Thirty-six million Europeans — including more than one million in the Nordics[1] — live with a rare disease.[2] For patients and their families, this is not just a medical challenge; it is a human rights issue. Diagnostic delays mean years of worsening health and needless suffering. Where treatments exist, access is far from guaranteed. Meanwhile, breakthroughs in genomics, AI and targeted therapies are transforming what is possible in health care. But without streamlined systems, innovations risk piling up at the gates of regulators, leaving patients waiting. Even the Nordics, which have some of the strongest health systems in the world, struggle to provide fair and consistent access for rare-disease patients. Expectations should be higher. THE BURDEN OF DELAY The toll of rare diseases is profound. People living with them report health-related quality-of-life scores 32 percent lower than those without. Economically, the annual cost per patient in Europe — including caregivers — is around €121,900.[3] > Across Europe, the average time for diagnosis is six to eight years, and > patients continue to face long waits and uneven access to medications. In Sweden, the figure is slightly lower at €118,000, but this is still six times higher than for patients without a rare disease. Most of this burden (65 percent) is direct medical costs, although non-medical expenses and lost productivity also weigh heavily. Caregivers, for instance, lose almost 10 times more work hours than peers supporting patients without a rare disease.[4] This burden can be reduced. European patients with access to an approved medicine face average annual costs of €107,000.[5] Yet delays remain the norm. Across Europe, the average time for diagnosis is six to eight years, and patients continue to face long waits and uneven access to medications. With health innovation accelerating, each new therapy risks compounding inequity unless access pathways are modernized. PROGRESS AND REMAINING BARRIERS Patients today have a better chance than ever of receiving a diagnosis — and in some cases, life-changing therapies. The Nordics in particular are leaders in integrated research and clinical models, building world-class diagnostics and centers of excellence. > Without reform, patients risk being left behind. But advances are not reaching everyone who needs them. Systemic barriers persist: * Disparities across Europe: Less than 10 percent of rare-disease patients have access to an approved treatment.[6] According to the Patients W.A.I.T. Indicator (2025), there are stark differences in access to new orphan medicines (or drugs that target rare diseases).[7] Of the 66 orphan medicines approved between 2020 and 2023, the average number available across Europe was 28. Among the Nordics, only Denmark exceeded this with 34. * Fragmented decision-making: Lengthy health technology assessments, regional variation and shifting political priorities often delay or restrict access. Across Europe, patients wait a median of 531 days from marketing authorization to actual availability. For many orphan drugs, the wait is even longer. In some countries, such as Norway and Poland, reimbursement decisions take more than two years, leaving patients without treatment while the burden of disease grows.[8] * Funding gaps: Despite more therapies on the market and greater technology to develop them, orphan medicines account for just 6.6 percent of pharmaceutical budgets and 1.2 percent of health budgets in Europe. Nordic countries — Sweden, Norway and Finland — spend a smaller share than peers such as France or Belgium. This reflects policy choices, not financial capacity.[9] If Europe struggles with access today, it risks being overwhelmed tomorrow. Rare-disease patients — already facing some of the longest delays — cannot afford for systems to fall farther behind. EASING THE BOTTLENECKS Policymakers, clinicians and patient advocates across the Nordics agree: the science is moving faster than the systems built to deliver it. Without reform, patients risk being left behind just as innovation is finally catching up to their needs. So what’s required? * Governance and reforms: Across the Nordics, rare-disease policy remains fragmented and time-limited. National strategies often expire before implementation, and responsibilities are divided among ministries, agencies and regional authorities. Experts stress that governments must move beyond pilot projects to create permanent frameworks — with ring-fenced funding, transparent accountability and clear leadership within ministries of health — to ensure sustained progress. * Patient organizations: Patient groups remain a driving force behind awareness, diagnosis and access, yet most operate on short-term or volunteer-based funding. Advocates argue that stable, structural support — including inclusion in formal policy processes and predictable financing — is critical to ensure patient perspectives shape decision-making on access, research and care pathways. * Health care pathways: Ann Nordgren, chair of the Rare Disease Fund and professor at Karolinska Institutet, notes that although Sweden has built a strong foundation — including Centers for Rare Diseases, Advanced Therapy (ATMP) and Precision Medicine Centers, and membership in all European Reference Networks — front-line capacity remains underfunded. “Government and hospital managements are not providing  resources to enable health care professionals to work hands-on with diagnostics, care and education,” she explains. “This is a big problem.” She adds that comprehensive rare-disease centers, where paid patient representatives collaborate directly with clinicians and researchers, would help bridge the gap between care and lived experience. * Research and diagnostics: Nordgren also points to the need for better long-term investment in genomic medicine and data infrastructure. Sweden is a leader in diagnostics through Genomic Medicine Sweden and SciLifeLab, but funding for advanced genomic testing, especially for adults, remains limited. “Many rare diseases still lack sufficient funding for basic and translational research,” she says, leading to delays in identifying genetic causes and developing targeted therapies. She argues for a national health care data platform integrating electronic records, omics (biological) data and patient-reported outcomes — built with semantic standards such as openEHR and SNOMED CT — to enable secure sharing, AI-driven discovery and patient access to their own data DELIVERING BREAKTHROUGHS Breakthroughs are coming. The question is whether Europe will be ready to deliver them equitably and at speed, or whether patients will continue to wait while therapies sit on the shelf. There is reason for optimism. The Nordic region has the talent, infrastructure and tradition of fairness to set the European benchmark on rare-disease care. But leadership requires urgency, and collaboration across the EU will be essential to ensure solutions are shared and implemented across borders. The need for action is clear: * Establish long-term governance and funding for rare-disease infrastructure. * Provide stable, structural support for patient organizations. * Create clearer, better-coordinated care pathways. * Invest more in research, diagnostics and equitable access to innovative treatments. Early access is not only fair — it is cost-saving. Patients treated earlier incur lower indirect and non-medical costs over time.