen der Macht. Die nächste Folge hört ihr am Dienstag, 30.12.2025. Dann mit einem Porträt der dänischen Ministerpräsidentin Mette Frederiksen. Das Berlin Playbook als Podcast gibt es jeden Morgen ab 5 Uhr. Gordon Repinski und das POLITICO-Team liefern Politik zum Hören – kompakt, international, hintergründig. Für alle Hauptstadt-Profis: Der Berlin Playbook-Newsletter bietet jeden Morgen die wichtigsten Themen und Einordnungen. ⁠Jetzt kostenlos abonnieren.⁠ Mehr von Host und POLITICO Executive Editor Gordon Repinski:Instagram: ⁠@gordon.repinski⁠ | X: ⁠@GordonRepinski⁠. Legal Notice (Belgium) POLITICO SRL Forme sociale: Société à Responsabilité Limitée Siège social: Rue De La Loi 62, 1040 Bruxelles Numéro d’entreprise: 0526.900.436 RPM Bruxelles info@politico.eu www.politico.eu

Disclaimer POLITICAL ADVERTISEMENT * This is sponsored content from AstraZeneca. * The advertisement is linked to public policy debates on the future of cancer care in the EU. More information here. Europe has made huge strides in the fight against cancer.[1] Survival rates have climbed, detection has improved and the continent has become home to some of the world’s most respected research hubs.[2],[3] None of that progress came easy — it was built on years of political attention and cooperation across borders. However, as we look to 2026 and beyond, that progress stands at a crossroads. Budget pressures and tougher global competition threaten to push cancer and health care down the EU agenda. Europe’s Beating Cancer Plan — a flagship initiative aimed at expanding screening, improving early detection and boosting collaboration — is set to expire in 2027, with no clear plan to secure or extend its gains.[4],[5] “My [hope is that we can continue] the work started with Europe’s Beating Cancer Plan and make it sustainable… [and] build on the lessons learned, [for other disease areas] ” says Antonella Cardone, CEO of Cancer Patients Europe. A new era in cancer treatment Concern about the lapsing initiative is compounded by two significant shifts in health care: declining investment and increasing scientific advancement. Firstly, Europe has seen the increased adoption of cost-containment policies by some member states. Under-investment in Europe in cancer medicines has been a challenge — specifically with late and uneven funding, and at lower levels than international peers such as the US — potentially leaving patients with slower and more limited access to life-saving therapies.[6],[7],[8] Meanwhile, the U.S., which pays on average double for medicines per capita than the EU,[9] is actively working to rebalance its relationship with pharmaceuticals to secure better pricing (“fair market value”) through policies across consecutive administrations.[10] All the while, China is rapidly scaling investment in biotech and clinical research, determined to capture the trials, talent, and capital that once flowed naturally to Europe.[11] The rebalancing of health and life-science investment can have significant consequences. If Europe does not stay attractive for life-sciences investment, the impact will extend beyond cancer patient outcomes. Jobs, tax revenues, advanced manufacturing, and Europe’s leadership in strategic industries are all at stake.[12] Secondly, medical science has never looked more promising.[7] Artificial intelligence is accelerating drug discovery, clinical trials, and diagnostics, and the number of approved medicines for patients across Europe has jumped from an average of one per year between 1995 and 2000 to 14 per year between 2021 and 2024.[13],[14],[15], [7] Digital health tools and innovative medtech startups are multiplying, increasing competitiveness and lowering costs — guiding care toward a future that is more personalized and precise.[16],[17] Europe stands at the threshold of a new era in cancer treatment. But if policymakers ease up now, progress could stall — and other regions, especially the U.S. and China, are more than ready to widen the innovation gap. Recognizing the strategic investment Health spending is generally treated as a budget item to be contained. Yet investment in cancer care has been one of Europe’s smartest economic bets.