The UK has historically been a global leader in life sciences innovation, but recent statistics paint a worrying picture for medicines access. The right policy can start to reverse this. We are living in a time where the intersection between breakthrough science, technology and data insights has the potential to transform treatment options for some of the toughest health conditions faced by patients in the UK. The UK has long played a central role in driving innovation when it comes to healthcare, and at Johnson & Johnson (J&J) we were pleased to see some positive signs from the Government at the end of 2025, illustrating an intent to reverse a decade of decline of investment in how the UK values innovative treatments. It was a positive first step, but now the real work begins to enable us to deliver the best possible outcomes for UK patients. To achieve this, our focus must be on ensuring our health system is set up to match the pace and gain the benefits of innovation that science provides. We need a supportive medicines environment that fully fosters growth, because even the most pioneering drugs and therapies are only valuable if they can be accessed by patients when they need them most. > even the most pioneering drugs and therapies are only valuable if they can be > accessed by patients when they need them most. At J&J, we are proud to have been part of the UK’s health innovation story for more than a century. We believe that turning ambition into delivery requires a clearer focus on the foundations that enable innovation to reach patients. We have had a substantial and long-term economic presence, with our expertise serving as the grounds for successful partnerships with patients, healthcare providers, clinical researchers and the NHS. Recent national developments are a step in the right direction The UK Government’s recent announcements on the life sciences industry are an important move to help address concerns around medicines access, innovation and the UK’s international standing. This includes a welcome planned increase to the baseline cost-effectiveness threshold (the first change to be made since its introduction in the early 2000s). While it is crucial to get this implemented properly, this seems like a step in the right direction — providing a starting point towards meaningful policy reform, industry partnership and progress for patients. The true impact of stifling medicine innovation in the UK compared with our peers These positive developments come at a critical time, but they do not fix everything. Over the past decade, spending on branded medicines has fallen in real terms, even as the NHS budget has grown by a third.[i] Years of cost-containment have left the UK health system ill-prepared for the health challenges of today, with short-term savings creating long-term consequences. Right now, access to innovative medicines in the UK lags behind almost every major European country[ii]; the UK ranks 16th and 18th among 19 comparable countries for preventable and treatable causes of mortality.[iii]These are conditions for which effective medicines already exist. Even when new medicines are approved, access is often restricted. One year after launch, usage of innovative treatments in England is just over half the average of comparator countries such as France, Germany and Spain.[iv] The effect is that people living with cancer, autoimmune conditions and rare diseases wait longer to access therapies that are already transforming lives elsewhere in Europe. And even at its new level, the UK’s Voluntary Scheme for Branded Medicines Pricing, Access and Growth (VPAG) clawback rate remains higher than in comparable countries.[v] J&J is committed to working together to develop a new pricing and access framework that is stable, predictable and internationally competitive — enabling the UK to regain its position as a leading destination for life sciences. Seeing the value of health and medicines investment as a catalyst for prosperity and growth Timely access to the right treatment achieves two things; it keeps people healthy and prevents disease worsening so they can participate in society and a thriving economy. New research from the WifOR Institute, funded by J&J, shows that countries that allocate more resources to health — especially when combined with a skilled workforce and strong infrastructure — consistently achieve better outcomes.[vi] > Timely access to the right treatment achieves two things; it keeps people > healthy and prevents disease worsening so they can participate in society and > a thriving economy. The UK Government’s recent recognition of the need for long-term change, setting out plans to increase investment in new medicines from 0.3 percent of GDP to 0.6 percent over the next 10 years is positive. It signals a move towards seeing health as one of our smartest long-term investments, underpinning the UK’s international competitiveness by beginning to bring us nearer to the levels in other major European countries. This mindset shift is critical to getting medicines to patients, and the life sciences ecosystem, including the pharmaceutical sector as a cornerstone, plays a pivotal role. It operates as a virtuous cycle — driven by the generation, production, investment in, access to and uptake of innovation. Exciting scientific developments and evolving treatment pathways mean that we have an opportunity to review the structures around medicines reimbursement to ensure they remain sustainable, competitive and responsive. At J&J, we have the knowledge and heritage to work hand-in-hand with the Government and all partners to achieve this. Together, we can realise the potential of medicine innovation in the UK Patients have the right to expect that science and innovation will reach them when they need it. Innovative treatments can be transformative for patients, meaning an improved quality of life or more precious time with loved ones. We fully support the Government’s ambitions for life sciences and the health of the nation. Now is the moment to deliver meaningful change — the NHS, Government and all system partners, including J&J, must look at what valuing innovation actually means when it comes to modernising the frameworks and mechanisms that support access and uptake. Practical ways to do this include: * Establishing a new pricing and access framework that is stable, predictable and internationally competitive. * Evolving medicines appraisal methods and processes, to deliver on the commitments of the UK-US Economic Prosperity Deal. * Adapting thresholds and value frameworks to ensure they are fit for the future — in the context of wider system pressures, including inflation, and the evolution of medical innovation requiring new approaches to assessment and access. > the NHS, Government and all system partners, including J&J, must look at what > valuing innovation actually means when it comes to modernising the frameworks > and mechanisms that support access and uptake. By truly recognising the value of health as an investment, rather than as a cost, we can return the UK to a more competitive position. The direction of travel is positive. At J&J, we stand ready to work in partnership to help ensure the UK is once again the best place in the world to research, develop and access medicines. Follow Johnson & Johnson Innovative Medicine UK on LinkedIn for updates on our business, our people and our community. CP-562703 | January 2026 -------------------------------------------------------------------------------- [i] House of Commons Library (2026). ‘NHS Funding and Expenditure’ Research Briefing. Available at: https://commonslibrary.parliament.uk/research-briefings/sn00724/ (Accessed January 2026). [ii] IQVIA & EFPIA (2025). EFPIA Patients W.A.I.T Indicator 2024 Survey. Available at: https://efpia.eu/media/oeganukm/efpia-patients-wait-indicator-2024-final-110425.pdf. (Accessed January 2026) [iii] The Kings Fund (2022). ‘How does the NHS compare to the health care systems of other countries?’ Available at: https://www.kingsfund.org.uk/insight-and-analysis/reports/nhs-compare-health-care-systems-other-countries (Accessed January 2026) [iv] Office for Life Sciences (2024). Life sciences competitiveness indicators 2024: summary. Available at: https://www.gov.uk/government/publications/life-sciences-sector-data-2024/life-sciences-competitiveness-indicators-2024-summary (Accessed January 2026). [v] ABPI. VPAG payment rate for newer medicines will be 14.5% in 2026. December 2025. Available at: https://www.abpi.org.uk/media/news/2025/december/vpag-payment-rate-for-newer-medicines-will-be-145-in-2026/. (Accessed January 2026). [vi] WifOR Institute (2025). Healthy Returns: A Catalyst for Economic Growth and Resilience. Available at: https://www.wifor.com/en/download/healthy-returns-a-catalyst-for-economic-growth-and-resilience/?wpdmdl=360794&refresh=6942abe7a7f511765977063. (Accessed January 2026).