[10] Inaction, by contrast, compounds the burden for patients, families and health systems alike. Science will forge ahead. The task now is to sustain momentum and reform systems so that no rare-disease patient in the Nordics, or anywhere in Europe, is left waiting. -------------------------------------------------------------------------------- [1] https://nordicrarediseasesummit.org/wp-content/uploads/2025/02/25.02-Nordic-Roadmap-for-Rare-Diseases.pdf [2] https://nordicrarediseasesummit.org/wp-content/uploads/2025/02/25.02-Nordic-Roadmap-for-Rare-Diseases.pdf [3] https://media.crai.com/wp-content/uploads/2024/10/28114611/CRA-Alexion-Quantifying-the-Burden-of-RD-in-Europe-Full-report-October2024.pdf [4] https://media.crai.com/wp-content/uploads/2024/10/28114611/CRA-Alexion-Quantifying-the-Burden-of-RD-in-Europe-Full-report-October2024.pdf [5] https://media.crai.com/wp-content/uploads/2024/10/28114611/CRA-Alexion-Quantifying-the-Burden-of-RD-in-Europe-Full-report-October2024.pdf [6] https://www.theparliamentmagazine.eu/partner/article/a-competitive-and-innovationled-europe-starts-with-rare-diseases? [7] https://www.iqvia.com/-/media/iqvia/pdfs/library/publications/efpia-patients-wait-indicator-2024.pdf [8] https://www.iqvia.com/-/media/iqvia/pdfs/library/publications/efpia-patients-wait-indicator-2024.pdf [9] https://copenhageneconomics.com/wp-content/uploads/2025/09/Copenhagen-Economics_Spending-on-OMPs-across-Europe.pdf [10] https://media.crai.com/wp-content/uploads/2024/10/28114611/CRA-Alexion-Quantifying-the-Burden-of-RD-in-Europe-Full-report-October2024.pdf Disclaimer POLITICAL ADVERTISEMENT * The sponsor is Alexion Pharmaceuticals * The entity ultimately controlling the sponsor: AstraZeneca plc * The political advertisement is linked to policy advocacy around rare disease governance, funding, and equitable access to diagnosis and treatment across Europe More information here.

President Donald Trump’s latest round of Europe-bashing has the U.S.’s allies across the Atlantic revisiting a perennial question: Why does Trump hate Europe so much? Trump’s disdain for America’s one-time partners has been on prominent display in the past week — first in Trump’s newly released national security strategy, which suggested that Europe was suffering from civilizational decline, and then in Trump’s exclusive interview with POLITICO, where he chided the “decaying” continent’s leaders as “weak.” In Europe, Trump’s criticisms were met with more familiar consternation — and calls to speed up plans for a future where the continent cannot rely on American security support. But where does Trump’s animosity for Europe actually come from? To find out, I reached out to a scholar who’d been recommended to me by sources in MAGA world as someone who actually understands their foreign policy thinking (even if he doesn’t agree with it). “He does seem to divide the world into strength and weakness, and he pays attention to strength, and he kind of ignores weakness,” said Jeremy Shapiro, the research director at the European Council on Foreign Relations and an expert on Trump’s strained relations with the continent. “And he has long characterized the Europeans as weak.” Shapiro explained that Trump has long blamed Europe’s weakness on its low levels of military spending and its dependence on American security might. But his critique seems to have taken on a new vehemence during his second term thanks to input from new advisers like Vice President JD Vance, who have successfully cast Europe as a liberal bulwark in a global culture war between MAGA-style “nationalists” and so-called globalists. Like many young conservatives, Shapiro explained, Vance has come to believe that “it was these bastions of liberal power in the culture and in the government that stymied the first Trump term, so you needed to attack the universities, the think tanks, the foundations, the finance industry, and, of course, the deep state.” In the eyes of MAGA, he said, “Europe is one of these liberal bastions.” This conversation was edited for length and clarity. Trump’s recent posture toward Europe brings to mind the old adage that the opposite of love isn’t hate, it’s indifference. Do you think Trump hates Europe, or does he just think it’s irrelevant? My main impression is that he’s pretty indifferent toward it. There are moments when specific European countries or the EU really pisses him off and he expresses something that seems close to hatred, but mostly he doesn’t seem very focused on it. Why do you think that is? He does seem to divide the world into strength and weakness, and he pays attention to strength, and he kind of ignores weakness. And he has long characterized the Europeans as weak for a bunch of different reasons having to do with what seems to him to be a decadence in their society, their immigration, their social welfare states, their lack of apparent military vigor. All of those things seem to put them in the weak category, and in Trump’s world, if you’re in the weak category, he doesn’t pay much attention to you. What about more prosaic things like the trade imbalance and NATO spending? Do those contribute to his disdain, or does it originate from a more guttural place? I get the impression that it is more at a guttural level. It always seemed to me that the NATO spending debate was just a stick with which to beat the NATO allies. He has long understood that that’s something that they felt a little bit guilty about, and that’s something that American presidents had beat them about for a while, so he just sort of took it to an 11. The trade deficit is something that’s more serious for him. He’s paid quite a bit of attention to that in every country, so it’s in the trade area where he takes Europeans most seriously. But because they’re so weak and so dependent on the United States for security, he hasn’t had to deal with their trade problems in the same way. He’s able to threaten them on security, and they have folded pretty quickly. Does some of his animosity originate from his pre-presidency when he did business in Europe? He likes to blame Europeans for nixing some of his business transactions, like a golf course in Ireland. How serious do you think that is? I think that’s been important in forming his opinion of the EU rather than of Europe as a whole. He never seems to refer to the EU without referring to the fact that they blocked his golf course in Ireland. It wasn’t even the EU that blocked