[18],[19] The sector anchors millions of high-skilled jobs (it employs around 29 million people in the EU[11]) and attracts global life sciences investment. According to the European Commission, the sector contributes nearly €1.5 trillion to the EU economy.[12] Studies from the Institute of Health Economics confirm that money put into research directly translates into better survival outcomes.[20] The same report shows that although the overall spend on cancer is increasing, the cost per patient has actually decreased since 1995, suggesting that innovative treatments are increasing efficiency.[20] Those gains matter not only to patients and families, but to Europe’s long-term stability: healthier populations mean fewer costs down the line, stronger productivity, and more sustainable public finances.[20] Fixing Europe’s access gap Cancer medicines bring transformative value — to patients, to society and to the wider economy. [21] However, even as oncology therapies advance, patients across Europe are not benefiting equally. EFPIA’s 2024 Patients W.A.I.T. indicator shows that, on average, just 46 percent of innovative medicines approved between 2020 and 2023 were available to patients in 2024.[22] On average, it takes 578 days for a new oncology medicine to reach European patients, and only 29 percent of drugs are fully available in all member states.[23] This is not caused by a lack of breakthrough medicines, but by national policy mechanisms that undervalue innovation. OECD and the Institute for Health Economics data show that divergent HTA requirements, rigid cost-effectiveness thresholds, price-volume clawbacks, ad hoc taxes on pharmaceutical revenues and slow national reimbursement decisions collectively suppress timely access to new cancer medicines across the EU.[24] These disparities cut against Europe’s long-standing reputation as a collection of societies that values equitable, high-quality care for all of its citizens. It risks eroding one of the EU’s defining strengths: the commitment to fairness and collective progress. Cancer policy solutions for the EU Although this is ultimately a matter for member states, embedding cancer as a permanent EU priority — backed by funding, coordination, and accountability — could give national systems the incentives and strategic direction to buck these trends. These actions will reassure pharmaceutical companies that Europe is serious about attracting clinical trials and the launch of new medicines, ensuring that its citizens, societies and economies enjoy the benefits this brings. Europe’s Beating Cancer Plan delivered progress, but its expiry presents a pivotal moment. 2026 and beyond bring a significant opportunity for the EU to build on this by ensuring that member states implement National Cancer Control Plans and have clear targets and accountability on their national performance, including on investment and access. To do this, EU policymakers should consider three actions as an immediate priority with lasting impact: * Embed cancer and investment within EU governance. Build it into the European Semester on health with mandatory indicators, regular reviews, and accountability frameworks to ensure continuity. This model worked well during Covid-19 and should be adapted for non-communicable diseases starting with cancer as a pilot. * Secure stable and sufficient funding. The Multiannual Financial Framework must ensure adequate funding for health and cancer to encourage coordinated initiatives across member states. * Strengthen EU-level coordination. Ensure that pan-EU structures such as the Comprehensive Cancer Centres and Cancer Mission Hubs are adequately funded and empowered. These are the building blocks of a lasting European commitment to cancer. With action, Europe can secure a sustainable foundation for patients, resilience and continued scientific excellence. -------------------------------------------------------------------------------- [1] European Commission, OECD/European Observatory on Health Systems and Policies. 