January 2026 I GB-73006 Disclaimer  POLITICAL ADVERTISEMENT  * This is sponsored content from AstraZeneca.  * The advertisement is linked to public policy debates on the future of cardiovascular care in the UK.  * This content has been paid for and developed by AstraZeneca UK  Cardiovascular disease (CVD) has shaped the nation’s health for generations. It remains a leading cause of death and a major driver of long-term sickness, yet it is also one of the most preventable. Today, 8 million people in the U.K. live with CVD, and early deaths from CVD in England have reached a 14-year high.1,2 The reality is stark: without urgent action, one million more could live with CVD by 2030 — and two million by 2040.1  Tackling CVD is not only a moral imperative, it’s an economic necessity. In the U.K., 2.5 million working-age people are economically inactive due to long-term sickness, and CVD contributes to long-term sickness at unprecedented levels3 Each year, CVD costs the U.K. economy an estimated £24 billion, straining public finances, dampening productivity and widening inequalities.4  In July 2023, AstraZeneca convened the CVD-risk coalition — with charities, clinical organizations and patient groups — to shape a coordinated response to these trends.   Today, the coalition has published Getting to the heart of the matter: A national action plan for tackling cardiovascular disease5 — a blueprint for decisive action and a call for the government and the NHS to confront CVD head on. It has a clear message: the tools exist to tackle this challenge, but we need leadership, investment, and a focus on prevention and early intervention to unlock meaningful change.  > the tools exist to tackle this challenge, but we need leadership, investment, > and a focus on prevention and early intervention to unlock meaningful change. Diagnosis and prevention gaps we cannot afford   CVD often arises from detectable and treatable conditions: hypertension, high cholesterol, diabetes, chronic kidney disease. Yet millions remain undiagnosed. Six million people in the U.K. don’t know they have high blood pressure — a silent driver of heart attacks, strokes and kidney disease.6,7   This systemic diagnosis gap is not the result of a lack of evidence or clinical consensus; rather, the longstanding pressure on primary and community care, fragmentation across services, and declining investment in public health. Between 2015/16 and 2023/24, funding for key preventative services — including smoking cessation and adult obesity support — fell sharply in real terms.8  Additionally, secondary prevention remains patchy across England. Despite clear treatment guidance from NICE, less than half of patients with CVD meet recommended cholesterol levels. Almost 30 percent of hypertension patients are not meeting recommended blood pressure targets or don’t have a recent blood pressure measurement in their records.9   The consequences are clear: progress on CVD outcomes has stalled, premature deaths are rising and those in England’s most deprived areas are four times more likely to die prematurely from CVD than those in the least deprived.10  > progress on CVD outcomes has stalled, premature deaths are rising and those in > England’s most deprived areas are four times more likely to die prematurely > from CVD than those in the least deprived We must place prevention at the heart of our health system.  A vision for proactive, personalized cardiovascular care  Early CVD prevention and treatment save lives and money. It benefits patients, reduces NHS pressure and strengthens the UK’s economic resilience.   A 20 percent reduction in CVD incidence could save the NHS £1.1 billion annually within five years and place 60-70,000 more people into work.11 Recent CVDACTION modeling suggests that even modest near-term improvements in treatment could prevent approximately 61,000 events of heart attack, stroke, heart failure admission and end-stage kidney disease in three years.12   This is not theoretical. We know what integrated, proactive models can do.   Unlocking the power of data and digital tools  Platforms like CVDPREVENT and CVDACTION already demonstrate how data-driven insights from GP records can flag undiagnosed or undertreated patients — enabling clinicians to prioritize, optimize treatment and thus prevent avoidable heart attacks and strokes every year.13,14  Additionally, as the NHS App becomes a digital ‘front door’, there is an opportunity to deliver personalized risk information, lifestyle guidance and seamless access to services.  But digital transformation requires investment in workforce capability, interoperability between systems and national procurement frameworks that can scale at pace.  Tom Keith Roach A neighborhood approach to prevention  Joined-up neighborhood services — across community pharmacies, general practice, specialist teams and local authorities — could identify risk earlier, manage long-term conditions holistically and reduce avoidable admissions.   Community pharmacy hypertension screening has delivered over two million blood pressure checks in a single year, identifying thousands previously unaware of their risk.15    The LUCID program, developed as part of a joint working initiative between AstraZeneca and University Hospitals Leicester, has shown that integrated care across nephrology specialists and primary care can identify high-risk chronic kidney disease patients and optimize their treatment, reducing emergency admissions and long-term NHS costs.16    But to truly deliver change, resources must be rebalanced toward primary and community care. Cardiovascular prevention cannot be driven from hospitals alone. The neighborhood service must be properly resourced, with contracts and incentives aligned to prevention and outcomes, not activity.  A whole-system effort to transform lives and the economy  The forthcoming Modern Service Framework for CVD, promised within the Government’s 10 Year Health Plan, presents a critical opportunity. This framework must: * Embed prevention into every level of care  * Enable earlier diagnosis using digital and community-based tools  * Support optimal treatment through data and workforce innovation  * Define clear national priorities backed by accountability  CVD is a health challenge and a national prosperity challenge. We cannot afford rising sickness, worsening inequalities, and an NHS stretched by late-stage, preventable disease. The link between health and wealth has never been clearer: investing in CVD prevention will deliver both immediate and long-term returns.  > The link between health and wealth has never been clearer: investing in CVD > prevention will deliver both immediate and long-term returns. The action plan published today provides a clear, evidence-based roadmap.5 It calls for:  * National clinical and political leadership  * Ambitious targets, including a 20 percent reduction in incidence  * Investment in prevention and the expansion of Health Checks  * Improved uptake of effective treatments, guided by data  * Digital and diagnostic excellence across neighborhoods  * Partnership working at every level  A call to action  CVD has affected too many lives for too long. But progress is within reach. The decisions we make today will determine whether the next decade is defined by a widening crisis or a renewed national effort to prevent avoidable illness.  AstraZeneca stands ready to support the government, the NHS and partners to deliver the change our country needs. The time to act is now.  Find out more at astrazeneca.co.uk   References [1] British Heart Foundation. UK factsheet. January 2026. Available at: https://www.bhf.org.uk/-/media/files/for-professionals/research/heart-statistics/bhf-cvd-statistics-uk-factsheet-jan26.pdf.Last accessed: January 2026. [2] British Medical Journal. Early deaths from cardiovascular disease reach 14 year high in England. British Medical Journal. January 2024. Available at: https://www.bmj.com/content/384/bmj.q176. Last accessed: December 2025.   [3] Rising ill-health and economic inactivity because of long-term sickness, UK: 2019 to 2023. Office for National Statistics. Available at: https://www.ons.gov.uk/employmentandlabourmarket/peoplenotinwork/economicinactivity/articles/risingillhealthandeconomicinactivitybecauseoflongtermsicknessuk/2019to2023. Last accessed: December 2025.   [4] UK Government. UIN HL5942. March 2025. Available at: https://questions-statements.parliament.uk/written-questions/detail/2025-03-18/hl5942. Last accessed: December 2025. [5] Getting to the heart of the matter. A national action plan for tackling cardiovascular disease. AstraZeneca. 2025. Available at: https://qr.short.az/r/Getting-to-the-heart-of-the-matter. Last accessed: January 2026. [6] Blood Pressure UK. Why is know your numbers! needed?. Available at: https://www.bloodpressureuk.org/know-your-numbers/why-is-know-your-numbers-needed/. Last accessed: December 2025.   [7] Department of Health and Social Care. Get your blood pressure checked. March 2024. Available at: https://www.gov.uk/government/news/get-your-blood-pressure-checked. Last accessed: December 2025. [8] The Health Foundation. Investing in the public health grant. February 2025. Available at: https://www.health.org.uk/reports-and-analysis/analysis/investing-in-the-public-health-grant. Last Accessed January 2026.  [9] CVDPREVENT. CVDP Annual Audit Report 2025. March 2025. Available at: https://static1.squarespace.com/static/65eafc36395e4d64e18a3232/t/6937fb8666a6d23761182c05/1765276550824/CVDPREVENT+Fifth+Annual+Report.pdf Last Accessed: January 2026. [10] Public Health England. Health matters: preventing cardiovascular disease. February 2019. Available at: https://www.gov.uk/government/publications/health-matters-preventing-cardiovascular-disease/health-matters-preventing-cardiovascular-disease. Last accessed: December 2025. [11] Tony Blair Institute for Global Change. The economic case for Protect Britain, a preventative health care delivery programme. July 2024. Available at: https://assets.ctfassets.net/75ila1cntaeh/7CcuI38C3mxgps6lC9O2iA/825bf2a41f933cf719459087c1599190/Tony_Blair_Institute_for_Global_Change__The_Economic_Case_for_Protect_Britain__July_2024.pdf Last accessed January 2026 [12] Into-Action.Health. Powering the prevention shift – The CVDACTION impact model.  September 2025. Available at: https://www.into-action.health/_files/ugd/ee4262_81e75612f13e403aab6594727b338771.pdf. Last Accessed January 2026. [13]Data & Improvement Tool. CVDPREVENT. Available at: https://www.cvdprevent.nhs.uk/. Last accessed: December 2025.   [14] Transforming the prevention of CVD. CVDACTION. Health Innovation Network. Available at: https://thehealthinnovationnetwork.co.uk/case_studies/transforming-the-prevention-of-cvd/. Last accessed: December 2025. [15] NHS Business Services Authority. Dispensing contractors’ data. Available at: https://www.nhsbsa.nhs.uk/prescription-data/dispensing-data/dispensing-contractors-data . Last Accessed January 2026 [16] AstraZeneca UK. Executive summary of Joint Working outputs. Pan Leicester Integrated Chronic Kidney Disease (CKD) Transformation Project: a quality improvement project to identify CKD patients in primary care suitable for virtual management to improve patient outcomes. (LUCID). July 2024. Available at: https://www.astrazeneca.co.uk/content/dam/intelligentcontent/unbranded/astrazeneca/uk/en/pdf/work-with-nhs-uk/Executive_Summary_of_Joint_Working_Outputs_Pan_Leicester.pdf. Last Accessed: January 2026

The term ‘moonshot’ references the NASA moon missions of the 1960s, describing visionary, ambitious and innovative undertakings that redefined the boundaries of science and society. In recent times, it’s a phrase that the European Commission has used in the draft Horizon Europe 2028-2034 research initiative to describe building the Future Circular Collider or achieving commercial nuclear fusion. What the phrase does not connote or encompass is the continuation of a status quo that fails to meet the needs of European citizens. As the Commission rightly points out, the EU is suffering from “an alarming failure to translate innovation into products or services”. This problem is particularly acute in the context of health research, an arena in which only a very small proportion of pre-clinical discoveries leads to actual advances for patients. This has been referred to as the “valley of death” in drug discovery, with an estimated 95 percent of promising drugs failing at clinical stage. A large percentage of this failure rate is a result of ‘animal models’ of human disease and toxicity that simply do not translate from the laboratory to human beings in the real world. > Achieving a high degree of translational relevance in biomedical models would > be a true moonshot project, with its embrace of human biology as the new gold > standard. Achieving a high degree of translational relevance in biomedical models would be a true moonshot project, with its embrace of human biology as the new gold standard and a shift in research focus and funding to augment and enhance the existing toolbox of human-specific nonanimal methods (NAMs). The EU stands on the threshold of such a moment: a €1 billion investment in a NAMs Moonshot Programme under Horizon Europe 2028-2034. Such a programme would represent a transformative, coordinated effort to accelerate the development, validation and adoption of more human-relevant research methods across the full innovation cycle, from discovery to deployment. Europe’s current investment trajectory risks leaving it behind. Under the Choose Europe for Life Sciences strategy announced in July, the Commission pledged €10 billion annually through EU funding programs to position the EU as a global leader in health and life sciences. Yet only €50 million of that investment is earmarked for NAMs in 2026-27, not nearly enough to drive EU innovation or strengthen EU competitiveness. FG Trade/Getty Images By contrast, other global actors have not only recognised the strategic value of NAMs, but they have also put forward their money. The United States launched the NIH Complement-ARIE initiative in 2024, a 10-year, US$400 million programme to advance non-animal research methods, while the Netherlands established the Utrecht Ombion Centre for Animal-Free Biomedical Translation in 2025 with a €245 million investment. The current €50 million reserved for NAMs in the Commission’s strategy is not enough to get the job done. With Horizon Europe 2028-2034 doubling its budget and foregrounding a set of visionary moonshot projects, there’s a window of opportunity for the EU to strengthen NAMs funding and secure a leadership role in human-relevant, next-generation life sciences. A structured, €1 billion EU-wide NAMs Moonshot Programme, grounded in the principles of scientific excellence, strategic autonomy and societal benefit is in close alignment with the European Research Area Action on NAMs, which focuses on validation, infrastructure, education and awareness. > With Horizon Europe 2028-2034 doubling its budget and foregrounding a set of > visionary moonshot projects, there’s a window of opportunity for the EU to > strengthen NAMs funding and secure a leadership role in human-relevant, > next-generation life sciences. To set a NAMs moonshot up for success, validation capacity (i.e., proving NAMs work reliably and accurately for their intended purpose) must be prioritised, along with solid infrastructure and training to build scientific credibility and technological scalability. Education and awareness initiatives are essential to develop a skilled workforce and sustain long-term adoption of these approaches. This investment would drive scientific innovation and strengthen EU competitiveness. NAMs and human-centred experimental design must be embedded into educational curricula across disciplines. Inter- and transdisciplinary learning, integrating complex in vitro models, in silico tools and artificial intelligence (AI) will equip future researchers with the knowledge and skills needed to lead this scientific transition. Europe should promote open-access research repositories, supported by AI technologies, to foster collaboration and knowledge sharing across sectors. Establishing a coordinated European NAMs Integration Hub would enhance alignment, build synergies and accelerate the uptake of human-relevant approaches across academia, industry, regulators and international partners. This would help avoid fragmentation while preventing the formation of new silos, enabling full knowledge sharing and cooperation. > Just as humankind once looked to the moon and saw immense possibilities, > Europe must now be bold and invest in a future for health research that > delivers for its citizens. Social sciences and humanities must also play a central role in funded health research, ensuring fair partnerships with patient groups, regulators and other key interest holders. This will help align research with real-world needs, clarify intended outcomes and ensure the feasibility and social relevance of new approaches. Just as humankind once looked to the moon and saw immense possibilities, Europe must now be bold and invest in a future for health research that delivers for its citizens. A €1 billion investment in human-specific NAMs would support improved patient outcomes, greener and more ethical research, and enhanced EU competitiveness. It would bring cutting-edge science closer to the lives it seeks to improve and place Europe in the driving seat of the next revolution in human health. -------------------------------------------------------------------------------- Disclaimer POLITICAL ADVERTISEMENT * The sponsor is Humane World for Animals * The ultimate controlling entity is Humane World for Animals More information here.