it, actually — it was an Irish local government authority — but it conforms to the general MAGA view of the EU as overly bureaucratic, anti-development and basically as an extension of the American liberal approach to development and regulation, which Trump certainly does hate. That’s part of what led Trump and his movement more generally to put the EU in the category of supporters of liberal America. In that sense, the fight against the EU in particular — but also against the other liberal regimes in Europe — became an extension of their domestic political battle with liberals in America. That effort to pull Europe as a whole into the American culture war by positioning it as a repository of all the liberal pieties that MAGA has come to hate — that seems kind of new. That is new for the second term, yeah. Where do you think that’s coming from? It definitely seems to be coming from [Vice President] JD Vance and the sort of philosophers who support him — the Patrick Deneens and Yoram Hazonys. Those types of people see liberal Europe as quite decadent and as part of the overall liberal problem in the world. You can also trace some of it back to Steve Bannon, who has definitely been talking about this stuff for a while. There does seem to be a real preoccupation with the idea that Europe is suffering from some sort of civilizational decline or civilization collapse. For instance, in both the new national security strategy and in his remarks to POLITICO this week, Trump has suggested that Europe is “decaying.” What do you make of that? This is a bit of a projection, right? If you look at the numbers in terms of immigration and diversity, the United States is further ahead in that decay — if you want to call it that — than Europe. There was this view that emerged among MAGA elites in the interregnum that it wasn’t enough to win the presidency in order to successfully change America. You had to attack all of the bastions of liberal power. It was these bastions of liberal power in the culture and in the government that stymied the first Trump term, so you needed to attack the universities, the think tanks, the foundations, the finance industry and, of course, the deep state, which is the first target. It was only through attacking these liberal bastions and conquering them to your cause that you could have a truly transformative effect. One of the things that they seem to have picked up while contemplating this theory is that Europe is one of these liberal bastions. Europe is a support for liberals in the United States, in part because Europe is the place where Americans get their sense of how the world views them. It’s ironic that that image of a decadent Europe coexists with the rise of far-right parties across the continent. Obviously, the Trump administration has supported those parties and allied with them, but at least in France and Germany, the momentum seems to be behind these parties at the moment. That presents them with an avenue to destroy liberal Europe’s support for liberal America by essentially transforming Europe into an illiberal regime. That is the vector of attack on liberal Europe. There has been this idea that’s developed amongst the populist parties in Europe since Brexit that they’re not really trying to leave the EU or destroy the EU; they’re trying to remake the EU in their nationalist and sovereigntist image. That’s perfect for what the Trump people are trying to do, which is not destroy the EU fully, but destroy the EU as a support for liberal ideas in the world and the United States. You mentioned the vice president, who has become a very prominent mouthpiece for this adversarial approach to Europe — most obviously in his speech at Munich earlier this year. Do you think he’s just following Trump’s guttural dislike of Europe or is he advancing his own independent anti-European agenda? A little of both. I think that Vance, like any good vice president, is very careful not to get crosswise with his boss and not contradict him in any way. So the fact that Trump isn’t opposed to this and that he can support it to a degree is very, very important. But I think that a lot of these ideas come from Vance independently, at least in detail. What he’s doing is nudging Trump along this road. He’s thinking about what will appeal to Trump, and he’s mostly been getting it right. But I think that especially when it comes to this sort of culture war stuff with Europe, he’s more of a source than a follower. During this latest round of Trump’s Euro-bashing, did anything stand out to you as new or novel? Or was it all of a piece with what you had heard before? It was novel relative to a year ago, but not relative to February and since then. But it’s a new mechanism of describing it — through a national security strategy document and through interviews with the president. The same arguments have achieved a sort of higher status, I would say, in the last week or so. You could sit around in Europe — as I did — and argue about the degree to which this really was what the Trump administration was doing, or whether this was just a faction — and you can still have that argument, because the Trump administration is generally quite inconsistent and incoherent when it comes to this kind of thing — but I think it’s undoubtedly achieved a greater status in the last week or two. How do you think Europe should deal with Trump’s recurring animosity towards the continent? It seems they’ve settled on a strategy of flattery, but do you think that’s effective in the long run? No, I think that’s the exact opposite of effective. If you recall what I said at the beginning, Trump abhors weakness, and flattery is the sort of ultimate manifestation of weakness. Every time the Europeans show up and flatter Trump, it enables them to have a good meeting with him, but it conveys the impression to him that they are weak, and so it increases his policy demands against them. We’ve seen that over and over again. The Europeans showed up and thought they had changed his Ukraine position, they had a great meeting, he said good things about them, they went home and a few weeks later, he had a totally different Ukraine position that they’re now having to deal with. The flattery has achieved the sense in the Trump administration that they can do anything they want to the Europeans, and they’ll basically swallow it. They haven’t done what some other countries have done, like the Chinese or the Brazilians, or even the Canadians to some degree, which is to stand up to Trump and show him that he has to deal with them as strong actors. And that’s a shame, because the Europeans — while they obviously have an asymmetric dependence on the United States, and they have some weaknesses — are a lot stronger than a lot of other countries, especially if they were working together. I think they have some capacity to do that, but they haven’t really managed it as of yet. Maybe this will be a wake-up call to do that.

