LONDON — A mutated influenza strain is spreading early in Europe this winter, but some experts warn talk of a “superflu” is misleading, erodes public trust and distracts from the underlying problems of the National Health Service. The new strain has triggered dramatic headlines in the U.K., where health leaders are warning of a “worst-case scenario” for the country’s NHS. Health Secretary Wes Streeting described it as a “tidal wave of flu tearing through our hospitals” and labelled it a “challenge unlike any [the NHS] has seen since the pandemic.” While hospital admissions have been rising sharply due to the early arrival of flu season, there is currently no evidence that this season’s variant is more deadly or transmissible, experts at the World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC) told POLITICO. Neither does the data suggest hospital admissions will peak higher than previous years — although this is possible — just that they’re a few weeks early. But some experts in the U.K. have criticized the government’s “superflu” narrative, suggesting it’s being used as leverage in talks on doctor pay and conditions ahead of a looming strike. Prime Minister Keir Starmer wrote in The Guardian Friday it was “beyond belief” doctors would consider striking in these “potentially dire” circumstances, citing “a superflu epidemic.” The British Medical Association (BMA), the union representing resident doctors due to go on strike Wednesday, claimed it was “irresponsible to portray the current winter flu crisis as unprecedented” given that rates of infection and hospitalization were “comparable to most years,” a spokesperson told POLITICO. Mathematician Christina Pagel, a professor at University College London, said the “superflu” line was based on the “highly misleading use of statistics” and had more to do with the impending doctors’ strike than real trends. When contacted by POLITICO, the U.K. government stood by its health leaders’ warnings of the current flu season, in which they described it as an “unprecedented wave of super flu.” They said staff were being “pushed to the limit.” The government also pointed to stats showing the NHS is under pressure. A DHSC spokesperson told POLITICO the government had offered the BMA an extended mandate so they could strike in January instead, but the union rejected it. The BMA told POLITICO the extension included “several restrictive conditions.” THE IMPORTANCE OF TRUST The government and NHS bosses have warned the heavy burden on hospitals in December could set the health system up for a very severe winter. NHS statistics published last week show an average of 2,660 patients in hospital with flu per day, a record for this time of year, while the Health Foundation has said the NHS could face “major pressures” if cases continue to climb rapidly in the weeks ahead. Yet, while NHS staff are stretched, Pagel and others argue this year is largely consistent with previous severe flu seasons. However, without being clear about this with the public, some experts are concerned the government’s messaging could do more harm than good. “One of the real issues we have with governments everywhere is trust,” Martin McKee, professor of public health at the London School of Hygiene and Tropical Medicine, told POLITICO. While NHS staff are stretched, experts argue this year is largely consistent with previous severe flu seasons. | Geography Photos/Getty Images “The difficulty is we’ve seen them do all sorts of things for all sorts of motives. That then becomes a problem whenever they are saying something accurate,” McKee said, adding that the government should be more careful in its flu messaging given the declining trust in science. POLITICO put these concerns over trust in science to DHSC, but the department did not respond by the time of publication. A spokesperson for government-sponsored NHS England told POLITICO: “The NHS is not misleading the public — this is the earliest flu season we have seen in recent years with the latest data showing the numbers of patients in hospital with flu is extremely high for this time of year.” The NHS is struggling as it often does in winter, with a spike in delayed discharges — people who are ready to leave hospital but have nowhere to go — posing an extra challenge for hospitals, The Guardian reported Sunday. Hospital admissions for flu per 100,000 rose 23 percent in last week’s data, compared to 69 percent the previous week, but this doesn’t rule out another surge in the weeks ahead. McKee said the NHS was paying the price for chronic underinvestment. “We almost seem surprised that it’s arrived,” he said of the current flu wave, citing a “massive shortage” in beds, IT equipment and scanners.  WHAT THE EXPERTS SAY There is no reason to think the current flu strain (H3N2 sub-clade K) causes more severe disease than other types of flu, Hans Kluge, head of the World Health Organization’s Europe office, told POLITICO. Nor is there any solid evidence that it is more transmissible, said Edoardo Colzani, a flu expert at the European Centre for Disease Prevention and Control. It’s possible the lower level of immunity to this strain could lead to more cases “but this is still speculative at this stage,” Colzani said. “The epidemiological situation at the moment [in the EU] does not seem worse than in previous years apart from the fact that it is two-to-three weeks earlier,” Colzani said. Kluge said it was “about 4 weeks earlier than usual,” which “is not out of the ordinary” and trending similar to the 2022–2023 influenza season. There were some concerns the available flu vaccine might not be a “perfect match” for the current strain, Kluge said, but early data from the U.K. suggests it provides “meaningful protection” and may prevent severe disease and death, especially among vulnerable groups. “We [could] end up having a much bigger wave than usual but we have no evidence,” Pagel said, adding she thought it was “most likely” to peak “in a couple of weeks.” But the available data can’t tell us whether it will be a normal wave that starts and ends early, or an especially bad season, she added.  “We don’t know when it will turn the corner but the actual shape of the wave doesn’t look that different from previous years,” McKee said. The NHS has previously warned of the risk of a “long and drawn-out flu season” due to the early start. According to the WHO, some countries in the southern hemisphere had unusually long flu seasons this year.  “Based on previous trends, this season is expected to peak in late December or early January,” Kluge said. The advice from EU and U.K. authorities remains the same — get a flu vaccine as soon as possible, especially for those in a vulnerable group.