2023. State of Health in the EU: Synthesis Report 2023. Available at: https://health.ec.europa.eu/system/files/2023-12/state_2023_synthesis-report_en.pdf [Accessed December 2025] [2] Efpia. 2025. Cancer care 2025: an overview of cancer outcomes data across Europe. Available at: https://www.efpia.eu/news-events/the-efpia-view/statements-press-releases/ihe-cancer-comparator-report-2025/ [Accessed December 2025] [3] Cancer Core Europe. 2024. Cancer Core Europe: Advancing Cancer Care Through Collaboration. Available at: https://www.cancercoreeurope.eu/cce-advancing-cancer-care-collaboration/ [Accessed December 2025] [4] European Commission. 2021. Europe’s Beating Cancer Plan. Available at:https://health.ec.europa.eu/system/files/2022-02/eu_cancer-plan_en_0.pdf [Accessed December 2025] [5] European Parliament. 2025. Europe’s Beating Cancer Plan: Implementation findings. https://www.europarl.europa.eu/RegData/etudes/STUD/2025/765809/EPRS_STU(2025)765809_EN.pdf [Accessed December 2025] [6] Hofmarcher, T., et al. 2024. Access to Oncology Medicines in EU and OECD Countries (OECD Health Working Papers, No.170). OECD Publishing. Available at: https://www.oecd.org/content/dam/oecd/en/publications/reports/2024/09/access-to-oncology-medicines-in-eu-and-oecd-countries_6cf189fe/c263c014-en.pdf [Accessed December 2025] [7] Manzano, A., et al. 2025. Comparator Report on Cancer in Europe 2025 – Disease Burden, Costs and Access to Medicines and Molecular Diagnostics (IHE). Available at: https://ihe.se/app/uploads/2025/03/IHE-REPORT-2025_2_.pdf [Accessed December 2025] [8] Efpia. [no date]. Europe’s choice. Available at: https://www.efpia.eu/europes-choice/ [Accessed December 2025] [9] OECD. 2024. Prescription Drug Expenditure per Capita. https://data-explorer.oecd.org/vis?lc=en&pg=0&snb=1&vw=tb&df[ds]=dsDisseminateFinalDMZ&df[id]=DSD_SHA%40DF_SHA&df[ag]=OECD.ELS.HD&df[vs]=&pd=2015%2C&dq=.A.EXP_HEALTH.USD_PPP_PS%2BPT_EXP_HLTH._T..HC51%2BHC3.._T…&to[TIME_PERIOD]=false&lb=bt [Accessed December 2025] [10] The White House. 2025. Delivering most favored-nation prescription drug pricing to American patients. Available at: https://www.whitehouse.gov/presidential-actions/2025/05/delivering-most-favored-nation-prescription-drug-pricing-to-american-patients/ [Accessed December 2025] [11] Eleanor Olcott, Haohsiang Ko and William Sandlund. 2025. The relentless rise of China’s Biotechs. Financial Times. Available at: https://www.ft.com/content/c0a1b15b-84ee-4549-85eb-ed3341112ce5 [Accessed December 2025] [12] European Commission, Directorate-General for Communication. 2025. Making Europe a Global Leader in Life Sciences. Available at: https://commission.europa.eu/news-and-media/news/making-europe-global-leader-life-sciences-2025-07-02_en [Accessed December 2025] [13] Financial Times. 2025. How AI is reshaping drug discovery. Available at: https://www.ft.com/content/8c8f3c10-9c26-4e27-bc1a-b7c3defb3d95 [Accessed December 2025] [14] Seedblink. 2025. Europe’s HealthTech investment landscape in 2025: A deep dive. https://seedblink.com/blog/2025-05-30-europes-healthtech-investment-landscape-in-2025-a-deep-dive [15] European Commission. [No date]. Artificial Intelligence in healthcare. Available at: https://health.ec.europa.eu/ehealth-digital-health-and-care/artificial-intelligence-healthcare_en [Accessed December 2025] [16] Codina, O. 2025. Code meets care: 20 European HealthTech startups to watch in 2025 and beyond. EU-Startups. Available at: https://www.eu-startups.com/2025/06/code-meets-care-20-european-healthtech-startups-to-watch-in-2025-and-beyond [Accessed December 2025] [17] Protogiros et al. 2025. Achieving digital transformation in cancer care across Europe: Practical recommendations from the TRANSiTION project. Journal of Cancer Policy. Available at: https://www.sciencedirect.com/science/article/pii/S2213538325000281 [Accessed December 2025] [18] R-Health Consult. [no date]. The case for investing in a healthier future for the European Union. EFPIA. Available at: https://www.efpia.eu/media/xpkbiap5/the-case-for-investing-in-a-healthier-future-for-the-european-union.pdf [Accessed December 2025] [19] Pousette A., Hofmarcher T. 2024.Tackling inequalities in cancer care in the European Union. Available at: https://ihe.se/en/rapport/tackling-inequalities-in-cancer-care-in-the-european-union-2/ [Accessed December 2025] [20] Efpia. 