Paul McCartney has joined forces with U.K. MPs who are urging Brussels to scrap any plans to ban the use of meat-related names such as “burger” and “sausage” for plant-based products. The proposed EU ban, if passed into law, would prohibit food producers from using designations such as “veggie burger” or “vegan sausage” for plant-based and lab-grown dishes. “To stipulate that burgers and sausages are ‘plant-based,’ ‘vegetarian’ or ‘vegan’ should be enough for sensible people to understand what they are eating,” the former Beatles star, who became a vegetarian in 1975, told The Times of London. “This also encourages attitudes essential to our health and that of the planet.” The proposed EU ban “could increase confusion” and “undermine economic growth, sustainability goals, and the EU’s own simplification agenda,” eight British MPs, including Jeremy Corbyn, wrote in a letter to Brussels. The Times reported the contents of the letter Saturday evening. The missive includes the support of the McCartney family, which owns a business selling vegetarian food and recipes. The looming ban stems from an amendment that French center-right MEP Céline Imart introduced into legislation that aims to reform EU farming rules. These proposed reforms include how farmers sign contracts with buyers alongside other technical provisions. The bill is now subject to legislative negotiations with the Council of the EU, which represents EU governments.  The proposed rules will become law if and when MEPs and the Council agree on a final version of the legislation to become EU law. MPs in the U.K. fear that the ban, if it survives, would also impact British supermarkets, as markets and companies across the continent are so closely intertwined. Imart’s burger-busting tweaks were supposed to be a gesture of respect toward the French farmers that she represents — but they have divided MEPs within her own European People’s Party. “A steak is not just a shape,” Imart told POLITICO in an interview last month. “People have eaten meat since the Neolithic. These names carry heritage. They belong to farmers.” Limiting labels for vegetarian producers will also help shoppers understand the difference between a real burger and a plant-based patty, according to Imart, despite years of EU surveys showing consumers largely understand the difference. U.K. MPs also cite research in their letter, stating that European shoppers “overwhelmingly understand and support current naming conventions” such as “veggie burger.”

After more than three decades in the pharmaceutical industry, I know one thing: science transforms lives, but policy determines whether innovation thrives or stalls. That reality shapes outcomes for patients — and for Europe’s competitiveness. Today, Europeans stand at a defining moment. The choices we make now will determine whether Europe remains a global leader in life sciences or we watch that leadership slip away. It’s worth reminding ourselves of the true value of Europe’s life sciences industry and the power we have as a united bloc to protect it as a European good. Europe has an illustrious track record in medical discovery, from the first antibiotics to the discovery of DNA and today’s advanced biologics. Still today, our region remains an engine of medical breakthroughs, powered by an extraordinary ecosystem of innovators in the form of start-ups, small and medium-sized enterprises, academic labs, and university hospitals. This strength benefits patients through access to clinical trials and cutting-edge treatments. It also makes life sciences a strategic pillar of Europe’s economy. The economic stakes Life sciences is not just another industry for Europe. It’s a growth engine, a source of resilience and a driver of scientific sovereignty. The EU is already home to some of the world’s most talented scientists, thriving academic institutions and research clusters, and a social model built on universal access to healthcare. These assets are powerful, yet they only translate into future success if supported by a legislative environment that rewards innovation. > Life sciences is not just another industry for Europe. It’s a growth engine, a > source of resilience and a driver of scientific sovereignty. This is also an industry that supports 2.3 million jobs and contributes over €200 billion to the EU economy each year — more than any other sector. EU pharmaceutical research and development spending grew from €27.8 billion in 2010 to €46.2 billion in 2022, an average annual increase of 4.4 percent. A success story, yes — but one under pressure. While Europe debates, others act Over the past two decades, Europe has lost a quarter of its share of global investment to other regions. This year — for the first time — China overtook both the United States and Europe in the number of new molecules discovered. China has doubled its share of industry sponsored clinical trials, while Europe’s share has halved, leaving 60,000 European patients without the opportunity to participate in trials of the next generation of treatments. Why does this matter? Because every clinical trial site that moves elsewhere means a patient in Europe waits longer for the next treatment — and an ecosystem slowly loses competitiveness. Policy determines whether innovation can take root. The United States and Asia are streamlining regulation, accelerating approvals and attracting capital at unprecedented scale. While Europe debates these matters, others act. A world moving faster And now, global dynamics are shifting in unprecedented ways. The United States’ administration’s renewed push for a Most Favored Nation drug pricing policy — designed to tie domestic prices to the lowest paid in developed markets — combined with the potential removal of long-standing tariff exemptions for medicines exported from Europe, marks a historic turning point. A fundamental reordering of the pharmaceutical landscape is underway. The message is clear: innovation competitiveness is now a geopolitical priority. Europe must treat it as such. A once-in-a-generation reset The timing couldn’t be better. As we speak, Europe is rewriting the pharmaceutical legislation that will define the next 20 years of innovation. This is a rare opportunity, but only if reforms strengthen, rather than weaken, Europe’s ability to compete in life sciences. To lead globally, Europe must make choices and act decisively. A triple A framework — attract, accelerate, access — makes the priorities clear: * Attract global investment by ensuring strong intellectual property protection, predictable regulation and competitive incentives — the foundations of a world-class innovation ecosystem. * Accelerate the path from science to patients. Europe’s regulatory system must match the speed of scientific progress, ensuring that breakthroughs reach patients sooner. * Ensure equitable and timely access for all European patients. No innovation should remain inaccessible because of administrative delays or fragmented decision-making across 27 systems. These priorities reinforce each other, creating a virtuous cycle that strengthens competitiveness, improves health outcomes and drives sustainable growth. > Europe has everything required to shape the future of medicine: world-class > science, exceptional talent, a 500-million-strong market and one of the most > sophisticated pharmaceutical manufacturing bases in the world. Despite flat or declining public investment in new medicines across most member states over the past 20 years, the research-based pharmaceutical industry has stepped up, doubling its contributions to public pharmaceutical expenditure from 12 percent to 24 percent between 2018 and 2023. In effect, we have financed our own innovation. No other sector has done this at such scale. But this model is not sustainable. Pharmaceutical innovation must be treated not as a cost to contain, but as a strategic investment in Europe’s future. The choice before us Europe has everything required to shape the future of medicine: world-class science, exceptional talent, a 500-million-strong market and one of the most sophisticated pharmaceutical manufacturing bases in the world. What we need now is an ambition equal to those assets. If we choose innovation, we secure Europe’s jobs, research and competitiveness — and ensure European patients benefit first from the next generation of medical breakthroughs. A wrong call will be felt for decades. The next chapter for Europe is being written now. Let us choose the path that keeps Europe leading, competing and innovating: for our economies, our societies and, above all, our patients. Choose Europe. -------------------------------------------------------------------------------- Disclaimer POLITICAL ADVERTISEMENT * The sponsor is European Federation of Pharmaceutical Industries and Associations (EFPIA) * The ultimate controlling entity is European Federation of Pharmaceutical Industries and Associations (EFPIA) * The political advertisement is linked to the Critical Medicines Act. More information here.