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

By Kathryn Kranhold and Jason McLure of The Examination and Rory O’Neill and Antonia Zimmermann of POLITICO. This article was reported in collaboration with The Examination, a nonprofit newsroom that investigates global health threats. BRUSSELS — When the world’s largest tobacco company needed help lifting international restrictions on its products, it enlisted an unlikely ally: the European Union, a leader in tobacco control.  EU officials met with Philip Morris International representatives at least six times from September 2022 through 2024, according to documents released through public records requests. The tobacco giant’s agenda: Enlist EU officials’ help in loosening restrictions or setting favorable tax rates on its products — including IQOS, a heated tobacco device key to the company’s future — in 10 countries outside the EU. Officials with the European Commission, the EU’s executive arm, took action at least three times that would have benefitted the company, The Examination and POLITICO found. They published a notice saying Mexico’s ban on new nicotine products was a possible barrier to free trade. They asked Turkish officials whether they planned to maintain the country’s requirement that cigarettes contain a minimum amount of local tobacco. And in a high-level report for EU officials, they flagged that rule and Turkey’s cigarette tax rate as issues that could affect ties between it and the EU.  The Commission’s actions regarding Turkey were “of great help for us,” a PMI representative wrote to staffers at the Commission. “We would like to express our gratitude in regard of (sic) the actions that you took.”  A Philip Morris International representative thanked European Commission trade officials for flagging Turkey’s cigarette tax and a rule on domestic tobacco as possible trade issues. (Redactions by the European Commission. Highlighting by The Examination) The revelations, contained in documents released through public information requests by the French anti-tobacco group Contre-Feu, raise questions about whether the EU breached its commitment to a global treaty to combat smoking signed by the EU and member countries. Guidelines to implement that treaty — the Framework Convention on Tobacco Control (FCTC) — say that when setting and implementing public health policies, governments should restrict their dealings with the tobacco industry and disclose any meetings whenever possible. None of the meetings with PMI or other industry groups cited in the documents were disclosed, according to The Examination and POLITICO’s review of the EU’s disclosure websites. The “fact that EU officials acted upon PMI’s requests signals a troubling willingness to give the tobacco industry privileged access. That is precisely what the FCTC was designed to prevent,” said Tilly Metz, a member of the European Parliament with the Greens. “It undermines both public trust and the EU’s credibility as a global leader in tobacco control.” A spokesperson for the European Commission told The Examination and POLITICO  that it “strictly follows” the treaty guidelines. But tobacco products are covered by EU trade policy, and the Commission can negotiate tariffs and trade rules, the spokesperson said.  “The Commission does not shape, influence or lobby for specific health policies in third countries on behalf of any industry,” the spokesperson said.  While industry associations and companies can share concerns on market access in non-EU countries with the Commission, and the Commission may meet with complainants to get more information, the spokesperson said such meetings are “strictly related to trade facilitation and market access.” European parliamentarians appeared divided over whether the dealings were improper.  Vytenis Andriukaitis with the Socialists and Democrats and a former EU health commissioner said the European Commission “cannot represent the interests of tobacco companies,” nor “press other countries to weaken” their tobacco controls. Barry Andrews, a member of the centrist Renew Europe Group, said: “These regular meetings with big tobacco lobbyists and the flurry of emails should not have happened.” By contrast, Stine Bosse, a member of the same political group, said: “The tobacco industry has every right to employ lobbyists.” However, Bosse added: “Morally, I stand in a very different place. While they constantly try to reinvent new products to get people hooked on nicotine and tobacco, I am fighting for precisely the opposite.”  Philip Morris International did not answer questions from The Examination and POLITICO about its dealing with EU officials. On its website, the company said it shares its perspectives with policymakers and it is “particularly active with respect to policies regarding less harmful alternatives to cigarettes, trade and fiscal matters, and intellectual property.” (The company is separate from Philip Morris USA, which is part of Altria Group.) The Examination and POLITICO have not found evidence that any of the 10 countries targeted by PMI altered their tobacco taxes or regulations following meetings with EU officials, including where the EU took action with regard to Mexico and Turkey. Most of PMI’s entreaties focused on IQOS, which it says is better than cigarettes because heating tobacco releases fewer toxins than burning it. Public health experts say the long-term risks of heated tobacco are unknown and products like IQOS could increase tobacco use. IQOS devices with heated tobacco sticks. Philip Morris International says IQOS is better than cigarettes because heating tobacco releases fewer toxins than burning it. Public health experts say the long-term risks of heated tobacco are unknown. | Roberto Pfeil/picture alliance via Getty Images Public health advocates said Commission officials’ actions were especially surprising because the EU has been one of the strongest supporters of the FCTC.  