2025. Comparator Report Cancer in Europe 2025. Available at: https://www.efpia.eu/media/0fbdi3hh/infographic-comparator-report-cancer-in-europe.pdf [Accessed December 2025] [21] Garau, E. et al. 2025. The Transformative Value of Cancer Medicines in Europe. Dolon Ltd. Available at: https://dolon.com/wp-content/uploads/2025/09/EOP_Investment-Value-of-Oncology-Medicines-White-Paper_2025-09-19-vF.pdf?x16809 [Accessed December 2025] [22] IQVIA. 2025. EFPIA Patients W.A.I.T. Indicator 2024 Survey. Available at: https://www.efpia.eu/media/oeganukm/efpia-patients-wait-indicator-2024-final-110425.pdf [Accessed December 2025] [23] Visentin M. 2025. Improving equitable access to medicines in Europe must remain a priority. The Parliament. Available at: https://www.theparliamentmagazine.eu/partner/article/improving-equitable-access-to-medicines-in-europe-must-remain-a-priority [Accessed December 2025] [24] Hofmarcher, T. et al. 2025. Access to novel cancer medicines in Europe: inequities across countries and their drivers. ESMO Open. Available at: https://www.esmoopen.com/action/showPdf?pii=S2059-7029%2825%2901679-5 [Accessed December 2025]

Listen on * Spotify * Apple Music * Amazon Music In der Generaldebatte zeichnet Kanzler Friedrich Merz ein Bild globaler Unsicherheit und bittet um Geduld für komplexe Lösungen. Doch die Rede zeigt einen Regierungschef, der zunehmend erklären muss, warum zentrale Konflikte seiner Koalition ungelöst bleiben. Parallel sorgen brisante Trump-Leaks International für Aufsehen. Aufzeichnungen zweier Telefonate legen nahe, dass Trumps Unterhändler Steve Witkoff mit Kreml-Berater Juri Uschakow über mögliche Bedingungen eines Ukraine-Deals spricht. Für die Europäer wird das zur Gefahr: Sie sind außen vor, aber müssen am Ende jede Vereinbarung mittragen. Entscheidend wird nun die Debatte über die russischen Frozen Assets: Nur wenn es gelingt, diese Vermögen für einen milliardenschweren Ukraine-Kredit zu nutzen, hat Europa wieder Einfluss.  Das Berlin Playbook als Podcast gibt es jeden Morgen ab 5 Uhr. Gordon Repinski und das POLITICO-Team liefern Politik zum Hören – kompakt, international, hintergründig. Für alle Hauptstadt-Profis: Der Berlin Playbook-Newsletter bietet jeden Morgen die wichtigsten Themen und Einordnungen. Jetzt kostenlos abonnieren. Mehr von Host und POLITICO Executive Editor Gordon Repinski: Instagram: @gordon.repinski | X: @GordonRepinski. Legal Notice (Belgium) POLITICO SRL Forme sociale: Société à Responsabilité Limitée Siège social: Rue De La Loi 62, 1040 Bruxelles Numéro d’entreprise: 0526.900.436 RPM Bruxelles info@politico.eu www.politico.eu

Europe must work to unleash the untapped potential of its internal market, European Central Bank President Christine Lagarde said, noting that she given the very same message in 2019 – before Russia’s war on Ukraine and U.S. President Donald Trump’s disruptive second presidency. Speaking at the annual European Banking Congress in Frankfurt, Lagarde said the ECB estimates that internal barriers in services and goods markets are equivalent to tariffs of around 100 percent and 65 percent, respectively. While acknowledging that barriers cannot be removed entirely, she pointed out to three key steps to boost potential. These include a overhaul of EU governance to see the bloc move to qualified majority voting to avoid legislation being bogged down by individual vetoes. The EU should also introduce a pan-European regime for corporate law, the so-called 28th regime. Finally, it should revive the principle of mutual recognition to allow goods and services to move freely within its Single Market. Lagarde gave political leaders a pat on the back for boosting government spending on defense and infrastructure, and for learning from the experience of past crises. “The fiscal packages now being implemented for defense and infrastructure – especially here in Germany – are coming at the right time for Europe and will have a measurable effect on growth,” she said.