LONDON — Keir Starmer is promising British voters he’ll fix the Brexit-shaped hole in the U.K. economy, but Brussels appears to have quite enough on its plate. Days after Britain’s grim growth prospects were laid bare in the U.K. budget, the country’s PM gave two speeches promising closer ties with the European Union and elevated his EU point person, Nick Thomas-Symonds, to the Cabinet. “We have to keep moving towards a closer relationship with the EU, and we have to be grown-up about that, to accept that that will require trade-offs,” Starmer said on Monday.   But European leaders are already grappling with packed in-trays as they look for an end to Russia’s war in Ukraine and confront their own domestic economic challenges — and skepticism remains as to how much room for maneuver the British PM actually has.  Starmer’s political red lines — no customs union, no single market, and no return to freedom of movement — remain in place, and ministers continue to stress that a return to full EU membership remains off the table. Even Starmer’s existing EU “reset” agenda — which aims to walk back some of the harder edges of Boris Johnson’s Brexit settlement — is not all going to plan. A push to join the EU’s SAFE loans-for-arms scheme crashed last week after the two sides failed to agree on how much money the U.K. would pay. “The same ‘how much should the U.K. contribute?’ question has been slowing down the actual implementation of basically all the reset topics,” said one EU diplomat who was not authorized to speak on the record. Despite plenty of talk in London about closer ties, the forum for putting fresh topics on the agenda would be the EU-U.K. summit that is due next year. But a date has yet to be set for that gathering. “Nobody is talking about the next summit here yet. I’m not saying it isn’t going to happen, it’s just a question of bandwidth,” another EU diplomat said. “For us the focus now is to work through our existing commitments and finalize those deals, start implementing them and then showing that the deals are bringing value. That takes time,” a third diplomat said. LIMITED SCOPE  The problem for Starmer is that his existing plan to rebuild EU ties is unlikely to move the dial on U.K. economic growth. Economists at the Centre for European Reform reckon that the government’s reset package — if delivered in full — is worth somewhere between 0.3 percent and 0.7 per cent of U.K. GDP over a decade.   Meanwhile, academics at the Bank of England and Stanford University calculate that the economic hit from Brexit could be as high as 8 percent of GDP over a similar period. “It is striking how frequently the chancellor and prime minister will now lament the costs of Brexit, without making any suggestions on how to change the status quo,” said Joël Reland, research fellow at the U.K. In A Changing Europe think tank.  “This could be read as a slow creep towards a breach of their red lines, but I suspect it is mostly about domestic political management. They are in a sticky economic situation and Brexit is a convenient thing to blame. I don’t think they’d be brave enough to risk a manifesto breach on Brexit, but I’d be surprised if ‘no single market or customs union’ is in the 2029 manifesto,” Reland said.  One British government official stressed that Labour’s red lines remain in place — but added: “We don’t think we’re at those red lines yet.”  BREAKING THE TABOO  Labour’s previous reluctance to talk about Brexit was born of a fear of upsetting Leave-leaning swing voters whom the party wanted to win over in the last election.  But that started to change over the summer.  Thomas-Symonds, the minister in charge of delivering the reset, went on the attack in a speech hosted by the Spectator, a right-wing magazine. Parties pledging to reverse Starmer’s reset were offering “more red tape, mountains of paperwork, and a bureaucratic burden,” he argued. To the surprise of Downing Street aides, the attacks landed well and drew a line between the government’s agenda and that of Reform UK boss Nigel Farage — the longstanding Brexiteer dominating in the polls — and Conservative Leader Kemi Badenoch.  It emboldened Starmer and his lieutenants. Rachel Reeves, the U.K.’s chief finance minister, used her speech at the Labour Party conference in Liverpool to talk up the benefits of improved cross-border mobility for the economy.   Ahead of last week’s difficult budget stuffed with tax rises, she waded in further, damning the effects of a “chaotic Brexit.” While the new rhetoric has yet to be backed up by a shift in policy, there are signs that some of Starmer’s close allies are starting to think bigger.  Rejoining the EU customs union was reportedly raised as an option by Starmer’s economic advisor ahead of the budget — but was rejected. “There are definitely people who have been pushing at this for a long time,” one person with knowledge of conversations in government said.  “I don’t think that will be that surprising to people, because if your primary goal allegedly is growth then that’s one of the easiest levers you can pull. Most economists would agree — it’s the politics that’s stopping it.”  Pressed on the prospect of Britain’s applying to rejoin the customs union on Wednesday, Health Secretary Wes Streeting did not explicitly rule out the idea but stressed the government’s policy was about “new partnerships and new relationships, not relitigating the past.” If Starmer opts for a risky manifesto-busting push to rejoin the customs union, diplomats say even that is unlikely to be a quick fix for the British PM.  “It would take time. Just consider how slow has been so far the progress on SPS, ETS and Erasmus,” the first diplomat quoted above said. “As of now, the U.K. needs the EU to spur its growth, not the other way around.”