This year, the Commission proposed hiking EU-wide taxes on most tobacco products and setting minimum taxes for vapes and heated tobacco for the first time. Health Commissioner Olivér Várhelyi has pledged to drive e-cigarette taxes even higher; his tax counterpart, Wopke Hoekstra, has called vapes the “revenge of the tobacco industry.” The countries that PMI sought help with were outside the EU. Nearly all of them — Argentina, Brazil, India, Mexico, Singapore, Thailand, Turkey and Vietnam — had banned heated tobacco. Taiwan had what PMI described as a burdensome approval process. Japanese leaders were in discussions to raise taxes on heated tobacco to the same rate as cigarettes. Philip Morris International asked for the EU’s help in loosening restrictions or setting favorable tax rates on its IQOS product in 10 countries outside the EU. (Redactions by the European Commission. Highlighting by The Examination) PMI officials wanted people in those countries to be able to buy IQOS as easily as cigarettes. The company calls IQOS part of its “dream team” of alternative nicotine products, including e-cigarettes and nicotine pouches, that are meant to offset declining cigarette consumption.  So the company sought help in the EU’s distinctive 15-story glass trade building, the Charlemagne, in Brussels. PMI SEEKS HELP IN MEXICO Mexico was the first country that PMI sought help with, according to the documents. That country was a key market for IQOS, but a ban on vapes and heated tobacco was set to go into effect in December 2022.  In an investor meeting on Sept. 6, 2022, an analyst asked about IQOS’ “lack of success” in the Americas. Emmanuel Babeau, the company’s chief financial officer, blamed “some restrictions” in Mexico but said, “it’s going to be a very successful market for IQOS once we can really sell the device really without any issue.” That same day, company staff had an online meeting with EU officials to discuss the ban. It was one of several discussions about Mexico. After the ban went into effect, PMI sought more help from EU officials. In an April 3, 2023, email, an executive at the company’s Swiss office asked for another meeting, explaining that Mexico’s “business environment is still marked by uncertainty, judicial processes, interpretations, and doubtful, temporary and unclear administrative acts.”    After a ban on vapes and heated tobacco went into effect in Mexico, Philip Morris International sought more help from EU officials. (Redactions by the European Commission. Highlighting by The Examination) Soon after the email, European trade officials issued what is known as a barrier to trade notice, reporting Mexico’s IQOS ban as a potential trade treaty violation. PMI representatives and trade officials met later that month, when the company contended similar bans in Argentina, Brazil and Vietnam were trade barriers, according to a Commission report summarizing the meeting. The Commission spokesperson said it had acted in response to a formal complaint that “involved discriminatory treatment of like products” and that it did not undertake any further action regarding Mexico. Mexico’s Supreme Court struck down the ban in November 2024, allowing PMI to continue selling IQOS there.  The correspondence shows how PMI leveraged its status as a major European employer and exporter. The company employed more than 21,500 people in Europe as of 2023 and had 20 manufacturing sites there. In one email, a PMI representative told a European trade official that a meeting would be a “good opportunity to update you [on] the most recent data on EU exports in the tobacco sector and PMI’s investments in the EU.” OFFICIALS QUESTION TURKEY’S TAXES, RULES ON LOCAL TOBACCO EU officials also assisted PMI in trying to change rules on cigarettes.  In July 2023, a company representative complained to EU officials about Turkey’s cigarette tax, saying in an email that Turkey had “one of the highest ad valorem duty levels in the world.” The representative also flagged Turkey’s “local content” rule, which required that cigarettes made and sold in the country contain a certain amount of domestic tobacco. The PMI representative wrote that the company had “prepared a few suggestions” for the Commission’s upcoming report on Turkey’s economic and diplomatic relationships with the EU.  That report, which came out in November 2023, flagged Turkey’s taxes and the local content rule. That elicited the email from PMI thanking EU officials for their help. Meanwhile, the company was pushing European Commission officials to raise the local content rule again, but in a different forum: an upcoming World Trade Organization (WTO) review of Turkey’s trade policies. PMI provided EU trade officials with questions to ask Turkey. EU officials then submitted a question prior to the review, asking whether the local content requirement for tobacco and other industries would continue, according to meeting minutes. The Commission spokesperson did not directly answer questions from The Examination and POLITICO about its actions regarding Turkey. Turkey has not changed its requirements on local tobacco or its tax rate.  MEETINGS PART OF A MULTIMILLION-DOLLAR LOBBYING EFFORT The meetings are part of an industry lobby that spends $16.2 million (14 million euros) a year in the EU, according to a report by Contre-Feu and STOP, another anti-tobacco group, released Wednesday. Contre-Feu mapped a network of 49 organizations and companies, including Philip Morris International and British American Tobacco, that lobbied the European Commission and Parliament to weaken tobacco regulations and set lower taxes on new nicotine products, both within and outside the EU. (British American Tobacco did not respond to requests for comment.) The interactions between the tobacco industry and EU officials appear to be extensive, according to the documents. They include several dozen email exchanges and refer to at least nine meetings between EU officials and tobacco companies or industry-supported groups.  