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

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

By ALEX PERRY in Paris Illustrations by Julius Maxim for POLITICO This article is also available in French When Patrick Pouyanné decided to spend billions on a giant natural gas field in a faraway warzone, he made the call alone, over a single dinner, with the head of a rival energy company. Pouyanné, the chairman and CEO of what was then called Total, was dining with Vicki Hollub, CEO of Houston-based Occidental Petroleum. It was late April 2019, and Hollub was in a David and Goliath battle with the American energy behemoth Chevron to buy Anadarko, like Occidental a mid-sized Texan oil and gas explorer. The American investor Warren Buffett was set to back Hollub with $10 billion, but it wasn’t enough. So Hollub flew to Paris to meet Pouyanné. Hollub’s proposal: Pouyanné would pitch in $8.8 billion in exchange for Anadarko’s four African gas fields, including a vast deep-sea reserve off northern Mozambique, an area in the grip of an Islamist insurgency. The Frenchman, who had previously approached Anadarko about the same assets, said yes in a matter of minutes. Advertisement “What are the strengths of Total?” Pouyanné explained to an Atlantic Council event in Washington a few weeks later. “LNG,” he went on, and the “Middle East and Africa,” regions where the company has operated since its origin in the colonial era. “So it’s just fitting exactly and perfectly.” Total, “a large corporation,” could be “so agile,” he said, because of the efficacy of his decision-making, and the clarity of his vision to shift from oil to lower-emission gas, extracted from lightly regulated foreign lands. In the end, “it [was] just a matter of sending an email to my colleague [Hollub],” he added. “This is the way to make good deals.” Six years later, it’s fair to ask if Pouyanné was a little hasty. On Nov. 17, a European human rights NGO filed a criminal complaint with the national counterterrorism prosecutor’s office in Paris accusing TotalEnergies of complicity in war crimes, torture and enforced disappearances, all in northern Mozambique. The allegations turn on a massacre, first reported by POLITICO last year, in which Mozambican soldiers crammed about 200 men into shipping containers at the gatehouse of a massive gas liquefaction plant TotalEnergies is building in the country, then killed most of them over the next three months. The complaint, submitted by the nonprofit European Centre for Constitutional and Human Rights (ECCHR), alleges that TotalEnergies became an accomplice in the “so-called ‘container massacre’” because it “directly financed and materially supported” the Mozambican soldiers who carried out the executions, which took place between June and September 2021. “TotalEnergies knew that the Mozambican armed forces had been accused of systematic human rights violations, yet continued to support them with the only objective to secure its facility,” said Clara Gonzales, co-director of the business and human rights program at ECCHR, a Berlin-based group specializing in international law that has spent the past year corroborating the atrocity. In response to the complaint, a company spokesperson in Paris said in a written statement: “TotalEnergies takes these allegations very seriously” and would “comply with the lawful investigation prerogatives of the French authorities.” Last year, in response to questions by POLITICO, the company — through its subsidiary Mozambique LNG — said it had no knowledge of the container killings, adding that its “extensive research” had “not identified any information nor evidence that would corroborate the allegations of severe abuses and torture.” This week, the spokesperson repeated that position. Advertisement Asked in May in the French National Assembly about the killings, Pouyanné dismissed “these false allegations” and demanded the company’s accusers “put their evidence on the table.” Questioned about the complaint on French television this week, he again rejected the allegations and described them as a “smear campaign” motivated by the fact that TotalEnergies produces fossil fuels. The war crimes complaint is based on POLITICO’s reporting and other open-source evidence. In the last year, the container killings have been confirmed by the French newspaper Le Monde and the British journalism nonprofit Source Material. The British Mozambique expert Professor Joseph Hanlon also said the atrocity was “well known locally,” and an investigation carried out by UK Export Finance (UKEF) — the British state lender, which is currently weighing delivery of a $1.15 billion loan to Total’s project — has heard evidence from its survivors.  The massacre was an apparent reprisal for a devastating attack three months earlier by ISIS-affiliated rebels on the nearby town of Palma, just south of the border with Tanzania, which killed 1,354 civilians, including 55 of Total’s workforce, according to a house-to-house survey carried out by POLITICO. Of those ISIS murdered, it beheaded 330. TotalEnergies has previously noted that Mozambique has yet to issue an official toll for the Palma massacre. In March, a French magistrate began investigating TotalEnergies for involuntary manslaughter over allegations that it abandoned its contractors to the onslaught.  After the jihadis left the area in late June, Mozambican commandos based at Total’s gas concession rounded up 500 villagers and accused them of backing the rebels. They separated men from women and children, raped several of the women, then forced the 180-250 men into two metal windowless shipping containers that formed a rudimentary fortified entrance to Total’s plant. There, the soldiers kept their prisoners in 30-degree-Celsius heat for three months. According to eleven survivors and two witnesses, some men suffocated. Fed handfuls of rice and bottle caps of water, others starved or died of thirst. The soldiers beat and tortured many of the rest. Finally, they began taking them away in groups and executing them. Only 26 men survived, saved when a Rwandan intervention force, deployed to fight ISIS, discovered the operation. A second house-to-house survey conducted by POLITICO later identified by name 97 of those killed or disappeared. Along with the new ECCHR complaint and the British inquiry, the killings are the subject of three other separate investigations: by the Mozambican Attorney General, the Mozambican National Human Rights Commission, and the Dutch government, which is probing $1.2 billion in Dutch state financing for TotalEnergies’ project. This week’s complaint was lodged with the offices of the French National Anti-Terrorism Prosecutor, whose remit includes war crimes. The prosecutor will decide whether to open a formal inquiry and appoint an investigating magistrate.  Should the case move ahead, TotalEnergies will face the prospect of a war crimes trial.  Such an eventuality would represent a spectacular fall from grace for a business that once held a central place in French national identity and a CEO whose hard-nosed resolve made him an icon of global business. Should a French court eventually find the company or its executives liable in the container killings, the penalties could include fines and, possibly, jail terms for anybody indicted. How did TotalEnergies get here? How did Patrick Pouyanné? ‘POUYANNÉ PETROLEUM’ Born in Normandy in 1963, the son of a provincial customs official and a post office worker, Pouyanné elevated himself to the French elite by winning selection to the École Polytechnique, the country’s foremost engineering university, and then the École des Mines, where France’s future captains of industry are made. Following a few years in politics as a minister’s aide, he joined the French state petroleum company Elf as an exploration manager in Angola in 1996. After moving to Qatar in 1999 as Elf merged with Total, Pouyanné ascended to the top job at Total in 2014 after his predecessor, Christophe de Margerie, was killed in a plane crash in Moscow. Pouyanné led by reason, and force of will. “To be number one in a group like Total … is to find yourself alone,” he said in 2020. “When I say ‘I don’t agree,’ sometimes the walls shake. I realize this.” A decade at the top has seen Pouyanné, 62, transform a company of 100,000 employees in 130 countries into a one-man show — “Pouyanné Petroleum,” as the industry quip goes. His frequent public appearances, and his unapologetically firm hand, have made him a celebrated figure in international business. “Patrick Pouyanné has done an extraordinary job leading TotalEnergies in a complex environment, delivering outstanding financial results and engaging the company in the energy transition quicker and stronger than its peers,” Jacques Aschenbroich, the company’s lead independent director, said in 2023. Advertisement Marc-Antoine Eyl-Mazzega, director of energy and climate at the French Institute of International Relations, agreed. “His involvement is his strength,” he said. “He’s able to take a decision quickly, in a much more agile and rapid way.” Still, Eyl-Mazzega said, “I’m not sure everyone is happy to work with him. You have to keep up the pace. There are often departures. He’s quite direct and frank.”  Among employees, Pouyanné’s lumbering frame and overbearing manner has earned him a nickname: The Bulldozer. The moniker isn’t always affectionate. A former Total executive who dealt regularly with him recalled him as unpleasantly aggressive, “banging fists on the table.” The effect, the executive said, has been to disempower the staff: “The structure of Total is trying to guess what Pouyanné wants to do. You can’t make any decisions unless it goes to the CEO.” In a statement to POLITICO, TotalEnergies called such depictions “misplaced and baseless.” ‘DON’T ASK US TO TAKE THE MORAL HIGH GROUND’ What’s not in dispute is how Pouyanné has used his authority to shape Total’s answer to the big 21st-century oil and gas puzzle: how to square demand for fossil fuels with simultaneous demands from politicians and climate campaigners to eliminate them. His response has been diversification, moving the company away from high-emission fuels towards becoming a broad-based, ethical energy supplier, centered on low-carbon gas, solar and wind, and pledging to reach net-zero emissions by 2050. The change was symbolized by Pouyanné’s renaming of the company TotalEnergies in 2021. A second, more unsung element of Pouyanné’s strategy has been moving much of his remaining fossil fuel operation beyond Western regulation.  