LONDON — The U.K. has agreed to raise how much its National Health Service spends on new drugs, in a concession made under pressure from the Trump administration in return for tariff-free access to the U.S. market. “Today’s agreement is a major win for American workers and our innovation economy,” U.S. Commerce Secretary Howard Lutnick said in a statement on Monday. “This deal doesn’t just deepen our economic partnership with the United Kingdom — it ensures that the breakthroughs of tomorrow will be built, tested, and produced on American soil.”  The deal will see Britain increase the National Institute for Health and Care Excellence (NICE) cost-effectiveness threshold by 25 percent, as POLITICO first reported in October, and slash the cap on revenue the NHS can reclaim from drugmakers to no more than 15 percent.  The new NICE threshold will be £25,000 to £35,000 per quality adjusted life year gained over and above current treatments. The U.S. said the combined changes would increase the net price the NHS pays for new medicines by 25 percent. In exchange, the administration will grant an exemption for U.K.-made pharmaceuticals, ingredients and medical technology from U.S. tariffs for the remainder of President Donald Trump’s term.  U.K. Business and Trade Secretary Peter Kyle said: “This deal guarantees that UK pharmaceutical exports – worth at least £5 billion a year – will enter the US tariff free, protecting jobs, boosting investment and paving the way for the UK to become a global hub for life sciences. “We will continue to build on the UK-US Economic Prosperity Deal, and the record-breaking investments we secured during the US State Visit, to create jobs and raise living standards as part of our Plan for Change.” The breakthrough comes after months of back-and-forth between both sides, with the sector not covered in the Economic Prosperity Deal and Washington demanding a “preferential environment” to lift the threat of steep import duties. The administration had threatened to impose up to 100 percent tariffs on drugs.  In July, the President issued a letter to 17 drugmakers, demanding they offer their drugs to Medicaid at most-favored-nation prices, prices tied to lower prices abroad, and shift manufacturing to U.S. soil.  Update: This story has been updated following confirmation from the U.S. and U.K. governments.

European Council President António Costa intends to summon EU leaders to an informal retreat in rural Belgium next February to discuss Europe’s competitiveness. The meeting of the bloc’s heads of state and government will take place on Feb. 12 at Alden Biesen Castle, a XVI century moated complex in the eastern Belgian region of Limburg, Costa said in an interview with Portuguese daily Expresso. The informal summit on competitiveness will take place just a few months after the leaders debated the European Commission’s proposal to foster a pan-European industrial revival by merging cash for research, defense and innovation in the EU’s 2028-2035 budget. Shortly before taking office a year ago, the Council president said he wanted to organize periodic, informal meetings of EU leaders where they could discuss broad, strategic topics without the need to reach definitive conclusions. The objective was to create space for the kinds of debates that regularly derailed official summits chaired by Costa’s predecessor, Charles Michel. Although Costa wanted to hold the retreats outside the Belgian capital, security concerns obliged him to hold the first of these events in Brussels’ central Egmont Palace last February. During that session, EU leaders discussed issues related to the wider topic of European defense. Last week the bloc’s leaders attended an informal meeting in Luanda, Angola, where talks focused on the ongoing efforts to secure a lasting peace in Ukraine. During the wide-ranging interview with Expresso, which marked his first year in the Council presidency, Costa said the greatest challenge he has faced was that of stabilizing relations between the EU and U.S. President Donald Trump. That goal, he said, had been achieved, but he acknowledged that the dynamics between Brussels and Washington are “different” than they once were. Costa said it was essential for the EU to “remain calm, serene, and continue to strive to be constructive” when dealing with Trump, and noted that the relationship between Brussels and Washington is not “between equals.” The EU, he noted, is made up of 27 member countries “each with its own policies and interests,” while the U.S. operates as a single, federal entity.

LONDON — The British government said it opposes attempts to cool the planet by spraying millions of tons of dust into the atmosphere — but did not close the door to a debate on regulating the technology.  The comments in parliament Thursday came after a POLITICO investigation revealed an Israeli-U.S. company Stardust Solutions aimed to be capable of deploying solar radiation modification, as the technology is called, inside this decade. “We’re not in favor of solar radiation modification given the uncertainty around the potential risks it poses to the climate and environment,” Leader of the House of Commons Alan Campbell said on behalf of the government. Stardust has recently raised $60 million in finance from venture capital investors, mostly based in Silicon Valley and Britain. It is the largest ever investment in the field.  The emergence of a well-funded, private sector actor moving aggressively toward planet cooling capability has led to calls for the global community to regulate the field.  Citing POLITICO’s reporting, Labour MP Sarah Coombes asked the government: “Given the potential risks of this technology, could we have a debate on how Britain will work with other countries to regulate experiments with the earth’s atmosphere, and ensure we cooperate with other countries on solutions that actually tackle the root cause of climate change?” Campbell signaled the government was open to further discussion of the issue by inviting Coombes to raise the point the next time Technology Secretary Liz Kendall took questions in parliament.  Stardust’s CEO Yanai Yedvab told POLITICO the company was also in favor of regulation to ensure the technology was deployed safely and after proper public debate. Some scientists and experts, though, have raised concerns about the level of secrecy under which the company has conducted its research.  Stardust is proposing to use high-flying aircraft to dump millions of tons of a proprietary particle into the stratosphere, around 12 miles above the Earth’s surface. The technology mimics the short term global cooling that occurs when volcanoes blow dust and gas high into the sky, blocking a small amount of the sun’s heat.  Most scientists agree this could temporarily lower the Earth’s surface temperature, helping to avert some impacts of global warming. The side effects, however, are not well researched.  The U.K. has one of the world’s best funded research programs looking at the impacts of its potential use, via its Advanced Research and Invention Agency.  “We do work closely with the international research community to evaluate the latest scientific evidence,” said Campbell.   POLITICO has meanwhile been blocked from receiving internal government advice on solar radiation modification. The Department for Energy Security and Net Zero has refused to release the documents, arguing this would have a “chilling effect” on the candor of advice by officials to ministers.  In a response to a records request, DESNZ Director of International Climate Matt Toombs said: “Our priority is to reduce greenhouse gas emissions from human activities and to adapt to the unavoidable impacts of climate change. Any research into cooling technologies in no way alleviates the urgent need for increased decarbonization efforts.”