In addition to the six meetings with PMI, there were three other meetings with tobacco representatives. Trade staff met with three other companies and a tobacco trade group in March 2024 to hear their requests for more favorable tariff rules for new nicotine products. In a separate video conference, British American Tobacco asked trade staff to intervene at a WTO hearing over Saudi Arabia’s proposed tax hike on e-cigarette cartridges. (The EU did not take action, according to the documents.) And in a third meeting, the EU’s former agriculture commissioner, a Polish member of the EU parliament and two tobacco farming lobby groups discussed tobacco subsidies and the Commission’s position on the global tobacco treaty. Nathalie Darge, secretary general of Tobacco Europe, the trade group included in one of those meetings, said its input focused on technical requirements and that it wanted to “ensure legal certainty for operators and customs authorities.” One European Commission report recapping a meeting with PMI was sent to 32 trade department officials and staff, including EU representatives assigned to Mexico, Brazil, Argentina and Vietnam and division directors. Contre-Feu wrote that the dealings between government officials and tobacco representatives showed that “current rules to limit industry influence are falling short and European policymakers continue to be heavily lobbied by the tobacco industry and those working on its behalf.” PMI’s efforts are part of a long history of the tobacco industry using trade and investment pacts to expand markets and undermine health policies, said Suzanne Zhou, who works for the World Health Organization FCTC Knowledge Hub on Legal Challenges and a senior fellow at the Melbourne Law School in Australia. “Tobacco companies have lost the argument from a health perspective,” Zhou said. “So they are reframing the issue as a trade issue in the hopes that they can advance their interests in that forum instead.”  In the 1980s, the U.S. Trade Representative threatened sanctions if Japan, Taiwan, South Korea and Thailand didn’t open their markets to U.S. cigarette companies. A study later concluded that cigarette consumption in those four markets was nearly 10 percent higher than it would have been if they had remained closed to U.S. companies.  More recently, Australia and Uruguay faced trade litigation from the industry or industry-aligned governments over their tobacco control policies.  COMMISSION CRITICIZED FOR UNDISCLOSED MEETINGS Contre-Feu contended that the documents also show that EU officials didn’t disclose meetings with the industry when they should have. To aid countries in implementing the tobacco treaty, delegates wrote a set of guidelines. They state that when setting and implementing public health policies, interactions with the tobacco industry should be limited to what is strictly necessary for effective regulation. Interactions should be conducted in public and disclosed whenever possible. And the guidelines emphasize that “all branches of government” should be made aware of industry efforts to interfere with policies. The Commission spokesperson said that’s exactly what it does: “Meetings with the tobacco industry are avoided, unless they are strictly necessary. If the applicable conditions are met, meetings are held in a fully transparent manner and are appropriately documented.” But EU trade officials did not disclose any of these meetings on the website where the trade department reports such contacts. One batch of documents was released through a request for access; another batch was obtained by Contre-Feu. One of the meetings not disclosed by trade officials occurred in July 2023. Global health leaders were scheduled to meet that November to update the FCTC. The European Commission was considering supporting strict limitations on heated tobacco products.  A Commission report summarizing a July 19, 2023, meeting with PMI said that the company had “alerted” the Commission about language “calling on WHO members to adopt import bans on heated tobacco products.” The company asserted that EU tobacco policy should take into account WTO agreements, which the company has contended would preclude countries from banning IQOS.  Philip Morris International met with European Commission trade officials in July 2023 to discuss a proposed change to a global tobacco control treaty that would have banned heated tobacco. Though such meetings are supposed to be disclosed, this one wasn’t. (Redactions by the European Commission. Highlighting by The Examination) The documents don’t say anything about whether the Commission took action, and tobacco-friendly countries in the EU such as Italy and Greece pushed back against restrictive guidelines. But in the end, the Commission took no position on heated tobacco— a victory for the industry.  During the period covered by the documents, the EU required only high-ranking Commission officials to report meetings with companies or special-interest groups. In December 2024, the Commission tightened rules to require disclosure by additional staff. It’s unclear whether those rules would’ve required disclosure of these meetings.  Former EU ombudsman, Emily O’Reilly, found other instances in which the Commission didn’t disclose meetings with the tobacco industry, which she concluded failed to meet transparency rules required under international law.  Contre-Feu has urged the EU to tighten transparency guidelines even further by extending disclosure requirements to all staff, among other things. The group said in its report that the extensive lobbying and lack of disclosure “reveal either a repeated violation of the FCTC by the European Commission or, at the very least, an insufficient implementation of the treaty’s measures.” Mathieu Tourliere of Proceso contributed reporting. STOP has received support from Bloomberg Philanthropies, which also provides financial support to The Examination. The Examination operates independently and is solely responsible for its content. Correction: This story has been corrected to say that the report on tobacco industry lobbying was jointly published by Contre-Feu and STOP, and that STOP has received support from Bloomberg Philanthropies.