Speaking to an audience at Chatham House in London in 2017, he said the catalyst for his move to favor reserves in poorer, less tightly policed parts of the planet was the penalties imposed on the British energy giant BP in the United States following the 2010 Deepwater Horizon blowout, in which 11 men died and an oil slick devastated the Gulf of Mexico coast. Pouyanné declared that the fines — between $62 billion and $142 billion, depending on the calculation used — represented an excessive “legal risk” to oil and gas development in the West. While other, more troubled territories came with their share of dangers, Pouyanné put the cost of failure of any project outside the West at a more manageable $2 to $3 billion, according to his Chatham House remarks. As a way of assessing risk, it was efficient. “Other players would spend a lot of money on consultancies and write 70 reports to conclude that a project is risky,” Eyl-Mazzega said. “Pouyanné, on the other hand, is prepared to take risks.” Asked by the French Senate in 2024 how he chose where to invest, however, Pouyanné admitted that his math was strictly about the bottom line. “Don’t ask us to take the moral high ground,” he said. ‘A COLLAPSE WILL NOT PUT TOTAL IN DANGER’ The first oil and gas prospectors arrived in northern Mozambique in 2006 as part of a Western effort to broaden supply beyond the Middle East. When Anadarko found gas 25 miles out to sea in 2010, the talk was of Mozambique as the new Qatar. At 2.6 million acres, or about a third of the size of Belgium, Rovuma Basin Area 1 was a monster, thought to hold 75 trillion cubic feet of gas, or 1 percent of all global reserves. An adjacent field, Area 4, quickly snapped up by ExxonMobil, was thought to hold even more. To cope with the volume of production, Anadarko’s Area 1 consortium drew up a plan for a $20 billion onshore liquefaction plant. Together with ExxonMobil’s field, the cost of developing Mozambique’s gas was estimated at $50 billion, which would make it the biggest private investment ever made in Africa. But in 2017, an ISIS insurgency emerged to threaten those ambitions.  By the time Pouyanné was preparing to buy Anadarko’s 26.5 percent share in Area 1 two years later, what had begun as a ragtag revolt against government corruption in the northern province of Cabo Delgado had become a full-scale Islamist rebellion.  Insurgents were taking ever more territory, displacing hundreds of thousands of people and regularly staging mass beheadings. Even under construction, the gas plant was a regular target. It was run by Europeans and Americans, intending to make money for companies thousands of miles away while displacing 2,733 villagers to build their concession and banning fishermen from waters around their drill sites. After several attacks on plant traffic to and from the facility, in February 2019, the militants killed two project workers in a village attack and dismembered a contract driver in the road.  A further risk had its origins in a ban on foreigners carrying guns. That made the plant reliant for security on the Mozambican army and police, both of which had a well-documented record of criminality and repression. Initially, Pouyanné seemed unconcerned. The gas field was outside international law, as Mozambique had not ratified the Rome Statute setting up the International Criminal Court. And Pouyanné appeared to see the pursuit of high-risk, high-reward projects almost as an obligation for a deep-pocketed corporation, telling the Atlantic Council in May 2019, soon after he agreed the Mozambique deal, that Total was so big, it didn’t need to care — at least, not in the way of other, lesser companies or countries. “We love risk, so we have decided to embark on the Mozambique story,” he said. “Even if there is a collapse, [it] will [not] put Total in danger.” Advertisement In September 2019, when Total’s purchase was formally completed, the company declared in a press release: “The Mozambique LNG project is largely derisked.” In one of several statements to POLITICO, TotalEnergies explained the term echoed the boss’s focus on “the project’s commercial and financial fundamentals. To infer this was a dismissal of security concerns amounts to a fundamental misunderstanding of the way the sector operates.” Still, for workers at the project, it was an arresting statement, given that a Mozambique LNG worker had recently been chopped to pieces. Around the same time, the project managers at Anadarko, many of whom were now working for Total, tried to warn their new CEO of the danger posed by the insurgency. It was when they met Pouyanné, however, that “things then all started to unwind,” said one. Pouyanné regaled the team who had worked on the Mozambique project for years with a speech “on how brilliant Total was, and how brilliantly Total was going to run this project,” a second executive added. Pouyanné added he had “a French hero” running the company’s security: Denis Favier who, as a police commander, led a team of police commandos as they stormed a hijacked plane on the tarmac at Marseille in 1994, and in 2015, as France’s most senior policeman, commanded the operation to hunt and kill the Islamist brothers who shot dead 12 staff at the Charlie Hebdo newspaper in Paris. “This is easy for him,” Pouyanné said. Asked about the transition from Anadarko to Total, the company maintained it was responsive to all concerns expressed by former Anadarko workers. “We are not aware of any such dismissal of security concerns by TotalEnergies or its senior management,” the company said. “It is incorrect to state that advice from the ground was not listened to.” Still, after meeting Pouyanné, the old Anadarko team called their Mozambique staff together to brief them on their new boss. “Well, holy shit,” one manager began, according to a person present. “We’ve got a problem.” ‘VERY VULNERABLE’ A third former Anadarko staffer who stayed on to work for Total said that on taking over, the company also put on hold a decision to move most contractors and staff from hotels and compounds in Palma to inside its fortified camp — a costly move that Anadarko was planning in response to deteriorating security. “This was a danger I had worked so hard to eliminate,” the staffer said. “Palma was very vulnerable. Almost nobody was supposed to be [there]. But Total wouldn’t listen to me.” Other measures, such as grouping traffic to and from the plant in convoys and flanking them with drones, also ended. One project contractor who regularly made the run through rebel territory described the difference between Anadarko and Total as “night and day.” Then in June 2020, the rebels captured Mocimboa da Praia, the regional hub, and killed at least eight subcontractors. In late December that year, they staged another advance that brought them to Total’s gates. At that, Pouyanné reversed course and assumed personal oversight of the security operation, the first Anadarko manager said. Despite no expertise in security, “[he] had to get into every little last possible detail.” The second executive concurred. “It went from, ‘I don’t care, we’ve got the best security people in the business to run this’ to ‘Oh my God, this is a disaster, let me micromanage it and control it,’” he said. The company was “not aware of any … criticism that Mr. Pouyanné lacks the necessary expertise,” TotalEnergies said, adding the CEO had “first-hand experience of emergency evacuation … [from] when Total had to evacuate its staff from Yemen in 2015.” The insurgents’ advance prompted Pouyanné to order the evacuation of all TotalEnergies staff. By contrast, many contractors and subcontractors, some of them behind schedule because of Covid, were told to keep working, according to email exchanges among contractors seen by POLITICO. “Mozambique LNG did not differentiate between its own employees, its contractors or subcontractors when giving these instructions,” the company said, but added that it was not responsible for the decisions of its contractors. Advertisement Then, in February 2021, Pouyanné flew to Maputo, the Mozambican capital, to negotiate a new security deal with then Mozambican President Filipe Nyusi. Afterward, the two men announced the creation of the Joint Task Force, a 1,000-man unit of soldiers and armed police to be stationed inside the compound.  The deal envisaged that the new force would protect a 25-kilometer radius around the gas plant, including Palma and several villages. In practice, by concentrating so many soldiers and police inside the wire, it left Palma comparatively exposed. “It is incorrect to allege that Palma was left poorly defended,” the company said. “However, it is a fact that these security forces were overwhelmed by the magnitude and violence of the terrorist attacks in March 2021.” TotalEnergies added it is not correct to say that “Mr. Pouyanné personally managed the security deal setting up the Joint Task Force.” ‘TRAIN WRECK’ By this time, the company’s own human rights advisers were warning that by helping to create the Joint Task Force — to which the company agreed to pay what it described as “hardship payments” via a third party, as well as to equip it and accommodate it on its compound — Pouyanné was effectively making TotalEnergies a party to the conflict, and implicating it in any human rights abuses the soldiers carried out. Just as worrying was TotalEnergies’ insistence — according to a plant security manager, and confirmed by minutes of a Total presentation on security released under a Dutch freedom of information request — that all major security decisions be handled by a 20-man security team 5,000 miles away in Paris. That centralization seemed to help explain how, when the Islamists finally descended on Palma on March 24, 2021, Total was among the last to know. One Western security contractor told POLITICO he had pulled his people out 10 days before the assault, based on intelligence he had on guns and young men being pre-positioned in town. In the days immediately preceding the attack, villagers around Palma warned friends and relatives in town that they had seen the Islamists advancing. WhatsApp messages seen by POLITICO indicate contractors reported the same advance to plant security on March 22 and March 23. Advertisement Nonetheless, at 9 a.m. on March 24, TotalEnergies in Paris announced that it was safe for its staff to return. Hours later, the Islamists attacked. “Neither Mozambique LNG nor TotalEnergies received any specific ‘advance warnings’ of an impending attack prior to March 24,” the company said. Faced with a three-pronged advance by several hundred militants, the plant security manager said TotalEnergies’ hierarchical management pyramid was unable to cope. Ground staff could not respond to evolving events, paralyzed by the need to seek approval for decisions from Paris. Total’s country office in Maputo was also in limbo, according to the security manager, neither able to follow what was happening in real-time, nor authorized to respond.  ‘WHO CAN HELP US?!’ Two decisions, taken as the attack unfolded, compounded the havoc wreaked by the Islamists. The first was Total’s refusal to supply aviation fuel to the Dyck Advisory Group (DAG), a small, South African private military contractor working with the Mozambican police. With the police and army overrun, DAG’s small helicopters represented the only functional military force in Palma and the only unit undertaking humanitarian rescues. But DAG’s choppers were limited by low supplies of jet fuel, forcing them to fly an hour away to refuel, and to ground their fleet intermittently. Total, as one of the world’s biggest makers of aviation fuel, with ample stocks at the gas plant, was in a position to help. But when DAG asked Total in Paris for assistance, it refused. “Word came down from the mountain,” DAG executive Max Dyck said, “and that was the way it was going to be.” Total has conceded that it refused fuel to DAG — out of concern for the rescuers’ human rights record, the company said — but made fuel available to the Mozambican security services. DAG later hired an independent lawyer to investigate its record, who exonerated the company. Advertisement A second problematic order was an edict, handed down by Pouyanné’s executives in Paris in the months before the massacre, according to the plant security manager, that should the rebels attack, gate security guards at the gas plant were to let no one in. It was an instruction that could only have been drawn up by someone ignorant of the area’s geography, the man said.  If the Islamists blocked the three roads in and out of Palma, as conventional tactics would prescribe, the only remaining ways out for the population of 60,000 would be by sea or air — both routes that went through TotalEnergies’s facility, with its port and airport. By barring the civilians’ way, the company would be exposing them. So it proved. TotalEnergies soon had 25,000 fleeing civilians at its gates, according to an internal company report obtained under a freedom of information request by an Italian NGO, Recommon. Among the crowd were hundreds of project subcontractors and workers. Witnesses described to POLITICO how families begged TotalEnergies’ guards to let them in. Mothers were passing their babies forward to be laid in front of the gates. But TotalEnergies in Paris refused to allow its guards on the ground to open up. On March 28, the fifth day of the attack, Paris authorized a ferry to evacuate 1,250 staff and workers from the gas plant, and make a single return trip to pick up 1,250 civilians, who had sneaked inside the perimeter. That still left tens of thousands stranded at its gates. On March 29, a TotalEnergies community relations manager in Paris made a panicked call to Caroline Brodeur, a contact at Oxfam America. “He’s like, ‘There’s this huge security situation in Mozambique!’” Brodeur said. “An escalation of violence! We will need to evacuate people! Who can help us? Which NGO can support us with logistics?’” Thirty minutes later, the man called back. “Wait,” he told Brodeur. “Don’t do anything.” TotalEnergies’ senior managers had overruled him, the man said. No outsiders were to be involved. “I think he was trying to do the right thing,” Brodeur said in an interview with POLITICO. “But after that, Total went silent.” Over the next two months, the jihadis killed hundreds of civilians in and around Palma and the gas plant before the Rwandan intervention force pushed them out. The second former Anadarko and Total executive said the rebels might have attacked Palma, whoever was in charge at the gas project. But Total’s distant, centralized management made a “train wreck … inevitable.” Advertisement TotalEnergies said its response to the attack “mitigated as much as was reasonably possible the consequences.” Confirming the phone call to Oxfam, it added: “There was no effort by whoever within TotalEnergies to shut any possibility for external assistance down.” The company was especially adamant that Pouyanné was not at fault.  “The allegation that Mr. Pouyanné’s management of TotalEnergies exacerbated the devastation caused by the attacks in Mozambique is entirely unsubstantiated,” it said. “Mr. Pouyanné takes the safety and security of the staff extremely seriously.” In his television appearance this week, Pouyanné defended the company’s performance. “We completely evacuated the site,” he said. “We were not present at that time.” He said he considered that TotalEnergies, whose security teams had helped “more than 2,000 civilians evacuate the area,” “had carried out heroic actions.” ‘AN ALMOST PERFECT DINNER PARTY’  TotalEnergies’ troubles in Mozambique have come amid a wider slump in the country’s fortunes and reputation. Years of climate protests outside the company’s annual general meetings in central Paris peaked in 2023 when police dispersed activists with batons and tear gas. For the last two years, TotalEnergies has retreated behind a line of security checks and riot police at its offices in Défense, in the western part of Paris. Though the company intended 2024, its centenary year, as a celebration, the company succeeded mostly in looking past its prime. When Pouyanné took over in 2014, Total was France’s biggest company, and 37th in the world. Today, it is France’s seventh largest and not even in the global top 100.  Several French media houses chose the occasion of TotalEnergies’ 100th birthday to declare open season on the company, portraying it as a serial offender on pollution, corruption, worker safety, and climate change. Pouyanné has also presided over a rift with the French establishment. Last year, when he suggested listing in New York to boost the stock, French President Emmanuel Macron berated him in public. Advertisement The division grew wider a few weeks later when the French Senate concluded a six-month inquiry into the company with a recommendation that the formerly state-owned enterprise be partly taken back into public ownership.  The company has faced five separate lawsuits, civil and criminal, claiming it is breaking French law on climate protection and corporate conduct.  In a sixth case, brought by environmentalists in Paris last month, a judge ordered TotalEnergies to remove advertising from its website claiming it was part of the solution to climate change. Given the company’s ongoing investments in fossil fuels, that was misleading, the judge said, decreeing that TotalEnergies take down its messaging and upload the court’s ruling instead. The Swedish activist Greta Thunberg has also led protests against TotalEnergies’ East Africa Crude Oil Pipeline. That project, intended to pump oil 1,000 miles from Uganda across Tanzania to the Indian Ocean, is similarly embroiled in accusations of human rights abuses, drawing criticism from the European Parliament plus 28 banks and 29 insurance companies who have refused to finance it. Pouyanné has also taken hits to his personal brand. A low point came in 2022 when he chose the moment his countrymen were recovering from Covid and struggling with soaring fuel prices to defend his salary of €5,944,129 a year. He was “tired” of the accusation that he had received a 52 percent rise, he wrote on Twitter. His pay, he added, had merely been restored to pre-pandemic levels.  Overnight, the CEO became the unacceptable face of French capitalism. “Pouyanné lives in another galaxy, far, far away,” said one TV host. Under a picture of the CEO, an MP from the leftist France Unbowed movement wrote: “A name, a face. The obstacle in the way of a nation.” So heated and widely held is the contempt that in 2023 the company produced a guide for its French employees on how to handle it. Titled “An Almost Perfect Dinner Party,” the booklet lays out arguments and data that staff might use to defend themselves at social occasions. “Have you ever been questioned, during a dinner with family or friends, about a controversy concerning the Company?” it asked. “Did you have the factual elements to answer your guests?” ‘FALSE ALLEGATIONS’ The war crimes case lodged this week against TotalEnergies was filed in France, despite the alleged crimes occurring in Mozambique, because, it argues, TotalEnergies’ nationality establishes jurisdiction.  The case represents a dramatic example of the extension of international justice — the prosecution in one country of crimes committed in another. A movement forged in Nuremberg and Tokyo in the wake of World War II, the principles of international justice have been used more recently by national and international courts to bring warlords and dictators to trial — and by national courts to prosecute citizens or companies implicated in abuses abroad where local justice systems are weak. U.S. courts have ordered ExxonMobil and banana giant Chiquita to stand trial for complicity in atrocities committed in the late 1990s and early 2000s by soldiers or militias paid to protect their premises in Indonesia and Colombia, respectively. Exxon settled a week before the case opened in 2023. A Florida court ordered Chiquita to pay $38 million to the families of eight murdered Colombian men in June 2024; Chiquita’s appeal was denied that October.  