Domènec Ruiz Devesa is president of the Union of European Federalists and was an MEP from 2019 to 2024. Negotiations on the EU’s 2028–2034 Multi-annual Financial Framework (MFF) have entered a new phase of political significance. Traditionally, this process follows a familiar pattern: The European Commission proposes a draft budget, the Council bargains behind closed doors, then, at the final stage, the Parliament is called in to give or withhold consent. It’s a sequence of affairs that has long placed the Parliament in a weak position before a nearly finished deal — but not this time. In a break from previous iterations, this time the Parliament intervened early and managed to secure concessions. This is a feat that should be acknowledged. However, recognizing this success shouldn’t obscure the political stakes that remain. Following the Commission’s initial proposal, the Parliament was able to assert itself at the very start of the MFF process through a joint letter from the presidents of its main political groups, expressing clear institutional expectations, financial priorities and political conditions. As a result, the Commission offered improvements regarding the role of regional authorities in the implementation of agricultural and cohesion programs, and accepted an enhanced role for the Parliament to monitor the MFF’s execution. As previously noted by this very publication, the Parliament’s unusually early involvement was able to influence the framework before the Council began its negotiations — a notable break from precedent that should be seen as a strategic gain for parliamentary democracy at the European level. It’s a move that demonstrates the Parliament can impact the overall direction of EU governance when it acts strategically and cohesively. It suggests that parliamentary authority in budgetary affairs isn’t just a legal formality but a tool that can shape policy. And even more crucially, it is an institutional win that the Parliament should take credit for. However, it’s important to note that many in the Parliament still view these changes as insufficient. As highlighted by the Socialists and Democrats, Greens and Renew Europe groups, though this early intervention demonstrates that the Parliament can influence the MFF process, the substance of these modifications doesn’t address other structural concerns regarding the budget’s size, long-term strategic priorities or governance transparency. The decisive phase still lies ahead, and the central negotiations won’t occur between the Parliament and the Commission but between the Parliament and the Council. The Council, representing member countries, traditionally holds the stronger position — especially when unanimity is required. Still, the Parliament’s consent is indispensable. So, if it is to play an equal role in shaping the bloc’s strategic future, the Parliament must be willing to use its veto power if necessary. And in order to act effectively, it must link its consent on the MFF to broader issues beyond the budget. The MFF isn’t merely a financial plan — it is the backbone of Europe’s political priorities for the coming decade. And it shouldn’t be adopted in isolation from the bloc’s strategic goals or its capacity to act. But for that to happen, three things must take place: First, the so-called “passerelle clauses” need to be activated. This would allow the Council to shift from unanimity to qualified majority voting in specific policy areas without the need for treaty reform, which is essential to overcome persistent deadlocks. Next comes European defense. Article 42 of the Treaty on European Union provides a mutual defense clause, which could potentially lead to a common defense. In an era of heightened geopolitical tension, reliance on fragmented national capabilities is untenable. However, a credible European security posture would require joint procurement as well as shared operational planning. Therefore, linking MFF funding to concrete steps in defense integration would improve European security while also reinforcing the bloc’s global credibility. Lastly, there has to be movement on treaty reform. In November 2023, the Parliament approved a proposal to reform the EU Treaties, aiming to update the institutional framework, democratize decision-making and enhance the bloc’s capacity to act — particularly in terms of enlargement. But such reform cannot advance without political pressure, as the Council has little incentive to take up the proposal unless the Parliament conditions its agreement to the MFF on progress in the reform process. The MFF negotiations thus present a strategic opportunity. They aren’t only about allocating funds or how these funds are supervised — as fundamental as this is. They’re also about determining the direction of European integration. If the Parliament approves an MFF that doesn’t support the reforms needed to strengthen a potentially larger bloc, then its moment of influence will be wasted. The achievements of the first phase show that coordinated parliamentary action can, indeed, shape outcomes. Now, the next step is to use that influence where it matters most: in negotiations with the Council. The Parliament must be strategic and firm. Only then can it ensure that the next MFF isn’t merely a financial instrument but the foundation for a more capable, united and democratic union.

Listen on * Spotify * Apple Music * Amazon Music Friedrich Merz trifft den türkischen Präsidenten Recep Tayyip Erdoğan – und das vor dem Hintergrund massiver innenpolitischer Spannungen in der Türkei: Ein neuer Haftbefehl gegen Oppositionsführer Ekrem İmamoğlu, staatliche Eingriffe in die Pressefreiheit und wachsendes Misstrauen gegenüber Deutschland. Gemeinsam mit Deniz Yücel analysiert Rixa Fürsen, was die Reise des Kanzlers bedeutet – politisch, wirtschaftlich und strategisch. Das Berlin Playbook als Podcast gibt es morgens um 5 Uhr. Gordon Repinski und das POLITICO-Team bringen euch jeden Morgen auf den neuesten Stand in Sachen Politik — kompakt, europäisch, hintergründig. Und für alle Hauptstadt-Profis: Unser Berlin Playbook-Newsletter liefert jeden Morgen die wichtigsten Themen und Einordnungen. Hier gibt es alle Informationen und das kostenlose Playbook-Abo. Mehr von Berlin Playbook-Host und Executive Editor von POLITICO in Deutschland, Gordon Repinski, gibt es auch hier:   Instagram: @gordon.repinski | X: @GordonRepinski.