PARIS — Foreign pensioners who dream of spending their retirement under the sun in the French Riviera might have to reconsider their plans if their free health care gets axed. France wants non-European Union pensioners who are currently benefitting from the public health care system to start paying for it. It’s a move that would particularly affect American retirees, who have flocked to one of Europe’s most generous welfare states not only for its food, scenery and culture, but also, in some cases, for its world-class free health care. “It is a matter of fairness,” François Gernigon, the lawmaker who put forward the proposal, told POLITICO. “If you are a French citizen and you move to the U.S., you don’t have reciprocity, you don’t benefit from free social security.” Under French law, non-working citizens from outside the EU who have a long-stay visa and can prove they have sufficient pension or capital revenue (more than €23,000 annually) as well as private health care insurance can, after three months, obtain a carte vitale, which gives them free access to public health care. At that point, they can annul their previous private health insurance and benefit from the French one. It’s become a popular choice for U.S. retirees in recent years. But a majority of French lawmakers wants to put an end to that situation and make them pay a minimum contribution. France wants non-European Union pensioners who are currently benefitting from the public health care system to start paying for it. | Stephane de Sakutin/AFP via Getty Images That idea already passed in two branches of the parliament this month during budgetary discussions, and could see the light as soon as next year as the government has also backed it. Gernigon said that even U.S. expats have told him they don’t find the current situation normal and that they are ready to contribute more. Under the latest version of the proposal, as modified by the French Senate, only non-EU citizens who are not paying taxes or contributing to other welfare programs in France would be required to pay the new minimum contribution. Lawmakers have not fixed the contribution amount as it will be up to the government to do it later. For Gernigon, the value could vary depending on the level of health care coverage, but it would still be cheaper than private insurance in the U.S. or abroad which, he said, costs around €300 to €500 per month. The debate comes as France struggles to cut spending and bring down its budget deficit to 5 percent of gross domestic product next year. Gernigon said he had not yet evaluated how much revenue these new contributions would raise, but acknowledged that his main goal is fairness rather than fixing France’s budget problems. “This is not what is going to fill the hole in the social security budget,” he said.

The European Parliament on Wednesday called for a Europe-wide minimum threshold of 16 for minors to access social media without their parents’ consent. Parliament members also want the EU to hold tech CEOs like Mark Zuckerberg and Elon Musk personally liable should their platforms consistently violate the EU’s provisions on protecting minors online — a suggested provision that was added by Hungarian social-democrat member Dóra Dávid, who previously worked for Meta. The call for tougher rules on social media comes as several EU countries prepare more restrictions on social media for kids, following concerns about the effects on mental health and development of platforms like TikTok, Instagram, YouTube and others. Australia is in the process of implementing an age limit of 16 for users of social media accounts. The European Parliament backed an age limit in its report on how to better protect minors online, with 483 members voting in favor, 92 against and 86 abstaining. The report called on the European Commission to ensure that laws and measures on age checks are consistent across the bloc. Several countries are rushing to develop their own national checks. The bulk of the votes against and abstentions came from political groups on the right, who have argued that the report goes too far into EU countries’ competencies. The report was led by Danish social-democrat Christel Schaldemose, who also led Parliament’s work on the Digital Services Act, the EU’s content moderation regulation. The report could influence upcoming negotiations on EU law. The Commission is set to propose two legislative acts that will include heavy chunks on minor protections next year: the review of the Audiovisual Media Services Directive and a new Digital Fairness Act.

LONDON — Milkshakes and lattes will be subject to a sugar tax for the first time, U.K. Health Secretary Wes Streeting said Tuesday. Speaking ahead of the budget, Streeting said the government would remove the exemption that milk-based products currently have from the Soft Drinks Industry Levy in January 2028. The threshold at which the levy is imposed will also be lowered from 5 grams to 4.5 grams (g) per 100 milliliters (ml). Commonly dubbed the “sugar tax,” the levy, which was introduced in 2018 under the previous Conservative government, aims to reduce obesity and improve child health.  “Obesity robs children of the best possible start in life,” Streeting told MPs Tuesday. “It hits the poorest hardest — sets them up for a lifetime of problems.” Bottles and cartons of milkshakes, flavored milk,  sweetened yoghurt drinks, chocolate milk drinks, ready-to-drink coffees and milk substitute drinks will now be eligible for the levy. Drinks prepared in cafes and bars remain out of scope. The levy requires companies producing drinks that contain between 5g and 8g of sugar per 100ml to pay 19.4 pence per liter while drinks with 8g or more of sugar must pay 25.9 pence per liter. A government document published Tuesday said ministers expect the Treasury to raise between £40 million and £45 million a year as a result of the changes. The average sugar content in drinks has fallen by almost 50 percent since the levy’s introduction. It is associated with a fall in rotten tooth extractions in kids and an estimated 8 percent relative reduction in obesity levels among young girls. Sarah Woolnough, chief executive of the King’s Fund health think tank, said the measure was “not only common sense but also a quick win for government and, most importantly, for children and young people.”