The European Central Bank is hatching a plan to boost the use of the euro around the world, hoping to turn the world’s faltering confidence in U.S. political and financial leadership to Europe’s advantage. Liquidity lines — agreements to lend at short notice to other central banks — have long been a standard part of the crisis-fighting toolkits of central banks, but the ECB is now thinking of repurposing them to further Europe’s political aims, four central bank officials told POLITICO. One aim of the plan is to absorb any shocks if the U.S. — which has backstopped the global financial system with dollars for decades — suddenly decides not to, or attaches unacceptable conditions to its support. The other goal is to underpin its foreign trade more actively and, ultimately, grab some of the benefits that the U.S. has historically enjoyed from controlling the world’s reserve currency. Officials were granted anonymity because the discussions are private. Bruegel fellow Francesco Papadia, who was previously director-general for the ECB’s market operations, told POLITICO that such efforts are sensible and reflect an increasing willingness among European authorities to see the euro used more widely around the world. WHAT’S A LIQUIDITY LINE? Central banks typically use two types of facilities to lend to each other: either by swapping one currency for another (swap lines) or by providing funds against collateral denominated in the lender’s currency (repo lines). The ECB currently maintains standing, unlimited swap lines with the U.S. Federal Reserve, the Bank of Canada, the Bank of England, the Swiss National Bank, and the Bank of Japan, as well as standing but capped lines with the Danish and Swedish central banks. It also operates a facility with the People’s Bank of China, capped in both volume and duration. Other central banks seeking euro liquidity must rely on repo lines known as EUREP, under which they can borrow limited amounts of euros for a limited period against high-quality euro-denominated collateral. At present, only Hungary, Romania, Albania, Andorra, San Marino, North Macedonia, Montenegro and Kosovo have such lines in place. But these active lines have sat untouched since Jan. 2, 2024 — and even at the height of the Covid crisis, their use peaked at a mere €3.6 billion. For the eurozone’s international partners, the knowledge that they can access the euro in times of stress is valuable in itself, helping to pre-empt self-fulfilling fears of financial instability. But some say that if structured generously enough, the facilities can also reduce concerns about exchange rate fluctuations or liquidity shortages. Such details may sound academic, but the availability of liquidity lines has real impacts on business: A Romanian carmaker whose bank has trouble securing euros may fail to make payments to a supplier in Germany, disrupting its production and raising its costs.  “The knowledge that foreign commercial banks can borrow in euros while being assured that they have access to euro liquidity [as a backstop] encourages the use of the euro,” one ECB rate-setter explained.  French central bank chief François Villeroy de Galhau suggested that Europe could at least take a leaf out of China’s book, noting that the Eurosystem “can make euro invoicing more attractive” by expanding the provision of euro liquidity lines. | Kirill Kudryavtsev/Getty Images “Liquidity lines, in particular EUREP, should be flexible, simple and easy to activate,” he argued. One option, he said, would be to extend them to more countries. Another could be to make EUREP a standing facility — removing any doubts about whether, and under what conditions, euro access would be granted. Papadia added that the ECB could also ease access to EUREP by cutting its cost, boosting available volumes or extending the timeframe for use. NOT JUST AN ACADEMIC QUESTION French central bank chief François Villeroy de Galhau suggested in a recent speech that Europe could at least take a leaf out of China’s book, noting that the Eurosystem “can make euro invoicing more attractive” by expanding the provision of euro liquidity lines. China has established around 40 swap lines with trading partners worldwide to underpin its burgeoning foreign trade, especially with poorer and less stable countries. By contrast, the ECB — a historically cautious animal — “is not marketing the euro to the same extent that the Chinese market the renminbi,” according to Papadia.  Another policymaker told POLITICO that while there is a broad consensus that liquidity lines should be made more widely available, the Governing Council had not yet hashed out the details. Austrian National Bank Governor Martin Kocher told POLITICO in a recent interview that there has been “no deeper discussion” on the Council, adding that he sees no reason to promote euro liquidity lines actively. “I’m not arguing that you should incentivize or create a demand. Rather, if there is demand, we should be prepared for it,” he said, acknowledging that “preparation is very important.” He noted that erratic U.S. policies could force the euro “to take on a stronger role in the international sphere” — both as a reserve currency and in transactions. According to a Reuters report earlier this month, similar concerns among central banks worldwide have sparked a debate over creating an alternative to Federal Reserve funding backstops by pooling their own dollar reserves. The ECB declined to comment for this article. RISK AVERSION AND OTHER OBSTACLES  However, swap lines in particular don’t come without risks. “The main risk is that the country would use a swap and then would not be able to return the drawn euros,” said Papadia. “And then you will be left with foreign currency you don’t really know what to do with.” That is exactly the kind of trap some economists warn the U.S. is stumbling into with its $20 billion swap line to Argentina. “The United States doesn’t really want Argentina’s currency,” the Council on Foreign Relations’ Brad Setser wrote in a blog post. “It expects to be repaid in dollars, so it would be a massive failure if the swap was never unwound and the U.S. Treasury was left holding a slug of pesos.” Austrian National Bank Governor Martin Kocher said there has been “no deeper discussion” on the Council, adding that he sees no reason to promote euro liquidity lines actively. | Heinz-Peter Bader/Getty Images Such thinking, another central bank official said, will incline the ECB to focus first on reforming the EUREP lines, which have always been its preferred tool. The trouble with that, however, is that EUREP use may be limited by a lack of safe assets denominated in euros to serve as collateral. Papadia noted that the Fed’s network of liquidity lines works because “the Fed has the U.S.  Treasury as a kind of partner in granting these swaps.” So long as Europe fails to create a joint debt instrument, this may put a natural cap on such lines.  Even with a safe asset, focusing on liquidity lines first could be putting the cart before the horse, said Gianluca Benigno, professor of economics at the University of Lausanne and former head of the New York Fed’s international research department. Europe’s diminishing geopolitical relevance means that the ECB is unlikely to see much demand — deliberately engineered or not — for its liquidity outside Europe without much broader changes, Benigno told POLITICO. Liquidity lines can be used to advance your goals if you already have power — but they can’t create it. For that, he argued, Europe first needs a clear political vision for its role in the global economy, alongside a Capital Markets Union and the creation of a common European safe asset — issues that only politicians can address.