In Sweden, two executives from Lundin Oil are currently on trial for complicity in war crimes after Sudanese troops and government militias killed an estimated 12,000 people between 1999 and 2003 as they cleared the area around a company drill site. The executives deny the accusations against them. Advertisement ECCHR has initiated several international justice cases. Most notably, in 2016, it and another legal non-profit, Sherpa, filed a criminal complaint in Paris against the French cement maker Lafarge, accusing its Syrian plant of paying millions of dollars in protection money to ISIS. Earlier this month, Lafarge and eight executives went on trial in Paris, accused of funding terrorism and breaking international sanctions — charges they deny. The war crimes complaint against TotalEnergies cites internal documents, obtained under freedom of information requests in Italy and the Netherlands, that show staff at the site knew the soldiers routinely committed human rights abuses against civilians while working for the company.  There were “regular community allegations of JTF [Joint Task Force] human rights violations,” read one, including “physical violence, and arrests/disappearances.” The report also referred to “troops who were allegedly involved in a [human rights] case in August [2021].” These were deemed so serious that TotalEnergies suspended pay to all 1,000 Joint Task Force soldiers and the army expelled 200 from the region, according to the internal document. The ECCHR complaint accuses TotalEnergies and “X”, a designation leaving open the possibility for the names of unspecified company executives to be added. Among those named in the document’s 56 pages are Pouyanné and five other TotalEnergies executives and employees. Favier, the company’s security chief, is not among them. TotalEnergies declined to make any of its executives or security managers available for interviews. In April 2024, when Pouyanné was questioned about his company’s Mozambique operation by the French Senate, he stated that while the government was responsible for the security of Cabo Delgado, “I can ensure the security of whichever industrial premises on which I might operate.” Asked about the container executions before the National Assembly this May, Pouyanné reaffirmed his faith in the Mozambican state, saying: “I think we help these countries progress if we trust their institutions and don’t spend our time lecturing them.” Apparently forgetting how he helped negotiate a security deal to place Mozambican soldiers on Total’s premises, however, he then qualified this statement, saying: “I can confirm that TotalEnergies has nothing to do with the Mozambican army.” A company spokesperson clarified this week: “TotalEnergies is not involved in the operations, command or conduct of the Mozambican armed forces.” In addition to the war crimes complaint, TotalEnergies’ Mozambique operation is already the subject of a criminal investigation opened in March by French state prosecutors. The allegation against the company is that it committed involuntary manslaughter by failing to protect or rescue workers left in Palma when ISIS carried out its massacre. Though POLITICO’s previous reporting found that 55 project workers were killed, TotalEnergies — through its subsidiary, Mozambique LNG — initially claimed it lost no one. “All the employees of Mozambique LNG, its contractors and subcontractors were safely evacuated from the Mozambique LNG Project site,” Maxime Rabilloud, Mozambique LNG’s managing director, told POLITICO last year. Advertisement That assertion notwithstanding, the death of at least one British subcontractor, Philip Mawer, is the subject of a formal inquest in the U.K.  In December 2024, the company’s Paris press office adjusted its position on the Palma attack. “TotalEnergies has never denied the tragedy that occurred in Palma and has always acknowledged the tragic loss of civilian lives,” it told POLITICO. For the first time, it also admitted “a small number” of project workers had been stationed outside its secure compound during the attack and exposed to the bloodbath.  A resolution to the French manslaughter investigation will take years. A decision on whether to open a formal investigation into the new claims against TotalEnergies for complicity in war crimes, let alone to bring the case to trial, is not expected until 2026, at the earliest. Should anyone eventually be tried for involuntary manslaughter, a conviction would carry a penalty of three years in prison and a €45,000 fine in France, escalating to five years and €75,000 for “a manifestly deliberate violation of a particular obligation of prudence or safety.” For complicity in war crimes, the sentence is five years to life. ‘CAN YOU ACTUALLY LOOK AT YOURSELF IN THE MIRROR?’ The war crimes accusation adds new uncertainty to the 20-year effort to develop Mozambique’s gas fields. In the aftermath of the 2021 Palma massacre, TotalEnergies declared a state of “force majeure,” a legal measure suspending all contracted work due to exceptional events. The following four and a half years of shutdown have cost TotalEnergies $4.5 billion, in addition to the $3.9 billion that Pouyanné originally paid Anadarko for the Mozambique operation. Billions more in costs can be expected before the plant finally pumps gas, which Total now predicts will happen in 2029. The manslaughter case and the war crimes complaint have the potential to cause further holdups by triggering due diligence obligations from TotalEnergies’ lenders, preventing them from delivering loans of $14.9 billion — without which Pouyanné has said his star project will collapse. Total also faces a Friends of the Earth legal challenge to a $4.7 billion U.S. government loan to the project. A TotalEnergies spokesperson said this week that the project was able to “meet due diligence requirements by lenders.” Advertisement All this comes as the situation on the ground remains unstable. After a successful Rwandan counter-attack from 2021 to 2023, the insurgency has returned, with the Islamists staging raids across Cabo Delgado, including Palma and the regional hub of Mocimboa da Praia. The International Organization for Migration says 112,185 people fled the violence between September 22 and October 13. Among those killed in the last few months were two gas project workers — a caterer, murdered in Palma, and a security guard, beheaded in a village south of town. TotalEnergies has consistently said that neither recent legal developments nor the upsurge in ISIS attacks will affect its plans to formally reopen its Mozambique operation by the end of the year. “This new complaint has no connection with the advancement of the Mozambique LNG project,” a spokesperson said this week. Pouyanné himself has spent much of this year insisting the project is “back on track” and its financing in place. In October, in a move to restart the project, the company lifted the force majeure.  Still, in a letter seen by POLITICO, Pouyanné also wrote to Mozambican President Daniel Chapo asking for 10 more years on its drilling license and $4.5 billion from the country to cover its cost overruns.  Mozambique, whose 2024 GDP was $22.42 billion — around a tenth of TotalEnergies’ revenues for the year of $195.61 billion — has yet to respond. A final issue for TotalEnergies’ CEO is whether a formal accusation of war crimes will fuel opposition to his leadership among shareholders. At 2024’s annual general meeting, a fifth of stockholders rejected the company’s climate transition strategy as too slow, and a quarter declined to support Pouyanné for a fourth three-year term. In 2025, several institutional investors expressed their opposition to Pouyanné by voting against his remuneration. In the statement, the TotalEnergies spokesperson pointed to the 2023 comments by Aschenbroich, the independent board member: “The Board unanimously looks forward to his continued leadership and his strategic vision to continue TotalEnergies’ transition.” Yet, there seems little prospect that his popularity will improve, inside or outside the company. “Patrick Pouyanné is everyone’s best enemy,” says Olivier Gantois, president of the French oil and gas lobby group UFIP-EM, “the scapegoat we love to beat up on.” Recently, the 62-year-old Pouyanné has begun to sound uncharacteristically plaintive. At TotalEnergies’ 2022 shareholder meeting, he grumbled that the dissidents might not like CO2 emissions, “but they sure like dividends.” At last year’s, he complained that TotalEnergies was in an impossible position. “We are trying to find a balance between today’s life and tomorrow’s,” he said. “It’s not because TotalEnergies stops producing hydrocarbons that demand for them will disappear.” Advertisement TotalEnergies’ articles of association require Pouyanné to retire before he reaches 67, in 2030, around the time that TotalEnergies currently forecasts gas production to begin in Mozambique. Henri Thulliez, the lawyer who filed both criminal complaints against TotalEnergies in Paris, predicts Pouyanné’s successors will be less attached to the project — for the simple reason that Mozambique turned out to be bad business. “You invest billions in the project, and the project has been completely suspended for four years now,” Thulliez says. “All your funders are hesitating. You’re facing two potential litigations in France, maybe at some point elsewhere, too. You have to ask: what’s the point of all of this?” As for Pouyanné, two questions will haunt his final years at TotalEnergies, he suggests. First, “Can shareholders afford to keep you in your job?” Second, “Can you actually look at yourself in the mirror?” Aude Le Gentil and Alexandre Léchenet contributed to this report.