LONDON — Boris Johnson, look away now. The 800-page report from Britain’s official inquiry into the coronavirus pandemic landed Thursday evening. It makes for grim reading for the country’s former prime minister, and much of his top team. Johnson has yet to respond. But the inquiry machine-guns a “too little, too late” government response to the early raging of the virus in 2020, a “toxic culture” in No. 10 Downing Street under the then-PM — and a serious failure to take heed of mistakes made. “Unless the lessons are learned and fundamental change is implemented, the human and financial cost and sacrifice of the Covid-19 pandemic will have been in vain,” the inquiry’s chair Heather Hallett, warned as the report was published Thursday. POLITICO pored over the full report to full out some of the biggest recipients of criticism. 1) BORIS JOHNSON COULDN’T MAKE HIS MIND UP Johnson is roundly criticized for failing to take the virus seriously enough in the initial months, for “oscillating” between different decisions on whether to actually introduce a lockdown, and for a host of controversial comments which caused offense to victims’ families when they came out during the inquiry’s evidence gathering process.  Particular criticism is reserved for Johnson as boss. The culture in Johnson’s No. 10 is described as “toxic and chaotic.” He is accused of “reinforcing” a workplace where the views of others, particularly women, were ignored — and of “encouraging” the behavior of his chief aide, Dominic Cummings. 2) DOMINIC CUMMINGS MADE THE CULTURE WAY WORSE — BUT SAVED LIVES Cummings arguably comes in for even harder criticism than Johnson. The report accuses the then-PM’s chief aide of having “materially contributed to the toxic and sexist workplace culture at the heart of the U.K. government.” It says he was a “destabilising influence” at a time of crisis — and that he was at fault for a “culture of fear, mutual suspicion and distrust” in government. Cummings is, however, praised by the report for his “commendable action” in bringing about a change in the government’s early pandemic strategy, which saved lives.  The culture in Boris Johnson’s No. 10 is described as “toxic and chaotic.” | Wiktor Szymanowicz/Getty Images 3) MATT HANCOCK WASN’T TRUSTED TO BE STRAIGHT WITH PEOPLE The short-lived reality TV star Matt Hancock is a figure of fun in U.K. politics these days — but he once held a role of enormous importance as health secretary during the pandemic.  For his contribution to Britain’s efforts as the virus initially spread, Hancock earns multiple instances of harsh criticism in the report.  Hancock is slammed for the “overenthusiastic impression” he gave to Johnson and top officials on his department’s readiness to face a pandemic, and it is said he gained a reputation for “overpromising and underdelivering.” The report even says concerns were raised about Hancock’s reliability and trustworthiness in meetings as Britain grappled with how to respond in the early days. The report ultimately says Britain should have locked down a week earlier than it did in March 2020, blaming officials, politicians and scientists for not moving quicker. It argues that the failure to do so came at a cost of around 23,000 lives. 4) CHRIS WORMALD SHOULD’VE DONE MORE Government officials were concerned that the Covid inquiry could prove embarrassing for Chris Wormald — who now serves as Prime Minister Keir Starmer’s cabinet secretary, a supremely powerful role at the head of Britain’s civil service. During the pandemic, Wormald was the top civil servant at Hancock’s Department of Health and Social Care, which is repeatedly criticized for giving false impressions on how prepared it was. While Hancock is widely blamed for this, the report does slam Wormald for failing to “rectify” the health secretary’s overconfidence. It says his failure to take any action “gave rise to additional concerns about the effectiveness of Wormald’s leadership.  That was as bad as it got for the current Cabinet Secretary, who might breathe a sigh of relief. Dominic Cummings is praised by the report for his “commendable action” in bringing about a change in the government’s early pandemic strategy, which saved lives. | Wiktor Szymanowicz/Getty Images 5) BITS OF THE BRITISH STATE ITSELF WERE SERIOUSLY SHAKY Whitehall itself comes in for some stark criticism, although the report stops short of a damning indictment of the whole system. The Cabinet Office — often referred to as the wiring at the center of government — is particularly slammed for failing to take more of a lead in early pandemic decision making. The report says that the government’s decision making structures “required improvement” during the pandemic, and that Johnson often sidelined his cabinet in favor of “centralised decision making.”  Brief sections on Welsh and Scottish governing cultures during the pandemic conclude that neither had real issues with relationships, though then-First Minister Nicola Sturgeon is accused of hogging the limelight with her daily lockdown press conferences, even if there’s praise for her “serious and diligent” approach to leading Scotland through the pandemic.