BRUSSELS ― Ursula von der Leyen comfortably overcame her critics ― but her relationship with the European Parliament will never be the same again. In one of the most politically bruising weeks of her second term, the European Commission president faced down two motions of no confidence as well as a rebellion by lawmakers in her own conservative party. She remains safely in her job, and even came out of the fight with strengthened support, but there’s a price to pay. She’ll now have to take the Parliament — long considered the weakest of the EU’s three main institutions — much more seriously than she, or her predecessors, have done before. And Parliament’s voice is getting stronger just as far-right groups, like Patriots for Europe, are becoming more influential in the chamber. For lawmakers who have struggled for years to be given the same consideration as national leaders in the European Council, the spectacle of von der Leyen humbly vowing to take their views into account is a victory. It coincides with the recent revision of the framework agreement between the Commission and Parliament, which gave the elected assembly slightly more oversight over the Commission — useful for Parliament President Roberta Metsola to showcase the modest concessions she scored, and even more useful for von der Leyen to show MEPs she cares about them. “MEPs are steadily increasing their grip on lawmaking by holding the Commission to its treaty obligations,” said Andrew Duff, a former European lawmaker and co-author of the EU’s Lisbon Treaty. “This is much more important than posturing censure motions.” KID GLOVES But for von der Leyen, who’s also battling pushback from EU leaders like German Chancellor Friedrich Merz over her plans for a “drone wall” to fend off Russian air incursions, the more assertive Parliament is a problem, because she has to fight on two fronts to keep her agenda on track. She gave heed to the new power dynamic Monday when, responding to critiques from the far-right and far-left leaders who tabled the motions against her, she struck a conciliatory tone. Gone were the defiant notes of her speech to Parliament in July, when she accused the sponsors of a no-confidence motion of being puppets of Russian President Vladimir Putin. This time von der Leyen was wearing kid gloves. German lawmaker René Repasi told POLITICO that the group could put forward its own censure motion within the next six months unless Ursula von der Leyen. | Martin Bertrand and Hans Lucas/Getty Images Parliament’s grievances “come from a place of genuine and legitimate concern,” she said. The softer tone may have to do with the realization that it’s not just fringe politicians challenging her, but members of her own political tribe. The motions not only dented von der Leyen’s image but also gave her Socialist and liberal allies a perfect opportunity to air their frustrations, showing Europe that Brussels is not immune to the political instability hitting the continent. The Socialists & Democrats, for example, have doubled down on their demands, with prominent German lawmaker René Repasi telling POLITICO’s EU Confidential podcast that von der Leyen has six months to deliver on her promises to the group, or it could put forward its own censure motion. Von der Leyen “has to deliver,” Repasi said. THEY ALWAYS FALL IN LINE An even bigger headache for the Commission president is that lawmakers in her own political group, the conservative European People’s Party, are rebelling against a long-term budget plan she presented in July. While not unprecedented ― the EPP sank big chunks of von der Leyen’s green agenda last year ― such defiance shows her political family growing more assertive. Even so, diplomats still argue that when it comes to the pecking order of EU institutions, the Council, with its national leaders, still reigns supreme. “I don’t believe in this new Parliament, sorry,” said one diplomat who was granted anonymity to speak frankly. “They can threaten, but when a leader picks up the phone, they always fall in line.” A case in point: Despite threatening to torpedo von der Leyen’s omnibus bill, the socialists fell into line after Merz asked his Spanish counterpart, Pedro Sanchez, to rein in his fellow socialists. Indeed, despite the Parliament’s assertiveness, the EU’s pecking order remains more or less intact. That won’t be much comfort to von der Leyen. Max Griera and Sarah Wheaton contributed reporting.