LONDON — In the corridors of Whitehall, armies of officials are working out how best to spend billions of pounds earmarked for defense equipment. However, they have yet to inform the people it concerns the most: Britain’s arms industry. Many in the sector now fear that they’ve wasted their own money developing cutting-edge gear, as the government drags its feet on awarding contracts. U.K. Prime Minister Keir Starmer’s Labour Party has made a lot of noise on defense since entering government last year, plundering the aid budget to get defense spending to reach 2.6 percent of GDP by 2027 and a promise of 3.5 percent by 2035.  Alongside the funding boost, Starmer asked George Robertson, a Labour Party politician who is a former NATO secretary-general, to lead a major inquiry into how the U.K. would meet geopolitical threats, known as the Strategic Defence Review (SDR). The SDR was well received across the defense industry and viewed as a statement of intent from the government to devote effort and resources to building up the sector, with an emphasis on resilience and innovation.  Those good intentions were supposed to be followed by a series of complementary announcements — including a defense industrial strategy, the appointment of a new national armaments director, and a defense investment plan.  The industrial strategy and armaments director both arrived late, while the defense investment plan is still missing in action. It is now expected after this week’s fall budget.  Six months since the SDR, many in the industry complain that they haven’t received the certainty they need about where the British government — in many cases, their sole buyer —plans to invest.  Business owners say this is limiting their ability to make long-term plans and risks skilled workers departing for other jobs.  One representative of a mid-sized arms manufacturer — granted anonymity like others in this piece in order not to damage commercial prospects — said the problem was that the “big, bold” prescription of the SDR has given way to “repeated deferral, which always happens with delivery plans of this complexity.” INNOVATING IN THE DARK The war in Ukraine has radically reshaped other countries’ understanding of what’s needed on the battlefield, and the SDR set out a clear expectation that innovation would be rewarded. At September’s DSEI — an industry jamboree held in London — it was plain to see that private companies had stepped up to deliver prototypes for novel weaponry and other equipment, from modular robots that can deliver materiel to a battlefield and can also serve as stretchers, to AI that can read and predict threats on the ground in real time.  Defence Minister Luke Pollard said:  “We need to move to war-fighting readiness, and the SDR gave industry a very clear direction of how an increasing defense budget will be spent on new technologies and looking after our people better.” | John Keeble/Getty Images Much of that research and development was done by companies drawing on their own budgets or taking out loans as they wait for news of any specific government contracts.  For small suppliers in particular, the lag could prove existential.  One small manufacturer based in England said: “We are ready to go; we have built factories that could start making equipment tomorrow. But we can’t until an order is placed.” Armored vehicle maker Supacat has said that while its business is stable, suppliers will suffer without a predictable path ahead. “This is about the wider industry and our partners in the supply chain that have been contributing,” Toby Cox, the company’s head of sales, told POLITICO. “Our assumption is we don’t get more [orders], some of these companies will have a downturn in their orders.” KEEPING PRODUCTION LINES WARM Andrew Kinniburgh, defense director general of manufacturers association Make UK, echoed those concerns. While the industry “warmly welcomed” the Defence Ministry’s commitment to boost SME spending, he said, “the MOD must give companies certainty of long-term demand signals and purchase orders, allowing businesses to make the private investments needed in people, capital, and infrastructure.” Mike Armstrong, U.K. managing director of German defense firm Stark, which has recently opened a plant in Britain, added: “Giving the industry a clear view of future requirements is the fastest way to ensure the U.K. and its allies stay ahead.” Even some bigger companies that deal with the government on components for aircraft and submarines have privately complained about putting money into research and development without knowing what the end result will be.  An engineer working at one of Britain’s largest defense firms said: “We have multi-use items that could be for both military and civilian purposes, but cannot invest until we know what government strategy is. If it’s bad for us, it must be so hard for SMEs.” Mike Armstrong, U.K. managing director of German defense firm Stark, added: “Giving the industry a clear view of future requirements is the fastest way to ensure the U.K. and its allies stay ahead.” | Andrew Matthews/Getty Images The issue is not only one of investment, but also of skills. Supacat’s Cox said that keeping production lines warm matters because the workforce behind complex fabrications is fragile. “The U.K. has a skill shortage, particularly around engineering fabrication. If we’ve got an employee in that sector, we absolutely don’t want to lose them in another sector,” he said.  NOT LONG TO GO The Ministry of Defence said it appreciates the need for clarity. Defence Minister Luke Pollard, speaking to POLITICO at DSEI, said:  “We need to move to war-fighting readiness, and the SDR gave industry a very clear direction of how an increasing defense budget will be spent on new technologies and looking after our people better.” He argued there was “a neat synergy” between the “duty of government to keep the country safe and the first mission of this Labour government to grow the economy.” An MOD spokesperson said the defense investment plan would “offer clear, long-term capability requirements that enable industry to plan and unlocking private investment.” They pointed out that £250 million had already been allocated for “defense growth deals” alongside a £182 million skills package, and that the MOD had placed £31.7 billion in orders with U.K. industry in the last financial year. A government official rejected claims that ministers were moving too slowly, pointing to Defence Secretary John Healey’s recent announcement on new munitions factories as exactly the kind of demand signal that industry is looking for.  The director of a large U.K. defense producer said the signs from the government were “encouraging,” specifying that Chancellor Rachel Reeves, having agreed to more money for defense, “wants to see a return on investment.” While most of the country will be braced for Reeves’s big moment on Wednesday when she announces the national budget, one sector will have to hold its breath a little longer. Luke McGee contributed to this report.