President Donald Trump’s deep cuts to foreign aid and plans to quit the UN body that coordinates efforts to combat disease are already splintering a global approach to public health strained by a once-in-a-century pandemic. Picking up the pieces is Tedros Adhanom Ghebreyesus’ job. Facing the loss of his biggest funder when the U.S. officially withdraws in January — America’s contribution was $640 million in 2023, the most recent year for which data is available — the World Health Organization’s director-general is trying to appeal to Trump. He’s fundraising and has launched the largest downsizing in the body’s history. He’s also warning the world that retreating from health cooperation right after a pandemic swept the globe doesn’t make any sense. He says the sudden aid cuts this year have cost lives. “If donors or others also see that what they give is no charity and it’s a security for everybody, I think we’ll be in a better situation,” Tedros told POLITICO. At the same time, he’s also found a silver lining that sounds like something he and Trump could agree on: America’s aid cuts are pushing countries that have depended on U.S. funding to become more self-reliant. The first African head of the WHO, Tedros has led the organization since 2017, including through the turmoil of Covid, two mpox outbreaks and yearslong negotiations on an international agreement aimed at improving the world’s response when the next pandemic comes. This year he’s had to reorganize the WHO leadership and let go of some 600 people out of roughly 10,000 employees after losing U.S. funding. Tedros outlined for POLITICO his efforts to address Trump’s complaints of “inappropriate political influence” at the WHO and “onerous payments,” and explained how he’s engaging Trump officials to get the administration to reconsider its withdrawal. This interview has been edited for length and clarity. How does the world move forward after the funding cuts and U.S. withdrawal? Solidarity is important, because unless we support each other, viruses could get an advantage. It’s not charity. By investing in it, countries are protecting themselves. On top of that, though, self reliance is also important, and each and every country should invest in health. If countries take ownership, I see a better future. Covid-19 has killed more people than any war in recent memory. We have to protect ourselves from a common enemy that can strike any time. It’s a matter of when, not if. Trump, Republicans and many global health experts say some countries have become dependent on the U.S. and the cuts will force them to become self-reliant. So were the cuts a good thing? It’s a good thing and it’s a bad thing. It’s a bad thing because people are dying. It’s a good thing for the long term, because countries are now waking up and saying: ‘OK, I have to mobilize domestic resources, and I have to cover the expenses for the health system.’ Of course, there is the immediate impact. If there was a transition, it would have been better to avoid the impact of the service cuts now in terms of morbidity or mortality. How have you engaged with the Trump administration and how did that go? We have done that formally, informally, because we think informal is more effective. And we ask for meetings, but for reasons they don’t tell us, it hasn’t happened yet. I’m not saying the door is closed. We’re in touch with [Health Secretary] Bobby Kennedy. He helped us in evacuating kids from Gaza. The president supported it. There are some kids who came here and many to other countries, especially kids with cancer. I would like to thank the president for the peace deal and also for helping kids with cancer in the evacuation. We have already reached more than 300 kids. Kennedy has said the WHO needs “radical reform.” Have you talked to him about what reforms he wants? We don’t know what kind of reform they want, but the U.S. says other countries should pay and they want to pay less. We agree. The WHO wants the U.S. and other major donors to pay less because we want the burden to be shared. We started the finance reform in 2017. In 2022, our member states, including the U.S., agreed to increase the assessed contributions by 50 percent. The largest increase in the past was 3 percent. And that helps the WHO prevent shocks like these in the future, and also to be more independent. And that, I think, is what the U.S. also wants, for the WHO to be independent. So if that’s what they want, then we’re doing it. So is this a good reason to leave? No. Trump administration officials have accused the WHO of being too close to China and helping it cover up the origins of Covid. Have you had conversations with Kennedy or other Trump officials about it? It’s outright wrong. I don’t know if people know that China is not happy with the position that we have on Covid’s origins, because our position is that all hypotheses are on the table, including spillover and lab leak. This position is very similar to the United States’. Based on science and evidence, actually, that’s the conclusion you can have. But when people don’t want to see what exactly are the facts and are interested in spreading misinformation and disinformation, what can you do? Are you worried other countries could follow the U.S. out of the WHO? I’m not worried that much. There are good reasons to stay, even for the U.S.