BERLIN — German Chancellor Friedrich Merz is facing rising opposition — but this time it’s from within his own conservative ranks. A group of 18 young lawmakers in Merz’s conservative bloc are threatening to stop a pension reform bill put forth by the chancellor’s coalition government, arguing the benefits pledged in the agreement aren’t sustainable and “cannot be justified to the younger generation.” The revolt has turned into a test of Merz’s authority and the durability of his relatively weak government — a coalition between his conservative bloc and the center-left Social Democratic Party (SPD). Merz’s coalition only has a 12-seat majority in parliament — one of the narrowest in postwar German history — making his government vulnerable to even modest defections within the ranks. During a conference over the weekend, Merz pushed back against criticism from young conservatives that planned pension benefits are too generous. “Does anyone seriously believe that we can win a race to the bottom on who can offer the lowest pension levels?” Merz said. “You can’t be serious!” Merz faced a series of harsh questions from attendees, many of whom felt the chancellor was not taking their arguments sufficiently seriously. “Let me be perfectly clear: There will be no further changes to this law,” SPD Finance Minister Lars Klingbeil said. “We will pass it in the Bundestag.” | Bernd von Jutrczenka/picture alliance via Getty Images “Can you personally reconcile this with your credibility?” asked Laurenz Kiefer, a member of the young conservatives from Munich. Coalition lawmakers had initially expected to pass the pension reform package in early December as part of a series of bills Merz has attempted to push through to show his government can undertake the key structural reforms Germany needs to boost economic competitiveness. But the timing of that vote has now been cast into doubt amid the internal fighting. “I hope that we will have concluded this discussion by the end of the year so that we can enter 2026 with a genuine willingness to reform,” Merz said during an event in Berlin on Monday. Merz is effectively stuck between the demands of young conservatives to reconsider the pension package and the obduracy of his SPD coalition partners, who say they’re not willing to renegotiate it. “Let me be perfectly clear: There will be no further changes to this law,” SPD Finance Minister Lars Klingbeil said. “We will pass it in the Bundestag.” The pension issue has become particularly thorny as Germany’s baby-boomer generation enters retirement, with millions of people leaving the workforce and far fewer entering it. Pensions are the largest single item of public expenditure in the country. At the heart of the internal rebellion is a proposal to stabilize pension benefits after 2031. Young conservatives argue that this plan goes further than what was originally agreed by the coalition, and would mean over €115 billion in additional costs by 2040. The internecine dispute has led some in Merz’s coalition — including his own family minister, Karin Prien — to propose postponing the pension reform vote to avoid the kind of embarrassment and open discord that could potentially lead to the coalition’s unravelling. “It is important that fair solutions for the broad majority are found in parliament,” Prien told German newspaper Handelsblatt.

Senators have reached a deal to end the government shutdown. The broad framework for agreement, which was negotiated in part by Sens. Angus King, Jeanne Shaheen and Maggie Hassan as well as GOP senators, has “more than enough” members of the Senate Democratic Caucus to advance, according to two people granted anonymity to disclose the terms. he deal, said one of the people, was brokered between the Democratic negotiators, Senate Majority Leader John Thune and the White House. Members of the Appropriations Committee were also closely involved and helped negotiate the terms. As part of the deal, Democratic negotiators agreed to ensure at least eight members from their caucus would vote “yes” on procedural motions to advance the government funding package. That would provide certainty that the 60-vote procedural threshold is consistently met up until final passage, where only a simple majority is required. The Senate is poised to vote later Sunday night to advance the House-passed stopgap, which will later become the vehicle for the larger funding deal. It still needs to pass the House before the government can be reopened. The breakthrough follows weeks of closed-door negotiations not only among a bipartisan group of rank-and-file senators but also Thune and, according to one of the people granted anonymity to share private conversations, President Donald Trump. The Sunday vote would pave the way for consideration later this week of a legislative package that would fund the Department of Agriculture and the FDA, the Department of Veterans Affairs and military construction projects, and the operations of Congress, for the full fiscal year — the product of months of bipartisan, bicameral negotiations between top appropriators. “I also think it’s highly significant that we’ll have three year-long appropriations bills attached,” Senate Appropriations Chair Susan Collins (R-Maine) said Monday night. All other agencies would be funded through Jan. 30, according to the text of a continuing resolution released Sunday. As part of Democrats’ agreement to end the shutdown, Thune is promising Senate Democrats a vote in mid-December to extend Affordable Care Act subsidies that are due to expire at the end of the year without Congressional action. Democrats will also get to determine what extension bill receives that vote. The government-opening agreement guarantees that federal employees laid off during the shutdown are re-hired and gives federal employees backpay. It also would require agencies to give written notice to Congress about the withdrawal of the so-called reduction-in-force notices issued during the funding lapse, plus provide the amount of back pay owed. It would, as well, prevent some future firings with a blanket prohibition on reductions-in-force in any department or agency until at least the end date of the continuing resolution: Jan. 30, 2026. Sen. Tim Kaine (D-Va.), who was involved in negotiations over the RIF language, said in a statement shortly after the deal was announced that he would support it. “I have long said that to earn my vote, we need to be on a path toward fixing Republicans’ health care mess and to protect the federal workforce,” Kaine said. Many progressives in the Senate — along with a large number of House Democrats, including House Minority Leader Hakeem Jeffries — think anything short of a deal to enact an extension of the ACA tax credits is insufficient. “We will not support spending legislation advanced by Senate Republicans that fails to extend the Affordable Care Act tax credits. We will fight the GOP bill in the House of Representatives, where [Speaker] Mike Johnson will be compelled to end the seven week Republican taxpayer-funded vacation,” Jeffries said in a statement. House Democratic leadership has insisted the health subsidies be addressed in legislation rather than a handshake compromise, especially as Johnson has refused to offer Democrats the same promise of a vote on an extension in his chamber. But while attending a Sunday night football game, President Donald Trump appeared optimistic the end of the longest government shutdown in history might be finally within reach. “It looks like we’re getting very close to the shutdown ending,” he told reporters. A handful of centrist House Democrats are expected to support the deal, according to one House Democrat granted anonymity to speak candidly. News of the agreement came as the Senate Democratic Caucus was huddling behind closed-doors to talk about the path forward. Likely opponents, like Sen. Bernie Sanders (I-Vt.), spoke during the meeting, which is still ongoing. Negotiators involved in the talks are also giving pitches. Senate Minority Leader Chuck Schumer (D-N.Y.), who took heat from the progressive base for leading his party in shoring up the votes to prevent a government shutdown back in March, told reporters he would oppose the deal Sunday night. Other Senate Democrats also came out of the meeting vowing to oppose the agreement. “No deal without health care,” Sen. Richard Blumenthal (D-Conn.) told reporters leaving the meeting. Sen. Ruben Gallego (D-Ariz.) wrote in a social media post, “I’m voting NO.” Mia McCarthy, Katherine Tully-McManus, Calen Razor and Meredith Lee Hill contributed to this report.

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