BRUSSELS — The European Union will take at least another year to figure out how to wield its powerful digital law to rein in the risks of ChatGPT. Use of the artificial intelligence chatbot has taken off in Europe, and OpenAI this month declared it has crossed an important threshold for regulatory scrutiny. The news that more than 120 million people use ChatGPT’s search function each month came as no surprise to the European Commission, two officials told POLITICO. Yet regulators have not yet figured out how to handle ChatGPT under the EU’s powerful Digital Services Act, in force since early 2024, to make sure platforms minimize their risks. A decision is only expected in mid-2026, according to a senior Commission official.  It’s a test case of the EU’s ability to handle the risks posed by large language models, which are fast becoming as ubiquitous in people’s lives as traditional search engines.   The sluggishness reflects the fact that the flagship digital law was designed before ChatGPT hit the mainstream, and its definitions don’t cleanly cover AI chatbots — leaving Brussels at risk of falling behind the curve in tackling these risks, even as they come into sharper focus.   OpenAI recently acknowledged that 1.2 million people each week have conversations with ChatGPT that suggest they are planning to take their own lives, and that “in some rare cases, the model may not behave as intended in these sensitive situations.”  “For an industry used to voluntary AI-safety frameworks and self-defined benchmarks, the DSA’s legally binding due diligence regime might be a tough reality check,” said Mathias Vermeulen, director at Brussels law firm and consultancy AWO Agency.   “OpenAI will have to step up its game significantly and won’t be able to get away with a simple copy/paste job of what it is currently doing,” he said.  The company didn’t respond to the criticism, instead pointing to its online help pages for information on how the company is complying with the DSA. It also noted the 120 million figure refers to people using ChatGPT’s search capabilities and not to the whole service. HOW WIDE TO GO  ChatGPT is already regulated under the EU’s AI Act. As of August, it must assess risks and mitigate them, risking fines up to €15 million if it doesn’t comply.  But user figures now put the chatbot into the big league, shooting way above the 45-million-monthly-user threshold for large platforms and search engines under the DSA.   Once it falls under the DSA, it risks fines up to 6 percent of its annual global turnover.   What requirements are placed on OpenAI and how it can fulfill them largely depend on what the Commission decides. | Philipp von Ditfurth/Getty Images ChatGPT was not “foreseen” by the DSA, but it “fits the language of the statute,” said Martin Husovec, a law professor at the London School of Economics.   Under the law’s structure, the EU designates sites as either very large online platforms and search engines — so-called VLOPs or VLOSEs — that must comply with the most stringent rules.   “A core question” is the scope of the designation for ChatGPT, said Joris Van Hoboken, a law professor focused on AI governance at the Vrije Universiteit Brussels.   The Commission could narrow it to ChatGPT’s search functionalities, to classify it as a search engine, or open the aperture to the entire offering — either as a platform or service.  What requirements are placed on OpenAI and how it can fulfill them largely depend on what the Commission decides.   OpenAI will have to figure out how serious the risks posed by its chatbot — including to elections and public health — are. It will have to mitigate them and inform the Commission in a long compliance report. The wider the designation, the wider that report has to be.  These risk assessments include “the design of their recommender systems and any other relevant algorithmic system,” according to the DSA law. That may prove difficult if the Commission targets the entire large language model underlying ChatGPT and its responses, as opposed to a narrower focus on search content served to users.  A narrow definition could also save OpenAI from one commitment: As a search engine, it wouldn’t have to provide a notice-and-action mechanism that allows users to flag content for takedown.   If a designation is made in mid-2026, that means DSA requirements would hit OpenAI in the final quarter of next year. OpenAI may also contest the designation, as other platforms have unsuccessfully done in the past, said João Pedro Quintais, associate professor of information law at the University of Amsterdam. Any disagreement would further lengthen the process. TOO MANY LAWS? Key questions remain about how the two major laws tackling AI and platforms overlap. The AI Act and the DSA were designed to coexist in cases where AI is integrated into digital services, such as Google’s AI Overviews, said Quintais. They weren’t designed with so-called vertically integrated AI providers like OpenAI in mind. But under the AI Act, features integrated into VLOPSEs, such as Google’s AI Overviews, are assumed to be compliant with the AI rules if they file DSA assessments. | Ashish Vaishnav/Getty Images The two laws are based on two different risk frameworks. Platforms have to assess which risk categories they fall under and adjust their services appropriately. These risk frameworks are not perfectly aligned; the AI Act says models need to be classified as unacceptable, high, limited, or minimal or no risk. Platforms and search engines need to determine and mitigate four types of “systemic risks,” such as civic integrity, elections, public health and fundamental rights.    But under the AI Act, features integrated into VLOPSEs, such as Google’s AI Overviews, are assumed to be compliant with the AI rules if they file DSA assessments.   That means that some aspects of regulation — for example, disinformation and deepfakes — are “taken over by the DSA,” said Quintais, while other risks, for example, the use of ChatGPT in hiring processes, stay within the AI Act.   There could be gaps in how the company assesses the risk of its services because the two frameworks do not perfectly align, said Quintais.  The company may also benefit from what is known as safe harbor laws, under which platforms and search engines are not liable for content posted on them, he added.